Psychometric properties of the Chinese version of the Autism Spectrum Quotient (AQ)

Relationship Between Interoception and Autistic Traits: A Resting-State Functional Connectivity Study

Interoception, the sense of the physiological condition of our body, is impaired in individuals with autism spectrum disorders. Evidence suggests that subclinical autistic traits are mild manifestations of autistic symptoms, present in the general population. We examined the resting-state functional connectivity (rsFC) associating with interoception and autistic traits in 62 healthy young adults. Autistic traits correlated negatively with the rsFC between the lateral ventral anterior insula and anterior cingulate cortex. Interoceptive accuracy and sensibility correlated positively with the rsFC between interoceptive brain networks and the cerebellum, supplementary motor area, and visual regions. The results suggest that a negative relationship between interoception and autistic traits is largely accounted for by both self-report measures and decreased rsFC amongst the interoceptive brain network.

Pupillary response during social emotion tasks in autism spectrum disorder

Autistic individuals encounter challenges in recognizing emotional expressions of others. Pupillary response has been proposed as an indicator of arousal dysregulation or cognitive load. The pupillary response of autistic individuals during socio-affective tasks remains unclear. This study investigated pupillary response in autistic adults when viewing emotional faces/eyes and recognizing emotions during the Reading the Mind in the Eyes Test (RMET) and watching interpersonal touch scenes in the social touch task. The study included 98 participants diagnosed with autism spectrum disorder and 37 typically developing controls (TD). Pupil size was measured using the Tobii X2-30 Eye Tracker. The results showed that autistic adults had larger maximal pupil sizes, smaller minimal pupil sizes, and greater change rates of pupil size, particularly during the RMET Eyes task. Clinical correlations revealed that attention switching difficulty positively correlated with mean pupil size in TD participants, while social communication deficits positively correlated with mean pupil size in autistic participants. In conclusion, our findings suggest atypical pupillary responses in autistic adults during socio-affective tasks, indicating heightened cognitive demand. Further investigation is necessary to understand the underlying mechanisms and their association with autistic traits.

Unconscious and Conscious Gaze-Triggered Attentional Orienting: Distinguishing Innate and Acquired Components of Social Attention in Children and Adults with Autistic Traits and Autism Spectrum Disorders

Typically developing (TD) individuals can readily orient attention according to others' eye-gaze direction, an ability known as social attention, which involves both innate and acquired components. To distinguish between these two components, we used a critical flicker fusion technique to render gaze cues invisible to participants, thereby largely reducing influences from consciously acquired strategies. Results revealed that both visible and invisible gaze cues could trigger attentional orienting in TD adults (aged 20 to 30 years) and children (aged 6 to 12 years). Intriguingly, only the ability to involuntarily respond to invisible gaze cues was negatively correlated with autistic traits among all TD participants. This ability was substantially impaired in adults with autism spectrum disorder (ASD) and in children with high autistic traits. No such association or reduction was observed with visible gaze cues. These findings provide compelling evidence for the functional demarcation of conscious and unconscious gaze-triggered attentional orienting that emerges early in life and develops into adulthood, shedding new light on the differentiation of the innate and acquired aspects of social attention. Moreover, they contribute to a comprehensive understanding of social endophenotypes of ASD.

Individuals with high levels of autistic traits exhibit impaired cognitive but not affective theory of mind and empathy

Theory of mind (ToM) and empathy are considered key components of social cognition that are often impaired in individuals with autism spectrum disorders (ASD). However, it remains unclear whether individuals with high levels of autistic traits exhibit similar impairments in these two functions. This study examined the affective and cognitive domains of ToM and empathy in individuals with high levels of autistic traits. We recruited 84 participants with high levels and 78 participants with low levels of autistic traits to complete a set of self-reported checklists and performance-based tasks capturing affective and cognitive components of ToM and empathy. The results showed that participants with high levels of autistic traits exhibited significant impairments in cognitive but not in affective ToM and empathy compared with their counterparts with low levels of autistic traits. We also found that empathy impairments in people with high levels of autistic traits were confounded by alexithymia and depressive traits.

Quality of life and clinical correlates in cognitively-able autistic adults: A special focus on sensory characteristics and perceived parental support

BACKGROUND

Quality of life (QoL) has been suggested as an indicator of outcomes in autistic adults. Factors associated with QoL in autistic individuals remain unclear. This study aims to examine the subjective QoL for autistic adults in Taiwan and investigate the determinants for different domains of QoL.

METHODS

The study comprised 90 autistic adults (aged 26.9, SD 7.3; males, 80.9%). We used Taiwanese version of World Health Organization Quality of Life-BREF to measure QoL. Four domains of QoL were compared with 61 non-autistic controls, including physical, psychological, social, and environment. To identify the correlates of QoL domains, we assessed IQ, personality trait, family support, anxiety/depressive symptoms, autistic severity, and sensory symptoms by various questionnaires, and assessed their association with QoL by correlation analyses and model selection.

RESULTS

Our results showed that autistic adults reported lower QoL on the World Health Organization Quality of Life (WHOQOL)-BREF across all domains. QoL was significantly associated with autistic symptom severity, harm avoidance, family support, sensory symptoms, anxiety, and depression, but not intelligence. Model selections revealed male sex, poor paternal support, autism severity, depression, anxiety, and sensory symptoms were associated with specific QoL domains.

CONCLUSION

Findings supported lower QoL in autistic adults. Modifying the QoL correlates may improve life quality in autistic adults. Furthermore, our findings revealed the importance of sensory symptoms and paternal support in QoL of autistic adults, which was a novel finding in this population.

The effect of autistic traits on prosocial behavior: The chain mediating role of received social support and perceived social support

ABSTRACT

There is growing evidence that the defining characteristics of autism spectrum disorder are distributed across the general population; therefore, understanding the correlates of prosocial behavior in individuals with high levels of autistic traits could shed light on autism spectrum disorder and prosocial behavior. In this study, the mechanism underlying the influence of individuals’ autistic traits on their prosocial behavior was explored by conducting a questionnaire survey of 414 Chinese college students. The results showed that autistic traits can influence individuals’ prosocial behavior not only through the separate effects of received social support and perceived social support but also through the chain mediating effects of received social support and perceived social support; however, the direct effect of autistic traits on individuals’ prosocial behavior is not significant. This study is conducive to understanding the internal mechanism underlying the relationship between autistic traits and prosocial behavior. Future work is required to further investigate the clinical autism spectrum disorder samples and cross-cultural applicability of the model found in this study.

Unraveling the contributions of prosodic patterns and individual traits on cross-linguistic perception of Spanish sentence modality

Cross-linguistic perception is known to be molded by native and second language (L2) experiences. Yet, the role of prosodic patterns and individual characteristics on how speakers of tonal languages perceive L2 Spanish sentence modalities remains relatively underexplored. This study addresses the gap by analyzing the auditory performance of 75 Mandarin speakers with varying levels of Spanish proficiency. The experiment consisted of four parts: the first three collected sociolinguistic profiles and assessed participants' pragmatic competence and musical abilities. The last part involved an auditory gating task, where participants were asked to identify Spanish broad focus statements and information-seeking yes/no questions with different stress patterns. Results indicated that the shape of intonation contours and the position of the final stressed syllable significantly impact learners' perceptual accuracy, with effects modulated by utterance length and L2 proficiency. Moreover, individual differences in pragmatic and musical competence were found to refine auditory and cognitive processing in Mandarin learners, thereby influencing their ability to discriminate question-statement contrasts. These findings reveal the complex interplay between prosodic and individual variations in L2 speech perception, providing novel insights into how speakers of tonal languages process intonation in a non-native Romance language like Spanish.

