A review of joint attention and social-cognitive brain systems in typical development and autism spectrum disorder

Exploring Tactile Initiation of Joint Attention in Autistic Children

Initiation of joint attention (IJA) is often impaired in children who may be diagnosed with autism spectrum disorder (ASD). Traditionally, assessments of IJA have focused on visual and auditory means of communication. Recent research has expanded the understanding of joint attention to include tactile interactions. To investigate the early development of IJA in toddlers, particularly focusing on the differences in sensory modalities, we conducted a prospective study tracking 60 toddlers (30 males) up to 36 months of age, including 16 who were later diagnosed with ASD. We used videos taken during the administration of Communication and Symbolic Behavior Scales-Developmental Profile to code for IJA corresponding to different sensory modalities. During the second year of life, autistic children displayed lower frequencies of visual, auditory, and combined visual-auditory IJA compared to typically developing peers. Conversely, autistic children exhibited higher frequencies of tactile IJA. Notably, the frequencies of tactile IJA at 12 months were correlated with social symptoms at 24 months, showing a positive correlation across all participants and a negative correlation specifically within the ASD group. These results suggest that differences in the use of different sensory modalities of IJA may influence the development of future social communication abilities. Clinical Trial Registration: www.chictr.org.cn , identifier ChiCTR2100049811, 2021-08-10.

Who Leads and Who Follows? The Pathways to Joint Attention During Free-Flowing Interactions Change Over Developmental Time

Joint attention (JA) has been found to correlate with many developmental outcomes. However, little is known about how naturalistic JA is established and develops during early infancy. In this study, free-flowing tabletop toy play between infants at 5 and 15 months and their mothers (N = 48 dyads; 65% white) was observed to (1) examine changes in JA, (2) investigate whether infants become better leaders or followers of JA, and (3) explore the role of intentionally mediated forms of communication. JA episodes increased in frequency and duration, and initiations of JA became more evenly distributed between members of the dyad. Older infants became better at leading as well as following their mothers' attention behaviors and more frequently directed their attention towards their partner, though this had minimal impact on the organization of episodes of JA.

Individual variation in the chimpanzee arcuate fasciculus predicts vocal and gestural communication

Whether language has its evolutionary origins in vocal or gestural communication has long been a matter of debate. In humans, the arcuate fasciculus, a major fronto-temporal white matter tract, is left-lateralized, is larger than in nonhuman apes, and is linked to language. However, the extent to which the arcuate fasciculus of nonhuman apes is linked to vocal and/or manual communication is currently unknown. Here, using probabilistic tractography in 67 chimpanzees (45 female, 22 male), we report that the chimpanzee arcuate fasciculus is not left-lateralized at the population level, in marked contrast with humans. However, individual variation in the anatomy and leftward asymmetry of the chimpanzee arcuate fasciculus is associated with individual variation in the use of both communicative gestures and communicative sounds under volitional orofacial motor control. This indicates that the arcuate fasciculus likely supported both vocal and gestural communication in the chimpanzee/human last common ancestor, 6-7 million years ago.

A new psychometric tool for evaluating nonverbal social cue-following: regression-based normative data for children 6 to 10 years old

The ability to follow nonverbal social cues is impaired in several disorders. Our aim was to collect normative data for the first psychometric test (TooN) that assesses this skill in children. The normative sample consisted of 339 typically developing children aged 6 to 10. TooN is a computerized tool that includes 120 trials in which children must press a button as soon as possible when an object appears on the right or left side of the screen. Each object is preceded by a video of a model gazing and/or pointing to the side where the object appears (i.e. congruent condition) or the opposite side (i.e. incongruent condition). Linear regression analyses were conducted for reaction times (RTs) and for gaze and pointing cuing effects (i.e. the difference between RTs in incongruent and congruent conditions). Regression analyses showed that age, sex and parental education significantly predicted RTs. Age and sex, but not parental education, were significant predictors of gaze cuing effects. However, age was the only significant predictor of pointing cuing effects. Based on these analyses, we provided the equations to calculate the z-scores for RTs and cuing effects. Accuracy scores, stratified by age and/or sex, are reported as percentiles. Based on the performances of typically developing children, we present the normative data of a new psychometric tool designed to assess nonverbal social cue-following. This tool can be valuable for evaluating children with neurodevelopmental disorders. To support this claim, its validity should be tested across various clinical populations.

Infant EEG microstate dynamics relate to fine-grained patterns of infant attention during naturalistic play with caregivers

As infants grow, they develop greater attentional control during interactions with others, shifting from patterns of attention primarily driven by caregivers (exogenous) to those that are also self-directed (endogenous). The ability to endogenously control attention during infancy is thought to reflect ongoing brain development and is influenced by patterns of joint attention between infant and caregiver. However, whether measures of infant attentional control and caregiver behavior during infant-caregiver interactions relate to patterns of infant brain activity is unknown and key for informing developmental models of attentional control. Using data from 43 infant-caregiver dyads, we quantified patterns of visual attention with dyadic, head-mounted eye tracking during infant-caregiver play and associated them with the duration of infant EEG microstate D/4 measured during rest. Importantly, microstate D/4 is a scalp potential topography thought to reflect the organization and function of attention-related brain networks. We found that microstate D/4 associated positively with infant-led joint attention rate but did not associate with caregiver-led joint attention rate, suggesting that infant-led coordination of joint attention during play may be critical for the neurobiological development of attentional control, or vice versa. Further, we found that microstate D/4 associated negatively with infant attention shift rate and positively with infant sustained attention duration, suggesting that increased stability of microstate D/4 may reflect maturation of attentional control and its underlying neural substrates. Together, our findings provide insights into how infant attentional control abilities and infant-caregiver visual behavior during play are associated with the spatial and temporal dynamics of infant brain activity.

Do Children's Brains Function Differently During Book Reading and Screen Time? A fNIRS Study

Previous research suggests that book reading and screen time have contrasting effects on language and brain development. However, few studies have explicitly investigated whether children's brains function differently during these two activities. The present study used functional near-infrared spectroscopy (fNIRS) to measure brain response in 28 typically developing preschool-aged children (36-72 months old) during two conditions-a book reading condition, in which children listened to a story read by a live experimenter while viewing words and pictures in a book, and a screen time condition, in which children listened to a story that was played via an audio recording while viewing words and pictures on a screen. Analyses revealed significant activation in the right temporal parietal junction (TPJ) during the book reading condition only. Across regions of interest (ROIs), including the inferior and middle frontal gyrus (IMFG), the superior and middle temporal gyrus (SMTG), and the TPJ, brain response during the book reading condition was greater in right-lateralized ROIs than left-lateralized ROIs, while brain response during the screen time condition was similar across left and right ROIs. Findings suggest that the lateralization of preschool-aged children's brain function within these ROIs differs during book reading and screen time, which provides a possible neurobiological explanation for why book reading and screen time impact language development in such different ways. Findings provide important insights into how children's brains function during different types of activities (dyadic vs. solitary) and when using different types of media (print vs. digital).

Cortical Thickness Differences in Autistic Children With and Without Intellectual Disability

Of the 1 in 36 individuals in the United States who are diagnosed with autism spectrum disorder, nearly 40% also have intellectual disability (ID). The cortex has been widely implicated in neural processes underlying autistic behaviors as well as intellectual ability. Thus, neuroimaging features such as cortical thickness are of particular interest as a possible biomarkers of the condition. However, neuroimaging studies often fail to include autistic individuals with ID. As a result, there are few studies of cortical thickness in autistic individuals across the entire range of intellectual abilities. This study used MRI to evaluate cortical thickness in young autistic children (n = 88, mean age 5.37 years) with a large range of intellectual ability (IQ 19-133) as well as nonautistic, nondevelopmentally delayed (referred to here as typically developing [TD]) peers (n = 53, mean age 5.29 years). We first investigated associations between full scale IQ and cortical thickness in both autistic and TD children. Autistic children had significant negative associations (i.e., thinner cortex, higher IQ) in bilateral entorhinal cortex, right fusiform gyrus, superior, middle and inferior temporal gyri, and right temporal pole that were not present in TD children. Significantly thicker cortex was also observed in these regions for autistic children with ID (i.e., IQ ≤ 70) compared with those without. Last, given the reported correspondence between the severity of autism symptoms and intellectual ability, we compared cortical thickness associations with both IQ and ADOS Calibrated Severity Scores and found these patterns overlapped to a significant degree across the cortex.

