Theory of Mind Deficits and Neurophysiological Operations in Autism Spectrum Disorders: A Review

A Combined Interventional Approach to Train Interview Skills in Autistic Transition-Age Youth

BACKGROUND

The job interview can be challenging for autistic adolescents considering the required social communication skills. Further, having decreased awareness of personal strengths may make it difficult to advocate for oneself to a future employer. The purpose of the current pilot randomized controlled trial (RCT) is to examine the preliminary efficacy and feasibility of a combined interventional approach using: the Virtual Interview Tool for Autistic Transition-Age Youth (VIT-TAY) and Kessler Foundation Strength Identification and Expression (KF-STRIDE).

METHOD

Twenty autistic transition-age youth (TAY) were randomly assigned to two groups: an intervention group (n = 10) that received 9 h of VIT-TAY (interviewing practice with a virtual human), and three lessons of KF-STRIDE (positive psychology intervention to learn and discuss one's personal character strengths) and a services-as-usual (SAU) group (n = 10). The primary outcome was measured using a video-recorded mock job interview performed at pre- and post-test, which was rated by blinded assessors. Secondary outcomes included self-reports of job interview skill, interview anxiety, work readiness and recent job search behavior.

RESULTS

Paired samples t-tests revealed significant differences between pre- and post-test in the intervention group (but not the control group) on the mock interview total score (p = 0.02, d = 0.76) and self-reported job interview skills total score (p = 0.02, d = 0.75). The intervention group (but not the control group) had improvements in work-readiness (p = 0.06, d = 0.53) and job search behavior (p = 0.07, d = 0.52) that were characterized by medium effect sizes.

CONCLUSIONS

This pilot study suggests that combining VIT-TAY with KF-STRIDE leads to improvements in performance-based and self-reported job interview skills.

Examining the association between variation of ASD and cognitive and affective domains of mentalizing in verbal children with ASD

Cognitive research in autism has often approached mentalizing abilities in global terms, and ultimately judged them to be impaired in Autism Spectrum Disorder (ASD). However, recent studies have demonstrated that these social-cognitive abilities constitute neurocognitive constructs, encompassing both cognitive and affective domains, which are selectively found to be lacking in clinical categories. This study investigates the variation in autistic symptoms in relation to the graduation in gravity of cognitive and affective domains of mentalizing in children with ASD, aged 8 to 12 years. Mentalizing domains are assessed by the false-belief paradigms and by the Reading the Mind in the Eyes tasks in a group of 50 children with ASD. The findings showed that the severity of the children's autistic symptoms is inversely and strongly associated with their performance in first-(r = -0.762, p < .001) and second-order cognitive mentalizing (r = -0.674, p < .001), as well as affective mentalizing (r = -0.653, p < .001). However, the capacity for affective mentalizing was noticeably more impaired compared to those of cognitive mentalizing. The evidence confirms that the lower performance of children with ASD in mentalizing abilities is relatively dependent on the variation in their autistic symptoms and that the cognitive and affective domains of the latter are interrelated constructs.

Camera Movement Impacts on Mu-Wave Activity During Action Observation in Adults With Autism Spectrum Disorders Without Intellectual Disabilities

The aim of this study was to investigate differences in mu-wave modulation in individuals diagnosed with autism spectrum disorder (ASD) without intellectual disabilities compared to a group of neurotypical controls (NT). Thirty autistic individuals and 30 NT underwent an EEG recording while watching short videos depicting goal-oriented action filmed from a fixed position, zooming in on the scene, and approaching the scene by means of a steadycam. Then, participants underwent a rating task to evaluate their subjective viewing experience. We found that steadycam videos elicited enhanced event-related desynchronization (ERD), suggestive of enhanced neural activity, in the NT group, and a reduced ERD in the autistic group, compared to the other filming conditions. Autistic participants also showed difficulties in returning to baseline mu-power levels after watching videos filmed from a fixed position. Finally, NT reported feeling more comfortable watching videos with movement, whereas autistic participants did not exhibit differences between conditions. We speculated that static, less naturalistic stimuli might impose higher and prolonged cognitive demands on autistic individuals. Understanding these differences might help develop tailored interventions to support perceptual, cognitive, and social processes of autistic people.

A computational signature of self-other mergence in Borderline Personality Disorder

A tendency to merge mental representations of self and other is thought to underpin the intense and unstable relationships that feature in Borderline Personality Disorder (BPD). However, clinical theories of BPD do not specify, in computational terms, how the perspectives of self and other might become confused. To address this question, we used a probabilistic false belief task (p-FBT) to examine how individuals with BPD (N = 38) and matched controls from the general population (N = 74) selectively assigned beliefs to self or other. The p-FBT requires participants to track a gradually changing quantity, whilst also predicting another person's belief about that quantity. We found that BPD participants showed less selectivity in belief assignment compared with controls (Cohen's d = 0.64). Behaviourally, participants with BPD tended to predict that others' beliefs resembled their own. Modelling analysis revealed that BPD participants were prone to generalise their own learning signals to others. Furthermore, this generalising tendency correlated with BPD symptomatology across participants, even when controlling for demographic factors and affective psychopathology. Our results support a computational account of self-other mergence, based on a generalisation of learning across agents. Self-other generalisation in learning purports to explain key clinical features of BPD, and suggests a potential transdiagnostic marker of mentalising capability.

Comprehension of Spatial Demonstratives in Mandarin-speaking Children on the Autism Spectrum: The Roles of Theory of Mind and Executive Function

The present study aimed to examine whether Mandarin-speaking children on the autism spectrum showed differences in comprehending spatial demonstratives ("this" and "that", and "here" and "there"), as compared to typically developing (TD) children. Another aim of this study was to investigate the roles of theory of mind (ToM) and executive functions (EF) in the comprehension of spatial demonstratives. Twenty-seven autistic children (mean age 6.86) and 27 receptive-vocabulary-matched TD children (mean age 5.82) were recruited. Demonstrative comprehension was assessed based on participants' ability to place objects in certain locations according to experimenters' instructions which involved these demonstratives in three different conditions (same-, opposite-, and spectator-perspective conditions). Four false-belief tasks were administered to measure ToM, and the word-span task and the dimensional change card sort task were used to measure two subcomponents of EF - working memory and mental flexibility - respectively. Children on the autism spectrum were found to score below TD children in the comprehension of spatial demonstratives. In addition, the results showed that ToM and working memory were conducive to the correct interpretation of spatial demonstratives. The two cognitive abilities mutually influenced their respective roles in spatial demonstrative comprehension in the three different conditions. The findings suggest that the comprehension of spatial demonstratives comprehension is an area of need in Mandarin-speaking children on the autism spectrum, and it might be linked to their differences in cognitive abilities.

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.

