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IMPORTANCE Autism spectrum disorder (ASD) is 2 to 5 times more common in male Supplemental content
individuals than in female individuals. While the male preponderant prevalence of ASD might
partially be explained by sex differences in clinical symptoms, etiological models suggest that
the biological male phenotype carries a higher intrinsic risk for ASD than the female
phenotype. To our knowledge, this hypothesis has never been tested directly, and the
neurobiological mechanisms that modulate ASD risk in male individuals and female
individuals remain elusive.
MAIN OUTCOMES AND MEASURES Sample and population ASD probability estimates as a
function of normative sex-related diversity in brain structure, as well as neuroanatomical
patterns associated with low or high ASD probability in male individuals and female individuals.
RESULTS Among the 98 individuals with ASD, 49 were male and 49 female, with a mean (SD)
age of 26.88 (7.18) years. Among the 98 controls, 51 were male and 47 female, with a mean
(SD) age of 27.39 (6.44) years. The sample probability of ASD increased significantly with
predictive probabilities for the male neuroanatomical brain phenotype. For example,
biological female individuals with a more male-typic pattern of brain anatomy were
significantly (ie, 3 times) more likely to have ASD than biological female individuals with a
characteristically female brain phenotype (P = .72 vs .24, respectively; 12 = 20.26; P < .001;
difference in P values, 0.48; 95% CI, 0.29-0.68). This finding translates to an estimated Author Affiliations: Author
variability in population prevalence from 0.2% to 1.3%, respectively. Moreover, the patterns affiliations are listed at the end of this
of neuroanatomical variability carrying low or high ASD probability were sex specific (eg, in article.
inferior temporal regions, where ASD has different neurobiological underpinnings in male Group Information: The Medical
Research Council Autism Imaging
individuals and female individuals).
Multicentre Study (MRC AIMS)
Consortium members are listed at the
CONCLUSIONS AND RELEVANCE These findings highlight the need for considering normative end of this article.
sex-related phenotypic diversity when determining an individuals risk for ASD and provide Corresponding Author: Christine
important novel insights into the neurobiological mechanisms mediating sex differences in Ecker, PhD, Department of Child
and Adolescent Psychiatry,
ASD prevalence.
Psychosomatics, and
Psychotherapy, Goethe University,
Deutschordenstrasse 50, 60528
JAMA Psychiatry. doi:10.1001/jamapsychiatry.2016.3990 Frankfurt am Main, Germany
Published online February 8, 2017. (christine.ecker@kgu.de).
(Reprinted) E1
A
utism spectrum disorder (ASD) is a complex neurode-
velopmental condition that is 2 to 5 times more com- Key Points
mon in male individuals than in female individuals.1,2
Question Does the neuroanatomical male brain phenotype carry
While the male preponderant prevalence of ASD might par- a higher intrinsic risk for autism spectrum disorder than the female
tially be explained by sex differences in clinical symptoms,3,4 neurophenotype, which could explain the male preponderant
etiological models suggest that the biological male pheno- prevalence of autism spectrum disorder?
type itself (ie, in general) carries a higher risk for ASD than the
Findings In this case-control study of 98 adults with autism
female phenotype.5 However, despite the growing number of spectrum disorder and 98 matched neurotypical control
studies examining sex differences in the brain in ASD (eg, those individuals, the neurobiological male phenotype was associated
by Lai et al6 and by Schaer et al7), this hypothesis has never with a higher risk for autism spectrum disorder than the female
been tested directly, to our knowledge, and the neurobiologi- phenotype across the binary categories dictated by biological sex.
cal mechanisms that underpin the male preponderant preva- Meaning In addition to genetic and environmental factors,
lence of ASD remain elusive.8 normative sex-related phenotypic diversity should be considered
This study examined the probability of ASD as a function when determining an individuals risk for autism spectrum
of normative sex-related phenotypic diversity in brain struc- disorder.
ture. To do so, we initially developed a predictive model of bio-
logical sex based on multivariate differences in brain struc-
ture in a sample of typically developing (TD) male and female chiatric disorder (eg, psychosis), head injury, ASD-associated ge-
control individuals. This normative model was subsequently netic disorders (eg, fragile X syndrome and tuberous sclero-
applied to male individuals and female individuals with ASD. sis), or any other medical condition affecting brain function (eg,
Unlike recent studies examining sexual dimorphism of the epilepsy). We also excluded individuals taking antipsychotic
brain (reviewed by Ruigrok et al9), we used a probabilistic pat- medication, mood stabilizers, or benzodiazepines.