Exploring Inter-Brain Electroencephalogram Patterns for Social Cognitive Assessment During Jigsaw Puzzle Solving

Social interaction enables the smooth progression of our daily lives. Mounting evidence from recent hyperscanning neuroimaging studies indicates that key components of social behavior can be evaluated using inter-brain oscillations and connectivity. However, mapping out inter-brain networks and developing neurocognitive theories that explain how humans co-create and share information during social interaction remains challenging. In this study, we developed a jigsaw puzzle-solving game with hyperscanning electroencephalography (EEG) signals recorded to investigate inter-brain activities during social interactions involving cooperation and competition. Participants were recruited and paired into dyads to participate in the multiplayer jigsaw puzzle game with 32-channel EEG signals recorded. The corresponding event-related potentials (ERPs), brain oscillations, and inter-brain functional connectivity were analyzed. The results showed different ERP morphologies of P3 patterns in competitive and cooperative contexts, and brain oscillations in the low-frequency band may be an indicator of social cognitive activities. Furthermore, increased inter-brain functional connectivity in the delta, theta, alpha, and beta frequency bands was observed in the competition mode compared to the cooperation mode. By presenting comparable and valid hyperscanning EEG results alongside those of previous studies using traditional paradigms, this study demonstrates the potential of utilizing hyperscanning techniques in real-life game-playing scenarios to quantitatively assess social cognitive interactions involving cooperation and competition. Our approach offers a promising platform with potential applications in the flexible assessment of psychiatric disorders related to social functioning.

Higher Sensory Sensitivity is Linked to Greater Expansion Amongst Functional Connectivity Gradients

Insofar as the autistic-like phenotype presents in the general population, it consists of partially dissociable traits, such as social and sensory issues. Here, we investigate individual differences in cortical organisation related to autistic-like traits. Connectome gradient decomposition based on resting state fMRI data reliably reveals a principal gradient spanning from unimodal to transmodal regions, reflecting the transition from perception to abstract cognition. In our non-clinical sample, this gradient's expansion, indicating less integration between visual and default mode networks, correlates with subjective sensory sensitivity (measured using the Glasgow Sensory Questionnaire, GSQ), but not other autistic-like traits (measured using the Autism Spectrum Quotient, AQ). This novel brain-based correlate of the GSQ demonstrates sensory issues can be disentangled from the wider autistic-like phenotype.

The factor structure and measurement invariance of the Autism Spectrum Quotient-28: A cross-cultural comparison between Malaysia and the Netherlands

LAY ABSTRACT

The AQ-28 is a questionnaire measuring autistic traits, that is, traits that are related to Autism Spectrum Conditions, but its reliability in other cultures has not been thoroughly evaluated. We, therefore, tested whether the properties of the AQ-28 are comparable between two countries with different cultures, Malaysia and the Netherlands. A total of 437 Malaysian and 818 Dutch participants completed the AQ-28 online. We measured whether the AQ-28 measures autistic traits similarly in Malaysia and the Netherlands. The AQ-28 measures autistic traits similarly, and the reliability was acceptable and good in the general population of Malaysia and the Netherlands, respectively. However, Malaysians scored higher than Dutch participants. Moreover, 11 AQ-28 items showed cultural bias, indicating that these items are answered/interpreted differently in Malaysia and the Netherlands. Cross-cultural differences in interpreting, reporting, and/or expressing autistic traits highlighted in this study could potentially explain why some items are culturally biased and why Malaysians score higher on these items. The findings of this work imply that cutoff scores derived from one culture should not be generalised to another culture. Moreover, the findings are informative for future development of culturally neutral or appropriate screening and diagnostic tools for autism.

Measuring the Autistic Women's Experience (AWE)

We developed a Dutch questionnaire called the Autistic Women's Experience (AWE) and compared its psychometric properties to the Autism Spectrum Quotient (AQ). Whilst attenuated gender differences on the AQ have been widely replicated, this instrument may not fully capture the unique experience of autistic women. The AWE was co-developed with autistic women to include items that reflect autistic women's experience. We investigated the AWE (49 items) and compared it with the AQ (50 items) in Dutch autistic individuals (N = 153, n = 85 women) and in the general population (N = 489, n = 246 women) aged 16+. Both the AQ and AWE had excellent internal consistency and were highly and equally predictive of autism in both women and men. Whilst there was a gender difference on the AQ among non-autistic people (men > women), there was no gender difference among autistic people, confirming all earlier studies. No gender differences were detected on the AWE overall scale, yet subtle gender differences were observed on the subscales. We conclude that the AQ is valid for both genders, but the AWE provides an additional useful perspective on the characteristics of autistic women. The AWE needs further validation in independent samples using techniques that allow for testing gender biases, as well as a confirmatory factor analysis in a larger sample.

Corneal structural alterations in autism spectrum disorder: An in vivo confocal microscopy study

Individuals with autism spectrum disorder (ASD) often exhibit joint hypermobility and connective tissue disorders. However, it remains unclear if ASD individuals also have structural alterations in the connective tissue of the cornea. This study aims to determine whether the Kobayashi structure (K-structure) characteristics differ between adults with ASD and typically developing controls (TDC) and explore the clinical correlates of the K-structure abnormality. We recruited 30 ASD adults and 35 TDC. Corneal structures, particularly the K-structure in the Bowman's layer, of the participants were examined using in vivo confocal microscopy (IVCM), and a K-grading ranging from 1 to 4 was given to each eye based on the level of morphological mosaicism. The ASD participants' eyes received a significantly higher single-eye K-grading than that of the TDC eyes (p < 0.001), and the medians [25th, 75th percentile] of bilateral-eye summed K-grading were 8 [7, 8] and 5 [4, 6] in ASD and TDC, respectively (p < 0.001). A significantly higher K-grading in the ASD participants' eyes was still observed after adjusting for the within-subject inter-eye correlation (p < 0.001). Youden Index showed the optimal cutoffs to differentiate ASD from TDC by bilateral-eye summed K-grading and single-eye K-grading was >6 and >3, respectively. Additionally, a higher K-grading was associated with fewer visual sensation seeking in ASD (Spearman's correlation coefficient ρ = -0.518, p = 0.008) and low visual registration (i.e., higher sensory threshold) in TDC (ρ = 0.446, p = 0.023). This study provided novel evidence of corneal structural alterations in ASD by IVCM. Our findings may not only support the prior hypothesis of the association between ASD and connective tissue abnormalities but also shed light on the relationship between connective tissue disorder and neurodevelopmental disorders.

