Autism challenges the individual, their family, the community and the practitioner. The complexity and variety of symptoms that define Autism Spectrum Disorders (ASD) require service providers to constantly update their knowledge and skills to best serve these individuals. Sensorimotor synchronization training with Interactive Metronome (IM), as part of a comprehensive treatment plan, has the potential to directly and positively influence the person’s ability to learn and engage with the world around him. This course will introduce practitioners to new advances in our understanding of ASD, including the pivotal role of timing & rhythm for speech, language, pragmatic, cognitive, motor and sensory processing skills. Participants will learn strategies to evaluate the unique strengths and needs of each individual with ASD as well as how to develop and implement effective IM training with consideration for communication, sensory, motor & behavioral challenges. The expert presenter will incorporate several videos and real examples to illustrate techniques. Take the course at https://secure.interactivemetronome.com/NetSite/IM/CEU/SimpleRegistration.aspx?course_id=2778

1. Dillen Hartley, OTR/L
An Introduction and Practical
Guide to the Effective
Treatment of Autism with IM

2. Agenda
• Introduction and logistics
• Review of the Research
• Characteristics of an effective IM
training program
• The IM assessment
• Developing an effective IM training
PLAN
• Preparing & setting up the treatment
• IM training and treatment techniques
• Education
• Questions
• Post Test 2

3. Introduction
My name is Dillen Hartley
3

4. The Questions:
Why would I consider
IM for individuals on
the Spectrum?
How do I use IM with
individuals on the
Spectrum?
4

5. 1. Million dollar question: What does the Autistic
brain look like?
How does timing, sensory processing and connectivity relate to Autism
2. What does the research reveal about how IM
might influence the brain with Autism.
Timing, Brain Connectivity and Autism
5

6. Research on
AutismThe bulk of the research related to Autism is
currently focused on genetics, co-morbid
psychiatric conditions, sensory disturbances,
family and support models and treatment
effectiveness.
There are some interesting new
developments that will influence our clinical
decision making and approach to these
individuals:
6

7. 7
Golden nuggets from 2018 research on
Autism• A recent study that looked at all of the previous studies of anxiety that occurred alongside of ASD showed that
adults with ASD were twenty times more likely to have anxiety and much more likely to have obsessive
compulsive disorder (OCD) than people without ASD ¹
• People with Phelan-McDermid Syndrome, or PMS, have autism about 70% of the time2. About 75% of people
with Fragile X syndrome also have ASD3
• Researchers who study the brains of people with autism examined a protein, called FMRP, which is missing in
people with Fragile X syndrome. They looked for this protein in those with a genetic form of autism called
Dup15q Syndrome, as well as those with idiopathic autism and found a correlation4
www.takesbrains.org/signup
• Where are the girls: Hoarding. Children with autism are five times more likely to show hoarding behavior . This
is similar to the hoarding rates in ADHD and OCD36, with girls showing more hoarding behavior than boys do.5

8. More from 2018
• Researchers who examined baby teeth of those with a later autism diagnosis, found that the normal cycles of
zinc and copper, which occur as part of normal biological processes, were altered in ASD6. This might reflect an
inability to detoxify the body following an exposure during pregnancy. However, that theory needs further study.
• In 2018, researchers used brain tissue to show that genes relating to mitochondrial function were altered in
those with autism, and the changes correlated to genes which affect how brain cells, or neurons, are shaped
and function. These findings suggest that mitochondria, which are the targets of environmental factors, may act
by altering the function of autism-related genes7
• In 2018, a new drug received fast track approval to treat the core symptoms of autism: balovaptan50. It
targets the vasopressin receptor. It has been shown to positively influence social interaction and social
communication in adults. 8
• Changes in brainwave patterns, even as early as three months of age, years before a diagnosis, were shown to
be a strong predictor of diagnosis9and even abnormal brainwave patterns without full blown seizure activity is
common in those with ASD10
8

9. Timing and Brain
Connectivity
Integration of Auditory and Visual Information
• Trouble integrating simultaneous auditory & visual sensory information
• This timing deficit hampers development of social, communication &
language skills.
Stevenson et al. (2014) 11
Autism and abnormal Networks
• Autism has been hypothesized to arise from the development of abnormal
neural networks that exhibit irregular synaptic connectivity and abnormal
neural synchronization.
• Toddlers with autism exhibited significantly weaker interhemispheric
synchronization (i.e., weak ‘‘functional connectivity’’ across the two
hemispheres)
• Disrupted cortical synchronization appears to be a notable characteristic of
autism neurophysiology that is evident at very early stages of autism
development.
Dinstein et al. (2011) 12
9

