Categorizing the cries of infants with ASD versus typically developing infants: A study of adult accuracy and reaction time

Voice acoustics allow classifying autism spectrum disorder with high accuracy

Early identification of children on the autism spectrum is crucial for early intervention with long-term positive effects on symptoms and skills. The need for improved objective autism detection tools is emphasized by the poor diagnostic power in current tools. Here, we aim to evaluate the classification performance of acoustic features of the voice in children with autism spectrum disorder (ASD) with respect to a heterogeneous control group (composed of neurotypical children, children with Developmental Language Disorder [DLD] and children with sensorineural hearing loss with Cochlear Implant [CI]). This retrospective diagnostic study was conducted at the Child Psychiatry Unit of Tours University Hospital (France). A total of 108 children, including 38 diagnosed with ASD (8.5 ± 0.25 years), 24 typically developing (TD; 8.2 ± 0.32 years) and 46 children with atypical development (DLD and CI; 7.9 ± 0.36 years) were enrolled in our studies. The acoustic properties of speech samples produced by children in the context of a nonword repetition task were measured. We used a Monte Carlo cross-validation with an ROC (Receiving Operator Characteristic) supervised k-Means clustering algorithm to develop a classification model that can differentially classify a child with an unknown disorder. We showed that voice acoustics classified autism diagnosis with an overall accuracy of 91% [CI95%, 90.40%-91.65%] against TD children, and of 85% [CI95%, 84.5%-86.6%] against an heterogenous group of non-autistic children. Accuracy reported here with multivariate analysis combined with Monte Carlo cross-validation is higher than in previous studies. Our findings demonstrate that easy-to-measure voice acoustic parameters could be used as a diagnostic aid tool, specific to ASD.

Should Echolalia Be Considered a Phonic Stereotypy? A Narrative Review

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) defines echolalia as a pathological, parrotlike, and apparently senseless repetition (echoing) of a word or phrase just uttered by another person and classifies this condition among the “restrictive and repetitive behaviours” of Autism Spectrum Disorder (ASD). The authors reviewed the existing literature on echolalia and its role in the development of children with ASD. Current conceptualizations include echolalia among repetitive behaviors and stereotypies and thus interpret this symptom as lacking any communicative significance, with negative effects on learning and sensory processing. Echoic behaviors, however, have been described in neurotypical infants and children as having a substantial effect on the consequent development of language and communication. Relevant research has documented a functional role of echolalia in ASD children as well since it facilitates the acquisition of verbal competencies and affords a higher degree of semantic generalization. This developmental function could be restricted to specific contexts. Considering echolalia as stereotypy and treating it as a disturbing symptom could impair the development of ASD-specific learning and communication processes. In light of this evidence, the authors propose a different conceptualization of echolalia and suggest that this symptom be considered among atypical communication patterns in children with ASD, with implications for treatment and prognosis.

Are Cry Studies Replicable? An Analysis of Participants, Procedures, and Methods Adopted and Reported in Studies of Infant Cries

Infant cry is evolutionarily, psychologically, and clinically significant. Over the last half century, several researchers and clinicians have investigated acoustical properties of infant cry for medical purposes. However, this literature suffers a lack of standardization in conducting and reporting cry-based studies. In this work, methodologies and procedures employed to analyze infant cry are reviewed and best practices for reporting studies are provided. First, available literatures on vocal and audio acoustic analysis are examined to identify critical aspects of participant information, data collection, methods, and data analysis. Then, 180 peer-reviewed research articles have been assessed to certify the presence of critical information. Results show a general lack of critical description. Researchers in the field of infant cry need to develop a consensual standard set of criteria to report experimental studies to ensure the validity of their methods and results.

Pre- and Paralinguistic Vocal Production in ASD: Birth Through School Age

PURPOSE OF REVIEW

We review what is known about how pre-linguistic vocal differences in autism spectrum disorder (ASD) unfold across development and consider whether vocalization features can serve as useful diagnostic indicators.

RECENT FINDINGS

Differences in the frequency and acoustic quality of several vocalization types (e.g., babbles and cries) during the first year of life are associated with later ASD diagnosis. Paralinguistic features (e.g., prosody) measured during early and middle childhood can accurately classify current ASD diagnosis using cross-validated machine learning approaches. Pre-linguistic vocalization differences in infants are promising behavioral markers of later ASD diagnosis. In older children, paralinguistic features hold promise as diagnostic indicators as well as clinical targets. Future research efforts should focus on (1) bridging the gap between basic research and practical implementations of early vocalization-based risk assessment tools, and (2) demonstrating the clinical impact of targeting atypical vocalization features during social skill interventions for older children.

