Continuous measurement of attachment behavior: A multimodal view of the strange situation procedure.

Infant attachment is a critical indicator of healthy infant social-emotional functioning, which is typically measured using the gold-standard Strange Situation Procedure (SSP). However, expert-based attachment classifications from the SSP are time-intensive (with respect both to expert training and rating), and do not provide an objective, continuous record of infant behavior. To continuously quantify predictors of key attachment behaviors and dimensions, multimodal movement and audio data were collected during the SSP. Forty-nine 1-year-olds and their mothers participated in the SSP and were tracked in three-dimensional space using five synchronized Kinect sensors; LENA recordings were used to quantify crying duration. Theoretically-informed multimodal measures of attachment-related behavior (e.g., dyadic contact duration, infant velocity of approach toward the mother, and infant crying) were used to predict expert rating scales and dimensional summaries of attachment outcomes. Stepwise regressions identified sets of multimodal objective measures that were significant predictors of eight of nine of the expert ratings of infant attachment behaviors in the SSP's two reunions. These multimodal measures predicted approximately half of the variance in the summary approach/avoidance and resistance/disorganization attachment dimensions. Incorporating all objective measures as predictors regardless of significance levels, predicted individual ratings within an average of one point on the original Likert scales. The results indicate that relatively inexpensive Kinect and LENA sensors can be harnessed to quantify attachment behavior in a key assessment protocol, suggesting the promise of objective measurement to understanding infant-parent interaction.

Detection of eye contact with deep neural networks is as accurate as human experts.

Eye contact is among the most primary means of social communication used by humans. Quantification of eye contact is valuable as a part of the analysis of social roles and communication skills, and for clinical screening. Estimating a subject's looking direction is a challenging task, but eye contact can be effectively captured by a wearable point-of-view camera which provides a unique viewpoint. While moments of eye contact from this viewpoint can be hand-coded, such a process tends to be laborious and subjective. In this work, we develop a deep neural network model to automatically detect eye contact in egocentric video. It is the first to achieve accuracy equivalent to that of human experts. We train a deep convolutional network using a dataset of 4,339,879 annotated images, consisting of 103 subjects with diverse demographic backgrounds. 57 subjects have a diagnosis of Autism Spectrum Disorder. The network achieves overall precision of 0.936 and recall of 0.943 on 18 validation subjects, and its performance is on par with 10 trained human coders with a mean precision 0.918 and recall 0.946. Our method will be instrumental in gaze behavior analysis by serving as a scalable, objective, and accessible tool for clinicians and researchers.

Intermittent high-flux albumin dialysis with continuous venovenous hemodialysis for acute-on-chronic liver failure and acute kidney injury.

Acute-on-chronic liver failure (ACLF) requiring intensive medical care and associated with acute kidney injury (AKI) has a mortality rate as high as 90% due to the lack of effective therapies. In this study, we assessed the effects of intermittent high-flux single-pass albumin dialysis (SPAD) coupled with continuous venovenous hemodialysis (CVVHD) on 28-day and 90-day survival and an array of clinical and laboratory parameters in patients with severe ACLF and renal insufficiency. Sixteen patients were studied. The diagnosis of ACLF and AKI was made in accordance with current EASL Clinical Practice Guidelines, including the recommendations of the International Club of Ascites. All patients received SPAD/CVVHD treatments as the blood purification therapy to support liver, kidneys, and other organs. Five patients were transplanted and 11 were not listed for transplantation because of active alcoholism. Data at the initiation of SPAD/CVVHD were compared with early morning data after the termination of the extracorporeal treatment phase. All patients had ACLF and renal insufficiency with 13/16 additionally fulfilling the AKI criteria. A total of 37 SPAD/CVVHD treatments were performed [2.3 ± 1.4]. The baseline MELD-Na score was 37.6 ± 6.6 and decreased to 33.4 ± 8.7 after SPAD/CVVHD (P < 0.001). In parallel, the CLIF-C ACLF grade and OF score, estimated at 28- and 90-day mortality, AKI stage, hepatic encephalopathy grade, and liver function tests were lowered (P = 0.001-0.032). The 28- and 90-day survivals were 56.2% overall and 53.8% in AKI. Survival in patients not transplanted (n = 11) was 45.4%. In patients with severe ACLF and AKI, the renal replacement therapy coupled with high-performance albumin dialysis improved estimated 28- and 90-day survival and several key clinical and laboratory parameters. It is postulated that these results may be further improved with earlier intervention and more SPAD treatments per patient. High-performance albumin dialysis improves survival and key clinical and laboratory parameters in severe ACLF and AKI.

