1
|
Chu L, Shen L, Ma C, Chen J, Tian Y, Zhang C, Gong Z, Li M, Wang C, Pan L, Zhu P, Wu D, Wang Y, Yu G. Effects of a Nonwearable Digital Therapeutic Intervention on Preschoolers With Autism Spectrum Disorder in China: Open-Label Randomized Controlled Trial. J Med Internet Res 2023; 25:e45836. [PMID: 37616029 PMCID: PMC10485722 DOI: 10.2196/45836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause difficulty with communication and social interactions as well as complicated family dynamics. Digital health interventions can reduce treatment costs and promote healthy lifestyle changes. These therapies can be adjunctive or replace traditional treatments. However, issues with cooperation and compliance prevent preschool patients with ASD from applying these tools. In this open-label, randomized controlled trial, we developed a nonwearable digital therapy called virtual reality-incorporated cognitive behavioral therapy (VR-CBT). OBJECTIVE The aim of this study was to assess the adjunctive function of VR-CBT by comparing the effects of VR-CBT plus learning style profile (LSP) intervention with those of LSP-only intervention in preschool children with ASD. METHODS This trial was performed in China on 78 preschool children (age 3-6 years, IQ>70) diagnosed with ASD who were randomized to receive a 20-week VR-CBT plus LSP intervention (intervention group, 39/78, 50%) or LSP intervention only (control group, 39/78, 50%). The primary outcome was the change of scores from baseline to week 20, assessed by using the parent-rated Autism Behavior Checklist (ABC). Secondary outcomes included the Childhood Autism Rating Scale (CARS), Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV), and behavioral performance data (accuracy and reaction time) in go/no-go tasks. All primary and secondary outcomes were analyzed in the intention-to-treat population. RESULTS After the intervention, there was an intervention effect on total ABC (β=-5.528; P<.001) and CARS scores (β=-1.365; P=.02). A similar trend was observed in the ABC subscales: sensory (β=-1.133; P=.047), relating (β=-1.512; P=.03), body and object use (β=-1.211; P=.03), and social and self-help (β=-1.593; P=.03). The intervention also showed statistically significant effects in improving behavioral performance (go/no-go task, accuracy, β=2.923; P=.04). Moreover, a significant improvement of ADHD hyperactivity-impulsivity symptoms was observed in 53 children with comorbid ADHD based on ADHD-RS-IV (β=-1.269; P=.02). No statistically significant intervention effect was detected in the language subscale of ABC (β=-.080; P=.83). Intervention group girls had larger improvements in ABC subscales, that is, sensory and body and object use and in the CARS score and accuracy of go/no-go task (all P<.05) than the control group girls. Statistically significant intervention effects could be observed in hyperactivity-impulsivity symptoms in the intervention group boys with comorbid ADHD compared with those in the control group boys (β=-1.333; P=.03). CONCLUSIONS We found potentially positive effects of nonwearable digital therapy plus LSP on core symptoms associated with ASD, leading to a modest improvement in the function of sensory, motor, and response inhibition, while reducing impulsivity and hyperactivity in preschoolers with both ASD and ADHD. VR-CBT was found to be an effective and feasible adjunctive digital tool. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2100053165; http://www.chictr.org.cn/showproj.aspx?proj=137016.
Collapse
Affiliation(s)
- Liting Chu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Division of Child and Adolescent Health, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Li Shen
- Clinical Research Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chenhuan Ma
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinjin Chen
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Tian
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuncao Zhang
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zilan Gong
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mengfan Li
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chengjie Wang
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lizhu Pan
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peiying Zhu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Danmai Wu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Wang
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangjun Yu
- Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
| |
Collapse
|
2
|
Lopez KL, Monachino AD, Vincent KM, Peck FC, Gabard-Durnam LJ. Stability, change, and reliable individual differences in electroencephalography measures: a lifespan perspective on progress and opportunities. Neuroimage 2023; 275:120116. [PMID: 37169118 DOI: 10.1016/j.neuroimage.2023.120116] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
Electroencephalographic (EEG) methods have great potential to serve both basic and clinical science approaches to understand individual differences in human neural function. Importantly, the psychometric properties of EEG data, such as internal consistency and test-retest reliability, constrain their ability to differentiate individuals successfully. Rapid and recent technological and computational advancements in EEG research make it timely to revisit the topic of psychometric reliability in the context of individual difference analyses. Moreover, pediatric and clinical samples provide some of the most salient and urgent opportunities to apply individual difference approaches, but the changes these populations experience over time also provide unique challenges from a psychometric perspective. Here we take a developmental neuroscience perspective to consider progress and new opportunities for parsing the reliability and stability of individual differences in EEG measurements across the lifespan. We first conceptually map the different profiles of measurement reliability expected for different types of individual difference analyses over the lifespan. Next, we summarize and evaluate the state of the field's empirical knowledge and need for testing measurement reliability, both internal consistency and test-retest reliability, across EEG measures of power, event-related potentials, nonlinearity, and functional connectivity across ages. Finally, we highlight how standardized pre-processing software for EEG denoising and empirical metrics of individual data quality may be used to further improve EEG-based individual differences research moving forward. We also include recommendations and resources throughout that individual researchers can implement to improve the utility and reproducibility of individual differences analyses with EEG across the lifespan.
