A wearable device-enabled therapeutic approach to improve joint attention in autism spectrum disorder: a prospective pilot study.

It has been previously proposed that interventions aimed at integrating and co-activating music processing and motor control systems could have therapeutic potential for priming social skill development in children with autism spectrum disorder (ASD). In this study, we assessed this hypothesis through a wearable sensor platform called Ambulosono ("Ambulo"-walk; "sono"-sound) in which pleasurable children's musical stimuli are contingently linked to effortful motor action (locomotor step size), thus creating a motivational state proposed to be conducive to joint attention (JA) operation. Five participants were recruited from a community-based partner and were assessed by scoring responses following therapist-directed bids for JA. Multiple assessment sessions through a repeated time-series design were conducted to determine baseline and post-intervention scores. The intervention session consisted of approximately 15 min of Ambulosono exposure. Baseline and post-intervention data were aggregated and analyzed using a linear mixed-effect model. The wearable sensor and wireless headphones of the Ambulosono system were tolerated by the participants, and there were no adverse effects associated with the use of the device. We found an increase in the average responses to bids for JA during the Ambulosono intervention phase compared to baseline across participants. This increase did not appear to result from enhanced general arousal. Our pilot data support feasibility and further testing of Ambulosono as a therapeutic aid for integration into community-based ASD programs to augment shared child-therapist social interactions.

Understanding the Needs of Autistic Post-Secondary Students.

Autistic students are a growing subgroup within post-secondary schooling; however, little is known about barriers to their success in that context. Research suggests autistic students face more challenges to completing post-secondary education than neurotypical students, but findings often rely on expert opinion and fail to incorporate first-hand perspectives. To address this gap, a qualitative inquiry into barriers to success for autistic post-secondary students was conducted. Thematic Analysis yielded 10 themes in three categories, while two separate cross-cutting themes emerged; themes interact with one another, intensifying concerns of autistic students. Findings can support post-secondary institutions to reflect on the extent to which these barriers are present for their autistic students and modify support services accordingly.

Variables Associated With Successful Treatment Outcomes of Autistic Youth Enrolled in PEERS.

This study sought to examine how certain variables of autistic youth who completed a formal social intervention program (PEERS) predicted social skill improvement post intervention. Specifically, this research aimed to determine if age, gender, emotional intelligence, intellectual ability, and/or autism symptomatology predicted social skill outcomes. Using extant data from parent and self-report batteries, change scores and multiple regressions were employed to examine which variables accounted for social skill improvement. Only intellectual ability (FSIQ), specifically perceptual reasoning, significantly predicted social skill outcomes based upon teen self-report, suggesting that autistic youth with specific cognitive profiles may be benefit more from PEERS. This research also exemplifies the heterogeneous nature of autism symptomology and the continued need for research examining social skill interventions. Limitations and future directions are discussed.

Autism interest intensity in early childhood associates with executive functioning but not reward sensitivity or anxiety symptoms.

LAY ABSTRACT: Personal interests in autism are a source of joy, pride, and assist with the formation of social relationships. However, highly intense engagement can also interfere with other activities including activities of daily living. Theories have suggested that intense interests relate to executive functioning, reward sensitivity, and anxiety symptoms; but none of these theories have been tested in early childhood. Understanding which behavioral traits relate to intense interests in early childhood could help understand how intense interests may emerge, while also providing clues for how to manage interest intensity and best promote the many benefits of personal interests. We recruited families with autistic and non-autistic children aged 3-6 years. Parents completed questionnaires to assess children's interest diversity and intensity, executive functioning, reward sensitivity, and anxiety symptoms. We found that for autistic and non-autistic children, greater difficulty shifting attention between activities related to more intense interests. In autistic children only, difficulty with inhibitory control of attention also related to more intense interests. However, reward sensitivity and anxiety symptoms did not relate to interest intensity. Based on these observations, assisting young children with developing executive functioning skills could help with mediating the interference of interests in daily life to ultimately promote the many benefits of personal interests.

Tactile cortical responses and association with tactile reactivity in young children on the autism spectrum.

