A sensory signature of unaffected biological parents predicts the risk of autism in their offspring.

AIM: Despite the emphasis on sensory dysfunction phenotypes in the revised diagnostic criteria for autism spectrum disorder (ASD), there has been limited research, particularly in the field of neurobiology, investigating the concordance in sensory features between individuals with ASD and their genetic relatives. Therefore, our objective was to examine whether neurobehavioral sensory patterns could serve as endophenotypic markers for ASD. METHODS: We combined questionnaire- and lab-based sensory evaluations with sensory fMRI measures to examine the patterns of sensory responsivity in 30 clinically diagnosed with ASD, 26 matched controls (CON), and 48 biological parents for both groups (27 parents of individuals with ASD [P-ASD] and 21 for individuals with CON [P-CON]). RESULTS: The ASD and P-ASD groups had higher sensory responsivity and rated sensory stimuli as more unpleasant than the CON and P-CON groups, respectively. They also exhibited greater hemodynamic responses within the sensory cortices. Overlapping activations were observed within these sensory cortices in the ASD and P-ASD groups. Using a machine learning approach with robust prediction models across cohorts, we demonstrated that the sensory profile of biological parents accurately predicted the likelihood of their offspring having ASD, achieving a prediction accuracy of 71.4%. CONCLUSIONS: These findings provide support for the hereditary basis of sensory alterations in ASD and suggest a potential avenue to improve ASD diagnosis by utilizing the sensory signature of biological parents, especially in families with a high risk of ASD. This approach holds promising prospects for early detection, even before the birth of the offspring.

Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan.

LAY ABSTRACT: The Early Start Denver Model is an evidence-based early intervention program for young and very young children with autism. This interdisciplinary model is used by many types of professionals, such as psychologists, occupational therapists, speech pathologists, early child special educators, and paraprofessionals, as well as by parents. Most previous studies on the Early Start Denver Model were conducted in the West, and there are scarce studies on the topics of generalization in culture and countries outside the Western world. In this study, we evaluated the effect of the Early Start Denver Model with some adaptations, including a lower intensity, shorter duration, and delivery in regional general hospitals in Northern Taiwan. In total, 45 young children with autism, aged 2-4 years, were divided into the Early Start Denver Model and community-based control groups. The children in the Early Start Denver Model group received one-on-one intervention for approximately 8-9 h per week for 6 months. The results revealed that compared with the control group, the Early Start Denver Model group showed greater gains in overall development ability and nonverbal development ability from pre- to post-intervention. However, these differences did not sustain at the 6-month follow-up after the completion of the intervention. Being mindful of some caveats in trial designs, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in the regional general hospital settings in the context of Han-Chinese-mainly culture. Our findings can provide helpful information to stakeholders and policymakers of early intervention service systems for children with autism in Taiwan, as well as in Asian countries.

Neural correlates of understanding emotional words in late childhood.

Prior studies involving adults have shown that words can elicit emotional processing, with emotion-label (e.g., happiness) and emotion-laden words (e.g., gift) having distinct processes. However, limited studies have explored the developmental changes in these processes in relation to emotional valence. To address this question, this exploratory study measured event-related potentials (ERPs) in 11-14-year-old children/adolescents (N = 25) and adults (N = 23) while performing an emotional categorization task. The stimuli used were two-character Chinese words, with factors for word type (emotion-label versus emotion-laden) and valence (positive versus negative). To confirm word emotionality, neutral words were also included and compared with all emotional words. The results showed that adults exhibited reduced N400 amplitudes to emotion-label words compared to emotion-laden ones in both positive and negative valence contexts. The differentiation was only sustained for negative valence in the late positive component (LPC). Similar scalp distributions of the effects of word type were found in children/adolescents; however, they exhibited a more prolonged processing of all emotional words than adults. These results suggest that the processing of emotion-label and emotion-laden words are distinct in late childhood, and this discrepancy varies with emotional valence and increasing age.

T-STAT for detecting autism spectrum disorder in toddlers aged 18-24 months.

