Social attention in a virtual public speaking task in higher functioning children with autism

Behavioral Intervention for Adults With Autism on Distribution of Attention in Triadic Conversations: A/B-Tested Pre-Post Study

BACKGROUND

Cross-neurotype differences in social communication patterns contribute to high unemployment rates among adults with autism. Adults with autism can be unsuccessful in job searches or terminated from employment due to mismatches between their social attention behaviors and society's expectations on workplace communication.

OBJECTIVE

We propose a behavioral intervention concerning distribution of attention in triadic (three-way) conversations. Specifically, the objective is to determine whether providing personalized feedback to each individual with autism based on an analysis of their attention distribution behavior during an initial conversation session would cause them to modify their orientation behavior in a subsequent conversation session.

METHODS

Our system uses an unobtrusive head orientation estimation model to track the focus of attention of each individual. Head orientation sequences from a conversation session are analyzed based on five statistical domains (eg, maximum exclusion duration and average contact duration) representing different types of attention distribution behavior. An intervention is provided to a participant if they exceeded the nonautistic average for that behavior by at least 2 SDs. The intervention uses data analysis and video modeling along with a constructive discussion about the targeted behaviors. Twenty-four individuals with autism with no intellectual disabilities participated in the study. The participants were divided into test and control groups of 12 participants each.

RESULTS

Based on their attention distribution behavior in the initial conversation session, 11 of the 12 participants in the test group received an intervention in at least one domain. Of the 11 participants who received the intervention, 10 showed improvement in at least one domain on which they received feedback. Independent t tests for larger test groups (df>15) confirmed that the group improvements are statistically significant compared with the corresponding controls (P<.05). Crawford-Howell t tests confirmed that 78% of the interventions resulted in significant improvements when compared individually against corresponding controls (P<.05). Additional t tests comparing the first conversation sessions of the test and control groups and comparing the first and second conversation sessions of the control group resulted in nonsignificant differences, pointing to the intervention being the main effect behind the behavioral changes displayed by the test group, as opposed to confounding effects or group differences.

CONCLUSIONS

Our proposed behavioral intervention offers a useful framework for practicing social attention behavior in multiparty conversations that are common in social and professional settings.

Involving autism stakeholders in identifying priorities for interventions based on augmented reality

PURPOSE

Literature supports the use of technological tools such as augmented reality, 3 D avatars and mobile devices to improve individuals with autism spectrum disorder skills. Possibilities of including these technological tools in intervention and the critical issues related to intervention design are essential research questions. The aim of the current work is to present an interdisciplinary research study on the design of an autism intervention considering these technologies.

MATERIALS AND METHODS

This study used qualitative evidence and thematic analysis to identify the main design guidelines. A semi-structured interview was administered to a total of twenty participants representing four stakeholder categories: ASD, clinicians, therapists and caregivers. Interviews focussed on three dimensions related to user, technology and environment since they represent a complex system within which the individual using technology is situated.

RESULTS

Thematic analysis of the interviews identified a total of 10 themes considered central to the design of the technological intervention.

CONCLUSIONS

Since the application of technology in autism intervention is a relatively new area, the guidelines related to the potential incentives and barriers of the proposed technology are helpful to inform future treatment studies.Implications for RehabilitationThis study highlights the strengths and barriers associated with the use of smartphones and augmented reality in autism spectrum disorder interventions considering the dimensions within which the user using assistive technology is located.Strengths and major concerns that emerged are key points to consider during the development of the technological intervention.Considering these points can foster the use of technology within the intervention and promote its effectiveness.

Tübinger Training for Autism Spectrum Disorders (TüTASS): a structured group intervention on self-perception and social skills of children with autism spectrum disorder (ASD)

In autism spectrum disorders (ASD), social communication and stereotypical behaviour patterns affect all areas of life, and can result in a decrease of its quality. Previous research has shown promising results for the social skills of groups of children with ASD. Furthermore, a pilot study of the Tübingen Group Training for Autism Spectrum Disorders (TüTASS) has demonstrated that mindfulness-based elements achieve additional positive effects. To build on these findings, the TüTASS training was adapted and expanded. Indeed, the TüTASS currently includes 20 90-min appointments starting with the basic skills of emotions, body, and communication, which are then transferred to personal, family, peer, and school spheres. The appointments have a fixed, consistent structure and each includes a body awareness exercise. In this study, we evaluated the TÜTASS with 27 children with ASD. The results showed improvements in pre-post comparison in behaviours associated with autism, as well as in externalising and internalising behaviours as assessed by parent reports, participant self-reports, and independent raters in participating children. Furthermore, the perceived parent burden in relation to their children decreased, whereas the participants' self-rated quality of life increased. Overall, both the participants and their parents rated the TüTASS very positively in rating sheets and in free feedback. If replicated in larger controlled trials, TÜTASS training might be a useful treatment tool for groups of children with ASD.

