Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people.

Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.

Atypical visual motion prediction abilities in autism spectrum disorder.

A recent theory posits that prediction deficits may underlie the core symptoms in autism spectrum disorder (ASD). However, empirical evidence for this hypothesis is minimal. Using a visual extrapolation task, we tested motion prediction abilities in children and adolescents with and without ASD. We examined the factors known to be important for motion prediction: the central-tendency response bias and smooth pursuit eye movements. In ASD, response biases followed an atypical trajectory that was dominated by early responses. This differed from controls who exhibited response biases that reflected a gradual accumulation of knowledge about stimulus statistics. Moreover, while better smooth pursuit eye movements for the moving object were linked to more accurate motion prediction in controls, in ASD, better smooth pursuit was counterintuitively linked to a more pronounced early response bias. Together, these results demonstrate atypical visual prediction abilities in ASD and offer insights into possible mechanisms underlying the observed differences.

Visual Attention Preference for Intermediate Predictability in Young Children.

How do children allocate their attention? There is too much information in the world to encode it all, so children must pick and choose. How do they organize their sampling to make the most of the learning opportunities that surround them? Previous work shows infants actively seek intermediately predictable information. Here we employ eye-tracking and computational modeling to examine the impact of stimulus predictability across early childhood (ages 3-6 years, n = 72, predominantly Non-Hispanic White, middle- to upper-middle-income), by chronological age and cognitive ability. Results indicated that children prefer attending to stimuli of intermediate predictability, with no differences in this pattern based on age or cognitive ability. The consistency may suggest a robust general information-processing mechanism that operates across the lifespan.

Computer Vision Analysis of Reduced Interpersonal Affect Coordination in Youth With Autism Spectrum Disorder.

Atypical social-emotional reciprocity is a core feature of autism spectrum disorder (ASD) but can be difficult to operationalize. One measurable manifestation of reciprocity may be interpersonal coordination, the tendency to align the form and timing of one's behaviors (including facial affect) with others. Interpersonal affect coordination facilitates sharing and understanding of emotional cues, and there is evidence that it is reduced in ASD. However, most research has not measured this process in true social contexts, due in part to a lack of tools for measuring dynamic facial expressions over the course of an interaction. Automated facial analysis via computer vision provides an efficient, granular, objective method for measuring naturally occurring facial affect and coordination. Youth with ASD and matched typically developing youth participated in cooperative conversations with their mothers and unfamiliar adults. Time-synchronized videos were analyzed with an open-source computer vision toolkit for automated facial analysis, for the presence and intensity of facial movements associated with positive affect. Both youth and adult conversation partners exhibited less positive affect during conversations when the youth partner had ASD. Youth with ASD also engaged in less affect coordination over the course of conversations. When considered dimensionally across youth with and without ASD, affect coordination significantly predicted scores on rating scales of autism-related social atypicality, adaptive social skills, and empathy. Findings suggest that affect coordination is an important interpersonal process with implications for broader social-emotional functioning. This preliminary study introduces a promising novel method for quantifying moment-to-moment facial expression and emotional reciprocity during natural interactions. LAY SUMMARY: This study introduces a novel, automated method for measuring social-emotional reciprocity during natural conversations, which may improve assessment of this core autism diagnostic behavior. We used computerized methods to measure facial affect and the degree of affect coordination between conversation partners. Youth with autism displayed reduced affect coordination, and reduced affect coordination predicted lower scores on measures of broader social-emotional skills.

Interactional Synchrony and Its Association with Social and Communication Ability in Children With and Without Autism Spectrum Disorder.

Social partners tend to coordinate their behaviors in time. This "interactional synchrony" is associated with a host of positive social outcomes, making it ripe for study in autism spectrum disorder (ASD). Twenty children with ASD and 17 typically developing (TD) children participated in conversations with familiar and unfamiliar adults. Conversations were rated for movement synchrony and verbal synchrony, and mothers completed measures regarding children's everyday social and communication skills. Children with ASD exhibited less interactional synchrony, with familiar and unfamiliar partners, than TD peers. Beyond group-level differences, interactional synchrony negatively correlated with autism symptom severity, and predicted dimensional scores on established social and communication measures. Results suggest that disrupted interactional synchrony may be associated with impaired social functioning in ASD.