Relationship between autistic traits and letter-recognition under attention to face-likeness: study using a henohenomoheji-type compound stimulus

This study aimed to clarify the relationship between autistic traits and letter information processing, specifically, the components of faces when attention is paid to face-like information. We created a new "henohenomoheji-type compound stimulus," in which letters are placed in positions in such a way as to resemble a face. In Experiment 1, we examined the relationship between autistic traits and the participants' performance in a letter-recognition task in which a henohenomoheji-type compound stimulus was used. The results showed a significant moderate negative correlation between Autism-Spectrum Quotient-Japanese Version (AQ-J) scores and letter-recognition sensitivity when the compound stimuli were arranged like a face. The letter-detection task was employed in Experiment 2 to examine how autistic traits affect tasks' performance with a lower cognitive load than in Experiment 1. We found no correlation between AQ-J scores and letter-detection sensitivity with or without face-like features. These results suggest that paying attention to faces reduces the participants' performance in letter recognition, which represents a higher cognitive load in individuals with higher autistic traits. A major implication of this study is that the henohenomoheji-type compound stimuli can be applied to several cognitive tasks, such as cognitive processing in individuals with autistic traits.

The Chinese "Reading the Mind in the Eyes" Test: A study with normal adults, and adults with Asperger syndrome/high-functioning autism

We developed a 28-item Chinese Eyes Test and tested its psychometric properties with a mixed sample of high-functioning adults with autism or Asperger syndrome and neurotypical adults. The Chinese Eyes Test showed good convergent and divergent validity, satisfactory known-group discrimination, and acceptable internal consistency. The identified cutoff score of 18 or below (Sensitivity: 66.7%; Specificity: 84.0%) should be useful for identifying clinically significant levels of social cognitive deficits, in terms of difficulty with the perceptual understanding of others' mental states, in high-functioning adults with autism or Asperger syndrome.

The three-factor structure of the Autism-Spectrum Quotient Japanese version in pregnant women

Background

There is a rising interest in perinatal mental health studies, and proper psychometric tools to assess autistic traits among this population in Japan are vital.

Objective

This study aimed to clarify the optimal factor structure of the AQ as part of a perinatal mental health research project.

Methods

We used the Japanese version of the AQ (AQ-J) to measure autistic-like traits in pregnant women. Participants were 4,287 Japanese women who were pregnant or who had given birth within the last month. We performed exploratory factor analysis (EFA) using the first sample group (n = 2,154) to obtain factor structures for the final item selections. We performed confirmatory factor analysis (CFA) using the second sample group (n = 2,133) to obtain a model with good fit, then compared the model to all previously proposed models to determine the best-fitting model.

Results

The EFA analysis identified a model consisting of 25 items distributed across three factors. Cronbach's alpha for the total 25-item AQ-J, 9-item "Social interaction" factor, 11-item "Non-verbal communication" factor, and 5-item "Restricted interest" factor was 0.829, 0.829, 0.755, and 0.576, respectively. McDonald's omega and its 95% confidence interval were 0.826 (0.821-0.836), 0.835 (0.821-0.837), 0.755 (0.744-0.766), and 0.603 (0.556-0.596), respectively. CFA confirmed that the three-factor structure had an acceptable fit (goodness of fit index: 0.900, comparative fit index: 0.860, root mean square error of approximation: 0.066). These findings indicated that the three-factor model was better than the 13 existing models.

Conclusion

The findings are discussed in relation to the adequacy of the AQ-J for assessing autistic traits in perinatal women. We recommend the use of this 25-item, three-factor AQ-J model for this population owing to its superiority to all previous models.

Gender bias in autism screening: measurement invariance of different model frameworks of the Autism Spectrum Quotient

BACKGROUND

The Autism Spectrum Quotient is a popular autism screening tool recommended for identifying potential cases of autism. However, many women with autism demonstrate a different presentation of traits to those currently captured by screening measures and assessment methods, such as the Autism Spectrum Quotient.

AIMS

Different models of the Autism Spectrum Quotient have been proposed in the literature, utilising different items from the original 50-item scale. Within good-fitting models, the current study aimed to explore whether these items assess autistic traits similarly across men and women.

METHOD

Seventeen Autism Spectrum Quotient models were identified from the literature. Using the responses of a large sample of adults from the UK general population (5246 women, 1830 men), confirmatory factor analysis was used to evaluate the fit of each model. Measurement invariance with respect to gender, adjusting for age, was explored in the 11 model frameworks that were found to have satisfactory fit to our data.

RESULTS

It emerged that only two items were gender invariant (non-biased), whereas for the remaining items, the probability of endorsement was influenced by gender. In particular, women had a higher probability of endorsing items relating to social skills and communication.

CONCLUSIONS

If the items of the Autism Spectrum Quotient indeed reflect autism-related traits, those items should be rephrased to ensure they do not present a gender-related bias. This is vital for ensuring more timely diagnoses and support for all people with autism.

Effectiveness, durability, and clinical correlates of the PEERS social skills intervention in young adults with autism spectrum disorder: the first evidence outside North America

BACKGROUND

Despite the fact that social deficits among individuals with autism spectrum disorder (ASD) are lifelong and impact many aspects of personal functioning, evidence-based programs for social skills training were not available until recently. The Program for the Education and Enrichment of Relational Skills (PEERS^®) has been shown to effectively improve social skills for adolescents on the spectrum across different social cultures. However, the effectiveness for young adults beyond North America has yet to be examined. This study aimed to investigate the effectiveness of the PEERS intervention in Taiwanese young adults with ASD, and examine its durability and clinical correlates.

METHODS

We recruited 82 cognitively-able young adults with ASD, randomized to the PEERS treatment or treatment-as-usual.

RESULTS

Following treatment, significant improvement was found in aspects of social deficits, autism severity, social interaction anxiety, empathy, and social skills knowledge either by self-report or coach-report. Additionally, communicative behaviors rated by observers improved throughout the sessions, showing a trend toward more appropriate eye contact, gestures, facial expression during conversation, and appropriate maintenance of conversation and reciprocity. Most effects maintained at 3-month and 6-month follow-ups. The improvement of social deficits was positively correlated with baseline severity, while gains in social skills knowledge were positively correlated with IQ. The improvement of social deficits, autism severity, and empathy were positively correlated with each other.

CONCLUSION

Overall, the PEERS intervention appears to effectively improve social functioning in Taiwanese young adults with ASD. Improvement of social response and knowledge may be predicted by baseline severity and intelligence respectively.

Autistic Traits in the Neurotypical Chinese Population: A Chinese Version of Glasgow Sensory Questionnaire and a Cross-Cultural Difference in Attention-to-Detail

The aim of this study was to assess cross-cultural differences in autistic traits relating to sensory sensitivity/attention-to-detail versus socio-communicative problems in a Chinese sample. A measure of atypical sensory sensitivity (Glasgow Sensory Questionnaire, GSQ) was translated into Chinese and compared against another measure of autistic traits (Chinese version of Autism Quotient, AQ). A second Chinese sample was administered English-language versions. We show that the translated GSQ has: good internal reliability; a similar profile of item responses to the English version; and a significant correlation with the AQ. Secondly we report an unexpected, but replicable, finding amongst the Chinese. Specifically, attention-to-detail was negatively correlated with socio-communicative difficulties (whereas in Western samples it is the reverse).

Psychometric properties of the Mandarin version of the autism diagnostic observation Schedule-Generic

BACKGROUND/PURPOSE

The diagnosis of autism spectrum disorder (ASD), involving multiple components of clinical assessments, is challenging. The Autism Diagnostic Observation Schedule-Generic (ADOS-G), one of the standardized and validated instruments for ASD diagnostic evaluation, has been widely used in many countries. With the preparation of the Mandarin version of the ADOS-G (Mandarin-ADOS-G), this study aims to examine its psychometric properties, including reliability and validity.

