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Caitlin Whyte (Host): Welcome to Hally HealthCast, the wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic, important to your health and wellbeing, bringing in expert doctors, therapists, scientists, and specialists who offer advice and answer your most pressing questions.

April is Autism Acceptance Month. So, today we're talking about autism spectrum disorder or ASD. Specifically, we'll be addressing advances in scientific research, focused on treatment, care and learning more about ASD. Here with us is Researcher and Professor Sheba Arnold, a Biomedical Engineer by training and holding a PhD, she is a Clinical Investigator at the Stevens Family Clinical Research Institute and an Assistant Professor at the Carle Illinois Advanced Imaging Center at Carle Foundation Hospital in Urbana, Illinois. She's an expert in using MRI technology to research autism spectrum disorder and similar conditions.

Welcome Professor Arnold and thanks for being with us today. Now let's begin. Before we dig into the questions about research and the latest advances, let's give our listeners some general information about ASD. Can you briefly explain what autism spectrum disorder is? How it affects those who have it and how common it is?

Sheeba Arnold Anteraper, PhD (Guest): Yes. So, autism spectrum disorder or ASD for short is a highly morbid neurodevelopmental disorder. And it is often characterized by varying degrees of deficits in social emotional functioning, or restricted repetitive behaviors and interests. Althoug ASD can be a lifelong disorder, the good news is that treatments and services can improve people's symptoms and ability to function.

Regarding prevalence, it is increasingly becoming prevalent. Depending on epidemiological surveys conducted in the United States, since 2000, the latest prevalence is estimated to be one in 44 youth in the general population. I have to add, although the numbers sound a little grim, the rise in prevalence is mostly due to increased recognition of ASD in intellectually capable populations.

Host: Thank you, Professor Arnold for that insight and thorough explanation. I'm wondering if you can also tell us a little bit about your personal connection to autism spectrum disorder?

Professor Arnold: So, I'll give you two reasons for my personal connection. The first one is that I started my career at the Kennedy Krieger Institute, which is a very special place that's dedicated to improving the lives of children and young adults on the spectrum. And this experience gave me very early on a mental shift that those with disabilities, disabilities can be turned to abilities. And the second reason is that years later, when I started as a researcher at the Allen and Lorraine Bressler Clinical and Research program for ASD at Mass General Hospital, I was actually parenting a child with ASD.

Host: Well, thank you for sharing that. Now we'll start talking about all the scientific research that's happening, focused on ASD. Before we get into your own work and the latest discoveries, can you tell us a little about the history of autism spectrum disorder in terms of what scientists have known over the years?

Professor Arnold: Yes. The clinical presentation of ASD is highly heterogeneous. So, when developmentally expected social demands exceed limited capacities, symptoms hurt the patient's ability to function properly in school or work or other areas of life. Presence of psychopathologies complicate the matter. So, there is a lot of phenotypic heterogeneity, as you can imagine.

And the conditions that overlap with autism generally fall into classic medical problems, such as epilepsy, gastrointestinal issues, or developmental diagnosis or speech delays, or other mental health conditions and so forth. So, to answer your question on the history I'll give you a brief overview. So, we know that autism has been around for a while.

Right? In fact, over a century. It was initially described in 1911, by a German psychiatrist named Eugen Bleuler. He used the term to encompass severe cases of schizophrenia in which patients possess childlike desires. The word autism maintained this meaning for 50 more years until it was entirely reversed in the 60's. The diagnosis of autism slipped from symptoms of excessive fantasies to complete lack of unconscious symbolic life.

A 1943 report from Leo Kanner played an important role in this shifting perspective. The report was titled Autistic Disturbances of Effective Contact and described 11 child case studies. Kanner described autistic traits as inability to relate to others, social withdrawal and abnormal language development. Kanner was one of the first to distinguish between childhood schizophrenia and autism supporting the greater social change.

It was Hans Asperger who discovered the autistic continuum. Asperger and his colleagues at the University of Vienna discovered that autism was a lifelong condition that encompassed a very wide variety of clinical presentations. Another person who has done some seminal research into autism is Isabelle Rapin, who was a faculty at the Albert Einstein College of Medicine from 1958 to 2012.

Dr. Rapin advocated, early educational intervention for autistic children with a focus on their abilities, not their disabilities. She also popularized the term autism spectrum disorder. The level of impairments has a wide range in ASD and depending on the intellectual capability, the person can be further classified as low functioning or high functioning. High functioning autism means individuals that intellectually capable have necessary language skills to communicate and are socially curious. I have to say this classification is purely based on IQ and often people who are labeled high functioning have invisible yet profound difficulties and people who are on the low functioning often have hidden talents.

And paired with the right therapeutic strategies, these individuals can reach their true potential and lead healthier lives. And for your question on known support of ASD, there are several, because ASD is highly complex and heterogeneous, you know, it's a spectrum disorder. And although there are lot of unknowns, evidence demonstrating the role of genetics and ASD is growing with approximately 80% heritability reported.

Host: Well, thank you for that great explanation. Now I want our listeners to, of course, learn more about your own research. First, can you tell us a little bit about your background and expertise?

Professor Arnold: Yes. So, I'm a biomedical engineer by training and my work uses magnetic resonance imaging as a tool to bridge medicine with engineering and for clinical translation. My research is focused on identifying regions of interest in the brain for therapeutic intervention. And as you know, the associated psychopathologies as the last combination and severity of symptoms are heterogeneous in ASD. One of the brain regions that have started to emerge in ASD is the cerebellum. So, my research focus in a nutshell is to use MRI as a tool to probe the structure and function of cerebellum in ASD.

