Object-directed imitation in autism spectrum disorder is differentially influenced by motoric task complexity, but not social contextual cues

Digital tools for direct assessment of autism risk during early childhood: A systematic review

LAY ABSTRACT

The challenge of finding autistic children, and finding them early enough to make a difference for them and their families, becomes all the greater in parts of the world where human and material resources are in short supply. Poverty of resources delays interventions, translating into a poverty of outcomes. Digital tools carry potential to lessen this delay because they can be administered by non-specialists in children's homes, schools or other everyday environments, they can measure a wide range of autistic behaviours objectively and they can automate analysis without requiring an expert in computers or statistics. This literature review aimed to identify and describe digital tools for screening children who may be at risk for autism. These tools are predominantly at the 'proof-of-concept' stage. Both portable (laptops, mobile phones, smart toys) and fixed (desktop computers, virtual-reality platforms) technologies are used to present computerised games, or to record children's behaviours or speech. Computerised analysis of children's interactions with these technologies differentiates children with and without autism, with promising results. Tasks assessing social responses and hand and body movements are the most reliable in distinguishing autistic from typically developing children. Such digital tools hold immense potential for early identification of autism spectrum disorder risk at a large scale. Next steps should be to further validate these tools and to evaluate their applicability in a variety of settings. Crucially, stakeholders from underserved communities globally must be involved in this research, lest it fail to capture the issues that these stakeholders are facing.

Influence of instructor's facial expressions in video lectures on motor learning in children with autism spectrum disorder

During the COVID-19 pandemic, video materials have played crucial roles in supporting learning among children with autism spectrum disorder (ASD). This study aimed to explore the effects of the instructor's facial expressions in video lectures on attention and motor learning in children with ASD versus typically developing (TD) children. A total of 60 children were randomly assigned to four groups: (1) ASD-happy, (2) ASD-neutral, (3) TD-happy, and (4) TD-neutral. Both happy groups paid more attention to the video lectures. The ASD groups achieved higher accuracy and fidelity of motor learning when the instructor smiled. Results revealed that greater attention to video lectures predicted better performance in children with ASD. This study has practical implications for the design of learning materials for children with ASD: An instructor should be encouraged to show a happy expression to promote learning.

C-Hg

Computer-assisted systems can provide efficient and engaging ASD intervention environments for children with Autism Spectrum Disorder (ASD). However, most existing computer-assisted systems target only one skill deficit (e.g., social conversation skills) and ignore the importance of other areas, such as motor skills, that could also impact social interaction. This focus on a single domain may hinder the generalizability of learned skills to real-world scenarios, because the targeted teaching strategies do not reflect that real-world tasks often involve more than one skill domain. The work presented in this article seeks to bridge this gap by developing a Collaborative Haptic-gripper virtual skill training system (C-Hg). This system includes individual and collaborative games that provide opportunities for simultaneously practicing both fine motor skills (hand movement and grip control skills) as well as social skills (communication and collaboration) and investigating how they relate to each other. We conducted a usability study with 10 children with ASD and 10 Typically Developing (TD) children (8–12 years), who used C-Hg to play a series of individual and collaborative games requiring differing levels of motor and communication skill. Results revealed that participant performance significantly improved in both individual and collaborative fine motor skill training tasks, including significant improvements in collaborative manipulations between partners. Participants with ASD were found to conduct more collaborative manipulations and initiate more conversations with their partners in the post collaborative tasks, suggesting more active collaboration and communication of participants with ASD in the collaborative tasks. Results support the potential of our C-Hg system for simultaneously improving fine motor and social skills, with implications for impacts of improved fine motor skills on social outcomes.

The Lost Neural Hierarchy of the Autistic Self-Locked-Out of the Mental Self and Its Default-Mode Network

Autism spectrum disorder (ASD) is characterized by a fundamental change in self-awareness including seemingly paradoxical features like increased ego-centeredness and weakened self-referentiality. What is the neural basis of this so-called "self-paradox"? Conducting a meta-analytic review of fMRI rest and task studies, we show that ASD exhibits consistent hypofunction in anterior and posterior midline regions of the default-mode network (DMN) in both rest and task with decreased self-non-self differentiation. Relying on a multilayered nested hierarchical model of self, as recently established (Qin et al. 2020), we propose that ASD subjects cannot access the most upper layer of their self, the DMN-based mental self-they are locked-out of their own DMN and its mental self. This, in turn, results in strong weakening of their self-referentiality with decreases in both self-awareness and self-other distinction. Moreover, this blocks the extension of non-DMN cortical and subcortical regions at the lower layers of the physical self to the DMN-based upper layer of the mental self, including self-other distinction. The ASD subjects remain stuck and restricted to their intero- and exteroceptive selves as manifested in a relative increase in ego-centeredness (as compared to self-referentiality). This amounts to what we describe as "Hierarchical Model of Autistic Self" (HAS), which, characterizing the autistic self in hierarchical and spatiotemporal terms, aligns well with and extends current theories of ASD including predictive coding and weak central coherence.