BACKGROUND: Unusual behavioral reactions to sensory stimuli are frequently reported in individuals on the autism spectrum (AS). Despite the early emergence of sensory features (< age 3) and their potential impact on development and quality of life, little is known about the neural mechanisms underlying sensory reactivity in early childhood autism. METHODS: Here, we used electroencephalography (EEG) to investigate tactile cortical processing in young children aged 3-6 years with autism and in neurotypical (NT) children. Scalp EEG was recorded from 33 children with autism, including those with low cognitive and/or verbal abilities, and 45 age- and sex-matched NT children during passive tactile fingertip stimulation. We compared properties of early and later somatosensory-evoked potentials (SEPs) and their adaptation with repetitive stimulation between autistic and NT children and assessed whether these neural measures are linked to "real-world" parent-reported tactile reactivity. RESULTS: As expected, we found elevated tactile reactivity in children on the autism spectrum. Our findings indicated no differences in amplitude or latency of early and mid-latency somatosensory-evoked potentials (P50, N80, P100), nor adaptation between autistic and NT children. However, latency of later processing of tactile information (N140) was shorter in young children with autism compared to NT children, suggesting faster processing speed in young autistic children. Further, correlational analyses and exploratory analyses using tactile reactivity as a grouping variable found that enhanced early neural responses were associated with greater tactile reactivity in autism. LIMITATIONS: The relatively small sample size and the inclusion of a broad range of autistic children (e.g., with low cognitive and/or verbal abilities) may have limited our power to detect subtle group differences and associations. Hence, replications are needed to verify these results. CONCLUSIONS: Our findings suggest that electrophysiological somatosensory cortex processing measures may be indices of "real-world" tactile reactivity in early childhood autism. Together, these findings advance our understanding of the neurophysiological mechanisms underlying tactile reactivity in early childhood autism and, in the clinical context, may have therapeutic implications.

Feeding and eating problems in children and adolescents with autism: A scoping review.

LAY ABSTRACT: Feeding problems, such as picky eating and food avoidance, are common in youth with autism. Other, broader difficulties with feeding and eating (eating disorder symptoms such as restricting food intake or preoccupation with body shape or weight and insistence on specific food presentation) are also common in autistic individuals. Here, we describe the nature and extent of feeding and eating problems in youth with autism. We found no common characteristics (such as severity of autism symptoms) that best describe autistic youth who experience problems with feeding or eating. Almost all studies we reviewed focused on problems with feeding (selective or picky eating), and only a few studies focused on eating disorder symptoms (concern with weight, shape, and/or body image). However, some researchers reported that eating disorder symptoms may occur more often in autistic individuals compared to their peers without autism. Many studies used the terms "feeding" and "eating" problems interchangeably, but understanding the difference between these problems is important for researchers to be consistent, as well as for proper identification and treatment. We suggest future researchers use "eating problems" when behaviors involve preoccupation with food, eating, or body image, and "feeding problems" when this preoccupation is absent. We highlight the importance of understanding whether feeding or eating problems are separate from autism traits, and the role of caregivers and other adults in the child's treatment. Considerations for health-care providers to assist with diagnosis and treatment are also provided.

Learning with individual-interest outcomes in Autism Spectrum Disorder.

Recent work has suggested atypical neural reward responses in individuals with Autism Spectrum Disorder (ASD), particularly for social reinforcers. Less is known about neural responses to restricted interests and few studies have investigated response to rewards in a learning context. We investigated neurophysiological differences in reinforcement learning between adolescents with ASD and typically developing (TD) adolescents (27 ASD, 31 TD). FMRI was acquired during a learning task in which participants chose one of two doors to reveal an image outcome. Doors differed in their probability of showing liked and not-liked images, which were individualized for each participant. Participants chose the door paired with liked images, but not the door paired with not-liked images, significantly above chance and choice allocation did not differ between groups. Interestingly, participants with ASD made choices less consistent with their initial door preferences. We found a neural prediction-error response at the time of outcome in the ventromedial prefrontal and posterior cingulate cortices that did not differ between groups. Together, behavioural and neural findings suggest that learning with individual interest outcomes is not different between individuals with and without ASD, adding to our understanding of motivational aspects of ASD.

Reduced White Matter Fiber Density in Autism Spectrum Disorder.

