Affective exchanges between young autistic children and their mothers

"You should smile more": Population-level sex differences in smiling also exist in autistic people

Societal expectations for social-emotional behavior differ across sexes; however, diagnostic definitions of autism do not account for this when delineating "typical" versus "atypical." This study examines sex differences in autism in one behavior associated with strong gender biases: smiling. Computer vision was used to quantify smiling in 60 autistic (20 female) and 67 neurotypical (25 female) youth during conversations. Effects of sex and diagnosis were examined on degree of smiling, smile prototypicality, changes in smiling, and impact of smiling on interaction quality. Sex differences in smiling persisted across diagnosis groups: females smiled more than males, and their smiles were more prototypical. Autistic youth smiled less, and less prototypically, than neurotypical youth, with no sex by diagnosis interactions. In autism, the association between smile activity and interaction quality approached statistical significance, seemingly driven by autistic males but not females. Findings are consistent with population trends for females to smile more during social exchanges and "display rules" requiring more positive expressivity from females. Autism has historically been defined based on differences between autistic and neurotypical males. Failure to acknowledge sex-based differences in social-emotional behavior may leave some females appearing to have fewer autistic traits, increasing their risk of being under-identified and misunderstood.

Pre-trained artificial intelligence language model represents pragmatic language variability central to autism and genetically related phenotypes

Many individuals with autism experience challenges using language in social contexts (i.e., pragmatic language). Characterizing and understanding pragmatic variability is important to inform intervention strategies and the etiology of communication challenges in autism; however, current manual coding-based methods are often time and labor intensive, and not readily applied in ample sample sizes. This proof-of-concept methodological study employed an artificial intelligence pre-trained language model, Bidirectional Encoder Representations from Transformers, as a tool to address such challenges. We applied Bidirectional Encoder Representations from Transformers to computationally index pragmatic-related variability in autism and in genetically related phenotypes displaying pragmatic differences, namely, in parents of autistic individuals, fragile X syndrome, and FMR1 premutation. Findings suggest that without model fine-tuning, Bidirectional Encoder Representations from Transformers's Next Sentence Prediction module was able to derive estimates that differentiate autistic from non-autistic groups. Moreover, such computational estimates correlated with manually coded characterization of pragmatic abilities that contribute to conversational coherence, not only in autism but also in the other genetically related phenotypes. This study represents a step forward in evaluating the efficacy of artificial intelligence language models for capturing clinically important pragmatic differences and variability related to autism, showcasing the potential of artificial intelligence to provide automatized, efficient, and objective tools for pragmatic characterization to help advance the field.Lay abstractAutism is clinically defined by challenges with social language, including difficulties offering on-topic language in a conversation. Similar differences are also seen in genetically related conditions such as fragile X syndrome (FXS), and even among those carrying autism-related genes who do not have clinical diagnoses (e.g., the first-degree relatives of autistic individuals and carriers of the FMR1 premutation), which suggests there are genetic influences on social language related to the genes involved in autism. Characterization of social language is therefore important for informing potential intervention strategies and understanding the causes of communication challenges in autism. However, current tools for characterizing social language in both clinical and research settings are very time and labor intensive. In this study, we test an automized computational method that may address this problem. We used a type of artificial intelligence known as pre-trained language model to measure aspects of social language in autistic individuals and their parents, non-autistic comparison groups, and individuals with FXS and the FMR1 premutation. Findings suggest that these artificial intelligence approaches were able to identify differences in social language in autism, and to provide insight into the individuals' ability to keep a conversation on-topic. These findings also were associated with broader measures of participants' social communication ability. This study is one of the first to use artificial intelligence models to capture important differences in social language in autism and genetically related groups, demonstrating how artificial intelligence might be used to provide automatized, efficient, and objective tools for language characterization.

Acoustic features of vocalizations in typically developing and autistic infants in the first year

BACKGROUND

We describe acoustic patterns across the five most prominent vocal types in typically developing infants (TD) and compare them with patterns in infants who develop autism (ASD) or a developmental disability (DD) not related to autism. Infant-directed speech (IDS) is a potentially important influence on such vocal acoustic patterns. Both acoustic patterns and effects of IDS are important for understanding the earliest origins of communication disorders.

AIMS

To compare duration, pitch and loudness of infant vocalizations for three groups of infants (TD, ASD, DD) in circumstances with high or low amounts of IDS.

METHODS AND PROCEDURES

Two five-minute segments from each of 1259 all-day recordings across the first year were coded and acoustically analyzed for three groups of infants (130 TD, 44 ASD, 21 DD). Duration, mean fundamental frequency, and root mean square amplitude were determined for >162,000 infant utterances.

OUTCOMES AND RESULTS

Cries were longest and loudest, and vowel-like sounds were shortest of the five vocal types in all groups. TD infants showed significant alterations in vocal acoustics during periods of high IDS.

CONCLUSIONS AND IMPLICATIONS

Strong similarities in acoustic patterns occurred across the three groups, but only the TD group showed significant acoustic effects of IDS.

Autism Identification Based on the Intelligent Analysis of Facial Behaviors: An Approach Combining Coarse- and Fine-Grained Analysis

BACKGROUND

Facial behavior has emerged as a crucial biomarker for autism identification. However, heterogeneity among individuals with autism poses a significant obstacle to traditional feature extraction methods, which often lack the necessary discriminative power. While deep-learning methods hold promise, they are often criticized for their lack of interpretability.

METHODS

To address these challenges, we developed an innovative facial behavior characterization model that integrates coarse- and fine-grained analyses for intelligent autism identification. The coarse-grained analysis provides a holistic view by computing statistical measures related to facial behavior characteristics. In contrast, the fine-grained component uncovers subtle temporal fluctuations by employing a long short-term memory (LSTM) model to capture the temporal dynamics of head pose, facial expression intensity, and expression types. To fully harness the strengths of both analyses, we implemented a feature-level attention mechanism. This not only enhances the model's interpretability but also provides valuable insights by highlighting the most influential features through attention weights.

RESULTS

Upon evaluation using three-fold cross-validation on a self-constructed autism dataset, our integrated approach achieved an average recognition accuracy of 88.74%, surpassing the standalone coarse-grained analysis by 8.49%.

CONCLUSIONS

This experimental result underscores the improved generalizability of facial behavior features and effectively mitigates the complexities stemming from the pronounced intragroup variability of those with autism, thereby contributing to more accurate and interpretable autism identification.