Acting with shared intentions: A systematic review on joint action coordination in Autism Spectrum Disorder

BACKGROUND

Joint actions, described as a form of social interaction in which individuals coordinate their actions in space and time to bring about a change in the environment, rely on sensory-motor processes that play a role in the development of social skills. Two brain networks, associated with "mirroring" and "mentalizing", are engaged during these actions: the mirror neuron and the theory of mind systems. People with autism spectrum disorder (ASD) showed impairment in interpersonal coordination during joint actions. Studying joint action coordination in ASD will contribute to clarify the interplay between sensory-motor and social processes throughout development and the interactions between the brain and the behavior.

METHOD

This review focused on empirical studies that reported behavioral and kinematic findings related to joint action coordination in people with ASD.

RESULTS

Literature on mechanisms involved in the joint action coordination impairment in ASD is still limited. Data are controversial. Different key-components of joint action coordination may be impaired, such as cooperative behavior, temporal coordination, and motor planning.

CONCLUSIONS

Interpersonal coordination during joint actions relies on early sensory-motor processes that have a key role in guiding social development. Early intervention targeting the sensory-motor processes involved in the development of joint action coordination could positively support social skills.

Differential mirror neuron system (MNS) activation during action observation with and without social-emotional components in autism: a meta-analysis of neuroimaging studies

Background

Impaired imitation has been found to be an important factor contributing to social communication deficits in individuals with autism spectrum disorder (ASD). It has been hypothesized that the neural correlate of imitation, the mirror neuron system (MNS), is dysfunctional in ASD, resulting in imitation impairment as one of the key behavioral manifestations in ASD. Previous MNS studies produced inconsistent results, leaving the debate of whether “broken” mirror neurons in ASD are unresolved.

Methods

This meta-analysis aimed to explore the differences in MNS activation patterns between typically developing (TD) and ASD individuals when they observe biological motions with or without social-emotional components. Effect size signed differential mapping (ES-SDM) was adopted to synthesize the available fMRI data.

Results

ES-SDM analysis revealed hyperactivation in the right inferior frontal gyrus and left supplementary motor area in ASD during observation of biological motions. Subgroup analysis of experiments involving the observation of stimuli with or without emotional component revealed hyperactivation in the left inferior parietal lobule and left supplementary motor during action observation without emotional components, whereas hyperactivation of the right inferior frontal gyrus was found during action observation with emotional components in ASD. Subgroup analyses of age showed hyperactivation of the bilateral inferior frontal gyrus in ASD adolescents, while hyperactivation in the right inferior frontal gyrus was noted in ASD adults. Meta-regression within ASD individuals indicated that the right cerebellum crus I activation increased with age, while the left inferior temporal gyrus activation decreased with age.

Limitations

This meta-analysis is limited in its generalization of the findings to individuals with ASD by the restricted age range, heterogeneous study sample, and the large within-group variation in MNS activation patterns during object observation. Furthermore, we only included action observation studies which might limit the generalization of our results to the imitation deficits in ASD. In addition, the relatively small sample size for individual studies might also potentially overestimate the effect sizes.

Conclusion

The MNS is impaired in ASD. The abnormal activation patterns were found to be modulated by the nature of stimuli and age, which might explain the contradictory results from earlier studies on the “broken mirror neuron” debate.

Soundbeam imitation intervention: Training children with autism to imitate meaningless body gestures through music

Purpose

This paper aims to present the application and critical reflection on the effects of a intervention for children with autism spectrum disorder (ASD): the Soundbeam Imitation Intervention (SII). The intervention is based on the imitation of meaningless body gestures supported by a musical feedback. The rationale underlying SII is that mirror neurons deficit may represent the cause for the incomplete development of social and motor functioning in children with ASD. Following this assumption, it is possible to hypothesise that a systematic activation of this a system through the simultaneous observation-execution of meaningless body gestures may affect functional changes of mirror-related functions.

Design/methodology/approach

A sample of 14 children, who were between 5 and 9 years of age, with a diagnosis of ASD were involved in a six weeks’ SII programme. The programme is designed as a three-step progression, where each step includes exercises that focus on an activity: synchronous/one arm imitation, synchronous/two arms imitation and delayed imitation. Exercises are based on repeated movements-melodies associations of increasing difficulty. Motor imitation and social attention were assessed using a synchronous video-modelling task pre and post intervention.

