Becoming a face expert: a computerized face-training program for high-functioning individuals with autism spectrum disorders

Randomized controlled pilot study of an app-based intervention for improving social skills, face perception, and eye gaze among youth with autism spectrum disorder

Introduction

This pilot study aimed to examine the effectiveness of an app-based intervention (Yface) in 53 children with autism spectrum disorder. Yface is a combined program that improves social skills, facial perception, and eye gaze.

Methods

Children were randomly assigned to one of the two training groups or a waitlist control group. One of the training groups completed the Yface training program lasting for 66 days, while the other training group used a similar app called Ycog, which focuses on cognitive rehabilitation. Questionnaires, computerized tasks, and semi-structured interviews were administered to children and their parents at pre- and post-training sessions.

Results

The Yface group showed improvements in face perception and some social skills compared to waitlist controls, and in eye gaze compared to the Ycog group.

Discussion

Our results suggest that this app-based intervention is effective in improving targeted social skills and face perception, although their relative effectiveness differs across skill domains.

Face perception predicts affective theory of mind in autism spectrum disorder but not schizophrenia or typical development

Autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SCZ) have overlapping symptomatology related to difficulties with social cognition. Yet, few studies have directly compared social cognition in ASD, SCZ, and typical development (TD). The current study examined individual differences in face recognition and its relation to affective theory of mind (ToM) in each diagnostic group. Adults with ASD (n = 31), SCZ (n = 43), and TD (n = 47) between the ages of 18 and 48 years-old with full scale IQ above 80 participated in this study. The Reading the Mind in the Eyes Test (RMET) measured affective ToM, and the Benton Facial Recognition Test (BFRT) measured face perception. Adults with ASD and SCZ did not differ in their affective ToM abilities, and both groups showed affective ToM difficulties compared with TD. However, better face recognition ability uniquely predicted better affective ToM ability in ASD. Results suggest that affective ToM difficulties may relate to face processing in ASD but not SCZ. By clarifying the complex nature of individual differences in affective ToM and face recognition difficulties in these disorders, the present study suggests there may be divergent mechanisms underlying pathways to social dysfunction in ASD compared with SCZ. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Non-pharmacological Interventions for Adults with Autism: a Systematic Review of Randomised Controlled Trials

To determine the effects of non-pharmacological randomised controlled trials in adults with autism, a systematic review was conducted across five electronic databases. A total of 3865 abstracts were retrieved, of which 41 articles met all inclusion criteria: randomised controlled trial; non-pharmacological intervention; adults with autism; and English publication. Twenty included studies had strong methodological quality ratings. No meta-analysis could be performed due to heterogeneity between studies. Articles reported on interventions for (1) social functioning and language skills, (2) vocational rehabilitation outcomes, (3) cognitive skills training, and (4) independent living skills. Social functioning was the most studied intervention. PEERS for young adults and Project SEARCH plus ASD support interventions had the strongest evidence. Emerging evidence suggests non-pharmacological interventions could be effective.

Digital Interventions for Autism Spectrum Disorder: A Meta-analysis

This study aimed to review digital interventions in the treatment of autism spectrum disorder (ASD). A systematic review and meta-analysis was conducted. Nineteen studies were included. The interventions aimed to improve social skills (n = 11), developmental skills (n = 2) and 6 other different targets. Technology used were computer programs (n = 14), tablet apps (n = 3), a robot (n = 1) and an interactive DVD (n = 1). The meta-analysis resulted in an overall effect size (Cohen's d) of 0.32 [0.12-0.51], indicating a small effect. Heterogeneity between studies was high (I² = 100%), limiting the generalization of results. Therefore, we recommend larger RCT studies, and guidelines for the development of trials evaluating digital interventions for ASD, for making comparison of future studies possible.Registration can be found online at Prospero: https://www.crd.york.ac.uk/prospero/ , registration no. CRD42020146542.

Psychosocial Interventions Targeting Social Functioning in Adults on the Autism Spectrum: a Literature Review

PURPOSE OF REVIEW

There is a perceived shortage of evidence-based treatment programs for adults on the autism spectrum. This article reviews the recent research literature on psychosocial/behavioral interventions targeting social functioning in autistic adults without intellectual disability.

RECENT FINDINGS

We identified only 41 peer-reviewed studies published from 1980 to 2017 that tested intervention programs focused on one or more of the behavioral components of social functioning (i.e., social motivation, social anxiety, social cognition, and social skills) in more than one adult with autism spectrum disorder (ASD). The studies demonstrated substantial variability in treatment objectives, intervention procedures, assessment methods, and methodologic quality. The results indicate a strong need for additional research to develop and rigorously test interventions for autistic adults that target the many behavioral components of social functioning and that include procedures to promote generalization of knowledge and skills to community settings.