tern classification approach,10 which allowed us to accommo- All participants with ASD were diagnosed according to the
date interindividual phenotypic diversity within and across the International Statistical Classification of Diseases, Tenth Revi-
binary categories dictated by biological sex.11 As a result, we sion research criteria. The clinical diagnosis was confirmed
were able (1) to examine the probability of ASD along a nor- using the Autism Diagnostic InterviewRevised (ADI-R)20 or
mative phenotypic axis ranging from the characteristic fe- the Autism Diagnostic Observation Schedule (ADOS).21 All par-
male to male brain phenotype and (2) to identify the patterns ticipants diagnosed with the ADI-R reached algorithm cut-
of sex-related neuroanatomical variability associated with low offs in the 3 domains of (1) communication (cutoff of 8), (2) re-
or high probability of ASD. ciprocal social interaction (cutoff of 10), and (3) repetitive
We based our analysis on measures of cortical thickness behaviors and stereotyped patterns of interest (cutoff of 3), al-
(CT) because these measurements have previously been shown though failure to reach the cutoff in the repetitive domain by
to be highly variable between neurotypical male individuals maximally 2 points was permitted. Because reliable infor-
and female individuals12,13 and tend to be significantly al- mants were unavailable, we were unable to obtain ADI-R di-
tered in individuals with ASD (eg, as shown by Ecker et al14 and agnostic data from 5 female individuals with ASD and con-
by Wallace et al15). Moreover, measures of CT are less sensi- firmed diagnostic status using ADOS cutoffs. In all other
tive to global confounders associated with biological sex (eg, participants, the ADOS scores were used to assess the sever-
differences in total brain volume) than other morphometric ity of current symptoms. One female individual with ASD fell
features (eg, surface area).16-19 Last, we investigated whether short by 1 point on the ADI-R communication and repetitive
the cortical underpinnings of ASD are significantly modu- behavior domains but met ADOS criteria. All participants had
lated by biological sex and whether ASD has common or dis- a full-scale IQ greater than 70 assessed using the Wechsler Ab-
tinct neuroanatomical underpinnings in male individuals and breviated Scale of Intelligence.22 Participants gave informed
female individuals. written consent in accord with ethics approval by the Na-
tional Research Ethics Committee, Suffolk, England. The study
dates were June 2005 to October 2009, and this analysis was
conducted between June 2015 and July 2016.
Methods
Participants Magnetic Resonance Imaging Data Acquisition
Ninety-eight right-handed adults with ASD (49 male and 49 fe- Imaging took place at the IoPPN and the Addenbrookes Hos-
male; mean [SD] age, 26.88 [7.18] years) and 98 matched neu- pital, Cambridge, using a 3-T system (Signa; GE Medical Sys-
rotypical controls (51 male and 47 female; mean [SD] age, 27.39 tems). A specialized acquisition protocol using quantitative,
[6.44] years) aged 18 to 42 years were recruited locally by ad- T1-weighted mapping was used to ensure standardization of
vertisement and assessed at the Institute of Psychiatry, Psy- structural magnetic resonance imaging scans across sites,23,24
chology and Neuroscience (IoPPN), London, England, and the which resulted in high-resolution structural T1-weighted
Autism Research Centre, Cambridge, England (Table). Approxi- inversion recovery images, with 1 1 1mm resolution, a
mately equal ratios of cases to controls and male individuals to 256 256 176pixel matrix, repetition time of 1800 milli-
female individuals were recruited within sites (eTable 1 in the seconds, inversion time of 50 milliseconds, flip angle of 20,
Supplement). Exclusion criteria included a history of major psy- and field of view of 25 cm.
