Adding to the Conversation: Language Delays and Parent-Child Interactions in the Younger Siblings of Children With Autism

In their first three years, children begin to maintain topics and add new information in conversation. In turn, caregivers create opportunities for language learning. Compared to children with no family history of autism (typical likelihood, TL), the younger siblings of children with autism spectrum disorder (ASD) are at elevated likelihood (EL) for both ASD and language delays. This study asked: (1) Do profiles of spoken language and conversational skills differ across groups? (2) Does spoken language relate to conversational skills? and (3) How does parent speech relate to child spoken language and conversational skills? Child spoken language, conversational skills, and parent speech were examined during toy play at home with three-year-old TL (n = 16) and EL children with ASD (EL-ASD, n = 10), non-ASD language delay (EL-LD, n = 21), and no delays or diagnoses (EL-ND, n = 37). EL-ASD children produced fewer intelligible utterances, and EL-LD and EL-ASD children produced shorter utterances than TL and EL-ND children. When utterances were intelligible, all groups were highly contingent to the topic. EL-ASD children were less likely than all other groups to add new information, and adding new information was positively associated with utterance length. Parents of EL-ASD children had fewer opportunities to respond contingently. However, all parents were highly topic-contingent when child speech was intelligible, and parent speech complexity varied with child language and conversational skills. Findings highlight strengths in conversational skills for EL-ASD children during toy play with parents and show that children and caregivers together shape opportunities for developing language and conversation.

Differences in Interpersonal Resources and Risk Factors Among Mothers and Fathers of Children on the Autism Spectrum: A Serial Mediation Model

Mothers and fathers of children on the autism spectrum may differ in their perception of their interpersonal resources and risk factors. Fathers (114) and mothers (507) of children on the autism spectrum participated in the study. Fathers (vs. mothers) reported lower interpersonal resources (interpersonal emotion regulation and perceived support from friends and formal sources, but not family) and higher levels of interpersonal risk factors (social, not emotional, loneliness). A serial mediation model indicated that parents' gender predicted interpersonal emotion regulation which in turn related to parents' social loneliness directly and indirectly through perceived social support. Fathers of children on the autism spectrum may differ from mothers in perceptions of interpersonal resources and risk factors related to parents' social belonging needs.

Ethnic Group Differences in the Timing of Autism Diagnosis, Intellectual Disability, and Educational Placement of Autistic Children in Singapore

AIM

Given Singapore's distinct multicultural identity, this study examined the hypotheses that there may be ethnic group differences in diagnosis and outcomes in autistic children in Singapore.

METHODS

Retrospective data were obtained from medical records of all children born between 2008 and 2011 who were diagnosed with clinical or confirmed autism. One-way ANOVAs and regression analyses were used to analyze data.

RESULTS

Data from 2577 medical records were extracted. There were more boys (82.5%) and ethnic group distribution was Chinese (67%), Malay (14%), Indian (10%), and Others (10%). Chinese children were more likely to present at a developmental clinic with concerns 3-4 months younger compared to Malay children and those from Other Races (F(3, 2038) = 9.58, p < .001, Cohen's F = 0.12). Chinese children were also more likely to receive an autism diagnosis approximately 3 months younger compared to Malay children. Fewer autistic Chinese children were diagnosed with co-occurring intellectual disability (13.1%) while there were almost twice more Malay children than expected with co-occurring intellectual disability (29.9%) (χ2 (3) = 55.17, p < .001). There are correspondingly more Malay children on the autism spectrum who attend special education schools. Possible confounding variables such as household income level and mother's level of education were identified in some of these findings.

CONCLUSION

Several significant ethnic group differences in autistic children in Singapore exist that warrant more investigation into possible causes and support systems needed, with implications for other ethnically diverse nations.

Informant-Reports for Women High in Autism Spectrum Traits

There is uncertainty among researchers and clinicians about how to best measure autism spectrum dimensional traits in adults. In a sample of adults with high levels of autism spectrum traits and without intellectual disability (probands, n = 103) and their family members (n = 96), we sought to compare self vs. informant reports of autism spectrum-related traits and possible effects of sex on discrepancies. Using correlational analysis, we found poor agreement between self- and informant-report measures for probands, yet moderate agreement for family members. We found reporting discrepancy was greatest for female probands, often self-reporting more autism-related behaviors. Our findings suggest that autism spectrum traits are often underrecognized by informants, making self-report data important to collect in clinical and research settings.

A Systematic Review of Family Functioning in Families of Children on the Autism Spectrum

This article aims to review the literature on family functioning in the field of autism. The search was conducted in August 2021 in PubMed, PsycINFO, and PubPsy and sixty-two articles were included. Studies were published in English between 1980 and 2021 and provided quantitative data from validated measures of family functioning in families with an official diagnosis of autism. Results showed that family functioning appeared more problematic for families of autistic children than non-autistic ones. Difficulties were correlated with more caregiver demand and less resources. Interventional results varied. The findings highlight the importance of considering family functioning when providing care for autistic children and their families. Limitations and implications for future research are discussed.Prospero registration number: CRD42022297696.

Medical Home Care and Educational Services for Children and Youth on the Autism Spectrum: A Scoping Review

This scoping review examined current evidence on medical home care and its association with educational services for children and youth on the autism spectrum. We searched five databases and grey literature resulting in 328 publications. Publications meeting inclusion criteria were mapped to medical home care component(s) addressed, type(s) of educational services and their strength and type of association. The Andersen Behavioral Model of Health Services Use was used to summarize predisposing, enabling, and need factors considered. Eighteen publications were reviewed, including eight practice/policy reports and ten original research publications. Medical home care components most addressed included family-centered care (n = 10), referrals (n = 16), and effective care coordination (n = 13). Seven publications also addressed multiple educational service types. Two of the five publications that established a significant association between medical home care components and educational services had mixed results, with one publication reporting a negative association and the other publication reporting a positive association. Challenges to medical home care and educational services were most categorized as enabling factors. Results suggest three areas for further investigation: (1) limited evidence on the strength and type of association between medical home care components and educational services; (2) limited use of population data sources; and (3) the need to consider a broader range of factors when examining their association.

Integrating Social Cognition Into Domain-General Control: Interactive Activation and Competition for the Control of Action (ICON)

Social cognition differs from general cognition in its focus on understanding, perceiving, and interpreting social information. However, we argue that the significance of domain-general processes for controlling cognition has been historically undervalued in social cognition and social neuroscience research. We suggest much of social cognition can be characterized as specialized feature representations supported by domain-general cognitive control systems. To test this proposal, we develop a comprehensive working model, based on an interactive activation and competition architecture and applied to the control of action. As such, we label the model "ICON" (interactive activation and competition model for the control of action). We used the ICON model to simulate human performance across various laboratory tasks. Our simulations emphasize that many laboratory-based social tasks do not require socially specific control systems, such as those that are argued to rely on neural networks associated with theory-of-mind. Moreover, our model clarifies that perceived disruptions in social cognition, even in what appears to be disruption to the control of social cognition, can stem from deficits in social representation instead. We advocate for a "default stance" in social cognition, where control is usually general, but representation is specific. This study underscores the importance of integrating social cognition within the broader realm of domain-general control processing, offering a unified perspective on task processing.

