Reducing auditory hypersensitivities in autistic spectrum disorder: preliminary findings evaluating the listening project protocol.

Auditory hypersensitivities are a common feature of autism spectrum disorder (ASD). In the present study, the effectiveness of a novel intervention, the listening project protocol (LPP), was evaluated in two trials conducted with children diagnosed with ASD. LPP was developed to reduce auditory hypersensitivities. LPP is based on a theoretical "neural exercise" model that uses computer altered acoustic stimulation to recruit the neural regulation of middle ear muscles. Features of the intervention stimuli were informed by basic research in speech and hearing sciences that has identified the specific acoustic frequencies necessary to understand speech, which must pass through middle ear structures before being processed by other components of the auditory system. LPP was hypothesized to reduce auditory hypersensitivities by increasing the neural tone to the middle ear muscles to functionally dampen competing sounds in frequencies lower than human speech. The trials demonstrated that LPP, when contrasted to control conditions, selectively reduced auditory hypersensitivities. These findings are consistent with the polyvagal theory, which emphasizes the role of the middle ear muscles in social communication.

Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum.

BACKGROUND: Unstuck and On Target (UOT) is an executive function (EF) intervention for children with autism spectrum disorders (ASD) targeting insistence on sameness, flexibility, goal-setting, and planning through a cognitive-behavioral program of self-regulatory scripts, guided/faded practice, and visual/verbal cueing. UOT is contextually-based because it is implemented in school and at home, the contexts in which a child uses EF skills. METHODS: To evaluate the effectiveness of UOT compared with a social skills intervention (SS), 3rd-5th graders with ASD (mean IQ = 108; UOT n = 47; SS n = 20) received interventions delivered by school staff in small group sessions. Students were matched for gender, age, race, IQ, ASD symptomotolgy, medication status, and parents' education. Interventions were matched for 'dose' of intervention and training. Measures of pre-post change included classroom observations, parent/teacher report, and direct child measures of problem-solving, EF, and social skills. Schools were randomized and evaluators, but not parents or teachers, were blinded to intervention type. RESULTS: Interventions were administered with high fidelity. Children in both groups improved with intervention, but mean change scores from pre- to postintervention indicated significantly greater improvements for UOT than SS groups in: problem-solving, flexibility, and planning/organizing. Also, classroom observations revealed that participants in UOT made greater improvements than SS participants in their ability to follow rules, make transitions, and be flexible. Children in both groups made equivalent improvements in social skills. CONCLUSIONS: These data support the effectiveness of the first contextually-based EF intervention for children with ASD. UOT improved classroom behavior, flexibility, and problem-solving in children with ASD. Individuals with variable background/training in ASD successfully implemented UOT in mainstream educational settings.

Atypical modulation of distant functional connectivity by cognitive state in children with Autism Spectrum Disorders.

We examined whether modulation of functional connectivity by cognitive state differed between pre-adolescent children with Autism Spectrum Disorders (ASD) and age and IQ-matched control children. Children underwent functional magnetic resonance imaging (fMRI) during two states, a resting state followed by a sustained attention task. A voxel-wise method was used to characterize functional connectivity at two levels, local (within a voxel's 14 mm neighborhood) and distant (outside of the voxel's 14 mm neighborhood to the rest of the brain) and regions exhibiting Group × State interaction were identified for both types of connectivity maps. Distant functional connectivity of regions in the left frontal lobe (dorsolateral [BA 11, 10]; supplementary motor area extending into dorsal anterior cingulate [BA 32/8]; and premotor [BA 6, 8, 9]), right parietal lobe (paracentral lobule [BA 6]; angular gyrus [BA 39/40]), and left posterior middle temporal cortex (BA 19/39) showed a Group × State interaction such that relative to the resting state, connectivity reduced (i.e., became focal) in control children but increased (i.e., became diffuse) in ASD children during the task state. Higher state-related increase in distant connectivity of left frontal and right angular gyrus predicted worse inattention in ASD children. Two graph theory measures (global efficiency and modularity) were also sensitive to Group × State differences, with the magnitude of state-related change predicting inattention in the ASD children. Our results indicate that as ASD children transition from an unconstrained to a sustained attentional state, functional connectivity of frontal and parietal regions with the rest of the brain becomes more widespread in a manner that may be maladaptive as it was associated with attention problems in everyday life.

Do Social Attribution Skills Improve with Age in Children with High Functioning Autism Spectrum Disorders?