Implicit associations to infant cry: Genetics and early care experiences influence caregiving propensities

Adults' sensitive appraisal of and response to infant cry play a foundational role in child development. Employing a gene × environment (G × E) approach, this study investigated the interaction of genetic polymorphisms of the serotonin transporter gene (5-HTTLPR) and oxytocin receptor genes (OXTR; rs53576, rs2254298) with early parental care experiences in influencing adults' implicit associations to infant cry. Eighty nulliparous adults (40 females, 40 males) responded to the Parental Acceptance-Rejection Questionnaire (PARQ), a measure of early care experiences, and participated in a Single Category Implicit Association Task (SC-IAT) to measure implicit associations to infant cry. Independent of parental experience, the valence of the implicit response to infant cry is associated with the serotonin transporter gene polymorphism (5-HTTLPR), with LL-carriers showing more positive implicit associations than S-carriers. OXTR rs53576 moderated the relation between parental rejection and implicit appraisal of infant cry: A-carriers who experienced negative early care showed an implicit positive appraisal of infant cry, whereas in GG carriers, positive early care experiences were associated with an implicit positive reaction to infant cry. OXTR rs2254298 had no relation to implicit associations to infant cry or to early care experiences. These findings cast light on the possible interplay of genetic inheritance and early environment in influencing adults' responses to infant cry that may be incorporated into screening protocols aimed at identifying at-risk adult-infant interactions.

Gene × Environment Interaction in Developmental Disorders: Where Do We Stand and What's Next?

Although the field of psychiatry has witnessed the proliferation of studies on Gene × Environment (G×E) interactions, still limited is the knowledge we possess of G×E interactions regarding developmental disorders. In this perspective paper, we discuss why G×E interaction studies are needed to broaden our knowledge of developmental disorders. We also discuss the different roles of hazardous versus self-generated environmental factors and how these types of factors may differentially engage with an individual's genetic background in predicting a resulting phenotype. Then, we present examplar studies that highlight the role of G×E in predicting atypical developmental trajectories as well as provide insight regarding treatment outcomes. Supported by these examples, we explore the need to move beyond merely examining statistical interactions between genes and the environment, and the motivation to investigate specific genetic susceptibility and environmental contexts that drive developmental disorders. We propose that further parsing of genetic and environmental components is required to fully understand the unique contribution of each factor to the etiology of developmental disorders. Finally, with a greater appreciation of the complexities of G×E interaction, this discussion will converge upon the potential implications for clinical and translational research.

Putting salient vocalizations in context: Adults' physiological arousal to emotive cues in domestic and external environments

Salient vocalizations are automatically processed and distinguished from emotionally irrelevant information. However, little is known of how contextual, gender and attentional variables interact to modulate physiological responses to salient emotive vocalizations. In this study, electrocardiogram (ECG) was utilized to investigate differences in peripheral nervous activity of men and women to infant cry (IC), infant laughter (IL) and adult cry (AC) in two different situational contexts: the domestic environment (DE) and the outside environment (OE). As the mental state of listeners can affect their response to vocalizations, a between-subject design was applied: one group was instructed to imagine being inside the scenes (Task 1: explicit task), and the other group was told to look at the scenes (Task 2: implicit task). Results revealed that females exhibited lower inter-beat interval (IBI) index in the OE condition, as compared to both males in OE and females in DE conditions, suggesting greater physiological arousal amongst females in response to vocalizations in an outside environment. Additionally, Task 1 revealed that males demonstrated higher Low Frequency/High Frequency (LFHF) index towards AC than IL. Task 2 showed the same association between these two sounds in females. The implicit task also elicited lower LFHF index in response to both IL and IC than control sound (CS), only amongst females. Findings highlight the important roles that contextual information and cognitive demand play in regulating physiological responses to salient emotive vocalizations. Integrated perspectives of physiological responses to emotive vocalizations that consider the influence of internal (adult mental states) and external (environment) contextual information will provide a better understanding of mechanisms underlying emotional processing of salient social cues.

Cry, baby, cry: Expression of Distress as a Biomarker and Modulator in Autism Spectrum Disorder

Background:

Early diagnosis of autism spectrum disorder is critical, because early intensive treatment greatly improves its prognosis.

Methods:

We review studies that examined vocalizations of infants with autism spectrum disorder and mouse models of autism spectrum disorder as a potential means to identify autism spectrum disorder before the symptomatic elements of autism spectrum disorder emerge. We further discuss clinical implications and future research priorities in the field.

Results:

Atypical early vocal calls (i.e., cry) may represent an early biomarker for autism spectrum disorder (or at least for a subgroup of children with autism spectrum disorder), and thus can assist with early detection. Moreover, cry is likely more than an early biomarker of autism spectrum disorder; it is also an early causative factor in the development of the disorder. Specifically, atypical crying, as recently suggested, might induce a “self-generated environmental factor” that in turn, influences the prognosis of the disorder. Because atypical crying in autism spectrum disorder is difficult to understand, it may have a negative impact on the quality of care by the caregiver (see graphical abstract).

Conclusions:

Evidence supports the hypothesis that atypical vocalization is an early, functionally integral component of autism spectrum disorder.