Autonomic Dysregulation During Sensory Stimulation in Children with Autism Spectrum Disorder

C. Social Context in Stress and Autism: Comparing Physiological Profiles Across Two Social Paradigms in Youth with and without Autism Spectrum Disorder

Background

The social world is often stressful for individuals with autism spectrum disorder (ASD). Research shows youth with ASD demonstrate physiological hyperreactivity to some social stressors (e.g., interaction) but not others (e.g., evaluation); therefore, this study examined diagnosis (ASD or typical development (TD)), social context, perceived anxiety, and physiological responsivity across multiple stress systems; namely, the hypothalamic pituitary adrenal (HPA) axis and autonomic nervous system (ANS).

Method

This study examined 244 ten-to-thirteen-year-olds with ASD (N = 140) or TD (N = 104). Physiological responses, measured by salivary cortisol, heart rate (HR), and respiratory sinus arrhythmia (RSA), were assessed before and after a social evaluative threat paradigm (Trier Social Stress Test; TSST) and social interaction (Trier Social Stress Test- Friendly; TSST-F). Mediation models examined the relationships between anxiety, diagnosis, and physiology.

Results

Significant three-way interactions were observed for cortisol (p=0.007) and HR (p=0.002), suggesting diagnostic groups respond differently across context and time points. There was no significant interaction for RSA (p=0.149), although ASD youth had significantly lower RSA overall (p=0.038). State and trait anxiety did not mediate the relationship between diagnosis and physiology (all p>0.05).

Conclusions

Findings emphasize the critical role of context and a multisystem approach in examination of physiological social stress in youth with ASD. Results provide a foundation to elucidate unique response patterns across physiological systems to more precisely identify those with heightened physiological arousal across social contexts. It is proposed that future identification of subtypes may ultimately inform approaches for enhancing social engagement.

Development and Parasympathetic Regulation in Male and Female Adolescents with Autism Spectrum Disorder: A Two-Timepoint Longitudinal Study

Prolonged dysregulation of the autonomic nervous system (ANS) may increase propensity for physical or psychiatric illness. The current study examined differences in respiratory sinus arrhythmia (RSA) regulation in 215 adolescents with or without autism spectrum disorder (ASD) at Time 1 (T1; 10-13 years old) and 1 year later (Time 2; T2). Linear mixed effects models demonstrated lower RSA regulation in ASD, and a small interaction effect, showing blunted change in RSA from T1 to T2. Developmental differences in RSA regulation were particularly notable in females with ASD and those taking psychotropic medications. Results expand previous findings of reduced parasympathetic regulation in ASD by revealing a blunted developmental slope, indicating diagnostic differences may persist or worsen over time, particularly in females.

Autism spectrum disorders in adults and the autonomic nervous system: Heart rate variability markers in the diagnostic procedure

The diagnostic assessment of autism spectrum disorders (ASD) in adults is a challenging and time-consuming procedure. In order to address the lack of specialised health-care professionals and improve the waiting time, we aimed to identify specific electrocardiogram (ECG) derived Heart Rate Variability (HRV) parameters that could be used for diagnostic purposes. 152 patients were diagnosed based on a standardised clinical procedure and assigned to one of three groups: ASD (n = 56), any other psychiatric disorder (OD) (n = 72), and patients with no diagnosis (ND) (n = 24). Groups were compared using ANOVA. Discriminative power of biological parameters and the clinical assessment were compared using receiver operating characteristic curves (ROCs). Patients with ASD showed reduced parasympathetic and increased sympathetic activity compared to ND. The accuracy determined by the area under the curve (AUC) of the biological parameters for discrimination between ASD vs. pooled OD/ND was 0.736 (95% CI = 0.652-0.820), compared to .856 (95% CI = 0.795-0.917) for the extensive clinical assessment. Our results confirmed the dysregulation of the autonomic nervous system in ASD with reduced parasympathetic and increased sympathetic activity as compared to ND. The discriminative power of biological markers including HRV was considerable and could supplement less sophisticated clinical assessments.

A working taxonomy for describing the sensory differences of autism

BACKGROUND

Individuals on the autism spectrum have been long described to process sensory information differently than neurotypical individuals. While much effort has been leveraged towards characterizing and investigating the neurobiology underlying the sensory differences of autism, there has been a notable lack of consistency in the terms being used to describe the nature of those differences.

MAIN BODY

We argue that inconsistent and interchangeable terminology-use when describing the sensory differences of autism has become problematic beyond mere pedantry and inconvenience. We begin by highlighting popular terms that are currently being used to describe the sensory differences of autism (e.g. "sensitivity", "reactivity" and "responsivity") and discuss why poor nomenclature may hamper efforts towards understanding the aetiology of sensory differences in autism. We then provide a solution to poor terminology-use by proposing a hierarchical taxonomy for describing and referring to various sensory features.

CONCLUSION

Inconsistent terminology-use when describing the sensory features of autism has stifled discussion and scientific understanding of the sensory differences of autism. The hierarchical taxonomy proposed was developed to help resolve lack of clarity when discussing the sensory differences of autism and to place future research targets at appropriate levels of analysis.

Neurophysiological Correlates of Sensory-Based Phenotypes in ASD

Children with autism spectrum disorder frequently present with atypical behavioral responses to sensory stimuli, as well as differences in autonomic nervous system (ANS) and neuroendocrine activity. However, no one consistent pattern appears to explain these differences within this heterogeneous population. To conceptualize more homogenous ASD subgroups, sensory-based subtypes have been explored. One subtyping mechanism groups children by sensory responsivity pattern in addition to sensory domain. Differences in nervous system responsivity to sensory input within this sensory-based subtyping scheme have not yet been investigated. This exploratory study used ANS indices (respiratory sinus arrhythmia [RSA], skin conductance level) and neuroendocrine (salivary cortisol) response to examine patterns differentiating these subtypes. Significant differences in RSA were found during baseline, and during tactile, tone and movement stimuli (p < 0.05). Subtype membership was predicted by RSA changes during auditory stimulation and recovery periods (p < 0.05). Results confirm that children with an adaptive sensory responsivity subtype differ from those children with sensory processing dysfunction, however, physiological variables did not distinguish between children with different patterns of sensory processing dysfunction.