LAY ABSTRACT: The benefits of early intervention for young children with autism spectrum disorder highlight the importance of early diagnosis. Reliable diagnoses of autism spectrum disorder can be made before 24 months of age. However, many children are diagnosed with autism spectrum disorder at a later age. Delayed diagnosis can occur for children with less severe symptoms and lead to missed opportunities for early intervention. This current study was executed to examine the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds in detecting autism spectrum disorder in toddlers between 18 and 24 months of age. One strength of this study was the inclusion of toddlers with autism spectrum disorder or mild-autism spectrum disorder using the strict and relaxed Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for autism spectrum disorder simultaneously. The results of this study supported that diagnosis of toddlers with autism spectrum disorder could be made reliable before 24 months of age. And the Taiwanese version of the Screening Tool for Autism in Two-Year-Olds was a Level 2 autism-specific screening tool for toddlers aged from 18 to 24 months in Taiwan.

Early Neurodevelopmental Trajectories for Autism Spectrum Disorder in Children Born Very Preterm.

BACKGROUND: Children born preterm are at high risk for autism spectrum disorder (ASD). However, there is still a lack of appropriate developmental markers. In this study, we aim to examine whether early mental performance trajectory is related to ASD outcome in the preterm population. METHODS: The population-based cohort included 414 very preterm survivors born between 2008 and 2014. After excluding children with severe neurosensory impairment, 319 children with available records of developmental quotients before age 2 years were enrolled. The trajectory of mental performance evaluated by using the Bayley Scales of Infant Development across 6, 12, and 24 months of age was analyzed with group-based trajectory modeling. At 5 years of age, the ASD diagnosis was established by using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. RESULTS: There were 29 children with ASD and 290 children without ASD. The mental performances from age 6 to 24 months could be classified into 3 trajectory patterns: low declining, high declining, and high stable, which corresponded to ASD prevalence at age 5 years of 35%, 9%, and 3%, respectively. ASD odds was 15 times higher in the low-declining group than in the high-stable group (odds ratio 15; 95% confidence interval 3.8-59; P < .001). Through the analysis of multinomial logistic regression, we found that male infants with longer exposure to oxygen therapy whose mothers had lower maternal education levels tended to follow the low-declining trajectory. CONCLUSIONS: The early-life mental trajectory patterns, by using the Bayley Scales of Infant Development, may lead to identification of vulnerable children born preterm for early ASD diagnosis and targeted intervention.

The Utility of the Screening Tool for Autism in 2-Year-Olds in Detecting Autism in Taiwanese Toddlers Who are Less than 24 Months of Age: A Longitudinal Study.

The present longitudinal study examined the utility of the screening tool for autism in 2-year-olds (STAT) in detecting autism spectrum disorder (ASD) in toddlers who are less than 24 months of age. The study sample, which consisted of 119 toddlers with developmental problems, were assessed when they were between 16 and 24 months of age (Time 1) and after a period of 18 months to finalize the diagnosis (Time 2); 57 children had ASD and 62 children had developmental delays. A cutoff score of 2.5 on the STAT yielded an optimal combination of high sensitivity and specificity. The STAT demonstrated adequate predictive validity in detecting ASD in Taiwanese toddlers who are less than 24 months of age.

Preliminary clinical outcomes of a short-term low-intensity Early Start Denver Model implemented in the Taiwanese public health system.

LAY ABSTRACT: The Early Start Denver Model is a comprehensive naturalistic developmental behavioral intervention for young children with autism spectrum disorder. Rigorous studies indicate that long-term, high-intensity Early Start Denver Model in home-based settings can help young children with autism spectrum disorder have great progress in language, cognitive development, and adaptive skills and reduce overall symptom severity. In accordance with the current limitations in resourcing for early intervention in Taiwan, this study evaluated the effects of implementing the Early Start Denver Model in the Taiwanese public health system with some adaptations, including lower intensity, shorter duration, and delivery in general hospitals. A total of 16 children with autism spectrum disorder, aged between 25 and 46 months, received approximately 8 h per week one-on-one Early Start Denver Model intervention. After 6 months of intervention, the children showed great improvements in language and overall cognitive functioning and reduced symptom severity in communication and play. This study suggests that directly delivering the Early Start Denver Model in community-based hospitals may be an effective intervention, which can make more young children with autism spectrum disorder in Taiwan access the Early Start Denver Model service.