Objective Measurement of Social Gaze and Smile Behaviors in Children with Suspected Autism Spectrum Disorder During Administration of the Autism Diagnostic Observation Schedule, 2nd Edition

Best practice for the assessment of autism spectrum disorder (ASD) symptom severity relies on clinician ratings of the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), but the association of these ratings with objective measures of children's social gaze and smiling is unknown. Sixty-six preschool-age children (49 boys, M = 39.97 months, SD = 10.58) with suspected ASD (61 confirmed ASD) were administered the ADOS-2 and provided social affect calibrated severity scores (SA CSS). Children's social gaze and smiling during the ADOS-2, captured with a camera contained in eyeglasses worn by the examiner and parent, were obtained via a computer vision processing pipeline. Children who gazed more at their parents (p = .04) and whose gaze at their parents involved more smiling (p = .02) received lower social affect severity scores, indicating fewer social affect symptoms, adjusted R2 = .15, p = .003.

Parent-child interaction related to brain functional alterations and development outcomes in autism spectrum disorder: A study based on resting state-fMRI

BACKGROUND

Limited study has investigated the influence of parent-child interaction on brain functional alterations and development outcomes of autism spectrum disorder (ASD) children. This pilot study aimed to explore the relationship between parent-child interaction, brain functional activities and development outcomes of ASD children.

METHODS

and Procedures: 653 ASD with an average age of 41.06 ± 10.88 months and 102 typically developmental (TD) children with an average age of 44.35 ± 18.39 months were enrolled in this study, of whom 155 ASD completed brain rs-fMRI scans. The amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) measured using resting-state functional magnetic resonance imaging (rs-fMRI) data reflect local brain function. The parent-child interaction was assessed by the Chinese Parent-child Interaction Scale (CPCIS). Childhood Autism Rating Scale (CARS) and developmental quotient (DQ) indicated development outcomes.

OUTCOMES AND RESULTS

Total CPCIS score was negatively correlated with CARS total score, and positively correlated with DQ. The frequency of parent-child interaction was negatively correlated with ALFF values in the left median cingulate and paracingulate gyri (DCG.L) and ReHo values in the right superior frontal gyrus, medial (SFGmed.R)(P < 0.05, FDR correction). ALFF values in the DCG.L and ReHo values in the SFGmed.R play complete mediating roles in the relationship between parent-child interaction and performance DQ.

CONCLUSION AND IMPLICATIONS

This study suggest that parent-child interaction has an impact on autistic characteristics and DQ of ASD children. Local brain regions with functional abnormalities in the DCG.L and SFGmed.R may be a crucial factors affecting the performance development of ASD children with reduced parent-child interaction.

Autism as a Disorder of Affective Empathy

Since the first description by Leo Kanner, individuals with autism spectrum disorder (ASD) have been attributed a reduced empathy. However, it has not yet been clarified how empathy is specifically impaired in autism. Typically, scholars distinguish between the affective and the cognitive dimensions of empathy. The latter largely overlaps with the concept of the theory of mind (ToM), according to which we need internal inferences or simulations for gaining access to the hidden mental states of others. Since a deficit in ToM is a widely accepted explanation for difficulties of individuals with ASD in social interactions, limitations in cognitive empathy are accordingly assumed. Regarding affective empathy, there are contradictory results using various methods, showing an impaired affective empathy. The main aim of the paper is to present ASD primarily as a disorder of shared interpersonal and interaffective experiences and thus of affective empathy by means of a phenomenological analysis considering empirical studies. In this framework, a deficit of the ToM is accepted but criticized as a central explanatory approach for ASD since (1) it assumes a fundamental inaccessibility of other people, which does not correspond to our everyday social situations, and (2) it manifests developmentally long after the first signs of ASD, which means that its deficit cannot explain the basic autistic difficulties in social interactions.

Non-autistic adults can recognize posed autistic facial expressions: Implications for internal representations of emotion

Autistic people report that their emotional expressions are sometimes misunderstood by non-autistic people. One explanation for these misunderstandings could be that the two neurotypes have different internal representations of emotion: Perhaps they have different expectations about what a facial expression showing a particular emotion looks like. In three well-powered studies with non-autistic college students in the United States (total N = 632), we investigated this possibility. In Study 1, participants recognized most facial expressions posed by autistic individuals more accurately than those posed by non-autistic individuals. Study 2 showed that one reason the autistic expressions were recognized more accurately was because they were better and more intense examples of the intended expressions than the non-autistic expressions. In Study 3, we used a set of expressions created by autistic and non-autistic individuals who could see their faces as they made the expressions, which could allow them to explicitly match the expression they produced with their internal representation of that emotional expression. Here, neither autistic expressions nor non-autistic expressions were consistently recognized more accurately. In short, these findings suggest that differences in internal representations of what emotional expressions look like are unlikely to play a major role in explaining why non-autistic people sometimes misunderstand the emotions autistic people are experiencing.

Diminished Repetition Suppression Reveals Selective and Systems-Level Face Processing Differences in ASD

Repeated exposure to a stimulus results in reduced neural response, or repetition suppression, in brain regions responsible for processing that stimulus. This rapid accommodation to repetition is thought to underlie learning, stimulus selectivity, and strengthening of perceptual expectations. Importantly, reduced sensitivity to repetition has been identified in several neurodevelopmental, learning, and psychiatric disorders, including autism spectrum disorder (ASD), a neurodevelopmental disorder characterized by challenges in social communication and repetitive behaviors and restricted interests. Reduced ability to exploit or learn from repetition in ASD is hypothesized to contribute to sensory hypersensitivities, and parallels several theoretical frameworks claiming that ASD individuals show difficulty using regularities in the environment to facilitate behavior. Using fMRI in autistic and neurotypical human adults (females and males), we assessed the status of repetition suppression across two modalities (vision, audition) and with four stimulus categories (faces, objects, printed words, and spoken words). ASD individuals showed domain-specific reductions in repetition suppression for face stimuli only, but not for objects, printed words, or spoken words. Reduced repetition suppression for faces was associated with greater challenges in social communication in ASD. We also found altered functional connectivity between atypically adapting cortical regions and higher-order face recognition regions, and microstructural differences in related white matter tracts in ASD. These results suggest that fundamental neural mechanisms and system-wide circuits are selectively altered for face processing in ASD and enhance our understanding of how disruptions in the formation of stable face representations may relate to higher-order social communication processes.SIGNIFICANCE STATEMENT A common finding in neuroscience is that repetition results in plasticity in stimulus-specific processing regions, reflecting selectivity and adaptation (repetition suppression [RS]). RS is reduced in several neurodevelopmental and psychiatric conditions including autism spectrum disorder (ASD). Theoretical frameworks of ASD posit that reduced adaptation may contribute to associated challenges in social communication and sensory processing. However, the scope of RS differences in ASD is unknown. We examined RS for multiple categories across visual and auditory domains (faces, objects, printed words, spoken words) in autistic and neurotypical individuals. We found reduced RS in ASD for face stimuli only and altered functional connectivity and white matter microstructure between cortical face-recognition areas. RS magnitude correlated with social communication challenges among autistic individuals.