Correlation Between Gaze Behaviors and Social Communication Skills of Young Autistic Children: A Meta-Analysis of Eye-Tracking Studies

This meta-analysis examined correlations between eye-tracking measures of gaze behaviors manifested during dynamic salient social stimuli and behavioral assessment measures of social communication skills of young autistic children. We employed a multilevel model with random effects to perform three separate meta-analyses for correlation between social communication skills and (a) all gaze behaviors, (b) gaze duration, and (c) gaze transition. Subsequently, we performed meta-regression to assess the role of four moderators, including age, continuum of naturalness of stimuli, gaze metric, and area of interest, on correlation effect sizes that were heterogeneous at the population level. A total of 111 correlation coefficients from 17 studies for 1132 young autistic children or children with high-likelihood for autism (Mage range = 6-95 months) were included in this meta-analysis. The correlation effect sizes for all three meta-analyses were significant, supporting the relation between improved gaze behaviors and better social communication skills. In addition, age, gaze metric, and area of interest were significant moderators. This suggests the importance of identifying meaningful gaze behaviors related to social communication skills and the increasingly influential role of gaze behaviors in shaping social communication skills as young autistic children progress through the early childhood stage. The continuum of naturalness of stimuli, however, was revealed to trend towards having a significant moderating effect. Lastly, it is important to note the evidence of potential publication bias. Our findings are discussed in the context of early identification and intervention and unraveling the complex nature of autism.

Visual Attention in Joint Attention Bids: A Comparison Between Toddlers with Autism Spectrum Disorder and Typically Developing Toddlers

Impairments in joint attention are considered core symptoms of autism spectrum disorder (ASD) and are crucial for early assessment and intervention. However, existing information about visual attention during joint attention and its relation to developmental functioning is limited. The current study investigated the visual attention differences between toddlers with ASD and typically developing (TD) toddlers during single and multiple joint attention cue conditions. This study further examined whether visual attention in joint attention Area of Interests (AOIs) is related to cognitive, language, and motor development in participants. Participants included 56 toddlers with ASD and 56 TD toddlers, aged 18-36 months. A passive viewing paradigm was used to assess participants' visual attention across four different joint attention conditions. Study results showed that toddlers with ASD displayed limited visual attention towards joint attention AOIs, Target, Face, and Target and Face AOIs, in all conditions. As the joint attention cues increased from Condition 1 to Condition 4, toddlers with ASD showed increased visual attention directed towards the Target AOI over the Face AOI. Moreover, increased visual attention on the joint attention AOIs was associated with improved cognitive and language development in toddlers with ASD. This research broadens our understanding of the positive relationships between visual attention to joint attention AOIs and cognitive as well as language development in toddlers with ASD, suggesting that early interventions targeting joint attention may offer promising pathways for treatment.

MHNet: Multi-view High-Order Network for Diagnosing Neurodevelopmental Disorders Using Resting-State fMRI

Deep learning models have shown promise in diagnosing neurodevelopmental disorders (NDD) like ASD and ADHD. However, many models either use graph neural networks (GNN) to construct single-level brain functional networks (BFNs) or employ spatial convolution filtering for local information extraction from rs-fMRI data, often neglecting high-order features crucial for NDD classification. We introduce a Multi-view High-order Network (MHNet) to capture hierarchical and high-order features from multi-view BFNs derived from rs-fMRI data for NDD prediction. MHNet has two branches: the Euclidean Space Features Extraction (ESFE) module and the Non-Euclidean Space Features Extraction (Non-ESFE) module, followed by a Feature Fusion-based Classification (FFC) module for NDD identification. ESFE includes a Functional Connectivity Generation (FCG) module and a High-order Convolutional Neural Network (HCNN) module to extract local and high-order features from BFNs in Euclidean space. Non-ESFE comprises a Generic Internet-like Brain Hierarchical Network Generation (G-IBHN-G) module and a High-order Graph Neural Network (HGNN) module to capture topological and high-order features in non-Euclidean space. Experiments on three public datasets show that MHNet outperforms state-of-the-art methods using both AAL1 and Brainnetome Atlas templates. Extensive ablation studies confirm the superiority of MHNet and the effectiveness of using multi-view fMRI information and high-order features. Our study also offers atlas options for constructing more sophisticated hierarchical networks and explains the association between key brain regions and NDD. MHNet leverages multi-view feature learning from both Euclidean and non-Euclidean spaces, incorporating high-order information from BFNs to enhance NDD classification performance.

Pragmatic performance, its relationship with symptom severity, and early clinical predictors of pragmatics in 5 ~ 6-year-old children with autism spectrum disorder

BACKGROUND

Pragmatic language refers to using spoken language to convey messages effectively across diverse social communication contexts. However, minimal longitudinal research has focused on defining early predictors of pragmatic development in children with autism spectrum disorder (ASD).

METHODS

In the present study, 71 children with ASD and 38 age- and gender- matched 24- to 30-month-old typically developing (TD) children were enrolled. Social-communication, language, and parent‒child interaction measures were collected for the ASD group at baseline. Three years later, all subjects were assessed for pragmatic ability via the Chinese version of the Language Use Inventory (LUI-Mandarin). First, the differences in pragmatic performance between the ASD and TD groups at follow-up were analyzed. Second, pragmatic performance was correlated with autism symptomatology at follow-up, as well as the structural language difficulties and joint engagement (JE) levels at baseline in the ASD group. Furthermore, hierarchical multiple regression analyses and machine learning techniques were performed to explore the effects of early potential predictors of pragmatic development in the ASD group.

RESULTS

First, our results revealed that performance was significantly lower in the ASD than in the TD group with respect to the LUI-Mandarin total scores and subscale scores (except for subscale C). Second, correlation analysis revealed that more severe symptoms of ASD at follow-up were associated with lower LUI-Mandarin total scores and better language performance on the Gesell Developmental Schedules (GDS). Additionally, increased proportions of supported JE (SJE) states were associated with higher LUI-Mandarin total scores. In contrast, increased proportions of unengaged (UE) states were associated with lower LUI-Mandarin total scores in the ASD group. Third, hierarchical multiple regression analyses and machine learning techniques indicated that the proportions of SJE during parent‒child interactions, as well as the degree of social symptoms and structural language impairments, were significant contributors to pragmatic development for the ASD group in the prediction models.

CONCLUSION

In summary, our findings suggest that pragmatic language difficulties are present in children with ASD as early as preschool age. Additionally, given the close correlation between the LUI-Mandarin score and symptom severity on the ADOS/ADI-R, the LUI-Mandarin might be a good way to triage children who need to wait a long time for a more extensive evaluation. Furthermore, this study provides new insights into potential targets for pragmatic interventions, and interventions can be designed to promote SJE between caregivers and children in future work.