Initial eye gaze to faces and its functional consequence on face identification abilities in autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined and diagnosed by core deficits in social communication and the presence of restricted and repetitive behaviors. Research on face processing suggests deficits in this domain in ASD but includes many mixed findings regarding the nature and extent of these differences. The first eye movement to a face has been shown to be highly informative and sufficient to achieve high performance in face identification in neurotypical adults. The current study focused on this critical moment shown to be essential in the process of face identification. METHODS: We applied an established eye-tracking and face identification paradigm to comprehensively characterize the initial eye movement to a face and test its functional consequence on face identification performance in adolescents with and without ASD (n = 21 per group), and in neurotypical adults. Specifically, we presented a series of faces and measured the landing location of the first saccade to each face, while simultaneously measuring their face identification abilities. Then, individuals were guided to look at specific locations on the face, and we measured how face identification performance varied as a function of that location. Adolescent participants also completed a more traditional measure of face identification which allowed us to more fully characterize face identification abilities in ASD. RESULTS: Our results indicate that the location of the initial look to faces and face identification performance for briefly presented faces are intact in ASD, ruling out the possibility that deficits in face perception, at least in adolescents with ASD, begin with the initial eye movement to the face. However, individuals with ASD showed impairments on the more traditional measure of face identification. CONCLUSION: Together, the observed dissociation between initial, rapid face perception processes, and other measures of face perception offers new insights and hypotheses related to the timing and perceptual complexity of face processing and how these specific aspects of face identification may be disrupted in ASD.

The Influence of Noise on Autonomic Arousal and Cognitive Performance in Adolescents with Autism Spectrum Disorder.

This study examined the impact of noise on cognitive performance in autism spectrum disorder (ASD), while concurrently measuring sympathetic responses. Adolescents with and without ASD completed visually presented span tasks in a 2 × 2 experimental manipulation of noise (quiet vs. 75 dB gated broadband noise) and task difficulty (easier vs. harder). Analyses revealed a significant noise × difficulty interaction on performance, and a significant group × noise × difficulty interaction on sympathetic arousal. Correlational analyses indicated an adaptive effect of noise and increased arousal on performance in the easier condition for the control group and a detrimental effect of noise and increased arousal in the harder condition for the ASD group. Implications for sensory processing research and intervention development are discussed.

The Importance of Adolescent Self-Report in Autism Spectrum Disorder: Integration of Questionnaire and Autonomic Measures.

Anxiety and sensory symptoms are highly prevalent and meaningful in the daily lives of individuals with autism spectrum disorder (ASD). Despite the importance of carefully measuring, researching, and treating these symptoms, current methods in ASD seldom include self-report. This study investigated the consistency of adolescent and parent reports of anxiety and auditory sensitivity in individuals with ASD, and examined their validity via comparisons with sympathetic arousal at baseline and in response to an auditory challenge. Fifty adolescent-parent dyads (n = 26 ASD, n = 24 typically developing; 12-16 years old; IQ>80) completed parallel versions of both anxiety and auditory hypersensitivity scales, which were compared to heart rate collected at rest and during an aversive noise task. Adolescents with ASD exhibited greater anxiety and auditory hypersensitivity than their peers, based on both self and parent report. Across groups, self-report was higher than parent report. In individuals with ASD, a significant relationship was found between self-reported anxiety and autonomic arousal at rest, and between self-reported auditory sensitivity and autonomic reactivity during the noise task. These relationships were not significant for parent-report. These findings extend past work by demonstrating greater self-reported (than parent-reported) anxiety and sensory symptoms. Furthermore, the presence of significant correlations between self-reported symptoms and sympathetic arousal supports the validity of self-report in adolescents with ASD with average or above average cognitive abilities. This indicates that adolescents with ASD have a unique perspective on their internal experience, which can complement parent reports and provide a more comprehensive assessment of symptoms in research and clinical settings.

Expanding the neurodevelopmental phenotype of PURA syndrome.

PURA syndrome is a recently described developmental encephalopathy presenting with neonatal hypotonia, feeding difficulties, global developmental delay, severe intellectual disability, and frequent apnea and epilepsy. We describe 18 new individuals with heterozygous sequence variations in PURA. A neuromotor disorder starting with neonatal hyptonia, but ultimately allowing delayed progression to walking, was present in nearly all individuals. Congenital apnea was present in 56% during infancy, but all cases in this cohort resolved during the first year of life. Feeding difficulties were frequently reported, with gastrostomy tube placement required in 28%. Epilepsy was present in 50% of the subjects, including infantile spasms and Lennox-Gastaut syndrome. Skeletal complications were found in 39%. Disorders of gastrointestinal motility and nystagmus were also recurrent features. Autism was diagnosed in one individual, potentially expanding the neurodevelopmental phenotype associated with this syndrome. However, we did not find additional PURA sequence variations in a cohort of 120 subjects with autism. We also present the first neuropathologic studies of PURA syndrome, and describe chronic inflammatory changes around the arterioles within the deep white matter. We did not find significant correlations between mutational class and severity, nor between location of the sequence variation in PUR repeat domains. Further studies are required in larger cohorts of subjects with PURA syndrome to clarify these genotype-phenotype associations.