Modeling multiple time series annotations as noisy distortions of the ground truth: An Expectation-Maximization approach.

Studies of time-continuous human behavioral phenomena often rely on ratings from multiple annotators. Since the ground truth of the target construct is often latent, the standard practice is to use ad-hoc metrics (such as averaging annotator ratings). Despite being easy to compute, such metrics may not provide accurate representations of the underlying construct. In this paper, we present a novel method for modeling multiple time series annotations over a continuous variable that computes the ground truth by modeling annotator specific distortions. We condition the ground truth on a set of features extracted from the data and further assume that the annotators provide their ratings as modification of the ground truth, with each annotator having specific distortion tendencies. We train the model using an Expectation-Maximization based algorithm and evaluate it on a study involving natural interaction between a child and a psychologist, to predict confidence ratings of the children's smiles. We compare and analyze the model against two baselines where: (i) the ground truth in considered to be framewise mean of ratings from various annotators and, (ii) each annotator is assumed to bear a distinct time delay in annotation and their annotations are aligned before computing the framewise mean.

Representing Sudden Shifts in Intensive Dyadic Interaction Data Using Differential Equation Models with Regime Switching.

A growing number of social scientists have turned to differential equations as a tool for capturing the dynamic interdependence among a system of variables. Current tools for fitting differential equation models do not provide a straightforward mechanism for diagnosing evidence for qualitative shifts in dynamics, nor do they provide ways of identifying the timing and possible determinants of such shifts. In this paper, we discuss regime-switching differential equation models, a novel modeling framework for representing abrupt changes in a system of differential equation models. Estimation was performed by combining the Kim filter (Kim and Nelson State-space models with regime switching: classical and Gibbs-sampling approaches with applications, MIT Press, Cambridge, 1999) and a numerical differential equation solver that can handle both ordinary and stochastic differential equations. The proposed approach was motivated by the need to represent discrete shifts in the movement dynamics of [Formula: see text] mother-infant dyads during the Strange Situation Procedure (SSP), a behavioral assessment where the infant is separated from and reunited with the mother twice. We illustrate the utility of a novel regime-switching differential equation model in representing children's tendency to exhibit shifts between the goal of staying close to their mothers and intermittent interest in moving away from their mothers to explore the room during the SSP. Results from empirical model fitting were supplemented with a Monte Carlo simulation study to evaluate the use of information criterion measures to diagnose sudden shifts in dynamics.

A short-term longitudinal study of correlates and sequelae of attachment security in autism.

In this short-term longitudinal study, 30 preschool-aged children with autism were first observed in Ainsworth's Strange Situation Procedure and, separately, interacting with the primary caregiver in the home. One year later, each child completed both a developmental assessment and an observational assessment of empathic responding. Behaviors typical for children with autism were distinguished from behaviors suggestive of relationally based attachment disorganization. Forty-five percent of the children were classified as securely attached. The secure group demonstrated language skills superior to those of the insecurely attached group, concurrently and during the follow-up. Compared to parents of children who were insecurely attached, parents of securely attached children were rated as more sensitive. Compared to both organized insecure and disorganized children, secure children were rated as more responsive to an examiner's apparent distress during the follow-up relative to their ratings at intake, whereas empathy ratings of children with insecure classifications did not increase. Importantly, attachment security was associated with empathy above and beyond the contribution of children's language level. These results indicate that the sequelae of attachment security in autism may be similar to those documented for typically developing children.

