Mechanisms of selective attention are vital for guiding human behavior. The parietal cortex has long been recognized as a neural substrate of spatial attention, but the unique role of distinct parietal subregions has remained unclear. Using single-pulse transcranial magnetic stimulation, we found that the angular gyrus of the right parietal cortex mediates spatial orienting during two distinct time periods after the onset of a behaviorally relevant event. The biphasic involvement of the angular gyrus suggests that both fast and slow visual pathways are necessary for orienting spatial attention.

The aim of this study was to examine functional attention and executive deficits present in everyday living in a large sample of children with neurofibromatosis type 1 (NF1). Data are presented from 199 children with NF1 and 55 unaffected sibling controls who were administered the Behavior Rating Inventory of Executive Function (BRIEF) and Conners' ADHD DSM-IV Scales (CADS). Convergent validity was examined by correlating scale scores from these functional measures with scores from traditional cognitive measures of attention and executive function. Results indicated global functional attention and executive deficits in children with NF1. Relationships between functional impairments and scores on cognitive measures were inconsistent; at best, the magnitude of these relationships was in the moderate range, yet there was also a lack of association between many cognitive tasks and the functional skills they purport to assess. Findings suggest that cognitive and functional measures may tap different constructs and that neuropsychological evaluations should be supplemented with functional assessment tools to provide a more accurate and sensitive encapsulation of a child's strengths and weaknesses to guide remediation programs.

IMPORTANCE Recent reports have demonstrated a higher incidence of autism spectrum disorder (ASD) and substantially elevated autistic trait burden in individuals with neurofibromatosis type 1 (NF1). However, important discrepancies regarding the distribution of autistic traits, sex predominance, and association between ASD symptoms and attentional problems have emerged, and critical features of the ASD phenotype within NF1 have never been adequately explored. Establishing NF1 as a monogenic cause for ASD has important implications for affected patients and for future research focused on establishing convergent pathogenic mechanisms relevant to the potential treatment targets for ASD. OBJECTIVE To characterize the quantitative autistic trait (QAT) burden in a pooled NF1 data set. DESIGN, SETTING, AND PARTICIPANTS Anonymized, individual-level primary data were accumulated from 6 tertiary referral centers in the United States, Belgium, United Kingdom, and Australia. A total of 531 individuals recruited from NF1 clinical centers were included in the study. MAIN OUTCOMES AND MEASURES Distribution of ASD traits (Social Responsiveness Scale, second edition [SRS-2], with T scores of ≥75 associated with a categorical ASD diagnosis); attention-deficit/hyperactivity disorder (ADHD) traits (4 versions of Conners Rating Scale, with T scores of ≥65 indicating clinically significant ADHD symptoms); ASD symptom structure, latent structure, base rate derived from mixture modeling; and familiality. RESULTS Of the 531 patients included in the analysis, 247 were male (46.5%); median age was 11 years (range, 2.5–83.9 years). QAT scores were continuously distributed and pathologically shifted; 13.2%(95%CI, 10.3%–16.1%) of individuals scored within the most severe range (ie, above the first percentile of the general population distribution) in which the male to female ratio was markedly attenuated (1.6:1) relative to idiopathic ASD. Autistic symptoms in this NF1 cohort demonstrated a robust unitary factor structure, with the first principal component explaining 30.9%of the variance in SRS-2 scores, and a strong association with ADHD symptoms (r = 0.61). Within-family correlation for QAT burden (intraclass correlation coefficient, 0.73 in NF1-affected first-degree relatives) exceeded that observed in the general population and ASD family samples. CONCLUSIONS AND RELEVANCE This study provides confirmation that the diversity of mutations that give rise to NF1 function as quantitative trait loci for ASD. Moreover, the within-family correlation implicates a high degree of mutational specificity for this associated phenotype. Clinicians should be alerted to the increased frequency of this disabling comorbidity, and the scientific community should be aware of the potential for this monogenic disorder to help elucidate the biological features of idiopathic autism.