10. 10
Temporal Processing and
Time
Consistent with prior research linking
auditory working memory (Allman et al.,
2011) to temporal processing in
children with ASD, auditory working
memory was a significant predictor in
our study. Across the full sample
(individuals with ASD and those
without) poorer working memory is
associated with worse accuracy and
consistency of time reproduction with
that effect being magnified at younger
ages.
Laurie A. Brenner et al. (2015)13

11. Sensory Processing and White
Matter
“This was the first study to demonstrate
reduced white matter microstructural
integrity in children with SPD. The
disrupted white matter microstructure
predominantly involves posterior cerebral
tracts and correlates strongly with
atypical unimodal and multisensory
integration behavior. These findings
suggest abnormal white matter may
serve as a biological basis for SPD and
may distinguish SPD from overlapping
clinical conditions such as autism and
attention deficit hyperactivity disorder.”
Owen JP, et al 201314
11

12. White Matter structure in ASD and
ADHD
“Taken together, our results indicate that white matter
organization was affected by both ASD diagnosis and ASD traits
across diagnoses.”
“While categorical comparisons detected a significant influence of
autism spectrum disorder on multiple white matter metrics in the
corpus callosum, dimensional analyses yielded an association
with autism spectrum disorder symptoms and white matter
metrics in a set of both callosal and other tracts, regardless of
diagnosis.”
Yuta Aoki, MD, PhD, 201715
12

13. IM influence on the
Brain - Autism
IM has an effect on timing
Neural connectivity
IM activates areas of the
brain related to timing
13

14. 14
The IM Hierarchy
Neural
Efficiency
Visual & Auditory
Processing
Attention & Impulse
Control
Emotional & Behavioral
Regulation
Sensory Discrimination
Sensory Registration & Arousal
Cause & Effect
Neural Timing/Internal Clock

15. Neural Synchronization - Timing
15

16. IM Training Synchronizes Neural
Networks
Repetition reinforces connectivity between these brain structures
16

17. 17
Neural Connectivity
Arcuate fasciculus
• White matter tracts involved in
• language and speech processing
• integration of auditory and motor function
• Arcuate fasciculus connects the frontal motor coordinating and planning centers with the
posterior temporal comprehension and auditory feedback regions.
Wan et al. (2010)
• IM TBI study conducted by Dr. Nelson on Blast Injury victims
The experimental group that received IM training in addition to speech, occupational and
physical therapies showed re-myelenation and re-establishment of important white matter
tracts and neural synchronization of bilateral prefrontal & parietal cortices based upon ERP
data

18. Characteristics of an
Effective IM Training
Program for Autism
• Timing and sequencing
• Repetition reinforces neurological
pathways
• Cause and Effect
• Therapeutic Alliance /
Engagement
• Elicits sensory registration,
discrimination and integration
• Auditory discrimination and
integration
• Functional endurance
• Attention and executive
functioning 18

19. Neuroplasticity
Principles
Neuroplasticity in depended on:
• Frequency
• Intensity
• Duration
• Engagement
To support lasting neurological
changes and improved neural
connectivity and subcortical
processing.
IM dosage goal is at least 1000
repetitions per session at least 2 to 3
times per week.
19

20. 20
Cause and Effect
Principles
• Visual reinforcement of action /
effect
• Repetitive rhythmical nature
supports continued engagement
• Important step in cognitive
awareness
• Draw the child out of an escape
world by focusing on the ball and

21. Therapeutic
Alliance
Principles
• MAKE IT FUN
• Visual feedback and engagement with Hand over
Hand assist elicit the awareness that collaboration
or help can mean greater success (the monkey
climbs the tree)
• Opportunity for taking turns and reciprocal
engagement
• Reinforcement of positive feedback loop
• Structure opportunity for learned imitation
21

