An examination of active inference in autistic adults using immersive virtual reality

Interceptive abilities in autism spectrum disorder: Comparing naturalistic and virtual visuomotor tasks

A growing body of research reveals that autistic individuals exhibit motor coordination challenges. Multiple theoretical frameworks propose that the seemingly disparate features of autism may arise from a common underlying process: a diminished ability to make predictions. Sensorimotor skills, such as catching a ball, critically rely on predicting the ball's trajectory as well as anticipatory coordination of the entire body. Here, we assessed four different naturalistic and virtual interception tasks with 31 neurotypical and 23 autistic children (ages 7-12). In a naturalistic setting, participants caught the ball either with their hands or a hand-held funnel with an enlarged catch area that also prevented the ball from bouncing off. A virtual setup reduced whole-body demands, as children only moved a paddle to catch or bounce a ball on a screen. Control tasks, involving rapid reaching to grasp a static object and quiet standing, which largely eliminated the requirements for prediction, were also tested. Results from all task variations demonstrated that autistic children completed fewer successful interceptions, suggesting that predictive requirements, inherent to all interception tasks, played a critical role. Effect sizes in the virtual tasks were smaller. Correlations of the task metrics with behavioral assessments rendered the strongest correlations with Praxis scores. The control tasks showed no differences between autistic and neurotypical children. These findings lend support to the emerging hypothesis that predictive challenges are present in autism. Further research with larger sample sizes will help identify to what extent these visuomotor differences may inform core domains of autism.

Toward a strengths-based model for designing virtual reality learning experiences for autistic users

LAY ABSTRACT

Virtual reality has been studied for its potential in supporting individuals with autism, but existing research often focuses on deficits and lacks consideration of individual preferences and strengths. This article introduces a framework that emphasizes the strengths and abilities of autistic individuals when designing virtual reality interventions. It builds upon an existing taxonomy of educational technology affordances and extends it to align with the unique needs of autistic individuals. The framework provides guidance for incorporating virtual reality technology that supports and amplifies autistic strengths, such as visual perception and response to positive feedback. The framework has implications for practice, research, and policy. For practitioners, it offers a tool for designing virtual reality experiences that cater to the strengths of autistic individuals, enhancing engagement and educational outcomes. Researchers can utilize the framework to guide the development of user-centered virtual reality interventions and expand our understanding of the potential benefits of virtual reality for autistic populations. Policymakers and educators can consider this framework when incorporating virtual reality into educational settings, ensuring that virtual reality technology is used in a way that aligns with the strengths and needs of autistic learners. Overall, the framework promotes a strengths-based approach in utilizing virtual reality technology for individuals with autism, fostering inclusivity and maximizing the benefits of immersive experiences.

The role of prediction and visual tracking strategies during manual interception: An exploration of individual differences

The interception (or avoidance) of moving objects is a common component of various daily living tasks; however, it remains unclear whether precise alignment of foveal vision with a target is important for motor performance. Furthermore, there has also been little examination of individual differences in visual tracking strategy and the use of anticipatory gaze adjustments. We examined the importance of in-flight tracking and predictive visual behaviors using a virtual reality environment that required participants (n = 41) to intercept tennis balls projected from one of two possible locations. Here, we explored whether different tracking strategies spontaneously arose during the task, and which were most effective. Although indices of closer in-flight tracking (pursuit gain, tracking coherence, tracking lag, and saccades) were predictive of better interception performance, these relationships were rather weak. Anticipatory gaze shifts toward the correct release location of the ball provided no benefit for subsequent interception. Nonetheless, two interceptive strategies were evident: 1) early anticipation of the ball's onset location followed by attempts to closely track the ball in flight (i.e., predictive strategy); or 2) positioning gaze between possible onset locations and then using peripheral vision to locate the moving ball (i.e., a visual pivot strategy). Despite showing much poorer in-flight foveal tracking of the ball, participants adopting a visual pivot strategy performed slightly better in the task. Overall, these results indicate that precise alignment of the fovea with the target may not be critical for interception tasks, but that observers can adopt quite varied visual guidance approaches.