Ex vivo exposure to polybrominated diphenyl ether (PBDE) selectively affects the immune response in autistic children

Children on the autism spectrum have been shown to have immune dysregulation that often correlates with behavioral deficits. The role of the post-natal environment in this dysregulation is an area of active investigation. We examined the association between plasma levels of polybrominated diphenyl ether (PBDE) and immune cell function in age-matched autistic children and non-autistic controls. Plasma from children on the autism spectrum (n = 38) and typically developing controls (TD; n = 60) were analyzed for 14 major PBDE congeners. Cytokine/chemokine production was measured in peripheral blood mononuclear cell (PBMC) supernatants with and without ex vivo BDE-49 exposure. Total plasma concentration (∑PBDE14) and individual congener levels were also correlated with T cell function. ∑PBDE14 did not differ between diagnostic groups but correlated with reduced immune function in children on the autism spectrum. In autistic children, IL-2 and IFN-γ production was reduced in association with several individual BDE congeners, especially BDE-49 (p = 0.001). Furthermore, when PBMCs were exposed ex vivo to BDE-49, cells from autistic children produced elevated levels of IL-6, TNF-α, IL-1β, MIP-1α and MCP-1 (p < 0.05). Therefore, despite similar plasma levels of PBDE, these data suggest that PBMC function was differentially impacted in the context of several PBDE congeners in autistic children relative to TD children where increased body burden of PBDE significantly correlated with a suppressed immune response in autistic children but not TD controls. Further, acute ex vivo exposure of PBMCs to BDE-49 stimulates an elevated cytokine response in AU cases versus a depressed response in TD controls. These data suggest that exposure to the toxicant BDE-49 differentially impacts immune cell function in autistic children relative to TD children providing evidence for an underlying association between susceptibility to PBDE exposure and immune anomalies in children on the autism spectrum.

The Influence of Bilingual Language Exposure on the Narrative, Social and Pragmatic Abilities of School-Aged Children on the Autism Spectrum

We examined the narrative abilities of bilingual and monolingual children on the autism spectrum (AS), whether bilinguals presented stronger social and pragmatic language abilities compared to monolinguals, and the link between narrative, social, and pragmatic language abilities.The narrative, social, and pragmatic language skills of school-aged bilinguals (n = 54) and monolinguals (n = 80) on the AS were assessed using normed measures. Language exposure was estimated through a parent questionnaire.Bilinguals performed similarly to monolinguals on measures of narrative, social, and pragmatic language skills. However, balanced bilinguals performed better on a nonliteral language task.Overall, results indicate that bilingual children on the AS can become as proficient in using language as monolinguals and may enjoy a bilingual advantage.

Increasing linguistic and prelinguistic communication for social closeness during naturalistic AAC instruction with young children on the autism spectrum

This study examined the effects of an intervention package using high-tech augmentative and alternative communication (AAC) with Naturalistic Instruction (NI), time delay, and prompting during social routines for preschoolers on the autism spectrum. The AAC was a communication application on a tablet programmed with color photo representations of participants and communication partners engaged in social routines. The primary dependent measure was a linguistic communication turn on the AAC device completing the instructor's cloze phrase related to the routine. A secondary dependent measure was prelinguistic communication -nonspecific vocalizations and smiling - within each turn of the routine. Results indicated that all communication types increased and maintained for all three participants with two participants meeting mastery criteria within the minimal number of sessions. These results are significant in providing additional evidence for the effectiveness of AAC intervention beyond teaching simple object requests and in teaching more socially meaningful communication to children on the autism spectrum. Additionally, this study supports the use of color photo representations to promote social interaction. Future research should continue to evaluate such interventions on a larger scale and include naturally occurring communication partners, such as siblings and peers.

Student Teachers' Positive Perceptions of Characteristics and Personality of People on the Autism Spectrum: "Challenging in a Positive Way"

This paper presents quantitative and qualitative findings from an interdisciplinary research project exploring student teachers' positive perceptions of people on the autism spectrum. The set of findings reported in this paper asked 704 student teachers from one university in England (n = 191), Finland (n = 251) and Sweden (n = 262) to write down the first three words they thought of to identify the characteristics of people on the autism spectrum. Data was analysed using a multi-layered, deductive co-rated coding approach. Through this approach repeated words were extracted as were negative and undetermined words, leaving only positive words. Examination of the positive words identified found differences in the manner student teachers focus on the positive characteristics of people on the autism spectrum as this is an understudied area of research. Finnish student teachers more frequently used language to describe the positive characteristics of people on the autism spectrum that reflected their perception of learning being their primary professional role. However, English and Swedish student teachers used language that showed they perceived their role as encompassing the social and emotional development of their pupils, with little reflection about the positive characteristics of people on the autism spectrum as learners.

IL-6, homocysteine, and autism spectrum phenotypes: an investigation among adults with autism spectrum disorder and their first-degree relatives

BACKGROUND

The importance of recognizing different kinds of autism spectrum presentations among adults, including subthreshold forms and the broad autism phenotype (BAP), has been increasingly highlighted in recent studies. Meanwhile, the possible involvement of immune system deregulation and altered methylation/trans-sulfuration processes in autism spectrum disorder (ASD) is gaining growing attention, but studies in this field are mainly focused on children. In this framework, the aim of this study was to compare plasmatic concentrations of IL-6 and homocysteine (HCY) among adults with ASD, their first-degree relatives, and healthy controls (CTLs), investigating also possible correlations with specific autism symptoms.

METHODS

Plasma concentrations of IL-6 and HCY were measured in a group of adult subjects with ASD, their first-degree relatives (BAP group), and healthy controls (CTL). All participants were also evaluated with psychometric instruments.

RESULTS

IL-6 and HCY concentrations were significantly higher in the ASD group than in CTLs, while BAP subjects reported intermediate results. Significant correlations were reported between biochemical parameters and psychometric scales, particularly for the dimension of ruminative thinking.

CONCLUSIONS

These findings support the hypothesis of a key involvement of HCY-related metabolism and immune system alteration in autism spectrum pathophysiology. HCY and IL-6 seem to show different associations with specific autism dimensions.

Do Types of Information in an Animated Video Intervention Affect University Students' Autism Knowledge and Openness Towards Peers on the Autism Spectrum?

This pre-test post-test control group design sought to compare the effectiveness of delivering different types of information ([1] factual information vs. [2] factual information + descriptive and explanatory information vs. [3] factual information + descriptive, explanatory + directive information) in an animated video intervention in increasing university students' autism knowledge and openness toward peers on the autism spectrum. The sample consisted of 92 undergraduates (27 males, 65 females; age range = 18-36) from various universities in Singapore. Participants were randomly assigned to one of the three experimental conditions/videos, where they completed a measure of their autism knowledge and openness scale, before viewing a 5-minute long animated video containing different types of information about autism. After which, participants completed the measure of autism knowledge and openness scale again, followed by a measure of their empathy level. Results indicated that participants' autism knowledge improved following the viewing of the animated video. However, the three different videos containing different types of information did not differ in influencing participants' openness toward peers on the autism spectrum. Nevertheless, qualitative responses proposed that the video containing factual information, with descriptive, explanatory, and directive information was useful in helping participants to know how to interact with their peers on the autism spectrum. The findings of this study provide preliminary support for the most effective method to educate and raise awareness about autism, among the general student population in order to foster a supportive and inclusive environment.

