Children with autism spectrum disorder (ASD) attend typically to faces and objects presented within their picture communication systems

Familiarization with Mixed Reality for Individuals with Autism Spectrum Disorder: An Eye Tracking Study

Mixed Reality (MR) technology is experiencing significant growth in the industrial and healthcare sectors. The headset HoloLens 2 displays virtual objects (in the form of holograms) in the user's environment in real-time. Individuals with Autism Spectrum Disorder (ASD) exhibit, according to the DSM-5, persistent deficits in communication and social interaction, as well as a different sensitivity compared to neurotypical (NT) individuals. This study aims to propose a method for familiarizing eleven individuals with severe ASD with the HoloLens 2 headset and the use of MR technology through a tutorial. The secondary objective is to obtain quantitative learning indicators in MR, such as execution speed and eye tracking (ET), by comparing individuals with ASD to neurotypical individuals. We observed that 81.81% of individuals with ASD successfully familiarized themselves with MR after several sessions. Furthermore, the visual activity of individuals with ASD did not differ from that of neurotypical individuals when they successfully familiarized themselves. This study thus offers new perspectives on skill acquisition indicators useful for supporting neurodevelopmental disorders. It contributes to a better understanding of the neural mechanisms underlying learning in MR for individuals with ASD.

Gaze and social functioning associations in autism spectrum disorder: A systematic review and meta-analysis

Autism spectrum disorder (ASD) is characterized by significant social functioning impairments, including (but not limited to) emotion recognition, mentalizing, and joint attention. Despite extensive investigation into the correlates of social functioning in ASD, only recently has there been focus on the role of low‐level sensory input, particularly visual processing. Extensive gaze deficits have been described in ASD, from basic saccadic function through to social attention and the processing of complex biological motion. Given that social functioning often relies on accurately processing visual information, inefficient visual processing may contribute to the emergence and sustainment of social functioning difficulties in ASD. To explore the association between measures of gaze and social functioning in ASD, a systematic review and meta‐analysis was conducted. A total of 95 studies were identified from a search of CINAHL Plus, Embase, OVID Medline, and psycINFO databases in July 2021. Findings support associations between increased gaze to the face/head and eye regions with improved social functioning and reduced autism symptom severity. However, gaze allocation to the mouth appears dependent on social and emotional content of scenes and the cognitive profile of participants. This review supports the investigation of gaze variables as potential biomarkers of ASD, although future longitudinal studies are required to investigate the developmental progression of this relationship and to explore the influence of heterogeneity in ASD clinical characteristics.

Gauging facial feature viewing preference as a stable individual trait in autism spectrum disorder

Eye tracking provides insights into social processing deficits in autism spectrum disorder (ASD), especially in conjunction with dynamic, naturalistic free-viewing stimuli. However, the question remains whether gaze characteristics, such as preference for specific facial features, can be considered a stable individual trait, particularly in those with ASD. If so, how much data are needed for consistent estimations? To address these questions, we assessed the stability and robustness of gaze preference for facial features as incremental amounts of movie data were introduced for analysis. We trained an artificial neural network to create an object-based segmentation of naturalistic movie clips (14 s each, 7410 frames total). Thirty-three high-functioning individuals with ASD and 36 age- and IQ-equated typically developing individuals (age range: 12-30 years) viewed 22 Hollywood movie clips, each depicting a social interaction. As we evaluated combinations of one, three, five, eight, and 11 movie clips, gaze dwell times on core facial features became increasingly stable at within-subject, within-group, and between-group levels. Using a number of movie clips deemed sufficient by our analysis, we found that individuals with ASD displayed significantly less face-centered gaze (centralized on the nose; p < 0.001) but did not significantly differ from typically developing participants in eye or mouth looking times. Our findings validate gaze preference for specific facial features as a stable individual trait and highlight the possibility of misinterpretation with insufficient data. Additionally, we propose the use of a machine learning approach to stimuli segmentation to quickly and flexibly prepare dynamic stimuli for analysis. LAY SUMMARY: Using a data-driven approach to segmenting movie stimuli, we examined varying amounts of data to assess the stability of social gaze in individuals with autism spectrum disorder (ASD). We found a reduction in social fixations in participants with ASD, driven by decreased attention to the center of the face. Our findings further support the validity of gaze preference for face features as a stable individual trait when sufficient data are used.