22. Sensory Processing and
Discrimination
Principles
• IM incorporates the registration, integration and output of multiple sensory systems.
• The Auditory system hears the reference tone and the feedback
• The Visual system monitors performance and provides information for analysis and is linked to
motivation / reinforcement
• The proprioceptive system is actively engaged by provided feedback on the position of the limbs and
speed of movement needed to engage with switch at the appropriate time.
• The vestibular system constantly making adjustments to the balance and core of the person
depending on their positioning
Multisensory nature and feedback of IM activities ensure sensory input is provided context
in the form of performance and visual reinforcement.
Performance based feedback loops validate and organize sensory discrimination.
22

23. 23
Auditory Processing and
Discrimination
Principles
• Engage the auditory system and
auditory neural pathways through
reference tone at 54 beats per
minute and Guide sounds that
provide feedback based on
performance.
• Visual supports assist in the
validation and discrimination of
guide sounds and which ear the
sounds are gear in. (Left ear early
or before the bell, right ear late or
after the bell)
• Tone awareness and sequencing
elicit language decoding

24. Functional Endurance and Persistence
Principles
Work on “stay ability”
Eliciting postural adjustments
Opportunities for both physical or
cognitive endurance
Increase repetitions and use novelty
items
Grade feedback to build resilience and
behavioral recovery
24

25. Attention and Executive Functioning
• Start with visual attention
• Shifting to auditory attention
• Shifting thoughts form objects to
performance
• Response to feedback eliciting problem
solving
• Activating memory pathways
• Motor planning and organizing thoughts
(away from scripting)
25

26. Assessment Domains
• Sensory Processing
• Behavior Analysis
• Motor / Perceptual
Assessment
• Cognitive ability
• Emotional Awareness
• Family support and
understandingIMPORTANT: Complete discipline specific standardized and clinical
assessments, parent interviews and questionnaires
26

27. 27
Sensory Processing

28. Behavior Analysis
Preferred activities / Screen time
Ability to transition between activities
Do they respond to picture schedules
Identify Antecedent rewards
Identify triggers for aggressive or fleeing behavior
28

29. Motor / Perceptual Assessment
• Reflex Assessment
• Visual Screening
• Audiology screening
• Motor performance
assessment
• Limitations to range of motion
• Hand tone / strength
• Ability to imitate movement
patterns
• Can client achieve a position
or movement with verbal only
29

30. Cognitive ability
• Ability to follow directions
(Receptive Language)
• Understanding first this then
that
• Ability to attend to an activity
• Verbal and non-verbal abilities
• Ability to choose between two /
three options
• Understanding of self (name /
body awareness)
• Ability to play appropriately
with toys
30

31. Emotional Awareness
• Status of Autonomic nervous
system
• Fight or flight
• Separation anxiety
• Facial recognition
• Emotional engagement
(Reference)
• Response to playful
obstructions (Frustration
tolerance)
• IMPORTANT: Recovery time
and techniques 31

32. 32
Family Support
• Primary predictor for positive
long term outcome
• Understanding of IM activities
• Ability to be consistent with
home program /
reinforcement
• Resources (Time, finances
and emotional availability)
• IMPORTANT: Expectation
management

33. Assessment Principles
• Prioritize information
• Take Video
• Identify data points for
progress
• Develop a system to data
collection
• Determine strengths
• Visual processing
• Rhythm
• Desire to please
• Motor performance
33

34. 34
Developing an Effective IM Training
Plan
• Keep it simple!!
• Incorporate considerations and
principles based on Assessment
• Establish goals and ways to measure
progress
• Determine environment / equipment
setup
• Determine IM settings – Starting
point
• Select Pre-IM activities
• Select Post-IM activities
• Identify reward system for
participation

35. Sensory Over-Responding (SOR)
Predisposition to respond too much, too soon, or
for too long to sensory stimuli most people find
quite tolerable
Considerations:
• May be sensitive to IM® Touch, Movement or
Sound
• Short duration IM® activities
• Consider visuals / games
• Child may be very sensitive to his performance
• Monitor for signs of over-stimulation
• Flushed cheeks
• Decreased fluency (stuttering)
• A slight tremor
• Sweaty (clammy palms)
• Increasing anxiety about performance
35

36. 36
Sensory Under-Responding (SUR)
Predisposition to be unaware of sensory
stimuli, to have a delay before responding,
responses are muted or responds with less
intensity compared to the average person
Considerations:
• May be hard to motivate
• Have low tone and will fatigue quickly
• Will hit the switches hard (ballistic)
• Can get aggressive when overstimulated
• Great difficulty discriminating information
and usually need a visual cue to assist
with discriminating left from right ear for
feedback