Investigating how Explicit Contextual Cues Affect Predictive Sensorimotor Control in Autistic Adults

Research suggests that sensorimotor difficulties in autism could be reduced by providing individuals with explicit contextual information. To test this, we examined autistic visuomotor control during a virtual racquetball task, in which participants hit normal and unexpectedly-bouncy balls using a handheld controller. The probability of facing each type of ball was varied unpredictably over time. However, during cued trials, participants received explicit information about the likelihood of facing each uncertain outcome. When compared to neurotypical controls, autistic individuals displayed poorer task performance, atypical gaze profiles, and more restricted swing kinematics. These visuomotor patterns were not significantly affected by contextual cues, indicating that autistic people exhibit underlying differences in how prior information and environmental uncertainty are dynamically modulated during movement tasks.

Testing predictive coding theories of autism spectrum disorder using models of active inference

Several competing neuro-computational theories of autism have emerged from predictive coding models of the brain. To disentangle their subtly different predictions about the nature of atypicalities in autistic perception, we performed computational modelling of two sensorimotor tasks: the predictive use of manual gripping forces during object lifting and anticipatory eye movements during a naturalistic interception task. In contrast to some accounts, we found no evidence of chronic atypicalities in the use of priors or weighting of sensory information during object lifting. Differences in prior beliefs, rates of belief updating, and the precision weighting of prediction errors were, however, observed for anticipatory eye movements. Most notably, we observed autism-related difficulties in flexibly adapting learning rates in response to environmental change (i.e., volatility). These findings suggest that atypical encoding of precision and context-sensitive adjustments provide a better explanation of autistic perception than generic attenuation of priors or persistently high precision prediction errors. Our results did not, however, support previous suggestions that autistic people perceive their environment to be persistently volatile.

An investigation of feed-forward and feedback eye movement training in immersive virtual reality

The control of eye gaze is critical to the execution of many skills. The observation that task experts in many domains exhibit more efficient control of eye gaze than novices has led to the development of gaze training interventions that teach these behaviours. We aimed to extend this literature by i) examining the relative benefits of feed-forward (observing an expert's eye movements) versus feed-back (observing your own eye movements) training, and ii) automating this training within virtual reality. Serving personnel from the British Army and Royal Navy were randomised to either feed-forward or feed-back training within a virtual reality simulation of a room search and clearance task. Eye movement metrics - including visual search, saccade direction, and entropy - were recorded to quantify the efficiency of visual search behaviours. Feed-forward and feed-back eye movement training produced distinct learning benefits, but both accelerated the development of efficient gaze behaviours. However, we found no evidence that these more efficient search behaviours transferred to better decision making in the room clearance task. Our results suggest integrating eye movement training principles within virtual reality training simulations may be effective, but further work is needed to understand the learning mechanisms.

From "one big clumsy mess" to "a fundamental part of my character." Autistic adults' experiences of motor coordination

Altered motor coordination is common in autistic individuals affecting a range of movements such as manual dexterity, eye-hand coordination, balance and gait. However, motor coordination is not routinely assessed leading to undiagnosed and untreated motor coordination difficulties, particularly in adults. Few studies have investigated motor coordination difficulties and their impact from the viewpoint of autistic people. Therefore, the current study used FGs and thematic analysis to document the experience of motor coordination difficulties from the viewpoint of 17 autistic adults. Four main themes were identified. First, motor coordination difficulties were pervasive and variable, being present life-long and within multiple movements and affecting many aspects of life. Furthermore, the nature of the difficulties was variable within and between participants along with differing awareness of coordination ability. Second, participants described motor coordination as an active process, requiring concentration for most actions and at a level seemingly greater than other people. Third, motor coordination difficulties impacted upon social and emotional wellbeing by placing strain on relationships, prompting bullying and exclusion, putting safety at risk and causing a range of negative emotions. Fourth, in the absence of any support, participants described multiple learning and coping strategies. Findings highlight how it is essential to address the current lack of support for motor coordination considering the significant social and emotional consequences described by our participants. Further investigation of motor learning and interactions between sensory and motor performance in autistic adults is also warranted.