High internal noise and poor external noise filtering characterize perception in autism spectrum disorder.

An emerging hypothesis postulates that internal noise is a key factor influencing perceptual abilities in autism spectrum disorder (ASD). Given fundamental and inescapable effects of noise on nearly all aspects of neural processing, this could be a critical abnormality with broad implications for perception, behavior, and cognition. However, this proposal has been challenged by both theoretical and empirical studies. A crucial question is whether and how internal noise limits perception in ASD, independently from other sources of perceptual inefficiency, such as the ability to filter out external noise. Here, we separately estimated internal noise and external noise filtering in ASD. In children and adolescents with and without ASD, we computationally modeled individuals' visual orientation discrimination in the presence of varying levels of external noise. The results revealed increased internal noise and worse external noise filtering in individuals with ASD. For both factors, we also observed high inter-individual variability in ASD, with only the internal noise estimates significantly correlating with severity of ASD symptoms. We provide evidence for reduced perceptual efficiency in ASD that is due to both increased internal noise and worse external noise filtering, while highlighting internal noise as a possible contributing factor to variability in ASD symptoms.

Larger Receptive Field Size as a Mechanism Underlying Atypical Motion Perception in Autism Spectrum Disorder.

Atypical visual motion perception has been widely observed in individuals with autism spectrum disorder (ASD). The pattern of results, however, has been inconsistent. Emerging mechanistic hypotheses seek to explain these variable patterns of atypical motion sensitivity, each uniquely predicting specific patterns of performance across varying stimulus conditions. Here, we investigated the integrity of two such fundamental mechanisms-response gain control and receptive field size. Twenty children and adolescents with ASD and 20 typically developing (TD) age- and IQ-matched controls performed a motion discrimination task. To adequately model group differences in both mechanisms of interest, we tested a range of 23 stimulus conditions varying in size and contrast. Results revealed a motion perception impairment in ASD that was specific to the smallest sized stimuli (1°), irrespective of stimulus contrast. Model analyses provided evidence for larger receptive field size in ASD as the mechanism that explains this size-specific reduction of motion sensitivity.

Auditory spatial attention to speech and complex non-speech sounds in children with autism spectrum disorder.

One of the earliest observable impairments in autism spectrum disorder (ASD) is a failure to orient to speech and other social stimuli. Auditory spatial attention, a key component of orienting to sounds in the environment, has been shown to be impaired in adults with ASD. Additionally, specific deficits in orienting to social sounds could be related to increased acoustic complexity of speech. We aimed to characterize auditory spatial attention in children with ASD and neurotypical controls, and to determine the effect of auditory stimulus complexity on spatial attention. In a spatial attention task, target and distractor sounds were played randomly in rapid succession from speakers in a free-field array. Participants attended to a central or peripheral location, and were instructed to respond to target sounds at the attended location while ignoring nearby sounds. Stimulus-specific blocks evaluated spatial attention for simple non-speech tones, speech sounds (vowels), and complex non-speech sounds matched to vowels on key acoustic properties. Children with ASD had significantly more diffuse auditory spatial attention than neurotypical children when attending front, indicated by increased responding to sounds at adjacent non-target locations. No significant differences in spatial attention emerged based on stimulus complexity. Additionally, in the ASD group, more diffuse spatial attention was associated with more severe ASD symptoms but not with general inattention symptoms. Spatial attention deficits have important implications for understanding social orienting deficits and atypical attentional processes that contribute to core deficits of ASD. Autism Res 2017, 10: 1405-1416. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

I tawt i taw a puddy tat: Gestures in canary row narrations by high-functioning youth with autism spectrum disorder.

