Chapter 5. Hormones and the Brain
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By Claudia Wallis Dinosaurs, Star Wars, train schedules, Disney princesses, maps, LEGO—subjects such as these can become all-consuming passions for children on the autism spectrum. What therapists and educators often call “circumscribed” or “restricted” interests (or, more generously, “special” interests) make up a characteristic symptom of autism spectrum disorder (ASD). The current edition of psychiatry’s Diagnostic and Statistical Manual of Mental Disorders describes them as “highly restricted, fixated interests that are abnormal in intensity or focus.” Roughly 90 percent of high-functioning kids with ASD display at least one such interest during their elementary school years, according to a 2007 survey conducted at the Yale University Child Study Center, one of the few studies to have examined the topic. For a family with an affected child, this kind of narrow preoccupation can be tedious and exhausting. Imagine a kid who will talk about nothing but the exits on the New Jersey Turnpike or the Captain Underpants book series. (Both actual examples.) Therapists and educators have traditionally tried to suppress or modulate a child’s special interest, or use it as a tool for behavior modification: Keep your hands still and stop flapping, and you will get to watch a Star Wars clip; complete your homework or no Harry Potter. But what if these obsessions themselves can be turned into pathways to growth? What if these intellectual cul-de-sacs can open up worlds? That is the idea explored in the film Life, Animated, a contender for the Academy Award for Best Documentary this Sunday night. © 2017 Scientific American
Link ID: 23277 - Posted: 02.24.2017
Jon Brock What if I told you that we can now identify babies who are going to develop autism based on a simple brain scan? This, in essence, is the seductive pitch for a study published last week in the journal Nature, and making headlines around the world. Early identification and diagnosis is one of the major goals of autism research. By definition, people with autism have difficulties with social interaction and communication. But these skills take many years to develop, even in typically developing (i.e., non-autistic) children. Potential early signs of autism are extremely difficult to pick out amidst the natural variation in behaviour and temperament that exists between all babies. A brain scan for autism would be a major step forward. But is the hype justified? Are we really on the brink of a new era in autism diagnostics? Without wishing to detract from the efforts of everyone involved in the study, it’s important to look at the results critically, both in terms of the scientific findings and their potential implications for clinical practice. The study, led by Heather Cody Hazlett at the University of North Carolina, was part of a larger research program investigating the development of babies who have an older sibling with autism. Because autism runs in families, these babies are much more likely to develop autism than babies from the general population.
Patricia Neighmond Many men over 65 with low testosterone levels say their sense of well-being, not to mention sexual function, isn't what it used to be. That's why some doctors prescribe testosterone replacement. But the effectiveness of testosterone has been controversial. Studies of the risks and benefits have been mixed, and the Food and Drug Administration beefed up its warnings about cardiac side effects of testosterone supplementation in 2015. And the findings of five studies released Tuesday aren't likely to clear up the confusion. They appear in JAMA, the journal of the American Medical Association and JAMA Internal Medicine. The studies are collectively called the Testosterone Trials (TTrials) and they compared a testosterone gel, AndroGel, against a placebo. The results are based on 788 men with below normal levels of testosterone studied at 12 sites across the country over a year. Overall, researchers saw improvements in bone density and bone strength in men who used a testosterone gel, which raised their testosterone to levels seen in younger men. In men with unexplained anemia, testosterone also improved iron levels in the blood. (A reviewer of the study raised questions about whether it was done ethically.) But in men using testosterone who had been reporting memory problems at the start of the study, there were no improvements in memory or cognition. And there were worrisome signs of an increase in the risk of cardiovascular problems. © 2017 npr