Neural Mechanisms of Social Interaction Perception: Observing Interpersonal Synchrony Modulates Action Observation Network Activation and Is Spared in Autism

How the temporal dynamics of social interactions are perceived arguably plays an important role in how one engages in social interactions and how difficulties in establishing smooth social interactions may occur. One aspect of temporal dynamics in social interactions is the mutual coordination of individuals' behaviors during social interaction, otherwise known as behavioral interpersonal synchrony (IPS). Behavioral IPS has been studied increasingly in various contexts, such as a feature of the social interaction difficulties inherent to autism. To fully understand the temporal dynamics of social interactions, or reductions thereof in autism, the neural basis of IPS perception needs to be established. Thus, the current study's aim was twofold: to establish the basic neuro-perceptual processing of IPS in social interactions for typical observers and to test whether it might differ for autistic individuals. In a task-based fMRI paradigm, participants viewed short, silent video vignettes of humans during social interactions featuring a variation of behavioral IPS. The results show that observing behavioral IPS modulates the Action Observation Network (AON). Interestingly, autistic participants showed similar neural activation patterns as non-autistic participants which were modulated by the behavioral IPS they observed in the videos, suggesting that the perception of temporal dynamics of social interactions is spared and may not underly reduced behavioral IPS often observed in autism. Nevertheless, a general difference in processing social interactions was found in autistic observers, characterized by decreased neural activation in the right middle frontal gyrus, angular gyrus, and superior temporal areas. These findings demonstrate that although the autistic and non-autistic groups indeed differed in the neural processing of social interaction perception, the temporal dynamics of these social interactions were not the reason for these differences in social interaction perception in autism. Hence, spared recruitment of the AON for processing temporal dynamics of social interactions in autism does not account for the widely reported attenuation of IPS in autism and for the widely reported and presently observed differences in social interaction perception in autism.

Attitudes of Chinese public towards the autism community: Evidence from a decade of Weibo data

Autism is a highly stigmatized developmental disorder in Chinese society, with the public harboring many prejudices and misunderstandings towards individuals with autism.Grounded in ABC attitude theory, explores the status, trends, and characteristics of Weibo users' attitudes towards the autism community. Utilizing natural language processing and machine learning techniques, the study analyzes 1,113,014 Weibo posts concerning autism, spanning from January 1, 2013, to December 31, 2022. Findings indicate that Weibo users generally hold a positive and progressively improving attitude towards the autism community, particularly in affective and behavioral dimensions. However, the cognitive dimension of these attitudes remains relatively underdeveloped. Notable variations in attitudes and their components are evident across demographic variables such as gender, age, educational level, and verification status. These insights offer valuable guidance for policy-making by relevant authorities and contribute to enhancing public acceptance of individuals with autism.

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 Theory of Mind and Listening Comprehension Among Chinese Preschoolers with and without Autism Spectrum Disorder

The study aimed to examine the performance on linguistic and cognitive tasks among Chinese preschool children with and without autism spectrum disorder (ASD) and explore the direct and indirect relationships between theory of mind (ToM) and literal and inferential listening comprehension. Forty-nine (N = 49) children with ASD and fifty-two (N = 52) age- and gender-matched typically developing (TD) children participated in the study. All participants were administered tasks evaluating their listening comprehension of literal and inferential statements, ToM, as well as verbal and nonverbal IQ. Results showed that the ASD group performed statistically worse on listening comprehension, ToM abilities, verbal IQ, and nonverbal IQ than their TD peers. Further, we found statistically significant correlations between general ToM performance and overall listening comprehension among Chinese preschool children with and without ASD. More specifically, ToM abilities of children with ASD had an indirect effect on their literal listening comprehension via the mediation of verbal IQ, whereas ToM performance among TD children predicted their literal listening comprehension via the mediation of nonverbal IQ. The major findings were discussed in detail based on the situation model. The research facilitated insights into listening comprehension among Chinese preschool children with and without ASD, providing their caregivers and teachers with viable strategies to improve their listening comprehension.

The Brunswik Lens Model: a theoretical framework for advancing understanding of deceptive communication in autism

Due to differences in social communication and cognitive functioning, autistic adults may have greater difficulty engaging in and detecting deception compared to neurotypical adults. Consequently, autistic adults may experience strained social relationships or face increased risk of victimization. It is therefore crucial that research investigates the psychological mechanisms that are responsible for autistic adults' difficulties in the deception process in order to inform interventions required to reduce risk. However, weaknesses of extant research exploring deception in autism include a heavy focus on children and limited theoretical exploration of underlying psychological mechanisms. To address these weaknesses, this review aims to introduce a system-level theoretical framework to the study of deception in autistic adulthood: The Brunswik Lens Model of Deception. Here, we provide a comprehensive account of how autism may influence all processes involved in deception, including: Choosing to Lie (1), Producing Deception Cues (2), Perceiving Deception Cues (3), and Making the Veracity Decision (4). This review also offers evidence-based, theoretical predictions and testable hypotheses concerning how autistic and neurotypical adults' behavior may differ at each stage in the deception process. The call to organize future research in relation to a joint theoretical perspective will encourage the field to make substantive, theoretically motivated progress toward the development of a comprehensive model of deception in autistic adulthood. Moreover, the utilization of the Brunswik Lens Model of Deception in future autism research may assist in the development of interventions to help protect autistic adults against manipulation and victimization.

Reading comprehension differences between children with Autism Spectrum Disorder and low cognitive abilities and children with Autism Spectrum Disorder and intact cognitive skills: the roles of decoding, fluency and morphosyntax

Introduction

Reading comprehension is one of the most important skills learned in school and it has an important contribution to the academic success of children with Autism Spectrum Disorder (ASD). Though previous studies have investigated reading comprehension difficulties in ASD and highlighted factors that contribute to these difficulties, this evidence has mainly stemmed from children with ASD and intact cognitive skills. Also, much emphasis has been placed on the relation between reading comprehension and word recognition skills, while the role of other skills, including fluency and morphosyntax, remains underexplored. This study addresses these gaps by investigating reading comprehension in two groups of school-aged children with ASD, one with intact and one with low cognitive abilities, also exploring the roles of word decoding, fluency and morphosyntax in each group's reading comprehension performance.

Methods

The study recruited 16 children with ASD and low cognitive abilities, and 22 age-matched children with ASD and intact cognitive skills. The children were assessed on four reading subdomains, namely, decoding, fluency, morphosyntax, and reading comprehension.

Results

The children with ASD and low cognitive abilities scored significantly lower than their peers with intact cognitive abilities in all reading subdomains, except for decoding, verb production and compound word formation. Regression analyses showed that reading comprehension in the group with ASD and intact cognitive abilities was independently driven by their decoding and fluency skills, and to a lesser extent, by morphosyntax. On the other hand, the children with ASD and low cognitive abilities mainly drew on their decoding, and to a lesser extent, their morphosyntactic skills to perform in reading comprehension.

Discussion

The results suggest that reading comprehension was more strongly affected in the children with ASD and low cognitive abilities as compared to those with intact cognitive skills. About half of the children with ASD and intact cognitive skills also exhibited mild-to-moderate reading comprehension difficulties, further implying that ASD may influence reading comprehension regardless of cognitive functioning. Finally, strengths in decoding seemed to predominantly drive cognitively-impaired children's reading performance, while the group with ASD and intact cognitive skills mainly recruited fluency and metalinguistic lexical skills to cope with reading comprehension demands, further suggesting that metalinguistic awareness may be a viable way to enhance reading comprehension in ASD.

