Neurocognitive considerations when assessing Theory of Mind in Autism Spectrum Disorder

Information and communication technologies-based interventions for children with autism spectrum conditions: a systematic review of randomized control trials from a positive technology perspective

Information and communication technologies (ICTs) have become more widely used in the past years to help people with autism spectrum conditions (ASC). Serious games embedded into computers or tablets, as well as social robots, are the most employed ICT-related tools that are appealing to and appropriate for autistic children. The goal of ICT applications is to enhance behavioral abnormalities associated with ASC while also creating an interactive link between one person and one computer. Comparatively, to human-based therapy, ICT tools aid to inspire autistic children by providing predictability and regularity of tasks. Regaining social skills is the primary behavioral goal for which ICT tools have been designed and implemented. In the past several years, many studies have been created to show how effective it is at improving targeted behaviors. However, only a small number of researchers have used an RCT approach to evaluate its effectiveness. In this systematic review, we only included RCT studies where ICT technologies were used to help children with ASC in improving their social skills. Only 14 RCT studies satisfied the criteria and 12 described significant improvements, showing how the use of technology in educational contexts produced better improvement in developing several social skill facets with respect to the traditional face-to-face approach. Some studies used interventions and outcome measures focused on the core ASC symptoms, but many others addressed neurocognitive functions directly, like social cognition or emotional regulation, while other more general functions such as language or adaptive behaviors. We propose a classification based on processes and outcome measures to foster future research in this specific area of research. The behavioral intervention mediated by technological tools such as computer-based, tablet, and social robotics, undoubtedly provides a comfortable environment that promotes constant learning for people with ASC. Evidence provided in this review highlights the translational potential of this field of study in primary care practice and educational settings.

A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa

BACKGROUND

Even though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa.

METHODS

The World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS.

RESULTS

In domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or 'child- and adolescent-friendly' mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research.

CONCLUSIONS

This study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.

Theory of Mind and Moral Decision-Making in the Context of Autism Spectrum Disorder

Social impairment in Autism Spectrum Disorder (ASD) has been linked to Theory of Mind (ToM) deficits. However, little research has investigated the relationship between ToM and moral decision-making in children with ASD. This study compared moral decision-making and ToM between aggregate-matched ASD and neurotypical boys (n = 38 per group; aged 6-12). In a third-party resource allocation task manipulating recipient merit, wealth, and health, neurotypical children allocated significantly more resources to the morally deserving recipient, suggesting equitable allocation. A comparatively larger portion of the ASD group allocated equally. ToM emerged as a predictor of moral decision-making. We suggest that ToM (cognitive empathy) deficits may underly atypical moral decision-making in ASD by limiting the integration of empathic arousal (affective empathy) with moral information.

Validation of the Tunisian Social Situation Instrument in the General Pediatric Population

Background

In order to better understand the deployment of the theory of mind (ToM) in Tunisian neurotypical children, we have developed a new tool of assessment of the ToM called the “Tunisian Social Situations Instrument” (TSSI). We opted for the creation of this test in view of the intercultural differences in the development of social skills. Our purpose was to validate this tool in general pediatric population.

Methods

It was a cross-sectional evaluative study that aimed to validate the TSSI in the general pediatric population. We initially conducted a beta test and a pre-validation study before taking the initial version of the TSSI on 123 neurotypical children. Then, we followed the typical validation procedure: appearance validity, content validity, construct validity, and reliability study.

Results

Regarding the validity of appearance, the TSSI was comprehensible and adapted to the Tunisian pediatric population. About content validity, the exploratory factor analysis extracted 6 factors that explain 69.3% of the total variance. These factors were respectively social clumsiness types 1 and 2, intention attribution, emotional ToM, epistemic ToM, and simple comprehension questions. The subdomains of social clumsiness (types 1 and 2) and emotional ToM had a Cronbach alpha higher than 0.8. This factor structure as well as the significant inter-correlation between subdomains and the global score were in favor of a good construct validity. The internal consistency study showed good reliability of the final version of the TSSI (alpha of Cronbach at 0,809). Regarding the performance of children at the TSSI, we have noticed a significant association between the global score, age, and verbal intelligence.

Conclusion

This work offers valuable insights about ToM and provides clinicians with a reliable tool to assess social clumsiness and emotional ToM in typically developing children.