Collapse
Affiliation(s)
- K L Lopez
- Northeastern University, 360 Huntington Ave, Boston, MA, United States
| | - A D Monachino
- Northeastern University, 360 Huntington Ave, Boston, MA, United States
| | - K M Vincent
- Northeastern University, 360 Huntington Ave, Boston, MA, United States
| | - F C Peck
- University of California, Los Angeles, Los Angeles, CA, United States
| | - L J Gabard-Durnam
- Northeastern University, 360 Huntington Ave, Boston, MA, United States.
| |
Collapse
|
3
|
Cheng X, Li Y, Cui X, Cheng H, Li C, Fu L, Jiang J, Hu Z, Ke X. Atypical Neural Responses of Cognitive Flexibility in Parents of Children With Autism Spectrum Disorder. Front Neurosci 2022; 15:747273. [PMID: 34975368 PMCID: PMC8719598 DOI: 10.3389/fnins.2021.747273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Impaired cognitive flexibility has been repeatedly demonstrated in autism spectrum disorder (ASD). There is strong evidence for genetic involvement in ASD. First-degree relatives of individuals with ASD may show mild deficits in cognitive inflexibility. The present study investigated cognitive flexibility and its neuroelectrophysiological mechanisms in first-degree relatives of individuals with ASD to assess its potential familiality. Forty-five biological parents of individuals/children with ASD (pASD) and thirty-one biological parents of typically developing individuals/children (pTD), matched by gender, age, and IQ, were enrolled. The broad autism phenotype questionnaire (BAPQ) and cognitive flexibility inventory (CFI) were used to quantitatively assess autistic traits and cognitive flexibility in daily life, respectively. The task-switching paradigm was used to evaluate the behavioral flexibility in a structured assessment situation. Event-related potentials (ERPs) induced by this paradigm were also collected. Results showed that compared with the pTD group, the pASD group had lower CFI scores (t = −2.756, p < 0.01), while both groups showed an equivalent “switch cost” in the task-switching task (p > 0.05). Compared with the pTD group, the pASD group induced greater N2 amplitude at F3, F4, Fz, and C4 (F = 3.223, p < 0.05), while P3 amplitude and latency did not differ between the two groups. In addition, there was a significant negative correlation between the CFI total scores and BAPQ total scores in the pASD group (r = −0.734, p < 0.01). After controlling for age and IQ, the N2 amplitude in the frontal lobe of pASD was negatively correlated with the CFI total scores under the repetition sequence (r = −0.304, p = 0.053). These results indicated that pASD had deficit in cognitive flexibility at the self-reported and neurological levels. The cognitive flexibility difficulties of parents of children with ASD were related to autistic traits. These findings support that cognitive flexibility is most likely a neurocognitive endophenotype of ASD, which is worthy of further investigation.
Collapse
Affiliation(s)
- Xin Cheng
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China.,Department of Child Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Yu Li
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xiwen Cui
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Hong Cheng
- Physical Diagnostic Department, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Chunyan Li
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Linyan Fu
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jiying Jiang
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Zhenyu Hu
- Department of Child Psychiatry, Ningbo Kangning Hospital, Ningbo, China
| | - Xiaoyan Ke
- The Child Mental Health Research Center, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
McPartland JC, Lerner MD, Bhat A, Clarkson T, Jack A, Koohsari S, Matuskey D, McQuaid GA, Su WC, Trevisan DA. Looking Back at the Next 40 Years of ASD Neuroscience Research. J Autism Dev Disord 2021; 51:4333-4353. [PMID: 34043128 PMCID: PMC8542594 DOI: 10.1007/s10803-021-05095-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 12/18/2022]
Abstract
During the last 40 years, neuroscience has become one of the most central and most productive approaches to investigating autism. In this commentary, we assemble a group of established investigators and trainees to review key advances and anticipated developments in neuroscience research across five modalities most commonly employed in autism research: magnetic resonance imaging, functional near infrared spectroscopy, positron emission tomography, electroencephalography, and transcranial magnetic stimulation. Broadly, neuroscience research has provided important insights into brain systems involved in autism but not yet mechanistic understanding. Methodological advancements are expected to proffer deeper understanding of neural circuitry associated with function and dysfunction during the next 40 years.