37. Sensory Craver (SC)
Driven to obtain sensory stimulation, but getting
the stimulation results in disorganization and
does not satisfy the drive for more
Considerations:
• Hard to contain and run off with equipment
• “Build” while doing IM® Have a hard time
coming down from IM activities
• Vocal speed will increase with IM®
• Get very frustrated with performance during
IM®
• Respond well to movement rewards for work
• Very manipulative
• Want to “drive the program”
37

38. Behavior
• Choose communication system for
transitions
• Determine Antecedent rewards –
have them ready
• Games or no games
• Determine strategy for termination
of IM activity
• Establish routine and home
program that include rhythmic IM
activities
• Have a plan on how you want to
“Fade” your support
38

39. Motor Performance
• Positioning
• Standing (balance board)
• Seated on your lap
• Seated in Chair (Rifton?)
• Floor or modified environment
• Positioning of IM equipment
• Clapping
• Switch on table
• Trainer hold switch
• Modified switches
• IMPORTANT: If client had dyspraxia
or motor planning challenges,
incorporate those treatment
principles discussed later in the
presentation
39

40. Dyspraxia / Motor Planning
Challenges
What is dyspraxia?
• Individuals with dyspraxia have trouble processing
sensory information properly, resulting in problems
planning and carrying out new motor actions.
• They may have difficulty in forming a goal or idea,
planning a sequence of actions or performing new
motor tasks.
• These individuals are clumsy, awkward, and
accident-prone.
• They have difficulty imitating movements
• Have difficulty demonstrating every day actions like
opening a door
• Can’t assume a position or demonstrate a movement
with demosntration
• They may prefer sedentary activities or try to hide
their motor planning problem with verbalization or
with fantasy play
40

41. 41
Cognition and Language
• Establish communication
system
• Sign language
• Verbal prompting
• Picture schedule
• Determine IM settings and
games
• Select Pre and Post IM
activities
• Determine “During IM”
activities

42. Emotion
• Establish plan to practice self
regulation
• Counting
• Co-regulation
• Deep breaths
• Redirection
• Establish a way for client to ask for
help
• Consider using an object to
interact with the switch (use
yourself)
• Be mentally prepared and Self
regulated yourself
• Leave your phone in your office
42

43. Goals
• {patient} will be able to perform 500
reps of IM training without taking a
break to improve cognitive endurance
for functional performance
• {patient} will demonstrate the ability
to speed up and slow down with IM
activities in response to feedback
100% of attempts without cuing
demonstrating improvement in
cognition and ability to respond to
feedback
• {patient} will demonstrate the ability
to respond to visual / auditory
feedback in IM program without
verbal prompting 20/20 attempts
43

44. Goals Cont.
• {patient} will be able to maintain the
processing speed and problem
solving skills necessary to perform
IM ____ activities maintaining a
score of at least 50 milliseconds
• {patient} will demonstrate the ability
to hit on the IM tempo for 20
consecutive hits when the therapist
withdraws Hand over Hand support
• {patient} will demonstrate the ability
request for help when therapist
withdraws support during IM
activity
• IMPORTANT: Establish discipline
specific functional goals
44

45. Preparing & Setting up the Treatment
Environment
Principles for Environment
• Have your equipment
ready… You don’t want to
wait for your computer to
turn on while your client is
trying to tap the keys to get
to work faster
• Consider covering the
keyboard
• Placement of screen (visual
feedback – games)
• Choose your switch
• Consider lighting
• The room
• The screen intensity
• Remove distracting items 45

46. IM Settings
Recommended Settings
• Adjust Difficulty & SRO settings so that
buzzer is heard less often, making it easier
to process.
• Reference Bell only or Turn down the
volume of the guide sounds so that the ref
tone is the loudest sound he hears to aid
processing.
• Turn on the visual mode to help process
guide sounds & learn to respond to them.
• Difficulty: 300
• Tempo to match client speed
• SRO: 50 – 60 ms
• SPEAKERS initially
46

