On the Spectrum

Chapter 8
symptoms could be more specifically related to attention and executive functioning. These
results can potentially help in determining the prognosis of a child and making informed
treatment decisions, particularly if the clinical picture is characterized by comorbidity. For
example, to specifically target executive functioning problems in a child that presents with
a mixture of symptoms, it could be helpful to treat the externalizing component of the
psychopathology. Finally, specific patterns of symptoms may respond better to particular
interventions. For instance, children with comorbid internalizing and externalizing problems
appeared to benefit more from a family-centered intervention than children with problems
in a single domain (Connell, Bullock, Dishion, Shaw, Wilson et al. 2008).
In this thesis, we sought neurobiological correlates, mostly of autistic traits in young
children, using a range of MRI methodologies. Neurobiological research in psychiatry has
been criticized for being very descriptive in nature, and, despite huge monetary investments,
its failure to lead to very consistent biomarkers or large-scale breakthroughs in the diagnosis
and treatment of psychiatric disorders. Neurobiology currently plays little to no role in clinical
practice: it is not used in diagnostics, nor does it play a role in deciding which patient is
assigned to what treatment. Perhaps adding to the suspicion that some clinicians have against
neuroimaging research is the fact that historically, diseases like dementia were transferred
from the psychiatrist’s to the neurologist’s treatment responsibility once the neurobiological
or ‘organic’ nature of the disease became apparent. However, nowadays the classical
dichotomy between functional and organic psychiatric disorders is deemed obsolete and
this should not deter psychiatrists to pursue the search of neurobiological mechanisms that
could ultimately help find better treatment (Rosenberg 2000). Using the words of Bullmore
and colleagues, psychiatrists these days cannot afford to be neurophobic (Bullmore, Fletcher
and Jones 2009). Eventually, replication of neurobiological findings and careful description
of the corresponding phenotype can lead to development of novel treatments. In line with
the RDoC initiative, there are now some efforts to incorporate neurobiological measures as
outcome measures to evaluate treatment effects (Van Hecke, Stevens, Carson, Karst, Dolan
et al. 2015).
RECOMMENDATIONS FOR RESEARCH
ASD likely comprises a cluster of many different disorders, with different neurobiological
pathways. While the complexity of this collection of pathways presents researchers with an
immense challenge, it will be crucial to understand these pathways better in order to develop
specific treatment targets. Much like other fields in medicine, this has the potential to lead to
so-called ‘personalized’ or ‘precision’ medicine. The notion that ASD may involve a diverse set
of pathways has far-reaching consequences. Although ASD, with a prevalence of 1-3% is not
202