Brief Report: Using a Point-of-View Camera to Measure Eye Gaze in Young Children with Autism Spectrum Disorder During Naturalistic Social Interactions: A Pilot Study.

Children with autism spectrum disorder (ASD) show reduced gaze to social partners. Eye contact during live interactions is often measured using stationary cameras that capture various views of the child, but determining a child's precise gaze target within another's face is nearly impossible. This study compared eye gaze coding derived from stationary cameras to coding derived from a "point-of-view" (PoV) camera on the social partner. Interobserver agreement for gaze targets was higher using PoV cameras relative to stationary cameras. PoV camera codes, but not stationary cameras codes, revealed a difference between gaze targets of children with ASD and typically developing children. PoV cameras may provide a more sensitive method for measuring eye contact in children with ASD during live interactions.

Increased Eye Contact During Conversation Compared to Play in Children With Autism.

Children with autism have atypical gaze behavior but it is unknown whether gaze differs during distinct types of reciprocal interactions. Typically developing children (N = 20) and children with autism (N = 20) (4-13 years) made similar amounts of eye contact with an examiner during a conversation. Surprisingly, there was minimal eye contact during interactive play in both groups. Gaze behavior was stable across 8 weeks in children with autism (N = 15). Lastly, gaze behavior during conversation but not play was associated with autism social affect severity scores (ADOS CSS SA) and the Social Responsiveness Scale (SRS-2). Together findings suggests that eye contact in typical and atypical development is influenced by subtle changes in context, which has implications for optimizing assessments of social communication skills.

Investigating the accuracy of a novel telehealth diagnostic approach for autism spectrum disorder.

Research indicates that a substantial amount of time elapses between parents' first concerns about their child's development and a formal diagnosis of autism spectrum disorder (ASD). Telehealth presents an opportunity to expedite the diagnostic process. This project compared a novel telehealth diagnostic approach that utilizes clinically guided in-home video recordings to the gold standard in-person diagnostic assessment. Participants included 40 families seeking an ASD evaluation for their child and 11 families of typically developing children. Children were between the ages of 18 months and 6 years 11 months; mean adaptive behavior composite = 75.47 (SD = 15.94). All parent participants spoke English fluently. Families completed the Naturalistic Observation Diagnostic Assessment (NODA) for ASD, which was compared to an in-person assessment (IPA). Agreement between the 2 methods, as well as sensitivity, specificity, and interrater reliability, were calculated for the full sample and the subsample of families seeking an ASD evaluation. Diagnostic agreement between NODA and the IPA was 88.2% (κ = 0.75) in the full sample and 85% (κ = 0.58) in the subsample. Sensitivity was 84.9% in both, whereas specificity was 94.4% in the full sample and 85.7% in the subsample. Kappa coefficients for interrater reliability indicated 85% to 90% accuracy between raters. NODA utilizes telehealth technology for families to share information with professionals and provides a method to inform clinical judgment for a diagnosis of ASD. Due to the high level of agreement with the IPA in this sample, NODA has potential to improve the efficiency of the diagnostic process for ASD. (PsycINFO Database Record

A Novel System for Supporting Autism Diagnosis Using Home Videos: Iterative Development and Evaluation of System Design.

