Exploring telehealth during COVID for assessing autism spectrum disorder in a diverse sample.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the importance of telehealth has rapidly increased, in particular as many in-person clinics have closed. Early intervention is crucial for improving outcomes in children with autism spectrum disorder (ASD). As such, the need for timely assessments and diagnoses remains despite COVID-19-related closures. This study offers preliminary data collected from 23 children assessed through a no-cost autism clinic in Southern California using a novel telehealth model. This includes an overview of an adapted, telehealth version of in-person observational assessment techniques for diagnosing autism. In addition, preliminary data on social validity assessed at two points are presented. Findings suggest that caregivers found the telehealth assessment procedures acceptable and convenient, and overall were satisfied with both the assessment and the written report/verbal feedback. Implications for future uses of telehealth are discussed, including how telehealth can assist with decision-making around school-based services and/or placement.

Investigating Changes in Reward-Related Neural Correlates After PEERS Intervention in Adolescents With ASD: Preliminary Evidence of a "Precision Medicine" Approach.

Background: The Social Motivation Hypothesis proposes that individuals with autism spectrum disorder (ASD) experience social interactions as less rewarding than their neurotypical (TD) peers, which may lead to reduced social initiation. Existing studies of the brain's reward system in individuals with ASD report varied findings for anticipation of and response to social rewards. Given discrepant findings, the anticipation of and response to social rewards should be further evaluated, particularly in the context of intervention outcome. We hypothesized that individual characteristics may help predict neural changes from pre- to post-intervention. Methods: Thirteen adolescents with ASD received the Program for the Education and Enrichment of Relational Skills (PEERS) intervention for 16 weeks; reward-related EEG was collected before and after intervention. Fourteen TD adolescents were tested at two timepoints but did not receive intervention. Event-related potentials were calculated to measure anticipation of (stimulus-preceding negativity; SPN) and response to (reward-related positivity; RewP) social and non-social rewards. Additionally, measures of social responsiveness, social skills, and intervention-engagement were collected. Group differences were analyzed as well as individual differences using prediction models. Result: Parent-reported social responsiveness and social skills improved in adolescents with ASD after participation in PEERS. ASD adolescents displayed marginally decreased anticipation of social rewards at post-intervention compared to pre-intervention. Regression models demonstrated that older adolescents and those with lower parent-reported social motivation prior to participation in PEERS displayed marginally increased social reward anticipation (more robust SPN) from pre- to post-intervention. Participants who displayed more parent-reported social motivation before intervention and were more actively engaged in the PEERS intervention evidenced increased social reward processing (more robust RewP) from pre- to post-intervention. Conclusion: Findings suggest that there may be differences in saliency between wanting/anticipating social rewards vs. liking/responding to social rewards in individuals with ASD. Our findings support the hypothesis that identification of individual differences may predict which adolescents are poised to benefit the most from particular interventions. As such, reported findings set the stage for the advancement of "precision medicine." This investigation is a critical step forward in our ability to understand and predict individual response to interventions in individuals with ASD.

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence.

BACKGROUND: Challenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood. METHOD: Adolescents with typical cognitive development (TD, n=84), intellectual disability (ID, n=30), or ASD (n=45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors. RESULTS: All domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS. CONCLUSIONS: DLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.

The effects of oxytocin administration on individuals with ASD: Neuroimaging and behavioral evidence.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication and the presence of restricted interests and repetitive behaviors. Although behavioral interventions are numerous, there are no Federal Drug Administration approved pharmacological treatments for the core symptoms of ASD. The neuropeptide oxytocin has been studied in animals for decades, and is involved in pair bonding and social affiliation. Given oxytocin's involvement in social communication in animals, researchers have begun exploring whether oxytocin administration in humans affects social behaviors and attachment. Particular attention has been paid to whether oxytocin has therapeutic benefits for improving social behaviors in individuals with ASD. Research on oxytocin administration in ASD has utilized both behavioral and brain-based outcomes. This chapter reviews the effects of oxytocin administration in ASD, with a focus on functional outcomes from neuroimaging investigations. Evidence of potential therapeutic benefits are reviewed, as well as limitations of extant research. A proposed model for future research into the therapeutic benefits of oxytocin includes combining pharmacological (e.g. oxytocin) and behavioral (e.g. evidence-based behavioral interventions) techniques to improve social communication skills in ASD.