Referent selection in children with Autism Spectrum Condition and intellectual disabilities: Do social cues affect word-to-object or word-to-location mappings?

BACKGROUND

There is conflicting evidence regarding whether children with Autism Spectrum Condition (ASC) and intellectual disabilities (ID) follow social pragmatic cues such as a speaker's eye gaze or pointing towards a novel object to assist mapping a new word onto a new object (e.g. fast mapping).

AIMS

We test fast mapping from a speaker's gaze and pointing towards objects in children with ASC and ID with varying chronological and receptive language ages compared with receptive language matched groups of typically developing (TD) children.

METHODS AND PROCEDURE

Across eight trials, a speaker gazed and/or pointed towards one out of two objects while saying a new word. Pointing was either 'referential' (with intention), or 'incidental' (without obvious intention). To investigate whether children formed more robust word-to-object links rather than associative word-to-location ones, we reversed the original location of the objects in half of the test trials.

OUTCOMES AND RESULTS

Children with ASC were as successful as TD children using social cues to form word-to-object mappings. Surprisingly, children with ID did not fast map from referential pointing, or when objects changed location.

CONCLUSIONS AND IMPLICATIONS

Children with ID may use different processes to facilitate word learning compared to TD children and even children with ASC.

Contemporary Trainee Knowledge of Autism: How Prepared Are Our Future Providers?

Background: Over the last several decades, the prevalence of Autism Spectrum Disorder (ASD) has continued to increase, creating a unique challenge for general physicians who are likely to encounter these patients in their practice. The primary aim of this cross-sectional study design was to identify potential knowledge gaps that were present among medical students and pediatric trainees (interns, residents, and fellows) particularly during the management of a sick child with ASD. Methods: A 23-question online survey was developed and distributed to medical students and pediatric trainees at a tertiary children's hospital affiliated with a medical school. Results: Medical students and pediatric trainees reported a low general knowledge of ASD and were unfamiliar with sensory issues that are often present in these children. Increased discomfort and insufficient didactic and clinical training for providing care to children with ASD during an acute illness were also identified. Both medical students and trainees reported the need for increased education and training, preferentially via patient interaction and small group-based learning. We found that as education/training levels increased, participants perceived increased comfort, and knowledge in managing an ill child with ASD. Conclusions: A perceived knowledge gap and discomfort is present amongst medical students and pediatric trainees on the management of children with ASD. Across all education levels, awareness for sensory dysregulation in ASD children is low. Education programs using direct patient interaction and small group learning were the preferred training modalities to learn how to provide optimal care for children with ASD.

Postural Control and Emotion in Children with Autism Spectrum Disorders

Autism Spectrum Disorders subjects (ASD) are well known to have deficits in social interaction. We recorded simultaneously eye movements and postural sway during exploration of emotional faces in children with ASD and typically developing children (TD). We analyzed several postural and ocular parameters. The results showed that all postural parameters were significantly greater in children with ASD; ASD made significantly fewer saccades and had shorter fixation time than TD, particularly in the eyes, and especially for unpleasant emotions. These results suggest that poor postural control of ASD and their impaired visual strategies could be due to a lack of interest in social cognition, causing a delay in the development of the cortical areas, and thus could have an effect on their postural control.

Visuo-spatial construction trajectories in Fragile X Syndrome (FXS) and Autism Spectrum Disorders (ASD): Evidence of cognitive heterogeneity within neurodevelopmental conditions

BACKGROUND/AIMS

There have been discrepancies reported in visuo-spatial construction ability in children with Autism Spectrum Disorders (ASD), fragile X Syndrome (FXS) and those with a comorbid diagnosis of FXS and ASD (AFXS). This study aimed to provide a better understanding of the visuo-spatial processing styles in these heterogeneous neurodevelopmental disorders.