Acceptability and effects of acquiring an assistance or companion dog for families of children on the autism spectrum

PURPOSE

Assistance and companion dogs have numerous positive effects for family of autistic children, such as supporting their rehabilitation and improving their quality of life. To date, very few studies have compared the effects of both types of dogs. This comparison, considering the limited access to assistance dogs, could be helpful for families wanting to adopt a dog.

METHODS

An explanatory sequential design with a mixed-method approach was used. First, 85 parents (n_{assistance dogs} = 57; n_{companion dogs} = 28) of children aged between 3 and 17 years old (M = 10.73, SD = 3.67) completed an online questionnaire including sociodemographic questions and the Treatment Acceptability Rating Form-Revised (TARF-R). Then, 17 of these participants (n_{assistance dogs} = 14; n_{companion dogs} = 3) completed a semi-structured interview.

RESULTS

The quantitative data analyses showed that parents with assistance dogs were significantly more satisfied: t (83) = -2.12, p = .037, d = 0.49. Significant associations between some sociodemographic variables (e.g., number of children, comorbid condition, reasons for acquiring a dog) and acceptability/satisfaction (TARF-R total scores) were found. The qualitative analysis revealed that families with both dog types observed positive effects.

CONCLUSIONS

In brief, having an assistance dog constitutes a significant added value; nevertheless, both types of dogs are appreciated.

Sensory Processing and Executive Functioning in Autistic Adults

PURPOSE

One of the core features that can be experienced by adults on the autism spectrum is hyper- and hyporeactivity to sensory stimuli. Research suggests that executive functioning (EF) impairments are related to sensory issues. In this study the relationship between sensory processing issues and EF was investigated. We expected sensory processing issues to predict EF impairments.

METHODS

Thirty men and 30 women on the autism spectrum, 20 men and 24 women without autism were included and matched on intelligence and age. Group comparisons were conducted to determine if groups differed regarding self-reported sensory processing issues (GSQ-NL) and self-reports on EF (BRIEF-A). Correlational and regression analyses were carried out to investigate the relationship between self-reports on GSQ-NL and BRIEF-A.

RESULTS

We found significant differences between men and women on the spectrum with regard to sensory processing issues and EF. Hyporeactivity to sensory information explained most of the EF problems.

CONCLUSION

Clinicians should be aware of differences in sensory experiences between adults on the spectrum and non-autistic adults and differences between men and women during assessment and subsequent counselling.

Visual Attention to Dynamic Emotional Faces in Adults on the Autism Spectrum

Using eye-tracking, we studied allocation of attention to faces where the emotional expression and eye-gaze dynamically changed in an ecologically-valid manner. We tested typically-developed (TD) adults low or high in autistic-like traits (Experiment 1), and adults with high-functioning autism (HFA; Experiment 2). All groups fixated more on the eyes than on any of the other facial area, regardless of emotion and gaze direction, though the HFA group fixated less on the eyes and more on the nose than TD controls. The sequence of dynamic facial changes affected the groups similarly, with reduced attention to the eyes and increased attention to the mouth. The results suggest that dynamic emotional face scanning patterns are stereotypical and differ only modestly between TD and HFA adults.

Prenatal Androgen Exposure and Traits of Autism Spectrum Disorder in the Offspring: Odense Child Cohort

Fetal androgen exposure may be associated with autism spectrum disorder (ASD). We studied 1777 mother-child pairs in the prospective Odense Child Cohort. Prenatal androgen exposure was assessed by maternal 3rd trimester testosterone concentrations, maternal polycystic ovary syndrome (PCOS), and 3 months offspring anogenital distance. ASD traits were assessed at age 3 years with the ASD-symptom scale of the Child Behavior Checklist for ages 1½-5 years. Maternal testosterone was positively associated with traits of ASD in boys (p < 0.05). Maternal PCOS was associated with increased offspring ASD traits (p = 0.046), but became non-significant after excluding parental psychiatric diagnosis. Offspring anogenital distance was not linked to ASD traits. Higher prevalence of ASD in boys could be linked to higher susceptibility to fetal androgen exposure.

Identification of subgroups of children in the Australian Autism Biobank using latent class analysis

BACKGROUND

The identification of reproducible subtypes within autistic populations is a priority research area in the context of neurodevelopment, to pave the way for identification of biomarkers and targeted treatment recommendations. Few previous studies have considered medical comorbidity alongside behavioural, cognitive, and psychiatric data in subgrouping analyses. This study sought to determine whether differing behavioural, cognitive, medical, and psychiatric profiles could be used to distinguish subgroups of children on the autism spectrum in the Australian Autism Biobank (AAB).

METHODS

Latent profile analysis was used to identify subgroups of children on the autism spectrum within the AAB (n = 1151), utilising data on social communication profiles and restricted, repetitive, and stereotyped behaviours (RRBs), in addition to their cognitive, medical, and psychiatric profiles.

RESULTS

Our study identified four subgroups of children on the autism spectrum with differing profiles of autism traits and associated comorbidities. Two subgroups had more severe clinical and cognitive phenotype, suggesting higher support needs. For the 'Higher Support Needs with Prominent Language and Cognitive Challenges' subgroup, social communication, language and cognitive challenges were prominent, with prominent sensory seeking behaviours. The 'Higher Support Needs with Prominent Medical and Psychiatric and Comorbidity' subgroup had the highest mean scores of challenges relating to social communication and RRBs, with the highest probability of medical and psychiatric comorbidity, and cognitive scores similar to the overall group mean. Individuals within the 'Moderate Support Needs with Emotional Challenges' subgroup, had moderate mean scores of core traits of autism, and the highest probability of depression and/or suicidality. A fourth subgroup contained individuals with fewer challenges across domains (the 'Fewer Support Needs Group').

LIMITATIONS

Data utilised to identify subgroups within this study was cross-sectional as longitudinal data was not available.

CONCLUSIONS

Our findings support the holistic appraisal of support needs for children on the autism spectrum, with assessment of the impact of co-occurring medical and psychiatric conditions in addition to core autism traits, adaptive functioning, and cognitive functioning. Replication of our analysis in other cohorts of children on the autism spectrum is warranted, to assess whether the subgroup structure we identified is applicable in a broader context beyond our specific dataset.

Development of a novel, theoretically motivated scale to assess cognitive learning styles related to the autism spectrum

BACKGROUND

Although theoretical efforts have been made to address the cognitive learning styles of individuals on the autism spectrum, no instrument to measure such learning styles is currently available. The current study aimed to develop such a scale based on the learning style theory of Qian and Lipkin (Front Hum Neurosci 5:77, 2011).

METHODS

Response data from total of 768 undergraduate students was used for this study. This sample was split into two subsamples of N = 460 and N = 308 for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. The correlations between the resulting new subscales and some other potentially related measures were examined.

