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Your Face Confuses Me. My Condition Could Help Understand My Son's Brain

MIKE MCRAE
24 NOV 2019

My brain can't tell the difference between Ryan Reynolds and Ryan Gosling. And the Hollywood Chrises? Yeah... forget it. I have a condition called prosopagnosia, which means I have no talent when it comes to recognising people.

 

My son has a similar issue. As somebody on the autism spectrum, he also struggles with reading faces. New research suggests that by studying brains similar to mine, we might be able to better understand brains like his.

Alexander Cohen, a neurologist from Boston Children's Hospital in the US, understands the challenges people diagnosed with autism spectrum disorder (ASD) have when it comes to interpreting a face.

"Over half of children with autism score very poorly on standard tests of face processing," says Cohen.

"In eye gaze studies, autistic kids often don't look at the faces in a video. Or they just look at one part, often the mouth, maybe because it's giving more information about speech. Many find eye contact uncomfortable."

I know the pain well. While I've never been diagnosed with autism, I know what it's like to see a face as less than the sum of its parts.

Like ASD, prosopagnosia covers a spectrum of severities. Fortunately my version is less a form of blindness and more like facial dyslexia. The components are all clear, and I can read them all individually, but interpreting an identity takes way too much time.

 

For others, the condition can be debilitating, completely robbing them of an ability to recognise not just Hollywood hunks, but family members and loved ones.

I was probably born with my slow face-identification software. But the disorder can also arise out of neurological trauma, often to the right side of a band of brain tissue called the fusiform gyrus facial area (FFA).

There has to be more to the condition than a bunk FFA, though. Not everybody with an acquired form of prosopagnosia has clear signs of a lesion affecting this section of anatomy.

Cohen's search through the literature found 44 cases of patients who experienced face blindness after a stroke. Out of those, 15 showed no sign of damage to the fusiform gyrus' face area.

This suggests a more likely explanation for the condition involves not just a single suburb of grey matter, but one or more highways connecting multiple districts within our brains.

The question is, could the atypical connections behind poor facial recognition skills share similarities with the connections that make it harder for my son to interpret facial cues?

 

"That's where looking at face processing in people with stroke really helps," says Cohen.  

"If you find an abnormality involving the same brain areas in a child with autism, there's a much higher chance that the abnormality may be driving the face processing deficit."

The researchers applied a relatively new mapping technology to MRI images of the stroke cases to pick out potential relationships between different areas of the brain, building a picture that could consistently explain their face blindness.

They found connections that all involved the right side of the fusiform gyrus, even where the tissue itself seemed healthy. Some of those connections formed inverse relationships, where one zone flared up in activity when the facial-recognition tissues were quiet, or vice-versa.

It's almost as if there's multiple networks in action working in tandem to create a moment of recognition. In brains like mine, that interaction isn't what we might call balanced.

And it seems my lad and I might have at least that much in common. Other studies also hint at the involvement of some of those same interconnected regions.

 

"That exact imbalance is something that has been seen in autism," says Cohen.  

To be clear, the study didn't explore developmental forms of prosopagnosia. But it could help better understand how my face blindness formed, not to mention how it might relate to my son's neurodevelopment.

Future studies could pull apart these networks to reveal precisely how autism's traits interfere with pulling useful information from faces.

If we've learned nothing else in recent years, it's that the spectrum of characteristics represented by ASD isn't caused by simple differences in anatomy, but the complex way behaviours arise from the brain's connectivity.

"Just as many disorders can be affected by multiple genes, it may take a whole network of brain regions to cause a symptom," says Cohen.

Research of this nature often looks forward to the possibility of future therapies. I'm fortunate that my prosopagnosia is more of a personality quirk than a troubling disorder.

Others might one day find relief in potential treatments, of course. Or at least comfort in understanding their brains a little better.

At least my son and I can still enjoy movies together. Even if he can't tell me which Ryan is starring.

This research was published in Brain.