How So Much of Autism Boils Down to One Major Part of the Brain

Over and over again in my work with children diagnosed with autism I observe a consistent deficit: these children lack the ability to direct their attention on purpose. Often I see that glint in a child’s eyes as I repeatedly fail at getting them to look at a picture or object that I am holding in front of them. I interpret it as them saying “I know what you are asking me to do, but I just can’t get myself to look at that thing”.

I understand this deficit to be the result of a dysfunctional anterior cingulate cortex (ACC), the part of the brain I find to be the most important in my work with ASD children. If you have an autistic child, read the list below and ask yourself if the items remind you of him or her (or them God bless you):

5 Ways a Dysfunctional ACC Causes Autistic Symptoms

1)     The ACC plays a major role in the recognition of pain signals from the body. Dysfunction in the ACC can lead to amplified distress upon the occurrence of pain, making pain that much more painful. It also detects if a pain signal occurs or not, making some with problem ACCs under-responsive to pain stimuli while they are over-responsive to what otherwise would be neutral. This affect is heightened when the subject is engaged in a cognitive task.

• Children with Autism and other Neurobehavioral disorders often have atypical responses to painful and neutral stimuli.

2)     The ACC is in charge of detecting relevant social cues and directs other parts of the brain to organize responses. When it is not working right, it may totally miss critical signals from others (like a disgusted look from someone watching you pick your nose) or over-respond to others, like in social anxiety. Based on the info coming into the ACC, we learn from our social mistakes and gradually become more successful in our interactions with others.

• ASD kids are very often socially oblivious or insensitive. Many of their social skill deficits stem from problems learning from everyday social interactions. I believe this is part of why social stories are so effective. They don’t require the learner to detect and respond to errors. They teach through a different pathway and mechanism.

3)     The ACC holds expectations about what the person is about to experience. When something happens in the environment that is not expected, it emits a “ping” telling other parts of the brain to turn on and pay attention. It has the same response when we do something that is unintended, when we make an error in the performance of some action. It tells another part of the brain to turn on and fix the problem so that the desired outcome can be achieved. This is a core process in behavioral learning.

• This is why many behavior analysts prefer an Errorless Teaching Approach to language training in autism. These kids have deficits in learning through trial-and-error teaching methods and often experience error with more emotional distress than is helpful in a teaching situation.

4)     The ACC is the Grand Central Station, the Air Traffic Controller, and master conductor of the brain. Once an event has been detected, it orchestrates a specific brain network response. It decides which parts will be involved and which parts will not. ACC dysfunction can make it hard to switch gears and to optimize the brain’s response in order to achieve the best outcome that is available.  

• Kids with autism are famous for problems with disengaging from a behavior or topic of conversation and for engaging in a different task, especially when it is not of immediate interest. This experience can be experienced as painful and distressing.

5)     Although I mentioned it a little above, I think the most important role I see the ACC playing is in predicting what will happen next. The “ping” I mentioned above is called the ERN or Error Related Negativity. It is set off when something happens that was not expected. I have worked with kids that acted like they were under a constant barrage of ERNs, reacting aggressively to every minor turn as they walked through hallways that they had transversed several times before. Their ACCs were massively over-reacting and seemed to be triggering the wrong part of the brain resulting in a fight-or-flight response to any stimuli that it thought was out of place or surprising. When you give kids like this excessively frequent “precues” (advanced warning reminders) about aspects of the environment that they will be encountering in the next moment, their tolerance for transitions dramatically improves.

My greatest joy and frustration about neurotherapy is that it can normalize the functioning of a dysregulated Anterior Cingulate Cortex. With pEMF (pulsed electromagnetic field stimulation), tACS (transcranial alternating current stimulation), tDCS (transcranial direct current stimulation), and Low Level Light Therapy, we can push the ACC into more normal functioning. Then we use Neurofeedback to fine tune its behavior. The benefits on kids with autism can be astounding. My frustration stems from the fact that so few treating these kids know the first thing about the organ that is responsible for these sometimes massive deficits.