Positive, negative, neutral-or unknown? The perceived valence of emotions expressed by young autistic children in a novel context suited to autism

LAY ABSTRACT

Autistic people are believed to have emotions that are too negative and not positive enough, starting early in life. Their facial expressions are also persistently judged to be unusual, as reflected in criteria used to identify autism. But it is possible that common autistic facial expressions are poorly understood by observers, as suggested by a range of findings from research. Another issue is that autistic emotions have always been assessed in contexts suited to non-autistics. In our study, the facial expressions of young autistic and typical children were rated as positive, negative, neutral, or "unknown"-a category we created for emotions that observers notice but do not understand. These emotions were assessed using a context suited to autistic children, including objects of potential interest to them. We found that in this context, autistic and typical children did not differ in positive, negative, or neutral facial emotions. They did differ in unknown emotions, which were found only in autistic children. We also found that repetitive behaviors in autistic children co-occurred with positive, neutral, and unknown emotions, but not with negative emotions. In a context which suits their characteristics, autistic children do not show emotions that are too negative or not positive enough. They do show emotions perceived as unknown, which means we need to improve our understanding of their full emotional repertoire.

Young children with autism show atypical prefrontal cortical responses to humanoid robots: An fNIRS study

BACKGROUND

Previous behavioral studies have found that children with autism spectrum disorder (ASD) show greater interest in humanoid robots than in humans. However, the neural mechanism underlying this is not clear. This study compared brain activation patterns between children with ASD and neurotypical children while they watched videos with robots and humans.

METHOD

We recruited 45 children with ASD and 53 neurotypical children aged 4-6 years and recorded their neural activity in the dorsolateral prefrontal cortex (DLPFC) using a functional near-infrared spectroscopy (fNIRS) device when the two groups interacted with a robot or a human in a video.

RESULTS

First, neural activity in the right DLPFC in children with ASD was significantly lower in the robot condition than in the human condition. Neural activity in the right DLPFC in children with ASD was also significantly lower than that of neurotypical children in the robot condition. Second, the neural activity in the left DLPFC between the human and robot conditions was negatively correlated in children with ASD, while it was positively correlated in neurotypical children. Moreover, neural activity in the left DLPFC in children with ASD was significantly correlated with the ADOS scores in both conditions.

CONCLUSIONS

While neurotypical children showed comparable neural activity to humanoid robots and human beings, the children with ASD showed significantly different neural activity under those two conditions. Children with ASD may need more selective attention resources for human interaction than for robot interaction. It is also much more difficult for children with ASD to neglect the attraction of robots. Neural activity of the left DLPFC of children with ASD is correlated with their symptoms, which maybe a possible indicator for early diagnosis. Neural activity of the right DLPFC guided their atypical reactions and engagements with robots. Our study contributes to the current understanding of the neural mechanisms responsible for the different behavioral reactions in children with ASD toward robots and humans.

Non-parental caregivers, low maternal education, gastrointestinal problems and high blood lead level: predictors related to the severity of autism spectrum disorder in Northeast China

Background

The prevalence of autism spectrum disorder (ASD) has increased rapidly in recent years. Environmental factors may play an important role in the pathogenesis of ASD. These factors may include socioeconomic factors, nutritional factors, heavy metal exposure, air pollution, etc. Our aim is to analyze possible environmental factors associated with the severity of ASD.

Methods

All participating children were divided into two groups (mild and moderate/severe) according to the severity of their symptoms, as determined by their Childhood Autism Rating Scale (CARS) scores. The socioeconomic, demographic factors and the nutritional factors that may affect the severity of ASD were included in the logistic regression to analyze whether they were predictors that affected the severity of ASD.

Results

Logistic regression showed that caregivers(P = 0.042), maternal education (P = 0.030), gastrointestinal problems (P = 0.041) and a high serum concentration of lead (P = 0.003) were statistically significantly associated with ASD severity.

Conclusion

Many environmental factors affect the severity of ASD. We concluded that non-parental caregivers, low maternal education, gastrointestinal problems and high blood lead level maybe predictors that affected the severity of ASD in northeast China.

Proof of Concept: A Brief Psycho-Educational Training Program to Increase the Use of Positive Emotion Regulation Strategies in Individuals With Autism Spectrum Disorder

Attenuated positive emotions and difficulties in regulating emotions are frequently observed in individuals with autism spectrum disorders (ASD) and are linked to increased risk of affective disorders, problematic behaviors, and impaired socio-emotional functioning. As such, interventions specifically focused on positive emotion regulation (ER) skills could be very valuable for individuals with ASD, their caregivers, and therapists. However, the field of positive ER in ASD is under-researched. The present study aimed at testing the practical potential and the preliminary effects of a brief novel psycho-educational training program on positive ER for individuals with ASD. Thirty male participants with ASD (aged 10-35years; N _training=14, N _waitlist=16) underwent a three-session program on the use of adaptive positive ER strategies (i.e., attentional deployment, cognitive change, and response modulation). Participants rated the program as easy to understand, interesting, pleasant, and likable. No dropouts or adverse effects were observed. The training group showed a significant increase in the self-reported use of the ER strategies compared to the waitlist group. The increase in the use of ER strategies maintained up to 7 weeks in the overall sample. Having reached high satisfaction rates and the intended effects in this proof of concept study, this novel program represents a promising tool to support ER. Future research should next investigate the efficacy of the intervention on day-to-day emotional experience and wellbeing. Clinical Trial Registration: ClinicalTrials.gov # NCT02898298.

Effects of a creative yoga intervention on the joint attention and social communication skills, as well as affective states of children with Autism Spectrum Disorder

BACKGROUND

Yoga is gaining popularity as a multisystem intervention due to its impact on both the physical and mental well-being of children with typical development. However, there is limited empirical evidence to support the use of this approach in school-aged children with Autism Spectrum Disorder (ASD). The current pilot study evaluated the impact of a creative yoga intervention on the joint attention, social communication, and affective states of children with ASD.

METHODS

24 school-aged children with ASD received eight weeks of yoga (e.g., breathing, poses, relaxation) or tabletop play/academic intervention (e.g., reading, arts-crafts, building activities). Children were tested before and after the intervention using a standardized measure of responsive joint attention. Additionally, changes in socially directed verbal communication and affective states of children were assessed three times during the intervention period, i.e. during early, mid, and late intervention sessions.