Developmental Relationships Between Early Vocabulary Acquisition, Joint Attention and Parental Supportive Behaviors

In late infancy and early toddlerhood, joint attention ability is widely recognized as a crucial foundation for children's vocabulary development, though the exact nature of its contribution remains debated. This study investigates associations between joint attention and subsequent vocabulary development, as well as the possible moderating role of supportive parental behaviors. Seventy children and their families participated in this longitudinal study, which began when the children were 10 months of age. Parents completed the Swedish Communicative Development Inventory (CDI) at four age points (10, 12, 18, and 24 months) to assess receptive and expressive vocabulary growth. Children participated in lab-based assessment of joint attention abilities at 10, 12, and 18 months. Additionally, at 10 and 12 months, parent-child dyads participated in two semi-structured lab assessments to evaluate the quality of parental supportive behaviors during interactions with their child. Primary analysis showed no significant effects of joint attention on subsequent receptive and expressive vocabulary. However, a significant interaction was found between a child's ability to respond to joint attention cues and parental supportive behaviors on receptive vocabulary. These findings indicate that parental supportive behaviors play a crucial role in promoting the development of children's receptive vocabulary.

Synchrony Across Brains

Second-person neuroscience focuses on studying the behavioral and neuronal mechanisms of real-time social interactions within single and across interacting brains. In this review article, we describe the developments that have been undertaken to study socially interactive phenomena and the behavioral and neurobiological processes that extend across interaction partners. More specifically, we focus on the role that synchrony across brains plays in enabling and facilitating social interaction and communication and in shaping social coordination and learning, and we consider how reduced synchrony across brains may constitute a core feature of psychopathology.

Caregiver-child neural synchrony: Magic, mirage, or developmental mechanism?

Young children transition in and out of synchronous states with their caregivers across physiology, behavior, and brain activity, but what do these synchronous periods mean? One body of two-brain studies using functional near-infrared spectroscopy (fNIRS) finds that individual, family, and moment-to-moment behavioral and contextual factors are associated with caregiver-child neural synchrony, while another body of literature finds that neural synchrony is associated with positive child outcomes. Taken together, it is tempting to conclude that caregiver-child neural synchrony may act as a foundational developmental mechanism linking children's experiences to their healthy development, but many questions remain. In this review, we synthesize recent findings and open questions from caregiver-child studies using fNIRS, which is uniquely well suited for use with caregivers and children, but also laden with unique constraints. Throughout, we highlight open questions alongside best practices for optimizing two-brain fNIRS to examine hypothesized developmental mechanisms. We particularly emphasize the need to consider immediate and global stressors as context for interpretation of neural synchrony findings, and the need for full inclusion of socioeconomically and racially diverse families in future studies.

The effectiveness of social training in individuals with autism spectrum disorder (ASD): a systematic review and transfer analysis

Autism spectrum disorders (ASD) are characterized by impaired social communication and interactions, as well as constrained and repetitive manifestations of interests and behaviors. Various interventions at cognitive and behavioral levels aim to address impaired social communication and interaction in individuals with ASD. This study systematically explores the transferability of social training in individuals with ASD, guided by the conceptual model known as the FIELD framework (Function, Implement, Ecology, Level, and Durability). Employing the PRISMA methodology, 52 original experiments were included in the study. The transfer analysis, formulated as a conceptual meta-analysis based on the effect sizes, underscores the significant impact of variables including age, severity of autism, intervention tools, intervention intensity, intervention context, and intervention duration on the transferability of social training in individuals with ASD. The transfer of skills was particularly conspicuous among younger individuals, especially in face-to-face interventions, in contrast to digital alternatives. Moreover, cognitive interventions exhibited superior transferability compared to behavioral interventions, especially when administered with a higher intervention dose.

The Development of Socially Directed Attention: A Functional Magnetic Resonance Imaging Study in Infant Monkeys

Socially guided visual attention, such as gaze following and joint attention, represents the building block of higher-level social cognition in primates, although their neurodevelopmental processes are still poorly understood. Atypical development of these social skills has served as early marker of autism spectrum disorder and Williams syndrome. In this study, we trace the developmental trajectories of four neural networks underlying visual and attentional social engagement in the translational rhesus monkey model. Resting-state fMRI (rs-fMRI) data and gaze following skills were collected in infant rhesus macaques from birth through 6 months of age. Developmental trajectories from subjects with both resting-state fMRI and eye-tracking data were used to explore brain-behavior relationships. Our findings indicate robust increases in functional connectivity (FC) between primary visual areas (primary visual cortex [V1] - extrastriate area 3 [V3] and V3 - middle temporal area [MT], MT and anterior superior temporal sulcus area [AST], as well as between anterior temporal area [TE]) and amygdala (AMY) as infants mature. Significant FC decreases were found in more rostral areas of the pathways, such as between temporal area occipital part - TE in the ventral object pathway, V3 - lateral intraparietal (LIP) of the dorsal visual attention pathway and V3 - temporo-parietal area of the ventral attention pathway. No changes in FC were found between cortical areas LIP-FEF and temporo-parietal area - Area 12 of the dorsal and ventral attention pathways or between Anterior Superior Temporal sulcus area (AST)-AMY and AMY-insula. Developmental trajectory of gaze following revealed a period of dynamic changes with gradual increases from 1 to 2 months, followed by slight decreases from 3 to 6 months. Exploratory association findings across the 6-month period showed that infants with higher gaze following had lower FC between primary visual areas V1-V3, but higher FC in the dorsal attention areas V3-LIP, both in the right hemisphere. Together, the first 6 months of life in rhesus macaques represent a critical period for the emergence of gaze following skills associated with maturational changes in FC of socially guided attention pathways.

Evaluation of the Social Attention Hypothesis: Do Children with Autism Prefer to See Objects Rather than People?

A growing body of research shows that children with autism exhibit selective limitations in their ability to direct their visual attention to social stimuli. The cause of this selective limitation, however, remains unknown. The main purpose of this study is to determine whether the limitations in social attention are influenced by the objects in the environment. Specifically, the study examines the differences in visual attention between children with autism and typically developing (TD) children as they view videos of social interactions under two conditions, with and without objects. The sample consisted of 53 children with autism and 74 TD children, aged between 18 and 36 months. The findings indicated that young children with autism exhibited differences in their social attention compared to their TD peers. The results revealed that the presence of objects did not affect the visual attention differences between the two groups. However, removing objects from the environment positively impacted the social attention of both groups. In the condition without objects, both groups directed more visual attention more toward the Face and Body Areas of Interests (AoIs), whereas in the condition with objects, both groups prioritized looking at the Toy AoI. These findings have important implications for evidence-based decision-making, especially in designing early intervention environments for children with autism.

Is the precedence of social re-orienting only inherent to the initiators?

Previous researches have revealed that initiators preferentially re-orient their attention towards responders with whom they have established joint attention (JA). However, it remains unclear whether this precedence of social re-orienting is inherent to initiators or applies equally to responders, and whether this social re-orienting is modulated by the social contexts in which JA is achieved. To address these issues, the present study adopted a modified virtual-reality paradigm to manipulate social roles (initiator vs. responder), social behaviours (JA vs. Non-JA), and social contexts (intentional vs. incidental). Results indicated that people, whether as initiators or responders, exhibited a similar prioritisation pattern of social re-orienting, and this was independent of the social contexts in which JA was achieved, revealing that the prioritisation of social re-orienting is an inherent social attentional mechanism in humans. It should be noted, however, that the distinct social cognitive systems engaged when individuals switched roles between initiator and responder were only driven during intentional (Experiment 1) rather than incidental (Experiment 2) JA. These findings provide potential insights for understanding the shared attention system and the integrated framework of attentional and mentalising processes.

Social and joint attention during shared book reading in young autistic children: a potential marker for social development

BACKGROUND

Atypical patterns of social engagement and joint attention behaviors are diagnostic criteria for people with autism spectrum disorder. Experimental tasks using eye-tracking methodologies have, however, shown inconsistent results. The development of tasks with greater ecological validity and relevance for developmentally appropriate social milestones has been identified as important for the field.

