Children with autism display more social behaviors after repeated imitation sessions

From music making to speaking: engaging the mirror neuron system in autism

Individuals with autism show impairments in emotional tuning, social interactions and communication. These are functions that have been attributed to the putative human mirror neuron system (MNS), which contains neurons that respond to the actions of self and others. It has been proposed that a dysfunction of that system underlies some of the characteristics of autism. Here, we review behavioral and imaging studies that implicate the MNS (or a brain network with similar functions) in sensory-motor integration and speech representation, and review data supporting the hypothesis that MNS activity could be abnormal in autism. In addition, we propose that an intervention designed to engage brain regions that overlap with the MNS may have significant clinical potential. We argue that this engagement could be achieved through forms of music making. Music making with others (e.g., playing instruments or singing) is a multi-modal activity that has been shown to engage brain regions that largely overlap with the human MNS. Furthermore, many children with autism thoroughly enjoy participating in musical activities. Such activities may enhance their ability to focus and interact with others, thereby fostering the development of communication and social skills. Thus, interventions incorporating methods of music making may offer a promising approach for facilitating expressive language in otherwise nonverbal children with autism.

A3

HCI studies assessing nonverbal individuals (especially those who do not communicate through traditional linguistic means: spoken, written, or sign) are a daunting undertaking. Without the use of directed tasks, interviews, questionnaires, or question-answer sessions, researchers must rely fully upon observation of behavior, and the categorization and quantification of the participant’s actions. This problem is compounded further by the lack of metrics to quantify the behavior of nonverbal subjects in computer-based intervention contexts. We present a set of dependent variables called A3 (pronounced A-Cubed) or Annotation for ASD Analysis, to assess the behavior of this demographic of users, specifically focusing on engagement and vocalization. This paper demonstrates how theory from multiple disciplines can be brought together to create a set of dependent variables, as well as demonstration of these variables, in an experimental context. Through an examination of the existing literature, and a detailed analysis of the current state of computer vision and speech detection, we present how computer automation may be integrated with the A3 guidelines to reduce coding time and potentially increase accuracy. We conclude by presenting how and where these variables can be used in multiple research areas and with varied target populations.

Brain basis of human social interaction: from concepts to brain imaging

Modern neuroimaging provides a common platform for neuroscience and related disciplines to explore the human brain, mind, and behavior. We base our review on the social shaping of the human mind and discuss various aspects of brain function related to social interaction. Despite private mental contents, people can share their understanding of the world using, beyond verbal communication, nonverbal cues such as gestures, facial expressions, and postures. The understanding of nonverbal messages is supported by the brain's mirroring systems that are shaped by individual experience. Within the organism-environment system, tight links exist between action and perception, both within an individual and between several individuals. Therefore, any comprehensive brain imaging study of the neuronal basis of social cognition requires appreciation of the situated and embodied nature of human cognition, motivating simultaneous monitoring of brain and bodily functions within a socially relevant environment. Because single-person studies alone cannot unravel the dynamic aspects of interpersonal interactions, it seems both necessary and beneficial to move towards "two-person neuroscience"; technological shortcomings and a limited conceptual framework have so far hampered such a leap. We conclude by discussing some major disorders of social interaction.

When "Simon says" doesn't work: alternatives to imitation for facilitating early speech development

PURPOSE

To provide clinicians with evidence-based strategies to facilitate early speech development in young children who are not readily imitating sounds. Relevant populations may include, but are not limited to, children with autism spectrum disorders, childhood apraxia of speech, and late-talking toddlers.

METHOD

Through multifaceted search procedures, we found experimental support for 6 treatment strategies that have been used to facilitate speech development in young children with developmental disabilities. Each strategy is highlighted within this article through a summary of the underlying rationale(s), empirical support, and specific examples of how it could be applied within intervention.

CONCLUSIONS

Given the relatively sparse experimental data focused on facilitating speech in children who do not readily imitate, theoretical support emerges as particularly key and underscores the need for clinicians to consider why they are doing what they are doing. In addition, this review emphasizes the need for the research community to bridge the gap between pressing clinical needs and the limited evidence base that is currently available.