Benefits of fading in perceptual learning are driven by more than dimensional attention

Individuals learn to classify percepts effectively when the task is initially easy and then gradually increases in difficulty. Some suggest that this is because easy-to-discriminate events help learners focus attention on discrimination-relevant dimensions. Here, we tested whether such attentional-spotlighting accounts are sufficient to explain easy-to-hard effects in auditory perceptual learning. In two experiments, participants were trained to discriminate periodic, frequency-modulated (FM) tones in two separate frequency ranges (300–600 Hz or 3000–6000 Hz). In one frequency range, sounds gradually increased in similarity as training progressed. In the other, stimulus similarity was constant throughout training. After training, participants showed better performance in their progressively trained frequency range, even though the discrimination-relevant dimension across ranges was the same. Learning theories that posit experience-dependent changes in stimulus representations and/or the strengthening of associations with differential responses, predict the observed specificity of easy-to-hard effects, whereas attentional-spotlighting theories do not. Calibrating the difficulty and temporal sequencing of training experiences to support more incremental representation-based learning can enhance the effectiveness of practice beyond any benefits gained from explicitly highlighting relevant dimensions.

Spatial Frequency Training Modulates Neural Face Processing: Learning Transfers from Low- to High-Level Visual Features

Perception of visual stimuli improves with training, but improvements are specific for trained stimuli rendering the development of generic training programs challenging. It remains unknown to which extent training of low-level visual features transfers to high-level visual perception, and whether this is accompanied by neuroplastic changes. The current event-related potential (ERP) study showed that training-induced increased sensitivity to a low-level feature, namely low spatial frequency (LSF), alters neural processing of this feature in high-level visual stimuli. Specifically, neural activity related to face processing (N170), was decreased for low (trained) but not high (untrained) SF content in faces following LSF training. These novel results suggest that: (1) SF discrimination learning transfers from simple stimuli to complex objects; and that (2) training the use of specific SF information affects neural processing of facial information. These findings may open up a new avenue to improve face recognition skills in individuals with atypical SF processing, such as in cataract or Autism Spectrum Disorder (ASD).

Application of technology to social communication impairment in childhood and adolescence

Social communication impairment has been implicated in various mental health disorders. The primary aim of this review paper is to summarize the extant research on the development and application of technologies to address social communication deficits, conceptualized according to the four constructs outlined by the NIMH's Research Domain Criteria (RDoC), transdiagnostically in children and adolescents. An exhaustive and systematic search yielded 69 peer-reviewed articles meeting all inclusion criteria (i.e., used technology, applied the technology to target impairment in at least one of four constructs of social communication, included a child or adolescent samples). We found limited use of technology for exploration of impairment in reception of non-facial communication, compared to the other social communication constructs. In addition, there has been an overwhelming focus on social communication impairment in children and adolescents with Autism Spectrum Disorder (ASD), with relatively few studies evaluating technology application in other clinical populations. Implications for future directions for technological interventions to treat social communication impairments transdiagnostically are discussed.

The "Eye Avoidance" Hypothesis of Autism Face Processing

Although a growing body of research indicates that children with autism spectrum disorder (ASD) exhibit selective deficits in their ability to recognize facial identities and expressions, the source of their face impairment is, as yet, undetermined. In this paper, we consider three possible accounts of the autism face deficit: (1) the holistic hypothesis, (2) the local perceptual bias hypothesis and (3) the eye avoidance hypothesis. A review of the literature indicates that contrary to the holistic hypothesis, there is little evidence to suggest that individuals with autism do perceive faces holistically. The local perceptual bias account also fails to explain the selective advantage that ASD individuals demonstrate for objects and their selective disadvantage for faces. The eye avoidance hypothesis provides a plausible explanation of face recognition deficits where individuals with ASD avoid the eye region because it is perceived as socially threatening. Direct eye contact elicits a increased physiological response as indicated by heightened skin conductance and amygdala activity. For individuals with autism, avoiding the eyes is an adaptive strategy, however, this approach interferes with the ability to process facial cues of identity, expressions and intentions, exacerbating the social challenges for persons with ASD.