Estimation of ASD Probability tation testing). In total, 68.1% (32 of 47) of all biological fe-
To examine the probability of ASD as a function of normative male individuals were correctly allocated to the category of
phenotypic variability in brain structure, we converted the phenotypic female individuals and 74.5% (38 of 51) of all bio-
continuous axis of class probabilities into a set of discrete logical male individuals to the category of phenotypic male in-
bins (eg, from 0 to 1 in steps of 0.125). Within each bin, the dividuals (Figure 1A, lower panel). Across individuals, class
sample probability of ASD was determined as the ratio of probabilities ranged continuously from 0 to 1 for the charac-
individuals with ASD relative to the total number of individu- teristic female to male brain phenotype, respectively (Figure 1A,
als per bin. Moreover, these data allowed us to estimate the upper panel). Moreover, the patterns of CT variability associ-
population prevalence of ASD given that an individual exhib- ated with the phenotypic shift of the brain from a female to
its a male or female neuroanatomical phenotype in addition male presentation resembled the set of brain regions where fe-
to being biologically male or female (details are available in male individuals significantly differed from male individuals
the eMethods in the Supplement). In brief, using Bayes theo- (eFigure 1 and eFigure 2 in the Supplement). Therefore, while
rem, we combined our sample prevalence estimates with a perfect phenotypic differentiation between biological sexes
previously published population prevalence rates of ASD for could not be achieved, we were able to separate male indi-
biological male individuals and female individuals (ie, 1:42 viduals from female individuals in most cases based on mul-
for male individuals and 1:189 for female individuals31). In tivariate differences in brain structure.
this way, we were able to estimate the population prevalence
of ASD (D = 1) given a male (or female) neuroanatomical brain Phenotypic Prediction of Biological Sex
phenotype (M) for biological male individuals (or female for Individuals With ASD
individuals) (S), that is P (D = 1 | M, S). Confidence intervals When applying our normative predictive model of biological
were determined using an exact binomial test implemented sex to the independent sample of individuals with ASD, we
in a software package (R Project for Statistical Computing; https: found that, in female individuals with ASD, predictive class
//www.r-project.org). probabilities for the male neuroanatomical brain phenotype
were significantly increased relative to female controls
Vertexwise Between-Group Comparison of CT (t94 = 6.13, P < .001) (Figure 1B). Overall, 39 of 49 female in-
Vertexwise statistical analysis of CT measures was conducted dividuals (79.6%) with ASD were allocated to the category of
using the R2014a Matlab toolbox (SurfStat; http://www.math phenotypic male individuals, which was significantly more fre-
.mcgill.ca/keith/surfstat). For the comparison between male quent than expected based on the typical rate of misclassifi-
and female controls, parameter estimates were obtained by cation for female controls (79.6% [39 of 49] vs 31.9% [15 of 47],
regression of a general linear model at each vertex i, with bio- respectively; 21 = 20.26, P < .001). No such differences were
logical sex and center as categorical fixed-effects factors and observed in male individuals with ASD, who were correctly al-
total GM volume as a continuous covariate. To examine located to the male category in 81.6% (40 of 49) of all cases
whether the neuroanatomy of ASD is significantly modu- and also did not differ significantly from male controls in pre-
lated by biological sex, we also included a main effect of dictive class probabilities (t98 = 1.35, 2-tailed P > .17). There-
diagnostic group and biological sex and a group sex inter- fore, when representing individuals along a single axis of nor-
action as follows: mative sex-related phenotypic diversity in brain structure,
female individuals with ASD displayed a CT pattern that re-
yi = 0 + 1 Group + 2 Sex + 3 (Group Sex) + 4
sembled more closely the neurotypical male rather than fe-
GMtotal + 5 Center + i,
male neurophenotype. This phenotypic shift in female indi-
where y refers to the variable that is predicted by the model viduals is likely to influence the probability of ASD.