Figurative language processing in autism spectrum disorders: A review

Impairments in the broader domain of pragmatics are considered to be a defining feature of Autism Spectrum Disorders (ASD). A challenging aspect of pragmatic competence is the ability to process nonliteral language. Interestingly, previous studies in figurative language comprehension in ASD have demonstrated conflicting results regarding participants' performance. The main scientific debate focuses on the underlying skills which facilitate processing of nonliteral speech in ASD. Namely, Theory of Mind (ToM), language abilities and Executive functions (EFs) are regarded as factors affecting autistic individuals' performance. This review addresses figurative language comprehension in ASD in light of the above three interpretive accounts. We reviewed data from recent studies in this field concluding that autistic children indeed encounter systematic difficulties in the processing of non-literal language. Moreover, only ToM and verbal skills were found to correlate the most with figurative language comprehension in ASD. Notably, we found that differences related to research methodology and tasks' properties may have led to discrepancies between studies' results. Finally, we argue that future studies should encompass in their experimental design figurative comprehension tasks with minimal linguistic demands and also measures of ToM, verbal ability and EFs in order to shed more light in the independent contribution of those skills to the processing of nonliteral language in ASD.

Theory of mind in chronic migraine with medication overuse assessed with the MASC

Theory of Mind (ToM) is the ability to infer one's own and others' mental states. Growing research indicates that ToM is impaired in Chronic Migraine with Medication Overuse (CM + MO). However, the research in this field has been conducted using static scenario-based tasks, often failing to test mentalization in everyday situations and measuring only performance accuracy. We filled this gap by administering the Movie for the Assessment of Social Cognition (MASC) to subjects with CM + MO compared to episodic migraine (EM). This test allows us to assess both affective and cognitive ToM and which, in addition to being accurate, also analyzes the type of error in attribution of mental states, distinguishing between hypo-mentalization and hyper-mentalization. Thirty patients suffering from CM + MO and 42 from EM were enrolled. Results showed that CM + MO patients were less accurate in mental state attribution than EM. In addition, compared to EM, CM + MO individuals were more impaired in the affective ToM dimensions and committed more errors of hypo-mentalization. In conclusion, the application of MASC in patients with CM + MO allowed for the detection of an alteration in their ability to correctly draw conclusions about other people's mental states. This latter contributes critically to appropriate social reactions and also, possibly, to satisfactory social interactions.

Social-Motor Coordination Between Peers: Joint Action Developmental Trajectories in ASD and TD

Coordinating a physical movement in time and space with social and nonsocial partners to achieve a shared goal - "joint action" (JA) - characterizes many peer-engagement situations that pose challenges for individuals with autism spectrum disorder (ASD). This cross-sectional study examined development of JA capabilities comparing ASD versus typically developing (TD) groups in early childhood, preadolescence, and adolescence while performing mirroring and complementing JA tasks with social (peer) and nonsocial (computer) partners. Results indicated better motor coordination abilities on computerized tasks than in peer dyads, with larger peer-dyad deficits shown by the ASD group. Developmental growth in JA abilities emerged, but the ASD group lagged behind same-age peers with TD. Socio-motor interventions may offer new channels to facilitate peer engagement in ASD.

Evolution of a theory of mind

Even though the Theory of Mind in upper primates has been under investigation for decades, how it may evolve remains an open problem. We propose here an evolutionary game theoretical model where a finite population of individuals may use reasoning strategies to infer a response to the anticipated behavior of others within the context of a sequential dilemma, i.e., the Centipede Game. We show that strategies with bounded reasoning evolve and flourish under natural selection, provided they are allowed to make reasoning mistakes and a temptation for higher future gains is in place. We further show that non-deterministic reasoning co-evolves with an optimism bias that may lead to the selection of new equilibria, closely associated with average behavior observed in experimental data. This work reveals both a novel perspective on the evolution of bounded rationality and a co-evolutionary link between the evolution of Theory of Mind and the emergence of misbeliefs.

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.

Autism Traits and Cognitive Performance: Mediating Roles of Sleep Disturbance, Anxiety and Depression

Theories about autism spectrum disorder (ASD) have addressed cognitive deficits however few have examined how comorbid diagnoses, including sleep disturbance, anxiety and depression contribute to the underlying deficits. We investigated potential mediations of common ASD comorbidities in the relationship between sub-clinical autism traits and cognitive performance using an international community sample. Cognitive tasks assessed working memory [executive functioning (EF) theory], mental state attribution [theory of mind (ToM)], and global/local visual processing [weak central coherence (WCC) theory]. Structural equation modelling (SEM) demonstrated sleep disturbance and anxiety mediated the relationship of autism traits on measures of EF, but not WCC and ToM. This suggests that treating the symptoms of sleep disturbance and anxiety may lead to improvements in working memory.

Autism Spectrum Disorder in 2023: A Challenge Still Open

In this paper, we provide an update on autism spectrum disorder (ASD), including epidemiology, etiopathogenesis, clinical presentation, instrumental investigations, early signs, onset patterns, neuropsychological hypotheses, treatments, and long-term outcome. The prevalence of this condition has increased enormously over the last few decades. This increase prompted a search for possible environmental factors whose effects would add up to a genetic predisposition leading to the development of autism. But the genetic and environmental variables involved are extremely numerous, and conclusive data regarding the etiopathogenesis are still far away. Assuming that a well-defined etiology is still found today only in a minority of cases, numerous pathogenetic mechanisms have been hypothesized. Among these, we mention oxidative stress, mitochondrial dysfunction, alteration of the intestinal microbiota, immune dysregulation, and neuroinflammation. These pathogenetic mechanisms could alter epigenetic status and gene expression, finally leading to ASD. Inherent in the term spectrum is the great clinical heterogeneity of this condition, mainly due to the frequent comorbidity that characterizes it. The earlier the diagnosis is made and the earlier psychoeducational treatment begins, the better the prognosis. In this sense, the role of pediatricians can be decisive in making children with signs suggestive of autism undergo a specialist diagnostic course. The development of increasingly advanced cognitive-behavioral educational techniques has considerably improved the prognosis of affected individuals, even though only a small minority of them come off the autistic spectrum. Pharmacological therapies are used to treat comorbidities. During childhood, the most important prognostic factor for long-term outcome seems to be intellectual functioning.

Play brick therapy to aid the social skills of children and young people with autism spectrum disorder: the I-SOCIALISE cluster RCT

Background

Social skills interventions are commonly recommended to help children and young people with autism spectrum disorder develop social skills, but some struggle to engage in these interventions. LEGO® (LEGO System A/S, Billund, Denmark) based therapy, a group social skills intervention, aims to be more interesting and engaging.

Objective

To evaluate the clinical effectiveness of LEGO® based therapy on the social and emotional skills of children and young people with autism spectrum disorder in school settings compared with usual support. Secondary objectives included evaluations of cost-effectiveness, acceptability and treatment fidelity.

Design

A cluster randomised controlled trial randomly allocating participating schools to either LEGO® based therapy and usual support or usual support only.

Setting

Mainstream schools in the north of England.

Participants

Children and young people (aged 7-15 years) with autism spectrum disorder, their parent/guardian, an associated teacher/teaching assistant and a facilitator teacher/teaching assistant (intervention schools only).

Intervention

Schools randomised to the intervention arm delivered 12 weekly sessions of LEGO® based therapy, which promotes collaborative play and encourages social problem-solving in groups of three children and young people with a facilitator (trained teacher or teaching assistant). Participants received usual support from school and community services. Participants in the control arm received usual support only. Research assistants and statisticians were blind to treatment allocation.

