Children with autism display more social behaviors after repeated imitation sessions

Parental Imitations and Expansions of Child Language Predict Later Language Outcomes of Autistic Preschoolers

Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent-child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers' language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.

Dancing out for a voice; a narrative review of the literature exploring autism, physical activity, and dance

Autism Spectrum Disorder is characterised by profound challenges with social communication and social interaction. Currently, there are few therapeutic interventions that successfully target some of the functionally impairing traits associated with autism. Furthermore, many of these interventions comprise a variety of limitations; including, limited accessibility, extensive durations, or the requirement of a trained professional to deliver the intervention. New research suggests that instead of targeting all traits associated with Autism Spectrum Disorder with a single solution, scientific research should focus on providing therapeutic tools that alleviate functionally impairing facets specific to the individual. Owing to the nature of physical activity, sports, and dance (coordinated movement) these activities could provide opportunities to enhance communication skills and social development in autistic children. Therefore, this paper gives a narrative overview of the literature surrounding communication and coordinated movement; outlining what is meant by communication challenges, exploring the benefits of coordinated movement for traits associated with Autism Spectrum Disorder, and delineating how coordinated movement elicits positive outcomes for autistic children.

The mirror mechanism in schizophrenia: A systematic review and qualitative meta-analysis

BACKGROUND

Mirror neuron system (MNS) consists of visuomotor neurons that are responsible for the mirror neuron activity (MNA), meaning that each time an individual observes another individual performing an action, these neurons encode that action, and are activated in the observer's cortical motor system. Previous studies report its malfunction in autism, opening doors to investigate the underlying pathophysiology of the disorder in a more elaborate way and coming up with new rehabilitation methods. The study of MNA function in schizophrenia patients has not been as frequent and conclusive as in autism. In this research, we aimed to evaluate the functional integrity of MNA and the microstructural integrity of MNS in schizophrenia patients.

METHODS

We included case-control studies that have evaluated MNA in schizophrenia patients compared to healthy controls using a variety of objective assessment tools. In August 2022, we searched Embase, PubMed, and Web of Science for eligible studies. We used an adapted version of the NIH Quality Assessment of Case-Control Studies tool to assess the quality of the included studies. Evidence was analyzed using vote counting methods of the direction of the effect and was tested statistically using the Sign test. Certainty of evidence was assessed using CERQual.

RESULTS

We included 32 studies for the analysis. Statistical tests revealed decreased MNA (p = 0.002) in schizophrenia patients. The certainty of the evidence was judged to be moderate. Investigations of heterogeneity revealed a possible relationship between the age and the positive symptoms of participants in the included studies and the direction of the observed effect.

DISCUSSION

This finding contributes to gaining a better understanding of the underlying pathophysiology of the disorder by revealing its possible relation to some of the symptoms in schizophrenia patients, while also highlighting a new commonality with autism.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO identifier: CRD42021236453.

Effectivity of Play-Based Interventions in Children with Autism Spectrum Disorder and Their Parents: A Systematic Review

Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB.

Robot-Assisted Autism Therapy (RAAT). Criteria and Types of Experiments Using Anthropomorphic and Zoomorphic Robots. Review of the Research

Supporting the development of a child with autism is a multi-profile therapeutic work on disturbed areas, especially understanding and linguistic expression used in social communication and development of social contacts. Previous studies show that it is possible to perform some therapy using a robot. This article is a synthesis review of the literature on research with the use of robots in the therapy of children with the diagnosis of early childhood autism. The review includes scientific journals from 2005-2021. Using descriptors: ASD (Autism Spectrum Disorders), Social robots, and Robot-based interventions, an analysis of available research in PubMed, Scopus and Web of Science was done. The results showed that a robot seems to be a great tool that encourages contact and involvement in joint activities. The review of the literature indicates the potential value of the use of robots in the therapy of people with autism as a facilitator in social contacts. Robot-Assisted Autism Therapy (RAAT) can encourage child to talk or do exercises. In the second aspect (prompting during a conversation), a robot encourages eye contact and suggests possible answers, e.g., during free conversation with a peer. In the third aspect (teaching, entertainment), the robot could play with autistic children in games supporting the development of joint attention. These types of games stimulate the development of motor skills and orientation in the body schema. In future work, a validation test would be desirable to check whether children with ASD are able to do the same with a real person by learning distrust and cheating the robot.

Reciprocity and alignment: quantifying coupling in dynamic interactions

Recent accounts of social cognition focus on how we do things together, suggesting that becoming aligned relies on a reciprocal exchange of information. The next step is to develop richer computational methods that quantify the degree of coupling and describe the nature of the information exchange. We put forward a definition of coupling, comparing it to related terminology and detail, available computational methods and the level of organization to which they pertain, presenting them as a hierarchy from weakest to richest forms of coupling. The rationale is that a temporally coherent link between two dynamical systems at the lowest level of organization sustains mutual adaptation and alignment at the highest level. Postulating that when we do things together, we do so dynamically over time and we argue that to determine and measure instances of true reciprocity in social exchanges is key. Along with this computationally rich definition of coupling, we present challenges for the field to be tackled by a diverse community working towards a dynamic account of social cognition.