RESULTS

A three-factor structure with 19 items was obtained measuring need for task clarity/familiarity, susceptibility to cognitive load, and the grasping of conceptual relations.

CONCLUSIONS

This newly developed measure can be used to help understand the nature of the individual differences in cognitive processing that are evident across both the autism spectrum as well as the overall population more generally.

An attempted "suicide pact" in Covid-19 era - psychiatric perspectives

BACKGROUND

A "suicide pact" is a joint and actively induced death of two individuals with the essential and unavoidable characteristic of a mutual consent. One of the partners (dominant in the relationship, commonly male) usually induces the action and in most cases, it is the one who actively carries it out. Undiagnosed psychopathological dimension or pathological subthreshold traits are found in those who enter into suicide agreements, the presence of cluster B personality traits such as narcissistic or borderline is of particular relevance in the dominant partner, while in the submissive one dependent personality traits are more frequent. As in the case of other similar health emergencies, COVID-19 pandemic seems to lead to greater suicidality, including the "suicide pacts" of couples whose motivation varies including firstly financial problems, strictly followed by fear of infection and not being able to return home from abroad.

CASE PRESENTATION

We reported a case of a couple who entered a suicide agreement consequently to the economic difficulties caused by COVID-19 pandemic, hospitalized in our department. Both partners were assessed with Adult Autism Subthreshold Spectrum (AdAS Spectrum) and both crossed the threshold for clinically relevant autistic traits (M = 67; F = 49).

CONCLUSION

This case further confirms the link between COVID-19 pandemics and suicidality. The role of autism spectrum traits as a vulnerability factor towards the development of severe psychopathological consequences after traumatic events is also stressed.

Investigating the relationships between resilience, autism-related quantitative traits, and mental health outcomes among adults during the COVID-19 pandemic

Resilience is a dynamic process through which people adjust to adversity and buffer anxiety and depression. The COVID-19 global pandemic has introduced a shared source of adversity for people across the world, with detrimental implications for mental health. Despite the pronounced vulnerability of autistic adults to anxiety and depression during the COVID-19 pandemic, relationships among autism-related quantitative traits, resilience, and mental health outcomes have not been examined. As such, we aimed to describe the relationships between these traits in a sample enriched in autism spectrum-related quantitative traits during the COVID-19 pandemic. We also aimed to investigate the impact of demographic and social factors on these relationships. Across three independent samples of adults, we assessed resilience factors, autism-related quantitative traits, anxiety symptoms, and depression symptoms during the COVID-19 pandemic. One sample (recruited via the Autism Spectrum Program of Excellence, n = 201) was enriched for autism traits while the other two (recruited via Amazon Mechanical Turk, n = 624 and Facebook, n = 929) drew from the general population. We found resilience factors and quantitative autism-related traits to be inversely related, regardless of the resilience measure used. Additionally, we found that resilience factors moderate the relationship between autism-related quantitative traits and depression symptoms such that resilience appears to be protective. Across the neurodiversity spectrum, resilience factors may be targets to improve mental health outcomes. This approach may be especially important during the ongoing COVID-19 pandemic and in its aftermath.

Chasing the conversation: Autistic experiences of speech perception

BACKGROUND AND AIMS

Humans communicate primarily through spoken language and speech perception is a core function of the human auditory system. Among the autistic community, atypical sensory reactivity and social communication difficulties are pervasive, yet the research literature lacks in-depth self-report data on speech perception in this population. The present study aimed to elicit detailed first-person accounts of autistic individuals' abilities and difficulties perceiving the spoken word.

METHODS

Semi-structured interviews were conducted with nine autistic adults. The interview schedule addressed interviewees' experiences of speech perception, factors influencing those experiences, and responses to those experiences. Resulting interview transcripts underwent thematic analysis. The six-person study team included two autistic researchers, to reduce risk of neurotypical 'overshadowing' of autistic voices.

RESULTS

Most interviewees reported pronounced difficulties perceiving speech in the presence of competing sounds. They emphasised that such listening difficulties are distinct from social difficulties, though the two can add and interact. Difficulties were of several varieties, ranging from powerful auditory distraction to drowning out of voices by continuous sounds. Contributing factors encompassed not only features of the soundscape but also non-acoustic factors such as multisensory processing and social cognition. Participants also identified compounding factors, such as lack of understanding of listening difficulties. Impacts were diverse and sometimes disabling, affecting socialising, emotions, fatigue, career, and self-image. A wide array of coping mechanisms was described.

CONCLUSIONS

The first in-depth qualitative investigation of autistic speech-perception experiences has revealed diverse and widespread listening difficulties. These can combine with other internal, interpersonal, and societal factors to induce profound impacts. Lack of understanding of such listening difficulties - by the self, by communication partners, by institutions, and especially by clinicians - appears to be a crucial exacerbating factor. Many autistic adults have developed coping strategies to lessen speech-perception difficulties or mitigate their effects, and these are generally self-taught due to lack of clinical support.

IMPLICATIONS

There is a need for carefully designed, adequately powered confirmatory research to verify, quantify, and disentangle the various forms of listening difficulty, preferably using large samples to explore heterogeneity. More immediate benefit might be obtained through development of self-help and clinical guidance materials, and by raising awareness of autistic listening experiences and needs, among the autistic community, communication partners, institutions, and clinicians.

Neural-level associations of non-verbal pragmatic comprehension in young Finnish autistic adults

This video-based study examines the pragmatic non-verbal comprehension skills and corresponding neural-level findings in young Finnish autistic adults, and controls. Items from the Assessment Battery of Communication (ABaCo) were chosen to evaluate the comprehension of non-verbal communication. Inter-subject correlation (ISC) analysis of the functional magnetic resonance imaging data was used to reveal the synchrony of brain activation across participants during the viewing of pragmatically complex scenes of ABaCo videos. The results showed a significant difference between the ISC maps of the autistic and control groups in tasks involving the comprehension of non-verbal communication, thereby revealing several brain regions where correlation of brain activity was greater within the control group. The results suggest a possible weaker modulation of brain states in response to the pragmatic non-verbal communicative situations in autistic participants. Although there was no difference between the groups in behavioural responses to ABaCo items, there was more variability in the accuracy of the responses in the autistic group. Furthermore, mean answering and reaction times correlated with the severity of autistic traits. The results indicate that even if young autistic adults may have learned to use compensatory resources in their communicative-pragmatic comprehension, pragmatic processing in naturalistic situations still requires additional effort.

Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis

Background

Anxiety is common in youth on the autism spectrum and cognitive behavioural therapy (CBT) has been adapted to address associated symptoms. The aim of the current systematic review and meta-analysis was to examine the efficacy of CBT for reducing anxiety in autistic youth.

Method

Searches of PubMed and Scopus databases were undertaken from January 1990 until December 2020. Studies were included if they consisted of randomised controlled trials (RCTs) using CBT to reduce anxiety in autistic youth. Separate random effects meta-analyses assessed anxiety ratings according to informant (clinician; parent; child), both at end-of-trial and at follow-up.