Mothers' and infants' responses to their partners' spontaneous action and vocal/verbal imitation

Twenty mother-infant dyads (10 boys, 10 girls) were videotaped longitudinally at ages 10, 13, 17, and 21 months during in-home free play and bath sessions. Mothers' and infants' responses to their partners' naturally occurring action and vocal/verbal imitations were described, and relations to infants' imitation rates and vocabularies were examined. Mothers' response rates were consistently high and unrelated to infants' imitation rates. As early as 10 months, infants responded to the great majority of maternal imitations, especially action imitations, often with actions. Infants' return imitations to action matching indicated increasing awareness of being imitated. Infants' responses to mothers' vocal/verbal imitation were associated with their later vocabulary levels. Children who would be more lexically advanced at 17 and/or 21 months provided more social responses at 10 months, more socially responsive actions and return verbal imitations at 13 months, and more non-imitative socially responsive words at 17 and 21 months.

Behavioural and developmental interventions for autism spectrum disorder: a clinical systematic review

BACKGROUND

Much controversy exists regarding the clinical efficacy of behavioural and developmental interventions for improving the core symptoms of autism spectrum disorders (ASD). We conducted a systematic review to summarize the evidence on the effectiveness of behavioural and developmental interventions for ASD.

METHODS AND FINDINGS

Comprehensive searches were conducted in 22 electronic databases through May 2007. Further information was obtained through hand searching journals, searching reference lists, databases of theses and dissertations, and contacting experts in the field. Experimental and observational analytic studies were included if they were written in English and reported the efficacy of any behavioural or developmental intervention for individuals with ASD. Two independent reviewers made the final study selection, extracted data, and reached consensus on study quality. Results were summarized descriptively and, where possible, meta-analyses of the study results were conducted. One-hundred-and-one studies at predominantly high risk of bias that reported inconsistent results across various interventions were included in the review. Meta-analyses of three controlled clinical trials showed that Lovaas treatment was superior to special education on measures of adaptive behaviour, communication and interaction, comprehensive language, daily living skills, expressive language, overall intellectual functioning and socialization. High-intensity Lovaas was superior to low-intensity Lovaas on measures of intellectual functioning in two retrospective cohort studies. Pooling the results of two randomized controlled trials favoured developmental approaches based on initiative interaction compared to contingency interaction in the amount of time spent in stereotyped behaviours and distal social behaviour, but the effect sizes were not clinically significant. No statistically significant differences were found for: Lovaas versus special education for non-verbal intellectual functioning; Lovaas versus Developmental Individual-difference relationship-based intervention for communication skills; computer assisted instruction versus no treatment for facial expression recognition; and TEACCH versus standard care for imitation skills and eye-hand integration.

CONCLUSIONS

While this review suggests that Lovaas may improve some core symptoms of ASD compared to special education, these findings are based on pooling of a few, methodologically weak studies with few participants and relatively short-term follow-up. As no definitive behavioural or developmental intervention improves all symptoms for all individuals with ASD, it is recommended that clinical management be guided by individual needs and availability of resources.

Spontaneous imitation by children with autism during a repetitive musical play routine

Joint-attention-type intervention strategies have been identified as effective scaffolds for increasing social engagement in children with autism. Imitating children with autism within child-led social routines has increased children's attention and active participation in social interaction. The current study expands on this research by establishing a musical social milieu using repetitive imitation routines for four children with autism. Results were evaluated using an MPD across three behaviors and four children with an ABAB reversal for one child. Children increased spontaneous imitation of the researcher's models after being imitated with only social reinforcement for increased imitation. However, experimental control was weakened with carry-over effects for two children and failure to fully replicate results across participants and behaviors. The accumulation of evidence from varied studies, despite some mixed results, encourages further study into the effects of imitating children with autism to increase spontaneous social engagement.

Vagal activity, early growth and emotional development

A review of the research on infant vagal tone suggests that vagal activity is associated with both infant growth and infant socioemotional development. Vagal activity has been noted to increase following the stimulation of pressure receptors as in massage therapy. Vagal activity, in turn, stimulates gastric motility which mediates weight gain in infants. Vagal activity has also been notably elevated during synchronous mother-infant interactions and positive affect, providing confirmatory data for the Porges "social engagement system" model. In contrast, low vagal activity has been noted in prenatally depressed mothers (and prenatally angry and anxious mothers) and their infants, as well as in children with autism. These studies highlight the relations between vagal activity and the social behaviors of attentiveness, facial expressions and vocalizations.