Differences in brain networks and underlying white matter abnormalities have been suggested to underlie symptoms of autism spectrum disorder (ASD). However, robustly characterizing microstructural white matter differences has been challenging. In the present study, we applied an analytic technique that calculates structural metrics specific to differently-oriented fiber bundles within a voxel, termed "fixels". Fixel-based analyses were used to compare diffusion-weighted magnetic resonance imaging data from 25 individuals with ASD (mean age = 16.8 years) and 27 typically developing age-matched controls (mean age = 16.9 years). Group comparisons of fiber density (FD) and bundle morphology were run on a fixel-wise, tract-wise, and global white matter (GWM) basis. We found that individuals with ASD had reduced FD, suggestive of decreased axonal count, in several major white matter tracts, including the corpus callosum (CC), bilateral inferior frontal-occipital fasciculus, right arcuate fasciculus, and right uncinate fasciculus, as well as a GWM reduction. Secondary analyses assessed associations with social impairment in participants with ASD, and showed that lower FD in the splenium of the CC was associated with greater social impairment. Our findings suggest that reduced FD could be the primary microstructural white matter abnormality in ASD.

Largely Typical Electrophysiological Affective Responses to Special Interest Stimuli in Adolescents with Autism Spectrum Disorder.

Circumscribed interests are a symptom of autism spectrum disorder (ASD) that may be related to exaggerated affective neural responses. However, the use of generic ASD-interest image stimuli has left an open question as to whether affective responses towards individual interests are greater in ASD compared to typically developing (TD) controls. We compared amplitudes of the late positive potential (LPP), an affective electroencephalographic response, between adolescents with ASD (N = 19) and TD adolescents (N = 20), using images tailored to individual likes and dislikes. We found an LPP response for liked and disliked images, relative to neutral, with no difference in amplitude between groups. This suggests that the LPP is not atypical in adolescents with ASD towards images of individual interests.

The relation between emotional intelligence and resilience in at-risk populations.

PURPOSE: Resilience factors and their relation to emotional intelligence (EI) as a potential strength for children with attention-deficit/hyperactivity disorder (ADHD) or high-functioning autism spectrum disorder (HFASD) were investigated. Children with either ADHD or HFASD were hypothesized to demonstrate reduced EI and differential relations between EI and resilience as compared to typically developing (TD) children. METHODS: Fifty-four children aged 8-12 years (18 with ADHD, 18 with HFASD, and 18 TD controls) completed the Resilience Scales for Children and Adolescents and BarOn Emotional Quotient Inventory. Differences between groups (analysis of variance) and unique relations among the variables (correlation) for each group were examined. RESULTS: No group differences; however, unique relations between the variables were found within each sample. CONCLUSIONS: EI may be a unique area of interest for clinical populations and an important consideration in the development and implementation of interventions to capitalize upon inherent strengths. Implications of these results for intervention are discussed.

Reinforcement Learning in Autism Spectrum Disorder.

Early behavioral interventions are recognized as integral to standard care in autism spectrum disorder (ASD), and often focus on reinforcing desired behaviors (e.g., eye contact) and reducing the presence of atypical behaviors (e.g., echoing others' phrases). However, efficacy of these programs is mixed. Reinforcement learning relies on neurocircuitry that has been reported to be atypical in ASD: prefrontal-sub-cortical circuits, amygdala, brainstem, and cerebellum. Thus, early behavioral interventions rely on neurocircuitry that may function atypically in at least a subset of individuals with ASD. Recent work has investigated physiological, behavioral, and neural responses to reinforcers to uncover differences in motivation and learning in ASD. We will synthesize this work to identify promising avenues for future research that ultimately can be used to enhance the efficacy of early intervention.

Circumscribed interests in adolescents with Autism Spectrum Disorder: A look beyond trains, planes, and clocks.