Results

A total of 19 RCTs met our inclusion criteria (833 participants: CBT N = 487; controls N = 346). Random effects meta-analyses revealed a large effect size for clinician rated symptoms (g = 0.88, 95% CI 0.55, 1.12, k = 11), while those for both parent (g = 0.40, 95% CI 0.24, 0.56; k = 18) and child-reported anxiety (g = 0.25, 95% CI 0.06, 0.43; k = 13) were smaller, but significant. These benefits were not however maintained at follow-up. Moderator analyses showed that CBT was more efficacious for younger children (for clinician and parent ratings) and when delivered as individual therapy (for clinician ratings). Using the Cochrane Risk of Bias 2 tool, we found concerns about reporting bias across most trials.

Conclusions

The efficacy of CBT for anxiety in autistic youth was supported in the immediate intervention period. However, substantial inconsistency emerged in the magnitude of benefit depending upon who was rating symptoms (clinician, parent or child). Follow-up analyses failed to reveal sustained benefits, though few studies have included this data. It will be important for future trials to address robustness of treatment gains overtime and to further explore inconsistency in efficacy by informant. We also recommend pre-registration of methods by trialists to address concerns with reporting bias.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00658-8.

A Longitudinal Study of Features Associated with Autism Spectrum in Clinic Referred, Gender Diverse Adolescents Accessing Puberty Suppression Treatment

Literature has documented inflated rates of features associated with autism spectrum (AS) in clinic referred, gender diverse young people. This study examined scores on the Social Responsiveness Scale, Second Edition (SRS-2) over time in a group of clinic referred, gender diverse adolescents accessing gonadotropin-releasing hormone analogues (GnRHa) to supress puberty. Primary caregivers of 95 adolescents presenting to the Gender Identity Development Service (GIDS) completed the SRS-2 prior to receiving endocrine input (mean age: 13.6 ± SEM: 0.11) and after approximately one year of accessing GnRHa (mean age: 14.6 ± SEM: 0.13). No significant differences in SRS-2 scores over time and between birth assigned sex were found. No interactions between time and birth assigned sex were established for SRS-2 subscales or total scores.

Prior information use and response caution in perceptual decision-making: No evidence for a relationship with autistic-like traits

Interpreting the world around us requires integrating incoming sensory signals with prior information. Autistic individuals have been proposed to rely less on prior information and make more cautious responses than non-autistic individuals. Here, we investigated whether these purported features of autistic perception vary as a function of autistic-like traits in the general population. We used a diffusion model framework, whereby decisions are modelled as noisy evidence accumulation processes towards one of two bounds. Within this framework, prior information can bias the starting point of the evidence accumulation process. Our pre-registered hypotheses were that higher autistic-like traits would relate to reduced starting point bias caused by prior information and increased response caution (wider boundary separation). 222 participants discriminated the direction of coherent motion stimuli as quickly and accurately as possible. Stimuli were preceded with a neutral cue (square) or a directional cue (arrow). 80% of the directional cues validly predicted the upcoming motion direction. We modelled accuracy and response time data using a hierarchical Bayesian model in which starting point varied with cue condition. We found no evidence for our hypotheses, with starting point bias and response caution seemingly unrelated to Adult Autism Spectrum Quotient (AQ) scores. Alongside future research applying this paradigm to autistic individuals, our findings will help refine theories regarding the role of prior information and altered decision-making strategies in autistic perception. Our study also has implications for models of bias in perceptual decision-making, as the most plausible model was one that incorporated bias in both decision-making and sensory processing.

Social-Pragmatic Inferencing, Visual Social Attention and Physiological Reactivity to Complex Social Scenes in Autistic Young Adults

This study examined social-pragmatic inferencing, visual social attention and physiological reactivity to complex social scenes. Participants were autistic young adults (n = 14) and a control group of young adults (n = 14) without intellectual disability. Results indicate between-group differences in social-pragmatic inferencing, moment-level social attention and heart rate variability (HRV) reactivity. A key finding suggests associations between increased moment-level social attention to facial emotion expressions, better social-pragmatic inferencing and greater HRV suppression in autistic young adults. Supporting previous research, better social-pragmatic inferencing was found associated with less autistic traits.

Alterations in Rapid Social Evaluations in Individuals with High Autism Traits

Typically developing adults with low and high Autism Spectrum Quotient (AQ) scores made rapid social evaluations of neutral faces when these were primed by briefly presented emotional faces. High AQ participants rated neutral faces as more threatening than low AQ participants, regardless of the prime condition. Both groups rated target neutral faces as more threatening with fearful compared with neutral primes, while neither group demonstrated an effect of happy primes on the ratings of neutral target faces. These results demonstrate subtle anomalies in rapid visual processing of emotional faces across the broader autism spectrum. They suggest that higher autism traits may be associated with a generalized threat bias in rapid social evaluations.

"In Their Own Time": Parents Gently Push Their Autistic Youth Towards Independent Community Mobility and Participation

Autistic adults have decreased independence in community mobility and driving, which is associated with decreased participation in work, education and community participation. This is the first exploration of the development of community mobility, driving and participation skills over adolescence and emerging adulthood. Interviews with 15 mothers of autistic youth, capable of independence, were qualitatively analysed using grounded theory. Four major themes emerged: mothers gently pushing, teaching, letting go and working towards hopes and dreams. These results suggest earlier intervention across adolescence to address social skills, communication and anxiety in normative community environments, is required for successful development of community mobility and driving skills. Further understanding the critical role of confidence, feeling safe and accepted, could ultimately improve independence.

Binocular rivalry dynamics associated with high levels of self-reported autistic traits suggest an imbalance of cortical excitation and inhibition

An imbalance in cortical excitation and inhibition (E/I) may underlie both social and non-social symptoms of autism spectrum conditions (ASC). Recent work suggests that an E/I imbalance may underlie some of the sensory differences that are characteristic of ASCs such as anomalous perception. Binocular rivalry dynamics are thought to reflect the balance of E/I in the brain and could serve as a behavioural biomarker for ASC. Previous studies of clinical ASC populations have found a slower rate of binocular rivalry transitions; increased duration of the mixed percept and reduced perceptual suppression. There are some mixed reports of altered rivalry dynamics in the neurotypical population with high self-reported levels of autistic traits. Therefore, we used simple grating stimuli to measure binocular rivalry dynamics in a sample of seventy-nine adults aged 18-55 years. We additionally measured the level of autistic traits with the AQ-10 and used CAPS as a measure of anomalous perception. Bayesian correlations showed that those with higher AQ scores had a slower rate of perceptual switching and a longer mixed percept duration. Significant regression models with CAPS and AQ score revealed that AQ score was a significant predictor of switch rate and mixed percept duration, whereas CAPS was not. We also report that CAPS significantly predicted perceptual suppression, whereas AQ score did not. Overall, our findings suggest that in a non-clinical population, autistic traits are a predictor of binocular rivalry dynamics and the cortical E/I imbalance thought to underlie symptoms of ASC may extend to the broader phenotype.