First evidence of the feasibility of gaze-contingent attention training for school children with autism

A number of authors have suggested that attention control may be a suitable target for cognitive training in children with autism spectrum disorder. This study provided the first evidence of the feasibility of such training using a battery of tasks intended to target visual attentional control in children with autism spectrum disorder within school-based settings. Twenty-seven children were recruited and randomly assigned to either training or an active control group. Of these, 19 completed the initial assessment, and 17 (9 trained and 8 control) completed all subsequent training sessions. Training of 120 min was administered per participant, spread over six sessions (on average). Compliance with the training tasks was generally high, and evidence of within-task training improvements was found. A number of untrained tasks to assess transfer of training effects were administered pre- and post-training. Changes in the trained group were assessed relative to an active control group. Following training, significant and selective changes in visual sustained attention were observed. Trend training effects were also noted on disengaging visual attention, but no convincing evidence of transfer was found to non-trained assessments of saccadic reaction time and anticipatory looking. Directions for future development and refinement of these new training techniques are discussed.

Deficits in Early Stages of Face Processing in Schizophrenia: A Systematic Review of the P100 Component

INTRODUCTION

Schizophrenia is associated with deficits in face and affect recognition, which contribute to broader social functioning deficits. The present aim was to conduct a meta-analysis of early face processing in schizophrenia, as indexed by the P100 event-related potential component.

METHODS

Twelve studies (n = 328 patients with schizophrenia, n = 330 healthy controls) of the P100 component during face processing were evaluated by calculating Cohen's d for each study and overall weighted mean effect size (ES). In additional exploratory analyses, moderating influences of method and design were investigated, and the P100 component during face processing was evaluated based on valence: 5 studies (n = 225 patients, n = 225 controls) included neutral stimuli, 5 studies (n = 225 patients, n = 225 controls) included happy stimuli, and 4 studies (n = 209 patients, n = 209 controls) included fearful stimuli.

RESULTS

The amplitude of the P100 to face stimuli was smaller in patients relative to controls (ES = .41, P < .01). Methodological or design differences did not account for heterogeneity in ES. When split by valence, results indicate smaller P100 in patients relative to control subjects in response to neutral (ES = .32, P < .001) and happy (ES = .21, P < .05) stimuli, whereas there was no difference in response to fearful faces (ES = .09, P > .05).

DISCUSSION

The results indicate that P100 amplitude in response to faces is smaller in patients with schizophrenia, showing that socially relevant visual processing deficits begin earlier in processing than previously suggested. Additionally, the exploratory analyses suggest emotional specificity in these deficits. Ramifications for our understanding of face processing deficits and treatment development are discussed.

Face processing among twins with and without autism: social correlates and twin concordance

Autism spectrum disorder (ASD) has a strong heritable basis, as evidenced by twin concordance rates. Within ASD, symptom domains may arise via independent genetic contributions, with varying heritabilities and genetic mechanisms. In this article, we explore social functioning in the form of (i) electrophysiological and behavioral measures of face processing (P1 and N170) and (ii) social behavior among child and adolescent twins with (N = 52) and without ASD (N = 66). Twins without ASD had better holistic face processing and face memory, faster P1 responses and greater sensitivity to the effects of facial inversion on P1. In contrast, N170 responses to faces were similar across diagnosis, with more negative amplitudes for faces vs non-face images. Across the sample, stronger social skills and fewer social difficulties were associated with faster P1 and N170 responses to upright faces, and better face memory. Twins were highly correlated within pairs across most measures, but correlations were significantly stronger for monozygotic vs dizygotic pairs on N170 latency and social problems. We suggest common developmental influences across twins for face processing and social behavior, but highlight (i) neural speed of face processing and (ii) social difficulties as important avenues in the search for genetic underpinnings in ASD.

Outcome measures in intervention trials for adults with autism spectrum disorders; a systematic review of assessments of core autism features and associated emotional and behavioural problems

A systematic review was conducted of outcome measures used in treatment trials for older adolescents and adults with autism spectrum disorders (ASDs). Of 818 titles only 30 articles (19 of which involved pharmacological treatments) were identified that met inclusion criteria (sample size > 5; mean age of group > 15 years; mean IQ > 30; ASD diagnosis confirmed; use of objective ASD outcome measures; focus on symptoms core to or typically associated with ASDs). Selected studies included randomized and placebo-controlled trials, retrospective assessment studies, case series and open label or case-control trials. Use of outcome measures varied with frequent use of non-standardized assessments, very little use of measures designed specifically for individuals with ASD or of instruments focusing on core ASD deficits, such as communication or social functioning. Most commonly used were the Clinical Global Impression (CGI) rating scale and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The strengths or deficiencies of the outcome measures used were not systematically evaluated. Although there are now many well controlled treatment trials for children with ASDs, adult intervention research is very limited. The lack of valid and reliable outcome measures for adults with ASDs compromises attempts at treatment evaluation.