Findings

Data highlight significant improvements in imitation accuracy and duration of social sustained attention were achieved.

Originality/value

Data reported in this paper provide preliminary and promising evidence that imitation and social attention skills acquired through SII can be generalised to a video-modelling imitation setting. The SII ordinal execution has included meaningless gestures, usually excluded from previous interventions, and this adds further validity to the training.

Facilitating sensorimotor integration via blocked practice underpins imitation learning of atypical biological kinematics in autism spectrum disorder

The reduced efficacy of voluntary imitation in autism is suggested to be underpinned by differences in sensorimotor processing. We examined whether the imitation of novel atypical biological kinematics by autistic adults is enhanced by imitating a model in a predictable blocked practice trial order. This practice structure is expected to facilitate trial-to-trial sensorimotor processing, integration and encoding of biological kinematics. The results showed that neurotypical participants were generally more effective at imitating the biological kinematics across all experimental phases. Importantly, and compared to a pre-test where imitation was performed in a randomised (unpredictable) trial order, the autistic participants learned to imitate the atypical kinematics more effectively following an acquisition phase of repeatedly imitating the same model during blocked practice. Data from the post-test showed that autistic participants remained effective at imitating the atypical biological kinematics when the models were subsequently presented in a randomised trial order. These findings show that the reduced efficacy of voluntary imitation in autism can be enhanced during learning by facilitating trial-to-trial processing and integration of sensorimotor information using blocked practice.

Instructions to attend to an observed action increase imitation in autistic adults

This study investigated whether reduced visual attention to an observed action might account for altered imitation in autistic adults. A total of 22 autistic and 22 non-autistic adults observed and then imitated videos of a hand producing sequences of movements that differed in vertical elevation while their hand and eye movements were recorded. Participants first performed a block of imitation trials with general instructions to imitate the action. They then performed a second block with explicit instructions to attend closely to the characteristics of the movement. Imitation was quantified according to how much participants modulated their movement between the different heights of the observed movements. In the general instruction condition, the autistic group modulated their movements significantly less compared to the non-autistic group. However, following instructions to attend to the movement, the autistic group showed equivalent imitation modulation to the non-autistic group. Eye movement recording showed that the autistic group spent significantly less time looking at the hand movement for both instruction conditions. These findings show that visual attention contributes to altered voluntary imitation in autistic individuals and have implications for therapies involving imitation as well as for autistic people's ability to understand the actions of others.

A multiple-method review of accommodations to gross motor assessments commonly used with children and adolescents on the autism spectrum

The purpose of this study is to understand the common accommodations used during standardized motor assessment of children on the autism spectrum. This study was completed in three parts: (1) a narrative review of the literature; (2) an open-ended survey sent to the first authors of the identified articles; and (3) a descriptive analysis of responses. Results revealed that 56.7% of the identified articles did not report enough information of assessment procedures, 18.9% followed the assessment manual, 16.9% provided accommodations on a needs basis, and 7.5% used a consistent modified protocol. Individual responses showed that extra demonstrations (n = 5) were the most frequent accommodation, followed by extra breaks (n = 3), picture cards (n = 2), and hand-over-hand assistance (n = 1); some respondents stated that they did not provide accommodations. The findings indicate that a clear set of accommodation for motor skill assessments does not exist, though some commonalities were reported. Further research is necessary to understand the impact of accommodations in the assessment process, as well as which accommodations are needed and/or effective.

Who is a better teacher for children with autism? Comparison of learning outcomes between robot-based and human-based interventions in gestural production and recognition

BACKGROUND

Individuals with autism spectrum disorder (ASD) tend to show deficits in engaging with humans. Previous findings have shown that robot-based training improves the gestural recognition and production of children with ASD. It is not known whether social robots perform better than human therapists in teaching children with ASD.

AIMS

The present study aims to compare the learning outcomes in children with ASD and intellectual disabilities from robot-based intervention on gestural use to those from human-based intervention.

METHODS AND PROCEDURES

Children aged six to 12 with low-functioning autism were randomly assigned to the robot group (N = 12) and human group (N = 11). In both groups, human experimenters or social robots engaged in daily life conversations and demonstrated to children 14 intransitive gestures in a highly-structured and standardized intervention protocol.

OUTCOMES AND RESULTS

Children with ASD in the human group were as likely to recognize gestures and produce them accurately as those in the robot group in both training and new conversations. Their learning outcomes maintained for at least two weeks.

CONCLUSIONS AND IMPLICATIONS

The social cues found in the human-based intervention might not influence gestural learning. It does not matter who serves as teaching agents when the lessons are highly structured.