Atypical Response to Affective Touch in Children with Autism: Multi-Parametric Exploration of the Autonomic System

This study aimed at evaluating the autonomic response to pleasant affective touch in children with Autism Spectrum Disorders (ASD) and age-matched typically developing (TD) peers, thanks to multiple autonomic nervous system (ANS) parameters and by contrasting CT (C-tactile fibers) high- vs. low-density territory stimulations. We measured pupil diameter, skin conductance, and heart rate during gentle stroking of two skin territories (CT high- and low-density, respectively, forearm and palm of the hand) in thirty 6-12-year-old TD children and twenty ASD children. TD children showed an increase in pupil diameter and skin conductance associated with a heart rate deceleration in response to tactile stimulations at the two locations. Only the pupil was influenced by the stimulated location, with a later dilation peak following CT low-density territory stimulation. Globally, ASD children exhibited reduced autonomic responses, as well as different ANS baseline values compared to TD children. These atypical ANS responses to pleasant touch in ASD children were not specific to CT-fiber stimulation. Overall, these results point towards both basal autonomic dysregulation and lower tactile autonomic evoked responses in ASD, possibly reflecting lower arousal and related to social disengagement.

Diagnostic and Physical Effects in Parasympathetic Response to Social Evaluation in Youth With and Without Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) may demonstrate atypical autonomic (ANS) responses; however, research remains inconsistent. This study examined parasympathetic response during social evaluation in 241 youth (10-13 years) with ASD (n = 138) or typical development (TD; n = 103). Diagnosis, age, pubertal development, and body mass index (BMI) were hypothesized to be associated with ANS function. Linear mixed effects models demonstrated lower RSA in ASD relative to TD in a base model with no covariates. However, when accounting for differences in BMI, there was no evidence of atypical parasympathetic regulation in youth with ASD. As lower parasympathetic regulation may increase susceptibility for a number of conditions, it will be important to elucidate the link between BMI and the ANS, especially in ASD.

Investigating autonomic biomarkers of sensory processing patterns in young adults

Introduction

Autonomic nervous system functioning is theorised to underpin individual differences in sensory processing, with a small amount of supporting evidence. Despite recognition of the need to measure the balance between sympathetic and parasympathetic activity, most studies have measured only one of these systems. This study investigated whether sensory processing patterns are related to autonomic balance for young adults at rest and in response to a sensory-based stressor.

Method

In this cross-sectional laboratory study, 100 young adults completed the adolescent/adult sensory profile. Heart rate variability and pre-ejection period were recorded before, during and after a coldpressor task.

Results

Relationships between sensory processing patterns and autonomic balance varied by gender. In males, low sensory thresholds were generally related to a state of reciprocal sympathetic activation. In females, low thresholds were associated with greater autonomic reactivity in response to the coldpressor.

Conclusion

This study showed, for the first time in young adults, that sensory processing patterns may be linked to patterns of autonomic balance. Therapists should be aware that young men with low sensory thresholds may be more likely than others to exhibit a resting state of sympathetic hyperarousal and further research should investigate whether this impacts their daily functioning and wellbeing.

Autism risk in neonatal intensive care unit patients associated with novel heart rate patterns

BACKGROUND

Neonatal intensive care unit (NICU) patients are at increased risk for autism spectrum disorder (ASD). Autonomic nervous system aberrancy has been described in children with ASD, and we aimed to identify heart rate (HR) patterns in NICU patients associated with eventual ASD diagnosis.

METHODS

This retrospective cohort study included NICU patients from 2009 to 2016 with archived HR data and follow-up beyond age 3 years. Medical records provided clinical variables and ASD diagnosis. HR data were compared in infants with and without ASD.

RESULTS

Of the 2371 patients, 88 had ASD, and 689,016 h of data were analyzed. HR skewness (HRskw) was significantly different between ASD and control infants. Preterm infants at early postmenstrual ages (PMAs) had negative HRskw reflecting decelerations, which increased with maturation. From 34 to 42 weeks PMA, positive HRskw toward accelerations was higher in males with ASD. In 931 males with at least 4 days of HR data, overall ASD prevalence was 5%, whereas 11% in the top 5th HRskw percentile had ASD.

CONCLUSION

High HRskw in NICU males, perhaps representing autonomic imbalance, was associated with increased ASD risk. Further study is needed to determine whether HR analysis identifies highest-risk infants who might benefit from earlier screening and therapies.

IMPACT

In a large retrospective single-center cohort of NICU patients, we found that high positive skewness of heart rate toward more accelerations was significantly associated with increased risk of eventual autism spectrum disorder diagnosis in male infants but not in females. Existing literature describes differences in heart rate characteristics in children, adolescents, and adults with autism spectrum disorders, but the finding from our study in NICU infants is novel. Heart rate analysis during the NICU stay might identify, among an inherently high-risk population, those infants with especially high risk of ASD who might benefit from earlier screening and therapies.

Sensory Behaviours and Resting Parasympathetic Functions among Children with and without ADHD

Previous studies suggest that parasympathetic functions support sensory behaviours. However, the relationship between sensory behaviours and parasympathetic functions remain inconclusive and inconsistent among children with and without attention-deficit hyperactivity disorder (ADHD). This research aims to examine the sensory behaviours and resting parasympathetic functions among children with and without ADHD. We compared sensory behaviours and baseline parasympathetic functions of 64 participants, with 42 typically developing and 24 ADHD male children aged 7–12 years. Sensory behaviours were evaluated using the sensory profile. Baseline parasympathetic functions were indexed using the normalized unit of heart rate variability high-frequency bands (HF n.u.). Children underwent an experimental protocol consisting of watching a silent cartoon movie while HF n.u. is continuously monitored, within a controlled environment. The results of this research showed significantly lower HF n.u. (t(64) = 7.84, p < 0.01) and sensory processing total score (t(64) = 14.13 = p < 0.01) among children with ADHD compared to their typically developing peers. Likewise, a significant moderate positive correlation (r = 0.36, p < 0.05) was found between the HF n.u. and sensory profile total scores among children with ADHD. Children with ADHD have significantly lower resting state parasympathetic functions compared to their typically developing peers.

