title: Discordant mental and physical efforts in an autistic patient.
abstract: We investigated whether there was mental effort in response to verbal commands in a 16-year old girl with autism, a high degree of non-compliance with commands and symptoms of autonomic dysfunction by monitoring the brainstem autonomic tone during an attempt to perform isometric exercise. An index of cardiac vagal tone (CVT), cardiac sensitivity to baroreflex (CSB), heart rate (HR) and mean arterial blood pressure (MAP) were measured simultaneously. Physical non-compliance with our commands meant there was no force applied by the patient during the attempted exercise, but CVT and CSB were both reduced and sustained at very low levels throughout the attempt, while MAP and HR were increased concurrently to higher levels in the same period. This vagal withdrawal to allow concurrent increases in HR and MAP is an arousal response appropriate for isometric exercise, which is a sign of a positive mental effort to comply with our commands. These results demonstrate discordant mental and physical efforts in our patient. In this particular case, the physical inabilities in some instances could have been mislabelled as mental non-compliance due to autism. It would be worthwhile to investigate the prevalence of discordant mental and physical efforts in autism.
authors.affiliation: Department of Neuroscience, UMDNJ-New Jersey Medical School, MSB-H506 185 South Orange Avenue, Newark, NJ, USA. mingxu@umdnj.edu
authors.forename: Xue
authors.initials: X
authors.lastname: Ming
authors.forename: Peter O O
authors.initials: PO
authors.lastname: Julu
authors.forename: James
authors.initials: J
authors.lastname: Wark
authors.forename: Flora
authors.initials: F
authors.lastname: Apartopoulos
authors.forename: Stig
authors.initials: S
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D001143:Arousal / Q000502:physiology; D001321:Autistic Disorder / Q000150:complications / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000209:etiology / Q000503:physiopathology*; D017776:Autonomic Pathways / Q000503:physiopathology; D017704:Baroreflex / Q000502:physiology; D001933:Brain Stem / Q000503:physiopathology*; D002320:Cardiovascular Physiological Phenomena; D003072:Cognition Disorders / Q000209:etiology / Q000503:physiopathology*; D003299:Cooperative Behavior; D015444:Exercise / Q000502:physiology; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D007805:Language Development Disorders / Q000209:etiology / Q000503:physiopathology*; D010349:Patient Compliance; D020421:Vagus Nerve Diseases / Q000209:etiology / Q000503:physiopathology; D014836:Volition / Q000502:physiology