METHODS

The sample included 554 individuals clinically diagnosed with ASD (477 males, 86.1%) and 50 typically developing (TD) individuals (29 males, 58.0%) who were assessed with different modules of the Mandarin-ADOS-G between 4.1 and 34.0 years old with a mean age of 13.0 years (Module 1, n = 40; Module 2, n = 46; Module 3, n = 275; Module 4, n = 243). We evaluated the inter-rater reliability, test-retest reliability, internal consistency, and concurrent validity with the Chinese Autism Diagnostic Interview-Revised (ADI-R) and Social Responsiveness Scale (SRS) caregiver-report and self-report forms. The discriminative validity of Mandarin-ADOS-G was also examined.

RESULTS

The Mandarin-ADOS-G demonstrated good inter-rater reliability (agreement of ADOS classification 0.91), good test-retest reliability (intraclass correlations 0.55-0.73), and low to high good internal consistency (Cronbach's alpha 0.27-0.86). The concurrent validity showed significant correlations with ADI-R (Pearson correlations 0.22-0.37) and the SRS caregiver-report form (Pearson correlations 0.15-0.23). Moreover, all Mandarin-ADOS-G domains successfully differentiated autistic individuals from TD individuals (all p-values <0.001).

CONCLUSION

The Mandarin-ADOS-G is a reliable and valid instrument for assisting the diagnosis of ASD in the Mandarin-speaking population.

Dynamic eye avoidance patterns in the high autistic traits group: An eye-tracking study

Introduction

Reduced fixation to the eye area is the main characteristic of social deficits associated with Autism Spectrum Disorder; a similar pattern may exist in individuals with high autistic traits. However, their scanning patterns to the eye area of emotional faces are still unclear on the time scale.

Methods

In the present study, we recruited 46 participants and divided them into the high autistic traits (HAT) group (23 participants) and the low autistic traits (LAT) group (20 participants) based on their Autism Spectrum Quotient (AQ) scores. Moreover, we captured their eye movement patterns when observing different angular emotional faces. We extracted the proportional fixation time to the eye area under different time windows.

Results

The results showed that the fixation time of the HAT group was always significantly smaller than that of the LAT group (p < 0.05), and the difference between the two groups increased in the middle and late stages of face presentation. The results of the linear regression analysis showed that the proportional fixation time was negatively correlated with AQ scores (p < 0.05), indicating that the proportional fixation time to the eye area could be a potential indicator to measure the level of autistic traits. We then calculated the latency to orient the eye area and the latency to disengage the eye area to explore the priority of observation of the eyes. The results showed that compared with the LAT group, the HAT group has a longer latency to orient the eye area (p < 0.05) and has longer latency to disengage the eye area (p < 0.05), illustrating that the HAT group saw the eyes more slowly and left them faster.

Psychometric properties of the Persian version of the Autism-Spectrum Quotient (AQ-19) with Iranian university students

Studies suggest that autistic traits are widespread among the general population and, in this regard, the short form of the Autism-Spectrum Quotient (AQ), the AQ-28, was developed to measure autistic traits. The present study examines the factor structure, internal consistency, and convergent validity of the Persian version of the AQ-28 with 691 Iranian university students (M_age = 28.67, SD = 8.57, 57.3% women) who were recruited online and completed the AQ-28 and Symptom Checklist (SCL-25) measures. Confirmatory factor analysis results yielded a four-factor model, which was internally consistent and demonstrated hypothesized correlations with the external correlates of interest (e.g., anxiety, depression, and phobia). Results support the Persian version of the AQ with 19 items (AQ-19) as a measure with sound psychometrics to be used in studies with Iranian university students.

Exploring social emotion processing in autism: evaluating the reading the mind in the eyes test using network analysis

BACKGROUND

Features of autism spectrum disorder (ASD) include difficulties in processing and interpreting socioemotional information. The "Reading the Mind in the Eyes" test (RMET) is a validated measurement for processing socioemotional ability. However, previous RMET studies did not explore patterns of incorrect answers and the emotional valence of the test items. This study used the Taiwanese version of the RMET and the network analysis methods to examine the differences in underlying mechanisms of socioemotional processes between 30 males with autism spectrum disorder (ASD) (mean age = 18 years) and 30 healthy control males (mean age = 17 years). For each test item, a picture of a person's eyes and partial face was shown with four words describing the emotional status on picture corners. Participants were instructed to choose one of the four words that best matched the person's thinking or feeling. We further classified the words into three valences of emotional categories to examine socioemotional processes.

RESULTS

Our results showed that ASD males performed poorer on the RMET than the controls. ASD males had higher network density and in-degree scores, especially in negative words, than control males.

CONCLUSIONS

The findings suggest that males with ASD might have deficits in mapping the best emotional concept words to the target item, especially for processing negative emotion.

A network analysis of interoception, self-awareness, empathy, alexithymia, and autistic traits

Altered interoception has been consistently found in people with autism spectrum disorder (ASD), and this impairment may contribute to social cognitive dysfunctions. However, little is known regarding the intercorrelations between interoceptive sensibility, autistic, alexithymic, empathic, and self-related traits. We recruited 1360 non-clinical college students and adults to investigate the complex inter-relationship between these variables using network analysis. The resultant network revealed patterns connecting autistic traits to interoceptive sensibility, empathy, alexithymia, and self-awareness, with reasonable stability and test-retest consistency. The node of alexithymia exhibited the highest centrality and expected influence. As revealed by the network comparison test, networks constructed in high- and low-autistic subgroups were comparable in global strength and structure. Our findings suggested that alexithymia serves as an important node, bridging interoceptive deficits, self-awareness, and empathic impairments of autism spectrum disorder. The co-morbidity of alexithymia should be considered carefully in future studies of interoceptive impairments and social deficits in ASD.

Exploratory study on the use of HMD virtual reality to investigate individual differences in visual processing styles

Purpose

Global and local processing is part of human perceptual organisation, where global processing helps extract the “gist” of the visual information and local processing helps perceive the details. Individual differences in these two types of visual processing have been found in autism and ADHD (Attention-Deficit Hyperactivity Disorder). Virtual reality (VR) has become a more available method of research in the last few decades. No previous research has investigated perceptual differences using this technology.

Design/methodology/approach

The objective of the research is to threefold: (1) identify if there is association between ADHD and autistic traits and the performance on the Rey-Osterrieth complex figure (ROCF) task, (2) investigate practical effects of using VR drawing tools for research on perceptual experiences and (3) explore any perceptual differences brought out by the three-dimensional nature of the VR. The standard ROCF test was used as a baseline task to investigate the practical utility of using VR as an experimental platform. A total of 94 participants were tested.

Findings

Attention-to-detail, attention switching and imagination subscales of autism quotient (AQ) questionnaire were found to be predictors of organisational ROCF scores, whereas only the attention-to-detail subscale was predictive of perceptual ROCF scores.

Originality/value

The current study is an example of how classic psychological paradigms can be transferred into the virtual world. Further investigation of the distinct individual preferences in drawing tasks in VR could lead to a better understanding of individual differences in the processing of visuospatial information.

