Clinical Characteristics And Brain Volume In Children With ASD With Regression

[Background]Autism Spectrum Disorder(ASD)is a serious of severe neurodevelopmental disorders,characterised by social communication and unusually restricted,repetitive behaviour and interests and sensory processing dysfunction[1].The heterogeneity of clinical manifestations of individuals with ASD poses a major challenge to the characterization of the disease,and there are many limitations to the interpretability and reproducibility of the findings.ASD children had a wide range of heterogeneity in cognitive,language,social,adaptive ability,and patterns of onset.There were two different onset patterns(regressive and non-regressive)in children with ASD.Although many neuroimaging studies reported children with ASD had abnormalities in brain volume and,there was little research about children with ASD with regression.It is valuable to investigate the brain volume of children with ASD with different patterns of onset.[Objective]To investigate the difference of the developmental trajectories of brain volume between 2-5 years old children with ASD and those with developmental delay(DD).To compare the developmental characteristic and clinical symptom of children with ASD with regression and non-regression.[Methods]The children were divided into two groups according to the diagnostic criteria of American Diagnostic and Statistical Manual of mental disorders 4th edition(revised)diagnostic criteria of autistic disorder.The general condition and related information of the children were assessed by Self-designed General Condition Questionnaire.The Bailey Infant Development Scale was used for Development Quotient(DQ)measurement.The Childhood Autism Rating Scale(CARS)was used to assess the severity of autistic disorder.Compare developmental characteristic and clinical symptom of children using Regression Supplement Form and Autism Diagnostic Interview-Revised divided into two groups according to the oneset of regression or not,which include regressive type group and non-regressive type group.The Statistical Parametric Mapping(SPM)Software was used to investigate the change of the brain volume of each subject.[Results](1)Of 121 children with ASD,there were 30 patients(32.97%)with regression,whose mean onset age was 23.81months.There was no significant difference in the proportion of male and female between regressive ASD and development delay(40 males,11 females)(P>0.05).There was no significant difference in the proportion of male and female between R-ASD group(22 males,8 females)and NR-ASD(78 males,12 females)group(P>0.05).There was no significant difference in language development Quotient,motor development Index and total development Index between R-ASD and DD(P>0.05).The same results was found in NR-ASD and DD.Total score of CARS in the regressive group(36.57 ± 6.96)was significantly higher than the non regressive group(33.52±5.16)and the developmental delay group(26.84 ± 4.28).Major regressive types were in language,social,and the combination of both.The first three life events reported by parents(36.67%)in children with regressive autism when regression occurred were the changes of the primary caregivers(23.33%),the children's illness(13.22%)and the family conflict(6.67%).73.33%of the regressive group reported regained skills,and the related events were behavior training(30.00%)and parents spend more time with children(10.00%).(2)Group differences in volume of total brain,left and right cerebral hemisphere,total brain gray matter and white matter,bilateral brain gray matter and white matter were analyzed using variance analysis.Significant difference shows between DD and children with ASD with and without regression(Ps<0.05).Compared with the children with ASD with regression,the volume was not significant(P>0.05).Between regressive and non-regressive group,there was significant differences in gray matter volume of bilateral paracingulate gyri(Ps<0.05),and the difference was not significant in the remaining 88 gray matter volume(Ps>0.05).The volume of total brain volume,total brain grey matter volume,total brain white matter volume was not significant difference in children with regression and non-regression(Ps>0.05).When the analysis of covariance with age as a covariate,compared with the NR-ASD group,the volume of the lefe superior frontal gyrus orbital part,right middle frontal gyrus orbital part,bilateral calcarine fissure and surronding cortex,bilateral cuneus gyrus,bilateral lingualis gyrus,bilateral superior occipital gyrus,right inferior occipital gyrus,left precuneus,bilateral heschl gyrus of grey matter was no significantly in the R-ASD group(Ps>0.05),the difference was significant in the remaining 75 gray matter volume(Ps<0.05).Between regressive and J.non-regressive group,there was no significant difference in the volume of grey matter and white matter corrected by FEW(P>0.05).In the group of ASD with regression,the total CARS score was not associated with grey matter volume of bilateral paracingulate gyri.[Conclusions](1)There are approximately 1/3 children with ASD with regression.Compared with the non-regressive group,the regression group demonstrates more severe symptoms.The family environment and medical condition of children with regressive may be related to their regression.Autism training and being accompanied more by their parents will help them regain skills.(2)The total brain volume was increased in children with ASD with regression.There was no relationship between the brain volume of gray matter of ASD with regression and increased bilateral paracingulate gyri.