Anomalous Pattern of Left Hemisphere Visual Connectivity in Children With Autism: Association With Impaired Praxis

Prominent theories of autism suggest autism-associated differences in visual-motor integration (VMI) may disrupt learning of motor and social skills typically acquired by observation and imitation. Supporting these theories, children with autism spectrum disorder (ASD) show robust differences in motor tasks reliant on dynamic VMI (e.g., ball-catching and motor imitation) and anomalous visual-motor connectivity between higher-order visual (HOV) and sensory-motor cortices. Use of functional MRI (fMRI) to examine HOV functional connectivity (FC) has been particularly revealing with other conditions. For instance, research with congenitally blind adults reveals a particular pattern of altered HOV connectivity, showing reduced HOV connectivity with primary sensory-motor (SM1) and primary auditory (A1) cortices yet "compensatory" increased connectivity between HOV and prefrontal cortex (PFC). Informed by these findings, we used fMRI to examine HOV FC in children with ASD, hypothesizing they would show a distinct pattern of HOV connectivity relative to typically developing (TD) children, with decreased HOV-SM1 connectivity and increased "compensatory" HOV-PFC connectivity. We further hypothesized that this altered pattern of HOV connectivity would correlate with autism-associated difficulties with performing skilled actions ("praxis"), often learned through visual imitation. Our findings suggest ASD children show an altered pattern of HOV connectivity that is characterized by reduced HOV connectivity with SM1 yet increased connectivity with PFC. Further, this HOV connectivity correlated with impaired praxis in children with ASD, suggesting that altered patterns of HOV connectivity may contribute to difficulty acquiring a range of skilled behaviors observed in autism.