Ewen Callaway Researchers have no way to tell whether young babies may later be diagnosed with autism. But brain scans could help, a small study suggests. By scanning the brains of babies whose siblings have autism, researchers say they have been able to make reasonably accurate forecasts about which of these high-risk infants will later develop autism themselves. The findings raise the prospect of diagnosing autism spectrum disorder (ASD) months before children develop symptoms, a goal that has proved elusive. Nature looks at the new study and its implications. Why has it been so tough to diagnose autism in infants? Children typically show symptoms of ASD, such as difficulty making eye contact, after the age of 2. Researchers believe that the brain changes underlying ASD begin much earlier — possibly even in the womb. But behavioural assessments haven't been helpful in predicting who will get autism, says Joseph Piven, a psychiatrist at the University of North Carolina (UNC) in Chapel Hill, who co-led the study, published online in Nature1. “Children who end up with autism at 2 or 3, they don’t look like they have autism in the first year," he says. Certain rare mutations are linked to ASD, but the vast majority of cases cannot be pinned to a single or even a handful of genetic risk factors. Beginning in the 1990s, Piven and other researchers noticed that children with autism tended to have larger brains than developmentally normal children, suggesting that brain growth could be a biomarker for ASD. But Piven and colleague Heather Cody Hazlett, a psychologist at UNC-Chapel Hill, say it had not been clear when overgrowth occurred. What did their latest study look at? © 2017 Macmillan Publishers Limited,
By Jesse Singal Those who advocate for sound, evidence-based research about autism are extremely alarmed about Donald Trump, and for good reason: In addition to Trump’s ties to Andrew Wakefield, the disgraced British doctor whose debunked research helped fuel the false idea of links between childhood vaccines and autism, Robert F. Kennedy Jr., a notorious anti-vaxxer himself, told reporters back in January that Trump planned to tap him as chair of a commission on “vaccine safety.” There is no question at this point that Trump has significant connections to a pseudoscientific medical movement that spreads dangerous, disproven ideas. Today, Trump gave nervous observers yet more reason to worry. It occurred at a White House event in which Trump and Secretary of Education Betsy DeVos met with a bunch of educators. Trump seemed to fixate, for a moment, on one educator named Jane (her last name is hard to make out) after she explained that she is the principal of a special education center in Virginia. The sequence starts at about 5:38 in this video: After Jane noted that many of her students have autism, Trump asked, “Have you seen a big increase in the autism, with the children?” Jane replied in the affirmative, but seemed to couch her response as being more about an increase in demand for services — she didn’t explicitly agree there’s been a big increase in the overall rate. Trump continued: “So what’s going on with autism? When you look at the tremendous increase, it’s really — it’s such an incredible — it’s really a horrible thing to watch, the tremendous amount of increase. Do you have any idea? And you’re seeing it in the school?” Jane replied — again, in a way that seems a bit noncommittal vis-à-vis Trump’s claim — that the rate of autism is something like 1-in-66 or 1-in-68 children. To which Trump responds: “Well now, it’s gotta be even lower [presumably meaning higher, rate-wise] than that, which is just amazing — well, maybe we can do something.” (Jane had the rate right, and Trump is incorrect that it has crept higher.) © 2017, New York Media LLC.
Link ID: 23233 - Posted: 02.15.2017
Having a thicker outer layer of the brain is linked to an increased likelihood of having autism. The cerebral cortex is the wrinkled outer layer of the brain that is responsible for many of our most human traits, including thought, language and consciousness. This layer is typically thicker in men than in women, and its structure has been linked to differences in personality. Now brain scans have shown that women who have a more male-like brain structure are three times more likely to have been diagnosed with autism. The study compared the brains of 98 men and women with high functioning autism with those of 98 people who don’t have autism. These findings provide new insights into the brain’s role in sex differences in autism, according to the team that did the study. Autism is thought to be two to five times more common in men than in women, and some think the condition is caused by having an “extreme male brain”. Journal reference: JAMA Psychiatry, DOI: 10.1001/jamapsychiatry.2016.3990 © Copyright Reed Business Information Ltd.
In the mood? Feeling sexy and romantic has been linked to a hormone named kisspeptin. Researchers hope the chemical may help treat people with some sexual problems. Kisspeptin occurs naturally in the body, where it stimulates the release of other signalling chemicals that have been linked to reproduction. Now a study of 29 heterosexual young men has found that injections of the hormone enhance the brain’s response to sexual and romantic pictures of couples. After injection, MRI scans showed increased activity in the regions of the brain that are usually stimulated by sexual arousal and romance. But this activity was only prompted by arousing pictures – non-sexy images did not have the same effect. “Our findings indicate that kisspeptin could play a role in stimulating some of the emotions and responses that lead to sex and reproduction,” says Waljit Dhillo, at Imperial College London. “Ultimately, we are keen to look into whether kisspeptin could be an effective treatment for psychosexual disorders.” The team now plans to study the effects of the hormone in a larger group of people, including women as well as men. Journal reference: Journal of Clinical Investigation © Copyright Reed Business Information Ltd.