Child Development Outcomes of DIR/Floortime TM-based Programs: A Systematic Review

BACKGROUND

Occupational therapy is often part of the multi-disciplinary approach within the Developmental, Individual-differences, Relationship-based (DIR) FloortimeTM Model. The model addresses the emotional development of children, which is considered to be critical for the other child developmental areas.

PURPOSE

This review serves to inform practitioner decision-making about the use of this model, as no systematic reviews exist on child development outcomes.

METHODS

The systematic search included Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane. For critical appraisal, the McMaster Critical Review was utilized.

FINDINGS

Nine studies were identified with varying quality levels. Outcomes were mostly reported for increased socio-emotional development.

IMPLICATIONS

The evidence base for this model is emerging from a published research perspective. It is recommended that the use of this model be supported by sound clinical reasoning processes, intervention fidelity, use of valid outcome measures, and regular monitoring. Higher quality research is urgently needed to progress the research base for this intervention.

Within- and Cross-Modal Integration and Attention in the Autism Spectrum

Although impairment in sensory integration is suggested in the autism spectrum (AS), empirical evidences remain equivocal. We assessed the integration of low-level visual and tactile information within and across modalities in AS and typically developing (TD) individuals. TD individuals demonstrated increased redundancy gain for cross-modal relative to double tactile or visual stimulation, while AS individuals showed similar redundancy gain between cross-modal and double tactile conditions. We further observed that violation of the race model inequality for cross-modal conditions was observed over a wider proportion of the reaction times distribution in TD than AS individuals. Importantly, the reduced cross-modal integration in AS individuals was not related to atypical attentional shift between modalities. We conclude that AS individuals displays selective decrease of cross-modal integration of low-level information.

The mediating effect of trauma and stressor related symptoms and ruminations on the relationship between autistic traits and mood spectrum

An increasing number of studies highlighted significant correlations between autistic traits (AT) and mood spectrum symptoms. Moreover, recent data showed that individuals with high AT are likely to develop trauma and stressor-related disorders. This study aims to investigate the relationship between AT and mood symptoms among university students, focusing in particular on how AT interact with ruminations and trauma-related symptomatology in predicting mood symptoms. 178 students from three Italian Universities of excellence were assessed with The Structured Clinical Interview for DSM-5 (SCID-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Trauma and Loss Spectrum (TALS) and the Moods Spectrum (MOODS). Considering the AdAS Spectrum total scores, 133 subjects (74.7%) were categorized as "low scorers" and 45 subjects (25.3%) as "high scorers". Students in the high scorer group showed significantly higher scores on RRS, TALS-SR and MOOD-SR total scores. Total and direct effects of AdAS Spectrum total score on MOODS-SR total score were both statistically significant. AdAS Spectrum total score also showed a significant indirect effect on MOODS-SR total score through TALS and RRS total scores. Results showed a significant relationship between AT and mood spectrum, which is partially mediated by ruminations and trauma/stressor-related symptomatology.

Public transport planning tool for users on the autism spectrum: from concept to prototype

PURPOSE

This research explored the challenges of public transport use for individuals on the autism spectrum. It, subsequently, proposed a mobile application solution, coproduced by individuals on the autism spectrum, to facilitate public transport use.

METHODS

We, first, conducted a review of the literature to highlight the challenges people on the autism spectrum face when utilizing public transport. We, then, designed a list of mobile application functionalities that address the identified problems. To validate these functionalities, 27 young autistic adults and 19 families of autistic individuals were employed. Finally, based on the findings, we designed a mobile application that helps facilitate public transport use for those on the autism spectrum.

RESULTS

We found that the most prevalent concerns, in public transport use, amongst autistic individuals and their families are safety and spatial awareness. Specific problems include finding one's way to the bus stop, boarding the correct service and disembarking at the correct stop. Interestingly, anxiety about unexpected events was also a barrier. Sensory sensitivity, similarly, was found to be an obstacle.

CONCLUSIONS

This study defined the challenges of public transport use for autistic individuals and proposed a technological solution. The findings can also inform innovators, public transport providers and policymakers to improve public transport accessibility.Implications for rehabilitationPeople on the autism spectrum heavily rely on other individuals, namely family and friends, for their transportation needs. This dependence results in immobility for the autistic individuals and significant time and economical sacrifice for the person responsible for the transportation.Public transport, a cheap and widely available form of transportation, has not yet been clearly studied with individuals on the autism spectrum.We clearly define the challenges of using public transport and put forward a trip planner mobile application, coproduced by autistic individuals, that facilitate it.In the long term, this enhanced travel independence can lead to greater education and employment opportunities and an overall improved quality of life.

Autistic traits in adults who have attempted suicide

Background

An emerging literature suggests that autistic adults are at increased risk of experiencing suicidal thoughts, making suicidal plans and attempts, and dying by suicide. However, few studies have investigated whether autistic traits are related to suicidal behaviour. The current study examined autistic traits in a sample of adults who reported at least one suicide attempt.

Methods

An online questionnaire was advertised between June and September 2017 on suicide prevention websites, research databases, and social media. Participants reported whether they had ever attempted suicide (yes/no), and if so, how many times they had attempted (once/more than once). They also reported diagnosed and suspected mental health or neurodevelopmental conditions, and completed the Autism Spectrum Quotient (AQ). Two hundred forty-five adults accessed the survey; 132 reported having attempted suicide and also completed the AQ. It was hypothesised that AQ total scores and subscale scores would be higher in adults who had attempted suicide more than once compared to adults who had attempted once. These hypotheses were tested using an independent samples t test, Mann-Whitney U tests, and binary logistic regression.

Results

Most participants were female (83.3%, male = 12.9%, other = 3.8%), and ages ranged from 18 to 65 (median = 36.00; IQR = 19.00). Total AQ scores, as well as communication and imagination subscale scores were significantly higher in adults who had attempted suicide more than once compared to adults who had attempted suicide once. Even after removing participants with diagnosed or suspected autism (n = 34), 40.6% had an AQ score indicative of clinical concern (≥ 26).

Conclusions

The findings suggest that high levels of autistic traits may frequently be present in adults who have attempted suicide, and that AQ scores are higher in those with a history of more than one suicide attempt. It may be possible to better identify suicide risk by screening autistic adults with mental health conditions for suicidal thoughts and behaviours, and by screening people with suicidal thoughts and/or behaviours for autism.

Mismatch Negativity and P3a in Adolescents and Young Adults with Autism Spectrum Disorders: Behavioral Correlates and Clinical Implications

In a sample of 37 adolescents and young adults with autism spectrum disorder (ASD) and 35 typically-developing controls (TDC), we investigated sensory symptoms by clinical measures, and Mismatch Negativity and P3a component at Fz with the frequency and duration oddball paradigms of event-related potentials. Results showed that compared to TDC, ASD participants reported more sensory symptoms, and presented a shorter P3a peak latency in the duration paradigm, which was correlated with more social awareness deficits. In the frequency paradigm, P3a parameters were correlated with sensation avoiding and attention characteristics of ASD. Our findings suggest that sensory abnormality in ASD may extend into adolescence and young adulthood. P3a latency might be a potential neurophysiological marker for ASD.