Adolescence is a unique developmental period, characterized by physical and emotional growth and significant maturation of cognitive and social skills. For individuals with Autism Spectrum Disorder (ASD), it is also a vulnerable period as cognitive and social skills can deteriorate. Circumscribed interests (CIs), idiosyncratic areas of intense interest and focus, are a core symptom of ASD that may be associated with social development. Yet, relatively little is known about the expression of CIs in adolescents with ASD. Many studies investigating CIs have used images depicting items of special interest; however, it is not clear how images should be customized for adolescent studies. The goal of this study was to gain insight into the types of images that may be appropriate for studies of CIs in adolescents with ASD. To this end, we used a mixed methods design that included, 1) one-on-one interviews with 10 adolescents (4 with ASD and 6 TD), to identify categories of images that were High Autism Interest ('HAI') or High Typically Developing Interest ('HTD'), and 2) an online survey taken by fifty-three adolescents with ASD (42 male) and 135 typically developing (TD) adolescents (55 male) who rated how much they liked 105 'HAI' and 'HTD' images. Although we found a significant interaction between 'HAI' and 'HTD' categories and diagnosis, neither group significantly preferred one category over the other, and only one individual category ('Celebrities') showed a significant group effect, favored by TD adolescents. Males significantly preferred 'HAI' images relative to females, and TD adolescents significantly preferred images with social content relative to adolescents with ASD. Our findings suggest that studies investigating affective or neural responses to CI-related stimuli in adolescents should consider that stereotypical ASD interests (e.g. trains, gadgets) may not accurately represent individual adolescents with ASD, many of whom show interests that overlap with TD adolescents (e.g. video games).

Resilience and emotional intelligence in children with high-functioning autism spectrum disorder.

PURPOSE: This article presents the results of an investigation of resilience factors and their relation to emotional intelligence (EI) as an area of potential strength for children with high-functioning autism spectrum disorder (HFASD). Based upon previous research with young adults, it was hypothesized that children with HFASD would demonstrate reduced EI and differential relations between EI and resilience as compared to typically developing (TD) children. METHODS: Forty children aged 8-12 years (20 with HFASD and 20 TD control children) completed measures of resilience and EI. RESULTS: Children with HFASD did not significantly differ from TD children on either measure. However, several significant correlations between resilience and EI were found in the HFASD sample. CONCLUSIONS: The findings suggest that EI may be a unique area of interest for this population, particularly for interventions that propose to capitalize upon potentially inherent strengths. Implications of these results for intervention are discussed.

Pivotal response treatment for children with autism spectrum disorder: a systematic review of research quality.

OBJECTIVE: Research has indicated support for pivotal response treatment (PRT) as an effective, efficacious and naturalistic intervention for communication and social functioning of children with autism spectrum disorder (ASD). Previously not undertaken, this article describes a systematic evaluation of the adherence of PRT research studies to standards of ASD research quality. METHOD: A systematic search was conducted on two databases. Seventeen PRT studies were evaluated on their use of seven specified research standards. RESULTS: Strong adherence to research quality standards was demonstrated in the use of standardized protocols, systematic application of intervention procedures, inter-rater reliability and objective evaluators. Variation was found in adherence to treatment fidelity standards and in the use of longitudinal designs. Only two studies implemented comparison designs. CONCLUSION: It is recommended that researchers compare interventions, use longitudinal designs, better describe their methodology and implement greater adherence to treatment fidelity to enhance research quality and strengthen conclusions.

Hot dogs and zavy cats: preschoolers' and adults' expectations about familiar and novel adjectives.

In recent years, a growing body of research has begun to examine the processes that underlie young children's acquisition of adjectival meanings. In the present studies, we examined whether preschoolers' willingness to extend adjectives was influenced by the type of property labeled by familiar adjectives (Experiment 1) and by semantic information conveyed in the sentence used to introduce novel adjectives (Experiment 2). In Experiment 1, we examined preschoolers' and adults' expectations about the generalizability of familiar adjectives of three different types: emotional state terms, physiological state terms, and stable trait terms. On each trial, we labeled a target animal with one of the three different types of adjectives and asked whether these terms could apply to a subordinate-level match, a basic-level match, a superordinate-level match, or an inanimate object. Results indicated that 4-year-olds and adults extended the trait terms, but not the emotional or physiological terms, to members of the same basic-level category. In Experiment 2, we presented 4-year-olds and adults with novel adjectives in one of two verb frames: stable ("This X is very daxy") or transient ("This X feels very daxy"). Participants were more likely to extend the novel adjective to subordinate matches if they were in the Stable frame group than if they were in the Transient frame group. These findings are discussed in terms of implications for young children's expectations about familiar and novel adjectives.