A new group-based online job interview training program using computer graphics robots for individuals with autism spectrum disorders

Introduction

Job interviews are a major barrier to employment for individuals with autism spectrum disorders (ASD). During the coronavirus pandemic, establishing online job interview training at home was indispensable. However, many hurdles prevent individuals with ASD from concentrating on online job interview training. To facilitate the acquisition of interview skills from home for individuals with ASD, we developed a group interview training program with a virtual conferencing system (GIT-VICS Program) that uses computer graphics (CG) robots.

Methods

This study investigated the feasibility of the GIT-VICS Program in facilitating skill acquisition for face-to-face job interviews in pre-post measures. In the GIT-VICS Program, five participants were grouped and played the roles of interviewees (1), interviewers (2), and human resources (2). They alternately practiced each role in GIT-VICS Program sessions conducted over 8 or 9 days over three consecutive weeks. Before and after the GIT-VICS Program, the participants underwent a mock face-to-face job interview with two experienced human interviewers (MFH) to evaluate its effect.

Results

Fourteen participants completed the trial procedures without experiencing any technological challenges or distress that would have led to the termination of the session. The GIT-VICS Program improved their job interview skills (verbal competence, nonverbal competence, and interview performance).

Discussion

Given the promising results of this study and to draw clear conclusions about the efficacy of CG robots for mock online job interview training, future studies adding appropriate guidance for manner of job interview by experts are needed.

I see you, you see me: the impact of social presence on social interaction processes in autistic and non-autistic people

Environments that require social interaction are complex, challenging and sometimes experienced as overwhelming by autistic people. However, all too often theories relating to social interaction processes are created, and interventions are proposed, on the basis of data collected from studies that do not involve genuine social encounters nor do they consider the perception of social presence to be a potentially influential factor. In this review, we begin by considering why face-to-face interaction research is important in this field. We then discuss how the perception of social agency and social presence can influence conclusions about social interaction processes. We then outline some insights gained from face-to-face interaction research conducted with both autistic and non-autistic people. We finish by considering the impact of social presence on cognitive processes more broadly, including theory of mind. Overall, we demonstrate that choice of stimuli in studies assessing social interaction processes has the potential to substantially alter conclusions drawn. Ecological validity matters and social presence, in particular, is a critical factor that fundamentally impacts social interaction processes in both autistic and non-autistic people. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.

Vitamin A supplementation ameliorates prenatal valproic acid-induced autism-like behaviors in rats

INTRODUCTION

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social deficits and repetitive stereotyped behaviors. Prenatal exposure to the anticonvulsant drug valproic acid (VPA) is reported to induce ASD in human and ASD-like phenotypes in rodents. Unfortunately, the etiology and pathogenesis of ASD remains unclear.

METHODS

Pregnant rats received an intraperitoneal injection of 600 mg/kg VPA on E12.5 to construct the ASD rat model in offspring. The different expression of long non-coding RNA (lncRNA) and mRNA profiles in the hippocampus were determined by RNA sequencing to investigate potential mechanisms of VPA-induced ASD. Gene Ontology (GO) and pathway enrichment analysis were performed to predict the function of dysregulated lncRNAs. Co-expression network and real-time polymerase chain reaction (RT-PCR) analysis were conducted to validate the potential regulatory lncRNA-mRNA network.

RESULTS

VPA increased the total distance, time spent in the central zone and self-grooming (open field test) in rats. Meanwhile, VPA induced social impairment (three-chamber sociability test) and repetitive behaviors (marble burying test). A total of 238 lncRNAs and 354 mRNAs were differentially expressed in the VPA group. In addition, the dysregulated lncRNAs were involved in neural function and developmental processes of ASD. 5 lncRNAs and 7 mRNAs were differently expressed and included in the lncRNA-mRNA co-expression network. RT-PCR confirmed the upregulation of 4 lncRNAs and 6 mRNAs, and identified a potential regulatory network of NONRATT021475.2 (lncRNA) and Desert hedgehog (Dhh). Moreover, VPA decreased the serum vitamin A (VA) levels in offspring rats on postnatal day (PND) 21 and 49. Importantly, VA supplementation significantly restored VPA-induced autism-related behaviors and upregulation of NONRATT021475.2 and Dhh in the hippocampus of ASD rats.

CONCLUSION

This study not only contributed to understand the importance of lncRNAs and mRNAs in the progression of ASD, but also identified VA as a potential therapy for the condition.

DATA AVAILABILITY

The data that support the findings of this study are available from the corresponding author with reasonable request.

Virtual reality-based interventions for patients with paranoia: A systematic review

BACKGROUND AND OBJECTIVE

Paranoia is an important psychiatric symptom with a remarkable effect on daily life. Virtual reality (VR)-based treatments are influential and safe for patients with paranoia. This study aimed to evaluate the effectiveness, and define the clinical and technical characteristics of available VR strategies for the treatment of patients with paranoia.