Transdiagnostic symptom subtypes across autism spectrum disorders and attention deficit hyperactivity disorder: validated by measures of neurocognition and structural connectivity

BACKGROUNDS

Autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders that exhibit within-disorder heterogeneity and cross-disorder phenotypic overlap, thus suggesting that the current disease categories may not fully represent the etiologic essence of the disorders, especially for highly comorbid neurodevelopmental disorders. In this study, we explored the subtypes of a combined sample of ASD and ADHD by integrating measurements of behavior, cognition and brain imaging.

METHODS

A total of 164 participants, including 65 with ASD, 47 with ADHD, and 52 controls, were recruited. Unsupervised machine learning with an agglomerative hierarchical clustering algorithm was used to identify transdiagnostic symptom clusters. Neurocognition and brain structural connectivity measurements were used to assess symptom clusters. Mediation analysis was used to explore the relationship between transdiagnostic symptoms, neurocognition and brain structural connectivity.

RESULTS

We identified three symptom clusters that did not fall within the diagnostic boundaries of DSM. External measurements from neurocognition and neuroimaging domains supported distinct profiles, including fine motor function, verbal fluency, and structural connectivity in the corpus callosum between these symptom clusters, highlighting possible biomarkers for ASD and ADHD. Additionally, fine motor function was shown to mediate the relationship between the corpus callosum and perseveration symptoms.

CONCLUSIONS

In this transdiagnostic study on ASD and ADHD, we identified three subtypes showing meaningful associations between symptoms, neurocognition and brain white matter structural connectivity. The fine motor function and structural connectivity of corpus callosum might be used as biomarkers for neurodevelopmental disorders with social skill symptoms. The results of this study highlighted the importance of precise phenotyping and further supported the effects of fine motor intervention on ASD and ADHD.

Decreased interoceptive accuracy in children with autism spectrum disorder and with comorbid attention deficit/hyperactivity disorder

Interoception refers to the awareness of internal physiological state. Several previous studies reported that people with autism spectrum disorders (ASD) and adults with attention-deficit/hyperactivity disorder (ADHD) have diverse patterns of interoception, but the extent of literature is limited and inconsistent. This study aimed to investigate the interoceptive accuracy (IA) in children with ASD, children with comorbid ASD and ADHD, and typically developing (TD) children with high and low levels of autistic traits. We administered the eye-tracking interoceptive accuracy task (EIAT) to 30 children with ASD, 20 children with comorbid ASD and ADHD, and 63 TD controls with high and low levels of autistic traits. Parent-report scales concerning ASD and ADHD symptoms were collected. ASD children with and without comorbid ADHD both exhibited lower IA than TD children. Reduced IA was also found in TD children with high-autistic traits relative to those with low-autistic traits. IA was negatively correlated with autistic and ADHD symptoms. Atypical cardiac interoception could be found in children with ASD. Difficulties in sensing and comprehending internal bodily signals in childhood may be related to both ASD and ADHD symptoms.

The use of a tablet-based app for investigating the influence of autistic and ADHD traits on performance in a complex drawing task

This paper describes a smart tablet-based drawing app to digitally record participants’ engagement with the Rey-Osterrieth complex figure (ROCF) task, a well-characterised perceptual memory task that assesses local and global memory. Digitisation of the tasks allows for improved ecological validity, especially in children attracted to tablet devices. Further, digital translation of the tasks affords new measures, including accuracy and computation of the fine motor control kinematics employed to carry out the drawing Here, we report a feasibility study to test the relationship between two neurodevelopmental conditions: autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). The smart tablet app was employed with 39 adult participants (18-35) characterised for autistic and ADHD traits, and scored using the ROCF perceptual and organisational scoring systems. Trait scores and conditions were predictor variables in linear regression models. Positive correlations were found between the attention-to-detail, attention-switching and communication subscales of the autistic trait questionnaire and organisational scores on the ROCF task. These findings suggest that autistic traits might be linked to differential performance on the ROCF task. Novelty and future applications of the app are discussed.

Comparison of Autistic Traits Between Iranian Students With Different Ethnic Backgrounds: A Cross-Cultural Study

Autistic traits (ATs) include symptoms associated with autism spectrum conditions (ASCs), which are assumed to be continuously distributed across the general population. Studies have indicated the cultural differences in the expression of ATs. Notwithstanding, our literature review indicated that studies on cross-cultural differences in the expression of ATs included samples from different countries. This is the first study designed to compare the expression of ATs between different ethnicities from the same country. Using the Autism-spectrum Quotient (AQ-28), we examined the possible cultural differences in the expression of autistic traits from four groups of students with different ethnic backgrounds, including Turkish (n = 262), Persian (n = 290), Kurdish (n = 300), and Luri (n = 307) students. Behaviors associated with autistic traits were reported overall higher for males than females. Also, significant cultural differences in autistic traits were found that were different for males and females. Furthermore, while the medical sciences student group scored significantly higher than the humanities group in the Imagination dimension, the humanities group had significantly higher scores in Number/Pattern dimensions than the engineering and medical sciences groups. Altogether, our results provide further support for the idea that the expression of ATs is significantly influenced by culture. A significant limitation of the current study was that groups were not matched with respect to age, percentage of male participants, and fields of studies and that these variables may influence the AQ scores.

Exploring Cultural Differences in Autistic Traits: A Factor Analytic Study of Children with Autism in China and the Netherlands

Autism spectrum disorders are diagnosed globally, but recognition, interpretation and reporting may vary across cultures. To compare autism across cultures it is important to investigate whether the tools used are conceptually equivalent across cultures. This study evaluated the factor structure of the parent-reported Autism Spectrum Quotient Short Form in autistic children from China (n = 327; 3 to 17 years) and the Netherlands (n = 694; 6 to 16 years). Confirmatory factor analysis did not support the two-factor hierarchical model previously identified. Exploratory factor analysis indicated culturally variant factor structures between China and the Netherlands, which may hamper cross-cultural comparisons. Several items loaded onto different factors in the two samples, indicating substantial variation in parent-reported autistic traits between China and the Netherlands.

5-day Multi-Session Intermittent Theta Burst Stimulation over Bilateral Posterior Superior Temporal Sulci in Adults with Autism-a Pilot Study

Background

Theta burst stimulation (TBS), a patterned repetitive transcranial magnetic stimulation (rTMS) protocol with shorter simulation duration and lower stimulus intensity, could be a better protocol for individuals with autism spectrum disorder (ASD). Our study aimed to explore the impacts of intermittent TBS (iTBS) over the bilateral posterior superior temporal sulcus (pSTS) on intellectually able adults with ASD.

Methods

In this randomized, single-blinded, sham-controlled crossover trial, 13 adults with ASD completed iTBS for 5 consecutive days over the bilateral pSTS and inion (as a sham control) in a 16-weeks interval and in a randomly assigned order. The neuropsychological function was measured with the Wisconsin Card Sorting Test (WCST) for cognitive flexibility while the clinical outcomes were measured with both self-rate and parents-rate Autism Spectrum Quotient (AQ) before and after 5-day iTBS interventions.

Results

The results revealed significantly immediate effects of multi-session iTBS over the bilateral pSTS on parent-rate autistic symptoms in adults with ASD. The post-hoc analysis revealed the impacts of multi-session iTBS on cognitive flexibility were affected by baseline social-communicative impairment and baseline cognitive performance. Besides, the impacts of multi-session iTBS on clinical symptoms was affected by the concurrent psychotropic medication use and baseline autistic symptoms.

