Perceived and Observed Treatment Gains Following PEERS: A Preliminary Study with Latinx Adolescents with ASD.

The Program for the Education and Enrichment of Relational Skills (PEERS) social skills intervention has demonstrated effectiveness for adolescents with autism spectrum disorder (ASD). However, studies have been limited by a lack of objective outcome measures and an underrepresentation of Latinx families. This pilot study extends the PEERS literature by utilizing an observational measure of conversational skills (Contextual Assessment of Social Skills; CASS) with a diverse sample of 13 adolescents with ASD (with parent groups conducted in English and Spanish simultaneously) and a control group of 11 neurotypical adolescents. Consistent with previous research, adolescents with ASD and their parents perceived improvements in social functioning following intervention, which were maintained four months later and corroborated by improvements in conversational skills.

Systemic Racism in EEG Research: Considerations and Potential Solutions.

The current theoretical paper discusses the unintended systemic racism and racial biases that impact neuroscience, specifically in research utilizing electroencephalography (EEG). As a popular technique in affective science research, EEG requires adherence between the electrode and scalp to measure brain activity. To obtain high-quality data, various factors such as hair length, hair type, body movement, and/or extraneous noise from the environment are taken into consideration. As EEG researchers attempt to gather good-quality data, the recruitment and retention of Black American participants is challenging due to hairstyles commonly worn by Black American participants (e.g., cornrows, braids) and hair type. Taken together, the systemic lack of data from Black American participants renders research findings less generalizable and causes disparities in theoretical knowledge applicable to this population. To address this disparity, innovative solutions invented by bioengineers are discussed.

Exploring telehealth during COVID for assessing autism spectrum disorder in a diverse sample.

Due to the coronavirus disease 2019 (COVID-19) pandemic, the importance of telehealth has rapidly increased, in particular as many in-person clinics have closed. Early intervention is crucial for improving outcomes in children with autism spectrum disorder (ASD). As such, the need for timely assessments and diagnoses remains despite COVID-19-related closures. This study offers preliminary data collected from 23 children assessed through a no-cost autism clinic in Southern California using a novel telehealth model. This includes an overview of an adapted, telehealth version of in-person observational assessment techniques for diagnosing autism. In addition, preliminary data on social validity assessed at two points are presented. Findings suggest that caregivers found the telehealth assessment procedures acceptable and convenient, and overall were satisfied with both the assessment and the written report/verbal feedback. Implications for future uses of telehealth are discussed, including how telehealth can assist with decision-making around school-based services and/or placement.

A scoping review of telehealth diagnosis of autism spectrum disorder.

BACKGROUND: Considering the COVID-19 pandemic, understanding the reliability, validity, social validity, and feasibility of using telehealth to diagnose ASD is a critical public health issue. This paper examines evidence supporting the use of telehealth methods to diagnose ASD and outlines the necessary modifications and adaptations to support telehealth diagnosis. METHODS AND PROCEDURES: Studies were identified by searching PubMed and PsychInfo electronic databases and references lists of relevant articles. Only peer reviewed articles published in English with a focus on using telehealth for the purposes of diagnosing ASD were included. Searches were conducted through June 3rd, 2021. OUTCOMES AND RESULTS: A total of 10 studies were identified as meeting inclusion criteria. Of the eight papers that reported on reliability (e.g., accuracy), telehealth methods to diagnose ASD were between 80-91% accurate when compared with traditional in-person diagnosis. Six studies reported on validity (i.e., sensitivity and/or specificity). All six studies calculated sensitivity, with values ranging from 75% and 100%. Five of the six studies calculated specificity, with values ranging from 68.75% and 100%. The seven papers that reported social validity indicated that caregivers, as well as adult participants and clinicians, were mostly satisfied with telehealth. Feasibility was reported by seven studies and suggests that telehealth methods appear largely viable, though some challenges were reported. CONCLUSIONS AND IMPLICATIONS: Although findings reviewed here are promising, more research is needed to verify the accuracy, validity, and feasibility of utilizing telehealth to diagnose ASD. Studies with larger sample sizes and samples across sites will be critical, as these will allow clinicians to identify subjects most likely to benefit from telehealth as well as those more likely to require an in-person assessment. This research is important not only due to the current pandemic, but also due to increased prevalence rates of ASD and an insufficient number of diagnostic providers-particularly in rural and/or otherwise under-served communities.

Brief Report: Emotional and Behavioral Problems Among Young Children with ASD: An Exploratory Study of ADOS E-Codes and Child Characteristics.