A systematic review and meta-analysis of eye-tracking studies in children with autism spectrum disorders

Aberrant eye gaze mechanisms have been implicated in autism spectrum disorders (ASD). Studies of eye movements in children with ASD reveal diminished eye gaze duration and lack of specific eye gaze fixation to the eyes and/or mouth compared with controls. However, findings to date have been contradictory. We examined eye-tracking studies on face processing in children with ASD and conducted meta-analyses to examine whether these children demonstrate atypical fixation on primary facial regions. Twenty eye-tracking studies in children with ASD were reviewed, of which the results from 14 studies were incorporated in the meta-analyses that evaluated fixation duration on (i) eyes (eight studies) and (ii) mouth (six studies). The results reveal that children with ASD have significantly reduced gaze fixation to the eye region of faces. The results of the meta-analyses indicate that ASD patients have significant impairments in gaze fixation to the eyes. On the other hand, no significant difference was uncovered in terms of fixation to the mouth region; however, this finding needs to be interpreted with caution because of the significant heterogeneity in the mouth fixation studies. The findings of this meta-analysis add further clarity to an expanding literature and suggest that specific eye gaze fixation to the eye region may represent a robust biomarker for the condition. The heterogeneity associated with the mouth fixation data precludes any definitive statement as to the robustness of these findings.

Recognition of facial expressions and prosodic cues with graded emotional intensities in adults with Asperger syndrome

This study investigated the ability of adults with Asperger syndrome to recognize emotional categories of facial expressions and emotional prosodies with graded emotional intensities. The individuals with Asperger syndrome showed poorer recognition performance for angry and sad expressions from both facial and vocal information. The group difference in facial expression recognition was prominent for stimuli with low or intermediate emotional intensities. In contrast to this, the individuals with Asperger syndrome exhibited lower recognition accuracy than typically-developed controls mainly for emotional prosody with high emotional intensity. In facial expression recognition, Asperger and control groups showed an inversion effect for all categories. The magnitude of this effect was less in the Asperger group for angry and sad expressions, presumably attributable to reduced recruitment of the configural mode of face processing. The individuals with Asperger syndrome outperformed the control participants in recognizing inverted sad expressions, indicating enhanced processing of local facial information representing sad emotion. These results suggest that the adults with Asperger syndrome rely on modality-specific strategies in emotion recognition from facial expression and prosodic information.

Future directions for research in autism spectrum disorders

This article suggests future directions for research aimed at improving our understanding of the etiology and pathophysiology of autism spectrum disorder (ASD) as well as pharmacologic and psychosocial interventions for ASD across the lifespan. The past few years have witnessed unprecedented transformations in the understanding of ASD neurobiology, genetics, early identification, and early intervention. However, recent increases in ASD prevalence estimates highlight the urgent need for continued efforts to translate novel ASD discoveries into effective interventions for all individuals with ASD. In this article we highlight promising areas for ongoing and new research expected to quicken the pace of scientific discovery and ultimately the translation of research findings into accessible and empirically supported interventions for those with ASD. We highlight emerging research in the following domains as particularly promising and pressing: (a) preclinical models, (b) experimental therapeutics, (c) early identification and intervention, (d) psychiatric comorbidities and the Research Domain Criteria initiative, (e) ecological momentary assessment, (f) neurotechnologies, and (g) the needs of adults with ASD. Increased research emphasis in these areas has the potential to hasten the translation of knowledge on the etiological mechanisms of ASD to psychosocial and biological interventions to reduce the burden of ASD on affected individuals and their families.

The uses of cognitive training technologies in the treatment of autism spectrum disorders

In this review, we focus on research that has used technology to provide cognitive training - i.e. to improve performance on some measurable aspect of behaviour - in individuals with autism spectrum disorders. We review technology-enhanced interventions that target three different cognitive domains: (a) emotion and face recognition, (b) language and literacy, and (c) social skills. The interventions reviewed allow for interaction through different modes, including point-and-click and eye-gaze contingent software, and are delivered through diverse implementations, including virtual reality and robotics. In each case, we examine the evidence of the degree of post-training improvement observed following the intervention, including evidence of transfer to altered behaviour in ecologically valid contexts. We conclude that a number of technological interventions have found that observed improvements within the computerised training paradigm fail to generalise to altered behaviour in more naturalistic settings, which may result from problems that people with autism spectrum disorders experience in generalising and extrapolating knowledge. However, we also point to several promising findings in this area. We discuss possible directions for future work.