The school experiences of bilingual children on the autism spectrum: An interpretative phenomenological analysis

BACKGROUND

With growing numbers of bilingual children on the autism spectrum in UK classrooms, the interaction between autism and bilingualism is becoming a pressing issue for practitioners, researchers and families. In this study, we report the school experiences of bilingual, autistic children in the UK through their own voice with focus on five aspects of their school life.

METHOD

Using interpretative phenomenological analysis (IPA) as a methodological framework, semi-structured, computer-assisted interviews were conducted with 11 children aged 7 to 14 from across England and Wales. Interviews were carried out in English and took place in mainstream schools or the children's home, depending on their preference.

RESULTS

Results indicate that, while children's school experiences vary widely, there were commonalities in this population's identity formation, including being bilingual, and their classroom experiences. Most notably, children educated in more multilingual environments (i.e. in schools with larger multilingual populations) expressed more positive views about multilingualism than those in more monolingual settings. In line with previous studies, limited social circles and classroom anxiety were present in participants' school experiences.

IMPLICATIONS

The findings of this paper suggest that giving autistic children from bilingual backgrounds opportunities to explore their linguistic identities in the classroom may enhance their experiences of school. Further research should focus on parents' and practitioners' attitudes and perspectives towards the support available for this population.

Sex Differences in the Relationship between PTSD Spectrum Symptoms and Autistic Traits in a Sample of University Students

BACKGROUND

While growing literature is stressing the link between Autistic Traits (AT) and trauma-/stress-related disorders, in both conditions significant differences have been separately reported.

OBJECTIVE

This study aims to evaluate the relationship between AT and trauma-/stress-related symptoms with respect to sex.

METHODS

178 university students were assessed with the Structured Clinical Interview for DSM-5, the Trauma and Loss Spectrum (TALS) and the Adult Autism Subthreshold Spectrum (AdAS). In order to evaluate sex differences in trauma-/stress-related symptoms among subjects with higher or lower AT, the sample was split in two groups with an equal number of subjects on the basis of the median score reported on AdAS Spectrum ("AdAS high scorers" and "AdAS low scorers").

RESULTS

Females reported significantly higher TALS total score, Loss events and Grief reaction domain scores than males in the whole sample, while AdAS high scorers reported significantly higher TALS total and domain scores than AdAS low scorers. A significant interaction between high/low AdAS score and sex emerged for TALS domains, with females scoring significantly higher than males only among AdAS low scorers, specifically on Loss events, Grief reaction, Re-experiencing and Personal characteristics/Risk factors domains. Finally, among AdAS high scorers a significantly higher rate of subjects fulfilled symptomatological criteria for PTSD than among AdAS low scorers, without sex differences.

CONCLUSION

Our results confirm a significant relationship between AT and trauma-/stress-related symptoms, which seems to prevail on sex differences among high-risk subjects.

Double Helix Rainbow Kids

Double Helix Rainbow Kids is a letter to the editor in conjunction with the forthcoming issue on autism and gender that discusses the intersection between autism and gender expansiveness, calling on extant research, clinical observations at the UCSF Benioff Children's Hospital Child and Adolescent Gender Center and other clinics, as well as personal narratives. It alerts the reader to the importance of giving full attention to the gender stress or gender dysphoria that often accompanies autism spectrum in children, making constitutional-psychological-social links between neurodiversity and gender diversity.

Relationship Between Autism Spectrum Disorder Characteristics and Humor Appreciation in Typically Developing Individuals

Extant research regarding humor appreciation in individuals with autism spectrum disorder has been equivocal. This study aims to clarify the relationship between the severity of autism spectrum disorder characteristics and humor appreciation in typically developing individuals. We hypothesized that the severity of autistic traits would have a U-shaped linear relationship with humor appreciation. Eighty typically developing undergraduates between the ages of 18 and 22 years ( Mage = 20.20; SDage = 1.08) were recruited for this study. They were asked to answer 24 statements, devised to measure humor appreciation, in response to a joke stimulus comprising 12 typically funny daily life occurrences (two statements per episode). The participants also responded to the Japanese version of the Autism-Spectrum Quotient. A significant U-shaped relationship was observed between the severity of autistic traits and appreciation of humor. A similar significant U-shaped relationship was seen between humor appreciation and the Autism-Spectrum Quotient subscales of attention switching, communication, and imagination. Humor appreciation showed no significant U-shaped relationship with the Autism-Spectrum Quotient subscales of social skills and local details. This study identified ways that autistic traits may influence how people appreciate humor. These findings are discussed in relation to cognitive processes underlying humor appreciation.

Anti-NMDA receptor encephalitis in a toddler: A diagnostic challenge

Anti N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder and is considered to be one of the most common causes of encephalitis in children. Despite the fact that around half of all reported cases are of children, the number of studies that report infants and toddlers is very small. Furthermore, reports on children from the Middle East particularly are extremely rare.

We report a 21-month-old Jordanian female toddler with NMDAR encephalitis, who initially presented with behavioral changes and some autistic features. She presented a diagnostic challenge due to a concurrent urinary tract infection and gastroenteritis. Multiple investigations were conducted and she was treated with methylprednisolone and intravenous immunoglobulin (IVIg) empirically as well as plasma exchange and rituximab once the diagnosis was confirmed. Her condition improved gradually. We discuss her clinical picture and the diagnostic challenges within this age group; we also review the current related literature.

Sensory Clusters of Adults With and Without Autism Spectrum Conditions

We identified clusters of atypical sensory functioning adults with ASC by hierarchical cluster analysis. A new scale for commonly self-reported sensory reactivity was used as a measure. In a low frequency group (n = 37), all subscale scores were relatively low, in particular atypical sensory/motor reactivity. In the intermediate group (n = 17) hyperreactivity, sensory interests and sensory/motor issues were significantly elevated in relation to the first group, but not hyporeactivity. In a high frequency subgroup (n = 17) all subscale scores were significantly elevated and co-occurrence of hyper- and hyporeactivity was evident. In a population sample, a cluster of low scorers (n = 136) and high scorers relative to the other cluster (n = 26) was found. Identification of atypical sensory reactivity is important for targeting support.

Typical versus delayed speech onset influences verbal reporting of autistic interests

BACKGROUND

The distinction between autism and Asperger syndrome has been abandoned in the DSM-5. However, this clinical categorization largely overlaps with the presence or absence of a speech onset delay which is associated with clinical, cognitive, and neural differences. It is unknown whether these different speech development pathways and associated cognitive differences are involved in the heterogeneity of the restricted interests that characterize autistic adults.

METHOD

This study tested the hypothesis that speech onset delay, or conversely, early mastery of speech, orients the nature and verbal reporting of adult autistic interests. The occurrence of a priori defined descriptors for perceptual and thematic dimensions were determined, as well as the perceived function and benefits, in the response of autistic people to a semi-structured interview on their intense interests. The number of words, grammatical categories, and proportion of perceptual/thematic descriptors were computed and compared between groups by variance analyses. The participants comprised 40 autistic adults grouped according to the presence (N = 20) or absence (N = 20) of speech onset delay, as well as 20 non-autistic adults, also with intense interests, matched for non-verbal intelligence using Raven's Progressive Matrices.