My Lovely Granny's Farm: An immersive virtual reality training system for children with autism spectrum disorder

One of the biggest difficulties faced by children with Autism Spectrum Disorder during their learning process and general life, is communication and social interaction. In recent years, researchers and practitioners have invested in different approaches to improving aspects of their communication and learning. However, there is still no consolidated approach and the community is still looking for new approaches that can meet this need. Addressing this challenge, in this article we propose a novelty approach (i.e., an Adaptive Immersive Virtual Reality Training System), aiming to enrich social interaction and communication skills for children with Autism Spectrum Disorder. In this adaptive system (called My Lovely Granny's Farm), the behavior of the virtual trainer changes depending on the mood and actions of the users (i.e., patients/learners). Additionally, we conducted an initial observational study by monitoring the behavior of children with autism in a virtual environment. In the initial study, the system was offered to users with a high degree of interactivity so that they might practice various social situations in a safe and controlled environment. The results demonstrate that the use of the system can allow patients who needed treatment to receive therapy without leaving home. Our approach is the first experience of treating children with autism in Kazakhstan and can contribute to improving the communication and social interaction of children with Autism Spectrum Disorder. We contribute to the community of educational technologies and mental health by providing a system that can improve communication among children with autism and providing insights on how to design this kind of system.

The effect of performance pressure and error-feedback on anxiety and performance in an interceptive task

Introduction

Whilst the disruptive effects of anxiety on attention and performance have been well documented, the antecedents to anxiety in motivated performance scenarios are less well understood. We therefore sought to understand the cognitive appraisals that mediate the relationship between pressurised performance situations and the onset of anxiety.

Methods

We tested the effects of performance pressure and error feedback on appraisals of the probability and cost of failure, the experience of anxiety, and subsequent impacts on visual attention, movement kinematics, and task performance during a virtual reality interception task.

Results

A series of linear mixed effects models indicated that failure feedback and situational pressure influenced appraisals of the probability and cost of failure, which subsequently predicted the onset of anxious states. We did not, however, observe downstream effects on performance and attention.

Discussion

The findings support the predictions of Attentional Control Theory Sport, that (i) momentary errors lead to negative appraisals of the probability of future failure; and (ii) that appraisals of both the cost and probability of future failure are important predictors of anxiety. The results contribute to a better understanding of the precursors to anxiety and the feedback loops that may maintain anxious states.

Transdiagnostic computations of uncertainty: towards a new lens on intolerance of uncertainty

People radically differ in how they cope with uncertainty. Clinical researchers describe a dispositional characteristic known as "intolerance of uncertainty", a tendency to find uncertainty aversive, reported to be elevated across psychiatric and neurodevelopmental conditions. Concurrently, recent research in computational psychiatry has leveraged theoretical work to characterise individual differences in uncertainty processing. Under this framework, differences in how people estimate different forms of uncertainty can contribute to mental health difficulties. In this review, we briefly outline the concept of intolerance of uncertainty within its clinical context, and we argue that the mechanisms underlying this construct may be further elucidated through modelling how individuals make inferences about uncertainty. We will review the evidence linking psychopathology to different computationally specified forms of uncertainty and consider how these findings might suggest distinct mechanistic routes towards intolerance of uncertainty. We also discuss the implications of this computational approach for behavioural and pharmacological interventions, as well as the importance of different cognitive domains and subjective experiences in studying uncertainty processing.

10 years of Bayesian theories of autism: A comprehensive review

Ten years ago, Pellicano and Burr published one of the most influential articles in the study of autism spectrum disorders, linking them to aberrant Bayesian inference processes in the brain. In particular, they proposed that autistic individuals are less influenced by their brains' prior beliefs about the environment. In this systematic review, we investigate if this theory is supported by the experimental evidence. To that end, we collect all studies which included comparisons across diagnostic groups or autistic traits and categorise them based on the investigated priors. Our results are highly mixed, with a slight majority of studies finding no difference in the integration of Bayesian priors. We find that priors developed during the experiments exhibited reduced influences more frequently than priors acquired previously, with various studies providing evidence for learning differences between participant groups. Finally, we focus on the methodological and computational aspects of the included studies, showing low statistical power and often inconsistent approaches. Based on our findings, we propose guidelines for future research.

