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Neurosci Biobehav Rev. 2009 Sep;33(8):1198-203. doi: 10.1016/j.neubiorev.2009.06.002. Epub 2009 Jun 16.

The anterior insula in autism: under-connected and under-examined.

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  • 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, USA. lucina@stanford.edu

Abstract

Autism is a complex neurodevelopmental disorder of unknown etiology. While the past decade has witnessed a proliferation of neuroimaging studies of autism, theoretical approaches for understanding systems-level brain abnormalities remain poorly developed. We propose a novel anterior insula-based systems-level model for investigating the neural basis of autism, synthesizing recent advances in brain network functional connectivity with converging evidence from neuroimaging studies in autism. The anterior insula is involved in interoceptive, affective and empathic processes, and emerging evidence suggests it is part of a "salience network" integrating external sensory stimuli with internal states. Network analysis indicates that the anterior insula is uniquely positioned as a hub mediating interactions between large-scale networks involved in externally and internally oriented cognitive processing. A recent meta-analysis identifies the anterior insula as a consistent locus of hypoactivity in autism. We suggest that dysfunctional anterior insula connectivity plays an important role in autism. Critical examination of these abnormalities from a systems neuroscience perspective should be a priority for further research on the neurobiology of autism.

PMID:
19538989
PMCID:
PMC2743776
DOI:
10.1016/j.neubiorev.2009.06.002
[PubMed - indexed for MEDLINE]
Free PMC Article
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