(ie, the CT at voxel i) and i is the residual error. Effects were
estimated from the coefficients 1-3 normalized by the corre- ASD Probability as a Function of Normative Sex-Related
sponding standard error. Corrections for multiple compari- Phenotypic Variability in Brain Structure
sons were performed using a random field theorybased clus- In female individuals with ASD, the sample probability of ASD
ter analysis for nonisotropic images at a cluster threshold of increased with increasing predictive probabilities for the male
2-tailed P < .05.32 We also confirmed our findings using a non- neuroanatomical brain phenotype (eFigure 3A in the Supple-
parametric clustering approach (2-tailed P < .05) using 10 000 ment). More specifically, female individuals with class prob-
permutations of the original data.33 abilities exceeding the binary sex cutoff of 0.5 (ie, biological
female individuals falling into the category of phenotypic male
individuals) were significantly (ie, 3 times) more likely to have
a diagnosis of ASD than biological female individuals with a
Results class probability lower than 0.5 (P = .72 vs .24, respectively;
Prediction of Biological Sex Based 21 = 20.26; P < .001; difference in P values, 0.48; 95% CI, 0.29-
on Normative Variability in CT 0.68). Reciprocally, male individuals with class probabilities
Overall, our CT-driven probabilistic classifier predicted bio- lower than 0.5 (ie, biological male individuals falling into the
logical sex at an accuracy of 71.4% under cross-validation in category of phenotypic female individuals) were 1.2 times
neurotypical controls, which was significantly higher than less likely to have ASD than male individuals allocated to the
would be expected by chance (P < .001 obtained via permu- category of phenotypic male individuals (P = .41 vs .51,
A Gaussian process classification between male B Probabilistic predictions for male individuals and
and female control individuals female individuals with ASD
2.1 2.1 Female individuals
Male individuals
1.4 1.4
Density
Density
0.7 0.7
0 0
0 0.2 0.4 0.6 0.8 1.0 0 0.2 0.4 0.6 0.8 1.0
Predictive Class Probabilities Predictive Class Probabilities
60 60
Female individuals
50 50 Male individuals
40 40
Participants, No.
Participants, No.
30 30
20 20
10 10
0 0
0 0.2 0.4 0.6 0.8 1.0 0 0.2 0.4 0.6 0.8 1.0
Predictive Class Probabilities Predictive Class Probabilities
A, Gaussian process classification between male and female typically axis of class probabilities. B, Probabilistic predictions for male individuals and
developing (TD) control individuals based on normative (ie, neurotypical) female individuals with autism spectrum disorder (ASD) using the normative
variability in cortical thickness. The x-axis indicates predictive class model for biological sex. The density functions for male individuals and female
probabilities. Therefore, a class probability of 0.5 served as a binary cutoff individuals with ASD (upper panel) show the phenotypic shift of the brain in
separating male individuals from female individuals. The y-axis indicates the female individuals with ASD toward a more male phenotypic presentation. Of
position of each individual on the normative axis of sex-related phenotypic 49 female individuals with ASD, 39 (79.6%) fell within the category of
diversity in brain structure (lower panel). The upper panel shows the density phenotypic male individuals (lower panel).
(ie, frequency) of male individuals and female individuals along the normative
respectively; 21 = 0.38; P > .53; difference in P values, 0.10; sible to link the probability of ASD to particular patterns of neu-
95% CI, 0.36 to 0.15) (eFigure 3B in the Supplement). If one roanatomical variability in CT, our findings suggest that these
combines these sample probabilities with previously pub- patterns are sex specific.
lished prevalence rates of ASD in the general population (eg,
1:42 for male individuals and 1:189 for female individuals31), our Biological Sex Significantly Modulates
study shows that biological female individuals with male neu- the Cortical Anatomy of ASD
roanatomical features were 6.5 times more likely to have ASD Last, using a conventional general linear model, we tested
than biological female individuals with a characteristically fe- for significant CT differences between men and women
male neuroanatomy, which translates to an estimated vari- with ASD and group sex interactions. We found that the
ability in population prevalence between 0.2% to 1.3%, re- cortical neuroanatomy of ASD was significantly modulated
spectively (eTable 2 in the Supplement). Therefore, normative by biological sex, particularly in the bilateral parahippocam-
sex-related phenotypic diversity in brain structure signifi- pal and entorhinal cortex (Brodmann area [BA] 28/34), the
cantly affected the probability of ASD in addition to biologi- fusiform and lingual gyrus (BA 20/37/19), and the inferior or
cal sex alone, with male neuroanatomical characteristics car- middle temporal lobe (BA 21/22) (Figure 3 and eTable 4 and
rying a higher intrinsic risk for ASD than female characteristics. eFigure 5 in the Supplement). In these regions, the degree of
The particular patterns of neuroanatomical variability as- cortical abnormality in female individuals significantly
sociated with low or high ASD probability differed between men exceeded the degree of abnormality observed in male indi-
and women in sign and regional composition (Figure 2 and viduals compared with their respective normative popula-
eTable 3 and eFigure 4 in the Supplement). For example, CT tions (t = 3.29, cluster P = 3.5 106 for the left; t = 3.42, clus-
variability in the left and right inferior temporal lobe differ- ter P = 5.49 104 for the right) (Figure 3B and C and eFigure
entiated between low or high risk in women but not in men 6 in the Supplement). However, female individuals with ASD
(tmax = 3.78, cluster P = 6.29 106 for the left; tmax = 3.47, clus- were not more significantly impaired than male individuals
ter P = 1.09 102 for the right). Therefore, while it is pos- in clinical symptom severity (eTable 5 in the Supplement).