RESULTS

The overall nature, function, and benefit of intense interests were similar across autistic subgroups, and between autistic and non-autistic groups. However, autistic participants with a history of speech onset delay used more perceptual than thematic descriptors when talking about their interests, whereas the opposite was true for autistic individuals without speech onset delay. This finding remained significant after controlling for linguistic differences observed between the two groups.

CONCLUSIONS

Verbal reporting, but not the nature or positive function, of intense interests differed between adult autistic individuals depending on their speech acquisition history: oral reporting of intense interests was characterized by perceptual dominance for autistic individuals with delayed speech onset and thematic dominance for those without. This may contribute to the heterogeneous presentation observed among autistic adults of normal intelligence.

Visual integration of fear and anger emotional cues by children on the autism spectrum and neurotypical peers: An EEG study

Communication deficits in children with autism spectrum disorders (ASD) are often related to inefficient interpretation of emotional cues, which are conveyed visually through both facial expressions and body language. The present study examined ASD behavioral and ERP responses to emotional expressions of anger and fear, as conveyed by the face and body. Behavioral results showed significantly faster response times for the ASD than for the typically developing (TD) group when processing fear, but not anger, in isolated face expressions, isolated body expressions, and in the integration of the two. In addition, EEG data for the N170 and P1 indicated processing differences between fear and anger stimuli only in TD group, suggesting that individuals with ASD may not be distinguishing between emotional expressions. These results suggest that ASD children may employ a different neural mechanism for visual emotion recognition than their TD peers, possibly relying on inferential processing.

Instructions to mimic improve facial emotion recognition in people with sub-clinical autism traits

People tend to mimic the facial expression of others. It has been suggested that this helps provide social glue between affiliated people but it could also aid recognition of emotions through embodied cognition. The degree of facial mimicry, however, varies between individuals and is limited in people with autism spectrum conditions (ASC). The present study sought to investigate the effect of promoting facial mimicry during a facial-emotion-recognition test. In two experiments, participants without an ASC diagnosis had their autism quotient (AQ) measured. Following a baseline test, they did an emotion-recognition test again but half of the participants were asked to mimic the target face they saw prior to making their responses. Mimicry improved emotion recognition, and further analysis revealed that the largest improvement was for participants who had higher scores on the autism traits. In fact, recognition performance was best overall for people who had high AQ scores but also received the instruction to mimic. Implications for people with ASC are explored.

Altered brain network dynamics in youths with autism spectrum disorder

The heterogeneity of behavioral manifestation of autism spectrum disorders (ASDs) requires a model which incorporates understanding of dynamic differences in neural processing between ASD and typically developing (TD) populations. We use network approach to characterization of spatiotemporal dynamics of EEG data in TD and ASD youths. EEG recorded during both wakeful rest (resting state) and a social–visual task was analyzed using cross-correlation analysis of the 32-channel time series to produce weighted, undirected graphs corresponding to functional brain networks. The stability of these networks was assessed by novel use of the L¹-norm for matrix entries (edit distance). There were a significantly larger number of stable networks observed in the resting condition compared to the task condition in both populations. In resting state, stable networks persisted for a significantly longer time in children with ASD than in TD children; networks in ASD children also had larger diameter, indicative of long-range connectivity. The resulting analysis combines key features of microstate and network analyses of EEG.

Development and pilot validation of a sensory reactivity scale for adults with high functioning autism spectrum conditions: Sensory Reactivity in Autism Spectrum (SR-AS)

BACKGROUND

Unusual reactions to sensory stimuli are experienced by 90-95% of people with an autism spectrum condition (ASC). Self-reported sensory reactivity in ASC has mainly been measured with generic questionnaires developed and validated on data from the general population. Interest in sensory reactivity in ASC increased after the inclusion of hyper- and hypo-reactivity together with unusual sensory interest as diagnostic markers of ASC in the DSM-5.

AIMS

To develop and pilot validate a self-report questionnaire designed from first-hand descriptions of the target group of adults diagnosed with high functioning ASC. Psychometric properties of the questionnaire were evaluated on a sample of participants with ASC diagnoses (N = 71) and a random sample from the general population (N = 162).

RESULTS

The Sensory Reactivity in Autism Spectrum (SR-AS is intended to be used as a screening tool in diagnostic processes with adults and for support in adapting compensating strategies and environmental adjustments. The internal consistency was high for both the SR-AS and its subscales. The total scale Cronbach's alpha was 0.96 and the subscales alphas were ≥ 0.80. Confirmatory factor analysis (CFA) showed best fit for a four-factor model of inter-correlated factors: hyper and hypo-reactivity, strong sensory interest and a sensory/motor factor. The questionnaire discriminated well between ASC-diagnosed participants and participants from the general population.

CONCLUSIONS

The SR-AS displayed good internal consistency and discriminatory power and promising factorial validity.

Speech acquisition predicts regions of enhanced cortical response to auditory stimulation in autism spectrum individuals

A continuum of phenotypes makes up the autism spectrum (AS). In particular, individuals show large differences in language acquisition, ranging from precocious speech to severe speech onset delay. However, the neurological origin of this heterogeneity remains unknown. Here, we sought to determine whether AS individuals differing in speech acquisition show different cortical responses to auditory stimulation and morphometric brain differences. Whole-brain activity following exposure to non-social sounds was investigated. Individuals in the AS were classified according to the presence or absence of Speech Onset Delay (AS-SOD and AS-NoSOD, respectively) and were compared with IQ-matched typically developing individuals (TYP). AS-NoSOD participants displayed greater task-related activity than TYP in the inferior frontal gyrus and peri-auditory middle and superior temporal gyri, which are associated with language processing. Conversely, the AS-SOD group only showed enhanced activity in the vicinity of the auditory cortex. We detected no differences in brain structure between groups. This is the first study to demonstrate the existence of differences in functional brain activity between AS individuals divided according to their pattern of speech development. These findings support the Trigger-threshold-target model and indicate that the occurrence of speech onset delay in AS individuals depends on the location of cortical functional reallocation, which favors perception in AS-SOD and language in AS-NoSOD.

Sex differences in brain plasticity: a new hypothesis for sex ratio bias in autism

Several observations support the hypothesis that differences in synaptic and regional cerebral plasticity between the sexes account for the high ratio of males to females in autism. First, males are more susceptible than females to perturbations in genes involved in synaptic plasticity. Second, sex-related differences in non-autistic brain structure and function are observed in highly variable regions, namely, the heteromodal associative cortices, and overlap with structural particularities and enhanced activity of perceptual associative regions in autistic individuals. Finally, functional cortical reallocations following brain lesions in non-autistic adults (for example, traumatic brain injury, multiple sclerosis) are sex-dependent. Interactions between genetic sex and hormones may therefore result in higher synaptic and consecutively regional plasticity in perceptual brain areas in males than in females. The onset of autism may largely involve mutations altering synaptic plasticity that create a plastic reaction affecting the most variable and sexually dimorphic brain regions. The sex ratio bias in autism may arise because males have a lower threshold than females for the development of this plastic reaction following a genetic or environmental event.