Task-evoked pupillary responses track precision-weighted prediction errors and learning rate during interceptive visuomotor actions

In this study, we examined the relationship between physiological encoding of surprise and the learning of anticipatory eye movements. Active inference portrays perception and action as interconnected inference processes, driven by the imperative to minimise the surprise of sensory observations. To examine this characterisation of oculomotor learning during a hand-eye coordination task, we tested whether anticipatory eye movements were updated in accordance with Bayesian principles and whether trial-by-trial learning rates tracked pupil dilation as a marker of 'surprise'. Forty-four participants completed an interception task in immersive virtual reality that required them to hit bouncing balls that had either expected or unexpected bounce profiles. We recorded anticipatory eye movements known to index participants' beliefs about likely ball bounce trajectories. By fitting a hierarchical Bayesian inference model to the trial-wise trajectories of these predictive eye movements, we were able to estimate each individual's expectations about bounce trajectories, rates of belief updating, and precision-weighted prediction errors. We found that the task-evoked pupil response tracked prediction errors and learning rates but not beliefs about ball bounciness or environmental volatility. These findings are partially consistent with active inference accounts and shed light on how encoding of surprise may shape the control of action.

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

Active inference, morphogenesis, and computational psychiatry

Active inference is a leading theory in neuroscience that provides a simple and neuro-biologically plausible account of how action and perception are coupled in producing (Bayes) optimal behavior; and has been recently used to explain a variety of psychopathological conditions. In parallel, morphogenesis has been described as the behavior of a (non-neural) cellular collective intelligence solving problems in anatomical morphospace. In this article, we establish a link between the domains of cell biology and neuroscience, by analyzing disorders of morphogenesis as disorders of (active) inference. The aim of this article is three-fold. We want to: (i) reveal a connection between disorders of morphogenesis and disorders of active inference as apparent in psychopathological conditions; (ii) show how disorders of morphogenesis can be simulated using active inference; (iii) suggest that active inference can shed light on developmental defects or aberrant morphogenetic processes, seen as disorders of information processing, and perhaps suggesting novel intervention and repair strategies. We present four simulations illustrating application of these ideas to cellular behavior during morphogenesis. Three of the simulations show that the same forms of aberrant active inference (e.g., deficits of sensory attenuation and low sensory precision) that have been used to explain psychopathological conditions (e.g., schizophrenia and autism) also produce familiar disorders of development and morphogenesis when implemented at the level of the collective behavior of a group of cells. The fourth simulation involves two cells with too high precision, in which we show that the reduction of concentration signaling and sensitivity to the signals of other cells treats the development defect. Finally, we present the results of an experimental test of one of the model's predictions in early Xenopus laevis embryos: thioridazine (a dopamine antagonist that may reduce sensory precision in biological systems) induced developmental (anatomical) defects as predicted. The use of conceptual and empirical tools from neuroscience to understand the morphogenetic behavior of pre-neural agents offers the possibility of new approaches in regenerative medicine and evolutionary developmental biology.

Motivation from Agency and Reward in Typical Development and Autism: Narrative Review of Behavioral and Neural Evidence

Our ability to perform voluntary actions and make choices is shaped by the motivation from having control over the resulting effects (agency) and positive outcomes (reward). We offer an overview of distinct and common behavioral and neural signatures of agency and reward. We discuss their typical and atypical developmental trajectories, focusing on autism spectrum disorder (ASD), which is characterized by neurodiverse processes underlying action selection. We propose that reduced sensitivity to agency and reward in ASD may be related to atypical multisensory processes and motor planning, with potential for understanding restricted and repetitive behaviors. We emphasize the limitations of the existing literature, and prospects for future research. Understanding the neurocognitive processes that shape the way people with ASD select actions and perceive outcomes is essential to support not only learning, but also volition and self-determination.