By Kevin Pelphrey, In September, the Florida State University football team made a visit to a Tallahassee middle school that would become famous. At lunchtime, student-athlete Travis Rudolph noticed sixth grader Bo Paske eating alone, so he joined Bo for the meal. Bo, who has autism, often sat by himself in the lunchroom. The world took note of the athlete’s gesture after his mother’s Facebook post about it went viral. “This is one day I didn’t have to worry if my sweet boy ate lunch alone, because he sat across from someone who is a hero in many eyes,” she wrote. This story touched people because it calls to mind something universal: the sting of social exclusion. We have all known children who often eat, or play, alone. And all of us have felt left out at one time or another. But although this experience may be universal, a new generation of children is experiencing a wave of inclusiveness. Technology of various types, often thought of as an isolating influence, can actually abet people’s good intentions or help those with autism learn to fit in. One new app called Sit With Us, invented by 16-year-old Natalie Hampton, helps vulnerable children who have difficulty finding a welcoming group in the lunchroom. Its motto is inspiring: “The first step to a warmer, more inclusive community can begin with LUNCH.” Sit With Us allows students to designate themselves as ‘ambassadors’ and to signal to anyone seeking company that they’re invited to join the ambassador’s table. © 2017 Scientific American
By LISA SANDERS, M.D. “You don’t look well,” the man at the gas station told the older woman in the car. He’d known her for years, always thinking of her as a lively, robust woman. But that day she looked pale and tired. Her sharp blue eyes seemed dim. She gave a feeble smile. “I don’t feel well at all,” she told him. There’s an urgent-care clinic just up the street, he said. Could she make it there? She was nearly 45 minutes away from her home in Halifax, Nova Scotia. Stopping just up the street seemed a much better option. At the clinic, the doctor took one look at her, put a blood pressure cuff around her arm and told her assistant to call an ambulance. The rest of the day was a blur. The woman remembers being bundled onto a stretcher and one of the E.M.T.s saying her blood pressure was very low. It was an odd thing to hear, because her blood pressure was usually high enough to require three medications. She was taken to the emergency room at the Queen Elizabeth II Health Sciences Center in Halifax. She remembers being fussed over — having blood drawn, receiving intravenous fluids, feeling sticky snaps being placed on her chest that connected her to a continuous heart monitor. She had been a nurse for many years when she was younger, yet seeing herself at the center of these familiar activities was strange. A blood test indicated that there may have been damage to her heart. The doctor told her she was having a heart attack, she recalls. You’ve got the wrong patient, she thought to herself. Sure, she had a little high blood pressure, a little asthma, a little back pain. But problems with her heart? Never. The patient used a cane, but she had no difficulty getting up on the exam table — an important test of mobility. © 2017 The New York Times Company
Keyword: Hormones & Behavior
Link ID: 23101 - Posted: 01.14.2017
By Andy Coghlan Can tiny brains grown in a dish reveal the secrets of sociability? Balls of brain tissue generated from stem cells are enabling us to understand the underlying differences between people who struggle to be sociable and those who have difficulty reining themselves in. Alysson Muotri at the University of California, San Diego, and his team created the mini-brains by exposing stem cells taken from the pulp of children’s milk teeth to cocktails of growth factors that help them mature. Eventually, they can develop as many as six layers of cerebral cortex – the outer surface of the brain. This region is much more sophisticated in humans than in other animals, and houses important circuitry governing our most complex thoughts and behaviours, including socialising with others. Each mini-brain is approximately 5 millimetres across. “Though they’re not as well defined as they are in a real brain, they resemble what you find in an embryonic fetus,” says Muotri. To understand how brain development affects sociability, the team used donated cells from children with autism and Rett syndrome, both of which are associated with impaired communication skills. They also used cells from children with Williams syndrome, a condition characterised by a hyper-sociable nature. People with Williams syndrome can be unable to restrain themselves from talking to complete strangers. © Copyright Reed Business Information Ltd.