An Exploratory Study of Executive Function Development in Children with Autism, after Receiving Early Intensive Behavioral Training

Objective: To examine the development of executive functions, in preschool children with autism spectrum disorders (ASD), receiving early intensive behavioral training (EIBI). Method: Executive functions (EF) were assessed with The Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P), by parents and preschool teachers at the time of diagnostic assessment and after 15 months of EIBI intervention. Ten children with ASD (M = 2.9 years, nine males) participated in the study. Reliable Change Index scores were computed for each of the participants in order to investigate any significant change in BRIEF-P T-scores. Results: Three children showed a significant improvement in EF, based on parent ratings. Four children showed a significant improvement in EF based on preschool teacher ratings. Conclusion: Findings indicating a reliable improvement in one third of preschool children with ASD receiving EIBI are encouraging but need to be replicated in larger scale controlled studies.

Altered Connectivity During a False-Belief Task in Adults With Autism Spectrum Disorder

BACKGROUND

Deficits in social communication are one of the main features of autism spectrum disorder (ASD). Adults with ASD show atypical brain activity during false-belief understanding, an aspect of social communication involving the ability to infer that an individual can have an incorrect belief about a situation. Our study is the first to investigate whether adults with ASD exhibit differences in frequency-specific functional connectivity patterns during false-belief reasoning.

METHODS

We used magnetoencephalography to contrast functional connectivity underlying false-belief understanding between 40 adults with ASD and 39 control adults. We examined whole-brain phase synchrony measures during a false-belief task in 3 frequency bands: theta (4-7 Hz), alpha (8-14 Hz), and beta (15-30 Hz).

RESULTS

Adults with ASD demonstrated reduced theta-band connectivity compared with control adults between several right-lateralized and midline regions such as the medial prefrontal cortex, right temporoparietal junction, right inferior frontal gyrus, and right superior temporal gyrus. During false-belief trials, they also recruited a network in the beta band that included primary visual regions such as the bilateral inferior occipital gyri and the left anterior temporoparietal junction.

CONCLUSIONS

Reduced theta-band synchrony between areas associated with mentalizing, inhibition, and visual processing implies some difficulty in communication among these functions in ASD. This impairment in top-down control in the theta band may be counterbalanced by their engagement of a beta-band network because both the left anterior temporoparietal junction and beta-band oscillations are associated with attentional processes. Thus, adults with ASD demonstrate alternative neural mechanisms for successful false-belief reasoning.

An approach to gut microbiota profile in children with autism spectrum disorder

In recent years, there has been an increase in studies on the implications of gut microbiota (GM) on the behaviour of children with autism spectrum disorders (ASD) due to a dysbiosis in GM that can trigger onset, development or progression of ASD through the microbiota-gut-brain axis. The aim of this study is to carry out a systematic review of articles from the last 6 years that analyse GM in children with ASD compared to GM in control groups. Children with ASD showed a higher abundance of Roseburia and Candida genera, and lower abundance of Dialister, Bilophila, Veillonella, Streptococcus, Coprococcus and Prevotella genera. Those differences can be attributed to factors such as different nationalities, nature of control groups, place where the sample was taken, gastrointestinal (GI) problems or bacterial detection methods. It is still too early to define a specific GM profile of children with ASD, and future studies should focus on homogenizing the characteristics of samples and control groups. Furthermore, new multicentre studies should also focus on the impact of GM on GI physiology, neurophysiology and behaviour of children with ASD, and on performing psychometric analyses of the correlation between the severity of ASD behavioural symptoms and GM profiles.