METHODS

We developed a novel, dynamic eye-tracking task emulating a shared book reading (SBR) scenario. Four SBR videos of an adult reader engaging with the viewer while reading a children's picture book and including sequenced bids for joint attention were developed. Participants included 90 children (N = 56 autistic children, N = 34 neurotypical children; aged 3-12). Social attention was also measured in a live free play task between participants and an experimenter.

RESULTS

Compared to neurotypical children, autistic children displayed reduced attention to socially salient stimuli including the reader's face and picture book across SBR videos and during joint attention bids specifically. In contrast, they showed increased attention to nonsalient background stimuli compared to their neurotypical peers. These attention patterns in autistic children were associated with reduced verbal and nonverbal cognitive skills and increased symptoms associated with autism. Interestingly, positive correlations in the frequency of eye gaze between SBR and free play suggested a potential predictive value for social attention in live social interactions.

CONCLUSIONS

Findings highlight the utility of SBR eye-tracking tasks in understanding underlying divergences in social engagement and joint attention between autistic and neurotypical children. This commonly practiced early childhood activity may provide insights into the relationship between social engagement and learning to reveal how such attentional patterns might influence broader developmental and educational outcomes.

Sex differences in trajectories of cortical development in autistic children from 2-13 years of age

Previous studies have reported alterations in cortical thickness in autism. However, few have included enough autistic females to determine if there are sex specific differences in cortical structure in autism. This longitudinal study aimed to investigate autistic sex differences in cortical thickness and trajectory of cortical thinning across childhood. Participants included 290 autistic (88 females) and 139 nonautistic (60 females) individuals assessed at up to 4 timepoints spanning ~2-13 years of age (918 total MRI timepoints). Estimates of cortical thickness in early and late childhood as well as the trajectory of cortical thinning were modeled using spatiotemporal linear mixed effects models of age-by-sex-by-diagnosis. Additionally, the spatial correspondence between cortical maps of sex-by-diagnosis differences and neurotypical sex differences were evaluated. Relative to their nonautistic peers, autistic females had more extensive cortical differences than autistic males. These differences involved multiple functional networks, and were mainly characterized by thicker cortex at ~3 years of age and faster cortical thinning in autistic females. Cortical regions in which autistic alterations were different between the sexes significantly overlapped with regions that differed by sex in neurotypical development. Autistic females and males demonstrated some shared differences in cortical thickness and rate of cortical thinning across childhood relative to their nonautistic peers, however these areas were relatively small compared to the widespread differences observed across the sexes. These results support evidence of sex-specific neurobiology in autism and suggest that processes that regulate sex differentiation in the neurotypical brain contribute to sex differences in the etiology of autism.

Impaired motor and social skill development in infancy predict high autistic traits in toddlerhood

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. Early diagnosis in the critical period is important for ASD children. Recent studies of neurodevelopmental behavioral features and joint attention in high-risk infants showed there are some special cues which can distinguish ASD from typical development infant. But the findings of high-risk population may not be applicable to the general population. It is necessary to "analogically" study the potential warning traits of ASD in infancy in the general population. We did a nested case-control study from June 2019 to November 2022 in Tianjin, China, including 76 general infants whom completed the neurodevelopmental evaluation, the Checklist for Autism in Toddlers-23 (CHAT-23) screening, and eye tracking task. Social behavior quotient in infancy was negatively correlated to CHAT-23 total scores in toddlerhood. Social behavior quotient in infancy was positively correlated to initiating joint attention in toddlerhood. Regression model showed that high fine motor scale and social behaviour scale quotient in infancy were associated with an decreased risk of the total score of CHAT-23 ≥ 2 in toddlerhood. The Receiver operating characteristic curve showed the social behaviour in infancy alone and the combination of fine motor and social behaviour in infancy contributed to auxiliary diagnosis of higher level of autistic traits in toddlerhood. These findings suggest that Impaired development of fine motor and social behavior in infancy are potential warning features of high autistic traits in general population.

Th.o.m.a.s.: new insights into theory of mind in adolescents with autism spectrum disorder

Previous studies indicated atypical Theory of Mind (ToM) abilities in individuals with autism spectrum disorder (ASD) at different ages. However, research focused on adolescents with ASD is still rare. This study aims to fill the gaps in the literature, by investigating ToM abilities in adolescents with ASD and in a group of typically developing ones. We applied the Theory of Mind Assessment Scale (Th.o.m.a.s.), a semi-structured interview that allows a multi-dimensional measurement of ToM, including different perspectives (first/s-order, first/third-person, egocentric/allocentric), various mental states (emotions, desires, beliefs) and metacognitive abilities related with mental states (awareness, relation, and strategies). The results indicated that ToM develops atypically in ASD, with strengths and weaknesses. First, participants with ASD were comparable to controls in some specific ToM aspects, i.e., third-person ToM, both from an egocentric and an allocentric perspective. However, they were significantly weaker in attributing an understanding of the mental states of others, both in first- and second-order ToM scenarios. Second, they showed the same level of awareness about mental states as controls, but they were significantly weaker in conceptualizing the relationship between mental states and behavior. Also, they found it very difficult to think about possible strategies that they or others might employ to realize desires and needs. Finally, they performed similarly to controls in understanding emotions, while they poorly understood desires and beliefs. These results point out the distinctive characteristics of ToM development in individuals with ASD, with important implications for individualized interventions.

Interacting with autistic virtual characters: intrapersonal synchrony of nonverbal behavior affects participants' perception

Temporal coordination of communicative behavior is not only located between but also within interaction partners (e.g., gaze and gestures). This intrapersonal synchrony (IaPS) is assumed to constitute interpersonal alignment. Studies show systematic variations in IaPS in individuals with autism, which may affect the degree of interpersonal temporal coordination. In the current study, we reversed the approach and mapped the measured nonverbal behavior of interactants with and without ASD from a previous study onto virtual characters to study the effects of the differential IaPS on observers (N = 68), both with and without ASD (crossed design). During a communication task with both characters, who indicated targets with gaze and delayed pointing gestures, we measured response times, gaze behavior, and post hoc impression formation. Results show that character behavior indicative of ASD resulted in overall enlarged decoding times in observers and this effect was even pronounced in observers with ASD. A classification of observer's gaze types indicated differentiated decoding strategies. Whereas non-autistic observers presented with a rather consistent eyes-focused strategy associated with efficient and fast responses, observers with ASD presented with highly variable decoding strategies. In contrast to communication efficiency, impression formation was not influenced by IaPS. The results underline the importance of timing differences in both production and perception processes during multimodal nonverbal communication in interactants with and without ASD. In essence, the current findings locate the manifestation of reduced reciprocity in autism not merely in the person, but in the interactional dynamics of dyads.

Caregiver-reported infant motor and imitation skills predict M-CHAT-R/F

Altered motor and social-communicative abilities in infancy have been linked to later ASD diagnosis. Most diagnostic instruments for ASD cannot be utilized until 12 months, and the average child is diagnosed substantially later. Imitation combines motor and social-communicative skills and is commonly atypical in infants at risk for ASD. However, few measures have been developed to assess infant imitation clinically. One barrier to the diagnostic age gap of ASD is accessibility of screening and diagnostic services. Utilization of caregiver report to reliably screen for ASD mitigates such barriers and could aid in earlier detection. The present study developed and validated a caregiver-report measure of infant imitation at 4, 6, and 9 months and explored the relationship between caregiver-reported imitation and motor abilities with later ASD risk. Participants (N = 571) were caregivers of term and preterm infants recruited as part of a large multi-site study of PediaTrac™, a web-based tool for monitoring and tracking infant development. Caregivers completed online surveys and established questionnaires on a schedule corresponding to well-child visits from birth to 18 months, including the M-CHAT-R/F at 18 months. Distinct imitation factors were derived from PediaTrac at 4, 6, and 9 months via factor analysis. The results supported validity of the imitation factors via associations with measures of infant communication (CSBS; ASQ). Imitation and motor skills at 9 months predicted 18-month ASD risk over and above gestational age. Implications for assessment of infant imitation, detecting ASD risk in the first year, and contributing to access to care are discussed.