Main outcome measure

The social skills subscale of the Social Skills Improvement System (SSIS), completed by the children and young people's unblinded teacher pre randomisation and 20 weeks post randomisation. The SSIS social skills subscale measures social skills including social communication, co-operation, empathy, assertion, responsibility and self-control. Participants completed a number of other pre- and post-randomisation measures of emotional health, quality of life, loneliness, problem behaviours, academic competence, service resource utilisation and adverse events.

Results

A total of 250 children and young people from 98 schools were randomised: 127 to the intervention arm and 123 to the control arm. Intention-to-treat analysis of the main outcome measure showed a modest positive difference of 3.74 points (95% confidence interval -0.16 to 7.63 points, standardised effect size 0.18; p = 0.06) in favour of the intervention arm. Statistical significance increased in per-protocol analysis, with a modest positive difference (standardised effect size 0.21; p = 0.036). Cost-effectiveness of the intervention was found in reduced service use costs and a small increase in quality-adjusted life-years. Intervention fidelity and acceptability were positive. No intervention-related adverse events or effects were reported.

Conclusions

The primary and pre-planned sensitivity analysis of the primary outcome consistently showed a positive clinical difference, with modest standardised effect sizes of between 0.15 and 0.21. There were positive health economics and qualitative findings, corroborated by the difference between arms for the majority of secondary outcomes, which were not statistically significant but favoured the intervention arm. Post hoc additional analysis was exploratory and was not used in drawing this conclusion. Given the small positive change, LEGO® based therapy for children and young people with autism spectrum disorder in schools should be considered.

Limitations

The primary outcome measure was completed by an unblinded teacher (rather than by the facilitator).

Future work

The study team recommends future research into LEGO® based therapy, particularly in school environments.

Trial registration

This trial is registered as ISRCTN64852382.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 15/49/32) and is published in full in Public Health Research; Vol. 11, No. 12. See the NIHR Funding and Awards website for further award information.

Examining whether adults with autism spectrum disorder encounter multiple problems in theory of mind: a study based on meta-analysis

Theory of mind (ToM) represents a complex ability, while persons with autism spectrum disorder (ASD) encounter difficulties in the processing of ToM. The present ToM-focused studies on adults with ASD report inconsistent results, possibly owing to the differences between tasks. For instance, different ToM-related tasks involve different cognitive abilities, but the development of these cognitive abilities is different among adults with ASD, thereby leading to different behaviors by the same individual with ASD in different tasks. Therefore, it is of vital significance to explore the potential reasons for inconsistencies in the existing studies based on the task classification perspective. Hence, this study primarily reviews the existing ToM tasks used in studies on adults with ASD; afterward, based on the forms and characteristics of the task, the current ToM tasks are classified into four categories-reading comprehension, perceptual scene comprehension, comprehensive scene comprehension , and self-other processing. Subsequently, a meta-analysis is undertaken to determine the difference in each ToM task category between the ASD group and the typically developing (TD) group. As a result, 110 research papers (including 3,205 adults with ASD and 3,675 TD adults) that fulfilled the stated criteria are examined in this study. The study findings suggest that adults with ASD demonstrate worse performance in terms of all four ToM task categories as compared to TD adults. Furthermore, compared with tasks of self-other processing and perceptual scene comprehension, adults with ASD perform worse in reading comprehension and comprehensive scene comprehension. This shows that the differences between tasks may exert a potential influence on the study results. Future studies should focus on different abilities involved in ToM processing and the choice of ToM tasks, in order to elucidate the critical problems of ToM in adults with ASD.

Effects of Transcranial Direct Current Stimulation on Social Attention Patterns and Emotion Recognition Ability in Male Adolescents with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is characterized by impairments in social cognition including emotion recognition (ER) abilities. Common symptoms include unusual patterns of visual social attention, which are investigated as early developmental biomarkers for ASD. Transcranial Direct Current Stimulation (tDCS) has shown promising results in influencing social functioning in individuals with ASD. However, the effects of tDCS on social attention patterns and ER ability in adolescents with ASD remain unclear. This double-blind, sham-controlled, randomized clinical trial examined the effects of repeated sessions of tDCS on gaze behavior and ER ability in 22 male adolescents diagnosed with ASD. Participants received either 20 min of 2 mA active tDCS or sham stimulation for 10 days and an intra-stimulation training. Social allocation patterns were assessed using eye-tracking paradigms, including ER tasks. Our results indicated no tDCS-specific effects. Both groups showed improvements in ER and more frequent, faster, and longer fixations on the eyes than the mouth, and on social than nonsocial areas. In tasks with low social content, fixating the mouth seemed to increase ER accuracy. Understanding the effects of tDCS on social functioning in adolescents with ASD holds promise for the development of targeted interventions to improve their social cognition abilities.

The impact of Lego® Therapy on cognitive skills in Autism Spectrum Disorders: a brief discussion

Over the years, several interventions have been implemented, including Lego® Therapy, with the aim of supporting and implementing social and communication skills impairments in Autism Spectrum Disorders (ASD). Although recent studies have shown that the ability to learn implicitly is preserved in ASDs, no study related to Lego® Therapy has analyzed whether and how this training can also affect aspects not directly treated. In this study, we report a first attempt of assessment of Lego® Therapy's effect on the specific area of cognitive skills in an ASD child. Over a period of 12 months, a child with ASD had weekly meetings with an expert operator of Lego® aiming to improve the child's ability to communicate, reduce impulsiveness and hyper verbalism, and encourage pro-social behavior. The intervention resulted in positive outcomes that were assessed after 12 months.

Obsessive-Compulsive, Psychotic, and Autism Dimensions Overlap in Real World: A Case Report

BACKGROUND

Obsessions, compulsions, and stereotypes are common psychopathological manifestations of obsessive-compulsive, psychotic, and autism spectrum disorders (ASDs). These nosological entities may be present in comorbidity, with relevant clinical difficulties in the differential diagnosis process. Moreover, ASDs are a complex group of disorders, with a childhood onset, which also persist into adulthood and present heterogeneous symptom patterns that could be confused with psychotic disorders.

METHODS AND RESULTS

We report a case of a 21-year-old man characterized by sexual and doubt obsessions; disorganized, bizarre, and stereotyped behaviors and compulsions; and social withdrawal, inadequate social skills, visual dispersions, and hypersensitivity to light stimuli. Obsessive and compulsive features were initially included within the differential diagnosis of psychotic and obsessive-compulsive spectrum disorders. However, aforementioned psychopathological elements did not improve when multiple antipsychotic drugs (olanzapine, haloperidol, and lurasidone) were administered in the hypothesis of schizophrenia and even worsened with clozapine therapy at a dose of 100 mg/d. Obsessions and compulsions progressively reduced during the fluvoxamine 14-week treatment paradigm at a dose of 200 mg/d. Considering the persistent deficits in social communication and interactions as well as the restricted interests pattern, a differential diagnostic hypothesis of ASD was formulated, and it was then confirmed at the final evaluation at a third-level health care center.

CONCLUSIONS

We discuss similarities and differences in the psychopathology of obsessions, compulsions, and stereotypes in the previously mentioned disorders, to underline factors that can help in the differential diagnosis of similar cases, and consequently in the appropriateness of treatment choice.