Innovative technology-based interventions for autism spectrum disorders: a meta-analysis

This article reports the results of a meta-analysis of technology-based intervention studies for children with autism spectrum disorders. We conducted a systematic review of research that used a pre-post design to assess innovative technology interventions, including computer programs, virtual reality, and robotics. The selected studies provided interventions via a desktop computer, interactive DVD, shared active surface, and virtual reality. None employed robotics. The results provide evidence for the overall effectiveness of technology-based training. The overall mean effect size for posttests of controlled studies of children with autism spectrum disorders who received technology-based interventions was significantly different from zero and approached the medium magnitude, d = 0.47 (confidence interval: 0.08-0.86). The influence of age and IQ was not significant. Differences in training procedures are discussed in the light of the negative correlation that was found between the intervention durations and the studies' effect sizes. The results of this meta-analysis provide support for the continuing development, evaluation, and clinical usage of technology-based intervention for individuals with autism spectrum disorders.

Getting a grip on social gaze: control over others' gaze helps gaze detection in high-functioning autism

We investigated the influence of control over a social stimulus on the ability to detect direct gaze in high-functioning autism (HFA). In a pilot study, 19 participants with and 19 without HFA were compared on a gaze detection and a gaze setting task. Participants with HFA were less accurate in detecting direct gaze in the detection task, but did not differ in their ability to establish direct gaze in the setting task. In the main experiment, the results of the pilot study were replicated with 37 participants with and 39 without HFA, suggesting that individuals with HFA have a specific deficit in the passive perception of social cues as opposed to the active control, which seems to be intact.

Mechanisms of change in psychosocial interventions for autism spectrum disorders

Research into psychosocial interventions (particularly cognitive-behavior therapies and social skills training) for social-communication deficits among individuals with autism spectrum disorder (ASD) has proliferated over the past decade. While this research has provided some empirical support for the efficacy of these interventions, little work has begun to elucidate therapeutic mechanisms-the when, why, how, for whom, and under what conditions an intervention may produce change, identification of mechanisms underlying these effects should help advance ASD intervention research. This article describes methods for assessing such mechanisms (ie, mediators and moderators) and presents promising candidates for common mechanisms impacting treatment response: behavior modification, therapeutic relationship, social knowledge, social motivation, social information processing, executive functioning, and internalizing comorbidities. Finally, future directions are discussed as a program of psychosocial intervention research designed to identify predictors of individual differences in treatment response (including biomarkers), isolate active therapeutic ingredients, and promote dissemination of optimized interventions.

The development of facial gender categorization in individuals with and without autism: the impact of typicality

While much research has examined the development of facial recognition abilities, less is known about the ability of individuals with and without autism to categorize facial gender. The current study tested gender categorization abilities in high-functioning children (5-7 and 8-12 years), adolescents (13-17 years), and adults (18-53 years) with autism and matched controls. Naturalistic videos depicted faces that were either typical or less typical of each gender. Both groups improved in their performance across development. However, control children reached expertise that was similar to control adults by 8-12 years; whereas, adults with autism never reached this level of expertise, particularly with less typical gender faces. Results suggest that individuals with autism employ different face processing mechanisms than typically developing individuals.

Candidate socioemotional remediation program for individuals with intellectual disability

The authors developed a computerized program, Vis-à-Vis (VAV), to improve socioemotional functioning and working memory in children with developmental disabilities. The authors subsequently tested whether participants showed signs of improving the targeted skills. VAV is composed of three modules: Focus on the Eyes, Emotion Recognition and Understanding, and Working Memory. Ten children with idiopathic developmental delay completed four 20-min weekly sessions of VAV for 12 weeks with an adult. Participants were evaluated before (Time 0) and after (Time 1) training and 6 months after remediation (Time 2). Subjects improved on all three modules during training and on emotion recognition and nonverbal reasoning post-VAV. These gains were still present at Time 2. VAV is a promising new tool for working on socioemotional impairments in hard-to-treat pediatric populations.

Computer-based interventions to improve social and emotional skills in individuals with autism spectrum disorders: a systematic review

OBJECTIVE

To review studies involving the use of computer-based interventions (CBI) to improve the social and emotional skills (e.g. emotional recognition) of individuals with autism spectrum disorders (ASD).