This study examined whether individuals with autism spectrum disorder (ASD) produce co-speech gestures similarly to typically developing (TD) peers. Participants were 20 youth ages 10-18 years with high-functioning ASD and 21 TD controls matched on age, gender, verbal IQ, and handedness. Gestures were elicited using a classic narrative-retelling task, in which participants watched a Tweety and Sylvester cartoon and retold the cartoon to a confederate. Analyses compared gesture rate, type, and viewpoint (character, observer, dual) across groups. Communicative utility of gestures was measured via naïve coder ratings of whether a movement was a gesture, and the clarity of a gesture's meaning. The ASD group produced shorter narratives and fewer total gestures than the TD group. Accounting for narrative length, the ASD group produced fewer gestures per clause than the TD group; however, proportions of gesture types (iconic, deictic, beat, metaphoric, emblems) did not differ. Most notably, the ASD group's gestures were rated as less clearly gestures in terms of timing and well formedness, with lower certainty ratings for gesture meaning. Gesture clarity and gesture meaning scores were related to diagnostic measures of gesture competence in ASD. Findings suggest that although fluent children and adolescents with ASD use the same type of gestures as controls, their gestures are more difficult to understand, which has significant implications for their communicative abilities more broadly. Autism Res 2017, 10: 1353-1363. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Children with autism spectrum disorder have reduced otoacoustic emissions at the 1 kHz mid-frequency region.

Autism spectrum disorder (ASD) is a behaviorally diagnosed disorder of early onset characterized by impairment in social communication and restricted and repetitive behaviors. Some of the earliest signs of ASD involve auditory processing, and a recent study found that hearing thresholds in children with ASD in the mid-range frequencies were significantly related to receptive and expressive language measures. In addition, otoacoustic emissions have been used to detect reduced cochlear function in the presence of normal audiometric thresholds. We were interested then to know if otoacoustic emissions in children with normal audiometric thresholds would also reveal differences between children with ASD and typical developing (TD) controls in mid-frequency regions. Our objective was to specifically measure baseline afferent otoacoustic emissions (distortion-product otoacoustic emissions [DPOAEs]), transient-evoked otoacoustic emissions (TrOAEs), and efferent suppression, in 35 children with high-functioning ASD compared with 42 aged-matched TD controls. All participants were males 6-17 years old, with normal audiometry, and rigorously characterized via Autism Diagnostic Interview-Revised and Autism Diagnostic Observation Schedule. Children with ASD had greatly reduced DPOAE responses in the 1 kHz frequency range, yet had comparable DPOAE responses at 0.5 and 4-8 kHz regions. Furthermore, analysis of the spectral features of TrOAEs revealed significantly decreased emissions in ASD in similar frequencies. No significant differences were noted in DPOAE or TrOAE noise floors, middle ear muscle reflex activity, or efferent suppression between children with ASD and TD controls. In conclusion, attention to specific-frequency deficits using non-invasive measures of cochlear function may be important in auditory processing impairments found in ASD. Autism Res 2017, 10: 337-345. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Temporal synchrony and audiovisual integration of speech and object stimuli in autism.

BACKGROUND: Individuals with Autism Spectrum Disorders (ASD) have been shown to have multisensory integration deficits, which may lead to problems perceiving complex, multisensory environments. For example, understanding audiovisual speech requires integration of visual information from the lips and face with auditory information from the voice, and audiovisual speech integration deficits can lead to impaired understanding and comprehension. While there is strong evidence for an audiovisual speech integration impairment in ASD, it is unclear whether this impairment is due to low level perceptual processes that affect all types of audiovisual integration or if it is specific to speech processing. METHOD: Here, we measure audiovisual integration of basic speech (i.e., consonant-vowel utterances) and object stimuli (i.e., a bouncing ball) in adolescents with ASD and well-matched controls. We calculate a temporal window of integration (TWI) using each individual's ability to identify which of two videos (one temporally aligned and one misaligned) matches auditory stimuli. The TWI measures tolerance for temporal asynchrony between the auditory and visual streams, and is an important feature of audiovisual perception. RESULTS: While controls showed similar tolerance of asynchrony for the simple speech and object stimuli, individuals with ASD did not. Specifically, individuals with ASD showed less tolerance of asynchrony for speech stimuli compared to object stimuli. In individuals with ASD, decreased tolerance for asynchrony in speech stimuli was associated with higher ratings of autism symptom severity. CONCLUSIONS: These results suggest that audiovisual perception in ASD may vary for speech and object stimuli beyond what can be accounted for by stimulus complexity.

Toward an Interdisciplinary Understanding of Sensory Dysfunction in Autism Spectrum Disorder: An Integration of the Neural and Symptom Literatures.