Psychopathic Traits and Theory of Mind Task Performance: A Systematic Review and Meta-analysis

This meta-analysis aims to examine the relationship between psychopathic traits and theory of mind (ToM), which is classically and broadly defined as competency in representing and attributing mental states such as emotions, intentions, and beliefs to others. Our search strategy gathered 142 effect sizes, from 42 studies, with a total sample size of 7463 participants. Random effects models were used to analyze the data. Our findings suggested that psychopathic traits are associated with impaired ToM task performance. This relationship was not moderated by age, population, psychopathy measurement (self-report versus clinical checklist) or conceptualization, or ToM task type (cognitive versus affective). The effect also remained significant after excluding tasks that did not require the participant to 1) mentalize or 2) differentiate self and other perspectives. However, interpersonal/affective traits were associated with a more pronounced impairment in ToM task performance compared to lifestyle/antisocial traits. Future research should investigate the effects of distinct psychopathy facets that will allow for a more precise understanding of the social-cognitive bases of relevant clinical presentations in psychopathy.

How social information impacts action in rodents and humans: the role of the prefrontal cortex and its connections

Day-to-day choices often involve social information and can be influenced by prior social experience. When making a decision in a social context, a subject might need to: 1) recognize the other individual or individuals, 2) infer their intentions and emotions, and 3) weigh the values of all outcomes, social and non-social, prior to selecting an action. These elements of social information processing all rely, to some extent, on the medial prefrontal cortex (mPFC). Patients with neuropsychiatric disorders often have disruptions in prefrontal cortical function, likely contributing to deficits in social reasoning and decision making. To better understand these deficits, researchers have turned to rodents, which have revealed prefrontal cortical mechanisms for contending with the complex information processing demands inherent to making decisions in social contexts. Here, we first review literature regarding social decision making, and the information processing underlying it, in humans and patient populations. We then turn to research in rodents, discussing current procedures for studying social decision making, and underlying neural correlates.

Reading the room: Autistic traits, gaze behaviour, and the ability to infer social relationships

Individuals high in autistic traits can have difficulty understanding verbal and non-verbal cues, and may display atypical gaze behaviour during social interactions. The aim of this study was to examine differences among neurotypical individuals with high and low levels of autistic traits with regard to their gaze behaviour and their ability to assess peers' social status accurately. Fifty-four university students who completed the 10-item Autism Quotient (AQ-10) were eye-tracked as they watched six 20-second video clips of people ("targets") involved in a group decision-making task. Simulating natural, everyday social interactions, the video clips included moments of debate, humour, interruptions, and cross talk. Results showed that high-scorers on the AQ-10 (i.e., those with more autistic traits) did not differ from the low-scorers in either gaze behaviour or assessing the targets' relative social status. The results based on this neurotypical group of participants suggest that the ability of individuals high in autistic traits to read social cues may be preserved in certain tasks crucial to navigating day-to-day social relationships. These findings are discussed in terms of their implications for theory of mind, weak central coherence, and social motivation theories of autism.

Overactivation of posterior insular, postcentral and temporal regions during preserved experience of envy in autism

Social emotions are critical to successfully navigate in a complex social world because they promote self-regulation of behaviour. Difficulties in social behaviour are at the core of autism spectrum disorder (ASD). However, social emotions and their neural correlates have been scarcely investigated in this population. In particular, the experience of envy has not been addressed in ASD despite involving neurocognitive processes crucially compromised in this condition. Here, we used an fMRI adapted version of a well-validated task to investigate the subjective experience of envy and its neural correlates in adults with ASD (n = 30) in comparison with neurotypical controls (n = 28). Results revealed that both groups reported similarly intense experience of envy in association with canonical activation in the anterior cingulate cortex and the anterior insula, among other regions. However, in participants with ASD, the experience of envy was accompanied by overactivation of the posterior insula, the postcentral gyrus and the posterior superior temporal gyrus, regions subserving the processing of painful experiences and mentalizing. This pattern of results suggests that individuals with ASD may use compensatory strategies based on the embodied amplification of pain and additional mentalizing efforts to shape their subjective experience of envy. Results have relevant implications to better understand the heterogeneity of this condition and to develop new intervention targets.

Altered cortical gyrification, sulcal depth, and fractal dimension in the autism spectrum disorder comorbid attention-deficit/hyperactivity disorder than the autism spectrum disorder

Autism spectrum disorder (ASD) frequently occurs accompanied by attention-deficit/hyperactivity disorder (ADHD), which catches increasing attention. The comorbid diagnosis of ASD with ADHD (ASD + ADHD) is permitted in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). However, compared to autism spectrum disorder without other symptoms (ASD-only), the special neural underpinnings in ASD+ADHD remain unclear. Therefore, this study aimed to uncover the differences in cortical complexity between ASD + ADHD and ASD-only patients. A total of 114 ASD participants (i.e. containing 40 ASD + ADHD and 74 ASD-only participants) with T1-weighted magnetic resonance images were collected from the Autism Brain Imaging Data Exchange II. Afterward, a surface-based morphometry method was carried out to compare the cortical complexity (i.e. gyrification index, fractal dimension, and sulcal depth) between the ASD + ADHD and ASD-only cohorts. Results showed the increased fractal dimension in the right fusiform gyrus of the ASD + ADHD cohort in comparison to the ASD-only cohort. Moreover, the ASD + ADHD cohort exhibited increased sulcal depth in the left middle temporal gyrus/inferior temporal gyrus and right middle temporal gyrus compared to the ASD-only cohort. Last but not least, the increased gyrification index in the insula/postcentral gyrus was observed in the ASD + ADHD cohort in comparison to the ASD-only cohort. Overall, the present study contributes to the delineation of particular structural abnormalities in ASD + ADHD than ASD-only, enriching the evidence of the combined phenotype of ASD + ADHD.

Emotional descriptions increase accidental harm punishment and its cortico-limbic signatures during moral judgment in autism

Individuals with autism spectrum disorder (ASD) present difficulties in integrating mental state information in complex moral tasks. Yet, ASD research has not examined whether this process is influenced by emotions, let alone while capturing its neural bases. We investigated how language-induced emotions modulate intent-based moral judgment in ASD. In a fMRI task, 30 adults with ASD and 27 neurotypical controls read vignettes whose protagonists commit harm either accidentally or intentionally, and then decided how much punishment the protagonist deserved. Emotional content was manipulated across scenarios through the use of graphic language (designed to trigger arousing negative responses) vs. plain (just-the-facts, emotionless) language. Off-line functional connectivity correlates of task performance were also analyzed. In ASD, emotional (graphic) descriptions amplified punishment ratings of accidental harms, associated with increased activity in fronto-temporo-limbic, precentral, and postcentral/supramarginal regions (critical for emotional and empathic processes), and reduced connectivity among the orbitofrontal cortex and the angular gyrus (involved in mentalizing). Language manipulation did not influence intentional harm processing in ASD. In conclusion, in arousing and ambiguous social situations that lack intentionality clues (i.e. graphic accidental harm scenarios), individuals with ASD would misuse their emotional responses as the main source of information to guide their moral decisions. Conversely, in face of explicit harmful intentions, they would be able to compensate their socioemotional alterations and assign punishment through non-emotional pathways. Despite limitations, such as the small sample size and low ecological validity of the task, results of the present study proved reliable and have relevant theoretical and translational implications.

