Randomized controlled trial of propranolol on social communication and anxiety in children and young adults with autism spectrum disorder.

RATIONALE: Autism spectrum disorder (ASD) is characterized by impaired social communication and is also frequently characterized by co-occurring anxiety. Propranolol is widely utilized to treat performance and public speaking anxiety. Single-dose psychopharmacological challenge studies suggested benefits using propranolol for verbal tasks and social interaction. OBJECTIVE: We conducted a double-blinded, placebo-controlled trial of the ß-adrenergic antagonist propranolol in ASD for social interaction, anxiety, and language. METHODS: Seventy-four participants with ASD, age 7-24 years, were enrolled and randomized to a 12-week course of propranolol or placebo, with blinded assessments at baseline, 6 weeks, and 12 weeks. The primary outcome was the General Social Outcome Measure-2 (GSOM-2) for social interaction, and secondary outcomes were the Clinician Global Clinical Impression-Improvement (CGI-I) ratings independently conducted for social interaction, anxiety, and language at 6 weeks and 12 weeks. RESULTS: Sixty-nine participants completed the 12-week visit. No significant effect of drug was found for the GSOM-2 or the CGI-I for social interaction or language. CGI-I for anxiety showed greater improvement with propranolol at the 12-week time point (p = 0.045, odds ratio = 2.58 (95% CI = 1.02-6.52). Expected decreases in heart rate and blood pressure were observed with propranolol, and side effects were uncommon. CONCLUSIONS: Propranolol did not impact social interaction measures or language, but there were indications of a beneficial effect for anxiety. This will need confirmation in a larger multicenter trial, monitoring markers or characteristics to identify those participants most likely to respond to propranolol for anxiety, and determine whether there is a subset of participants that are responsive for other previously reported outcomes.

Unconsciously registered items reduce working memory capacity.

The assumption that the contents of consciousness correspond to those of working memory (WM) is challenged by evidence that stimuli masked from awareness can be retained for several seconds (Soto et al., 2011; Bergström & Eriksson, 2015). To assess whether conscious and unconscious items compete in a unitary WM store we conducted an experiment in which some of the memory items in an array were masked from conscious sight using continuous flash suppression (CFS) while others remained visible. After a retention interval, participants decided whether the probed item (either masked or visible) had changed its orientation. Behavioral results indicated that change detection for visible items was significantly impaired when masked items were present, suggesting that masked items either displaced or reduced the precision of visible items in WM. However, change detection for masked items was at chance levels, indicating that these items were not stored. The unsuccessful attempt to encode them may have drawn upon a common pool of attentional resources needed to retain or retrieve visible items. Contralateral Delay Activity, an EEG index of net WM load, failed to temporally localize this interference.