Sensory processing differences have long been associated with autism spectrum disorder (ASD), and they have recently been added to the diagnostic criteria for the disorder. The focus on sensory processing in ASD research has increased substantially in the last decade. This research has been approached from two different perspectives: the first focuses on characterizing the symptoms that manifest in response to real world sensory stimulation, and the second focuses on the neural pathways and mechanisms underlying sensory processing. The purpose of this paper is to integrate the empirical literature on sensory processing in ASD from the last decade, including both studies characterizing sensory symptoms and those that investigate neural response to sensory stimuli. We begin with a discussion of definitions to clarify some of the inconsistencies in terminology that currently exist in the field. Next, the sensory symptoms literature is reviewed with a particular focus on developmental considerations and the relationship of sensory symptoms to other core features of the disorder. Then, the neuroscience literature is reviewed with a focus on methodological approaches and specific sensory modalities. Currently, these sensory symptoms and neuroscience perspectives are largely developing independently from each other leading to multiple, but separate, theories and methods, thus creating a multidisciplinary approach to sensory processing in ASD. In order to progress our understanding of sensory processing in ASD, it is now critical to integrate these two research perspectives and move toward an interdisciplinary approach. This will inevitably aid in a better understanding of the underlying biological basis of these symptoms and help realize the translational value through its application to early identification and treatment. The review ends with specific recommendations for future research to help bridge these two research perspectives in order to advance our understanding of sensory processing in ASD.

The relationship between contact and attitudes: Reducing prejudice toward individuals with intellectual and developmental disabilities.

Increases in intellectual and developmental disability (IDD) diagnoses coupled with higher rates of inclusion in school and community settings, has created more opportunities for exposure and integration between those with IDD and the mainstream population. Previous research has found that increased contact can lead to more positive attitudes toward those with IDD. The current study further investigated this impact of contact on attitudes by examining the influence of the quality and quantity of contact on both explicit and implicit levels of prejudice, while also considering potential mediation via intergroup anxiety and implicit attitudes. Based on past research and theory, we predicted that contact (especially quality contact) would have a strong relationship with explicit and implicit positive attitudes toward individuals with IDD. In the present study, 550 people completed a survey and short task that measured their level of contact with individuals with IDD across their lifetime, their current attitudes toward these individuals, and other constructs that are thought to influence this relationship. Multiple regression analyses suggested consistent links between higher quality of contact and lower levels of prejudice toward individuals with IDD at both the explicit and implicit levels. After controlling for quality of contact, higher quantity of contact was either not significantly associated with our measures of prejudice or was, importantly, associated with higher levels of prejudice. Additional analyses support intergroup anxiety and implicit positive attitudes as significant mediators in the associations between quality of contact and the various dimensions of explicit prejudice. Thus, it would seem that it is the quality of interpersonal interactions that is most strongly related to positive attitudes toward individuals with IDD, making it crucial to take care when developing inclusion opportunities in community settings.

A strong interactive link between sensory discriminations and intelligence.

Early psychologists, including Galton, Cattell, and Spearman, proposed that intelligence and simple sensory discriminations are constrained by common neural processes, predicting a close link between them. However, strong supporting evidence for this hypothesis remains elusive. Although people with higher intelligence quotients (IQs) are quicker at processing sensory stimuli, these broadly replicated findings explain a relatively modest proportion of variance in IQ. Processing speed alone is, arguably, a poor match for the information processing demands on the neural system. Our brains operate on overwhelming amounts of information, and thus their efficiency is fundamentally constrained by an ability to suppress irrelevant information. Here, we show that individual variability in a simple visual discrimination task that reflects both processing speed and perceptual suppression strongly correlates with IQ. High-IQ individuals, although quick at perceiving small moving objects, exhibit disproportionately large impairments in perceiving motion as stimulus size increases. These findings link intelligence with low-level sensory suppression of large moving patterns--background-like stimuli that are ecologically less relevant. We conjecture that the ability to suppress irrelevant and rapidly process relevant information fundamentally constrains both sensory discriminations and intelligence, providing an information-processing basis for the observed link.

Speech-and-gesture integration in high functioning autism.

This study examined iconic gesture comprehension in autism, with the goal of assessing whether cross-modal processing difficulties impede speech-and-gesture integration. Participants were 19 adolescents with high functioning autism (HFA) and 20 typical controls matched on age, gender, verbal IQ, and socio-economic status (SES). Gesture comprehension was assessed via quantitative analyses of visual fixations during a video-based task, using the visual world paradigm. Participants' eye movements were recorded while they watched videos of a person describing one of four shapes shown on a computer screen, using speech-and-gesture or speech-only descriptions. Participants clicked on the shape that the speaker described. Since gesture naturally precedes speech, earlier visual fixations to the target shape during speech-and-gesture compared to speech-only trials, would suggest immediate integration of auditory and visual information. Analyses of eye movements supported this pattern in control participants but not in individuals with autism: iconic gestures facilitated comprehension in typical individuals, while it hindered comprehension in those with autism. Cross-modal processing difficulties in autism were not accounted for by impaired unimodal speech or gesture processing. The results have important implications for the treatment of children and adults with this disorder.