Innovations of the ICD-11 in the Field of Autism Spectrum Disorder: A Psychological Approach

Background

This article aims to explain and elaborate upon the recently released ICD-11 criteria for Autism Spectrum Disorder (ASD, World Health Organization), which endorse a medical model.

Method

We integrate insights from several disciplines (e.g., psychology, linguistics, sociology and lived experiences) to reflect the scientific and ethical insights derived from the biopsychosocial, neurodiversity perspective on autism.

Results

First, we describe the core domains of ASD's behavioural characteristics and then the lifetime, developmental perspective on the manifestations of these behaviours. Subsequently, we discuss potential underlying neuropsychology, related behaviours (i.e. associated features/conditions) and we consider some similarities and differences with the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM 5, American Psychological Association).

Conclusions

Recommendations for clinical application are provided. For instance, diagnostic classification in clinical practise should be a means to provide proper, suitable care, and therefore all diagnostic assessments should be used to tailor interventions and/or care to the capacities and genuine needs of the people that ask for professional help.

The impact of prefrontal transcranial direct current stimulation (tDCS) on theory of mind, emotion regulation and emotional-behavioral functions in children with autism disorder: A randomized, sham-controlled, and parallel-group study

Advances in our knowledge about the neuropsychological mechanisms underlying core deficits in autism spectrum disorder (ASD) have produced several novel treatment modalities. One of these approaches is modulation of activity of the brain regions involved in ASD symptoms. This study examined the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) on autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functions in children with ASD. Thirty-two children (M_age  = 10.16, SD = 1.93, range 7-12 years) diagnosed with ASD were randomly assigned to active (N = 17) or sham stimulation (N = 15) groups in a randomized, sham-controlled, parallel-group design. Participants underwent 10 sessions of active (1.5 mA, 15 min, bilateral left anodal/right cathodal DLPFC, 2 sessions per week) or sham tDCS. Autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functioning of the patients were assessed at baseline, immediately after the intervention, and 1 month after the intervention. A significant improvement of autism symptom severity (i.e., communication), theory of mind (i.e., ToM 3), and emotion regulation strategies was observed for the active as compared to the sham stimulation group at the end of the intervention, and these effects were maintained at the one-month follow-up. The results suggest that repeated tDCS with anodal stimulation of left and cathodal stimulation of right DLPFC improves autism symptom severity as well as social cognition and emotion regulation in ASD.

Measuring Theory of Mind in Adolescents With Language and Communication Problems: An Ecological Perspective

We tested if the newly designed ToMotion task reflects a single construct and if the atypical groups differ in their performance compared to typically developing peers. Furthermore, we were interested if ToMotion maps a developmental sequence in a Theory of Mind (ToM) performance as exemplified by increasing difficulty of the questions asked in every item. The sample consisted of 13 adolescents that have been diagnosed with a developmental language disorder (DLD) and 14 adolescents that are deaf or hard of hearing (DHH). All of these adolescents were in special schools for secondary vocational education. The control group existed of 34 typical developing adolescents (TD) who were in regular intermediate vocational education, ranging from level 2 to 4. The ToMotion, available in a spoken Dutch version and in a version in Sign Language of the Netherlands (SLN), was used to map ToM abilities. An attempt has been made to fill the gap of missing studies of ToM in adolescents by developing a new measuring instrument. In conclusion, assessing ToM with the ToMotion results in a picture that DHH adolescents score lower than TD peers. However, their scores are as consistent as those of the TD peers. The picture of DLD adolescents is the reverse. They show no differences in ToM scores, but seem to be somewhat more inconsistent compared to TD peers. We provide a discussion on those results and its implications for future research. What this paper adds? The current study introduces a new visual Theory of Mind (ToM) task, ToMotion, designed specifically to assess ToM in adolescents in an ecologically valid way and adapted to the needs of adolescents with language and communication difficulties.

Social Interaction With an Anonymous Opponent Requires Increased Involvement of the Theory of Mind Neural System: An fMRI Study

An anonymous interaction might facilitate provoking behavior and modify the engagement of theory of mind (TOM) brain mechanisms. However, the effect of anonymity when processing unfair behavior of an opponent remains largely unknown. The current functional magnetic resonance imaging (fMRI) study applied the Taylor aggression paradigm, introducing an anonymous opponent to this task. Thirty-nine healthy right-handed subjects were included in the statistical analysis (13 males/26 females, mean age 24.5 ± 3.6 years). A player winning the reaction-time game could subtract money from the opponent during the task. Participants behaved similarly to both introduced and anonymous opponents. However, when an anonymous opponent (when compared to the introduced opponent) subtracted money, the right inferior frontal gyrus (IFG) demonstrated an increased BOLD signal and increased functional connectivity with the left IFG. Further, increased functional connectivity between the right IFG, the right temporal parietal junction and precuneus was observed during the perception of high provocation (subtracting a large amount of money) from the anonymous compared to the introduced opponent. We speculate that the neural changes may underlie different inferences about the opponents’ mental states. The idea that this reorganization of the TOM network reflects the attempt to understand the opponent by “completing” socially relevant details requires further investigation.

Attribution of intentions in autism spectrum disorder: A study of event-related potentials

Autism spectrum disorder (ASD) is characterized by social cognition deficits, including difficulties inferring the intentions of others. Although deficits in attribution of intentions (AI) have been consistently replicated in ASD, their exact nature remains unexplored. Here we registered the electrophysiological correlates of a nonverbal social cognition task to investigate AI in autistic adults. Twenty-one male autistic adults and 30 male neurotypical volunteers performed a comic strips task depicting either intentional action (AI) or physical causality with or without human characters, while their electroencephalographic signal was recorded. Compared to neurotypical volunteers, autistic participants were significantly less accurate in correctly identifying congruence in the AI condition, but not in the physical causality conditions. In the AI condition a bilateral posterior positive event-related potential (ERP) occurred 200-400 ms post-stimulus (the ERP intention effect) in both groups. This waveform comprised a P200 and a P300 component, with the P200 component being larger for the AI condition in neurotypical volunteers but not in autistic individuals, who also showed a longer latency for this waveform. Group differences in amplitude of the ERP intention effect only became evident when we compared autistic participants to a subgroup of similarly performing neurotypical participants, suggesting that the atypical ERP waveform in ASD is an effect of group, rather than a marker of low-task performance. Together, these results suggest that the lower accuracy of the ASD group in the AI task may result from impaired early attentional processing and contextual integration of socially relevant cues. LAY SUMMARY: To understand why autistic people have difficulties in inferring others' intentions, we asked participants to judge the congruence of the endings of comic strips depicting either intentional actions (e.g., fetching a chair to reach for something) or situations solely following physical rules (e.g., an apple falling on someone's head), while their electrical brain activity was recorded. Autistic individuals had more difficulties in inferring intentions than neurotypical controls, which may reflect impaired attention and contextual integration of social cues.

Phenotypic differences between female and male individuals with suspicion of autism spectrum disorder

BACKGROUND

Although autism spectrum disorder (ASD) is a common developmental disorder, our knowledge about a behavioral and neurobiological female phenotype is still scarce. As the conceptualization and understanding of ASD are mainly based on the investigation of male individuals, females with ASD may not be adequately identified by routine clinical diagnostics. The present machine learning approach aimed to identify diagnostic information from the Autism Diagnostic Observation Schedule (ADOS) that discriminates best between ASD and non-ASD in females and males.

