Differing Developmental Trajectories in Heart Rate Responses to Speech Stimuli in Infants at High and Low Risk for Autism Spectrum Disorder

Neural responses to syllable-induced P1m and social impairment in children with autism spectrum disorder and typically developing Peers

In previous magnetoencephalography (MEG) studies, children with autism spectrum disorder (ASD) have been shown to respond differently to speech stimuli than typically developing (TD) children. Quantitative evaluation of this difference in responsiveness may support early diagnosis and intervention for ASD. The objective of this research is to investigate the relationship between syllable-induced P1m and social impairment in children with ASD and TD children. We analyzed 49 children with ASD aged 40-92 months and age-matched 26 TD children. We evaluated their social impairment by means of the Social Responsiveness Scale (SRS) and their intelligence ability using the Kaufman Assessment Battery for Children (K-ABC). Multiple regression analysis with SRS score as the dependent variable and syllable-induced P1m latency or intensity and intelligence ability as explanatory variables revealed that SRS score was associated with syllable-induced P1m latency in the left hemisphere only in the TD group and not in the ASD group. A second finding was that increased leftward-lateralization of intensity was correlated with higher SRS scores only in the ASD group. These results provide valuable insights but also highlight the intricate nature of neural mechanisms and their relationship with autistic traits.

Functional near-infrared spectroscopy in pediatric clinical research: Different pathophysiologies and promising clinical applications

Over its 30 years of existence, functional near-infrared spectroscopy (fNIRS) has matured into a highly versatile tool to study brain function in infants and young children. Its advantages, amongst others, include its ease of application and portability, the option to combine it with electrophysiology, and its relatively good tolerance to movement. As shown by the impressive body of fNIRS literature in the field of cognitive developmental neuroscience, the method's strengths become even more relevant for (very) young individuals who suffer from neurological, behavioral, and/or cognitive impairment. Although a number of studies have been conducted with a clinical perspective, fNIRS cannot yet be considered as a truly clinical tool. The first step has been taken in this direction by studies exploring options in populations with well-defined clinical profiles. To foster further progress, here, we review several of these clinical approaches to identify the challenges and perspectives of fNIRS in the field of developmental disorders. We first outline the contributions of fNIRS in selected areas of pediatric clinical research: epilepsy, communicative and language disorders, and attention-deficit/hyperactivity disorder. We provide a scoping review as a framework to allow the highlighting of specific and general challenges of using fNIRS in pediatric research. We also discuss potential solutions and perspectives on the broader use of fNIRS in the clinical setting. This may be of use to future research, targeting clinical applications of fNIRS in children and adolescents.

Autism risk in neonatal intensive care unit patients associated with novel heart rate patterns

BACKGROUND

Neonatal intensive care unit (NICU) patients are at increased risk for autism spectrum disorder (ASD). Autonomic nervous system aberrancy has been described in children with ASD, and we aimed to identify heart rate (HR) patterns in NICU patients associated with eventual ASD diagnosis.

METHODS

This retrospective cohort study included NICU patients from 2009 to 2016 with archived HR data and follow-up beyond age 3 years. Medical records provided clinical variables and ASD diagnosis. HR data were compared in infants with and without ASD.

RESULTS

Of the 2371 patients, 88 had ASD, and 689,016 h of data were analyzed. HR skewness (HRskw) was significantly different between ASD and control infants. Preterm infants at early postmenstrual ages (PMAs) had negative HRskw reflecting decelerations, which increased with maturation. From 34 to 42 weeks PMA, positive HRskw toward accelerations was higher in males with ASD. In 931 males with at least 4 days of HR data, overall ASD prevalence was 5%, whereas 11% in the top 5th HRskw percentile had ASD.

CONCLUSION

High HRskw in NICU males, perhaps representing autonomic imbalance, was associated with increased ASD risk. Further study is needed to determine whether HR analysis identifies highest-risk infants who might benefit from earlier screening and therapies.

IMPACT

In a large retrospective single-center cohort of NICU patients, we found that high positive skewness of heart rate toward more accelerations was significantly associated with increased risk of eventual autism spectrum disorder diagnosis in male infants but not in females. Existing literature describes differences in heart rate characteristics in children, adolescents, and adults with autism spectrum disorders, but the finding from our study in NICU infants is novel. Heart rate analysis during the NICU stay might identify, among an inherently high-risk population, those infants with especially high risk of ASD who might benefit from earlier screening and therapies.