MATERIALS AND METHODS

Studies published up to 25/11/2021 reporting VR-based interventions for the treatment of patients with paranoia were reviewed in five databases, including PubMed, Embase, Web of Science, PsycINFO, and Scopus.

RESULTS

Out of 302 initial search results, eight were included in the present study based on the inclusion criteria. Six studies were randomized clinical trials with the interventions in the experimental group being based on VR, compared to routine interventions as controls. Two were before-after studies. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. Interventions had a range of 1-16 sessions with follow-up durations of 0-6 months. All investigations showed positive results in the main target, including improved social participation, reduced level of anxiety, as well as diminished suspicious ideas and paranoid symptoms.

CONCLUSIONS

Our findings demonstrated that VR-based interventions are effective treatments. Although the use of VR technology is limited for a variety of reasons, such as cost, it improves symptoms in patients with paranoia.

The relationship between social and academic outcomes and anxiety for children and adolescents on the autism spectrum: A systematic review

Anxiety is the most common co-occurring condition in children on the autism spectrum but the potential impacts of anxiety on social and academic outcomes of children on the autism spectrum have not been systematically examined. In this review, 50 studies were identified that explore the relationship between anxiety and scores on social or academic measures in children on the autism spectrum. Social competence was frequently measured, and the findings of these studies were mixed. While other social constructs have received little attention, associations were found between anxiety and victimisation, and anxiety and social relationships. Only three studies focused on the impact of anxiety on scores on academic measures, highlighting the need for further research in this area. Anxiety was most frequently measured using subscales from broader behavioural instruments, which may not capture the range of anxiety symptoms of children on the autism spectrum. Future studies that include multi-informant methodologies and proportional representation of females and children with intellectual disability will further knowledge of the impact of anxiety in children on the spectrum.

Conversation During a Virtual Reality Task Reveals New Structural Language Profiles of Children with ASD, ADHD, and Comorbid Symptoms of Both

Many studies have utilized standardized measures and storybook narratives to characterize language profiles of children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). They report that structural language of these children is on par with mental-age-matched typically developing (TD) peers. Few studies have looked at structural language profiles in conversational contexts. This study examines conversational speech produced in a virtual reality (VR) paradigm to investigate the strengths and weaknesses of structural language abilities of these children. The VR paradigm introduced varying social and cognitive demands across phases. Our results indicate that children from these diagnostic groups produced less complex structural language than TD children. Moreover, language complexity decreased in all groups across phases, suggesting a cross-etiology sensitivity to conversational contexts.

Piloting an adaptive skills virtual reality intervention for adults with autism: findings from user-centered formative design and evaluation

Purpose

The purpose of this paper is to present evaluation findings from a proof-of-concept virtual reality adaptive skills intervention called Virtuoso, designed for adults with autism spectrum disorders.

Design/methodology/approach

A user-centric usage test was conducted to investigate the acceptability, feasibility, ease-of-use and relevance of Virtuoso to the unique needs of participants, as well as the nature of participants’ user experiences. Findings are presented from the perspectives of expert testers and participant testers with autism.

Findings

This paper offers findings that suggest Virtuoso is feasible and relevant to the unique needs of the target population, and that user experience was largely positive. Anecdotal evidence of skills transfer is also discussed.

Research limitations/implications

The research was conducted in limited settings and with a small number of participants. Multiple VR hardware systems were used, and some experienced instability. This could be accounted for in future research by deploying across multiple settings and with a larger number of participants. Some evidence of cybersickness was observed. Future research must carefully consider the trade-offs between VR-based training and cybersickness for this vulnerable population.

Originality/value

This paper reports on cutting-edge design and development in areas that are under-represented and poorly understood in the literature on virtual reality for individuals with autism.

Group-Based Online Job Interview Training Program Using Virtual Robot for Individuals With Autism Spectrum Disorders

The rapid expansion of online job interviews during the COVID-19 pandemic is expected to continue after the pandemic has subsided. These interviews are a significant barrier for individuals with autism spectrum disorders (ASD). There is little evidence-based training for online job interviews for individuals with ASD, and the development of new trainings is expected. In an effort to facilitate online job interview skill acquisition for individuals with ASD, we developed a group-based online job interview training program using a virtual robot (GOT). In GOT, the interviewer and interviewee are projected as virtual robots on the screen. Five participants were grouped and performed the role of interviewee, interviewer, and evaluator. The participants performed all roles in a random order. Each session consisted of a first job interview session, feedback session, and second job interview session. The participants experienced 25 sessions. Before and after GOT, the participants underwent a mock online job interview with a human professional interviewer (MOH) to evaluate the effect of GOT. In total, 15 individuals with ASD took part in the study. The GOT improved self-confidence, motivation, the understanding of others' perspectives, verbal competence, non-verbal competence, and interview performance scores. There was also a significant increase in the recognition of the importance of the point of view of interviewers and evaluators after the second MOH compared to after the first MOH. Using a VR robot and learning the importance of interview skills by experiencing other perspectives (i.e., viewpoint of interviewer and evaluator) may have sustained their motivation and enabled greater self-confidence. Given the promising results of this study and to draw definitive conclusions regarding the efficacy of virtual reality (VR) robots for mock online job interview training, further studies with larger, more diverse samples of individuals with ASD using a longitudinal design are warranted.