BACKGROUND: Observing behavior in the natural environment is valuable to obtain an accurate and comprehensive assessment of a child's behavior, but in practice it is limited to in-clinic observation. Research shows significant time lag between when parents first become concerned and when the child is finally diagnosed with autism. This lag can delay early interventions that have been shown to improve developmental outcomes. OBJECTIVE: To develop and evaluate the design of an asynchronous system that allows parents to easily collect clinically valid in-home videos of their child's behavior and supports diagnosticians in completing diagnostic assessment of autism. METHODS: First, interviews were conducted with 11 clinicians and 6 families to solicit feedback from stakeholders about the system concept. Next, the system was iteratively designed, informed by experiences of families using it in a controlled home-like experimental setting and a participatory design process involving domain experts. Finally, in-field evaluation of the system design was conducted with 5 families of children (4 with previous autism diagnosis and 1 child typically developing) and 3 diagnosticians. For each family, 2 diagnosticians, blind to the child's previous diagnostic status, independently completed an autism diagnosis via our system. We compared the outcome of the assessment between the 2 diagnosticians, and between each diagnostician and the child's previous diagnostic status. RESULTS: The system that resulted through the iterative design process includes (1) NODA smartCapture, a mobile phone-based application for parents to record prescribed video evidence at home; and (2) NODA Connect, a Web portal for diagnosticians to direct in-home video collection, access developmental history, and conduct an assessment by linking evidence of behaviors tagged in the videos to the Diagnostic and Statistical Manual of Mental Disorders criteria. Applying clinical judgment, the diagnostician concludes a diagnostic outcome. During field evaluation, without prior training, parents easily (average rating of 4 on a 5-point scale) used the system to record video evidence. Across all in-home video evidence recorded during field evaluation, 96% (26/27) were judged as clinically useful, for performing an autism diagnosis. For 4 children (3 with autism and 1 typically developing), both diagnosticians independently arrived at the correct diagnostic status (autism versus typical). Overall, in 91% of assessments (10/11) via NODA Connect, diagnosticians confidently (average rating 4.5 on a 5-point scale) concluded a diagnostic outcome that matched with the child's previous diagnostic status. CONCLUSIONS: The in-field evaluation demonstrated that the system's design enabled parents to easily record clinically valid evidence of their child's behavior, and diagnosticians to complete a diagnostic assessment. These results shed light on the potential for appropriately designed telehealth technology to support clinical assessments using in-home video captured by families. This assessment model can be readily generalized to other conditions where direct observation of behavior plays a central role in the assessment process.

Undifferentiated facial electromyography responses to dynamic, audio-visual emotion displays in individuals with autism spectrum disorders.

We examined facial electromyography (fEMG) activity to dynamic, audio-visual emotional displays in individuals with autism spectrum disorders (ASD) and typically developing (TD) individuals. Participants viewed clips of happy, angry, and fearful displays that contained both facial expression and affective prosody while surface electrodes measured corrugator supercilli and zygomaticus major facial muscle activity. Across measures of average and peak activity, the TD group demonstrated emotion-selective fEMG responding, with greater relative activation of the zygomatic to happy stimuli and greater relative activation of the corrugator to fearful stimuli. In contrast, the ASD group largely showed no significant differences between zygomatic and corrugator activity across these emotions. There were no group differences in the magnitude and timing of fEMG response in the muscle congruent to the stimuli. This evidence that fEMG responses in ASD are undifferentiated with respect to the valence of the stimulus is discussed in light of potential underlying neurobiological mechanisms.

Infants' pre-empathic behaviors are associated with language skills.

Infants' responses to other people's distress reflect efforts to make sense of affective information about another person and apply it to oneself. This study sought to determine whether 12-month olds' responses to another person's display of negative affect reflect characteristics that support social learning and predict social functioning and language skills at 36 months. Measures of infants' responsiveness include congruent changes in affect and looking time to the person in distress. Attention to the examiner displaying positive affect, analyzed as a control condition, was not related to social functioning or language skills at 36 months. Neither attention nor affective response to the examiner's distress at 12 months was related to social functioning at 36 months. However, longer time spent looking at the examiner feigning distress predicted higher language scores. Moreover, infants who demonstrated a congruent affective response to distress had higher receptive language scores at 36 months than children who did not respond affectively. Importantly, these relations were not mediated by maternal education, household income, or 12-month verbal skills. These findings are consistent with the notion that adaptation to changes in a social partner's affective state supports an infants' ability to glean useful information from interactions with more experienced social partners. Infants' sensitivity to affective signals may thus be related to the ability to interpret other people's behavior and to achieve interpersonal understanding through language.