What Is Social about Autism? The Role of Allostasis-Driven Learning

Scientific research on neuro-cognitive mechanisms of autism often focuses on circuits that support social functioning. However, autism is a heterogeneous developmental variation in multiple domains, including social communication, but also language, cognition, and sensory-motor control. This suggests that the underlying mechanisms of autism share a domain-general foundation that impacts all of these processes. In this Perspective Review, we propose that autism is not a social deficit that results from an atypical "social brain". Instead, typical social development relies on learning. In social animals, infants depend on their caregivers for survival, which makes social information vitally salient. The infant must learn to socially interact in order to survive and develop, and the most prominent learning in early life is crafted by social interactions. Therefore, the most prominent outcome of a learning variation is atypical social development. To support the hypothesis that autism results from a variation in learning, we first review evidence from neuroscience and developmental science, demonstrating that typical social development depends on two domain-general processes that determine learning: (a) motivation, guided by allostatic regulation of the internal milieu; and (b) multi-modal associations, determined by the statistical regularities of the external milieu. These two processes are basic ingredients of typical development because they determine allostasis-driven learning of the social environment. We then review evidence showing that allostasis and learning are affected among individuals with autism, both neurally and behaviorally. We conclude by proposing a novel domain-general framework that emphasizes allostasis-driven learning as a key process underlying autism. Guided by allostasis, humans learn to become social, therefore, the atypical social profile seen in autism can reflect a domain-general variation in allostasis-driven learning. This domain-general view raises novel research questions in both basic and clinical research and points to targets for clinical intervention that can lower the age of diagnosis and improve the well-being of individuals with autism.

The effect of ambient sounds on decision-making and heart rate variability in autism

LAY ABSTRACT

Many autistic people report difficulties making decisions during everyday tasks, such as shopping. To examine the effect of sounds on decision-making, we developed a supermarket task where people watched a film shown from the shopper's perspective and were asked to make decisions between different products. The task was divided into three sections and participants completed each section in a different auditory environment: (1) no sounds, (2) non-social sounds (e.g. fridges humming) and (3) social sounds (e.g. people talking). Thirty-eight autistic and 37 neurotypical adults took part. We measured decision-making by examining how long it took to make a decision and how consistent people were with their decisions. We also measured heart rate variability because this biological response provides a measure of anxiety. After the supermarket shopping task, participants told us in their own words about their experiences. Autistic participants said that they found the non-social and social sound conditions more difficult than the no sound condition, and autistic participants found the social sound condition more negative than neurotypical participants. However, decision-making and heart rate variability were similar for autistic and neurotypical participants across the sound conditions, suggesting that these measures may not have been sensitive enough to reflect the experiences the autistic participants reported. Further research should consider alternative measures to explore the experiences reported by autistic people to help us understand which specific aspects of the environment autistic people are sensitive to. This, in turn, may enable more specific and evidence-based autism-friendly changes to be made.

Is autonomic function during resting-state atypical in Autism: A systematic review of evidence

BACKGROUND

Theories of differences in resting-state arousal in autistic individuals are influential. Differences in arousal during resting-state would impact engagement and adaptation to the environment, having a cascading effect on development of attentional and social skills.

OBJECTIVES

We systematically evaluated the evidence for differences in measures of autonomic arousal (heart rate, pupillometry or electrodermal activity) during resting-state in autistic individuals; to understand whether certain contextual or methodological factors impact reports of such differences.

DATA SOURCES

We searched PsycInfo, MEDLINE and EMBASE databases for papers published until 16th May 2019. Of 1207 titles initially identified, 60 met inclusion criteria.

RESULTS AND CONCLUSIONS

Of the 51 studies that investigated group differences between neurotypical and autistic participants, 60.8 % found evidence of group differences. While findings of hyperarousal were more common, particularly using indices of parasympathetic function, findings of hypo-arousal and autonomic dysregulation were also consistently present. Importantly, experimental context played a role in revealing such differences. The evidence is discussed with regard to important methodological factors and implications for future research are described.

Profiles of Autonomic Activity in Autism Spectrum Disorder with and without Anxiety

Both anxiety and autism spectrum disorder (ASD) are associated with atypical physiological activity. Few studies have systematically assessed the resting physiological activity in ASD with co-occurring anxiety disorders. We tested 75 participants divided in four groups: youth with ASD, with (ASD + Anxiety = 22, 6F, 12.29 ± 2.83 years old) and without co-occurring anxiety (ASD Alone = 15, 6F, 11.59 ± 2.85 years old) and compared their physiological profile with that of matched typically developing controls (TDC) with (Anxiety Alone = 16, 6F, 11.24 ± 3.36 years old) and without co-occurring anxiety disorders (TDC = 22, 8F, 11.88 ± 2.88 years old). Results indicated reduced sympathetic and parasympathetic activity at rest in ASD as compared to TDC youth. ASD + Anxiety and Anxiety Alone groups showed different sympathetic, but similar parasympathetic activity. These findings suggest that autonomic profile-based approaches may advance research, diagnosis, and treatment of ASD and anxiety.

Impact of a sensory activity schedule intervention on cognitive strategy use in autistic students: A school-based pilot study

Introduction

Autistic students may experience difficulty performing classroom tasks due to atypical sensory processing and inefficient use of higher-order cognitive strategies. Limited research has investigated the influence of in-class sensory activities to enhance the thinking strategies required for task performance. This study evaluated a classroom-based sensory activity schedule and its impact on cognitive strategy use.

