Stability and change in social interaction style of children with autism spectrum disorder: A 4-year follow-up study

Characterising the social interaction style of autism in young adult males with fragile X syndrome

BACKGROUND

The characterisation of autism in fragile X syndrome (FXS) has been a source of controversy due to the complexity of disentangling autism traits from common features of the FXS phenotype. Autism in FXS is significantly underdiagnosed in the community, which may be partly due to insufficient clinical description of the social interaction profile of autism within the FXS phenotype. In this study, we applied a classic framework for characterising social interaction styles in autism to a sample of young adult males with FXS and co-occurring autism to enhance understanding of how the social challenges associated with autism manifest within FXS.

METHODS

Participants were 41 males (M age = 18 years) with FXS and co-occurring autism. Interaction samples were coded for expression of predominately 'active' (characterised by a desire to make social approaches) or 'passive' (characterised by lack of initiation of social approach towards others) interaction profiles. Differences in the expression of phenotypic features of FXS, including anxiety, attention-deficit/hyperactivity disorder, cognitive, adaptive and language impairments and autism symptom severity, were examined across those with passive and active interaction styles.

RESULTS

Approximately half of the sample was classified as active and half as passive, demonstrating diversity in the social phenotype of autism associated with FXS. The two subtypes did not differ in autism severity, anxiety or attention-deficit/hyperactivity disorder symptoms or in cognitive, adaptive or language abilities.

CONCLUSIONS

This study enhances understanding of FXS-associated autism by documenting phenotypic variability in the social interaction profile in this group, with active and passive social interaction styles represented. The two social interaction styles were not associated with differential expression of common phenotypic features of FXS, suggesting similar support needs.

Visual-motor involvement in autism spectrum disorder: could the stereopsis deficit affect motor coordination?

Purpose

Given the known difficulty in sensory processing and in motor skills in patients with Autism Spectrum Disorder (ASD), and since visual impairment could interfere with children’s behaviour, early detection and management of visual-motor difficulties are crucial. This exploratory study aims to evaluate the visual-motor status in a cohort of children affected by ASD.

Methods

The records of patients affected by ASD and admitted between 2018 and 2022 to the Pediatric University Hospital of Verona were reviewed. Best Corrected Visual Acuity, cycloplegic refraction, stereopsis, convergence, complete ocular motility, strabismus examination, slit-lamp anterior segment examination and fundus ophthalmoscopy were collected and reviewed.

Results

A total of 253 patients (203 ASD and 50 healthy controls) were included in the study. A higher number of total orthoptic defects were detected in the ASD group, in comparison with the control group. Specifically, a higher percentage of stereopsis deficit and convergence insufficiency was observed.

Conclusion

In our cohort of children with ASD stereopsis deficit, convergence insufficiency and refractive errors are the most observed ocular conditions. These findings are consistent with the known alterations of motor skills and sensory processing in ASD. Moreover, our study supports the hypothesis that visual acuity is not compromised in children with ASD. As a result, a complete ophthalmic evaluation is highly recommended in children with ASD, to guarantee early detection and treatment of possible visual-motor defects.

Pathways to peer interaction in ASD and TD through individual and dyadic joint-action motor abilities

Purpose

Any social engagement, especially with peers, requires children's effective activation of social and motor mechanisms. Children and adolescents with autism spectrum disorder (ASD) often display dysfunctions both in individual motor functioning (e.g., fine/gross) and in dyadic joint action (JA), where two partners coordinate movement toward a shared goal. Yet, these mechanisms' contribution to peer interaction has been underexplored.

Method

This study examined the contribution of individual motor functioning and JA performance to peer interaction (cooperation, attentiveness, social engagement, and dyadic quality), while comparing children and adolescents' (youngsters) with ASD versus those with typical development (TD).