Brief Report: The Factors Associated with Social Cognition in Children with Autism Spectrum Disorder

This study examined whether school-aged autistic children without co-occurring intellectual disabilities (autisticWoID) show similar difficulty on Theory of Mind (ToM) tasks as young autisticWoID children and if these difficulties are related to problems in domain-general aspects of cognition. Eighty-one autisticWoID and 44 neurotypical (NT) children between the ages of 8-16 years participated in this study and were matched on verbal IQ. ToM performance significantly and independently differentiated many, but not all, autisticWoID and NT participants above and beyond the effects of working memory and inferential thinking. However, these cognitive variables did not fully explain difficulties with social cognition in autisticWoID children. These findings have implications for understanding autism, the factors that may impact intervention for social cognition in autism, and the factors that impact the education of autistic children who may struggle in general education classrooms.

The role of personality in social interaction perception: an ERP and source imaging study

Agreeableness, one of the five personality traits, is associated with socio-cognitive abilities. This study investigates how agreeableness impacts the perception of social interactions, while considering sex that might moderate this effect. Sixty-two young adults, preselected to ensure a wide range of agreeableness scores, underwent EEG recording while viewing images depicting real-world scenes of two people either engaged in a social interaction or acting independently. Behavioral results suggested a trend where higher agreeableness scores predicted better ability to detect social interactions primarily in males. ERP analysis showed that individuals with higher agreeableness exhibited stronger neural differentiation between social and non-social stimuli, observed in both females and males, and in the whole sample. This neural differentiation, occurring early in the processing timeline, was particularly extensive in males, and predictive of their performance. Three independent source analyses, conducted for the whole sample and for each sex, identified the engagement of right fronto-parietal regions for the ERP-agreeableness association. These findings enhance our understanding of how agreeableness shapes the neural mechanisms underlying social interaction detection and emphasize sex as an important factor in this dynamic. They also highlight the need for tailored approaches that consider personality traits and sex in clinical interventions targeting social impairments.

Understanding social cognition in children with cerebral palsy: exploring the relationship with executive functions and the intervention outcomes in a randomized controlled trial

Children with Cerebral Palsy (CP) experience Social Cognition (SC) difficulties, which could be related to executive functioning. While motor interventions are common, there is limited knowledge about the impact of cognitive interventions on SC in this population. This study examined the relationship between SC and Executive Function (EF) skills and the effectiveness of an EF intervention that included some SC tasks for improving SC in children with CP. SC and EF domains were assessed in 60 participants with CP (30 females; 8-12 years). The relationship between SC and EF baseline scores was analyzed by bivariate correlations and contingency tables. Participants were matched by age, sex, motor ability, and intelligence quotient and randomized into intervention or control groups. The intervention group underwent a 12-week home-based computerized EF intervention. Analysis of covariance was used to examine differences in SC components between groups at post-intervention and 9 months after. Significant positive correlations were found between the SC and EF scores. The frequencies of impaired and average scores in SC were distributed similarly to the impaired and average scores in EFs. The intervention group showed significant improvements in Affect Recognition performance post-intervention, which were maintained at the follow-up assessment, with a moderate effect size. Long-term improvements in Theory of Mind were observed 9 months after.

CONCLUSIONS

This study highlights the association between SC and EFs. A home-based computerized cognitive intervention program improves SC in children with CP. Including SC tasks in EF interventions may lead to positive short- and long-term effects for children with CP.

CLINICAL TRIAL REGISTRATION

NCT04025749 retrospectively registered on 19 July 2019.

WHAT IS KNOWN

• Executive functions and social cognition are associated with social and community participation in people with cerebral palsy. • A home-based computerized cognitive intervention can improve the executive functioning of children with cerebral palsy.

WHAT IS NEW

• Social cognition performance is related to core and higher-order executive functions. • A home-based computerized executive function intervention, including social cognition tasks, has positive short- and long-term effects on social cognition skills in children with cerebral palsy.

The Construct Validity of the Childhood Joint Attention Rating Scale (C-JARS) in School-Aged Autistic Children

Preliminary evidence from the Childhood Joint Attention Rating Scale (C-JARS; Mundy et al., 2017) suggests symptoms related to diminished joint attention and the spontaneous sharing of experience with others can be assessed with a parent-report measure in children and adolescents with autism. This study was designed to expand on the previous study by examining the validity of both a Social Symptom (SS) and a Prosocial (PS) scale of the C-JARS in a study of school-aged autistic children (n  = 89) with and without co-occurring intellectual disability (ID), as well as an age matched neurotypical sample (n  = 62). Results indicated that both C-JARS scales were sensitive and specific with respect to identifying the diagnostic status of the children. In addition, the PS scale was sensitive to differences in cognitive abilities (IQ) and sex differences in the autism group. These results are consistent with the hypothesis that joint attention and spontaneous sharing of experience symptoms are not only characteristic of preschool children with autism but may also constitute a developmentally continuous dimension of the social phenotype of autism that can be measured in school-aged children.

Characterizing Autism Spectrum Disorder Through Fusion of Local Cortical Activation and Global Functional Connectivity Using Game-Based Stimuli and a Mobile EEG System

The deficit in social interaction skills among individuals with autism spectrum disorder (ASD) is strongly influenced by personal experiences and social environments. Neuroimaging studies have previously highlighted the link between social impairment and brain activity in ASD. This study aims to develop a method for assessing and identifying ASD using a social cognitive game-based paradigm combined with electroencephalo-graphy (EEG) signaling features. Typically developing (TD) participants and autistic preadolescents and teenagers were recruited to participate in a social game while 12-channel EEG signals were recorded. The EEG signals underwent preprocessing to analyze local brain activities, including event-related potentials (ERPs) and time-frequency features. Additionally, the global brain network's functional connectivity between brain regions was evaluated using phase-lag indices (PLIs). Subsequently, machine learning models were employed to assess the neurophysiological features. Results indicated pronounced ERP components, particularly the late positive potential (LPP), in parietal regions during social training. Autistic preadolescents and teenagers exhibited lower LPP amplitudes and larger P200 amplitudes compared to TD participants. Reduced theta synchronization was also observed in the ASD group. Aberrant functional connectivity within certain time intervals was noted in the ASD group. Machine learning analysis revealed that support-vector machines achieved a sensitivity of 100%, specificity of 91.7%, and accuracy of 95.8% as part of the performance evaluation when utilizing ERP and brain oscillation features for ASD characterization. These findings suggest that social interaction difficulties in autism are linked to specific brain activation patterns. Traditional behavioral assessments face challenges of subjectivity and accuracy, indicating the potential use of social training interfaces and EEG features for cognitive assessment in ASD.

The Relationship Between Attention, Sensory Processing, and Social Responsiveness Among Adults on the Autism Spectrum

This study evaluated attention, sensory processing, and social responsiveness and the relationship between these constructs among autistic and neurotypical adults. Participants included 24 autistic adults (17-30 years) and 24 neurotypical peers who completed the Test of Everyday Attention, Adolescent/Adult Sensory Profile (AASP), and the Social Responsiveness Scale-2. Autistic individuals showed greater attention, sensory processing, and social responsiveness challenges compared to neurotypical peers. Using mediation models, we showed that the relationship between attention and social responsiveness was mediated by sensory processing, specifically the low registration and sensation-seeking AASP quadrants. The relationship between attention, sensory processing, and social responsiveness suggests that adults with greater attention issues may have greater sensory and social challenges. Specifically, having poor attention may lead to poor sensory processing skills which compound poor social responsiveness. Understanding the relationships between these domains is critical for developing effective interventions and support for autistic adults.