Conclusions

Given the caveat of the small sample size and discrepancy of multiple informants, this pilot study suggests the therapeutic potential of 5-day multi-session iTBS over the pSTS in adults with ASD. Individual factors modulating the response to rTMS should be explicitly considered in the future trial.

Whole Brain White Matter Tract Deviation and Idiosyncrasy From Normative Development in Autism and ADHD and Unaffected Siblings Link With Dimensions of Psychopathology and Cognition

OBJECTIVE

The heterogeneity of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) preclude definitive identification of neurobiomarkers and biological risks. High clinical overlap suggests multifaceted circuit-level alterations across diagnoses, which remains elusive. This study investigated whether individuals with ADHD or ASD and their unaffected siblings constitute a spectrum of neurodevelopmental conditions in terms of white matter etiology.

METHODS

Sex-specific white matter tract normative development was modeled from diffusion MRI of 626 typically developing control subjects (ages 5-40 years; 376 of them male). Individualized metrics estimating white matter tract deviation from the age norm were derived for 279 probands with ADHD, 175 probands with ASD, and their unaffected siblings (ADHD, N=121; ASD, N=72).

RESULTS

ASD and ADHD shared diffuse white matter tract deviations in the commissure and association tracts (rho=0.54; p<0.001), while prefrontal corpus callosum deviated more remarkably in ASD (effect size=-0.36; p<0.001). Highly correlated deviance patterns between probands and unaffected siblings were found in both ASD (rho=0.69; p<0.001) and ADHD (rho=0.51; p<0.001), but only unaffected sisters of ASD probands showed a potential endophenotype in long-range association fibers and projection fibers connecting prefrontal regions. ADHD and ASD shared significant white matter tract idiosyncrasy (rho=0.55; p<0.001), particularly in tracts connecting prefrontal regions, not identified in either sibling group. Canonical correlation analysis identified multiple dimensions of psychopathology/cognition across categorical entities; autistic, visual memory, intelligence/planning/inhibition, nonverbal-intelligence/attention, working memory/attention, and set-shifting/response-variability were associated with distinct sets of white matter tract deviations.

CONCLUSIONS

When conceptualizing neurodevelopmental disorders as white matter tract deviations from normative patterns, ASD and ADHD are more alike than different. The modest white matter tract alterations in siblings suggest potential endophenotypes in these at-risk populations. This study further delineates brain-driven dimensions of psychopathology/cognition, which may help clarify within-diagnosis heterogeneity and high between-diagnosis co-occurrence.

Individuals with Autistic Traits Exhibit Heightened Alexithymia But Intact Interoceptive-Exteroceptive Sensory Integration

Interoceptive accuracy has been widely measured using the Heartbeat Tracking Test (HTT). We devised the novel paradigm of Interoception-Exteroception Synchronicity Judgement (IESJ) task to assess participants' interoceptive accuracy, exteroceptive accuracy, and the balancing score which reflected the ability to allocate attentions between interoceptive and exteroceptive signals. This study administered the behavioural paradigms of the HTT and the IESJ as well as other self-report scales to 119 typically-developing youths. Individuals with lower autistic traits (n = 30) showed comparable interoceptive accuracy, exteroceptive accuracy, and balancing scores as their higher autistic traits counterparts (n = 33). Taken together, the high autistic traits subgroup exhibited higher levels of alexithymia but not empathy or interoception than the low autistic traits subgroup.

Multidimensional Interoception and Autistic Traits Across life Stages: Evidence From a Novel Eye-tracking Task

Interoception is believed to underlie socio-cognitive functions which are often impaired in individuals with autism spectrum disorders (ASD). In this study, Experiment 1 examined in a sample of 114 neurotypical college students the associations among autistic traits, alexithymia, and interoceptive accuracy (IA), which was assessed by a novel paradigm "Eye-tracking Interoceptive Accuracy Task (EIAT). In Experiment 2, EIAT and the Autism Spectrum Quotient were administered to 52 preschool children, 50 adolescents, and 50 adults. Experiment 1 supported the association between autistic traits and alexithymia, but failed to support their association with multidimensional interoception. Experiment 2 strongly supported the association between age and IA. We conclude that cardiac IA differs between neurotypical age groups, but shows limited relationship with autistic traits.

Qualitative Evaluation of a Social Cognitive Training Program for Parents of Children with Autism from Hong Kong

A key feature of autism spectrum disorder is a dysfunction in social participation. This study aimed to explore the parents' perceptions and experiences of social cognitive training for their child with autism in the Hong Kong context. Using a qualitative narrative approach, twenty-three parent participants were interviewed using purposive sampling techniques. Data were analyzed using content analysis method. Three themes included: Improvements and changes in children's social participation across different settings; Challenges in the implementation of and engagement in the social cognitive training; and Parents' views and suggestions about the training. The findings supported that there were parent perceived improvements in their child's social skills and social participation. The interviews also revealed generalization of social skills and behaviors across home, school and community settings. The results of this study can inform therapists to design appropriate social cognitive intervention and improve social participation for this population group.

Oxytocin facilitates socially directed attention

Socially directed gaze following is an important component of social interaction and communication, allowing us to attend mutually with others to objects or people so that we can share their experience and also learn from them. This type of joint social attention is impaired in disorders such as autism. Previous research has demonstrated that the neuropeptide oxytocin can facilitate attention toward social cues, although to date no study in humans has investigated its influence on socially directed gaze or on associations of the latter with autistic and empathic traits. In a within-subject, randomized, placebo-controlled trial we used eye-tracking to investigate the effects of intranasal oxytocin (24 IU) on socially directed gaze toward one of two objects in 40 adult male subjects. Subjects viewed videos of an actor and actress directing their gaze toward one of two objects by either moving only their eyes, moving both their eyes and head, or moving their eyes and head and pointing with a finger. Results showed that OXT increased the proportion of time subjects viewed the object the actor or actress were looking/pointing at across all three conditions, although unexpectedly we found no associations with trait autism or empathy under either placebo or OXT treatments. These findings demonstrate that OXT can facilitate socially directed gaze following to promote mutual attention toward objects which may be potentially beneficial therapeutically in disorders with impaired social communication and interaction.

The Comprehensive Autistic Trait Inventory (CATI): development and validation of a new measure of autistic traits in the general population

BACKGROUND

Traits and characteristics qualitatively similar to those seen in diagnosed autism spectrum disorder can be found to varying degrees in the general population. To measure these traits and facilitate their use in autism research, several questionnaires have been developed that provide broad measures of autistic traits [e.g. Autism-Spectrum Quotient (AQ), Broad Autism Phenotype Questionnaire (BAPQ)]. However, since their development, our understanding of autism has grown considerably, and it is arguable that existing measures do not provide an ideal representation of the trait dimensions currently associated with autism. Our aim was to create a new measure of autistic traits that reflects our current understanding of autism, the Comprehensive Autism Trait Inventory (CATI).