By Andy Coghlan Is the fabled “cuddle hormone” really a “warmone”? Oxytocin levels surge in troops of chimpanzees preparing for conflict with rival groups to defend or expand their territory. The finding is at odds with the prevailing image of oxytocin as something that helps strengthen bonds between parent and infant, or foster friendships. But given its capacity to strengthen loyalty, oxytocin could also be a warmonger hormone that helps chimps galvanise and cooperate against a common enemy. Catherine Crockford of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany, and her colleagues monitored two rival groups of chimpanzees in the Taï National Park in Ivory Coast, each containing five males and five females, for prolonged periods between October 2013 and May 2015. Thanks to trust built up between the team and the chimps, the team could safely track and video the groups – even during conflict, observing at close quarters what was happening. Crucially, the team was also able to pipette up fresh samples from soil when chimps urinated. The samples revealed that oxytocin levels surge in the mammals whenever the chimps on either side prepared for confrontation, or when either group took the risk of venturing near or into rival-held territories. These surges dwarfed the oxytocin levels seen during activities such as grooming, collaborative hunting for monkey prey or food sharing. © Copyright Reed Business Information Ltd.
By Kevin McCarthy There’s a dearth of safety data for melatonin, but there are a number of potential concerns, especially for children. “I think we just don’t know what the potential long-term effects are, particularly when you’re talking about young children,” said Dr. Judith Owens, director of the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. “Parents really need to understand that there are potential risks.” The pineal gland in the brain ramps up production of the hormone melatonin in the evening, as light fades, to encourage sleep, and it turns down production in the early morning hours. Synthetic forms of the hormone are also sold as a dietary supplement; because melatonin is found in some foods, like barley, olives and walnuts, it is regulated as a nutritional supplement rather than a drug, as most other hormones are. In adults, studies have found melatonin to be effective for jet lag and some sleep disorders. It is also hugely popular as a sleep aid for children and can be useful for sleep disorders among those with attention-deficit disorders or autism, Dr. Owens said. “I rarely see a family come in with a child with insomnia who hasn’t tried melatonin,” she said. “I would say at least 75 percent of the time when they come in to see us” at the sleep clinic, “they’re either on melatonin or they’ve tried it in the past.” While short-term use of the hormone is generally considered safe, it can have side effects, including headaches, dizziness and daytime grogginess, which could pose a risk for drivers. Melatonin can also interfere with blood pressure, diabetes and blood thinning medications. © 2017 The New York Times Company
National Institutes of Health (NIH) researchers have discovered molecular mechanisms that may underlie a woman’s susceptibility to disabling irritability, sadness, and anxiety in the days leading up to her menstrual period. Such premenstrual dysphoric disorder (PMDD) affects 2 to 5 percent of women of reproductive age, whereas less severe premenstrual syndrome (PMS) is much more common. “We found dysregulated expression in a suspect gene complex which adds to evidence that PMDD is a disorder of cellular response to estrogen and progesterone,” explained Peter Schmidt, M.D. of the NIH’s National Institute of Mental Health, Behavioral Endocrinology Branch. “Learning more about the role of this gene complex holds hope for improved treatment of such prevalent reproductive endocrine-related mood disorders.” Schmidt, David Goldman, M.D., of the NIH’s National Institute on Alcohol Abuse and Alcoholism, and colleagues, report on their findings January 3, 2017 in the journal Molecular Psychiatry. “This is a big moment for women’s health, because it establishes that women with PMDD have an intrinsic difference in their molecular apparatus for response to sex hormones – not just emotional behaviors they should be able to voluntarily control,” said Goldman. By the late 1990s, the NIMH team had demonstrated (link is external) that women who regularly experience mood disorder symptoms just prior to their periods were abnormally sensitive to normal changes in sex hormones — even though their hormone levels were normal. But the cause remained a mystery.