Neuroadaptive Bayesian optimisation to study individual differences in infants' engagement with social cues

Infants' motivation to engage with the social world depends on the interplay between individual brain's characteristics and previous exposure to social cues such as the parent's smile or eye contact. Different hypotheses about why specific combinations of emotional expressions and gaze direction engage children have been tested with group-level approaches rather than focusing on individual differences in the social brain development. Here, a novel Artificial Intelligence-enhanced brain-imaging approach, Neuroadaptive Bayesian Optimisation (NBO), was applied to infant electro-encephalography (EEG) to understand how selected neural signals encode social cues in individual infants. EEG data from 42 6- to 9-month-old infants looking at images of their parent's face were analysed in real-time and used by a Bayesian Optimisation algorithm to identify which combination of the parent's gaze/head direction and emotional expression produces the strongest brain activation in the child. This individualised approach supported the theory that the infant's brain is maximally engaged by communicative cues with a negative valence (angry faces with direct gaze). Infants attending preferentially to faces with direct gaze had increased positive affectivity and decreased negative affectivity. This work confirmed that infants' attentional preferences for social cues are heterogeneous and shows the NBO's potential to study diversity in neurodevelopmental trajectories.

Unconscious and Conscious Gaze-Triggered Attentional Orienting: Distinguishing Innate and Acquired Components of Social Attention in Children and Adults with Autistic Traits and Autism Spectrum Disorders

Typically developing (TD) individuals can readily orient attention according to others' eye-gaze direction, an ability known as social attention, which involves both innate and acquired components. To distinguish between these two components, we used a critical flicker fusion technique to render gaze cues invisible to participants, thereby largely reducing influences from consciously acquired strategies. Results revealed that both visible and invisible gaze cues could trigger attentional orienting in TD adults (aged 20 to 30 years) and children (aged 6 to 12 years). Intriguingly, only the ability to involuntarily respond to invisible gaze cues was negatively correlated with autistic traits among all TD participants. This ability was substantially impaired in adults with autism spectrum disorder (ASD) and in children with high autistic traits. No such association or reduction was observed with visible gaze cues. These findings provide compelling evidence for the functional demarcation of conscious and unconscious gaze-triggered attentional orienting that emerges early in life and develops into adulthood, shedding new light on the differentiation of the innate and acquired aspects of social attention. Moreover, they contribute to a comprehensive understanding of social endophenotypes of ASD.

Developmental Skills Moderate the Association Between Core Autism Features and Adaptive Behaviour in Early Childhood

PURPOSE

While research indicates that both the core features of autism and associated developmental skills influence adaptive behaviour outcomes, results to date suggest greater influence of the latter than the former, and little attention has been given to how the interaction of both together might impact functional disability. Seeking to expand understanding of associations between young children's core social autism features, developmental skills, and functional ability/disability, we specifically tested whether early developmental skills might have a moderating effect on the association between early social features and subsequent functional disability.

METHODS

Data from 162 preschool children were available for this study. These included time-1 measures of social autism features (ADOS-Social Affect score) and developmental skills (MSEL-Developmental Quotient; DQ), and a measure of functional ability/disability (VABS-Adaptive Behaviour Composite; ABC) available at follow-up 1-year later (time-2).

RESULTS

Time-1 ADOS-SA and MSEL-DQ scores were concurrently associated with one another, and both prospectively associated with time-2 VABS-ABC scores. Examination of partial correlations (i.e., controlling for MSEL-DQ) demonstrated that the association of time-1 ADOS-SA and time-2 VABS-ABC was accounted for by shared variance with DQ. Formal moderation analysis returned a non-significant overall interaction term, but showed a lower-bound region of significance whereby the association of time-1 ADOS-SA with time-2 VABS-ABC was significant for children with baseline DQ ≤ 48.33.

CONCLUSION

Our results add to a body of empirical evidence consistent with an understanding of the needs of and resources available to autistic people through a 'cognitive compensation' lens.

The Neural Bases of Language Processing During Social and Non-Social Contexts: A fNIRS Study of Autistic and Neurotypical Preschool-Aged Children

Background

Little is known about how the brains of autistic children process language during real-world "social contexts," despite the fact that challenges with language, communication, and social interaction are core features of Autism Spectrum Disorder (ASD).

Methods

We investigated the neural bases of language processing during social and non-social contexts in a sample of N=20 autistic and N=20 neurotypical (NT) preschool-aged children, 3 to 6 years old. Functional near-infrared spectroscopy (fNIRS) was used to measure children's brain response to "live language" spoken by a live experimenter during an in-person social context (i.e., book reading), and "recorded language" played via an audio recording during a non-social context (i.e., screen time). We examined within-group and between-group differences in the strength and localization of brain response to live language and recorded language, as well as correlations between children's brain response and language skills measured by the Preschool Language Scales.

Results

In the NT group, brain response to live language was greater than brain response to recorded language in the right temporal parietal junction (TPJ). In the ASD group, the strength of brain response did not differ between conditions. The ASD group showed greater brain response to recorded language than the NT group in the right inferior and middle frontal gyrus (IMFG). Across groups, children's language skills were negatively associated with brain response to recorded language in the right IMFG, suggesting that processing recorded language required more cognitive effort for children with lower language skills. Children's language skills were also positively associated with the difference in brain response between conditions in the right TPJ, demonstrating that children who showed a greater difference in brain response to live language versus recorded language had higher language skills.

Limitations

Findings should be considered preliminary until they are replicated in a larger sample.

Conclusions

Findings suggest that the brains of NT children, but not autistic children, process language differently during social and non-social contexts. Individual differences in how the brain processes language during social and non-social contexts may help to explain why language skills are so variable across children with and without autism.

Social impairment in survivors of pediatric brain tumors via reduced social attention and emotion-specific facial expression recognition

BACKGROUND/OBJECTIVES

Survivors of pediatric brain tumors (SPBT) experience significant social challenges, including fewer friends and greater isolation than peers. Difficulties in face processing and visual social attention have been implicated in these outcomes. This study evaluated facial expression recognition (FER), social attention, and their associations with social impairments in SPBT.

METHODS

SPBT (N = 54; ages 7-16) at least 2 years post treatment completed a measure of FER, while parents completed measures of social impairment. A subset (N = 30) completed a social attention assessment that recorded eye gaze patterns while watching videos depicting pairs of children engaged in joint play. Social Prioritization scores were calculated, with higher scores indicating more face looking. Correlations and regression analyses evaluated associations between variables, while a path analysis modeling tool (PROCESS) evaluated the indirect effects of Social Prioritization on social impairments through emotion-specific FER.

RESULTS

Poorer recognition of angry and sad facial expressions was significantly correlated with greater social impairment. Social Prioritization was positively correlated with angry FER but no other emotions. Social Prioritization had significant indirect effects on social impairments through angry FER.

CONCLUSION

Findings suggest interventions aimed at improving recognition of specific emotions may mitigate social impairments in SPBT. Further, reduced social attention (i.e., diminished face looking) could be a factor in reduced face processing ability, which may result in social impairments. Longitudinal research is needed to elucidate temporal associations between social attention, face processing, and social impairments.

Autistic young people adaptively use gaze to facilitate joint attention during multi-gestural dyadic interactions

LAY ABSTRACT

Autistic people have been said to have 'problems' with joint attention, that is, looking where someone else is looking. Past studies of joint attention have used tasks that require autistic people to continuously look at and respond to eye-gaze cues. But joint attention can also be done using other social cues, like pointing. This study looked at whether autistic and non-autistic young people use another person's eye gaze during joint attention in a task that did not require them to look at their partner's face. In the task, each participant worked together with their partner to find a computer-generated object in virtual reality. Sometimes the participant had to help guide their partner to the object, and other times, they followed their partner's lead. Participants were told to point to guide one another but were not told to use eye gaze. Both autistic and non-autistic participants often looked at their partner's face during joint attention interactions and were faster to respond to their partner's hand-pointing when the partner also looked at the object before pointing. This shows that autistic people can and do use information from another person's eyes, even when they don't have to. It is possible that, by not forcing autistic young people to look at their partner's face and eyes, they were better able to gather information from their partner's face when needed, without being overwhelmed. This shows how important it is to design tasks that provide autistic people with opportunities to show what they can do.