Personal identifiability of user tracking data during observation of 360-degree VR video

Virtual reality (VR) is a technology that is gaining traction in the consumer market. With it comes an unprecedented ability to track body motions. These body motions are diagnostic of personal identity, medical conditions, and mental states. Previous work has focused on the identifiability of body motions in idealized situations in which some action is chosen by the study designer. In contrast, our work tests the identifiability of users under typical VR viewing circumstances, with no specially designed identifying task. Out of a pool of 511 participants, the system identifies 95% of users correctly when trained on less than 5 min of tracking data per person. We argue these results show nonverbal data should be understood by the public and by researchers as personally identifying data.

Computer-Controlled Virtual Humans in Patient-Facing Systems: Systematic Review and Meta-Analysis

BACKGROUND

Virtual humans (VH) are computer-generated characters that appear humanlike and simulate face-to-face conversations using verbal and nonverbal cues. Unlike formless conversational agents, like smart speakers or chatbots, VH bring together the capabilities of both a conversational agent and an interactive avatar (computer-represented digital characters). Although their use in patient-facing systems has garnered substantial interest, it is unknown to what extent VH are effective in health applications.

OBJECTIVE

The purpose of this review was to examine the effectiveness of VH in patient-facing systems. The design and implementation characteristics of these systems were also examined.

METHODS

Electronic bibliographic databases were searched for peer-reviewed articles with relevant key terms. Studies were included in the systematic review if they designed or evaluated VH in patient-facing systems. Of the included studies, studies that used a randomized controlled trial to evaluate VH were included in the meta-analysis; they were then summarized using the PICOTS framework (population, intervention, comparison group, outcomes, time frame, setting). Summary effect sizes, using random-effects models, were calculated, and the risk of bias was assessed.

RESULTS

Among the 8,125 unique records identified, 53 articles describing 33 unique systems, were qualitatively, systematically reviewed. Two distinct design categories emerged - simple VH and VH augmented with health sensors and trackers. Of the 53 articles, 16 (26 studies) with 44 primary and 22 secondary outcomes were included in the meta-analysis. Meta-analysis of the 44 primary outcome measures revealed a significant difference between intervention and control conditions, favoring the VH intervention (SMD = .166, 95% CI .039-.292, P=.012), but with evidence of some heterogeneity, I2=49.3%. There were more cross-sectional (k=15) than longitudinal studies (k=11). The intervention was delivered using a personal computer in most studies (k=18), followed by a tablet (k=4), mobile kiosk (k=2), head-mounted display (k=1), and a desktop computer in a community center (k=1).

CONCLUSIONS

We offer evidence for the efficacy of VH in patient-facing systems. Considering that studies included different population and outcome types, more focused analysis is needed in the future. Future studies also need to identify what features of virtual human interventions contribute toward their effectiveness.

Machine Learning and Virtual Reality on Body Movements' Behaviors to Classify Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is mostly diagnosed according to behavioral symptoms in sensory, social, and motor domains. Improper motor functioning, during diagnosis, involves the qualitative evaluation of stereotyped and repetitive behaviors, while quantitative methods that classify body movements' frequencies of children with ASD are less addressed. Recent advances in neuroscience, technology, and data analysis techniques are improving the quantitative and ecological validity methods to measure specific functioning in ASD children. On one side, cutting-edge technologies, such as cameras, sensors, and virtual reality can accurately detect and classify behavioral biomarkers, as body movements in real-life simulations. On the other, machine-learning techniques are showing the potential for identifying and classifying patients' subgroups. Starting from these premises, three real-simulated imitation tasks have been implemented in a virtual reality system whose aim is to investigate if machine-learning methods on movement features and frequency could be useful in discriminating ASD children from children with typical neurodevelopment. In this experiment, 24 children with ASD and 25 children with typical neurodevelopment participated in a multimodal virtual reality experience, and changes in their body movements were tracked by a depth sensor camera during the presentation of visual, auditive, and olfactive stimuli. The main results showed that ASD children presented larger body movements than TD children, and that head, trunk, and feet represent the maximum classification with an accuracy of 82.98%. Regarding stimuli, visual condition showed the highest accuracy (89.36%), followed by the visual-auditive stimuli (74.47%), and visual-auditive-olfactory stimuli (70.21%). Finally, the head showed the most consistent performance along with the stimuli, from 80.85% in visual to 89.36% in visual-auditive-olfactory condition. The findings showed the feasibility of applying machine learning and virtual reality to identify body movements' biomarkers that could contribute to improving ASD diagnosis.