Did you say my name? Congruency of 12-month-old infants' behavioral and cardiac responses to name

Reduced orienting to name is an early behavioral risk marker for neurodevelopmental disorders. However, individual instances of infants' behavioral responses to name are limited in both reliability and predictive validity. Physiological responses such as heart rate (HR) deceleration may serve as more sensitive metrics than behavioral methods. As a first step toward validating HR deceleration as a candidate psychophysiological measure of name processing, we examined the congruency of behavioral and cardiac responses to name in 12-month-old typically developing infants. Infants exhibited greater median HR deceleration and spent a larger proportion of time in HR deceleration when they behaviorally oriented to their names than when they failed to do so; however, maximum HR deceleration was not related to behavioral responses. These findings provide preliminary evidence that specific HR deceleration metrics may be useful indices of infants' responses to name and may inform psychophysiological mechanisms underlying behavioral responses.

Neuroprotection of the Perinatal Brain by Early Information of Cerebral Oxygenation and Perfusion Patterns

Abnormal patterns of cerebral perfusion/oxygenation are associated with neuronal damage. In preterm neonates, hypoxemia, hypo-/hypercapnia and lack of cerebral autoregulation are related to peri-intraventricular hemorrhages and white matter injury. Reperfusion damage after perinatal hypoxic ischemia in term neonates seems related with cerebral hyperoxygenation. Since biological tissue is transparent for near infrared (NIR) light, NIR-spectroscopy (NIRS) is a noninvasive bedside tool to monitor brain oxygenation and perfusion. This review focuses on early assessment and guiding abnormal cerebral oxygenation/perfusion patterns to possibly reduce brain injury. In term infants, early patterns of brain oxygenation helps to decide whether or not therapy (hypothermia) and add-on therapies should be considered. Further NIRS-related technical advances such as the use of (functional) NIRS allowing simultaneous estimation and integrating of heart rate, respiration rate and monitoring cerebral autoregulation will be discussed.

Neural responses to happy, fearful and angry faces of varying identities in 5- and 7-month-old infants

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fNIRS and looking responses to emotional faces were measured in 5- and 7-month-olds.

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Emotional faces had varying identities within happy, angry, and fearful blocks.

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Temporo-parietal and frontal activations were observed, particularly to happy faces.

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Infants looked longer to the mouth region of angry faces.

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No difference in behavior or neural activity observed between 5- and 7-month-olds.

The processing of facial emotion is an important social skill that develops throughout infancy and early childhood. Here we investigate the neural underpinnings of the ability to process facial emotion across changes in facial identity in cross-sectional groups of 5- and 7-month-old infants. We simultaneously measured neural metabolic, behavioral, and autonomic responses to happy, fearful, and angry faces of different female models using functional near-infrared spectroscopy (fNIRS), eye-tracking, and heart rate measures. We observed significant neural activation to these facial emotions in a distributed set of frontal and temporal brain regions, and longer looking to the mouth region of angry faces compared to happy and fearful faces. No differences in looking behavior or neural activations were observed between 5- and 7-month-olds, although several exploratory, age-independent associations between neural activations and looking behavior were noted. Overall, these findings suggest more developmental stability than previously thought in responses to emotional facial expressions of varying identities between 5- and 7-months of age.

Social endophenotypes in autism spectrum disorder: A scoping review

Endophenotypes are measurable markers of genetic vulnerability to current or future disorder. Autism spectrum disorder (ASD) is well-suited to be examined within an endophenotype framework given past and current emphases on the broader autism phenotype and early detection. We conducted a scoping review to identify potential socially-related endophenotypes of ASD. We focused on paradigms related to sociality (e.g., theory of mind (TOM), social attention), which comprise most of this literature. We integrated findings from traditional behavioral paradigms with brain-based measures (e.g., electroencephalography, functional magnetic resonance imaging). Broadly, infant research regarding social attention and responsivity (Research Domain Criteria (RDoC) domain of affiliation) and attention to faces and voices (social communication) finds consistent abnormality in vulnerable infant siblings. Several additional paradigms that have shown differences in vulnerable infants and young children include animacy perception tasks (perception and understanding of others), measures of recognition and response to familiar faces (attachment), and joint attention and false-belief tasks (understanding mental states). Research areas such as alexithymia (the perception and understanding of self), empathic responding, and vocal prosody may hold interest; however, challenges in measurement across populations and age ranges is a limiting factor. Future work should address sex differences and age dependencies, specificity to ASD, and heterogeneous genetic pathways to disorder within samples individuals with ASD and relatives.