Host: So impressive Professor Arnold. And now within the last couple of years, I understand that you've embarked on even more groundbreaking research right here in central Illinois with a state of the art MRI. Some of our listeners might have heard of it. It's the 7 Tesla MRI scanner, or what we'll simply call the 7T. Can you tell us a bit about the 7T and why it's such an important piece of technology?

Professor Arnold: So, I work at the Carle Illinois Advanced Imaging Center, which is home to the Siemens MAGNETOM 7T MRI. It is one out of 14,7T MRI machines in the United States and the only 7T in the state of Illinois. The 7T acquisition is made possible by a partnership between the Stevens Family Clinical Research Institute at Carle and the University of Illinois. And what the technology allows is the ability to push spatial resolution.

So, we can see tiny structures of the human body, but much better contrast and exquisite detail. Which can open doors to a whole host of clinical research applications.

Host: Incredible, you know, with your brilliant mind and this amazing piece of technology, I can only imagine the discoveries that await and how many patients will benefit from them. Now, can you tell us about your current research, both with the 7T and other equipment focused on autism spectrum disorder?

Professor Arnold: Yes. Compared to lower field strength such as 1.5 T or 3T, visualizing tumors or micro hemorrhages, multiple sclerosis lesions, locating seizure origin sites in people that Douglas has can full clips.

Epilepsy are all made better with 7T MRI. For structural imaging, the delineation between gray and white matter is so much better. When it comes to functional imaging, 7T allows much better spatial and temporal resolution without sacrificing brain coverage. So these brains, the underrepresented regions such as cerebellum and spinal cord to be included in the picture, allowing researchers like us to see areas in the central nervous system, never seen before with MRI. The end goal of making an impact on the way patients receive treatments and therapies are so much more feasible with 7T compared to lower fields.

Host: Beautiful. And if I could ask, what are the most promising or even just surprising things you've found in your research so far?

Professor Arnold: I can tell you about how the cerebellum found me while I was a researcher at the McGovern Institute for Brain Research. So when we study brain function in ASD, we sometimes have a very clear notion on what parts of the brain we should study.

So, instead of following this brain region driven approach, I ran a data driven analysis asking which parts of the brain have the most abnormal patterns of function than other brain areas seen. And this approach gave us a simple, powerful response. Only the cerebellum survived or said status because So the reasons that stood out were hard to interpret at first sight. I took these results to a postdoctoral researcher at the lab of John Gabri and their mission, and at the time they didn't say, if you go. And he was working on something similar at the time in functional mapping of the cerebellum. So when Xavier pointed out that these regions are associated with the non-motor roles of the cerebellum, including working memory, language and social and emotional processing, the data fell into place and made sense. The results were published in Brain Connectivity, and even after three years, it remains as one of the most read papers of the journal. This work has also landed me on a small research plan from the National Institute of Mental Health.

Host: Oh, my gosh, incredible, promising, uplifting. There are so many words to describe the research you're doing and the opportunity it has to help so many people with autism spectrum disorder in the future.

Now I know you're not the only scientist out there researching ASD. Can you tell us about some of the other research going on in labs all over the world? What have been the most exciting advances or discoveries lately? And what do they tell us about ASD and caring for those who have it?

Professor Arnold: Yes, that's a great question. The American Academy of Pediatrics recommends that all children be screened for autism. One research study along the theme of early detection that I would like to highlight is a large study by researchers at Columbia University Mailman School of Public Health and the Norwegian National Institute of Public Health, which was published last month in the journal of Molecular Psychiatry. This study has identified molecular signatures of gestational information linked to be the risk of developing ASD, which provide insights into abnormal brain development, which could eventually lead to a test to screen for ASD at birth. I think it's very important for families to know that they are not alone.

The awareness for autism and other neuro diversity is increasing every day. From earlier diagnosis to job opportunities created to leverage the strength of autistic individuals. Positive change is happening. Parents are no longer at the mercy of free special ed resources or governmental organizations. Newer models of care access are emerging like, Vitalxchange which is a digital platform that provide families timely access to support and guidance.

Host: That's wonderful to hear. It's so encouraging. And now one last question, and it's a bit different. So much of what we've talked about today focuses on the future and the exciting discoveries you're making that will help so many people in the years ahead. But what message would you have for those dealing with autism spectrum disorder today and their families? What's most important for them to know? And any final words of hope or encouragement or simply advice.

Professor Arnold: Very important for parents to be the change, be vocal about your challenges, be loud about feeling marginalized or bullied. Be louder about your wins and loses. And finally remember that you're not alone. You can easily connect with others using digital platforms that I mentioned, like Vitalxchange is a good example of a support for the whole parenting journey from diagnosis to adult transition is available for a wide range of neuro-diversity from autism to learning disabilities.

Host: Truly such wonderful and inspiring information today, Professor. Thank you again for joining us and thanks for all you do every day at the Stevens Family Clinical Research Institute, the Research Enterprise at Carle Health and at the Carle Illinois Advanced Imaging Center. You're bringing hope and changing lives with the research that you're doing.

Well that concludes today's Hally HealthCast. Tune in next time as we tackle yet another topic important to your health and wellbeing. And remember Hally Health is your partner in helping you live your healthiest life. Visit hally.com for resources, information, tips, and much more. Let us help keep you and your family healthy and well.

Thanks for listening. We hope you tune in again. .