Feasibility of autism-focused public speech training using a simple virtual audience for autism spectrum disorder

AIM

Public speaking seems to be one of the most anxiety-provoking situations for individuals with autism spectrum disorder (ASD). However, there are few evidence-based interventions. We developed Autism-Focused Public Speech Training using Simple Virtual Audiences (APSV), which differs from a general virtual audience in terms of its simple facial expressions and emphasis on the importance of the eyes. The present study aimed to evaluate the feasibility of APSV as an educational method for individuals with ASD.

METHODS

Fifteen male individuals with ASD were randomly assigned to two groups: one group received APSV (n = 8), and the other group (n = 7) received independent study (IS). From Days 2 to 6, participants in the APSV and IS groups were encouraged to read and answer questions often asked in actual public speaking events. Participants in the APSV study group performed this activity in front of the APSV system, while those in the IS group performed in an empty room. Before and after the intervention (Days 1 and 7), the participants in the two groups had a mock public speaking experience in front of 10 people for approximately 10 min.

RESULTS

After the training sessions, the participants' self-confidence had improved and salivary cortisol levels were significantly decreased in the APSV group as compared to those in the IS group. APSV improved self-confidence and decreased public speaking stress in individuals with ASD.

CONCLUSION

APSV appears to be useful in improving self-confidence and decreasing public speaking stress in individuals with ASD.

Reward-Related Behavioral, Neurochemical and Electrophysiological Changes in a Rat Model of Autism Based on Prenatal Exposure to Valproic Acid

Prenatal exposure to the antiepileptic drug valproic acid (VPA) induces autism spectrum disorder (ASD) in humans and autistic-like behaviors in rodents, which makes it a good model to study the neural underpinnings of ASD. Rats prenatally exposed to VPA show profound deficits in the social domain. The altered social behavior displayed by VPA-exposed rats may be due to either a deficit in social reward processing or to a more general inability to properly understand and respond to social signals. To address this issue, we performed behavioral, electrophysiological and neurochemical experiments and tested the involvement of the brain reward system in the social dysfunctions displayed by rats prenatally exposed to VPA (500 mg/kg). We found that, compared to control animals, VPA-exposed rats showed reduced play responsiveness together with impaired sociability in the three-chamber test and altered social discrimination abilities. In addition, VPA-exposed rats showed altered expression of dopamine receptors together with inherent hyperexcitability of medium spiny neurons (MSNs) in the nucleus accumbens (NAc). However, when tested for socially-induced conditioned place preference, locomotor response to amphetamine and sucrose preference, control and VPA-exposed rats performed similarly, indicating normal responses to social, drug and food rewards. On the basis of the results obtained, we hypothesize that social dysfunctions displayed by VPA-exposed rats are more likely caused by alterations in cognitive aspects of the social interaction, such as the interpretation and reciprocation of social stimuli and/or the ability to adjust the social behavior of the individual to the changing circumstances in the social and physical environment, rather than to inability to enjoy the pleasurable aspects of the social interaction. The observed neurochemical and electrophysiological alterations in the NAc may contribute to the inability of VPA-exposed rats to process and respond to social cues, or, alternatively, represent a compensatory mechanism towards VPA-induced neurodevelopmental insults.

Joint Attention Virtual Classroom: A Preliminary Study

OBJECTIVE

Previous studies have suggested that a virtual classroom is immersive and ecologically valid neuropsychological assessment, but those studies have limited components for social attentions. Therefore, the objective in the current study is the development of a joint attention virtual reality (JA-VR) classroom to incorporate social attentions between a participant and a virtual avatar teacher.

METHODS

Fifty-eight participants were recruited for current study (25 for pilot and 33 for main studies; 32.8% female, n=19; age: M=24.5, SD=4.0). We suggested a JA-VR classroom, and compared it with previous methods including a VR classroom without JA components. We conducted attention experiments with AX-version of continuous performance tasks.

RESULTS

Our results suggest that the new JA-VR classroom had convergent validity with previous methods, and that the JA-VR classroom promoted attentional processing among participants better than both old VR and non-VR measures.

CONCLUSION

We add an important social attention concept to the virtual classroom, and believe that this work is an methodological foundation for the study of social attention in school life. We hope it ultimately help people with mental handicaps in social attention.