Neural correlates of response to joint attention in 2-to-5-year-olds in relation to ASD and social-communicative abilities: An fNIRS and behavioral study

Autism spectrum disorder (ASD) is associated with life-long challenges with social cognition, and one of its earliest and most common manifestations is atypical joint attention, which is a pivotal skill in social-cognitive and linguistic development. Early interventions for ASD children often focus on training initiation of joint attention (IJA) and response to joint attention bids (RJA), which are important for social communication and cognition. Here, we used functional near-infrared spectroscopy and behavioral measures to test typically developing (TD, n = 17) and ASD children (n = 18), to address the relationship between the neural correlates of RJA and social-communicative behavior. Group-level differences were present for RJA-specific activation over right temporal sites, where TD children showed higher levels of activation during RJA than ASD children, whereas the two groups did not differ in the control condition. Correlations between neural activation and behavioral traits suggest that, in ASD children, neural activation during RJA is related to the frequency of RJA behavior when the former is measured over left temporal sites, and to social affect symptoms when considered for right temporal sites. Possible implications of the evidenced correlations are discussed.

Atypical functional connectivity between the amygdala and visual, salience regions in infants with genetic liability for autism

The amygdala undergoes a period of overgrowth in the first year of life, resulting in enlarged volume by 12 months in infants later diagnosed with ASD. The overgrowth of the amygdala may have functional consequences during infancy. We investigated whether amygdala connectivity differs in 12-month-olds at high likelihood (HL) for ASD (defined by having an older sibling with autism), compared to those at low likelihood (LL). We examined seed-based connectivity of left and right amygdalae, hypothesizing that the HL and LL groups would differ in amygdala connectivity, especially with the visual cortex, based on our prior reports demonstrating that components of visual circuitry develop atypically and are linked to genetic liability for autism. We found that HL infants exhibited weaker connectivity between the right amygdala and the left visual cortex, as well as between the left amygdala and the right anterior cingulate, with evidence that these patterns occur in distinct subgroups of the HL sample. Amygdala connectivity strength with the visual cortex was related to motor and communication abilities among HL infants. Findings indicate that aberrant functional connectivity between the amygdala and visual regions is apparent in infants with genetic liability for ASD and may have implications for early differences in adaptive behaviors.

A multimodal interface for speech perception: the role of the left superior temporal sulcus in social cognition and autism

Multimodal integration is crucial for human interaction, in particular for social communication, which relies on integrating information from various sensory modalities. Recently a third visual pathway specialized in social perception was proposed, which includes the right superior temporal sulcus (STS) playing a key role in processing socially relevant cues and high-level social perception. Importantly, it has also recently been proposed that the left STS contributes to audiovisual integration of speech processing. In this article, we propose that brain areas along the right STS that support multimodal integration for social perception and cognition can be considered homologs to those in the left, language-dominant hemisphere, sustaining multimodal integration of speech and semantic concepts fundamental for social communication. Emphasizing the significance of the left STS in multimodal integration and associated processes such as multimodal attention to socially relevant stimuli, we underscore its potential relevance in comprehending neurodevelopmental conditions characterized by challenges in social communication such as autism spectrum disorder (ASD). Further research into this left lateral processing stream holds the promise of enhancing our understanding of social communication in both typical development and ASD, which may lead to more effective interventions that could improve the quality of life for individuals with atypical neurodevelopment.

Reciprocal Associations Between Language Ability and Social Functioning Development in Pre-verbal Autistic Children

Longitudinal research on language abilities and social functioning in young children suggests that gains in one domain affect gains in the other. However, few studies have examined inter-relations of language and social functioning jointly among young children diagnosed with autism spectrum disorder (ASD). Pre-verbal toddlers with ASD are a group of particular clinical relevance, given that greater language abilities at school entry have been associated with positive long-term adjustment in many areas, including adaptive and social functioning. Reduced attention to and engagement in social interactions among autistic toddlers who are not yet speaking may interfere with language development concurrently and over time. The present study examined reciprocal associations between language ability and social functioning over a 2-year period across three time points in a sample of 90 pre-verbal autistic toddlers using cross-lagged panel analyses conducted in MPlus. Cross-lagged panel analyses revealed significant within-timepoint synchronous correlations, within-domain autoregressive paths over time, and as hypothesized, reciprocal significance in all cross-lagged paths. For very young pre-verbal children with ASD, language ability and social functioning appear to exert concurrent and cascading developmental influences on one another. Targeting both language and social functioning simultaneously may enhance intervention efficacy for very young pre-verbal children with ASD.

Leveraging Communication Partner Speech to Automate Augmented Input for Children on the Autism Spectrum Who Are Minimally Verbal: Prototype Development and Preliminary Efficacy Investigation

PURPOSE

Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability.

METHOD

The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity.

RESULTS

Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype.

CONCLUSIONS

Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC.

Impaired recognition of interactive intentions in adults with autism spectrum disorder not attributable to differences in visual attention or coordination via eye contact and joint attention

Altered nonverbal communication patterns especially with regard to gaze interactions are commonly reported for persons with autism spectrum disorder (ASD). In this study we investigate and differentiate for the first time the interplay of attention allocation, the establishment of shared focus (eye contact and joint attention) and the recognition of intentions in gaze interactions in adults with ASD compared to control persons. Participants interacted via gaze with a virtual character (VC), who they believed was controlled by another person. Participants were instructed to ascertain whether their partner was trying to interact with them. In fact, the VC was fully algorithm-controlled and showed either interactive or non-interactive gaze behavior. Participants with ASD were specifically impaired in ascertaining whether their partner was trying to interact with them or not as compared to participants without ASD whereas neither the allocation of attention nor the ability to establish a shared focus were affected. Thus, perception and production of gaze cues seem preserved while the evaluation of gaze cues appeared to be impaired. An additional exploratory analysis suggests that especially the interpretation of contingencies between the interactants' actions are altered in ASD and should be investigated more closely.

Interpersonal eye-tracking reveals the dynamics of interacting minds

The human eye is a rich source of information about where, when, and how we attend. Our gaze paths indicate where and what captures our attention, while changes in pupil size can signal surprise, revealing our expectations. Similarly, the pattern of our blinks suggests levels of alertness and when our attention shifts between external engagement and internal thought. During interactions with others, these cues reveal how we coordinate and share our mental states. To leverage these insights effectively, we need accurate, timely methods to observe these cues as they naturally unfold. Advances in eye-tracking technology now enable real-time observation of these cues, shedding light on mutual cognitive processes that foster shared understanding, collaborative thought, and social connection. This brief review highlights these advances and the new opportunities they present for future research.