Figure 2. Neuroanatomical Patterns Associated With Low and High Autism Spectrum Disorder (ASD) Probability
Predictive maps (ie, w CT) associated with low and high probability of ASD in individuals falling into the category of phenotypic male individuals). At each
female individuals (A) and male individuals (B). Low ASD probability maps were vertex, the color scale thus indicates the product of the weight vector w and
computed across all male individuals (or female individuals) with predictive cortical thickness (CT), averaged across all individuals within the 4 probability
probabilities lower than 0.5 (ie, biological male individuals or female individuals groups. The probability of ASD was determined as the number of male
falling into the category of phenotypic female individuals). High ASD probability individuals (or female individuals) with ASD relative to the total number of
maps were computed across all male individuals (or female individuals) with individuals within predictive probability bins.
predictive probabilities larger than 0.5 (ie, biological male individuals or female
The clusters with significant group sex interactions also tomical characteristics carrying a higher intrinsic risk for
remained significant when controlling for variability in verbal ASD than female characteristics. This increase in risk was
and performance IQ (eTable 5 and eFigure 7 in the Supple- predominantly driven by female individuals with ASD, who
ment) and thus do not seem to reflect a simple functional dif- displayed a pattern of neuroanatomical variability in CT that
ference in these clinical or neurocognitive measures (further resembled more closely the neurotypical male rather than
details are available in eFigure 8 and the eAppendix in the female neurophenotype overall. Moreover, our study links
Supplement). low and high risk (ie, probability) of ASD to particular pat-
terns of sex-related neuroanatomical variability, thus provid-
ing important novel insights into the neurobiological mecha-
nisms underpinning the male preponderant prevalence of
Discussion ASD.
Our study demonstrates that normative sex-related pheno- An important feature of GPC is that it is possible to sum-
typic diversity in brain structure affects the prevalence of marize the highly complex and multivariate pattern of nor-
ASD in addition to biological sex alone, with male neuroana- mative sex-related phenotypic diversity in brain structure to
4 1.7 +1.7 +4
Left Right t(group sex)
Inferior
Lateral
Medial
Inferior
Lateral
A, Clusters with significant
group sex interactions in cortical
thickness (CT) as examined by a
conventional general linear
modeltype approach. In these
regions, the difference in CT between
female individuals with autism
Medial spectrum disorder (ASD) and female
control individuals significantly
exceeded the difference between
male individuals with ASD and male
controls (statistical details are
available in eTable 4 in the
C Clusters with significantly reduced CT in female individuals with ASD Supplement). The group sex
4 1.7 +1.7 +4 interactions were driven by reduced
Left Right t(ASD TD ) CT in female individuals with ASD
relative to female controls and
increased CT in male individuals with
Inferior ASD relative to male controls
(eFigure 6 in the Supplement).
Lateral B, Clusters with significantly
increased CT in male individuals with
ASD relative to male controls
(random field theorybased,
cluster-corrected P < .05). C, Clusters
with significantly reduced CT in
female individuals with ASD relative
to female controls (random field
theorybased, cluster-corrected
Medial P < .05). eFigure 5 in the Supplement
shows results of the
permutation-based cluster
thresholding of the same contrasts.
TD indicates typically developing.
a single measure (ie, class probability) indicative of the indi- by Escorial et al 34 ) examining sexual dimorphism of the
viduals neurophenotypic sex. This ability sets our approach brain based on univariate group differences between male
apart from existing studies (eg, those by Ruigrok et al9 and individuals and female individuals, which precludes the
ARTICLE INFORMATION College London, London, England (Ginestet); Author Contributions: Dr Ecker had full access to
Accepted for Publication: November 30, 2016. Behavioural Genetics Clinic, Adult Autism Service, all the data in the study and takes responsibility for
Behavioural and Developmental Psychiatry Clinical the integrity of the data and the accuracy of the
Published Online: February 8, 2017. Academic Group, South London and Maudsley data analysis. Drs Craig and D. G. M. Murphy
doi:10.1001/jamapsychiatry.2016.3990 Foundation National Health Service Trust, London, contributed equally to this article.