METHODS

In Study 1, 107 pilot items were administered to 1119 individuals in the general population and exploratory factor analysis of responses used to create the 42-item CATI comprising six subscales: Social Interactions, Communication, Social Camouflage, Repetitive Behaviours, Cognitive Rigidity, and Sensory Sensitivity. In Study 2, the CATI was administered to 1068 new individuals and confirmatory factor analysis used to verify the factor structure. The AQ and BAPQ were administered to validate the CATI, and additional autistic participants were recruited to compare the predictive ability of the measures. In Study 3, to validate the CATI subscales, the CATI was administered to 195 new individuals along with existing valid measures qualitatively similar to each CATI subscale.

RESULTS

The CATI showed convergent validity at both the total-scale (r ≥ .79) and subscale level (r ≥ .68). The CATI also showed superior internal reliability for total-scale scores (α = .95) relative to the AQ (α = .90) and BAPQ (α = .94), consistently high reliability for subscales (α > .81), greater predictive ability for classifying autism (Youden's Index = .62 vs .56-.59), and demonstrated measurement invariance for sex.

LIMITATIONS

Analyses of predictive ability for classifying autism depended upon self-reported diagnosis or identification of autism. The autistic sample was not large enough to test measurement invariance of autism diagnosis.

CONCLUSIONS

The CATI is a reliable and economical new measure that provides observations across a wide range of trait dimensions associated with autism, potentially precluding the need to administer multiple measures, and to our knowledge, the CATI is also the first broad measure of autistic traits to have dedicated subscales for social camouflage and sensory sensitivity.

Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent in Chinese population: Screening autism spectrum disorder against attention-deficit/hyperactivity disorder and typically developing peers

LAY ABSTRACT

The Autism-Spectrum Quotient is a 50-item questionnaire developed to assess autistic symptoms in adults, adolescents and children. Its original version and others in different countries are known to be effective tools in identifying individuals with autism spectrum disorder. This study examined whether the Hong Kong Chinese versions of the Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent were effective in identifying autism spectrum disorder children and adolescents. On top of comparing them with their typically developing peers, this study also included a group of children/adolescents with attention deficit/hyperactivity disorder, a disorder with similar social difficulties as autism spectrum disorder. Results showed that both the Autism-Spectrum Quotient questionnaires were effective in differentiating the autism spectrum disorder group from the typically developing and attention-deficit/hyperactivity disorder groups, separately and jointly. On the contrary, they could not identify the attention-deficit/hyperactivity disorder group from the typically developing group so that they were not misclassifying attention-deficit/hyperactivity disorder as autism spectrum disorder. These findings supported that both the Autism-Spectrum Quotient-Child and Autism-Spectrum Quotient-Adolescent were not general measures of child and adolescent psychopathology, but could claim to be specific measures of autism spectrum disorder. Such capability would enormously enhance their utility in clinical practice for identifying autism spectrum disorder children/adolescents from their typically developing peers and from those with attention-deficit/hyperactivity disorder. This is because, the latter is a common neurodevelopmental disorder frequently presented to child psychiatric clinics alongside with autism spectrum disorder.

Coping style predicts sense of security and mediates the relationship between autistic traits and social anxiety: Moderation by a polymorphism of the FKBP5 gene

The mechanism underlying the relationship between autistic traits and social anxiety still remains unknown. It is therefore necessary to investigate potential psychological and biological mechanisms. A total of 2695 college students were samples for this research during 2017-2018. The assessed variables included demographic characteristics and measures of autistic traits, sense of security, coping styles, and social anxiety. Blood samples were collected from which DNA was extracted. Regression analysis indicated that autistic traits and negative coping were positively associated with social anxiety; furthermore, positive coping, interpersonal security, and sense of control were negatively associated with social anxiety. Further analyses demonstrated that the relationship between autistic traits and social anxiety was mediated by coping styles (both positive coping and negative coping) and sense of security (both interpersonal security and sense of control), and coping style predicted the sense of security. The FK506 binding protein 5 (FKBP5) gene rs3800373 moderated the association between autistic traits and social anxiety. The present study is the first to demonstrate that both coping style and sense of security play an intermediate role between autistic traits and social anxiety in a sample of Chinese college students; moreover, the FKBP5 gene moderates this association between autistic traits and social anxiety.

Bayesian Network Structure and Predictability of Autistic Traits

The aim of this work is to explore the construct of autistic traits through the lens of network analysis with recently introduced Bayesian methods. A conditional dependence network structure was estimated from a data set composed of 649 university students that completed an autistic traits questionnaire. The connectedness of the network is also explored, as well as sex differences among female and male subjects in regard to network connectivity. The strongest connections in the network are found between items that measure similar autistic traits. Traits related to social skills are the most interconnected items in the network. Sex differences are found between female and male subjects. The Bayesian network analysis offers new insight on the connectivity of autistic traits as well as confirms several findings in the autism literature.

The role of the MTG in negative emotional processing in young adults with autistic-like traits: A fMRI task study

BACKGROUND

Few previous studies explored negative emotion processing in autistic-like traits people using task-based fMRI. In this study, we applied task fMRI to determine the relationship between negative emotion processing and social skill within autistic-like traits people. aimed to find which brain areas specificity play a key role in emotional processing.

METHODS

106 of Chinese individuals measured with AQ. Then applied emotion regulation task to explore the difference in brain activation and functional connectivity in individuals with autistic traits.

RESULTS

The results showed increased activation in the right middle temporal gyrus (MTG). The mediation analysis showed the right MTG mediates the relationship between autistic-like traits and negative emotion. Generalized psychophysiological interaction (gPPI) analysis also suggested that the right MTG shows significant functional connectivity with the left parahippocampal gyrus (PHG) and left precuneus cortex.

LIMITATIONS

Our sample are university students, there may have a bias in the sample compared to sub-average and have no differences between the gender, we will broaden the sample size and take the gender into account. We use two conditions as our focused theme, we want to use a more specific task to explore negative emotion in autistic-like traits people.

CONCLUSIONS

The results showed that the right MTG was an important brain region in individuals with autistic-like traits, and our study provides a wider discussion about autism brain activation and functional connectivity patterns and the use the MTG as a hallmark in individuals with autistic-like traits.

Small fiber pathology in autism and clinical implications

OBJECTIVE

To investigate small fiber innervation of the skin and its relationships with clinicometry of autism and peripheral afferents for contact heat-evoked potential (CHEP) and psychophysical measures of thermal thresholds.

METHODS

We recruited 32 men with autism (26.5 ± 5.9 years) and conducted small fiber assessments of skin biopsy with quantifying intraepidermal nerve fiber (IENF) density, CHEP, quantitative sensory testing, and large fiber physiology of nerve conduction studies. Results were compared with age-matched controls and analyzed with clinical measures of autism.

RESULTS

Patients with autism showed a lower IENF density than controls (5.53 ± 2.09 vs 11.13 ± 3.49 fibers/mm, p < 0.0001). The IENF density was reduced in 17 (53.1%) men with autism classified as skin denervation group. On psychophysics, 9 (28%) men with autism had elevated thermal thresholds, and the warm threshold of the big toe was negatively correlated with IENF density (p = 0.0073), indicating functional impairments of small fiber sensory nerves. IENF density was negatively correlated with CHEP amplitude in autism (p = 0.003), in contrast to the pattern of positive correlation in controls, indicating different processing of nociceptive afferent in autism. Clinically, IENF density was related to distinct tactile symptom patterns in the skin denervation vs normal innervation group, respectively. Furthermore, IENF density was associated with autistic symptoms measured by the Autism Spectrum Quotient in a U-shaped model (p = 0.014).