Results

Results indicated more competent peer interaction in TD than in ASD. Interestingly, only the ASD group showed significant maturation with age for social engagement and dyadic interaction quality, calls for further examination of developmental trajectories. However, even the oldest participants with ASD continued to lag behind the youngest TD group. Also, findings indicated that better individual motor functioning and JA performance explained better peer interactive competence; yet, the contribution of individual motor functioning to social cooperation and dyadic quality was moderated by JA performance. Thus, youngsters' individual motor system was found to be an important contributor to peer interaction in those with low to moderate JA coordination capabilities, but not for those with high JA.

Conclusion

Results emphasize possible distinct contributions of each motor mechanism and their interaction for facilitating social interaction, hence, encouraging incorporation of individual and dyadic motor skills explicitly into social interaction interventions for youngsters ASD.

Theory of Mind Predicts Social Interaction in Children with Autism Spectrum Disorder: A Two-Year Follow-Up Study

This two-year follow-up study examined the predictive relationships of theory of mind (ToM) to social interaction by reciprocal social behaviors (RSBs) and social functioning (SF) in 106 children with ASD. The results of the path analysis showed that the earlier ToM predicted children's current component RSBs (B = 3.53, SE = 1.86, p = 0.039) and the current SF (B = 1.79-1.87, SE = 0.03-0.34, p < 0.001). The aloof and passive social interaction styles predicted fewer turn-taking of RSBs (B =  - 48.77 to - 111.17, p < 0.001) and fewer components of RSBs (B =  - 36.30 to - 81.41, p < 0.001). This finding provides empirical evidence that ToM predicts social interaction in children with ASD.

Circuits underlying social function and dysfunction

Substantial advances have been made toward understanding the genetic and environmental risk factors for autism, a neurodevelopmental disorder with social impairment as a core feature. In combination with optogenetic and chemogenetic tools to manipulate neural circuits in vivo, it is now possible to use model systems to test how specific neural circuits underlie social function and dysfunction. Here, we review the literature that has identified circuits associated with social interest (sociability), social reward, social memory, dominance, and aggression, and we outline a preliminary roadmap of the neural circuits driving these social behaviors. We highlight the neural circuitry underlying each behavioral domain, as well as develop an interactive map of how these circuits overlap across domains. We find that some of the circuits underlying social behavior are general and are involved in the control of multiple behavioral aspects, whereas other circuits appear to be specialized for specific aspects of social behavior. Our overlapping circuit map therefore helps to delineate the circuits involved in the various domains of social behavior and to identify gaps in knowledge.

Exploring developmental trajectories throughout adolescence of children with autism spectrum disorder without intellectual disability

Characterizing the developmental trajectories of children with autism spectrum disorder (ASD) throughout adolescence and across different domains of functioning offers opportunities to improve long-term outcomes. This prospective study explored, for the first time, the evolution of children with ASD-without intellectual disability (ID) in terms of socio-adaptative skills, learning behaviors, executive functioning (EF), and internalizing/externalizing problems, compared to typically developing (TD) peers. Forty-five children with ASD-without ID and 37 matched TD children (aged 7-11) were assessed at baseline and after 5 years. Parents and teachers completed measures on theory of mind (ToM), socialization, daily living skills, learning style, EF, and emotional/behavioural difficulties at both time points. On all the domains assessed, the ASD group performed significantly worse than the TD group, both in childhood and adolescence. Specific changes were noted between baseline and follow-up assessment on adaptive skills, prosocial behavior, emotional control, inhibit, working memory and monitoring. Group membership (ASD/TD) was influenced by peer relationships and inhibit EF variables. These findings have implications for clinical and school settings.

An Explorative Study of Atypical Social Interaction Styles in Adult Men with Autism Spectrum Disorder, Men with Personality Disorders and Men from the General Population

Different atypical social interaction styles (SISs) were defined and tested in children and adolescents with autism spectrum disorder (ASD). Whether these styles can also be distinguished in adults with ASD has not yet been explored. In men with ASD, men with personality disorder (PD), and men from the general population (N = 90), aged 18-65 years, we tested which SISs can be distinguished and how they relate to the presence of PD traits. We found a significant distinction in allocation to atypical SISs between the three groups. This study shows the presence of atypical SISs in adults with ASD, and complements previous SIS findings in children and adolescents with ASD.Trial registration The Netherlands National Trial Register NTR6391. Registered 04 May 2017.