Author Affiliations: Department of Child and England (C. M. Murphy, D. G. M. Murphy); Autism Study concept and design: Ecker, Andrews,
Adolescent Psychiatry, Psychosomatics, and Research Centre, Department of Psychiatry, Marquand, C. M. Murphy, Lai, Bullmore, Williams,
Psychotherapy, Goethe University, Frankfurt am University of Cambridge, Cambridge, England (Lai, Baron-Cohen, Craig, D. G. M. Murphy.
Main, Germany (Ecker); Department of Forensic Lombardo, Ruigrok, Baron-Cohen); Child and Youth Acquisition, analysis, or interpretation of data:
and Neurodevelopmental Sciences, Sackler Mental Health Collaborative at the Centre for Ecker, Andrews, Gudbrandsen, Marquand,
Institute for Translational Neurodevelopmental Addiction and Mental Health, The Hospital for Sick Ginestet, Daly, C. M. Murphy, Lai, Lombardo,
Sciences, Institute of Psychiatry, Psychology and Children, Department of Psychiatry, University of Ruigrok, Suckling, Williams, Craig, D. G. M. Murphy.
Neuroscience, Kings College London, London, Toronto, Toronto, Ontario, Canada (Lai); Drafting of the manuscript: Ecker, Andrews,
England (Ecker, Andrews, Gudbrandsen, Daly, Department of Psychiatry, National Taiwan Ginestet, Daly, Lai, Lombardo, Suckling, Williams,
C. M. Murphy, Craig, D. G. M. Murphy); Donders University Hospital and College of Medicine, Taipei Craig, D. G. M. Murphy.
Institute for Brain, Cognition and Behaviour, (Lai); Department of Psychology and Center for Critical revision of the manuscript for important
Radboud University, Nijmegen, the Netherlands Applied Neuroscience, University of Cyprus, Nicosia intellectual content: Ecker, Gudbrandsen, Marquand,
(Marquand); Centre for Neuroimaging Sciences, (Lombardo); Brain Mapping Unit, Department of Ginestet, C. M. Murphy, Lai, Ruigrok, Bullmore,
Institute of Psychiatry, Psychology and Psychiatry, University of Cambridge, Cambridge, Williams, Baron-Cohen, Craig, D. G. M. Murphy.
Neuroscience, Kings College London, London, England (Bullmore, Suckling); National Autism Unit, Statistical analysis: Ecker, Andrews, Marquand,
England (Marquand, Williams); Department of Bethlem Royal Hospital, South London and Ginestet, Daly, Lai, Suckling, D. G. M. Murphy.
Biostatistics and Health Informatics, Institute of Maudsley Foundation National Health Service Trust, Obtained funding: Bullmore, Williams,
Psychiatry, Psychology and Neuroscience, Kings London, England (Craig). Baron-Cohen, D. G. M. Murphy.
Administrative, technical, or material support: (University of Cambridge), Sally J. Wheelwright, thinning in autism spectrum disorders. Brain. 2010;
Gudbrandsen, C. M. Murphy, Lombardo, Bullmore, MSc (University of Cambridge), Steven C. R. 133(pt 12):3745-3754.
Williams, Craig, D. G. M. Murphy. Williams, PhD (IoPPN), and C. Ellie Wilson, PhD 16. Lenroot RK, Giedd JN. Sex differences in the
Study supervision: Williams, Baron-Cohen, Craig, D. (IoPPN). adolescent brain. Brain Cogn. 2010;72(1):46-55.
G. M. Murphy. Additional Contributions: We thank the National 17. Lenroot RK, Gogtay N, Greenstein DK, et al.
Conflict of Interest Disclosures: Dr Bullmore Institute for Health Research Biomedical Research Sexual dimorphism of brain developmental
reported being employed half-time by Centre for Mental Health and The Dr Mortimer and trajectories during childhood and adolescence.
GlaxoSmithKline and reported being a stockholder Theresa Sackler Foundation. The MRC AIMS Neuroimage. 2007;36(4):1065-1073.
of GlaxoSmithKline shares. No other disclosures Consortium is a United Kingdom collaboration
were reported. between the Institute of Psychiatry, Psychology and 18. Geschwind DH, Rakic P. Cortical evolution:
Neuroscience at Kings College London, the Autism judge the brain by its cover. Neuron. 2013;80(3):
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