By Laurence O’Dwyer Daniel Tammet correctly recited the first 22,514 digits of Pi over the course of five hours and nine minutes. Less well-known, but similarly impressive, is the ability of a Clark’s nutcracker (Nucifraga columbiana)—a bird commonly found along the western flanks of North America—to remember where it stores thousands of separate caches of food. Tammet, who has autism spectrum disorder, is a savant. Some researchers have proposed that Clark’s nutcrackers might also represent a type of autistic savant. However, the unique abilities of a person with an autism spectrum disorder and savant syndrome usually comes at the price of social deficits. Experts in animal cognition who have examined similar abilities in birds and other creatures maintain that nonhuman animals that exhibit savant-like behavior do not display any equivalent dysfunction. The prodigious memory of the Clark’s nutcracker seems to be accompanied by an enlarged hippocampus compared with related species of birds that have not developed caching abilities, but in all other respects the bird seems to function normally. The hippocampus is a brain structure that is crucial for memory formation. In other words, its hyper-performance in one domain does not appear to come at a cost in another. (Admittedly, it is difficult to determine whether Clark’s nutcrackers are socially competent birds.) The “gift at a price” idea stems in part from the left hemisphere dysfunction and right hemisphere compensation that is often associated with savant syndrome. © 1986-2016 The Scientist
Laura Sanders Pregnancy changes nearly everything about an expectant mother’s life. That includes her brain. Pregnancy selectively shrinks gray matter to make a mom’s brain more responsive to her baby, and those changes last for years, scientists report online December 19 in Nature Neuroscience. “This study, coupled with others, suggests that a women’s reproductive history can have long-lasting, possibly permanent changes to her brain health,” says neuroscientist Liisa Galea of the University of British Columbia in Vancouver, who was not involved in the study. Researchers performed detailed anatomy scans of the brains of 25 women who wanted to get pregnant with their first child. More scans were performed about two months after the women gave birth. Pregnancy left signatures so strong that researchers could predict whether women had been pregnant based on the changes in their brains. The women who had carried a child and given birth had less gray matter in certain regions of their brains compared with 20 women who had not been pregnant, 19 first-time fathers and 17 childless men. These changes were still evident two years after pregnancy. A shrinking brain sounds bad, but “reductions in gray matter are not necessarily a bad thing,” says study coauthor Elseline Hoekzema, a neuroscientist at Leiden University in the Netherlands. A similar reduction happens during adolescence, a refinement that is “essential for a normal cognitive and emotional development,” says Hoekzema, who, along with colleagues, did most of the work at Universitat Autònoma de Barcelona. Following those important teenage years, pregnancy could be thought of almost as a second stage of brain maturing, she says. |© Society for Science & the Public 2000 - 2016.
By Sarah DeWeerdt, Toddlers with autism are oblivious to the social information in the eyes, but don’t actively avoid meeting another person’s gaze, according to a new study. The findings support one side of a long-standing debate: Do children with autism tend not to look others in the eye because they are uninterested or because they find eye contact unpleasant? “This question about why do we see reduced eye contact in autism has been around for a long time,” says study leader Warren Jones, director of research at the Marcus Autism Center in Atlanta, Georgia. “It’s important for how we understand autism, and it’s important for how we treat autism.” If children with autism dislike making eye contact, treatments could incorporate ways to alleviate the discomfort. But if eye contact is merely unimportant to the children, parents and therapists could help them understand why it is important in typical social interactions. The work also has implications for whether scientists who study eye contact should focus on social brain regions rather than those involved in fear and anxiety. Lack of eye contact is among the earliest signs of autism, and its assessment is part of autism screening and diagnostic tools. Yet researchers have long debated the underlying mechanism. The lack-of-interest hypothesis is consistent with the social motivation theory, which holds that a broad disinterest in social information underlies autism features. On the other hand, anecdotal reports from people with autism suggest that they find eye contact unpleasant. Studies that track eye movements as people view faces have provided support for both hypotheses. © 2016 Scientific American
Link ID: 22994 - Posted: 12.17.2016