CONCLUSIONS

These observations indicated that a substantial portion of individuals with autism had small fiber pathology, which was associated with tactile and autistic symptoms, providing structural and physiologic evidence for the involvement of peripheral sensory nerves in autism.

Oxytocin Facilitation of Emotional Empathy Is Associated With Increased Eye Gaze Toward the Faces of Individuals in Emotional Contexts

One of the most robust effects of intranasal oxytocin treatment is its enhancement of emotional empathy responses across cultures to individuals displaying emotions in realistic contexts in the Multifaceted Empathy Task (MET). However, it is not established if this effect of oxytocin on emotional empathy is due to altered visual attention toward different components of the stimulus pictures or an enhanced empathic response. In the current randomized placebo-controlled within-subject experiment on 40 healthy male individuals, we both attempted a further replication of emotional empathy enhancement by intranasal oxytocin (24 IU) and used eye-tracking measures to determine if this was associated by altered visual attention toward different components of the picture stimuli (background context, human face, and body posture). Results replicated previous findings of enhanced emotional empathy in response to both negative and positive stimuli and that this was associated with an increased proportion of time viewing the faces of humans in the pictures and a corresponding decrease in that toward the rest of the body and/or background context. Overall, our findings suggest that enhanced emotional empathy following oxytocin administration is due to increased attention to the faces of others displaying emotions and away from other contextual and social cues.

Clinical Trial Registration:www.ClinicalTrials.gov Oxytocin Modulates Eye Gaze Behavior During Social Processing; registration ID: NCT03293511; URL: https://clinicaltrials.gov/ct2/show/NCT03293511.

Exploring the spatial working memory and visual perception in children with autism spectrum disorder and general population with high autism-like traits

The aim of the study is to compare the spatial working memory and visual perception between children with autism spectrum disorder (ASD) and typically developing control (TDC). Furthermore, this study validated whether this impairment was a feature of autism in general population with different autism-like traits (ALTs). This study contains two parts: case-control study and community population study. The ASD group and the control group were enlisted voluntarily (ASD group, n = 52; control group, n = 32). In the population study, we recruited 2994 children. Based on the scores of Autism Spectrum Quotient (AQ), children were divided into two groups (higher ALTs n = 122, lower ALTs n = 122). The participants completed the cognition tasks focusing on spatial working memory, visual-motor integration, and Intelligence. Analysis of covariance (ANCOVA) was conducted, with potential confounders IQ, age, and gender were controlled. Pearson correlations were computed by controlling the IQ and age as covariate to better understand the relations between visual perception, spatial working memory, and autism-like traits. In the case-control study, the results of cognition tasks focusing on the spatial working memory and visual perception indicated underperformance in children with ASD. In the community population study, we found that individuals with higher ALTs performed worse than children with lower ALTs in spatial working memory. Pearson correlation analysis suggested that a correlation between SWM total errors and visual perception was identified both in the children with ASD and in community population (ASD group, r = -0.592, p<0.001; general population, r = -0.201, p = 0.003). It suggested that spatial working memory deficit was a characteristic of autism, and may be distributed across the general population. Furthermore, we speculated a correlation between spatial working memory and visual perception in children with ASD and in general population.

A Conceptual Framework for Understanding the Cultural and Contextual Factors on Autism Across the Globe

Autism research is heavily skewed toward western high-income countries. Culturally appropriate screening and diagnostic instruments for autism are lacking in most low- and middle-income settings where the majority of the global autism population lives. To date, a clear overview of the possible cultural and contextual factors that may affect the process of identifying and diagnosing individuals with autism spectrum disorders (ASD) is missing. This study aims to outline these factors by proposing a conceptual framework. A multidisciplinary review approach was applied to inform the development of the conceptual framework, combining a systematic review of the relevant autism research literature with a wider literature search spanning key texts in global mental health, cultural psychiatry, cross-cultural psychology, and intellectual disability research. The resulting conceptual framework considers the identification, help-seeking, and diagnostic process at four interrelated levels: (a) the expression; (b) recognition; (c) interpretation; and (d) reporting of autism symptoms, and describes the cultural and contextual factors associated with each of these levels, including cultural norms of typical and atypical behavior, culture-specific approaches to parenting, mental health literacy, cultural beliefs, attitudes and stigma, as well as the affordability, availability, accessibility, and acceptability of services. This framework, mapping out the cultural and contextual factors that can affect the identification, help-seeking, and diagnosis of ASD may function as a springboard for the development of culturally appropriate autism screening and diagnostic instruments, and inform future cross-cultural autism research directions. The framework also has relevance for clinicians and policy makers aiming to improve support for underserved autism populations worldwide. Autism Res 2020, 13: 1029-1050. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The vast majority of autism research is conducted in western high-income settings. We therefore know relatively little of how culture and context can affect the identification, help-seeking, and diagnosis of autism across the globe. This study synthesizes what is known from the autism research literature and a broader literature and maps out how culture and context may affect (a) the expression, (b) recognition, (c) interpretation, and (d) reporting of autism symptoms.

Comparing the Psychometric Properties of the Self- and Parent-Report Versions of Autism-Spectrum Quotient-Adult in Hong Kong (AQ-Adult-HK)

The Autism-Spectrum Quotient-Adult (AQ-Adult) is a screening tool for adults with autism spectrum disorder (ASD). The present study examined the psychometric properties of the Chinese self- and parent-report versions of the AQ-Adult in Hong Kong (AQ-Adult-HK). Participants included adults with ASD (n = 27) and community controls (n = 345). Parents of a subset of adults with ASD (n = 21) and controls (n = 87) also participated as informants. The parent-report version showed significantly stronger psychometric properties, including a larger area under receiver operating characteristic curve (AUC) and higher sensitivity/specificity, than those of the self-report version. The stronger psychometric properties of the former were related to its significantly higher ratings of ASD symptoms in the ASD adults.

Oxytocin biases eye-gaze to dynamic and static social images and the eyes of fearful faces: associations with trait autism

A key functional effect of intranasal oxytocin with potential therapeutic relevance for autism-spectrum disorder is its reported facilitation of attention towards social stimuli, notably the eye region of faces. In the current randomized placebo-controlled within-subject experiment on 40 healthy males, we investigated the robustness of this facilitation of attention by intranasal oxytocin (24IU) towards social cues. Eye-tracking measures of preference for dynamic and static social vs. non-social stimuli were taken in four different paradigms where autistic individuals tend to exhibit reduced interest in social stimuli. Additionally, we investigated whether oxytocin increases attention towards the eyes relative to other salient face regions in an emotional face paradigm. Results showed that the time spent viewing both dynamic and static social vs. non-social stimuli was negatively associated with trait autism and significantly increased following intranasal oxytocin. For face stimuli, oxytocin primarily increased gaze towards the eyes of fearful expression faces but not for other face emotions. Overall, our findings demonstrate that oxytocin significantly shifts gaze preference towards social vs. non-social stimuli and to the eyes of fearful faces. Importantly, oxytocin appears generally to shift attention more towards salient social stimuli of particular relevance in the context of autism providing further support for its potential therapeutic use in autism-spectrum disorder.