Behavioral characteristics of autism spectrum disorder in very preterm birth children.

Background: Lower gestational age may increase autism spectrum disorder (ASD) vulnerability; however, the incidence of ASD diagnosis through a direct assessment on every very preterm birth child on the population base remains unclear. Moreover, the behavioral characteristics of preterm birth ASD are unknown. Methods: Every very preterm birth child (gestational age < 32 weeks; birth weight < 1500 g) who was discharged from neonatal intensive care units in Southern Taiwan and prospectively followed to 5 years of age was evaluated using the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). The term birth (gestational age > 37 weeks) ASD children characterized by ADOS and ADI-R were group matched to the preterm birth ASD by age at examination for comparison. ADOS severity scores were calculated by the Mann-Whitney U test and ADI-R by multivariate analysis of variance and canonical discriminant analysis. Results: Two hundred forty-six (87%) of the 283 very preterm survivors were followed prospectively to 5 years of age. Nineteen (7.7%) of the 246 children fulfilled the diagnostic criteria of ASD. After excluding 1 patient with cerebral palsy and profound mental disability, 18 preterm ASD children were compared with 44 term birth ASD children. The two ASD groups were comparable for age at examination, gender, and intelligence quotient. The two groups showed comparable ADOS severity scores in social affect deficits, restricted repetitive behaviors, and total score, but had differences in qualitative abnormalities in reciprocal social interaction (Wilks lambda F value = 6.2, P < 0.001) of ADI-R. Compared to term birth ASD children, preterm birth ASD children exhibited worse nonverbal behaviors that regulate social interaction (OR 2.59, 95% CI 1.41-4.73, P = 0.002) but more favorable peer relationships (OR 0.58, 95% CI 0.38-0.90, P = 0.01) and socioemotional reciprocity (OR 0.55, 95% CI 0.33-0.92, P = 0.02). In contrast to the heterogeneous severity of social reciprocity in the term ASD group, the behavioral characteristics of the preterm ASD group showed a homogeneous reciprocal social interaction pattern. Conclusions: The 5-year incidence rate of ASD was high in very preterm birth children. Preterm birth ASD exhibited a specific behavioral phenotype of reciprocal social interaction.

Service system and cognitive outcomes for young children with autism spectrum disorders in a rural area of Taiwan.

Chiayi is a rural county located in southwestern Taiwan, and the effectiveness of its early intervention service system for autism spectrum disorders was studied in detail. A total of 71 children with autism spectrum disorders ( n = 35) and developmental delay ( n = 36) aged 2.5 years were referred from the only Early Intervention Reporting and Referral Center in Chiayi and followed up at 4 years. Results showed relatively low and varied services of early intervention for both groups during two time-point periods and a relative lack of specific early intervention programs for children with autism spectrum disorders. It was found, however, that cognitive abilities were increased for autism spectrum disorders and developmental delay groups. Additionally, the Early Learning Score at the initial evaluation could contribute to the high learner autism spectrum disorders subgroup. Parental socio-economic level was also determined to benefit the high learner developmental delay subgroup.

Young children with autism spectrum disorders imitate in the context of others' prior intention.

Many studies have shown that children with autism spectrum disorder have some understanding of intentions behind others' goal-directed actions on objects. It is not clear whether they understand intentions at a high level of abstraction reliant on the context in which the actions occur. This study tested their understanding of others' prior intentions with typically developing and developmentally delayed children. We replicated Carpenter et al.'s test of the ability to understand prior intentions embedded in the social situation with an additional context of no prior intention. Results showed that when the experimenter's intention was made known before the demonstration, children without autism spectrum disorder performed not only better than the autism spectrum disorder children but also better than themselves when there was no information about prior intention. No between-condition difference was found in the autism spectrum disorder group. It thus appears that children with autism spectrum disorder have difficulty decoupling intentions from the context of the situation. The present findings, together with previous evidence for the intactness of the ability to understand and to imitate goal-directed actions, suggest that asymmetrical imitation performance occurs at different levels of understanding of intention by children with autism spectrum disorder.