Imitation from 12 to 24 months in autism and typical development: a longitudinal Rasch analysis.

The development of imitation during the second year of life plays an important role in domains of sociocognitive development such as language and social learning. Deficits in imitation ability in persons with autism spectrum disorder (ASD) from toddlerhood into adulthood have also been repeatedly documented, raising the possibility that early disruptions in imitation contribute to the onset of ASD and the deficits in language and social interaction that define the disorder. This study prospectively examined the development of imitation between 12 and 24 months of age in 154 infants at familial risk for ASD and 78 typically developing infants who were all later assessed at 36 months for ASD or other developmental delays. The study established a developmental measure of imitation ability and examined group differences over time, using an analytic Rasch measurement model. Results revealed a unidimensional latent construct of imitation and verified a reliable sequence of imitation skills that was invariant over time for all outcome groups. Results also showed that all groups displayed similar significant linear increases in imitation ability between 12 and 24 months and that these increases were related to individual growth in both expressive language and ratings of social engagement but not in fine motor development. The group of children who developed ASD by age 3 years exhibited delayed imitation development compared with the low-risk typical outcome group across all time-points, but were indistinguishable from other high-risk infants who showed other cognitive delays not related to ASD.

Behavioral profiles of affected and unaffected siblings of children with autism: contribution of measures of mother-infant interaction and nonverbal communication.

We investigated whether deficits in social gaze and affect and in joint attention behaviors are evident within the first year of life among siblings of children with autism who go on to be diagnosed with autism or ASD (ASD) and siblings who are non-diagnosed (NoASD-sib) compared to low-risk controls. The ASD group did not differ from the other two groups at 6 months of age in the frequency of gaze, smiles, and vocalizations directed toward the caregiver, nor in their sensitivity to her withdrawal from interaction. However, by 12 months, infants in the ASD group exhibited lower rates of joint attention and requesting behaviors. In contrast, NoASD-sibs did not differ from comparison infants on any variables of interest at 6 and 12 months.

Response to distress in infants at risk for autism: a prospective longitudinal study.

BACKGROUND: Infants and preschoolers with ASD show impairment in their responses to other people's distress relative to children with other developmental delays and typically developing children. This deficit is expected to disrupt social interactions, social learning, and the formation of close relationships. Response to distress has not been evaluated previously in infants with ASD earlier than 18 months of age. METHODS: Participants were 103 infant siblings of children with autism and 55 low-risk controls. All children were screened for ASD at 36 months and 14 were diagnosed with ASD. Infants' responsiveness to distress was evaluated at 12, 18, 24, and 36 months. An examiner pretended to hit her finger with a toy mallet and infants' responses were video-recorded. Attention to the examiner and congruent changes in affect were coded on four-point Likert scales. RESULTS: Cross-sectional and longitudinal analyses confirm that the ASD group paid less attention and demonstrated less change in affect in response to the examiner's distress relative to the high-risk and low-risk participants who were not subsequently diagnosed with ASD. Group differences remained when verbal skills and general social responsiveness were included in the analytic models. CONCLUSIONS: Diagnostic groups differ on distress response from 12 to 36 months of age. Distress-response measures are predictive of later ASD diagnosis above and beyond verbal impairments. Distress response is a worthwhile target for early intervention programs.

A prospective study of the emergence of early behavioral signs of autism.