METHODS

Random forests (RF) were used to discover patterns of symptoms in diagnostic data from the ADOS (modules 3 and 4) in 1057 participants with ASD (18.1% female) and 1230 participants with non-ASD (17.9% % female). Predictive performances of reduced feature models were explored and compared between females and males without intellectual disabilities.

RESULTS

Reduced feature models relied on considerably fewer features from the ADOS in females compared to males, while still yielding similar classification performance (e.g., sensitivity, specificity).

LIMITATIONS

As in previous studies, the current sample of females with ASD is smaller than the male sample and thus, females may still be underrepresented, limiting the statistical power to detect small to moderate effects.

CONCLUSION

Our results do not suggest the need for new or altered diagnostic algorithms for females with ASD. Although we identified some phenotypic differences between females and males, the existing diagnostic tools seem to sufficiently capture the core autistic features in both groups.

Empathy, Theory of Mind, and Prosocial Behaviors in Autistic Children

BACKGROUND

Previous research has suggested that children with autism spectrum disorder (ASD) display fewer prosocial behaviors, and the role of empathy or Theory of Mind (ToM) in prosocial behaviors of autistic children remains unclear.

METHODS

Data were obtained from an ongoing longitudinal study in Guangzhou, China. A total of 96 autistic children and 167 typically developing (TD) children were enrolled. Prosocial behaviors were assessed using a subscale of the Strength and Difficulties Questionnaire and Dictator Game (DG) paradigm with stickers as incentives. Empathic traits and ToM ability were measured using the children's Empathy Quotient and the Chinese version of ToM toolkit. Generalized linear models were used to assess the differences of prosocial behaviors and empathic traits, ToM ability between the two groups and the associations between empathic traits, ToM ability and prosocial behaviors in autistic children.

RESULTS

Compared with TD children, autistic children exhibited worse ToM ability and performed less pro-socially in the DG paradigm, while there were no differences regarding empathic traits. In autistic children, empathic traits especially affective empathy, were positively associated with parent-reported prosocial behaviors [β = 0.17, 95% confidence interval (CI): 0.07-0.27; β = 0.47, 95%CI: 0.33-0.60]. ToM ability was associated with DG paradigm (β = 1.03, 95%CI: 0.16-1.89).

CONCLUSION

Autistic children showed less pro-sociality and ToM ability than TD children. In autistic children, empathic trait was associated with parent-reported prosocial behaviors while their ToM ability was associated with prosocial behaviors in experimental condition. Our findings indicated that better ToM ability and empathic trait might promote prosocial behaviors in autistic children.

Me looking at you, looking at me: The stare-in-the-crowd effect and autism spectrum disorder

INTRODUCTION

The stare-in-the-crowd (SITC) effect describes the ability to detect self-directed gaze in a crowd. Given the importance of gaze detection in initiating and maintaining social interactions, there is a need to better characterize the SITC effect.

METHODS

Autistic and neurotypical young adults were presented with four SITC conditions. Eye tracking outcomes and arousal were compared by diagnosis and condition using repeated measures analysis of variance. Hierarchical regression was used to explore behavioral measures.

RESULTS

Significant interaction of diagnosis and condition was found for eye tracking outcomes. Overall, autistic participants exhibited less looking than neurotypical participants. Interest area dwell time, fixation count, and second fixation duration were significantly higher for conditions with shifting gaze, as well as conditions with more self-directed gaze across participants. Two hierarchical regression models of gaze behaviors with advanced theory of mind as a predictor were significant.

DISCUSSION

Autistic individuals respond to various gaze conditions in similar patterns to neurotypical individuals, but to a lesser extent. These findings offer important targets for social interventions.

The Dopamine Hypothesis of Autism Spectrum Disorder Revisited: Current Status and Future Prospects

Autism spectrum disorder (ASD) comprises a group of neurodevelopmental disorders characterized by social deficits and stereotyped behaviors. Despite intensive research, its etiopathogenesis remains largely unclear. Although studies consistently reported dopaminergic anomalies, a coherent dopaminergic model of ASD was lacking until recently. In 2017, we provided a theoretical framework for a "dopamine hypothesis of ASD" which proposed that autistic behavior arises from a dysfunctional midbrain dopaminergic system. Namely, we hypothesized that malfunction of 2 critical circuits originating in the midbrain, that is, the mesocorticolimbic and nigrostriatal pathways, generates the core behavioral features of ASD. Moreover, we provided key predictions of our model along with testing means. Since then, a notable number of studies referenced our work and numerous others provided support for our model. To account for these developments, we review all these recent data and discuss their implications. Furthermore, in the light of these new insights, we further refine and reconceptualize our model, debating on the possibility that various etiologies of ASD converge upon a dysfunctional midbrain dopaminergic system. In addition, we discuss future prospects, providing new means of testing our hypothesis, as well as its limitations. Along these lines, we aimed to provide a model which, if confirmed, could provide a better understanding of the etiopathogenesis of ASD along with new therapeutic strategies.

Pharmacological modulation of AMPA receptors rescues specific impairments in social behavior associated with the A350V Iqsec2 mutation

In this study we tested the hypothesis that pharmacological modulation of glutamatergic neurotransmission could rescue behavioral deficits exhibited by mice carrying a specific mutation in the Iqsec2 gene. The IQSEC2 protein plays a key role in glutamatergic synapses and mutations in the IQSEC2 gene are a frequent cause of neurodevelopmental disorders. We have recently reported on the molecular pathophysiology of one such mutation A350V and demonstrated that this mutation downregulates AMPA type glutamatergic receptors (AMPAR) in A350V mice. Here we sought to identify behavioral deficits in A350V mice and hypothesized that we could rescue these deficits by PF-4778574, a positive AMPAR modulator. Using a battery of social behavioral tasks, we found that A350V Iqsec2 mice exhibit specific deficits in sex preference and emotional state preference behaviors as well as in vocalizations when encountering a female mouse. The social discrimination deficits, but not the impaired vocalization, were rescued with a single dose of PF-4778574. We conclude that social behavior deficits associated with the A350V Iqsec2 mutation may be rescued by enhancing AMPAR mediated synaptic transmission.

Patterns of Contagious Yawning and Itching Differ Amongst Adults With Autistic Traits vs. Psychopathic Traits

Both individuals with diagnosed with Autism Spectrum Disorder (ASD) and individuals high in psychopathic traits show reduced susceptibility to contagious yawning; that is, yawning after seeing or hearing another person yawn. Yet it is unclear whether the same underlying processes (e.g., reduced eye gaze) are responsible for the relationship between reduced contagion and these very different types of clinical traits. College Students (n = 97) watched videos of individuals yawning or scratching (a form of contagion not reliant on eye gaze for transmission) while their eye movements were tracked. They completed the Interpersonal Reactivity Index (IRI), the Autism-Spectrum Quotient (AQ), the Psychopathy Personality Inventory-Revised (PPI-R), and the Adolescent and Adult Sensory Processing Disorder Checklist. Both psychopathic traits and autistic traits showed an inverse relationship to contagious yawning, consistent with previous research. However, the relationship between autistic (but not psychopathic) traits and contagious yawning was moderated by eye gaze. Furthermore, participants high in autistic traits showed typical levels of contagious itching whereas adults high in psychopathic traits showed diminished itch contagion. Finally, only psychopathic traits were associated with lower overall levels of empathy. The findings imply that the underlying processes contributing to the disruptions in contagious yawning amongst individuals high in autistic vs. psychopathic traits are distinct. In contrast to adults high in psychopathic traits, diminished contagion may appear amongst people with high levels of autistic traits secondary to diminished attention to the faces of others, and in the absence of a background deficit in emotional empathy.