Understanding Stigma in Autism: A Narrative Review and Theoretical Model

The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.

Autism and attachment disorders – how do we tell the difference?

Clinicians assessing children with autism are sometimes faced with a dilemma, especially if there is a definite or suspected history of abuse or neglect: is this autism or attachment disorder? This is important because the attachment disorders (reactive attachment disorder and disinhibited social engagement disorder) are thought to be caused by abuse or neglect, whereas autism is not. We discuss the Coventry Grid, a clinical tool aiming to aid differentiation between autism and attachment disorders. We examine the small body of empirical studies focusing on this differential diagnosis and find that the Coventry Grid can be regarded as an evidence-based tool. We also discuss preliminary findings regarding a relatively unstructured observational method involving two assessors who engage the child in jokes and playful social dilemmas, which might help clinicians elicit the information required to complete the Coventry Grid.

The Bidirectional Social-Cognitive Mechanisms of the Social-Attention Symptoms of Autism

Differences in social attention development begin to be apparent in the 6th to 12th month of development in children with Autism Spectrum Disorder (ASD) and theoretically reflect important elements of its neurodevelopmental endophenotype. This paper examines alternative conceptual views of these early social attention symptoms and hypotheses about the mechanisms involved in their development. One model emphasizes mechanism involved in the spontaneous allocation of attention to faces, or social orienting. Alternatively, another model emphasizes mechanisms involved in the coordination of attention with other people, or joint attention, and the socially bi-directional nature of its development. This model raises the possibility that atypical responses of children to the attention or the gaze of a social partner directed toward themselves may be as important in the development of social attention symptoms as differences in the development of social orienting. Another model holds that symptoms of social attention may be important to early development, but may not impact older individuals with ASD. The alterative model is that the social attention symptoms in infancy (social orienting and joint attention), and social cognitive symptoms in childhood and adulthood share common neurodevelopmental substrates. Therefore, differences in early social attention and later social cognition constitute a developmentally continuous axis of symptom presentation in ASD. However, symptoms in older individuals may be best measured with in vivo measures of efficiency of social attention and social cognition in social interactions rather than the accuracy of response on analog tests used in measures with younger children. Finally, a third model suggests that the social attention symptoms may not truly be a symptom of ASD. Rather, they may be best conceptualized as stemming from differences domain general attention and motivation mechanisms. The alternative argued for here that infant social attention symptoms meet all the criteria of a unique dimension of the phenotype of ASD and the bi-directional phenomena involved in social attention cannot be fully explained in terms of domain general aspects of attention development.

Exploring Cultural Differences in Autistic Traits: A Factor Analytic Study of Children with Autism in China and the Netherlands

Autism spectrum disorders are diagnosed globally, but recognition, interpretation and reporting may vary across cultures. To compare autism across cultures it is important to investigate whether the tools used are conceptually equivalent across cultures. This study evaluated the factor structure of the parent-reported Autism Spectrum Quotient Short Form in autistic children from China (n = 327; 3 to 17 years) and the Netherlands (n = 694; 6 to 16 years). Confirmatory factor analysis did not support the two-factor hierarchical model previously identified. Exploratory factor analysis indicated culturally variant factor structures between China and the Netherlands, which may hamper cross-cultural comparisons. Several items loaded onto different factors in the two samples, indicating substantial variation in parent-reported autistic traits between China and the Netherlands.