Increased Neural Reward Responsivity in Adolescents with ASD after Social Skills Intervention.

The reward system has been implicated as a potential neural mechanism underlying social-communication deficits in individuals with autism spectrum disorder (ASD). However, it remains unclear whether the neural reward system in ASD is sensitive to behavioral interventions. The current study measured the reward positivity (RewP) in response to social and nonsocial stimuli in seven adolescents with ASD before and after participation in the Program for the Education and Enrichment of Relational Skills (PEERS®) intervention. This study also included seven neurotypical adolescents who were tested at two time points but did not receive intervention. We examined the RewP across the course of a task by comparing brain activity during the first versus second half of trials to understand patterns of responsivity over time. Improvements in social skills and decreased social-communication impairments for teens with ASD were observed after PEERS®. Event-related potential (ERP) results suggested increased reward sensitivity during the first half of trials in the ASD group after intervention. Adolescents with ASD who exhibited less reward-related brain activity before intervention demonstrated the greatest behavioral benefits from the intervention. These findings have implications for how neuroscience can be used as an objective outcome measure before and after intervention in ASD.

"It's so Cute I Could Crush It!": Understanding Neural Mechanisms of Cute Aggression.

The urge people get to squeeze or bite cute things, albeit without desire to cause harm, is known as "cute aggression." Using electrophysiology (ERP), we measured components related to emotional salience and reward processing. Participants aged 18-40 years (n = 54) saw four sets of images: cute babies, less cute babies, cute (baby) animals, and less cute (adult) animals. On measures of cute aggression, feeling overwhelmed by positive emotions, approachability, appraisal of cuteness, and feelings of caretaking, participants rated more cute animals significantly higher than less cute animals. There were significant correlations between participants' self-report of behaviors related to cute aggression and ratings of cute aggression in the current study. N200: A significant effect of "cuteness" was observed for animals such that a larger N200 was elicited after more versus less cute animals. A significant correlation between N200 amplitude and the tendency to express positive emotions in a dimorphous manner (e.g., crying when happy) was observed. RewP: For animals and babies separately, we subtracted the less cute condition from the more cute condition. A significant correlation was observed between RewP amplitude to cute animals and ratings of cute aggression toward cute animals. RewP amplitude was used in mediation models. Mediation Models: Using PROCESS (Hayes, 2018), mediation models were run. For both animals and babies, the relationship between appraisal and cute aggression was significantly mediated by feeling overwhelmed. For cute animals, the relationship between N200 amplitude and cute aggression was significantly mediated by feeling overwhelmed. For cute animals, there was significant serial mediation for RewP amplitude through caretaking, to feeling overwhelmed, to cute aggression, and RewP amplitude through appraisal, to feeling overwhelmed, to cute aggression. Our results indicate that feelings of cute aggression relate to feeling overwhelmed and feelings of caretaking. In terms of neural mechanisms, cute aggression is related to both reward processing and emotional salience.

An Electrophysiology Protocol to Measure Reward Anticipation and Processing in Children.

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation and processing. Its purpose is to create a reward task that is appropriate for young children with and without autism while controlling reward properties between two conditions: social and nonsocial. The current protocol allows for comparisons of brain activity between social and nonsocial reward conditions while keeping the reward itself identical between conditions. Using this protocol, we found evidence that neurotypical children demonstrate enhanced anticipatory brain activity during the social condition. Furthermore, we found that neurotypical children anticipate social reward more robustly than children with autism diagnoses. As the task uses snacks as a reward, it is most appropriate for young children. However, the protocol may be adapted for use with adolescent or adult populations if snacks are replaced by monetary incentives. The protocol is designed to measure electrophysiological events (event-related potentials), but it may be customized for use with eye-tracking or fMRI.

Normalization of Speech Processing After Whole-Vault Cranioplasty in Sagittal Synostosis.