Emotional and behavioral problems (EBPs), such as anxiety, overactivity, and aggression, can influence the diagnosis of autism spectrum disorder (ASD). The gold standard diagnostic tool for ASD, the Autism Diagnostic Observation Schedule-Second Edition, includes three items ("E-codes") for EBPs that are frequently associated with ASD. Few empirical investigations have explored the use of E-codes. This study examined the relationship between E-codes and child characteristics (e.g., cognitive abilities, ASD symptom severity) in a sample of young children with ASD (N = 233). Findings indicated that E-codes positively correlated with ASD symptom severity and negatively associated with IQ. Symptom severity also significantly accounted for the variance in EBPs. Implications for ASD assessment as well as future research are discussed.

Investigating Changes in Reward-Related Neural Correlates After PEERS Intervention in Adolescents With ASD: Preliminary Evidence of a "Precision Medicine" Approach.

Background: The Social Motivation Hypothesis proposes that individuals with autism spectrum disorder (ASD) experience social interactions as less rewarding than their neurotypical (TD) peers, which may lead to reduced social initiation. Existing studies of the brain's reward system in individuals with ASD report varied findings for anticipation of and response to social rewards. Given discrepant findings, the anticipation of and response to social rewards should be further evaluated, particularly in the context of intervention outcome. We hypothesized that individual characteristics may help predict neural changes from pre- to post-intervention. Methods: Thirteen adolescents with ASD received the Program for the Education and Enrichment of Relational Skills (PEERS) intervention for 16 weeks; reward-related EEG was collected before and after intervention. Fourteen TD adolescents were tested at two timepoints but did not receive intervention. Event-related potentials were calculated to measure anticipation of (stimulus-preceding negativity; SPN) and response to (reward-related positivity; RewP) social and non-social rewards. Additionally, measures of social responsiveness, social skills, and intervention-engagement were collected. Group differences were analyzed as well as individual differences using prediction models. Result: Parent-reported social responsiveness and social skills improved in adolescents with ASD after participation in PEERS. ASD adolescents displayed marginally decreased anticipation of social rewards at post-intervention compared to pre-intervention. Regression models demonstrated that older adolescents and those with lower parent-reported social motivation prior to participation in PEERS displayed marginally increased social reward anticipation (more robust SPN) from pre- to post-intervention. Participants who displayed more parent-reported social motivation before intervention and were more actively engaged in the PEERS intervention evidenced increased social reward processing (more robust RewP) from pre- to post-intervention. Conclusion: Findings suggest that there may be differences in saliency between wanting/anticipating social rewards vs. liking/responding to social rewards in individuals with ASD. Our findings support the hypothesis that identification of individual differences may predict which adolescents are poised to benefit the most from particular interventions. As such, reported findings set the stage for the advancement of "precision medicine." This investigation is a critical step forward in our ability to understand and predict individual response to interventions in individuals with ASD.

Daily living skills in adolescents with autism spectrum disorder: Implications for intervention and independence.

BACKGROUND: Challenges in adaptive behaviors are present in individuals with autism spectrum disorder (ASD), while variation in IQ, social skills, and comorbidities are possible influences on adaptive behaviors. However, adaptive behaviors do not consistently map onto cognitive abilities in ASD, as high IQ is not protective against challenges in adaptive behaviors. Additionally, individuals with both ASD and elevated levels of externalizing problem behaviors experience even worse adaptive behaviors. Identifying factors that contribute to the variance in adaptive behaviors, particularly daily living skills (DLS), may inform strategies to improve adaptive behaviors necessary for independence in adulthood. METHOD: Adolescents with typical cognitive development (TD, n=84), intellectual disability (ID, n=30), or ASD (n=45) were included in this study to examine group differences in adaptive behaviors, identify relations between IQ and DLS, and determine factors that contribute to variance in DLS at youth age 13. The Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II) was used to measure adaptive behaviors. RESULTS: All domains of adaptive behavior were significantly higher in TD groups compared to ASD and ID youth. Significant positive correlations were observed between IQ and DLS in the ASD and ID groups. In the ASD youth group, higher externalizing behavior problems explained the most variance in DLS. CONCLUSIONS: DLS are below age-expected levels in young adolescents with ASD, in part because of the higher externalizing behavior problems in this group. Incorporating adaptive skills training and behavior management strategies into current interventions may serve to prepare adolescents and families for the transition to adulthood.

Anticipation to Social and Nonsocial Dynamic Cues in Preschool-Age Children.