Naturalistic evaluation of preschoolers' spontaneous interactions: The Autism Peer Interaction Observation Scale

LAY ABSTRACT

Peer interaction can be challenging in autism spectrum disorder, but naturalistic peer-observation scales for preschoolers are limited. This study examined the newly developed Autism Peer Interaction Observation Scale, with 17 subcategories, which evaluate naturalistic peer interaction processes in preschoolers with autism spectrum disorder and typical development. We tested the Autism Peer Interaction Observation Scale to (a) characterize peer interactions of preschoolers with autism spectrum disorder who were cognitively able versus typical age-mates, (b) explore each group's hierarchical pattern of peer interaction behaviors, and (c) identify Autism Peer Interaction Observation Scale's links with standard reports for assessing social-communication functioning (Vineland Behavior Scales, 2nd ed.), social impairment (Social Responsiveness Scale, 2nd ed.), autism severity (Autism Diagnostic Observation Schedule, 2nd ed.), and intelligence quotient (Mullen) in the cognitively able preschoolers with autism spectrum disorder group. Participants comprised 85 preschoolers (50 cognitively able preschoolers with autism spectrum disorder, intelligence quotient > 75; 35 typical). Groups were matched according to age, intelligence quotient, and maternal education. Significant group differences emerged on all Autism Peer Interaction Observation Scale categories, with the typical group showing better social-communication functioning as compared to the cognitively able preschoolers with autism spectrum disorder group. Also, in cognitively able preschoolers with autism spectrum disorder that observed as demonstrating more typical peer relations on the Autism Peer Interaction Observation Scale showed better adaptive and socialization skills on the Vineland (Vineland Behavior Scales, 2nd ed.) and fewer social atypicalities on the Social Responsiveness Scale, 2nd ed. Higher intelligence quotient scores were linked with better observed social-communication functioning (on Autism Peer Interaction Observation Scale). Few Autism Peer Interaction Observation Scale social-communicative categories significantly correlated with the Autism Diagnostic Observation Schedule, 2nd ed. Findings highlight the Autism Peer Interaction Observation Scale as differentiating the two preschooler groups and providing additional knowledge about socially communicative peer interaction in natural settings. This new tool can help personalize social-communication programs and evaluations of early intervention outcomes, thereby leading to a fuller picture of these young children's functioning.

Overexpression of mGluR7 in the Prefrontal Cortex Attenuates Autistic Behaviors in Mice

Autism spectrum disorder (ASD) is associated with a range of abnormalities pertaining to socialization, communication, repetitive behaviors, and restricted interests. Owing to its complexity, the etiology of ASD remains incompletely understood. The presynaptic G protein-coupled glutamate receptor metabotropic glutamate receptor 7 (mGluR7) is known to be essential for synaptic transmission and is also tightly linked with ASD incidence. Herein, we report that prefrontal cortex (PFC) mGluR7 protein levels were decreased in C57BL/6J mice exposed to valproic acid (VPA) and BTBR T⁺ Itpr3^tf/J mice. The overexpression of mGluR7 in the PFC of these mice using a lentiviral vector was sufficient to reduce the severity of ASD-like behavioral patterns such that animals exhibited decreases in abnormal social interactions and communication, anxiety-like, and stereotyped/repetitive behaviors. Intriguingly, patch-clamp recordings revealed that the overexpression of mGluR7 suppressed neuronal excitability by inhibiting action potential discharge frequencies, together with enhanced action potential threshold and increased rheobase. These data offer a scientific basis for the additional study of mGluR7 as a promising therapeutic target in ASD and related neurodevelopmental disorders.

Developmental outcomes in adolescence of children with autism spectrum disorder without intellectual disability: A systematic review of prospective studies

Individuals with Autism Spectrum Disorder (ASD) without intellectual disability (ID) represent approximately two-thirds of the ASD population. Here we focused on prospective research assessing different areas of functioning of children with ASD, without ID, until adolescence. Based on a pre-registered protocol (PROSPERO CRD42020189029), a systematic review of prospective studies (published between 01.01.2010 and 01.01.2020) was conducted. Twenty-eight studies met eligibility criteria. Findings indicated that ASD diagnosis and the Intelligence Quotient were highly stable over time across studies. Executive Functioning, Theory of Mind and Central Coherence processes tended to improve, although deficits remained when compared to typically developed controls. Adaptive difficulties and psychiatric comorbidity were relatively stable over time. We discuss potential implications of the findings for clinicians and educators and suggest recommendations for future research.