OBJECTIVE: To examine prospectively the emergence of behavioral signs of autism in the first years of life in infants at low and high risk for autism. METHOD: A prospective longitudinal design was used to compare 25 infants later diagnosed with an autism spectrum disorder (ASD) with 25 gender-matched low-risk children later determined to have typical development. Participants were evaluated at 6, 12, 18, 24, and 36 months of age. Frequencies of gaze to faces, social smiles, and directed vocalizations were coded from video and rated by examiners. RESULTS: The frequency of gaze to faces, shared smiles, and vocalizations to others were highly comparable between groups at 6 months of age, but significantly declining trajectories over time were apparent in the group later diagnosed with ASD. Group differences were significant by 12 months of age on most variables. Although repeated evaluation documented loss of skills in most infants with ASD, most parents did not report a regression in their child's development. CONCLUSIONS: These results suggest that behavioral signs of autism are not present at birth, as once suggested by Kanner, but emerge over time through a process of diminishment of key social communication behaviors. More children may present with a regressive course than previously thought, but parent report methods do not capture this phenomenon well. Implications for onset classification systems and clinical screening are also discussed.

Play and developmental outcomes in infant siblings of children with autism.

We observed infant siblings of children with autism later diagnosed with ASD (ASD siblings; n = 17), infant siblings of children with autism with and without other delays (Other Delays and No Delays siblings; n = 12 and n = 19, respectively) and typically developing controls (TD controls; n = 19) during a free-play task at 18 months of age. Functional, symbolic, and repeated play actions were coded. ASD siblings showed fewer functional and more non-functional repeated play behaviors than TD controls. Other Delays and No Delays siblings showed more non-functional repeated play than TD controls. Group differences disappeared with the inclusion of verbal mental age. Play as an early indicator of autism and its relationship to the broader autism phenotype is discussed.

A prospective study of response to name in infants at risk for autism.

OBJECTIVE: To assess the sensitivity and specificity of decreased response to name at age 12 months as a screen for autism spectrum disorders (ASD) and other developmental delays. DESIGN: Prospective, longitudinal design studying infants at risk for ASD. SETTING: Research laboratory at university medical center. PARTICIPANTS: Infants at risk for autism (55 six-month-olds, 101 twelve-month-olds) and a control group at no known risk (43 six-month-olds, 46 twelve-month-olds). To date, 46 at-risk infants and 25 control infants have been followed up to 24 months. Intervention Experimental task eliciting response-to-name behavior. MAIN OUTCOME MEASURES: Autism Diagnostic Observation Schedule, Mullen Scales of Early Learning. RESULTS: At age 6 months, there was a nonsignificant trend for control infants to require a fewer number of calls to respond to name than infants at risk for autism. At age 12 months, 100% of infants in the control group "passed," responding on the first or second name call, while 86% in the at-risk group did. Three fourths of children who failed the task were identified with developmental problems at age 24 months. Specificity of failing to respond to name was 0.89 for ASD and 0.94 for any developmental delay. Sensitivity was 0.50 for ASD and 0.39 for any developmental delay. CONCLUSIONS: Failure to respond to name by age 12 months is highly suggestive of developmental abnormality but does not identify all children at risk for developmental problems. Lack of responding to name is not universal among infants later diagnosed with ASD and/or other developmental delays. Poor response to name may be a trait of the broader autism phenotype in infancy.

Early detection of core deficits in autism.

The goal of this review of the research literature is to discuss approaches to the early detection of autism in infancy. Early detection would enable diagnoses to be made before 18 months of age rather than at 24-30 months, the age where diagnoses start to be made now. After summarizing the criteria for a deficit to be considered "core" to the disorder, the literature on research strategies used in early detection is examined. In order to guide the design of future studies, the review then turns to an overview of what is known about the processes of early social development in typically developing children that underlie the domains in which core deficits are manifested in young children with autism. The social domains covered in the review are those that show development in typically developing infants below 18 months of age: dyadic interaction and imitation; emotion discrimination; and attachment. The review concludes that all of these areas are worthy of investigation in young children, particularly those at higher risk of showing some of the core deficits of autism such as the infant siblings of children with autism.