RESULTS

Children with ASD showed improvements in responsive joint attention in both groups in the posttest vs. the pretest. Furthermore, children in the yoga group showed improvements in socially directed verbal communication skills across the intervention sessions, i.e. greater spontaneous and responsive communication from early/mid to late intervention sessions compared to the academic group. There were no changes in affective states with the intervention, however, the yoga group showed greater interested and less negative affect compared to the academic group.

CONCLUSIONS

Creative yoga intervention is a promising tool that led to improvements in intervention-related social communication skills and generalized joint attention skills of children with ASD.

Assessment of the Autism Spectrum Disorder Based on Machine Learning and Social Visual Attention: A Systematic Review

The assessment of autism spectrum disorder (ASD) is based on semi-structured procedures addressed to children and caregivers. Such methods rely on the evaluation of behavioural symptoms rather than on the objective evaluation of psychophysiological underpinnings. Advances in research provided evidence of modern procedures for the early assessment of ASD, involving both machine learning (ML) techniques and biomarkers, as eye movements (EM) towards social stimuli. This systematic review provides a comprehensive discussion of 11 papers regarding the early assessment of ASD based on ML techniques and children's social visual attention (SVA). Evidences suggest ML as a relevant technique for the early assessment of ASD, which might represent a valid biomarker-based procedure to objectively make diagnosis. Limitations and future directions are discussed.

Digital Behavioral Phenotyping Detects Atypical Pattern of Facial Expression in Toddlers with Autism

Commonly used screening tools for autism spectrum disorder (ASD) generally rely on subjective caregiver questionnaires. While behavioral observation is more objective, it is also expensive, time-consuming, and requires significant expertise to perform. As such, there remains a critical need to develop feasible, scalable, and reliable tools that can characterize ASD risk behaviors. This study assessed the utility of a tablet-based behavioral assessment for eliciting and detecting one type of risk behavior, namely, patterns of facial expression, in 104 toddlers (ASD N = 22) and evaluated whether such patterns differentiated toddlers with and without ASD. The assessment consisted of the child sitting on his/her caregiver's lap and watching brief movies shown on a smart tablet while the embedded camera recorded the child's facial expressions. Computer vision analysis (CVA) automatically detected and tracked facial landmarks, which were used to estimate head position and facial expressions (Positive, Neutral, All Other). Using CVA, specific points throughout the movies were identified that reliably differentiate between children with and without ASD based on their patterns of facial movement and expressions (area under the curves for individual movies ranging from 0.62 to 0.73). During these instances, children with ASD more frequently displayed Neutral expressions compared to children without ASD, who had more All Other expressions. The frequency of All Other expressions was driven by non-ASD children more often displaying raised eyebrows and an open mouth, characteristic of engagement/interest. Preliminary results suggest computational coding of facial movements and expressions via a tablet-based assessment can detect differences in affective expression, one of the early, core features of ASD. LAY SUMMARY: This study tested the use of a tablet in the behavioral assessment of young children with autism. Children watched a series of developmentally appropriate movies and their facial expressions were recorded using the camera embedded in the tablet. Results suggest that computational assessments of facial expressions may be useful in early detection of symptoms of autism.

Preliminary Characterization of Parent-Child Interaction in Preschoolers With Prader-Willi Syndrome: The Relationship Between Engagement and Parental Stress

Early parent-child interactions (PCI) impact social cognitive development. Relatedly, children with various developmental disorders exhibit abnormal parental attachment relationships. Parental characteristics and behaviors can impact PCI and socioemotional development as well. No research has examined the parent-child dynamic in Prader-Willi syndrome (PWS), a neurodevelopmental disorder that presents with social cognitive deficits. This article provides a preliminary characterization of PCI quality and parenting stress in 17 PWS parent-child dyads, children ages 3-5 years, in comparison to 20 typically developing children and their parent. Results suggest early PCI disruption in preschoolers with PWS and their parents report increased levels of stress in various domains. These findings have important implications not only on parent well-being in PWS but its impact on child development.

Facetime vs. Screentime: Gaze Patterns to Live and Video Social Stimuli in Adolescents with ASD

Atypical eye gaze to social stimuli is one of the most frequently reported and studied social behaviors affected by autism spectrum disorder (ASD). The vast majority of this literature is based on analyses of gaze patterns as participants view social information, such as talking faces, on a computer screen. However, recent results suggest that generalizing gaze behaviors from computer screens to live interactions may not be valid. This study examines between- and within-group differences in gaze behaviors of children with ASD and their neurotypical (NT) peers during a screen-based and a live-interaction task. Results show between-group differences in gaze only for the screen-based, but not the live-interaction task. We also find that gaze behavior of NT children during the screen-based task significantly correlates with their gaze behavior during the live interaction; individuals who direct a higher percentage of gaze to the face in one task also did so in the other task. However, there is no significant relationship between the gaze patterns of children with ASD for those two tasks. These results strongly caution against using gaze of individuals with ASD recorded during screen-based tasks as a proxy for understanding their gaze behavior during live social interactions.

Less differentiated facial responses to naturalistic films of another person's emotional expressions in adolescents and adults with High-Functioning Autism Spectrum Disorder

BACKGROUND

Reduced facial expressivity (flat affect) and deficits in nonverbal communicative behaviors are characteristic symptoms of autism spectrum disorder (ASD). Based on the important interpersonal functions of facial emotional responsiveness the present study aimed at a comprehensive and differentiated analysis of perceptible facial behavior in response to another person's naturalistic, dynamic facial expressions of emotion.

METHODS

In a group of 21 adolescent and adult individuals with High-Funtioning autism spectrum disorder (HF-ASD) and in 21 matched healthy controls we examined perceptible facial responses using the whole range of action units of the Facial Action Coding System (FACS) while participants were watching films displaying continuous, dynamic real-life facial expressions of four universal emotions (cheerfulness, anger, sadness, anxiety). The duration of the 80 s films was in the typical range of casual face-to-face interactions.

RESULTS

Overall, the number of congruent facial muscle movements while watching the emotion-laden stimulus films did not differ in the two groups. However, the comprehensive FACS analysis indicated that participants with HF-ASD displayed less differentiated facial responses to the watched emotional expressions.

CONCLUSIONS

The unusual or awkward patterns of facial emotional responses in ASD may hamper the recognition of affect in other people as well as the interaction partner's sense of interpersonal resonance, and thereby lead to social disadvantage in individuals with ASD.