Methods

A quasi-experimental, non-equivalent groups design was used. Students ( n = 30, mean age 7.4 years) with atypical sensory processing negatively impacting classroom performance, and their teachers ( n = 23), from six autism-specific schools were grouped into intervention (Sensory Activity Schedule and usual teaching) and control (usual teaching only) groups. Students’ cognitive strategy use during the performance of classroom tasks was evaluated at baseline and post-intervention using Perceive, Recall, Plan, Perform Stage Two Cognitive Task Analysis.

Results

Statistical analysis (Mann–Whitney U test) indicated that students who received the Sensory Activity Schedule intervention improved significantly more than control group students in overall cognitive strategy use ( Z = –2.32, p = 0.02), and with strategy items involving attention and sensory perception (perceive, Z = –2.26, p = 0.02), and planning and organisation (Plan, Z = –.254, p = 0.01).

Conclusion

The Sensory Activity Schedule may enhance autistic students’ capacity to apply cognitive strategies more effectively during performance of classroom tasks.

The impact of sensory activity schedule (SAS) intervention on classroom task performance in students with autism – a pilot randomised controlled trial

Purpose

Sensory processing difficulties can negatively affect children with autism at school. There is limited evidence to guide practice in this area. The purpose of this study is to evaluate the efficacy of a sensory activity schedule (SAS) used in a school setting on task mastery and occupational performance in the classroom.

Design/methodology/approach

A randomised control trial (RCT) was conducted with 30 children to evaluate the efficacy of a school-based SAS. Children in the intervention group received SAS intervention and usual teaching. Children in the control group received only usual teaching. Outcome measures were the perceive, recall, plan and perform stage one procedural task analysis and goal attainment scaling.

Findings

Children in the intervention group demonstrated statistically significant improvements in school performance when compared with the control group in both outcome measures.

Research limitations/implications

This was a pilot study with small sample size, so results should be interpreted with caution. Further research is needed to replicate these findings.

Practical implications

A classroom-based SAS may have a positive effect on classroom performance for children with autism. This has implications for professionals who support children with autism and sensory processing difficulties in a school setting.

Originality/value

To the best of the authors’ knowledge, this study was the first of its kind in evaluating SAS intervention in a school setting using RCT methodology.

The use of wearable technology to measure and support abilities, disabilities and functional skills in autistic youth: a scoping review

Background:

Wearable technology (WT) to measure and support social and non-social functioning in Autism Spectrum Disorder (ASD) has been a growing interest of researchers over the past decade. There is however limited understanding of the WTs currently available for autistic individuals, and how they measure functioning in this population.

Objective:

This scoping review explored the use of WTs for measuring and supporting abilities, disabilities and functional skills in autistic youth.

Method:

Four electronic databases were searched to identify literature investigating the use of WT in autistic youth, resulting in a total of 33 studies being reviewed. Descriptive and content analysis was conducted, with studies subsequently mapped to the ASD International Classification of Functioning, Disability and Health Core-sets and the ICF Child and Youth Version (ICF-CY).

Results:

Studies were predominately pilot studies for novel devices. WTs measured a range of physiological and behavioural functions to objectively measure stereotypical motor movements, social function, communication, and emotion regulation in autistic youth in the context of a range of environments and activities.

Conclusions:

While this review raises promising prospects for the use of WTs for autistic youth, the current evidence is limited and requires further investigation.

Exploring Key Physiological System Profiles at Rest and the Association with Depressive Symptoms in Autism Spectrum Disorder

Depression is often associated with dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS). Individuals with autism spectrum disorder (ASD) may experience physiological dysregulation and psychological comorbidities; however, the extent to which the interactions between these systems predict internalizing symptoms in ASD has not been investigated. The study examined interactions with the HPA axis and ANS in 10-13-year-old children with ASD (n = 41) and typical development (TD; n = 46). The interrelated systems uniquely contributed to depressive symptoms in ASD above and beyond any system in isolation. A reciprocal, parasympathetic-dominant ANS was related to fewer affective symptoms in ASD. Findings highlight the importance of examining arousal across multiple systems to more precisely identify profiles associated with maladaptive psychiatric outcomes in ASD.

Diverse Autonomic Nervous System Stress Response Patterns in Childhood Sensory Modulation

The specific role of the autonomic nervous system (ANS) in emotional and behavioral regulation—particularly in relation to automatic processes—has gained increased attention in the sensory modulation literature. This mini-review article summarizes current knowledge about the role of the ANS in sensory modulation, with a focus on the integrated functions of the ANS and the hypothalamic-pituitary-adrenal (HPA) axis and their measurement. Research from the past decade illustrates that sympathetic and parasympathetic interactions are more complex than previously assumed. Patterns of ANS activation vary across individuals, with distinct physiological response profiles influencing the reactivity underlying automatic behavioral responses. This review article advances a deeper understanding of stress and the complex stress patterns within the ANS and HPA axis that contribute to allostatic load (AL). We argue that using multiple physiological measurements to capture individual ANS response variation is critical for effectively treating children with sensory modulation disorder (SMD) and sensory differences. We consider the relative contributions of automatic vs. deliberately controlled processes across large-scale neural networks in the development of sensorimotor function and their associated links with arousal patterns and sensory over- and under-responsivity.