The ability to learn from expectations is foundational to social and nonsocial learning in children. However, we know little about the brain basis of reward expectation in development. Here, 3- to 4-year-olds (N = 26) were shown a passive associative learning paradigm with dynamic stimuli. Anticipation for reward-related stimuli was measured via the stimulus preceding negativity (SPN). To our knowledge, this is the first study to measure an SPN in children younger than age 6. Our findings reveal distinct anticipatory neural signatures for social versus nonsocial stimuli, consistent with previous research in older children. This study suggests an SPN can be elicited in preschoolers and is larger for social than nonsocial stimuli.

The effects of oxytocin administration on individuals with ASD: Neuroimaging and behavioral evidence.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication and the presence of restricted interests and repetitive behaviors. Although behavioral interventions are numerous, there are no Federal Drug Administration approved pharmacological treatments for the core symptoms of ASD. The neuropeptide oxytocin has been studied in animals for decades, and is involved in pair bonding and social affiliation. Given oxytocin's involvement in social communication in animals, researchers have begun exploring whether oxytocin administration in humans affects social behaviors and attachment. Particular attention has been paid to whether oxytocin has therapeutic benefits for improving social behaviors in individuals with ASD. Research on oxytocin administration in ASD has utilized both behavioral and brain-based outcomes. This chapter reviews the effects of oxytocin administration in ASD, with a focus on functional outcomes from neuroimaging investigations. Evidence of potential therapeutic benefits are reviewed, as well as limitations of extant research. A proposed model for future research into the therapeutic benefits of oxytocin includes combining pharmacological (e.g. oxytocin) and behavioral (e.g. evidence-based behavioral interventions) techniques to improve social communication skills in ASD.

Increased Neural Reward Responsivity in Adolescents with ASD after Social Skills Intervention.

The reward system has been implicated as a potential neural mechanism underlying social-communication deficits in individuals with autism spectrum disorder (ASD). However, it remains unclear whether the neural reward system in ASD is sensitive to behavioral interventions. The current study measured the reward positivity (RewP) in response to social and nonsocial stimuli in seven adolescents with ASD before and after participation in the Program for the Education and Enrichment of Relational Skills (PEERS®) intervention. This study also included seven neurotypical adolescents who were tested at two time points but did not receive intervention. We examined the RewP across the course of a task by comparing brain activity during the first versus second half of trials to understand patterns of responsivity over time. Improvements in social skills and decreased social-communication impairments for teens with ASD were observed after PEERS®. Event-related potential (ERP) results suggested increased reward sensitivity during the first half of trials in the ASD group after intervention. Adolescents with ASD who exhibited less reward-related brain activity before intervention demonstrated the greatest behavioral benefits from the intervention. These findings have implications for how neuroscience can be used as an objective outcome measure before and after intervention in ASD.

Parent and Teacher Reports of Comorbid Anxiety and ADHD Symptoms in Children with ASD.

This study examined the prevalence of ADHD symptoms and anxiety as reported by parents and teachers for 180 preschool children (ages 4-5) and school-aged children (ages 6-7) with ASD using the Child Behavior Checklist-Parent and Teacher Report Forms (Achenbach and Rescorla, Manual for ASEBA school-age forms & profiles, Research Center for Children, Youth, and Families, University of Vermont, Burlington, VT, 2001). Parents reported elevated anxiety symptoms in 31% of preschool children and 50% of school-aged children, while teachers reported lower rates of 5 and 30%, respectively. Parents reported elevated ADHD symptoms in 22% of preschool children and 45% of school-aged children, while teachers reported elevations in 20 and 24%, respectively. There was low concordance between parents and teachers, with teachers reporting fewer problems overall. Specific behaviors endorsed by parents and teachers are also discussed.

Beyond Broadway: Analysis of Qualitative Characteristics of and Individual Responses to Creatively Able, a Music and Movement Intervention for Children with Autism.

Movement in response to music represents one of the natural social environments in which physical activity occurs. The study of music and movement, including dance, requires a careful, holistic consideration of many features, which may include music, physical activity, motor learning, social engagement, emotion, and creativity. The overarching goal of this manuscript is to examine qualitative characteristics of and individual responses to a music and movement intervention (Creatively Able) for children with Autism Spectrum Disorder (ASD). We provide a description of Creatively Able, illustrating how the program design and physical and social environment were informed by children's needs and preferences in order to provide an enriched environment in which to promote multiple systems in children with ASD. Using data from two pilot studies with 20 children with ASD, we illustrate how researchers can use observational research methods to measure important aspects of the social environment (e.g., children's engagement during intervention sessions) as well as engagement of potential underlying behavioral mechanisms (e.g., self-regulation) that might reduce clinical symptoms. We further illustrate how individual responses to intervention (e.g., improvements in behaviors or symptoms) can be studied in physically active interventions. Our pilot study results showed group-level reductions in Stereotyped and Compulsive behaviors of 8% and 4%, respectively; posthoc analysis revealed that there were substantial individual differences in children's responses to the intervention. This research illustrates robust methods that can be applied to intervention research to improve our understanding of important features of interventions that might help promote development in various domains, including executive functions and self-regulation.