Insular function in autism: Update and future directions in neuroimaging and interventions

The insular cortex, hidden within the lateral sulcus of the human brain, participates in a range of cognitive, affective, and sensory functions. Autism spectrum disorder (ASD), a neurodevelopmental condition affecting all of these functional domains, has increasingly been linked with atypical activation and connectivity of the insular cortices. Here we review the latest research linking atypical insular function to a range of behaviors characteristic of ASD, with an emphasis on neuroimaging findings in the domains of social cognition and executive function. We summarize some of the recent work linking the insula to interventions in autism, including oxytocin-based pharmacological treatments and music therapy. We suggest that future directions likely to yield significant insights into insular pathology in ASD include the analysis of the dynamics of this brain region. We also conclude that more basic research is necessary on the use of oxytocin pharmacotherapy, and larger studies addressing participant heterogeneity are needed on the use of music therapy in ASD. Long-term studies are needed to ascertain sustained effects of these interventions.

How Does Emotion Regulation Strategy Use and Psychological Wellbeing Predict Mood in Adults With and Without Autism Spectrum Disorder? A Naturalistic Assessment

The aim of this study was to identify emotion regulation (ER) strategies that most strongly impact momentary mood in a sample of 23 adults with and 19 without autism spectrum disorder (ASD). Participants completed cognitive and behavioural assessments, online questionnaires, and experience sampling methodology questions. In the ASD group, the use of dampening and other-blame reduced mood while savouring and emotional acceptance improved mood. The use of self-blame and avoidance negatively impacted mood only in the non-ASD group, suggesting the use of these two strategies do not reduce mood in individuals with ASD. ER and mental health interventions should capture ER strategy use and aim to decrease maladaptive strategy use and increase adaptive strategy use.

Application of the Scale for the Assessment of Feeding Interaction (SVIA) to Children With Autism Spectrum Disorder

Background and Objectives: Feeding problems occur more frequently among children with Autism spectrum disorder (ASD). The aim of this study was to analyse eating difficulties of ASD children through the direct observation of the caregiver-child co-regulation system. Methods: We compared 60 ASD children with a control group of 50 typically developing Italian children on the Scale for the Assessment of Feeding Interaction (SVIA). The Brief Autism Mealtime Behaviour Inventory (BAMBI) was used to define the presence of an eating disorder. Results: The ASD group showed higher scores on all dimensions of the SVIA compared to the control group. The SVIA and the BAMBI showed significant correlations. In a second step, the ASD sample was divided into two subgroups, children with and without feeding difficulties. The comparison between the ASD subgroups with the control group on the SVIA scales showed significant differences on all dimensions. Finally, significant differences emerged between the two ASD subgroups in three SVIA dimensions. Conclusion: These data suggest the importance of direct observation of feeding in the assessment of children with ASD. The SVIA seems to be able to point out some feeding difficulties in these subjects and to discriminate ASD with and without an eating disorder. Critical aspects of the application of SVIA to autistic children are discussed.

Signing with the Face: Emotional Expression in Narrative Production in Deaf Children with Autism Spectrum Disorder

This study examined facial expressions produced during a British Sign Language (BSL) narrative task (Herman et al., International Journal of Language and Communication Disorders 49(3):343-353, 2014) by typically developing deaf children and deaf children with autism spectrum disorder. The children produced BSL versions of a video story in which two children are seen to enact a language-free scenario where one tricks the other. This task encourages elicitation of facial acts signalling intention and emotion, since the protagonists showed a range of such expressions during the events portrayed. Results showed that typically developing deaf children produced facial expressions which closely aligned with native adult signers' BSL narrative versions of the task. Children with ASD produced fewer targeted expressions and showed qualitative differences in the facial actions that they produced.

Facial Expression Production in Autism: A Meta-Analysis

This meta-analysis summarized studies that examined group differences on the production of facial expressions in participants with ASD compared to typically developing or nonautistic clinical comparison groups. The overall summary effect from 67 effect sizes representing the average ASD-comparison group differences in facial expressions was -0.481, indicating a moderate effect size. We conducted subgroup analyses to group effect sizes according to separate facial expression abilities identified in the literature. These analyses revealed that participants with ASD display facial expressions less frequently and for less amount of time, and they are less likely to share facial expressions with others or automatically mimic the expressions of real faces or face stimuli. Their facial expressions are also judged to be lower in quality and are expressed less accurately. However, participants with ASD do not express emotions less intensely, nor is their reaction time of expression onset slower in response to odors, startling sensations, or in response to face stimuli in mimicry studies. ASD-comparison group differences were moderated by matching procedures, age, and intellectual functioning of the ASD participants suggesting that persons with higher IQ and larger number of accumulated life experiences are better able to produce facial expressions that are more consistent with "neurotypical" norms. Group differences were also stronger for "covertly elicited" than "explicitly elicited" facial expressions suggesting individuals with ASD may naturally produce facial expressions differently from other populations, but are less impaired in expressing emotions typically when prompted to do so in a laboratory setting. Autism Research 2018, 11: 1586-1601. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We reviewed studies that compared facial expressions in people with and without autism. Results revealed that facial expressions of people with autism are atypical in appearance and quality and are used atypically to regulate social interactions. The magnitude of these differences was influenced by participant characteristics (e.g. age and intellectual functioning), and by how facial expressions were measured and analyzed in various studies.

Automatic emotion and attention analysis of young children at home: a ResearchKit autism feasibility study

Current tools for objectively measuring young children's observed behaviors are expensive, time-consuming, and require extensive training and professional administration. The lack of scalable, reliable, and validated tools impacts access to evidence-based knowledge and limits our capacity to collect population-level data in non-clinical settings. To address this gap, we developed mobile technology to collect videos of young children while they watched movies designed to elicit autism-related behaviors and then used automatic behavioral coding of these videos to quantify children's emotions and behaviors. We present results from our iPhone study Autism & Beyond, built on ResearchKit's open-source platform. The entire study-from an e-Consent process to stimuli presentation and data collection-was conducted within an iPhone-based app available in the Apple Store. Over 1 year, 1756 families with children aged 12-72 months old participated in the study, completing 5618 caregiver-reported surveys and uploading 4441 videos recorded in the child's natural settings. Usable data were collected on 87.6% of the uploaded videos. Automatic coding identified significant differences in emotion and attention by age, sex, and autism risk status. This study demonstrates the acceptability of an app-based tool to caregivers, their willingness to upload videos of their children, the feasibility of caregiver-collected data in the home, and the application of automatic behavioral encoding to quantify emotions and attention variables that are clinically meaningful and may be refined to screen children for autism and developmental disorders outside of clinical settings. This technology has the potential to transform how we screen and monitor children's development.