METHODS

The use of computer-based intervention (CBI) in the treatment of autism spectrum disorders (ASD) may offer some advantages to traditional one-to-one or group instruction including easier differentiation of instruction, decreased distractions and the incorporation of an individual's relative visual learning strengths. However, the results of past research suggest varying outcomes for CBI with individuals with ASD. This review provides a systematic analysis of studies investigating CBI to improve social and emotional skills (e.g. emotion recognition) of individuals with ASD. Electronic database searches and ancestral searches were used to identify studies that met pre-determined inclusion criteria. The included studies were then summarized in terms of: (a) participant characteristics, (b) social and emotional skills targeted, (c) details of the CBI, (d) results, and (e) certainty of evidence.

RESULTS

The results of these studies indicated that CBI's effect on social and emotional skills was mixed, with the majority of studies reporting unacceptable outcomes following intervention.

CONCLUSIONS

Overall, this review suggests that the use of CBI to improve the social and emotional skills of individuals with ASD is a promising practice. A comparison of CBI plus tutoring and face-to-face social skills training suggests that CBI can be as effective as face-to-face instruction. Practitioners should carefully consider the preferences and existing abilities of individuals with ASD and the customizability of the software when deciding to use CBI and selecting a software program.

The effects of face expertise training on the behavioral performance and brain activity of adults with high functioning autism spectrum disorders

The effect of expertise training with faces was studied in adults with ASD who showed initial impairment in face recognition. Participants were randomly assigned to a computerized training program involving either faces or houses. Pre- and post-testing included standardized and experimental measures of behavior and event-related brain potentials (ERPs), as well as interviews after training. After training, all participants met behavioral criteria for expertise with the specific stimuli on which they received training. Scores on standardized measures improved after training for both groups, but only the face training group showed an increased face inversion effect behaviorally and electrophysiological changes to faces in the P100 component. These findings suggest that individuals with ASD can gain expertise in face processing through training.

Visual scan paths and recognition of facial identity in autism spectrum disorder and typical development

Background

Previous research suggests that many individuals with autism spectrum disorder (ASD) have impaired facial identity recognition, and also exhibit abnormal visual scanning of faces. Here, two hypotheses accounting for an association between these observations were tested: i) better facial identity recognition is associated with increased gaze time on the Eye region; ii) better facial identity recognition is associated with increased eye-movements around the face.

Methodology and Principal Findings

Eye-movements of 11 children with ASD and 11 age-matched typically developing (TD) controls were recorded whilst they viewed a series of faces, and then completed a two alternative forced-choice recognition memory test for the faces. Scores on the memory task were standardized according to age. In both groups, there was no evidence of an association between the proportion of time spent looking at the Eye region of faces and age-standardized recognition performance, thus the first hypothesis was rejected. However, the ‘Dynamic Scanning Index’ – which was incremented each time the participant saccaded into and out of one of the core-feature interest areas – was strongly associated with age-standardized face recognition scores in both groups, even after controlling for various other potential predictors of performance.

Conclusions and Significance

In support of the second hypothesis, results suggested that increased saccading between core-features was associated with more accurate face recognition ability, both in typical development and ASD. Causal directions of this relationship remain undetermined.

["Theory of mind" and its neuronal correlates in forensically relevant disorders]

Theory of mind (ToM), the ability to recognize mental states of others, and empathy are crucial cognitive-emotional processes for appropriate social interactions. Deficits in these processes can lead to maladjusted social behavior or even to aggressive or criminal behavior. ToM and empathy deficits have been found in different forensically relevant disorders, such as schizophrenia, pedophilia but especially in autism and psychopathy according to Hare. Most notably, autistic and psychopathic patients differ in their type of deficits and in their neuronal correlates. While autistic individuals lack the ability to take the perspective of others, psychopaths lack empathy. The aim of this article is to provide a better understanding of the pathophysiology of ToM and empathy deficits in forensically relevant disorders by reviewing and discussing the findings of neuroimaging and lesion studies and to highlight crucial implications for neuropsychotherapy according to Grawe.

Avatar assistant: improving social skills in students with an ASD through a computer-based intervention

This study assessed the efficacy of FaceSay, a computer-based social skills training program for children with Autism Spectrum Disorders (ASD). This randomized controlled study (N = 49) indicates that providing children with low-functioning autism (LFA) and high functioning autism (HFA) opportunities to practice attending to eye gaze, discriminating facial expressions and recognizing faces and emotions in FaceSay's structured environment with interactive, realistic avatar assistants improved their social skills abilities. The children with LFA demonstrated improvements in two areas of the intervention: emotion recognition and social interactions. The children with HFA demonstrated improvements in all three areas: facial recognition, emotion recognition, and social interactions. These findings, particularly the measured improvements to social interactions in a natural environment, are encouraging.