The role of limited salience of speech in selective attention to faces in toddlers with autism spectrum disorders

BACKGROUND

Impaired attention to faces of interactive partners is a marker for autism spectrum disorder (ASD) in early childhood. However, it is unclear whether children with ASD avoid faces or find them less salient and whether the phenomenon is linked with the presence of eye contact or speech.

METHODS

We investigated the impacts of speech (SP) and direct gaze (DG) on attention to faces in 22-month-old toddlers with ASD (n = 50) and typically developing controls (TD, n = 47) using the Selective Social Attention 2.0 (SSA 2.0) task. The task consisted of four conditions where the presence (+) and absence (-) of DG and SP were systematically manipulated. The severity of autism symptoms, and verbal and nonverbal skills were characterized concurrently with eye tracking at 22.4 (SD = 3.2) months and prospectively at 39.8 (SD = 4.3) months.

RESULTS

Toddlers with ASD looked less than TD toddlers at face and mouth regions only when the actress was speaking (direct gaze absence with speech, DG-SP+: d = 0.99, p < .001 for face, d = 0.98, p < .001 for mouth regions; direct gaze present with speech, DG+SP+, d = 1.47, p < .001 for face, d = 1.01, p < .001 for mouth regions). Toddlers with ASD looked less at the eye region only when both gaze and speech cues were present (d = 0.46, p = .03). Salience of the combined DG and SP cues was associated concurrently and prospectively with the severity of autism symptoms, and the association remained significant after controlling for verbal and nonverbal levels.

CONCLUSIONS

The study links poor attention to faces with limited salience of audiovisual speech and provides no support for the face avoidance hypothesis in the early stages of ASD. These results are consequential for research on early discriminant and predictive biomarkers as well as identification of novel treatment targets.

Typical Levels of Eye-Region Fixation in Toddlers With Autism Spectrum Disorder Across Multiple Contexts

OBJECTIVE

Unusual eye contact is a common clinical feature in autism spectrum disorder (ASD), yet eye-tracking studies that quantify eye fixation report inconsistent results, possibly because of small samples, varied stimuli, and considerable heterogeneity of eye-region fixation even within typical development. Goals were to examine eye-region fixation levels in a large, very young cohort; the degree to which the presence of speech, hand gestures, and a geometric distractor influence eye-region fixation; and possible developmental changes across time.

METHOD

In experiment 1, 385 toddlers (143 with ASD, 242 without ASD, 11-47 months old) watched an actress engaging in child-directed speech with hand gestures against a plain background. Ninety-one toddlers participated approximately 8 months later. In experiment 2, another 231 toddlers (74 with ASD, 157 without ASD, 12-47 months old) watched the same video, but with embedded geometric distractors. Total fixation duration on facial and body regions (eg, eyes, hands) and geometric distractor regions (experiment 2 only) while the actress was speaking or silent, with or without gesturing, was examined, as were relations with clinical traits.

RESULTS

Overall, across the 2 experiments and the 2 cross-sectional and longitudinal samples, eye-region fixation duration did not differ between toddlers with and without ASD, although fixation toward the face overall was decreased in toddlers with ASD. This decrease became more apparent with the presence of geometric distractors (experiment 2) as indexed by a geometric preference score, and this score was associated with autism severity.

CONCLUSION

Within the context of viewing child-friendly vignettes, decreased eye-region fixation does not reliably characterize toddlers with ASD. An index of competition between faces and external distractors might be a more robust measure.

Stress assessment by means of heart rate derived from functional near-infrared spectroscopy

Many studies have been carried out in order to detect and quantify the level of mental stress by means of different physiological signals. From the physiological point of view, stress promptly affects brain and cardiac function; therefore, stress can be assessed by analyzing the brain- and heart-related signals more efficiently. Signals produced by functional near-infrared spectroscopy (fNIRS) of the brain together with the heart rate (HR) are employed to assess the stress induced by the Montreal Imaging Stress Task. Two different versions of the HR are used in this study. The first one is the commonly used HR derived from the electrocardiogram (ECG) and is considered as the reference HR (RHR). The other is the HR computed from the fNIRS signal (EHR) by means of an effective combinational algorithm. fNIRS and ECG signals were simultaneously recorded from 10 volunteers, and EHR and RHR are derived from them, respectively. Our results showed a high degree of agreement [r  >  0.9, BAR (Bland Altman ratio) <5  %  ] between the two HR. A principal component analysis/support vector machine-based algorithm for stress classification is developed and applied to the three measurements of fNIRS, EHR, and RHR and a classification accuracy of 78.8%, 94.6%, and 62.2% were obtained for the three measurements, respectively. From these observations, it can be concluded that the EHR carries more useful information with regards to the mental stress than the RHR and fNIRS signals. Therefore, EHR can be used alone or in combination with the fNIRS signal for a more accurate and real-time stress detection and classification.