Efficacy of caregiver-mediated joint engagement intervention for young children with autism spectrum disorders.

Joint attention intervention for children with autism spectrum disorders was focused on improving joint engagement and joint attention skills. The purpose of this study was to develop a caregiver-mediated joint engagement intervention program combined with body movement play to investigate the effects of joint engagement/joint attention skills in young children with autism spectrum disorders. A quasi-experimental research design was conducted. A total of 34 young children with autism spectrum disorders aged 2-4 years were separated into an intervention and a control group. The program consisted of 20 sessions, 60 min per session, twice a week, for the target child and his or her parent. The results indicated that child-initiated supportive and coordinated joint engagement was greater for the intervention group compared with the control group at 3-month follow-up. This demonstrated that our joint engagement intervention could enhance joint engagement, especially coordinated joint engagement for young children with autism spectrum disorders. The limitations of the study and future directions were discussed.

Predictors of effectiveness of early intervention on children with intellectual disability: a retrospective cohort study.

BACKGROUND: The Taiwanese government has been promoting early intervention to children with intellectual disability for years, but data on its effectiveness are limited. METHODS: We recruited children who were treated for intellectual disability at a teaching hospital and had two IQ tests from 2001 to 2005 and used the difference between the two tests as the indicator of effectiveness. RESULTS: The participants included 23 boys and 13 girls 56.5 ± 5.9 months of age at the first test and 73.4 ± 4.9 months at the second. The IQ increased from 57.0 ± 8.0 to 65.1 ± 12.3 (p < 0.001). Multi-variate regressions showed that a low maternal educational level, male gender, and a younger age at the first test were significant independent predictors of the effectiveness. CONCLUSIONS: Early intervention can improve the IQ of children with intellectual disability, and the earlier the intervention the better. The effectiveness is demonstrable in boys and more prominent in children whose mothers had a low educational level.

The developmental sequence of social-communicative skills in young children with autism: a longitudinal study.

To explore the different developmental trajectories of social-communicative skills in children with autism and typically developing infants, two longitudinal studies were conducted. In Study 1, we examined the developmental sequence of social-communicative skills in 26 typically developing infants when they were 9 months old and reexamined them when they were 12 and 15 months old. The results indicated a reliable developmental sequence of social-communicative skills in infants with typical development. In Study 2, we explored the emergence sequence of social-communicative skills of 23 children with autism and 23 children with developmental delay between the ages of 2 and 4 years. The results demonstrated that the developmental sequence of social-communicative skills in young children with autism and children with developmental delays was different.

Development of T-STAT for early autism screening.

This study's purpose was to modify the Screening Tool for Autism in Two-Year-Olds (STAT) into a Taiwanese version called T-STAT. Study 1 included 15 children with Autism and 15 children with Developmental Delay (DD) or language impairment (LI) aged between 24 and 35 months. Study 2 had 77 young children with Autism, PDD-NOS, or DD/LI as a clinical-based validation sample. In Study 1, the signal detection procedure found that a cutoff score of 2 would yield high sensitivity and specificity in T-STAT. In Study 2, using a score of 2 as a cutoff, the agreement between T-STAT risk and ADOS classification was highly acceptable. Results were promising as a Level 2 screening tool for Autism for ages two to three.

Nonverbal communication skills in young children with autism.

OBJECTIVE: The study was to examine nonverbal communication in young children with autism. METHODS: The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18-20-month-old, and 22 13-15-month-old typically developing toddlers and infants. The abbreviated Early Social Communication Scales [Mundy et al. 1996, Early social communication scales (ESCS)] were used to test three types of nonverbal communicative skills, i.e., joint attention, requesting, and social interaction. Both frequency and proportion analyses were done in group comparisons. RESULTS: (1) Two- to three-year-old children with autism displayed deficits in joint attention ability, especially high-level skills. (2) The deficit in terms of frequency of communication was marked even compared with typically developing infants with younger mental age. (3) Young children with autism had different nonverbal communication profile compared with all three comparison groups. CONCLUSION: Early social-communicative difficulties in autism involve early triadic communications involving joint attention and possibly dyadic turn-taking skills, which has implications for both early screening and early intervention.