Collapse
Affiliation(s)
| | - Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Anjana Bhat
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Tessa Clarkson
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Allison Jack
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Sheida Koohsari
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - David Matuskey
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Goldie A McQuaid
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | - Wan-Chun Su
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | | |
Collapse
|
5
|
Beker S, Foxe JJ, Venticinque J, Bates J, Ridgeway EM, Schaaf RC, Molholm S. Looking for consistency in an uncertain world: test-retest reliability of neurophysiological and behavioral readouts in autism. J Neurodev Disord 2021; 13:43. [PMID: 34592931 PMCID: PMC8483424 DOI: 10.1186/s11689-021-09383-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Autism spectrum disorders (ASD) are associated with altered sensory processing and perception. Scalp recordings of electrical brain activity time-locked to sensory events (event-related potentials; ERPs) provide precise information on the time-course of related altered neural activity, and can be used to model the cortical loci of the underlying neural networks. Establishing the test-retest reliability of these sensory brain responses in ASD is critical to their use as biomarkers of neural dysfunction in this population. METHODS EEG and behavioral data were acquired from 33 children diagnosed with ASD aged 6-9.4 years old, while they performed a child-friendly task at two different time-points, separated by an average of 5.2 months. In two blocked conditions, participants responded to the occurrence of an auditory target that was either preceded or not by repeating visual stimuli. Intraclass correlation coefficients (ICCs) were used to assess test-retest reliability of measures of sensory (auditory and visual) ERPs and performance, for the two experimental conditions. To assess the degree of reliability of the variability of responses within individuals, this analysis was performed on the variance of the measurements, in addition to their means. This yielded a total of 24 measures for which ICCs were calculated. RESULTS The data yielded significant good ICC values for 10 of the 24 measurements. These spanned across behavioral and ERPs data, experimental conditions, and mean as well as variance measures. Measures of the visual evoked responses accounted for a disproportionately large number of the significant ICCs; follow-up analyses suggested that the contribution of a greater number of trials to the visual compared to the auditory ERP partially accounted for this. CONCLUSIONS This analysis reveals that sensory ERPs and related behavior can be highly reliable across multiple measurement time-points in ASD. The data further suggest that the inter-trial and inter-participant variability reported in the ASD literature likely represents replicable individual participant neural processing differences. The stability of these neuronal readouts supports their use as biomarkers in clinical and translational studies on ASD. Given the minimum interval between test/retest sessions across our cohort, we also conclude that for the tested age-range of ~ 6 to 9.4 years, these reliability measures are valid for at least a 3-month interval. Limitations related to EEG task demands and study length in the context of a clinical trial are considered.
Collapse
Affiliation(s)
- Shlomit Beker
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA
- The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - John Venticinque
- School of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juliana Bates
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth M Ridgeway
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Roseann C Schaaf
- Department of Occupational Therapy, Jefferson College of Health Professions Faculty, Farber Institute for Neurosciences Thomas Jefferson University Philadelphia, Philadelphia, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA.
- The Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
6
|
Jetha MK, Segalowitz SJ, Gatzke-Kopp LM. The reliability of visual ERP components in children across the first year of school. Dev Psychobiol 2021; 63:e22150. [PMID: 34110630 DOI: 10.1002/dev.22150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/04/2021] [Accepted: 05/25/2021] [Indexed: 11/06/2022]
Abstract
Event-related potentials (ERPs) are increasingly used as neurophysiological markers of perceptual and cognitive processes conveying risk for psychopathology. However, little is known about the reliability of ERP components during childhood, a time of substantial brain maturation. In the present study, we examine the early visual ERP components (P1, N170, VPP), frequently examined as indicators of attentional bias, for 110 children at kindergarten (T1) and first grade (T2). Children performed a Go/Nogo task at both time points, with exact stimuli changed to reduce habituation. All components showed increases in absolute amplitude and the P1 and VPP also showed decreases in latency. Retest reliability across time was good to very good for amplitude measures (Pearson rs ranging from .54 for N170 to .69 for P1) and low to very good for latencies (rs from .34 for P1 to .60 for N170), despite the change in visual stimuli. Although there was some evidence of moderation by sex, early visual ERP components appear to be a reliable measure of individual differences in attention processing in middle childhood. This has implications for the use of early visual ERP components as trait-like markers for individual differences in perceptual processes in developmental research.
Collapse
Affiliation(s)
- Michelle K Jetha
- Department of Psychology, Cape Breton University, Sydney, Nova Scotia, Canada
| | | | - Lisa M Gatzke-Kopp
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|