Sympathetic-Parasympathetic Interaction and Externalizing Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) exhibit significant difficulties with emotion regulation and reactivity, which may be linked to underlying psychophysiology. The present study examined associations between autonomic nervous system activity and individual differences in externalizing behavior problems in children with ASD. A multisystem approach was adopted to consider the interplay between markers of sympathetic (electrodermal reactivity-EDA-R) and parasympathetic reactivity (respiratory sinus arrhythmia reactivity-RSA-R) in relation to behavioral challenges. Fifty-two children with ASD ages 6-10 years contributed complete psychophysiological data. Measures of EDA-R and RSA-R (RSA withdrawal) were obtained in response to a laboratory challenge task and parents reported on child externalizing behavior problems using a standardized questionnaire and a structured clinical interview. An equifinality model was supported, with two distinct psychophysiological pathways linked to heightened externalizing behavior problems. Greater RSA-R was associated with more externalizing problems in the context of higher levels of EDA-R, and lower EDA-R was associated with increased externalizing problems at lower levels of RSA-R. Findings underscore the importance of considering the role of psychophysiology in the unfolding of comorbid externalizing problems in children with ASD. Potential implications for tailoring coregulatory supports are discussed. Autism Res 2019, 12: 1805-1816. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) exhibit elevated rates of challenging behavior. This study identified specific psychophysiological profiles (low sympathetic-low parasympathetic reactivity, and high sympathetic-high parasympathetic reactivity) that may place these children at greater risk for behavior problems. Findings have implications for better understanding behavioral challenges in children with ASD, and for tailoring supports to address underlying psychophysiology.

Psychometric Properties of Sensory Processing and Self-Regulation Checklist (SPSRC)

Background

Some children may encounter difficulties in processing sensory stimuli, which may affect their ability to participate in activities of daily living. Self-regulation abilities may also affect children on how to process different sensory experiences. The Sensory Processing and Self-Regulation Checklist (SPSRC) was developed as a single, parent-reported instrument for the examination of sensory processing and self-regulation difficulties in children.

Aims

This study is aimed at evaluating the psychometric properties of the SPSRC and examine the patterns of self-regulation and sensory processing in children with and without autism spectrum disorder (ASD).

Methods and Procedures

The contents of the SPSRC were validated by a group of experts, and a field test was subsequently conducted to examine the reliability and validity of this instrument in a sample of 997 typically developing children and 78 children with ASD.

Outcomes and Results

The results of the validation and field test analyses suggest that the SPSRC exhibits high internal consistency, good intrarater reliability, and a valid ability to measure and discriminate sensory processing and self-regulation in children aged 3-8 years with and without ASD.

Conclusions and Implications

The current results supported the reliability and validity of SPSRC to assess a child's sensory processing and self-regulation performance in activities of daily living. The study findings warrant further investigation to compare the performance of the SPSRC with laboratory-based tests, as this would better elucidate sensory responsivity in children with sensory modulation disorders from both clinical and research perspectives.

The Beneficial Effects of Massage on Motor Development and Sensory Processing in Young Children with Developmental Delay: A Randomized Control Trial Study

Purpose: We investigated the effects of massage on young children with developmental delay but no clear diagnosis (e.g., cerebral palsy, genetic diseases, or autism). Methods: Thirty-six children with DD, at 1-3 years of age, were randomly assigned to the massage (n = 18) or control group (n = 18) after being stratified by age and motor developmental quotient. The two groups continued to receive routine rehabilitation intervention, whereas the massage group additionally received 20 min of massage twice a week for 12 weeks. The Comprehensive Development Inventory for Infants and Toddlers - Diagnostic Test, the Infant/Toddler Sensory Profile - Chinese version, anthropometric measures, and a sleep questionnaire were administrated before and after the massage intervention. Results: The results of analysis of covariance revealed that the massage group exhibited a greater improvement in the total motor score (p = 0.023), gross motor score (p = 0.047), and sensory sensitivity behavior (p = 0.042). Conclusion: These findings suggest that massage can effectively enhance motor and sensory processing in children with DD.

Stop Making Noise! Auditory Sensitivity in Adults with an Autism Spectrum Disorder Diagnosis: Physiological Habituation and Subjective Detection Thresholds

Auditory sensitivities are common among people with autism spectrum disorder diagnoses (ASD). As underlying factors are unknown, we examined whether ASD adults (NASD = 33; NTypically Developing = 31; 25-45 years; IQ > 70): (1) habituated slower to auditory stimuli; (2) had lower auditory detection thresholds; and (3) whether these mechanisms related to self-reported auditory sensitivities. Two auditory stimuli (tone, siren) were repeated, whilst skin conductance responses were recorded to measure habituation. Detection thresholds were measured by stepwise reductions in tone volume. We found no evidence in favor of our hypotheses, but ASD adults did rate the auditory stimuli as more arousing. Based on explorative analyses, we argue that studying the strength of physiological responses to auditory stimuli is needed to understand auditory sensitivities.

Sensory Features as a Marker of Autism Spectrum Disorders

We explored sensory features as distinguishing characteristics of Autism spectrum disorder (ASD). Four groups of males (n = 36): Six with 47, XYY syndrome and ASD (XYY+ASD), six with 47, XYY syndrome and no ASD (XYY-ASD), 12 with idiopathic ASD (ASD-I) and 12 typically developing (TYP). The short sensory profile (SSP) the sensory challenge protocol (SCP) were used to assess sensory features. SSP Total Score for the YY+ASD was significantly lower than the XYY-ASD (p = .002) and TYP (p < .001), but were not different from ASD-I (p = .714). The XYY+ASD group had significantly lower baseline heart rate variability during the SCP than TYP (p = .044). Findings provide preliminary support of sensory features as important in ASD diagnosis.

Impact of Noise-Attenuating Headphones on Participation in the Home, Community, and School for Children with Autism Spectrum Disorder

AIM

The purpose of this study was to conceptualize the benefits and limitations of using noise-attenuating headphones for children with autism spectrum disorder (ASD) on participation in home, community, and school environments from the perspective of parents and teachers.

METHODS

Grounded theory methodology was used to guide data collection and analysis. Ten parents and five teachers of children with ASD and auditory hypersensitivity aged 6-12 completed recorded interviews. Interviews were transcribed and crosschecked prior to analysis by two or more researchers. Constant comparison was used during open and axial coding followed by theoretical integration.

RESULTS

Participants identified that the use of noise-attenuating headphones increased participation in home, community, and school settings. Barriers and benefits were identified for both around-ear and in-ear headphones. Preparation for use was an identified strategy that reduced the barriers and increased use of the headphones. Additionally, many of the children learned to predict when they needed the headphones and requested their use.