Mapping autism and schizophrenia onto the ontogenesis of social behaviour: A hierarchical-developmental rather than diametrical perspective

Co-morbidity of schizophrenia and autism is low because interpersonal concerns of schizophrenic patients presuppose developmental achievements that are absent in autism. Autism may arise if primary anxiety is not overcome at a key developmental stage by affective synchronisation between infant and caregiver. Schizophrenic patients will have learned to regulate primitive anxiety by affectively attuning to narrow social networks but remain highly vulnerable to exclusion from larger groups.

Mirror neuron system: basic findings and clinical applications

In primates, ventral premotor and rostral inferior parietal neurons fire during the execution of hand and mouth actions. Some cells (called mirror neurons) also fire when hand and mouth actions are just observed. Mirror neurons provide a simple neural mechanism for understanding the actions of others. In humans, posterior inferior frontal and rostral inferior parietal areas have mirror properties. These human areas are relevant to imitative learning and social behavior. Indeed, the socially isolating condition of autism is associated with a deficit in mirror neuron areas. Strategies inspired by mirror neuron research recently have been used in the treatment of autism and in motor rehabilitation after stroke.

Imitation and action understanding in autistic spectrum disorders: how valid is the hypothesis of a deficit in the mirror neuron system?

The motor mirror neuron system supports imitation and goal understanding in typical adults. Recently, it has been proposed that a deficit in this mirror neuron system might contribute to poor imitation performance in children with autistic spectrum disorders (ASD) and might be a cause of poor social abilities in these children. We aimed to test this hypothesis by examining the performance of 25 children with ASD and 31 typical children of the same verbal mental age on four action representation tasks and a theory of mind battery. Both typical and autistic children had the same tendency to imitate an adult's goals, to imitate in a mirror fashion and to imitate grasps in a motor planning task. Children with ASD showed superior performance on a gesture recognition task. These imitation and gesture recognition tasks all rely on the mirror neuron system in typical adults, but performance was not impaired in children with ASD. In contrast, the ASD group were impaired on the theory of mind tasks. These results provide clear evidence against a general imitation impairment and a global mirror neuron system deficit in children with autism. We suggest this data can best be understood in terms of multiple brain systems for different types of imitation and action understanding, and that the ability to understand and imitate the goals of hand actions is intact in children with ASD.

The mirror neuron system and the consequences of its dysfunction

The discovery of premotor and parietal cells known as mirror neurons in the macaque brain that fire not only when the animal is in action, but also when it observes others carrying out the same actions provides a plausible neurophysiological mechanism for a variety of important social behaviours, from imitation to empathy. Recent data also show that dysfunction of the mirror neuron system in humans might be a core deficit in autism, a socially isolating condition. Here, we review the neurophysiology of the mirror neuron system and its role in social cognition and discuss the clinical implications of mirror neuron dysfunction.

What Facilitates Social Engagement in Preschool Children with Autism?

We studied the association between an adult's behavior and episodes of social engagement (ESEs) in young children with autism during play-based assessment. ESEs were defined as events in which a child looked toward the adult's face and simultaneously showed an additional form of communicative behavior. The adult's behavior before each ESE, and before time-sampled control periods, was rated using Coding Active Sociability in Preschoolers with Autism (CASPA). As predicted, adult musical/motoric activity, communications that followed the child's focus of attention, scaffolding through social routines, imitations of the child, and adult repetitions were significantly more prevalent before ESEs, but cognitive assessment activities, adult inactivity, and "ignoring" were significantly less prevalent. We consider the implications for understanding the developmental psychopathology of autism.

Positive touch, the implications for parents and their children with autism: an exploratory study

The aims of this study were (1) to explore the experience of touch between parents and children with autism before, during, and after a Training and Support Programme (TSP), and (2) to develop a model of the process of touch therapy for this group of parents and children. Fourteen parents and their children agreed to take part in the study. Five of these parents withdrew. Reasons for withdrawal included personal circumstances and ill health. Data were collected by semi-structured interviews with parents before attending the TSP and Home Record Sheets completed by parents during the TSP. Results indicate that before the TSP touch was experienced as out of parents' control. During the TSP, the experience of touch appeared to change. A key benefit gained by parents was the feeling of closeness to children. The key benefits gained by children were perceived by the parents as improved sleep patterns, children were more relaxed after receiving the massage and appeared more amenable to touch. Of interest was children's request for massage at home. At 16-week follow-up both parents and children continue to enjoy giving and receiving touch therapy, respectively.