Reward-Related Behavioral, Neurochemical and Electrophysiological Changes in a Rat Model of Autism Based on Prenatal Exposure to Valproic Acid

Prenatal exposure to the antiepileptic drug valproic acid (VPA) induces autism spectrum disorder (ASD) in humans and autistic-like behaviors in rodents, which makes it a good model to study the neural underpinnings of ASD. Rats prenatally exposed to VPA show profound deficits in the social domain. The altered social behavior displayed by VPA-exposed rats may be due to either a deficit in social reward processing or to a more general inability to properly understand and respond to social signals. To address this issue, we performed behavioral, electrophysiological and neurochemical experiments and tested the involvement of the brain reward system in the social dysfunctions displayed by rats prenatally exposed to VPA (500 mg/kg). We found that, compared to control animals, VPA-exposed rats showed reduced play responsiveness together with impaired sociability in the three-chamber test and altered social discrimination abilities. In addition, VPA-exposed rats showed altered expression of dopamine receptors together with inherent hyperexcitability of medium spiny neurons (MSNs) in the nucleus accumbens (NAc). However, when tested for socially-induced conditioned place preference, locomotor response to amphetamine and sucrose preference, control and VPA-exposed rats performed similarly, indicating normal responses to social, drug and food rewards. On the basis of the results obtained, we hypothesize that social dysfunctions displayed by VPA-exposed rats are more likely caused by alterations in cognitive aspects of the social interaction, such as the interpretation and reciprocation of social stimuli and/or the ability to adjust the social behavior of the individual to the changing circumstances in the social and physical environment, rather than to inability to enjoy the pleasurable aspects of the social interaction. The observed neurochemical and electrophysiological alterations in the NAc may contribute to the inability of VPA-exposed rats to process and respond to social cues, or, alternatively, represent a compensatory mechanism towards VPA-induced neurodevelopmental insults.

The State of Virtual and Augmented Reality Therapy for Autism Spectrum Disorder (ASD)

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition affecting a growing number of individuals across the lifespan. It is characterized by observable impairments in social communication, as well as repetitive behaviors and restricted patterns of interests. Early, intensive behavioral interventions improve long-term outcomes in ASD, but are often expensive and hard to administer consistently. This chapter describes a new approach to autism intervention, using highly motivating virtual reality (VR) and augmented reality (AR) technologies that could soon support traditional autism therapies across ages and ability levels. The chapter begins by reviewing the ASD phenotype, followed by a review of the current landscape of research on VR and AR in ASD. A discussion of ASD-specific benefits and risks is followed by a presentation of new, harnessed immersive VR technology from Floreo, Inc. Finally, we propose a series of future research directions.

Improving sensitivity to eye gaze cues in autism using serious game technology: study protocol for a phase I randomised controlled trial

INTRODUCTION

Autism spectrum disorder (ASD) is characterised by impairments in social communication. Core symptoms are deficits in social looking behaviours, including limited visual attention to faces and sensitivity to eye gaze cues. We designed an intervention game using serious game mechanics for adolescents with ASD. It is designed to train individuals with ASD to discover that the eyes, and shifts in gaze specifically, provide information about the external world. We predict that the game will increase understanding of gaze cues and attention to faces.

METHODS AND ANALYSIS

The Social Games for Adolescents with Autism (SAGA) trial is a preliminary, randomised controlled trial comparing the intervention game with a waitlist control condition. 34 adolescents (10-18 years) with ASD with a Full-Scale IQ between 70 and 130 and a minimum second grade reading level, and their parents, will be randomly assigned (equally to intervention or the control condition) following baseline assessments. Intervention participants will be instructed to play the computer game at home on a computer for ~30 min, three times a week. All families are tested in the lab at baseline and approximately 2 months following randomisation in all measures. Primary outcomes are assessed with eye tracking to measure sensitivity to eye gaze cues and social visual attention to faces; secondary outcomes are assessed with questionnaires to measure social skills and autism-like behaviours. The analyses will focus on evaluating the feasibility, safety and preliminary effectiveness of the intervention.

ETHICS AND DISSEMINATION

SAGA is approved by the Institutional Review Board at Pennsylvania State University (00005097). Findings will be disseminated via scientific conferences and peer-reviewed journals and to participants via newsletter. The intervention game will be available to families in the control condition after the full data are collected and if analyses indicate that it is effective.

TRIAL REGISTRATION NUMBER

NCT02968225.