BACKGROUND: Neurocognitive studies have found impairments in language-related abilities in nonsyndromic craniosynostosis, highlighting clinical importance of early language processing. In this study, neural response to speech sounds in infants with nonsyndromic sagittal craniosynostosis (NSC) is compared, preoperatively and postoperatively, using event-related potentials (ERPs) to objectively characterize development in language processing. METHODS: Electroencephalogram was recorded while 39 infants (12 NSC and 27 controls; ages 73-283 days) listened to the Hindi dental /(Equation is included in full-text article.)a/ and retroflex /da/ phonemes (non-native phonemic discrimination task). The mismatch negativity (MMN) ERP was extracted as the peak amplitude of the largest negative deflection in the difference wave over 80 to 300 milliseconds poststimulus. Differences in MMN were analyzed using repeated measures analysis of variance. RESULTS: The MMN amplitude was attenuated in the infants with NSC preoperatively compared with controls (P = 0.047). A significant region by group interaction (P = 0.045) was observed, and infants with NSC displayed attenuated MMN in the frontal electrodes compared with controls (P = 0.010). Comparing the preoperative and postoperative MMN, a time by group interaction trend (P = 0.070) was observed. Pair-wise comparisons showed a trend for increase in MMN amplitude from preoperatively to postoperatively in the infants with NSC (P = 0.059). At the postoperative time point, infants with NSC showed no significant difference in MMN from controls (P = 0.344). CONCLUSION: Infants with NSC demonstrated atypical neural response to language preoperatively. After undergoing surgery, infants with NSC showed increased MMN amplitude which was not significantly different from controls. These findings support the idea that whole vault cranioplasty may improve neurocognitive outcomes in sagittal craniosynostosis.

Electrophysiological response during auditory gap detection: Biomarker for sensory and communication alterations in autism spectrum disorder?

Sensory symptoms, including auditory processing deficits, are common in autism spectrum disorder (ASD). Processing of temporal aspects of auditory input is understudied; yet, deficits in this domain could contribute to language-related impairments. In children with ASD and well-matched controls, this study examined electrophysiological response to silent gaps in auditory stimuli. Results revealed attenuated amplitude of the P2 event-related potential (ERP) component in ASD. The P2 amplitude reduction was also associated with sensory, language, and diagnostic features. These results suggest that neural response during auditory gap detection is a promising ASD biomarker that could be useful for stratifying subgroups and evaluating treatment response.

Autistic traits modulate conscious and nonconscious face perception.

Difficulty with emotion perception is a core feature of autism spectrum disorder (ASD) that is also associated with the broader autism phenotype. The current study explored the neural underpinnings of conscious and nonconscious perceptions of affect in typically developing individuals with varying levels of autistic-like traits, as measured by the Autism Quotient (AQ). We investigated the relationship between autistic traits and face processing efficiency using event-related potentials (ERPs). In 20 typically developing adults, we utilized ERPs (the P100, N170, and P300) to measure differences in face processing for emotional faces that were presented either (a) too quickly to reach conscious awareness (16 ms) or (b) slowly enough to be consciously observed (200 ms). All individuals evidenced increased P100 and P300 amplitude and shorter N170 latencies for nonconscious versus consciously presented faces. Individuals with high AQ scores evidenced delayed ERP components. Nonconsciously perceived emotional faces elicited enhanced neural responses regardless of AQ score. Higher levels of autistic traits were associated with inefficient face perception (i.e., longer latency of ERP components). This delay parallels processing delays observed in ASD. These data suggest that inefficient social perception is present in individuals with subclinical levels of social impairment.

Effect of familiarity on reward anticipation in children with and without autism spectrum disorders.

BACKGROUND: Previous research on the reward system in autism spectrum disorders (ASD) suggests that children with ASD anticipate and process social rewards differently than typically developing (TD) children--but has focused on the reward value of unfamiliar face stimuli. Children with ASD process faces differently than their TD peers. Previous research has focused on face processing of unfamiliar faces, but less is known about how children with ASD process familiar faces. The current study investigated how children with ASD anticipate rewards accompanied by familiar versus unfamiliar faces. METHODS: The stimulus preceding negativity (SPN) of the event-related potential (ERP) was utilized to measure reward anticipation. Participants were 6- to 10-year-olds with (N = 14) and without (N = 14) ASD. Children were presented with rewards accompanied by incidental face or non-face stimuli that were either familiar (caregivers) or unfamiliar. All non-face stimuli were composed of scrambled face elements in the shape of arrows, controlling for visual properties. RESULTS: No significant differences between familiar versus unfamiliar faces were found for either group. When collapsing across familiarity, TD children showed larger reward anticipation to face versus non-face stimuli, whereas children with ASD did not show differential responses to these stimulus types. Magnitude of reward anticipation to faces was significantly correlated with behavioral measures of social impairment in the ASD group. CONCLUSIONS: The findings do not provide evidence for differential reward anticipation for familiar versus unfamiliar face stimuli in children with or without ASD. These findings replicate previous work suggesting that TD children anticipate rewards accompanied by social stimuli more than rewards accompanied by non-social stimuli. The results do not support the idea that familiarity normalizes reward anticipation in children with ASD. Our findings also suggest that magnitude of reward anticipation to faces is correlated with levels of social impairment for children with ASD.