The Challenging Heterogeneity of Autism: Editorial for Brain Sciences Special Issue "Advances in Autism Research"

My personal experience as Guest Editor of the Special Issue (SI) entitled "Advances in Autism Research" began with a nice correspondence with Andrew Meltzoff, from the University of Washington, Seattle (WA, USA), which, in hindsight, I consider as a good omen for the success of this Special Issue: "Dear Antonio… [...].

Differentially altered social dominance- and cooperative-like behaviors in Shank2- and Shank3-mutant mice

BACKGROUND

Recent progress in genomics has contributed to the identification of a large number of autism spectrum disorder (ASD) risk genes, many of which encode synaptic proteins. Our understanding of ASDs has advanced rapidly, partly owing to the development of numerous animal models. Extensive characterizations using a variety of behavioral batteries that analyze social behaviors have shown that a subset of engineered mice that model mutations in genes encoding Shanks, a family of excitatory postsynaptic scaffolding proteins, exhibit autism-like behaviors. Although these behavioral assays have been useful in identifying deficits in simple social behaviors, alterations in complex social behaviors remain largely untested.

METHODS

Two syndromic ASD mouse models-Shank2 constitutive knockout [KO] mice and Shank3 constitutive KO mice-were examined for alterations in social dominance and social cooperative behaviors using tube tests and automated cooperation tests. Upon naïve and salient behavioral experience, expression levels of c-Fos were analyzed as a proxy for neural activity across diverse brain areas, including the medial prefrontal cortex (mPFC) and a number of subcortical structures.

FINDINGS

As previously reported, Shank2 KO mice showed deficits in sociability, with intact social recognition memory, whereas Shank3 KO mice displayed no overt phenotypes. Strikingly, the two Shank KO mouse models exhibited diametrically opposed alterations in social dominance and cooperative behaviors. After a specific social behavioral experience, Shank mutant mice exhibited distinct changes in number of c-Fos⁺ neurons in the number of cortical and subcortical brain regions.

CONCLUSIONS

Our results underscore the heterogeneity of social behavioral alterations in different ASD mouse models and highlight the utility of testing complex social behaviors in validating neurodevelopmental and neuropsychiatric disorder models. In addition, neural activities at distinct brain regions are likely collectively involved in eliciting complex social behaviors, which are differentially altered in ASD mouse models.

The Relationship between Carotid Doppler Ultrasound and EEG Metrics in Healthy Preschoolers and Adults

Despite widespread using electroencephalography (EEG) and Doppler ultrasound in pediatric neurology clinical practice, there are still no well-known correlations between these methods that could contribute to a better understanding of brain processes and development of neurological pathology. This study aims to reveal relationship between EEG and Doppler ultrasound methods. We compared two cohorts of adults and preschool children with no history of neurological or mental diseases. The data analysis included investigation of EEG and carotid blood flow indexes, which are significant in neurological diagnosis, as well as calculation of linear and non-linear EEG parameters and ratios between the systolic peak velocities of carotid arteries and carotid blood asymmetry. We have found age-dependent correlations between EEG and power Doppler ultrasound imaging (PDUI) data. Carotid blood flow asymmetry correlated with delta-rhythm power spectral density only in preschoolers. The ratios of blood flow velocities in the internal carotid arteries to those in the common carotid arteries correlated with higher peak alpha frequency and lower fractal dimension; moreover, they were associated with lower Epworth sleepiness scale scores. The study revealed significant correlations between EEG and PDUI imaging indexes, which are different for healthy children and adults. Despite the fact that the correlations were associated with non-clinical states such as overwork or stress, we assumed that the investigated parameters could be applicable for clinical trials.

EEG sensorimotor rhythms in children with autism spectrum disorders

One of the currently assumed causes of impaired social interaction exhibited by children with autism spectrum disorders (ASD) is dysfunction of the mirror neuron system (MNS), which is responsible for imitation, understanding the intentions and emotions of other people. Desynchronization of sensorimotor rhythms is considered to be the indicator of MNS activation. This study aimed to analyze the specific patterns of reactivity of the μ-rhythm in an individually determined frequency range and β-rhythm on the EEG in children with ASD during independent movements, observation, imitation and auditory perception of similar movements performed by another person. The data collected were compared to those describing normally developing children. The study involved right-handed children with ASD aged 5–10 (n = 10) and normally developing children (n = 10). In the independent movements exercise, β-rhythm desynchronization was more pronounced in children with ASD, with difference becoming significant in the P4 locus (p = 0.03). In the movements imitation exercise, the groups showed significant differences in the EEG μ-rhythm in the locus C3 (p = 0.03). Auditory perception of movements revealed significant differences in the ranges of both μ-rhythm (loci F3 and Fz (p = 0.02), F4 (p = 0.04), Cz (p = 0.009)) and β-rhythm (loci Fz (p = 0.01), F4 (p = 0.02)). In these situations, children with ASD exhibited synchronization of sensorimotor rhythms, while normally developing children showed desynchronization. The assumption is that the specific patterns revealed are the consequences of disruption of functions of MNS and anti-mirror system. The data obtained can be used in development of EEG biofeedback training protocols for children with ASD.

The Role of Executive Functions in the Development of Empathy and Its Association with Externalizing Behaviors in Children with Neurodevelopmental Disorders and Other Psychiatric Comorbidities

Executive functions have been previously shown to correlate with empathic attitudes and prosocial behaviors. People with higher levels of executive functions, as a whole, may better regulate their emotions and reduce perceived distress during the empathetic processes. Our goal was to explore the relationship between empathy and executive functioning in a sample of children and adolescents diagnosed with Attention Deficit and Hyperactivity Disorder alone or associated with comorbid Disruptive Behavior Disorders and/or Autism Spectrum Disorder. We also aimed to examine the role of empathic dimensions and executive skills in regulating externalizing behaviors. The 151 participants with ADHD were assigned to four groups according to their psychiatric comorbidity (either "pure" or with ASD and/or ODD/CD) and assessed by means of either parent- or self-reported questionnaires, namely the BRIEF-2, the BES, and the IRI. No questionnaire was found to discriminate between the four groups. Affective Empathy was found to positively correlate with Emotional and Behavioral Regulation competences. Furthermore, Aggressiveness and Oppositional Defiant Problems were positively associated with Executive Emotional and Behavioral Regulation competences. On the other hand, Rule-Breaking Behaviors and Conduct Problems were negatively associated with Affective Empathy and with Behavioral skills. Our study provides an additional contribution for a better understanding of the complex relationship between empathic competence and executive functions, showing that executive functioning and empathic attitudes interact with each other to regulate aggressive behaviors. This study further corroborates developmental models of empathy and their clinical implications, for which externalizing behaviors could be attenuated by enhancing executive functioning skills.