The Role of Gut Microbiota in Gastrointestinal Symptoms of Children with ASD

Background and objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication, social interaction disorder, and repetitive behavior. Dysbiotic gut microbiota (GM) could be a contributing factor to the appearance of ASD, as gastrointestinal (GI) symptoms are comorbidities frequently reported in ASD. As there is a lack of reviews about the role played by GM in the GI symptoms of ASD, this work aimed to carry out a systematic review of current studies comparing the GM of children with ASD and GI symptoms with those of healthy controls in the last six years. Materials and Methods: The systematic review was performed following the PRISMA guidelines. The databases chosen were Web of Science, Scopus, PubMed, and PsycINFO, and the keywords were (gut* OR intestine* OR bowel* OR gastrointestinal*) AND (microbiota* OR microflora* OR bacteria* OR microbiome* OR flora* OR bacterial* OR bacteria* OR microorganism* OR feces* OR stool*) AND (autistic* OR autism* OR ASD*). Results: A total of 16 articles were included. Ten articles performed correlations analysis between GI symptoms and ASD. Among those 10 articles, 7 found differences between the GI symptoms present in children with ASD and healthy controls. The most common GI symptom was constipation. Among the seven articles that found differences, three performed correlations analysis between GI symptoms and gut microbe abundance. Candida, Prevotella, Streptococcus, and Veillonella showed higher and lower abundance, respectively, in children with ASD and GI symptoms in more than one article. Bacteroidetes, Firmicutes, Actinomyces, Dorea, Lactobacillus, Faecalibacterium prausnitzii, and Bacteroidetes/Firmicutes ratios showed abundance discrepancies. Conclusions: It is still too early to draw a conclusion about the gut microbes involved in GI symptoms of ASD. Future research should consider the relationship between ASD behavior, GM, and GI symptoms in a multidisciplinary way and homogenize sample characteristics.

Establishment of a rodent cooperation assay as a model of social cognition

INTRODUCTION

Impaired cooperative skills form a characteristic symptom in autism, which lacks adequate treatment. The objective of this study was to establish a rat cooperation assay which fits the feasibility and capacity requirements of drug development.

METHODS

Long-Evans and Lister Hooded rats were trained in pairs to simultaneously perform nose-pokes (within 1 s) for reward in a Skinner box equipped with two nose-poke modules. Conditioning took place first with naive-naive pairs, then with naive-experienced and finally with experienced-experienced pairs, when the task was familiar for both rats. In a control experiment, experienced Lister-hooded pairs were tested under the learnt schedule but without the possibility to communicate with each other.

RESULTS

Rats were able to learn the task in 8-15 sessions. Experienced-experienced Long-Evans pairs completed the training significantly faster than the other pairs Analysis of the nose-poke latency data, sample video-recordings and the significantly decreased performance of rats in the control experiment suggested that the animals solved the task via real cooperation.

DISCUSSION

The newly developed rat cooperation model is quick and has sufficiently high throughput, therefore it may be used in the drug development of putative social cognitive enhancer compounds.

Impaired theory of mind in Chinese children and adolescents with idiopathic generalized epilepsy: Association with behavioral manifestations of executive dysfunction

BACKGROUND

Epilepsy is a common neurological disorder with a core feature of cognitive impairments. Previous studies showed that patients with focal epilepsy have deficits in both theory of mind (ToM) and executive function (EF). However, there are few studies of ToM in patients with idiopathic generalized epilepsy (IGE), especially in populations with pediatric epilepsy. The aim of this study was to examine the characteristics of ToM and EF, including some of their subcomponents, and explore the relationship between them in Chinese children with IGE.

MATERIALS AND METHODS

We recruited 54 children and adolescents with IGE as the experimental subjects and 37 typically developing children and adolescents as control subjects. Both groups completed ToM tests, namely, second-order false belief tasks (FBTs) and faux pas tasks (FPTs). Their caregivers completed the Behavior Rating Inventory of Executive Function (BRIEF) at the same time.

RESULTS

Children and adolescents with IGE displayed worse performance on some of the FBTs and FPTs than healthy controls (p<0.01). They also exhibited widespread EF deficits, comprising eight subcomponents (p<0.05). Pearson's correlation analysis revealed that several subcomponents of EF (inhibition, emotional control, initiation, working memory, and monitoring) were unequally correlated with FBT and FPT. Regression analysis showed that ToM had associations with inhibition, working memory, and duration of seizures. Analysis of variance (ANOVA) indicated that children with newly diagnosed epilepsy displayed significant deficits in FBT, FPT, and distinct subscales of EF.

CONCLUSIONS

Our results revealed significant impairments in ToM and EF in children and adolescents with IGE compared with healthy controls. We found significant correlations between ToM and two subcomponents of EF (inhibition and working memory) in children with IGE. Additionally, the duration of seizures affected ToM in patients but was a less powerful predictor than the two subcomponents of EF. Even for children with new-onset seizures and without medication, the deficits in ToM and some distinct subscales of EF were apparent. This result has clinical implications for both nonpharmaceutical therapies and cognitive rehabilitation.