Early interaction in autism spectrum disorder: Mothers' and children's behaviours during joint engagement

BACKGROUND

More knowledge about the interaction between young children with autism spectrum disorder and their parents is one way to improve intervention. This study aims to investigate the behaviours of mothers and children with autism spectrum disorder during joint engagement, with a focus on pacing or rate (i.e., incidences per minute) of their behaviours when being in this state.

METHOD

Video recordings of 10 min of free-play between 58 children (2-4 years) diagnosed with childhood autism and their mothers were used to examine rate of mothers' and children's behaviours (i.e., toy introduction, toy expansion, positive affect, and language) during joint engagement, the association between rate of mothers and children's behaviours, the relation between rate of mothers' behaviours and time in joint engagement, and how child factors might be associated with the latter.

RESULTS

Mothers^(m) and children^(c) showed similar rate of positive affect (M^m  = 0.6/M^c  = 0.5) and toy expansion (M^m  = 0.7/M^c  = 0.7) per minute, whereas mothers talked almost three times more than their children (M^m  = 10.2/M^c  = 3.8). In contrast, mothers introduced fewer toys compared to the children (M^m  = 0.7/M^c  = 1.2). Rate of mothers' toy introduction, toy expansion, and positive affect was inversely related to time in joint engagement (Regression coefficient = -70.7 to -48.5, p = .006 to .024). Rates of mothers' and children's behaviours were associated (Spearman rank order coefficient = .53 to .29, p < .001 to .03), but neither rate of children's behaviours nor mental age was associated with the observed relation between rate of these maternal behaviours and time in joint engagement.

CONCLUSION

Time in joint engagement was related to rate of mothers' behaviours and children's mental age but not to rate of children's behaviours in this study. Thus, intervention teaching parents of young children with autism strategies designed to increase time in joint engagement may be vital. The complex nature of the interaction between mother and child behaviours in promoting joint engagement warrants further elucidation.

Expressive Incoherence and Alexithymia in Autism Spectrum Disorder

Expressive incoherence can be implicated in socio-emotional communicative problems in autism spectrum disorder (ASD). The present study examined expressive incoherence in 37 children with ASD and 41 typically developing (TD) children aged 3-13 years old during a frustration task. The role of alexithymia in expressive incoherence was also assessed. Compared to TD children, children with ASD had higher expressive incoherence, such as more neutral and positive emotion expressions during negative behaviors, but not in the expression of negative emotions during positive behaviors. Further analyses revealed that alexithymia moderated the expressions of positive emotions during negative behaviors. These results suggest that children with ASD may benefit from interventions targeting alexithymia to increase emotional coherence, which may improve socio-emotional communication.

The Effect of Parenting Style on Social Smiling in Infants at High and Low Risk for ASD

This study examined how parenting style at 9 months predicts growth in infant social engagement (i.e., social smiling) between 9 and 18 months during a free-play interaction in infants at high (HR-infants) and low (LR-infants) familial risk for autism spectrum disorder (ASD). Results indicated that across all infants, higher levels of maternal responsiveness were concurrently associated with higher levels of social smiling, while higher levels of maternal directiveness predicted slower growth in social smiling. When accounting for maternal directiveness, which was higher in mothers of HR-infants, HR-infants exhibited greater growth in social smiling than LR-infants. Overall, each parenting style appears to make a unique contribution to the development of social engagement in infants at high- and low-risk for ASD.

Increased Eye Contact During Conversation Compared to Play in Children With Autism

Children with autism have atypical gaze behavior but it is unknown whether gaze differs during distinct types of reciprocal interactions. Typically developing children (N = 20) and children with autism (N = 20) (4-13 years) made similar amounts of eye contact with an examiner during a conversation. Surprisingly, there was minimal eye contact during interactive play in both groups. Gaze behavior was stable across 8 weeks in children with autism (N = 15). Lastly, gaze behavior during conversation but not play was associated with autism social affect severity scores (ADOS CSS SA) and the Social Responsiveness Scale (SRS-2). Together findings suggests that eye contact in typical and atypical development is influenced by subtle changes in context, which has implications for optimizing assessments of social communication skills.

Cross-site randomized control trial of the Social ABCs caregiver-mediated intervention for toddlers with autism spectrum disorder

To evaluate the efficacy of the Social ABCs parent-mediated intervention for toddlers with suspected or confirmed autism spectrum disorder (ASD), through a cross-site randomized control trial, sixty-three parent-toddler dyads (toddler age: 16-30 months) were randomized into treatment (Social ABCs) or control (service-as-usual) conditions. Video data were obtained at three key time-points: Baseline; Post-training (PT; week 12); and Follow-Up (week 24). Analyses included 62 dyads. Treatment allocation significantly accounted for PT gains, all favouring the Treatment group, in (1) child functional vocal responsiveness to parent prompts (R²  = 0.43, P < .001), (2) child vocal initiations (R²  = 0.28, P < .001), (3) parent smiling (R²  = 0.09, P = .017), and (4) fidelity of implementation (R²  = 0.71, P < .001). A trend was observed for increased social orienting (R²  = 0.06, P = 0.054); gains in parent smiling significantly predicted increases in child smiling and social orienting. Parents in the treatment condition reported significant gains in self-efficacy following the intervention (P = 0.009). No differential effects emerged for performance on standardized measures. The Social ABCs is a relatively low-resource, efficacious intervention, with potential to be a cost-effective means of intervening at the first signs of possible ASD. Autism Res 2017, 10: 1700-1711. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Clinical Trial Title: Social ABCs for Toddlers with Signs of Autism Spectrum Disorder: RCT of a Parent-Mediated Intervention http//ClinicalTrials.gov identifier: NCT02428452.

A theoretical approach to the deficits in infantile autism

Deficits specific to the syndrome of infantile autism appear in imitation, emotion sharing, theory of mind, pragmatics of communication, and symbolic play. Current competing theories of Hobson and of Baron-Cohen, Frith, and associates account for some, but not all, of these specific deficits. The present article suggests that early social capacities involving imitation, emotion sharing, and theory of mind are primarily and specifically deficient in autism. Further, these three capacities involve forming and coordinating social representations of self and other at increasingly complex levels via representational processes that extract patterns of similarity between self and other. Stern's theory of interpersonal development is offered as a continuous model for understanding the development and deficits of the autistic child and as a means for integrating competing theories about the primary deficits in autism. Finally, the article suggests a neuropsychological model of interpersonal coordination involving prefrontal cortex and executive function capacities that is consistent with the social deficits observed in autism.