Reward anticipation and processing of social versus nonsocial stimuli in children with and without autism spectrum disorders.

BACKGROUND: How children respond to social and nonsocial rewards has important implications for both typical and atypical social-cognitive development. Individuals with autism spectrum disorders (ASD) are thought to process rewards differently than typically developing (TD) individuals. However, there is little direct evidence to support this claim. METHODS: Two event-related potentials were measured. The stimulus preceding negativity (SPN) was utilized to measure reward anticipation, and the feedback related negativity (FRN) was utilized to measure reward processing. Participants were 6- to 8-year-olds with (N = 20) and without (N = 23) ASD. Children were presented with rewards accompanied by incidental face or nonface stimuli. Nonface stimuli were composed of scrambled face elements in the shape of arrows, controlling for low-level visual properties. RESULTS: Children with ASD showed smaller responses while anticipating and processing rewards accompanied by social stimuli than TD children. Anticipation and processing of rewards accompanied by nonsocial stimuli was intact in children with ASD. CONCLUSIONS: This is the first study to measure both reward anticipation and processing in ASD while controlling for reward properties. The findings provide evidence that children with autism have reward anticipation and processing deficits for social stimuli only. Our results suggest that while typically developing children find social stimuli more salient than nonsocial stimuli, children with ASD may have the opposite preference.

Reward sensitivity to faces versus objects in children: an ERP study.

How children respond to social and nonsocial rewards has important implications for understanding social cognitive development. Adults find faces intrinsically rewarding. However, little is known about how children respond to face vs nonface rewards. We utilized event-related potentials (the stimulus-preceding negativity, SPN) to measure differences in reward anticipation during a guessing game in 6- to 8-year-olds. Children were presented with reward indicators accompanied by incidental face or nonface stimuli. Nonface stimuli were comprised of scrambled faces in the shape of arrows, controlling for low-level properties of the two conditions. Children showed an increased SPN when the reward stimuli were accompanied by faces, relative to nonface stimuli. This suggests that children find a face stimulus more rewarding than a nonface stimulus. The results have important implications for processing social vs nonsocial rewards in typically developing children, and allow testing of populations with deficits in social reward processing, such as autism spectrum disorder.

Research review: Social motivation and oxytocin in autism--implications for joint attention development and intervention.

BACKGROUND AND SCOPE: The social motivation hypothesis (SMH) suggests that individuals with autism spectrum disorders (ASD) are less intrinsically rewarded by social stimuli than their neurotypical peers. This difference in social motivation has been posited as a factor contributing to social deficits in ASD. Social motivation is thought to involve the neuropeptide oxytocin. Here, we review the evidence for oxytocin effects in ASD, and discuss its potential role in one important social cognitive behavior. METHODS: Systematic searches were conducted using the PsychINFO and MEDLINE databases and the search terms 'oxytocin' and 'autism'; the same databases were used for separate searches for 'joint attention', 'intervention', and 'autism', using the same inclusion criteria as an earlier 2011 review but updating it for the period 2010 to October 2012. FINDINGS: Several studies suggest that giving oxytocin to both individuals with ASD and neurotypical individuals can enhance performance on social cognitive tasks. Studies that have attempted to intervene in joint attention in ASD suggest that social motivation may be a particular obstacle to lasting effects. CONCLUSIONS: The review of the evidence for the SMH suggests a potential role for oxytocin in social motivation deficits in ASD. Because of its importance for later communicative and social development, the focus here is on implications of oxytocin and social motivation in the development of and interventions in joint attention. Joint attention is a central impairment in ASD, and as a result is the focus of several behavioral interventions. In describing this previous research on joint attention interventions in ASD, we pay particular attention to problems encountered in such studies, and propose ways that oxytocin may facilitate behavioral intervention in this area. For future research, integrating behavioral and pharmacological interventions (oxytocin administration) would be a worthwhile experimental direction to improve understanding of the role of oxytocin in ASD and help optimize outcomes for children with ASD.