CONCLUSION

Results of the study identified parental and teacher support for the use of noise-attenuating headphones to increase participation in natural environments for children with ASD, as well as suggestions to facilitate use for practicing physical and occupational therapists.

Migration Influences on the Allostatic Load of Children: Systematic Review Protocol

Background

Migration is a worldwide phenomenon in recent times. Recently, documented studies suggest that the change in environments involved in migration may have an influence on children’s allostatic load related to health and well-being.

Objective

The aim of this review is to systematically search the extant literature and critically examine the evidence on how migration affects allostatic load in children and describe the relevant methods in measuring allostatic load.

Methods

A systematic review will be conducted to recapitulate the evidence on the influence of migration on allostatic load and describe the methods employed in measuring allostatic load parameters among migrant children using the following search terms combinations: 1) allostasis OR allostatic OR allostatic load OR allosta*; 2) migration OR migrant OR immigration OR immigrant OR migra* OR *migra*; and 3) children OR child* OR adolescen*. We will search for peer-reviewed articles in English using a three-step process: title and abstract review, individual article review, and reference hand-searching among the following databases: Medline, CINAHL, ProQuest, PubMed, Science Direct and BioMed Central. Two independent review authors will analyze for data quality, level of evidence and risk of bias; a third review author will be consulted if consensus cannot be met. Data on study details, participant characteristics, allostatic load operationalization and description, methods, and results summary will be extracted. Evidence will be synthesized statistically when possible and narratively clustered into themes.

Results

At present, we have conducted only a preliminary search to test out our search terms. The systematic search, appraisal, synthesis and analysis will be finished by June 2018. It is projected that the manuscript that describes the systematic review will be available by the last quarter of 2018.

Conclusions

The results of this systematic review have implications on supporting the concept of allostasis as a mechanism underlying the adaptive processes related to migration. Furthermore, our findings can lead to the development of innovative evidence-informed evaluation and intervention programs aimed at migrant children's needs. Likewise, it is hoped that this review can be an impetus to inform health and sociopolitical policies responsive of migrant children's current contexts.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO): CRD42017068895; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68895 (Archived by WebCite at http://www.webcitation.org/6wprRkxvA)

The Role of Ethnicity and Environment in the Regulation of Response to Sensory Stimulus in Children: Protocol and Pilot Findings of a Neurophysiological Study

BACKGROUND

The ability to regulate the response to sensory stimuli has been associated with successful behavioral patterns necessary for daily activities. However, it is not known whether a child's ethnicity and environment can influence autonomic regulatory mechanisms.

OBJECTIVE

This study aims to explore the role of ethnicity and environment in the regulation of responses to sensory stimuli in children.

METHODS

In this study, we intend to recruit 128 children from different ethnic groups or environment contexts as follows: (1) 32 typically developing Chinese children living in Hong Kong; (2) 32 typically developing Filipino children living in Hong Kong; (3) 32 typically developing Filipino children who are living in urban areas; and (4) 32 typically developing Filipino children who are living in rural areas in Philippines. Autonomic activity (heart rate variability [HRV] and electrodermal activity [EDA]) will be measured and recorded using Polar H2 heart rate monitor and eSense GSR skin response sensor. Autonomic activity (HRV-low frequency, HRV-high frequency, and EDA) at different conditions between pairwise groupings will be tested using multivariate analysis of variance (MANOVA). All significant levels will be set at P ≤.05.

RESULTS

We present the research protocol of this study, as well as a short discussion of the preliminary findings from our pilot data, with consequent power and sample size analysis that informs the appropriate sample needed to test our hypothesis.

CONCLUSIONS

This study will increase the understanding on the role of individual differences related to a child's ethnicity and environment in the regulation of response to sensory stimuli. The findings of this research may further shed light on the evaluation and treatment planning for children across and within cultures.

Behavioural and Autonomic Regulation of Response to Sensory Stimuli among Children: A Systematic Review of Relationship and Methodology

Background

Previous studies have explored the correlates of behavioural and autonomic regulation of response to sensory stimuli in children; however, a comprehensive review of such relationship is lacking. This systematic review was performed to critically appraise the current evidence on such relationship and describe the methods used in these studies.

Methods

Online databases were systematically searched for peer-reviewed, full-text articles in the English language between 1999 and 2016, initially screened by title and abstract, and appraised and synthesized by two independent review authors.

Results

Fourteen Level III-3 cross-sectional studies were included for systematic review, among which six studies explored the relationship between behaviour and physiological regulation of responses to sensory stimuli. Three studies reported significant positive weak correlations among ASD children; however, no correlations were found in typically developing children. Methodological differences related to individual differences among participants, measures used, and varied laboratory experimental setting were noted.

Conclusion

This review suggests inconclusive evidence supporting the relationship between behavioural and physiological regulation of responses to sensory stimuli among children. Methodological differences may likely have confounded the results of the current evidence. We present methodological recommendations to address this matter for future researches. This trial is registered with PROSPERO registration number CRD42016043887.

Physiological Response to Social Evaluative Threat in Adolescents with Autism Spectrum Disorder

The Trier Social Stress Test (TSST) was employed to study response to social evaluative threat in male adolescents with Autism Spectrum Disorder (ASD, n = 21) and typical development (n = 13). Participants wore a mobile electrocardiogram to collect heart rate data. There were significant group effects on respiratory sinus arrhythmia (RSA), a measure of parasympathetic nervous system function, with lower values in ASD (F = 4.97). Bivariate correlations also showed a significant relationship between parent reports of social problems and RSA response to the TSST (r = -0.586). These findings suggest that autonomic dysregulation may contribute to social deficits in adolescents with ASD.