The Roots of Mindblindness

This paper challenges the hypothesis that the type of social impairment observed in children with autism is evidence of an underlying malfunction in their ‘Theory of Mind’, resulting in ‘mindblindness’. To establish this point, the paper takes up two interesting ideas in the Theory of Mind literature, purged of their Cartesianism: first, that the study of autism does indeed provide us with critical insights into the development of social understanding and empathy; and, second, that no meaningful distinction can be drawn between a child’s interpersonal and intrapersonal development. The paper seeks to show how the ability to understand someone else’s thoughts and emotions is a product of endless co-regulated interactions in which the child’s own emotions and sense of self develop. The reason why children with autism so frequently exhibit impaired social relatedness is because basic biological challenges—such as sensory over-and under-reactivity—inhibit their ability to engage in these co-regulated interactive experiences.

Subdimensions of social-communication impairment in autism spectrum disorder

BACKGROUND

More refined dimensions of social-communication impairment are needed to elucidate the clinical and biological boundaries of autism spectrum disorders (ASD) and other childhood onset psychiatric disorders associated with social difficulties, as well as to facilitate investigations in treatment and long-term outcomes of these disorders.

METHODS

This study was intended to identify separable dimensions of clinician-observed social-communication impairments by examining scores on a widely used autism diagnostic instrument. Participants included verbally fluent children ages 3-13 years, who were given a clinical diagnosis of ASD (n = 120) or non-ASD (i.e. ADHD, language disorder, intellectual disability, mood or anxiety disorder; n = 118) following a comprehensive diagnostic assessment. Exploratory and confirmatory factor analysis examined the factor structure of algorithm items from the Autism Diagnostic Observation Schedule (ADOS), Module 3.

RESULTS

Results indicated that a three-factor model consisting of repetitive behaviors and two separate social-communication behavior factors had superior fit compared to a two-factor model that included repetitive behaviors and one social-communication behavior factor. In the three-factor model, impairments in 'Basic Social-Communication' behaviors (e.g. eye contact, facial expressions, gestures) were separated from impairments in 'Interaction quality.' Confirmatory factor analysis in an independent sample of children in the Simons Simplex Collection (SSC) further supported the division of social-communication impairments into these two factors. Scores in Interaction Quality were significantly associated with nonverbal IQ and male sex in the ASD group, and with age in the non-ASD group, while scores in basic social communication were not significantly associated with any of these child characteristics in either diagnostic group.

CONCLUSIONS

Efforts to conceptualize level, or severity, of social-communication impairment in children with neurodevelopmental disorders might be facilitated by separating the most basic (or proximal) social-communication impairments from those that could arise from a range of other phenotypic variables. Identification of social-communication subdimensions also highlights potential avenues for measuring different types of social-communication impairments for different purposes (e.g. for differential diagnosis vs. response to treatment).

Specifying the Nature and Course of the Joint Attention Impairment in Autism in the Preschool Years

The paper reviews recent experimental findings into the extent and specificity of the joint attention impairments shown by preschool children with autism. In contrast to the commonly held view that children with autism are impaired in declarative gestures but intact in requesting gestures, the pattern of intact and impaired joint attention abilities revealed by recent research is more complex. The research reviewed represents a significant advance on previous findings by dissociating form and function in gestural communicative acts, by adopting a developmental perspective and thus identifying changes in the precise nature of the joint attention impairments over time, and by taking advantage of recent advances in early detection and diagnosis that enable us to study very young preschoolers with autism. The lessons to be learnt from this research for clinical diagnosis, and early intervention and education programmes, are considered.

Micro-analysis of Social Interactions between Autistic Children and Normal Adults in Semi-structured Play Situations

The present study was designed to: (1) identify the qualitative and temporal characteristics of the exchange structures of autistic children interacting with an adult; and (2) analyse and compare the implementation of their interactive behaviour in a range of play situations. Ten autistic children aged 5 to 14 were video-taped while interacting with an adult in four play situations, with or without objects. The elementary behavioural events observed in the dyads were coded and processed on a computer by an automatic pattern detection program. The results showed that in this structured situation the autistic children engaged in a variety of behaviours for communicating with the adult, and that 8 of the 10 children repeatedly exhibited structures of interaction. These patterns were found to depend on IQ, but involved a certain number of peculiar characteristics (parasitic behaviours, lack of initiative, maladapted visual behaviour, etc.), even for the children with the highest IQ scores. The physical interaction situations gave rise to fewer and less elaborate patterns than the situations involving objects. Only the most advanced children participated in the joint-attention situation. The implications of the method for understanding the abnormal development of interaction in autism are discussed.

A Comparative Review of Early Forms of Object-Directed Play and Parent-Infant Play in Typical Infants and Young Children with Autism

The article reviews the empirical evidence relating to the development of early solitary object and parent-infant play in typical infants and children diagnosed with autism. Whilst, collectively, the findings indicate that there may be both qualitative and quantitative differences in the early play of children with autism, relative to that of other children, it is also clear that significant gaps exist in our current knowledge. It is proposed that longitudinal studies, which make a detailed examination of the form and developmental trajectory of early play, are needed if we are to devise the most effective content, design and outcome measures for intervention programmes using play as a therapeutic medium.

Naturalistic Developmental Behavioral Interventions: Empirically Validated Treatments for Autism Spectrum Disorder

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. “Naturalistic Developmental Behavioral Interventions (NDBI)” are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies.

Evaluating posed and evoked facial expressions of emotion from adults with autism spectrum disorder

Though many studies have examined facial affect perception by individuals with autism spectrum disorder (ASD), little research has investigated how facial expressivity in ASD is perceived by others. Here, naïve female observers (n = 38) judged the intensity, naturalness and emotional category of expressions produced by adults with ASD (n = 6) and typically developing (TD) adults (n = 6) in both a posed condition and an evoked condition in which emotions were naturalistically elicited and validated. ASD expressions were rated as more intense and less natural than TD expressions but contrary to prediction were identified with greater accuracy, an effect driven primarily by angry expressions. Naturalness ratings of evoked expressions were positively associated with identification accuracy for TD but not ASD individuals. Collectively, these findings highlight differences, but not a reduction, in facial expressivity in ASD that do not hinder emotion recognition accuracy but may affect social interaction quality.