47. The IM Treatment Program
IM® Training Phases Revisited
Decision Tree
Interview and IM Short
From
Phase 1
Long Form Assessment
Phase 2 (Guide sounds /
Visual)
Phase 3
Unable to assimilate bell Attempt to clap on bell
Attempt to clap on bell
3 Hit Recovery for change in timing tendency
Phase 41000 reps / session, 1 hit recovery
Best Practices
47

48. Treatment Principles
• Don’t stop assessing
• Make sure your room and IM settings are
ready
• Initiate IM activity based on assessment and
planning data
• Implement Pre-IM activities
• Monitor performance with IM and make
adjustments
• Be ready for post IM activities
• Follow motor planning / dyspraxia protocol in
applicable
• Communicate performance with Care-givers
• REMEMBER: Starting in Phase 1
48

49. IM Treatment
INCORPERATE ASSESSMENT AND PLANNING
INFORMATION
• Sensory Processing
• Behavior Analysis
• Motor / Perceptual Assessment
• Cognitive ability
• Emotional Awareness
• Family support and understanding
49

50. 50
IM Treatment
Suitable for all categories
business and personal
presentation
Description
Suitable for all categories
business and personal
presentation
Description
Suitable for all categories
business and personal
presentation
Description
Suitable for all categories
business and personal
presentation
Description
Suitable for all categories
business and personal
presentation
Description
Suitable for all categories
business and personal
presentation
Description

51. Pre-IM activities
Arousal
• Client that has high arousal “Wide
Open”
• Heavy work activities
• Resisted activities
• Animal movements
• Yoga or positioning activities
• Ball pit / climbing activities
• Push and pull activities
• Deep pressure / weighted options
• Client with low arousal (Hard to get
motivated)
• Trampoline
• Swing
• Tickle activities / Tag
• Riding bike / scooter
51

52. Pre-IM activities Cont…..
• Sensory Prep Activities
• Sensory Over-Responder
• Rhythmic activities
• Preferred hand manipulation activities
• Heavy work activities
• Organizing or sorting activities
• Stick to a routine
• Sensory Under-responder
• Activating activities
• Heavy work activities
• Trampoline and swing activities
• FUN
• Activating sensations / snack / smell /
touch
• Sensory Craver
• No movement – go straight into IM
52

53. 53
The Low Functioning Client
• Visual supports and games
• HOH assist
• Cause and effect
• Work on Stay-ability
• Management of frustrations
• Respond to feedback

54. The Rigid, Aggressive and Sensory
Client
• Routine
• Easiest settings
• They don’t like help.. But will
become frustrated
• Good prep activities
• Strong rewards
• Develop cognitive and language
skills
• Emotional supports
54

55. The High Functioning Verbal
Manage sensory
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Develop cognitive
and language skills
Incorporate motor
planning and
executive
functioning skills
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Work on attention
and mental
“shifting”
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55

56. Dyspraxia
• Typical in high functioning Autism
• Avoid feedback of any kind:
• Keep guide sounds off
• Avoid verbal cues
• Avoid training visuals & games
• Decrease tempo (48-52 bpm) to find just right
pace where can make circular, rhythmical
movements with greater ease.
• Hand over hand assist, weaning to modeling,
then no cues (your timing must be good) to
facilitate consistent rhythmical movement
• Bilateral imitation tasks with provider
• Decrease cognitive demands
• Gradually increase tempo to 54 bpm then
introduce Phase 2 (guide sounds)
56

57. Dyspraxia Treatment Continued…
IM settings for Phase 2 (guide
sounds ON):
• Adjust Diff to 300
• Turn down volume of Guide, RO,
and SRO guide sounds so they are
lower than the volume of the Ref
Tone
• Gradually adjust Diff to 200 then
100 as performance improves (don’t
rush this)
• Work on larger movements with low
loading
• Focus on success with games vs
scores
• Emphasize success – generalize
confidence and motor patterns in
daily functional tasks
• Structure “just right” challenge
activities after IM®
57

58. 58
Dyspraxia Treatment Continued...
Sequencing for IM foot exercises:
• BEGIN WITH individual R Toe AND L Toe
exercises…HOLD OFF ON both toes
exercise UNTIL MOTOR PLANNING AND
SEQUENCING IS BETTER WITH EACH
individual toe
• Consider bilateral tasks if unable to do both
feet
• Hand-over-hand assistance will be required
– don’t be afraid to do this and set your
repetitions high (5-10-15 min per exercise)
• Reduce the tempo to between 45-52 – just
like hand exercises earlier in training
• Do foot exercises with the client imitating
you
• If balance is an issue, do tasks while seated
to allow for greater focus on timing or allow
the person to hold onto something for
stability (this will be far less distracting)