The State of the Science on Sensory Factors and Their Impact on Daily Life for Children: A Scoping Review

The objective of this study was to identify and synthesize research about how sensory factors affect daily life of children. We designed a conceptual model to guide a scoping review of research published from 2005 to October 2014 (10 years). We searched MEDLINE, CINAHL, and PsycINFO and included studies about sensory perception/processing; children, adolescents/young adults; and participation. We excluded studies about animals, adults, and review articles. Our process resulted in 261 articles meeting criteria. Research shows that children with conditions process sensory input differently than peers. Neuroscience evidence supports the relationship between sensory-related behaviors and brain activity. Studies suggest that sensory processing is linked to social participation, cognition, temperament, and participation. Intervention research illustrates the importance of contextually relevant practices. Future work can examine the developmental course of sensory processing aspects of behavior across the general population and focus on interventions that support children's sensory processing as they participate in their daily lives.

Altered Pre-Ejection Period Response to Social Evaluative Threat in Adolescents with Autism Spectrum Disorder

INTRODUCTION

The autonomic nervous system (ANS) is involved in regulating social behavior; Autism Spectrum Disorder (ASD) is characterized by alterations in social behavior and reduced physiological response to threat. We hypothesized that adolescents with ASD would show reduced ANS response to social threat.

METHODS

Eighteen males with ASD and thirteen males with typical development (TD), ages 12 to 17, completed a social threat paradigm while wearing an impedance cardiography apparatus. We calculated pre-ejection period (PEP) and tested for between-group differences in PEP response to social threat. We also conducted correlation analyses between PEP change scores and clinical symptom scales.

RESULTS

There was an effect of diagnosis on change in PEP from baseline to the onset of social threat (F=7.60, p=0.01), with greater changes in PEP in TD compared to ASD. PEP change score and the Social Communication Questionnaire (r=0.634, p=0.005) and the ADHD Problems Subscale of the Child Behavior Checklist (r=0.568, p=0.014) were correlated.

CONCLUSIONS

These findings suggest reduced arousal in response to social threat in ASD, with preliminary evidence that reduced sympathetic activation is associated with increased social behavior symptoms.

Autism Spectrum Disorder Is Associated With Autonomic Underarousal

Autism spectrum disorder (ASD) is a serious neurodevelopmental disorder, associated with autonomic dysregulation. However, the pathomechanism leading to autonomic abnormalities is still unclear. The aim of this study was to assess autonomic nervous system (ANS) activity during baseline in homogenous group of autistic children using electrodermal activity (EDA), as an index of sympathetic activity and short-term heart rate variability (HRV) reflecting predominantly cardiac vagal control. Fifteen ASD boys and 15 healthy age-matched boys at the age of 7-15 years were examined. The continuous EDA and ECG were recorded during resting phase in a supine position. Evaluated parameters: EDA amplitude (µS), RR interval, spectral power, peak frequency and power spectral density in low (LF-HRV: 0.04-0.15 Hz) and high-frequency (HF-HRV: 0.15-0.4 Hz) bands of HRV spectral analysis. In ASD group we found significantly shortened RR intervals (729±20 ms vs. 843±30 ms, p=0.005), lower mean EDA (0.66±0.13 µS vs. 1.66±0.42 µS, p=0.033), reduced spectral activity and power spectral density in HF-HRV compared to controls (2.93±0.12 ms2 vs. 3.38±0.10 ms2, p=0.01; 4.12±0.10 ms2/Hz vs. 4.56±0.11 ms2/Hz, p=0.008, respectively). We suggest that impairment in resting autonomic regulation associated with ASD could represent an important pathomechanism leading to potential cardiovascular complications in ASD.

Heart Rate Variability and Skin Conductance During Repetitive TMS Course in Children with Autism

Autism spectrum disorder (ASD) is a developmental disorder marked by difficulty in social interactions and communication. ASD also often present symptoms of autonomic nervous system (ANS) functioning abnormalities. In individuals with autism the sympathetic branch of the ANS presents an over-activation on a background of the parasympathetic activity deficits, creating an autonomic imbalance, evidenced by a faster heart rate with little variation and increased tonic electrodermal activity. The objective of this study was to explore the effect of 12 sessions of 0.5 Hz repetitive transcranial magnetic stimulation (rTMS) over dorsolateral prefrontal cortex (DLPFC) on autonomic activity in children with ASD. Electrocardiogram and skin conductance level (SCL) were recorded and analyzed during each session of rTMS. The measures of interest were time domain (i.e., R-R intervals, standard deviation of cardiac intervals, NN50-cardio-intervals >50 ms different from preceding interval) and frequency domain heart rate variability (HRV) indices [i.e., power of high frequency (HF) and low frequency (LF) components of HRV spectrum, LF/HF ratio]. Based on our prior pilot studies it was proposed that the course of 12 weekly inhibitory low-frequency rTMS bilaterally applied to the DLPFC will improve autonomic balance probably through improved frontal inhibition of the ANS activity, and will be manifested in an increased length of cardiointervals and their variability, and in higher frequency-domain HRV in a form of increased HF power, decreased LF power, resulting in decreased LF/HF ratio, and in decreased SCL. Our post-12 TMS results showed significant increases in cardiac intervals variability measures and decrease of tonic SCL indicative of increased cardiac vagal control and reduced sympathetic arousal. Behavioral evaluations showed decreased irritability, hyperactivity, stereotype behavior and compulsive behavior ratings that correlated with several autonomic variables.

A systematic review of physiological reactivity to stimuli in autism

OBJECTIVE

The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity (PR) is typical in this population. This article reviewed studies assessing PR to sensory, social and emotional, and stressor stimuli in individuals with autism.

METHODS

Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. Studies were analysed to determine: (a) participant characteristics; (b) physiological measures used; (c) PR to sensory, social and emotional or stressor stimuli; (d) the relation between PR and behavioural or psychological variables and (e) baseline physiological activity. A novel measure of methodological quality suitable for use with non-randomized, non-interventional, psychophysiological studies was also developed and applied.

RESULTS

Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. However, this extant literature is characterized by variable and inconsistent findings, which do not appear to be accounted for by varying methodological quality, making it difficult to determine what specific factors differentiate individuals with autism who present with atypical PR from those who do not.