Effectiveness of Virtual Reality for Children and Adolescents with Autism Spectrum Disorder: An Evidence-Based Systematic Review

Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that is specially characterized by impairments in social communication and social skills. ASD has a high prevalence in children, affecting 1 in 160 subjects. Virtual reality (VR) has emerged as an effective tool for intervention in the health field. Different recent papers have reviewed the VR-based treatments in ASD, but they have an important limitation because they only use clinical databases and do not include important technical indexes such as the Web of Science index or the Scimago Journal & Country Rank. To our knowledge, this is the first contribution that has carried out an evidence-based systematic review including both clinical and technical databases about the effectiveness of VR-based intervention in ASD. The initial search identified a total of 450 records. After the exclusion of the papers that are not studies, duplicated articles, and the screening of the abstract and full text, 31 articles met the PICO (Population, Intervention, Comparison and Outcomes) criteria and were selected for analysis. The studies examined suggest moderate evidence about the effectiveness of VR-based treatments in ASD. VR can add many advantages to the treatment of ASD symptomatology, but it is necessary to develop consistent validations in future studies to state that VR can effectively complement the traditional treatments.

The Stability of Self-Reported Anxiety in Youth with Autism Versus ADHD or Typical Development

Children with autism spectrum disorder (ASD) are at risk for anxiety symptoms. Few anxiety measures are validated for individuals with ASD, and the nature of ASD raises questions about reliability of self-reported anxiety. This study examined longitudinal stability and change of self-reported anxiety in higher functioning youth with ASD (HFASD) compared to youth with symptoms of attention deficit hyperactivity disorder and typical development (TD) using the Multidimensional Anxiety Scale for Children (March, 2012; March et al. J Am Acad Child Adolesc Psychiatry 36(4):554-565, 1997). Diagnostic groups demonstrated comparable evidence of stability for most dimensions of anxiety. The HFASD group displayed higher anxiety than both comparison groups, especially physical symptoms. These findings have implications for identification and measurement of anxiety in ASD.

Restoring effects of oxytocin on the attentional preference for faces in autism

Reduced attentional preference for faces and symptoms of social anxiety are common in autism spectrum disorders (ASDs). The neuropeptide oxytocin triggers anxiolytic functions and enhances eye gaze, facial emotion recognition and neural correlates of face processing in ASD. Here we investigated whether a single dose of oxytocin increases attention to faces in ASD. As a secondary question, we explored the influence of social anxiety on these effects. We tested for oxytocin's effects on attention to neutral faces as compared to houses in a sample of 29 autistic individuals and 30 control participants using a dot-probe paradigm with two different presentation times (100 or 500 ms). A single dose of 24 IU oxytocin was administered in a randomized, double-blind placebo-controlled, cross-over design. Under placebo, ASD individuals paid less attention to faces presented for 500 ms than did controls. Oxytocin administration increased the allocation of attention toward faces in ASD to a level observed in controls. Secondary analyses revealed that these oxytocin effects primarily occurred in ASD individuals with high levels of social anxiety who were characterized by attentional avoidance of faces under placebo. Our results confirm a positive influence of intranasal oxytocin on social attention processes in ASD. Further, they suggest that oxytocin may in particular restore the attentional preference for facial information in ASD individuals with high social anxiety. We conclude that oxytocin's anxiolytic properties may partially account for its positive effects on socio-cognitive functioning in ASD, such as enhanced eye gaze and facial emotion recognition.

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

BACKGROUND

Attention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD.

METHOD

ADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2-5 from a large case-control study with ASD (n=548), TD (n=423), and DD (n=180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales.

RESULTS

Mean hyperactivity subscale scores were lowest in children with TD (mean=3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p<0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = -5.63, p=0.0005; Mullen visual reception scale = -2.94, p=0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically.

CONCLUSION

These results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.

Anxiety Levels in Children with Autism Spectrum Disorder: A Meta-Analysis

The aim of the current study was to meta-analytically examine whether anxiety levels in children with autism spectrum disorders (ASD) are elevated. A total of 83 articles were selected from a systematic literature search and were included in the meta-analyses. Results demonstrated that children with ASD had higher anxiety levels compared to typically developing children, and this difference increased with IQ. Youth with ASD also tended to have higher anxiety levels compared to clinically referred children, and this difference increased with age. Children with ASD had higher anxiety levels compared to youth with externalizing or developmental problems, but not when compared to youth with internalizing problems. The study findings highlight the importance of more research in order to fully understand the nature and development of anxiety in children with ASD. More specifically, the results suggest that especially high-functioning adolescents with ASD may be at risk for developing anxiety disorders. Therefore, it seems important to carefully follow and monitor children with ASD transcending to adolescence.

Level of Immersion in Virtual Environments Impacts the Ability to Assess and Teach Social Skills in Autism Spectrum Disorder

Virtual environments (VEs) may be useful for delivering social skills interventions to individuals with autism spectrum disorder (ASD). Immersive VEs provide opportunities for individuals with ASD to learn and practice skills in a controlled replicable setting. However, not all VEs are delivered using the same technology, and the level of immersion differs across settings. We group studies into low-, moderate-, and high-immersion categories by examining five aspects of immersion. In doing so, we draw conclusions regarding the influence of this technical manipulation on the efficacy of VEs as a tool for assessing and teaching social skills. We also highlight ways in which future studies can advance our understanding of how manipulating aspects of immersion may impact intervention success.