Anglo-Latino differences in parental concerns and service inequities for children at risk of autism spectrum disorder.

In an evaluation of Anglo and Latina mothers and their children at risk of autism, this study compared mother-reported child behavioral concerns to staff-observed symptoms of autism. Within Latina mothers, the impact of primary language (English/Spanish), mothers' education, and child age on ratings of developmental concerns was examined. Participants were 218 mothers (Anglo = 85; Latina = 133) of children referred to a no-cost autism screening clinic. Mothers reported on behavioral concerns, autism symptomology, and services received; children were administered the Autism Diagnostic Observation Schedule by certified staff. Results revealed that Anglo and Latino children did not differ by autism symptoms or classification. However, Anglo mothers reported significantly more concerns than Latina mothers. Within the Latina group, analyses revealed significant interaction effects of language and child age; Spanish-speaking mothers of preschoolers endorsed fewer concerns, while Spanish-speaking mothers of school-aged children endorsed more concerns. Despite these reports, Anglo children with a classification of autism spectrum disorder were receiving significantly more services than Latino children with autism spectrum disorder, suggesting early beginnings of a service divide as well as the need for improved parent education on child development and advocacy for Latino families.

"It's so Cute I Could Crush It!": Understanding Neural Mechanisms of Cute Aggression.

The urge people get to squeeze or bite cute things, albeit without desire to cause harm, is known as "cute aggression." Using electrophysiology (ERP), we measured components related to emotional salience and reward processing. Participants aged 18-40 years (n = 54) saw four sets of images: cute babies, less cute babies, cute (baby) animals, and less cute (adult) animals. On measures of cute aggression, feeling overwhelmed by positive emotions, approachability, appraisal of cuteness, and feelings of caretaking, participants rated more cute animals significantly higher than less cute animals. There were significant correlations between participants' self-report of behaviors related to cute aggression and ratings of cute aggression in the current study. N200: A significant effect of "cuteness" was observed for animals such that a larger N200 was elicited after more versus less cute animals. A significant correlation between N200 amplitude and the tendency to express positive emotions in a dimorphous manner (e.g., crying when happy) was observed. RewP: For animals and babies separately, we subtracted the less cute condition from the more cute condition. A significant correlation was observed between RewP amplitude to cute animals and ratings of cute aggression toward cute animals. RewP amplitude was used in mediation models. Mediation Models: Using PROCESS (Hayes, 2018), mediation models were run. For both animals and babies, the relationship between appraisal and cute aggression was significantly mediated by feeling overwhelmed. For cute animals, the relationship between N200 amplitude and cute aggression was significantly mediated by feeling overwhelmed. For cute animals, there was significant serial mediation for RewP amplitude through caretaking, to feeling overwhelmed, to cute aggression, and RewP amplitude through appraisal, to feeling overwhelmed, to cute aggression. Our results indicate that feelings of cute aggression relate to feeling overwhelmed and feelings of caretaking. In terms of neural mechanisms, cute aggression is related to both reward processing and emotional salience.

An Electrophysiology Protocol to Measure Reward Anticipation and Processing in Children.

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation and processing. Its purpose is to create a reward task that is appropriate for young children with and without autism while controlling reward properties between two conditions: social and nonsocial. The current protocol allows for comparisons of brain activity between social and nonsocial reward conditions while keeping the reward itself identical between conditions. Using this protocol, we found evidence that neurotypical children demonstrate enhanced anticipatory brain activity during the social condition. Furthermore, we found that neurotypical children anticipate social reward more robustly than children with autism diagnoses. As the task uses snacks as a reward, it is most appropriate for young children. However, the protocol may be adapted for use with adolescent or adult populations if snacks are replaced by monetary incentives. The protocol is designed to measure electrophysiological events (event-related potentials), but it may be customized for use with eye-tracking or fMRI.

Normalization of Speech Processing After Whole-Vault Cranioplasty in Sagittal Synostosis.