CONCLUSIONS

Despite this uncertainty, individual differences in PR are clearly present in autism, suggesting additional research is needed to determine the variables relating to PR among those with ASD and to examine the possible existence of physiological subtype responders in the population.

The impact of an in-class sensory activity schedule on task performance of children with autism and intellectual disability: A pilot study

Introduction

There is limited evidence to support use of sensory interventions by teachers in the classroom. The purpose of this pilot study is to determine the effectiveness of sensory activity schedule intervention in supporting participation and increasing classroom task performance in students with autism.

Method

A non-concurrent, AB single system research design across multiple baselines was used with four students with autism who attended an autism-specific school. Students demonstrated atypical sensory processing, which negatively affected their school performance. Repeated baseline and intervention data were collected by school staff using video recording during classroom tasks. Tasks performed were designated by the child’s teacher. Stage one of the Perceive, Recall, Plan, Perform System of Task Analysis was used as a repeated measure of student performance. Ratings were carried out by independent raters who were blinded to the condition of performance.

Results

Results revealed three out of four students achieved significant improvements in classroom task performance following the use of sensory activity schedule intervention developed in consultation with an occupational therapist as measured by the task analysis.

Conclusion

This study provides emerging evidence for the use of sensory activity schedule intervention in the classroom for students with autism.

Toward an Interdisciplinary Understanding of Sensory Dysfunction in Autism Spectrum Disorder: An Integration of the Neural and Symptom Literatures

Sensory processing differences have long been associated with autism spectrum disorder (ASD), and they have recently been added to the diagnostic criteria for the disorder. The focus on sensory processing in ASD research has increased substantially in the last decade. This research has been approached from two different perspectives: the first focuses on characterizing the symptoms that manifest in response to real world sensory stimulation, and the second focuses on the neural pathways and mechanisms underlying sensory processing. The purpose of this paper is to integrate the empirical literature on sensory processing in ASD from the last decade, including both studies characterizing sensory symptoms and those that investigate neural response to sensory stimuli. We begin with a discussion of definitions to clarify some of the inconsistencies in terminology that currently exist in the field. Next, the sensory symptoms literature is reviewed with a particular focus on developmental considerations and the relationship of sensory symptoms to other core features of the disorder. Then, the neuroscience literature is reviewed with a focus on methodological approaches and specific sensory modalities. Currently, these sensory symptoms and neuroscience perspectives are largely developing independently from each other leading to multiple, but separate, theories and methods, thus creating a multidisciplinary approach to sensory processing in ASD. In order to progress our understanding of sensory processing in ASD, it is now critical to integrate these two research perspectives and move toward an interdisciplinary approach. This will inevitably aid in a better understanding of the underlying biological basis of these symptoms and help realize the translational value through its application to early identification and treatment. The review ends with specific recommendations for future research to help bridge these two research perspectives in order to advance our understanding of sensory processing in ASD.

Monitoring of autonomic response to sociocognitive tasks during treatment in children with Autism Spectrum Disorders by wearable technologies: A feasibility study

BACKGROUND

Autism Spectrum Disorders (ASD) represent a heterogeneous set of neurodevelopmental disorders characterized by impairments in social domain, where the autonomic nervous system (ANS) plays an important role. Several researchers have studied the ANS in ASD, during specific cognitive or sensory stimuli while few studies have examined response during social interactions. Wearable technologies can be very helpful in monitoring autonomic response in children with ASD in semi-naturalistic setting. The novelty of this study is to use such technologies to acquire physiological signals during therapeutic sessions supported by interactive "serious games" and to correlate the ANS response to the engagement of the child during sociocognitive tasks for an evaluation of the treatment effect and for the personalization of the therapy.

METHOD

A wearable chest belt for electrocardiographic (ECG) signal recording was used and specific algorithms for the extraction of clinically relevant features (Heart Rate - HR, Root Mean Square of the Successive Differences - RMSSD and Respiratory Sinus Arrhythmia - RSA) were developed. Sociocognitive tasks were mediated by "serious games" implemented on two tablets, which allowed a precise coding of the behaviors of the children. A longitudinal assessment of the physiological response of the children during six months of treatment was performed.

RESULTS

A link between physiological response, i.e. decrease in RMSSD and RSA, and engagement of the children during sociocognitive tasks was found. Longitudinal changes in the children's autonomic response, including a decrease of RSA during the engagement throughout the therapeutic sessions, were found.

CONCLUSIONS

These results foster the feasibility of this methodology to be applied in a clinical setting for the monitoring of the ANS response of children with ASD during treatment. A larger sample of patients is needed to confirm these preliminary findings.

Effects of propranolol on conversational reciprocity in autism spectrum disorder: a pilot, double-blind, single-dose psychopharmacological challenge study

RATIONALE

Pharmacological intervention for autism spectrum disorder (ASD) is an important addition to treatment, yet currently available agents target co-morbid psychiatric concerns, such as aggression and irritability. Propranolol, a beta-adrenergic antagonist with anxiolytic effects, has been shown to improve verbal fluency and working memory in adults and adolescents with ASD in single-dose challenges.

OBJECTIVES

The present pilot study explores the acute effects of propranolol on a measure of conversational reciprocity in this population. We also examined whether autonomic activity and anxiety moderate or mediate response to the drug, given relationships between these variables and ASD, as well as the drug's effects.

METHODS

In a within-subject crossover design, 20 individuals with ASD received a single dose of propranolol or placebo during two sessions in a double-blinded, counterbalanced manner. After drug administration, participants performed a conversational reciprocity task by engaging in a short conversation with the researcher. Measurements of autonomic activity and anxiety were obtained before and after drug administration.

RESULTS

Propranolol significantly improved performance on the conversational reciprocity task total [d = 0.40] and nonverbal communication domain scores when compared to the placebo condition. However, neither autonomic activity nor anxiety was significantly associated with drug response.

CONCLUSIONS

Acute propranolol administration improved conversational reciprocity in ASD. Further exploration of these preliminary findings, as well as other potential treatment response predictors, with serial doses is warranted.