Age-related changes in social attribution skills were assessed using the "Triangles Playing Tricks" task in 7-17 year old high functioning children with ASDs (n=41) and in typically developing (TD) children (n=58) matched on age, IQ, and sex ratio. Children with ASDs gave responses that received lower intentionality and appropriateness ratings than did TD children in both the goal-directed and theory of mind (ToM) conditions. Results remained unchanged when the effects of verbal output (i.e., number of clause produced) and verbal IQ were included as covariates in the analyses. Whereas age was highly associated with ToM performance in the TD children, this relationship was not as strong among children with ASDs. These results indicate not only a diminished tendency among high functioning children with ASDs to attribute social meaning and intentionality to ambiguous visual displays of interactive forms but also an aberrant developmental trajectory. That is, children with ASDs may fall further behind their typically developing peers in social attribution abilities as they get older.

Emotion recognition in children with autism spectrum disorders: relations to eye gaze and autonomic state.

Respiratory Sinus Arrhythmia (RSA), heart rate, and accuracy and latency of emotion recognition were evaluated in children with autism spectrum disorders (ASD) and typically developing children while viewing videos of faces slowly transitioning from a neutral expression to one of six basic emotions (e.g., anger, disgust, fear, happiness, sadness, and surprise). Children with ASD were slower in emotion recognition and selectively made more errors in detecting anger. ASD children had lower amplitude RSA and faster heart rate. Within the ASD group, children with higher amplitude RSA recognized emotions faster. Less severe ASD symptoms and increased gaze to the eye region in children with ASD were related to more accurate emotion recognition.

Electroencephalogram and heart rate regulation to familiar and unfamiliar people in children with autism spectrum disorders.

Few studies have examined whether familiarity of partner affects social responses in children with autism. This study investigated heart rate regulation (respiratory sinus arrhythmia [RSA]: The myelinated vagus nerve's regulation of heart rate) and temporal-parietal electroencephalogram (EEG) activity while nineteen 8- to 12-year-old children with autism and 14 controls viewed videos of a familiar and an unfamiliar person reading a story. Children with autism had lower overall RSA levels and exhibited decreased RSA to the unfamiliar person, versus control children. Both groups decreased temporal-parietal EEG activity to the unfamiliar person. Higher RSA was related to higher social skill ratings and fewer problem behaviors. Thus, the social difficulties of children with autism may be characterized by specific mobilization to unfamiliar people.

Physiological responses to social and physical challenges in children: Quantifying mechanisms supporting social engagement and mobilization behaviors.

Physiological response patterns to laboratory-based social and physical challenges were investigated in 37 typically-developing 3- to 5-year-old children. The study was conducted to determine whether the response profiles during each challenge were similar and whether individual differences in the response profiles to the challenges were correlated. Results demonstrated challenge specific physiological response strategies. In response to the social challenge, respiratory sinus arrhythmia and heart period increased and motor activity decreased. In contrast, in response to the physical challenge, respiratory sinus arrhythmia and heart period decreased and motor activity increased. Neither challenge reliably elicited changes in salivary cortisol. Only heart period responses were correlated between the challenges.

Does motor activity during psychophysiological paradigms confound the quantification and interpretation of heart rate and heart rate variability measures in young children?

Respiratory sinus arrhythmia (RSA), heart period, and motor activity were monitored in preschoolers during a variety of tasks varying in required movement. The data analyses indicate: (1) that when activity increases during tasks, there are synchronous decreases in heart period and RSA; (2) that correlations between changes in RSA and heart period are related to activity only during exercise when there is a major demand for increased metabolic resources; and (3) that the covariation among the variables within each condition is low except during exercise. These findings suggest that the slight increases in motor activity (i.e., hand movements) often required in attention demanding psychophysiological protocols are not related to RSA and heart period responses. However, when tasks necessitate large increases in motor activity (e.g., exercise), the decreases in heart period and RSA are related to the change in motor activity.

Respiratory sinus arrhythmia and tympanic membrane compliance predict spontaneous eye gaze behaviors in young children: a pilot study.

The Polyvagal theory proposes the Social Engagement System as a theoretical model linking social behavior with the neural regulation of the heart (via the vagus) and the striated muscles of the face and head (via special visceral efferent pathways). The current pilot study tested the feasibility of this model with typically developing 3-5-year-old children by evaluating the relation between spontaneous social engagement behavior measured by eye gaze behaviors and the visceromotor (e.g., respiratory sinus arrhythmia) and somatomotor (e.g., right tympanic membrane compliance) components of the Social Engagement System. Regression analyses supported the hypothesis that the visceromotor and somatomotor components of the Social Engagement System significantly predict social behavior (indexed by spontaneous eye gazes). Future studies assessing indices of visceral regulation and middle ear muscle function may provide insights into neural mechanisms mediating features of developmental disorders, such as autism, that have deficits in spontaneous eye gaze, auditory processing, and social behavior.