Can Neurotypical Individuals Read Autistic Facial Expressions? Atypical Production of Emotional Facial Expressions in Autism Spectrum Disorders

The difficulties encountered by individuals with autism spectrum disorder (ASD) when interacting with neurotypical (NT, i.e. nonautistic) individuals are usually attributed to failure to recognize the emotions and mental states of their NT interaction partner. It is also possible, however, that at least some of the difficulty is due to a failure of NT individuals to read the mental and emotional states of ASD interaction partners. Previous research has frequently observed deficits of typical facial emotion recognition in individuals with ASD, suggesting atypical representations of emotional expressions. Relatively little research, however, has investigated the ability of individuals with ASD to produce recognizable emotional expressions, and thus, whether NT individuals can recognize autistic emotional expressions. The few studies which have investigated this have used only NT observers, making it impossible to determine whether atypical representations are shared among individuals with ASD, or idiosyncratic. This study investigated NT and ASD participants' ability to recognize emotional expressions produced by NT and ASD posers. Three posing conditions were included, to determine whether potential group differences are due to atypical cognitive representations of emotion, impaired understanding of the communicative value of expressions, or poor proprioceptive feedback. Results indicated that ASD expressions were recognized less well than NT expressions, and that this is likely due to a genuine deficit in the representation of typical emotional expressions in this population. Further, ASD expressions were equally poorly recognized by NT individuals and those with ASD, implicating idiosyncratic, rather than common, atypical representations of emotional expressions in ASD.

Positive emotional engagement and autism risk

Positive emotional engagement develops in the context of face-to-face interactions during the first 6 months of life. Deficits in emotional engagement are characteristic of autism spectrum disorder (ASD) and may characterize the younger siblings of children with ASD (high-risk siblings). High-risk siblings are likely to exhibit a broad range of positive emotional engagement that may or may not be associated with ASD outcomes. We examined positive emotional engagement (i.e., smiling rate and contingent responsiveness to the partner's smile) during the infant-parent interaction episodes of the face-to-face/still face protocol at 6 months of age. The sample included 43 high-risk infant siblings, 11 of whom went on to an ASD diagnosis, and 25 low-risk siblings with no family history of ASD. Low-risk siblings and high-risk siblings without ASD showed the typical still-face effect (i.e., decreases in smiling rate after period of parental nonresponsiveness), but high-risk siblings with later ASD outcomes did not show this decrease. Although high-risk siblings without an ASD diagnosis were less likely to respond to their parents' smiles than were low-risk siblings, the children with eventual ASD did not differ from the other groups in contingent responsiveness. Findings suggest that subtle differences in positive emotional engagement are present in the early development of high-risk siblings but are not consistently associated with ASD outcomes.

Brief report: the smiles of a child with autism spectrum disorder during an animal-assisted activity may facilitate social positive behaviors--quantitative analysis with smile-detecting interface

We quantitatively measured the smiles of a child with autism spectrum disorder (ASD-C) using a wearable interface device during animal-assisted activities (AAA) for 7 months, and compared the results with a control of the same age. The participant was a 10-year-old boy with ASD, and a normal healthy boy of the same age was the control. They voluntarily participated in this study. Neither child had difficulty putting on the wearable device. They kept putting on the device comfortably through the entire experiment (duration of a session was about 30-40 min). This study was approved by the Ethical Committee based on the rules established by the Institute for Developmental Research, Aichi Human Service Center. The behavior of the participants during AAA was video-recorded and coded by the medical examiner (ME). In both groups, the smiles recognized by the ME corresponded with the computer-detected smiles. In both groups, positive social behaviors increased when the smiles increased. Also, negative social behaviors decreased when the smiles increased in the (ASD-C). It is suggested that by leading the (ASD-C) into a social environment that may cause smiling, the child's social positive behaviors may be facilitated and his social negative behaviors may be decreased.

Social smiling and its components in high-risk infant siblings without later ASD symptomatology

Impaired affective expression, including social smiling, is common in children with autism spectrum disorder (ASD), and may represent an early marker for ASD in their infant siblings (Sibs-ASD). Social smiling and its component behaviors (eye contact and non-social smiling) were examined at 15 months in Sibs-ASD who demonstrated later ASD symptomatology (Sibs-ASD/AS), those who did not (Sibs-ASD/NS), and low-risk controls (Sibs-TD). Both Sibs-ASD subgroups demonstrated lower levels of social smiling than Sibs-TD, suggesting that early social smiling may reflect elevated genetic vulnerability rather than a specific marker for ASD. Only the Sibs-ASD/AS demonstrated less eye contact and non-social smiling than Sibs-TD, suggesting that different processes, threshold effects, or protective factors may underlie social smiling development in the two Sibs-ASD subgroups.

A quarter century of progress on the early detection and treatment of autism spectrum disorder

The last 25 years have witnessed tremendous changes in our ability to detect autism very early in life and provide interventions that can significantly influence children's outcomes. It was once questioned whether autism could be recognized before children had developed language and symbolic play skills; now changes in early behaviors, as well as structural brain changes, have been documented in infants 6-12 months of age who later develop autism. Advances in brain imaging and genetics offer the possibility of detecting autism before the syndrome is fully manifest, thereby reducing or preventing symptoms from developing. Whereas the primary mode of behavioral intervention a few decades ago relied on operant conditioning, recent approaches integrate the methods of applied behavioral analysis within a developmental, relationship-focused intervention model that are implemented by both parents and clinicians. These interventions have been found to have positive effects on children's developmental trajectory, as measured by both behavioral and neurophysiological assessments. Future approaches will likely combine both behavioral and pharmacological treatments for children who have less robust responses to behavioral interventions. There has been a paradigm shift in the way that autism is viewed, evolving from a lifelong condition with a very poor prognosis to one in which significant gains and neuroplasticity is expected, especially when the condition is detected early and appropriate interventions are provided. The grand challenge for the future is to bridge the tremendous gap between research and the implementation of evidence-based practices in the broader community, both in the United States and worldwide. Significant disparities in access to appropriate health care for children with autism exist that urgently require advocacy and more resources.

Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI): A randomized controlled trial

In a randomized controlled trial, we evaluated the early intervention program Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI) with 78 primary caregivers and their child (16-61 months) with Autism Spectrum Disorder. VIPP-AUTI is a brief attachment-based intervention program, focusing on improving parent-child interaction and reducing the child's individual Autism Spectrum Disorder-related symptomatology in five home visits. VIPP-AUTI, as compared with usual care, demonstrated efficacy in reducing parental intrusiveness. Moreover, parents who received VIPP-AUTI showed increased feelings of self-efficacy in child rearing. No significant group differences were found on other aspects of parent-child interaction or on child play behavior. At 3-months follow-up, intervention effects were found on child-initiated joint attention skills, not mediated by intervention effects on parenting. Implementation of VIPP-AUTI in clinical practice is facilitated by the use of a detailed manual and a relatively brief training of interveners.