Social Motivation Across Multiple Measures: Caregiver-Report of Children with Autism Spectrum Disorder

Social motivation is a foundational construct with regard to the etiology, neurobiology, and phenotype of autism spectrum disorder (ASD). Multiple theories suggest that early emerging alterations to social motivation underlie a developmental cascade of social and communication deficits across the lifespan. Despite this significance, methods to measure social motivation vary widely, with little data to date as to how different measures might compare. In this study, we explore three existing caregiver-report measures that have been proposed to quantify social motivation among school-age children with ASD (n = 18; all male) and without ASD (n = 36; 50% female), with the broad goal of characterizing social motivation across measures and specific aims of investigating (a) diagnostic and sex differences in social motivation, (b) correspondence between measures, and (c) relationships between social motivation and broader social outcomes. Across all three measures, individuals with ASD had lower social motivation by caregiver-report. However, they did display individual differences in the degree of social motivation reported. There were no differences in social motivation between males and females without ASD on any of the three measures. For the full sample, measures of social motivation correlated with one another as anticipated, and stronger social motivation was associated with stronger social skills and fewer social difficulties. Our data suggest that social motivation among children with ASD may be best conceptualized as an individual difference that is diminished on average relative to peers but which varies among children and adolescents with ASD, rather than as an absolute absence or uniform deficit. LAY SUMMARY: Several theories suggest that children with autism spectrum disorder (ASD) experience less social motivation than their peers without ASD, contributing to difficulties in social skills. Based on multiple caregiver-report questionnaires, social motivation was reduced on average for school-age children with ASD but also varied among children with ASD. Stronger social motivation was related to stronger social skills and fewer social problems. Future work should include more girls with ASD, consider social motivation across age groups, and include first-hand perspectives from people with ASD.

Increasing the Awareness of Autism Spectrum Disorder with Training of Pre-School Teachers and School Counselors in Turkey

Training programs for the awareness of autism for professions are supported under the leadership of the United Nations. Misinformation can cause socially destructive results as that which is incorrect is assumed to be known correctly. This study included a total of 308 participants comprising 226 (73.4%) preschool teachers and 82 (26.6%) school counselors. The basic questions related to the awareness and knowledge of autism spectrum disorder (ASD) were selected based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). It was attempted to categorize the questions into four fields: (1) social interaction, (2) social communication and speech, (3) limited interest pattern with stereotypical and ritualistic behaviors, and (4) comorbidities, etiological characteristics, and the relationship between vaccinations and autism. The results of the study indicate that the awareness of ASD, including core symptoms, was extremely lacking in preschool teachers and school counselors. Moreover, they had extreme prejudice to information known to be incorrect.

A cross-syndrome approach to the social phenotype of neurodevelopmental disorders: Focusing on social vulnerability and social interaction style

BACKGROUND

Following Annette Karmiloff-Smith's approach to cognitive research, this study applied a cross-syndrome approach to the social phenotype, focusing on social vulnerability (SV) and the factors that contribute to it.

AIMS

To (i) identify syndrome-specific differences in SV across four neurodevelopmental disorder (NDD) groups, (ii) determine the contribution of intellectual disability (ID), age or gender to SV, and (iii) explore its relationship with social interaction style (SIS).

METHODS AND PROCEDURES

262 parents of children: Autism (n = 29), Williams syndrome (n = 29), Attention deficit hyperactivity disorder (n = 36), Fragile X syndrome (n = 18), and Neurotypical (n = 150) reported on their child's SV, quality of SIS and other factors (ID, age, gender).

OUTCOMES AND RESULTS

Heightened SV was not syndrome-specific. Instead it was found equally across NDD groups (and not in the neurotypical group), and independently of ID, age and gender. Different atypical SISs were also distributed across NDD groups and each were significantly related to SV, independent of the factors above and beyond neurodevelopmental diagnosis.

CONCLUSIONS AND IMPLICATIONS

The findings emphasise that social phenotypes are best understood as distributed across diagnostic boundaries and offer opportunities to further test the role of varied atypical SISs in the development of heightened SV.