Recognition of own- and other-race faces in autism spectrum disorders

Empirical data regarding the extent of face recognition abnormalities in autism spectrum disorder (ASD) is inconsistent. Here, 27 ASD and 47 typically developing (TD) children completed an immediate two-alternative forced-choice identity matching task. We contrasted recognition of own- and other-race faces, and, counter to prediction, we found a typical advantage for recognizing own- over other-race faces in both the ASD and TD groups. In addition, ASD and TD groups responded similarly to stimulus manipulations (use of identical or different photographs for identity matching and cropping stimuli to remove hair information). However, age-standardized scores varied widely within the ASD sample, and a subgroup of ASD participants with impaired face recognition did not exhibit a significant own-race recognition advantage. An explanation regarding early experience with faces is considered, and implications for research of individual variation within ASD are discussed.

[Atypical perception processing and facial emotion disorder in autism]

INTRODUCTION

Autistic syndrome is defined by several abnormalities, mainly affecting social interaction skills. Disorders of the processes of processing facial and emotional stimuli, and particularly avoidance of gaze, have also been reported in this disorder. Some authors have suggested that these abnormalities may be explained, or at least contributed to, by the social disorder observed in this syndrome. The aim of this study was therefore to improve the understanding of the processes involved in perception AND the representation of faces expressing emotion in subjects with autism spectrum disorders (ASDs).

METHODS

Eleven children with ASDs (mean developmental age 7 years 11 months) and eleven normally developing children (mean age 7 years 9 months) took part in three experiments. The first involved overall discrimination of emotions using photographs of faces expressing six basic emotions, the second required local emotional discrimination on the basis of isolated elements of the face (photographs of eyes and mouths isolated from the rest of the face), and for the third the children were asked to create faces expressing emotions by means of a jig-saw puzzle format, using photographs of isolated elements of the face (overall representation necessitating local discrimination).

RESULTS

Our findings revealed that the normally developing children had difficulties with the process of local discrimination of emotions: their performance improved when overall perception was possible. In contrast, and astonishingly, the children with ASD were more able to discriminate isolated eyes expressing emotion than the controls, but their performance declined when overall processing was required.

DISCUSSION

Our results suggested that the emotional disorders observed in ASDs might be explained by greater skills in the processing of local information. This might explain the inability of children with ASDs to achieve coherent perception of their social environment and might also lead to the withdrawal that is characteristic of this disorder. These results also suggest that the gaze avoidance that is characteristic of individuals with ASDs is eliminated when eyes are presented alone. This gaze avoidance therefore seems to be related to the complexity and variability of this type of stimulus and not to the social nature of the stimulus.

Attention to social stimuli and facial identity recognition skills in autism spectrum disorder

BACKGROUND

Previous research suggests that individuals with autism spectrum disorder (ASD) have a reduced preference for viewing social stimuli in the environment and impaired facial identity recognition.

METHODS

Here, we directly tested a link between these two phenomena in 13 ASD children and 13 age-matched typically developing (TD) controls. Eye movements were recorded while participants passively viewed visual scenes containing people and objects. Participants also completed independent matching tasks for faces and objects.

RESULTS AND CONCLUSIONS

Behavioural data showed that participants with ASD were impaired on both face- and object-matching tasks relative to TD controls. Eye-tracking data revealed that both groups showed a strong bias to orient towards people. TD children spent proportionally more time looking at people than objects; however, there was no difference in viewing times between people and objects in the ASD group. In the ASD group, an individual's preference for looking first at the people in scenes was associated with level of face recognition ability. Further research is required to determine whether a causal relationship exists between these factors.

Facial identity recognition in the broader autism phenotype

BACKGROUND

The 'broader autism phenotype' (BAP) refers to the mild expression of autistic-like traits in the relatives of individuals with autism spectrum disorder (ASD). Establishing the presence of ASD traits provides insight into which traits are heritable in ASD. Here, the ability to recognise facial identity was tested in 33 parents of ASD children.

METHODOLOGY AND RESULTS

In experiment 1, parents of ASD children completed the Cambridge Face Memory Test (CFMT), and a questionnaire assessing the presence of autistic personality traits. The parents, particularly the fathers, were impaired on the CFMT, but there were no associations between face recognition ability and autistic personality traits. In experiment 2, parents and probands completed equivalent versions of a simple test of face matching. On this task, the parents were not impaired relative to typically developing controls, however the proband group was impaired. Crucially, the mothers' face matching scores correlated with the probands', even when performance on an equivalent test of matching non-face stimuli was controlled for.