59. Post IM activities
• Scaffold skills
• Motor planning functional
tasks
• Sensory activities / feeding /
play
• Social activities
• Playground activities
• Board games
• Cognitive activities
• Speech and language
activities
59

60. Questions
60

61. References
1. Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in
adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol
Med. 2018:1-14.
2. De Rubeis S, Siper PM, Durkin A, et al. Delineation of the genetic and clinical spectrum of
Phelan-McDermid syndrome caused by SHANK3 point mutations. Mol Autism. 2018;9:31
3. Abbeduto L, Thurman AJ, McDuffie A, et al. ASD Comorbidity in Fragile X Syndrome: Symptom
Profile and Predictors of Symptom Severity in Adolescent and Young Adult Males. J Autism Dev
Disord. 2018
4. Wegiel J, Brown WT, La Fauci G, et al. The role of reduced expression of fragile X mental
retardation protein in neurons and increased expression in astrocytes in idiopathic and
syndromic autism (duplications 15q11.2-q13). Autism Res.
5. La Buissonniere-Ariza V, Wood JJ, Kendall PC, et al. Presentation and Correlates of Hoarding
Behaviors in Children with Autism Spectrum Disorders and Comorbid Anxiety or Obsessive-
Compulsive Symptoms. J Autism Dev Disord. 2018;48(12):4167-4178.
6. Curtin P, Austin C, Curtin A, et al. Dynamical features in fetal and postnatal zinc-copper
metabolic cycles predict the emergence of autism spectrum disorder.Sci
Adv. 2018;4(5):eaat1293.
7. Schwede M, Nagpal S, Gandal MJ, et al. Strong correlation of downregulated genes related to
synaptic transmission and mitochondria in post-mortem autism cerebral cortex. J Neurodev
Disord. 2018;10(1):18.
61

62. 62
References Cont.
8. Willingham E. Optimism, confusion greet federal fast track for autism drug. Spectrum
News; 2018.
9. Bosl WJ, Tager-Flusberg H, Nelson CA. EEG Analytics for Early Detection of Autism
Spectrum Disorder: A data-driven approach. Sci Rep. 2018;8(1):6828.
10. Capal JK, Carosella C, Corbin E, Horn PS, Caine R, Manning-Courtney P. EEG
endophenotypes in autism spectrum disorder. Epilepsy Behav. 2018;88:341-348.
11. Ryan A. Stevenson, Justin K. Siemann, Brittany C. Schneider, Haley E. Eberly, Tiffany
G. Woynaroski, Stephen M. Camarata, and Mark T. Wallace. Multisensory Temporal
Integration in Autism Spectrum Disorders. The Journal of Neuroscience, 2014, January
15, 34(3):691– 697
12. Ilan Dinstein, Karen Pierce, Lisa Eyler, Stephanie Solso, Rafael Malach, Marlene
Behrmann, and Eric Courchesne. Disrupted neural synchronization in toddlers with
autism. Neuron. 2011 June 23; 70(6): 1218–1225
13. Laurie A. Brenner, Vivian H. Shih, Natalie L. Colich, Catherine A. Sugar, Carrie E.
Bearden, and Mirella Dapretto. Time reproduction performance is associated with age
and working memory in high functioning youth with autism spectrum disorder. Autism
Res. 2015 February ; 8(1): 29–37

63. References Cont.
14. Owen JP, Marco EJ, Desai S, et al., with Mukherjee P. Abnormal white matter
microstructure in children with sensory processing disorders. Neuroimage Clin. 2013
Jun 23;2:844-53
15. Yuta Aoki, MD, PhD, Yuliya N. Yoncheva, PhD, Bosi Chen, BA, Tanmay Nath,
PhD, Dillon Sharp, BA, Mariana Lazar, PhD, Pablo Velasco, PhD, Michael P. Milham,
MD, PhD, and Adriana Di Martino, MD. Association of White Matter Structure With
Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. JAMA
Psychiatry. 2017 Nov; 74(11): 1120–1128.
63

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