BACKGROUND: Neurocognitive studies have found impairments in language-related abilities in nonsyndromic craniosynostosis, highlighting clinical importance of early language processing. In this study, neural response to speech sounds in infants with nonsyndromic sagittal craniosynostosis (NSC) is compared, preoperatively and postoperatively, using event-related potentials (ERPs) to objectively characterize development in language processing. METHODS: Electroencephalogram was recorded while 39 infants (12 NSC and 27 controls; ages 73-283 days) listened to the Hindi dental /(Equation is included in full-text article.)a/ and retroflex /da/ phonemes (non-native phonemic discrimination task). The mismatch negativity (MMN) ERP was extracted as the peak amplitude of the largest negative deflection in the difference wave over 80 to 300 milliseconds poststimulus. Differences in MMN were analyzed using repeated measures analysis of variance. RESULTS: The MMN amplitude was attenuated in the infants with NSC preoperatively compared with controls (P = 0.047). A significant region by group interaction (P = 0.045) was observed, and infants with NSC displayed attenuated MMN in the frontal electrodes compared with controls (P = 0.010). Comparing the preoperative and postoperative MMN, a time by group interaction trend (P = 0.070) was observed. Pair-wise comparisons showed a trend for increase in MMN amplitude from preoperatively to postoperatively in the infants with NSC (P = 0.059). At the postoperative time point, infants with NSC showed no significant difference in MMN from controls (P = 0.344). CONCLUSION: Infants with NSC demonstrated atypical neural response to language preoperatively. After undergoing surgery, infants with NSC showed increased MMN amplitude which was not significantly different from controls. These findings support the idea that whole vault cranioplasty may improve neurocognitive outcomes in sagittal craniosynostosis.

Differential Diagnosis of Autism Spectrum Disorder and Post Traumatic Stress Disorder: Two Clinical Cases.

Autism spectrum disorder (ASD) is estimated to affect one in 68 children. Given the increase in both prevalence and awareness of ASD, it is critical to provide accurate and timely diagnosis. However, ASD often co-occurs with other disorders, making diagnosis difficult. The objective of the current case study was to provide two examples of differential diagnosis in ASD and post-traumatic stress disorder (PTSD) observed in an autism clinic. In both cases, the goal was to decide whether each child should be given a diagnosis of ASD, PTSD, or both.

Oscillatory rhythm of reward: anticipation and processing of rewards in children with and without autism.

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, and multiple theories have emerged concerning core social deficits. While the social motivation hypothesis proposes that deficits in the social reward system cause individuals with ASD to engage less in social interaction, the overly intense world hypothesis (sensory over-responsivity) proposes that individuals with ASD find stimuli to be too intense and may have hypersensitivity to social interaction, leading them to avoid these interactions. Methods: EEG was recorded during reward anticipation and reward processing. Reward anticipation was measured using alpha asymmetry, and post-feedback theta was utilized to measure reward processing. Additionally, we calculated post-feedback alpha suppression to measure attention and salience. Participants were 6- to 8-year-olds with (N = 20) and without (N = 23) ASD. Results: Children with ASD showed more left-dominant alpha suppression when anticipating rewards accompanied by nonsocial stimuli compared to social stimuli. During reward processing, children with ASD had less theta activity than typically developing (TD) children. Alpha activity after feedback showed the opposite pattern: children with ASD had greater alpha suppression than TD children. Significant correlations were observed between behavioral measures of autism severity and EEG activity in both the reward anticipation and reward processing time periods. Conclusions: The findings provide evidence that children with ASD have greater approach motivation prior to nonsocial (compared to social) stimuli. Results after feedback suggest that children with ASD evidence less robust activity thought to reflect evaluation and processing of rewards (e.g., theta) compared to TD children. However, children with ASD evidence greater alpha suppression after feedback compared to TD children. We hypothesize that post-feedback alpha suppression reflects general cognitive engagement-which suggests that children with ASD may experience feedback as overly intense. Taken together, these results suggest that aspects of both the social motivation hypothesis and the overly intense world hypothesis may be occurring simultaneously.

Electrophysiological response during auditory gap detection: Biomarker for sensory and communication alterations in autism spectrum disorder?

Sensory symptoms, including auditory processing deficits, are common in autism spectrum disorder (ASD). Processing of temporal aspects of auditory input is understudied; yet, deficits in this domain could contribute to language-related impairments. In children with ASD and well-matched controls, this study examined electrophysiological response to silent gaps in auditory stimuli. Results revealed attenuated amplitude of the P2 event-related potential (ERP) component in ASD. The P2 amplitude reduction was also associated with sensory, language, and diagnostic features. These results suggest that neural response during auditory gap detection is a promising ASD biomarker that could be useful for stratifying subgroups and evaluating treatment response.