The important role vitamin D plays in early life is back in the spotlight after Australian researchers noticed a link between a deficiency during pregnancy and autism. The study found pregnant women with low vitamin D levels at 20 weeks’ gestation were more likely to have a child with autistic traits by the age of six. The finding has led to calls for the widespread use of vitamin D supplements during pregnancy, just as taking folate has reduced the incidence of spina bifida in the community. “This study provides further evidence that low vitamin D is associated with neurodevelopmental disorders,” said Professor John McGrath from the University of Queensland’s Brain Institute, who led the research alongside Dr Henning Tiemeier from the Erasmus Medical Centre in the Netherlands. McGrath said supplements might reduce the incidence of autism, a lifelong developmental condition that affects, among other things, how an individual relates to their environment and other people. “We would not recommend more sun exposure, because of the increased risk of skin cancer in countries like Australia,” he said. “Instead, it’s feasible that a safe, inexpensive, and publicly accessible vitamin D supplement in at-risk groups may reduce the prevalence of this risk factor.” Vitamin D usually comes from exposure to the sun, but it can also be found in some foods and supplements. While it’s widely known vitamin D is vital for maintaining healthy bones, there’s also a solid body of evidence linking it to brain growth. © 2016 Guardian News and Media Limited
Link ID: 22988 - Posted: 12.14.2016
Nancy Shute Getting the flu while pregnant doesn't appear to increase the child's risk of being diagnosed with autism later on, a study finds, and neither does getting a flu shot while pregnant. The study, published Tuesday in JAMA Pediatrics, tries to tease apart subtle questions of risk and risk avoidance. Some smaller, earlier studies have found an association between serious viral infections in pregnancy or maternal fever in pregnancy and increased autism risk. This much larger study finds no such ties, though the authors note that it shouldn't be the last word on the topic. This study examined the health records of 196,929 children who were born at Kaiser Permanente facilities in Northern California between 2000 and 2010. They found that 3,101 children, or 1.6 percent, had been diagnosed with autism through June 2015. The researchers then looked at the mothers' health records to see if they had been diagnosed with flu while pregnant and whether they'd gotten a flu shot. Less than 1 percent of women had the flu; about 23 percent got a flu shot while pregnant, a number that rose from 6 percent in 2000 to 58 percent in 2010. They found no correlation overall between having the flu while pregnant and increased autism risk in children. © 2016 npr
By JAN HOFFMAN BOWLING GREEN, Ky. — Crosby J. Gardner has never had a girlfriend. Now 20 and living for the first time in a dorm here at Western Kentucky University, he has designed a fast-track experiment to find her. He ticks off the math. Two meals a day at the student dining hall, three courses per meal. Girls make up 57 percent of the 20,068 students. And so, he sums up, gray-blue eyes triumphant, if he sits at a table with at least four new girls for every course, he should be able to meet all 11,439 by graduation. “I’m Crosby Gardner!” he announces each time he descends upon a fresh group, trying out the social-skills script he had practiced in the university’s autism support program. “What is your name and what is your major?” The first generation of college students with an autism diagnosis is fanning out to campuses across the country. These growing numbers reflect the sharp rise in diagnosis rates since the 1990s, as well as the success of early-learning interventions and efforts to include these students in mainstream activities. But while these young adults have opportunities that could not have been imagined had they been born even a decade earlier, their success in college is still a long shot. Increasingly, schools are realizing that most of these students will not graduate without comprehensive support like the Kelly Autism Program at Western Kentucky. Similar programs have been taking root at nearly 40 colleges around the country, including large public institutions like Eastern Michigan University, California State University, Long Beach, the University of Connecticut and Rutgers. For decades, universities have provided academic safety nets to students with physical disabilities and learning challenges like dyslexia. But students on the autism spectrum need a web of support that is far more nuanced and complex. © 2016 The New York Times Company
Link ID: 22894 - Posted: 11.21.2016
Laurence O'Dwyer Until as late as 2013 a joint (or comorbid) diagnosis of autism and attention deficit hyperactivity disorder (ADHD) was not permitted by the most influential psychiatric handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is an essential tool in psychiatry as it allows clinicians and researchers to use a standard framework for classifying mental disorders. Health insurance companies and drug regulation agencies also use the DSM, so its definition of what does or doesn’t constitute a particular disorder can have far-reaching consequences. One of the reasons for the prohibition of a comorbid diagnosis of autism and ADHD was that the severity of autism placed it above ADHD in the diagnostic hierarchy, so the inattention that is normally present in autism did not seem to merit an additional diagnosis. Nevertheless, that was an odd state of affairs, as any clinician working in the field would be able to quote studies that point to anything from 30% to 80% of patients with autism also having ADHD. More problematic still is the fact that patients with both sets of symptoms may respond poorly to standard ADHD treatments or have increased side effects. The fifth edition of the DSM opened the way for a more detailed look at this overlap, and just a year after the new guidelines were adopted, a consortium (which I am a part of) at the Radboud University in Nijmegen (Netherlands) called NeuroIMAGE published a paper which showed that autistic traits in ADHD participants could be predicted by complex interactions between grey and white matter volumes in the brain. © 2016 Guardian News and Media Limited