Preterm toddlers' joint attention characteristics during dyadic interactions with their mothers and fathers compared to full-term toddlers at age 2 years

The current study investigates Joint Attention (JA) characteristics (duration, frequency, source of initiation, type of JA, agent of termination, missed and unsuccessful episodes) in preterm and full-term toddlers' interactions with their mothers and fathers, separately. Thirty-one singleton full-term (Mage = 24.07 months, SD = 1.45; 13 boys) and 17 singleton preterm toddlers (Madjustedage = 24.72 months, SD = 3.39; 12 boys) participated in the study with both parents. JA episodes were examined during dyadic five-minute free play sessions, were coded second-by-second, and were analysed using two-way mixed ANOVAs. Although the total amount of time spent in JA was not significantly different between the preterm and the full-term groups, JA episodes were more frequent, specifically supported JA episodes, and were more often terminated by the child during parent-preterm toddler interactions. Moreover, preterm toddlers missed their fathers' attempts for JA more often than their mothers' and more often than full-term toddlers missed their fathers' and mothers' bids for JA. Further, regardless of the birth status, toddlers initiated more JA with mothers than fathers, and fathers redirected their child's attention to initiate JA more than mothers. Findings indicate that preterm toddlers may struggle to respond to JA bids, especially with their fathers, and to sustain their attention on a specific object or event during interactions. Preterm toddlers may need more support to engage in JA relative to their full-term peers, and redirecting attention strategy may not be optimal for them. Also, toddlers' JA interactions may be different with their mothers and fathers. Findings contribute to the literature by demonstrating preterm toddlers' JA characteristics with both parents compared to full-term toddlers at age two.

Exploring the Acquisition of Social Communication Skills in Children with Autism: Preliminary Findings from Applied Behavior Analysis (ABA), Parent Training, and Video Modeling

Social communication skills, especially eye contact and joint attention, are frequently impaired in autism spectrum disorder (ASD) and predict functional outcomes. Applied behavior analysis is one of the most common evidence-based treatments for ASD, but it is not accessible to most families in low- and middle-income countries (LMICs) as it is an expensive and intensive treatment and needs to be delivered by highly specialized professionals. Parental training has emerged as an effective alternative. This is an exploratory study to assess a parental intervention group via video modeling to acquire eye contact and joint attention. Four graded measures of eye contact and joint attention (full physical prompt, partial physical prompt, gestural prompt, and independent) were assessed in 34 children with ASD and intellectual disability (ID). There was a progressive reduction in the level of prompting required over time to acquire eye contact and joint attention, as well as a positive correlation between the time of exposure to the intervention and the acquisition of abilities. This kind of parent training using video modeling to teach eye contact and joint attention skills to children with ASD and ID is a low-cost intervention that can be applied in low-resource settings.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Maternal and paternal insightfulness and reaction to the diagnosis in families of preschoolers with Autism spectrum disorder: associations with observed parental sensitivity and inter-parent interaction

Sensitivity among parents of children with Autism Spectrum Disorder (ASD) is based on parental insightfulness and on resolution regarding the child's diagnosis. This has been supported in studies of mothers, and we examined whether the same is true regarding fathers. Also, we asked whether parents' Insightfulness and Resolution tap general mentalization and therefore also be expressed in parent-parent interactions. Eighty preschooler boys with ASD and both of their parents participated. As expected, fathers who were more insightful and mothers who were more resolved were more sensitive. Contrary to expectations, no associations were found between fathers' resolution and mothers' insightfulness and their sensitivity. Associations were found between parental insightfulness and resolution and positive parent-parent interaction. The findings are the first to demonstrate the insightfulness-sensitivity link among fathers of children with ASD. Also, they suggest that both insightfulness and resolution involve general mentalization that is evident both in parent-child and parent-parent interactions.

Communicative signals during joint attention promote neural processes of infants and caregivers

Communicative signals such as eye contact increase infants' brain activation to visual stimuli and promote joint attention. Our study assessed whether communicative signals during joint attention enhance infant-caregiver dyads' neural responses to objects, and their neural synchrony. To track mutual attention processes, we applied rhythmic visual stimulation (RVS), presenting images of objects to 12-month-old infants and their mothers (n = 37 dyads), while we recorded dyads' brain activity (i.e., steady-state visual evoked potentials, SSVEPs) with electroencephalography (EEG) hyperscanning. Within dyads, mothers either communicatively showed the images to their infant or watched the images without communicative engagement. Communicative cues increased infants' and mothers' SSVEPs at central-occipital-parietal, and central electrode sites, respectively. Infants showed significantly more gaze behaviour to images during communicative engagement. Dyadic neural synchrony (SSVEP amplitude envelope correlations, AECs) was not modulated by communicative cues. Taken together, maternal communicative cues in joint attention increase infants' neural responses to objects, and shape mothers' own attention processes. We show that communicative cues enhance cortical visual processing, thus play an essential role in social learning. Future studies need to elucidate the effect of communicative cues on neural synchrony during joint attention. Finally, our study introduces RVS to study infant-caregiver neural dynamics in social contexts.

Remediation of theory of mind in children with autism spectrum disorders: Effectiveness and transferability of training effects to behavioral symptoms

BACKGROUND

Children with autism spectrum disorders (ASD) struggle with impaired theory of mind. We aimed to evaluate the effect of remediation of theory of mind on theory of mind, face perception, and behavioral symptoms in children with ASD.

METHODS

Thirty children with ASD were randomly assigned to two equal groups of theory of mind training and active control group. Attentive remediation of theory of mind (ARTOM) and story-telling sessions were used for intervention in the groups. Theory of mind and facial emotion recognition tests as well as Gilliam autism rating scale (GARS) were used for assessment in three baseline, post-intervention, and follow-up sessions. Repeated measures ANOVAs were used for analysis.

RESULTS

The results showed improvement in facial emotion recognition and theory of mind in intervention group. The behavioral symptoms, measured by GARS, were ameliorated in the intervention group. The training effects lasted until follow-up session.

CONCLUSIONS

The results suggest remediation of basic components of theory of mind, without direct intervention on theory of mind, improves theory of mind skill. The results also suggest that the remediation of basic components of theory of mind improves social and communicational performance and ameliorates stereotypes symptoms in children with ASD.

The importance and challenges of observing social interactions in autistic preschoolers during inclusive educational settings: A scoping review

Background and aims

A growing number of autistic children have access to inclusive education programs as early as kindergarten. However, little is known about how they actually participate in social interactions and develop their communicative skills according to the parameters of this environment. The aim of this article is to review observational studies on this topic and critically analyze their methodological choices by arguing on the aspects of communication skills noted in the observation grids. Disparities in the information collected depending on the method used have implications for understanding and supporting autistic children in an inclusive school environment.

Methods

Observational studies on social interactions of autistic preschoolers within inclusive preschool settings were scoped. The studies were analyzed according to the following parameters: aims of observation, method used for coding, communication partners considered (adults and peers), type of children's social engagement (initiatives and responses), diversity of communicative forms and communication functions, distinction and comparison of interactional contexts related to the activities, and whether changes linked to developmental variables are studied on an interindividual or longitudinal basis.

Results

Seventeen studies using the observation method in inclusive preschool settings were identified. Recordingmethods are mostly based on video recording. The coding grids mainly focus on autistic children while partners' behaviors (adults, peers) are often coded in less detail, thus providing littleinformation on their dynamic role in the interactions. Overall, autistic children were found to initiate interactions much less often than they respond to it. The data generally distinguish thecommunicative forms used by children and indicate a predominance of nonverbal means at preschool level. However, a few studies coded communicative functions, whether they areaddressed to children or produced by them. In addition, very few studies compare interactions across activity contexts. In addition, very few studies compare interactions across activity contexts.Results of some studies showed that children initiated interaction more frequently during free play than during work activity, but results are heterogeneous. Developmental trajectories in socialskills seem to be associated with the severity of autism and language skills, but longitudinal designs are still rare.

Conclusions and implications

Direct and fine-grained observation in the classroom is a key source of information about how communication takes place in preschool-inclusive settings. The data, despite some methodological challenges, offer opportunities for better adjustment based on professional objectives. Our review highlights the importance of offering occasions for initiatives to autistic children and training of neurotypical peers to better interact with autistic children and promote verbal communication. Further observational studies are needed to use more microanalytic measures of the functional quality of social interactions in autistic children, including joint comparisons between partners (adults vs. peers) and across contexts (e.g., play vs. structured development) so that appropriate strategies can be proposed in inclusive preschool settings.