CONCLUSIONS AND SIGNIFICANCE

Components of face recognition ability are impaired in some relatives of ASD individuals. Results suggest that face recognition skills are heritable in ASD, and genetic and environmental factors accounting for the pattern of heritability are discussed. In general, results demonstrate the importance of assessing the skill level in the proband when investigating particular characteristics of the BAP.

Using computerized games to teach face recognition skills to children with autism spectrum disorder: the Let's Face It! program

BACKGROUND

An emerging body of evidence indicates that relative to typically developing children, children with autism are selectively impaired in their ability to recognize facial identity. A critical question is whether face recognition skills can be enhanced through a direct training intervention.

METHODS

In a randomized clinical trial, children diagnosed with autism spectrum disorder were pre-screened with a battery of subtests (the Let's Face It! Skills battery) examining face and object processing abilities. Participants who were significantly impaired in their face processing abilities were assigned to either a treatment or a waitlist group. Children in the treatment group (N = 42) received 20 hours of face training with the Let's Face It! (LFI!) computer-based intervention. The LFI! program is comprised of seven interactive computer games that target the specific face impairments associated with autism, including the recognition of identity across image changes in expression, viewpoint and features, analytic and holistic face processing strategies and attention to information in the eye region. Time 1 and Time 2 performance for the treatment and waitlist groups was assessed with the Let's Face It! Skills battery.

RESULTS

The main finding was that relative to the control group (N = 37), children in the face training group demonstrated reliable improvements in their analytic recognition of mouth features and holistic recognition of a face based on its eyes features.

CONCLUSION

These results indicate that a relatively short-term intervention program can produce measurable improvements in the face recognition skills of children with autism. As a treatment for face processing deficits, the Let's Face It! program has advantages of being cost-free, adaptable to the specific learning needs of the individual child and suitable for home and school applications.

Response to familiar faces, newly familiar faces, and novel faces as assessed by ERPs is intact in adults with autism spectrum disorders

Individuals with autism spectrum disorders (ASD) have pervasive impairments in social functioning, which may include problems with processing and remembering faces. In this study, we examined whether posterior ERP components associated with identity processing (P2, N250 and face-N400) and components associated with early-stage face processing (P1 and N170) are atypical in ASD. We collected ERP responses to a familiar repeated face (Familiar), an unfamiliar repeated face (Other) and novel faces (Novels) in 29 high-functioning adults with ASD and matched controls. For both groups, the P2 and N250 were sensitive to repetition (Other vs. Novels) and personal familiarity (Familiar vs. Other), and the face-N400 was sensitive to repetition. Adults with ASD did not show significantly atypical processing of facial familiarity and repetition in an ERP paradigm, despite showing significantly poorer performance than controls on a behavioral test of face memory. This study found no evidence that early-stage facial identity processing is a primary contributor to the face recognition deficit in high-functioning ASD.

Learning New Faces in Typically Developing Children and Children on the Autistic Spectrum

As faces become familiar, recognition becomes easier but the style of processing also changes. Here, twenty-one typically developing (TD) children and twenty-one children with autism spectrum disorder (ASD) were familiarised with 6 identities over 3 days. Next, they completed a 4-alternative forced-choice matching test in which targets were the 6 familiarised faces and 6 unfamiliar faces. The TD group showed a significant advantage for familiarised faces when matching whole faces and both internal and external facial regions. The ASD group showed similar familiarisation effects for whole and external faces, but not for internal regions. The ASD group was also impaired at matching eyes and mouths of familiarised faces. Results suggest the process of acquiring familiarity with faces differs from ASD and TD children.

The role of face familiarity in eye tracking of faces by individuals with autism spectrum disorders

It has been shown that individuals with autism spectrum disorders (ASD) demonstrate normal activation in the fusiform gyrus when viewing familiar, but not unfamiliar faces. The current study utilized eye tracking to investigate patterns of attention underlying familiar versus unfamiliar face processing in ASD. Eye movements of 18 typically developing participants and 17 individuals with ASD were recorded while passively viewing three face categories: unfamiliar non-repeating faces, a repeating highly familiar face, and a repeating previously unfamiliar face. Results suggest that individuals with ASD do not exhibit more normative gaze patterns when viewing familiar faces. A second task assessed facial recognition accuracy and response time for familiar and novel faces. The groups did not differ on accuracy or reaction times.