METHODS AND PROCEDURE

Navon-type tasks were used to assess visuo-spatial construction ability across 5 groups of children: typically developing, FXS, AFXS, ASD children who scored low-moderate (HFA) and ASD children that scored severe (LFA) on the Childhood Autism Rating Scale (CARS). Analyses of their developmental trajectories compared the performance of these groups.

OUTCOMES AND RESULTS

Each group produced their own distinct trajectory. HFA achieved higher scores from an earlier age than the TD group, while the LFA group's performance was driven by a bias in local processing. The FXS performance was normalised by using mental age as a predictor while neither mental nor chronological age predicted the AFXS group performance.

CONCLUSIONS AND IMPLICATIONS

The study showed unique processing styles. These findings highlight the importance of taking comorbidity and the severity of symptoms within each condition into account in order to understand cognitive abilities and cognitive profiles.

Developmental trajectories of hierarchical visuo-spatial processing in fragile X syndrome and ASD: Within- and cross-syndrome variability

BACKGROUND/AIMS

Despite the advances in understanding visuo-spatial processing in developmental disorders such as ASD and fragile X syndrome (FXS), less is known about the profile of those with a comorbid diagnosis, or the role of within-disorder disparities between individuals across the ASD spectrum.

METHODS AND PROCEDURES

Using a developmental trajectory approach, we tested 5 groups of children: Typically developing, FXS, FXS+ASD, ASD individuals who had low-moderate symptoms (HFA) and ASD individuals who had severe symptoms (LFA). Symptoms of ASD were assessed using the Childhood Autism Rating Scale: CARS and hierarchical visuo-spatial processing was assessed using the Navon task.

OUTCOMES AND RESULTS

Crucially, results differed between HFA and LFA participants. Furthermore, the pattern of results differed between those who had a diagnosis of FXS only and FXS+ASD. Poorer performance within the FXS groups and the group who are low functioning on the ASD spectrum indicated a delayed developmental rate compared to typical controls.

CONCLUSIONS AND IMPLICATIONS

This study showed that diagnosis and severity of symptoms are indicative of differences in visuo-spatial processing styles. It is important that heterogeneity within FXS and ASD populations are considered in subsequent studies and look beyond diagnostic group differences.

Attentional allocation of autism spectrum disorder individuals: Searching for a Face-in-the-Crowd

A study is reported which tests the proposition that faces capture the attention of those with autism spectrum disorders less than a typical population. A visual search task based on the Face-in-the-Crowd paradigm was used to examine the attentional allocation of autism spectrum disorder adults for faces. Participants were required to search for discrepant target images from within 9-image arrays. Both participants with autism spectrum disorder and control participants demonstrated speeded identification of faces compared to non-face objects. This indicates that when attention is under conscious control, both autism spectrum disorder and typically developing comparison adults show an attentional bias for faces, which contrasts with previous research which found an absence of an attentional bias for faces in autism spectrum disorder. Theoretical implications of this differentiation are discussed.

Do iPads promote symbolic understanding and word learning in children with autism?

The use of the Apple iPad has skyrocketed in educational settings, along with largely unsubstantiated claims of its efficacy for learning and communication in children with autism spectrum disorder (ASD). Here, we examine whether children with ASD are better able to learn new word-referent relations using an iPad or a traditional picture book. We also examine the hypothesis that presenting multiple, differently colored, exemplars of a target referent will promote adaptive label generalization compared to the use of a single exemplar. Sixteen minimally verbal children with ASD were taught a new word in four within-subjects conditions, which varied by media (iPad vs. book) and content (single vs. multiple exemplar presentation). Children were then tested on the ability to symbolically relate the word to a 3-D referent (real-life depicted object) and generalize it to a differently colored category member (another similarly shaped object). The extent of symbolic understanding did not differ between the two media, and levels of generalization did not differ across conditions. However, presentation of multiple exemplars increased the rate that children with ASD extended labels from pictures to depicted objects. Our findings are discussed in terms of the importance of content to picture-based learning and the potential benefits and challenges of using the Apple iPad as an educational resource for children with ASD.