Trajectory of heart period to socioaffective threat in shy children

Although shyness is characterized by distinct psychophysiological correlates, we know very little about the development of these correlates. In this longitudinal study, we examined how children's shyness was associated with trajectories of heart period (HP) to socioaffective threat across four assessments spanning approximately 2 years. Children (M_age  = 6.39 years) viewed age-appropriate, socioaffective videos at each visit while having their HP measured concurrently. A growth curve analysis revealed that low shy children had a relatively lower HP at enrollment, but experienced increases in HP across visits, while high shy children exhibited relatively stable low HP across visits while viewing threat-related socioaffective video stimuli. These patterns did not exist for HP during resting baseline or HP to nonthreatening video stimuli. These findings suggest that longitudinal patterns of HP among shy children may reflect a stable, characteristic way of responding to socioaffective threat, and possibly a physiological mechanism underlying shyness in some children.

Heart rate-defined sustained attention in infants at risk for autism

Background

Although aberrant visual attention has been identified in infants at high familial risk for autism, the developmental emergence of atypical attention remains unclear. Integrating biological measures of attention into prospective high-risk infant studies may inform more nuanced developmental trajectories, clarifying the onset and course of atypical attention and potentially advancing early screening or treatment protocols. Heart rate-defined sustained attention (HRDSA) is a well-validated biological measure of attentional engagement that, in non-clinical infant populations, provides incremental information about attentional engagement beyond looking behaviors alone. The present study aimed to examine the characteristics and clinical correlates of HRDSA in high-risk infants, informing whether HRDSA may operate as a promising biological measure of attention and clinical symptoms in this population.

Methods

We examined age-related patterns of HRDSA during a passive looking task in 5- to 14-month-old high-risk infant siblings of children with autism (n = 21) compared to low-risk controls (n = 21), with most participants contributing multiple assessments. Emergent autism features were measured using the Autism Diagnostic Observation Schedule at 24 months. Primary dependent variables included the proportion of time in behavioral attention, proportion of time in HRDSA, and average heart rate deceleration during HRDSA. For each variable, we used nested multilevel models to examine whether attention differed by group, as well as whether attention predicted emergent autism features among high-risk infant siblings.

Results

As expected, HRDSA served as a global biological measure of attention in high-risk infants, predicting greater variability in group risk status than behavioral looking alone. Among high-risk infants, more severe ASD features were also associated with increasingly shallow heart rate deceleration during HRDSA across development, suggesting abnormal qualities of HRDSA may inform individual differences within this population.

Conclusions

These preliminary findings provide initial evidence that HRDSA may offer a sensitive, affordable, and portable biological measure of attention that may enhance understanding of atypical attention in high-risk infants. Using this method, we also provide initial evidence that atypical patterns of heart activity previously reported in children and adults with autism may emerge in the first year of life, warranting further study of how HRDSA may specifically inform attention profiles in ASD.

Motion correction for infant functional near-infrared spectroscopy with an application to live interaction data

Correcting for motion is an important consideration in infant functional near-infrared spectroscopy studies. We tested the performance of conventional motion correction methods and compared probe motion and data quality metrics for data collected at different infant ages (5, 7, and 12 months) and during different methods of stimulus presentation (video versus live). While 5-month-olds had slower maximum head speed than 7- or 12-month-olds, data quality metrics and hemodynamic response recovery errors were similar across ages. Data quality was also similar between video and live stimulus presentation. Motion correction algorithms, such as wavelet filtering and targeted principal component analysis, performed well for infant data using infant-specific parameters, and parameters may be used without fine-tuning for infant age or method of stimulus presentation. We recommend using wavelet filtering with [Formula: see text]; however, a range of parameters seemed acceptable. We do not recommend using trial rejection alone, because it did not improve hemodynamic response recovery as compared to no correction at all. Data quality metrics calculated from uncorrected data were associated with hemodynamic response recovery error, indicating that full simulation studies may not be necessary to assess motion correction performance.