An update on the comorbidity of ADHD and ASD: a focus on clinical management

Attention deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) commonly co-occur. With the DSM-5, clinicians are permitted to make an ASD diagnosis in the context of ADHD. In earlier versions of the DSM, this was not acceptable. Both ASD and ADHD are reported to have had substantial increases in prevalence within the past 10 years. As a function of both the increased prevalence of both disorders as well as the ability to make an ASD diagnosis in ADHD, there has been a significant amount of research focusing on the comorbidity between ADHD and ASD in the past few years. Here, we provide an update on the biological, cognitive and behavioral overlap/distinctiveness between the two neurodevelopmental disorders with a focus on data published in the last four years. Treatment strategies for the comorbid condition as well as future areas of research and clinical need are discussed.

A Virtual Joy-Stick Study of Emotional Responses and Social Motivation in Children with Autism Spectrum Disorder

A new virtual reality task was employed which uses preference for interpersonal distance to social stimuli to examine social motivation and emotion perception in children with Autism Spectrum Disorders. Nineteen high function children with higher functioning Autism Spectrum Disorder (HFASD) and 23 age, gender, and IQ matched children with typical development (TD) used a joy stick to position themselves closer or further from virtual avatars while attempting to identify six emotions expressed by the avatars, happiness, fear, anger, disgust, sadness, and surprise that were expressed at different levels of intensity. The results indicated that children with HFASD displayed significantly less approach behavior to the positive happy expression than did children with TD, who displayed increases in approach behavior to higher intensities of happy expressions. Alternatively, all groups tended to withdraw from negative emotions to the same extent and there were no diagnostic group differences in accuracy of recognition of any of the six emotions. This pattern of results is consistent with theory that suggests that some children with HFASD display atypical social-approach motivation, or sensitivity to the positive reward value of positive social-emotional events. Conversely, there was little evidence that a tendency to withdraw from social-emotional stimuli, or a failure to process social emotional stimuli, was a component of social behavior task performance in this sample of children with HFASD.

The use of virtual characters to assess and train non-verbal communication in high-functioning autism

High-functioning autism (HFA) is a neurodevelopmental disorder, which is characterized by life-long socio-communicative impairments on the one hand and preserved verbal and general learning and memory abilities on the other. One of the areas where particular difficulties are observable is the understanding of non-verbal communication cues. Thus, investigating the underlying psychological processes and neural mechanisms of non-verbal communication in HFA allows a better understanding of this disorder, and potentially enables the development of more efficient forms of psychotherapy and trainings. However, the research on non-verbal information processing in HFA faces several methodological challenges. The use of virtual characters (VCs) helps to overcome such challenges by enabling an ecologically valid experience of social presence, and by providing an experimental platform that can be systematically and fully controlled. To make this field of research accessible to a broader audience, we elaborate in the first part of the review the validity of using VCs in non-verbal behavior research on HFA, and we review current relevant paradigms and findings from social-cognitive neuroscience. In the second part, we argue for the use of VCs as either agents or avatars in the context of "transformed social interactions." This allows for the implementation of real-time social interaction in virtual experimental settings, which represents a more sensitive measure of socio-communicative impairments in HFA. Finally, we argue that VCs and environments are a valuable assistive, educational and therapeutic tool for HFA.

A potentiated startle study of uncertainty and contextual anxiety in adolescents diagnosed with autism spectrum disorder

Background

Beyond the core symptoms of autism spectrum disorder (ASD), associated symptoms of anxiety can cause substantial impairment for individuals affected by ASD and those who care for them.

Methods

We utilized a potentiated startle paradigm with a puff of air to the neck as the unconditioned stimulus in order to investigate differences between response to cued fear and contextual anxiety among cognitively able adolescents diagnosed with ASD and an age- and IQ-matched typically developing group.

Results

In a threat-modulated startle paradigm, response patterns to neutral, predictable, and unpredictable conditions were comparable across typically developing and ASD youth in terms of startle response magnitude and latency. However, the ASD group showed significantly greater absolute startle responsivity at baseline and throughout the experiment, suggesting possibly enhanced general sensitivity to threatening contexts. The ASD group, but not the control group, demonstrated moderate to strong negative correlations between psychophysiological response to unpredictable threats (uncertainty) and questionnaire measures of generalized anxiety, intolerance of uncertainty, and repetitive behavior.

Conclusions

Our data suggest enhanced general reactivity among the ASD group, possibly reflecting greater sensitivity to the threatening context of the startle paradigm. Associations with the response to uncertainty may help explain shared neurobehavioral mechanisms in ASD and anxiety. This task can provide useful targets for future neuroimaging and genetics studies as well as specific avenues for intervention. We emphasize the importance of further basic and clinical research into links among these important constructs.