Computerized Assessment of Motor Imitation as a Scalable Method for Distinguishing Children With Autism

BACKGROUND

Imitation deficits are prevalent in autism spectrum conditions (ASCs) and are associated with core autistic traits. Imitating others' actions is central to the development of social skills in typically developing populations, as it facilitates social learning and bond formation. We present a Computerized Assessment of Motor Imitation (CAMI) using a brief (1-min), highly engaging video game task.

METHODS

Using Kinect Xbox motion tracking technology, we recorded 48 children (27 with ASCs, 21 typically developing) as they imitated a model's dance movements. We implemented an algorithm based on metric learning and dynamic time warping that automatically detects and evaluates the important joints and returns a score considering spatial position and timing differences between the child and the model. To establish construct validity and reliability, we compared imitation performance measured by the CAMI method to the more traditional human observation coding (HOC) method across repeated trials and two different movement sequences.

RESULTS

Results revealed poorer imitation in children with ASCs than in typically developing children (ps < .005), with poorer imitation being associated with increased core autism symptoms. While strong correlations between the CAMI and HOC methods (rs = .69-.87) confirmed the CAMI's construct validity, CAMI scores classified the children into diagnostic groups better than the HOC scores (accuracyCAMI = 87.2%, accuracyHOC = 74.4%). Finally, by comparing repeated movement trials, we demonstrated high test-retest reliability of CAMI (rs = .73-.86).

CONCLUSIONS

Findings support the CAMI as an objective, highly scalable, directly interpretable method for assessing motor imitation differences, providing a promising biomarker for defining biologically meaningful ASC subtypes and guiding intervention.

The role of eye contact in young children's judgments of others' visibility: A comparison of preschoolers with and without autism spectrum disorder

Typically-developing (TD) children under age 5 often deny that they can see a person whose eyes are covered (e.g., Moll & Khalulyan, 2017). This has been interpreted as a manifestation of their preference for reciprocal interactions. We investigated how 3- to 4-year-old children with autism spectrum disorder (ASD, n = 12) respond in this situation. Because a lack of interpersonal connectedness and reciprocal communication are core features of this disorder, we predicted that young children with ASD will not make mutual regard a condition for seeing another person and therefore acknowledge being able to see her. Against this prediction, children with ASD gave the same negative answers as a group of TD (n = 36) age-mates. Various interpretations are discussed, including the possibility that some children with ASD are capable of relating to others as second persons.

Making Meaning Together: Embodied Narratives in a Case of Severe Autism

Shared understanding is generated between individuals before speech through a language of body movement and non-verbal vocalisation, expression of feeling and interest made in gestures of movement and voice. Human understanding is co-created in these embodied projects, displayed in serially organised expressions with shared timing of reciprocal actions between partners. These develop in narrative events that build over cycles of reciprocal expressive action in a four-part structure shared by all the time-based arts: "introduction," "development," "climax," and "conclusion." Pre-linguistic narrative establishes the foundation of later, linguistic intelligence. Yet, participating in social interactions that give rise to narrative development is a central problem of autism spectrum disorder. In this paper, we examine the rapid growth of narrative meaning-making between a non-verbal young woman with severe autism and her new therapist. Episodes of embodied, shared understanding were enabled through a basic therapeutic mode of reciprocal, creative mirroring of expressive gesture. These developed through reciprocal cycles and as the relationship progressed, complete co-created narratives were formed resulting in shared joy and the mutual interest and trust of companionship. These small, embodied stories enabled moments of co-regulated arousal that the young woman had previous difficulty with. These data provide evidence for an intact capacity for non-verbal narrative meaning-making in autism.

A Systematic Review of Interventions to Improve the Occupation of Play in Children With Autism

Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not established. To examine the efficacy of strategies used in occupational therapy to improve play in ASD, authors completed a systematic review of papers from January 1980 through January 2019. Search terms included autism, Asperger's, ASD, autistic in combination with play, playfulness, pretend, imagination, praxis, creativity, and generativity. Twenty papers met inclusion criteria and were reviewed. Reviewed interventions included parent education, modified play materials or environments, imitation of the child, and modeling by an adult, a peer, or video. Moderate to strong support exists for the specific strategies of imitation of the child and modeling for the child, with lesser or mixed support for other strategies. Certain strategies commonly used in occupational therapy may be effective in improving the occupation of play in ASD.

Moving Along and Beyond the Spectrum: Creative Group Therapy for Children With Autism

Group therapy for autism confronts the core of the syndrome. Non-directed dynamic approaches, in which moment-to-moment spontaneous expressions drive the content of group sessions, are even more intricate. The implementation of nonverbal creative techniques holds the key to self-expression and self-other exploration, promoting communication and play. This manuscript offers an integrative conceptual model and a case report regarding such mind-body therapeutic perspective. The creative arts intervention is presented via a small group of young minimally verbal children with autism, deprived of communicative language, offering an interdisciplinary perspective to delineate group challenges and rationale, process, and outcomes. Vignettes are provided to illustrate the group development. A thorough discussion follows, addressing three intertwining axes: firstly, the implications of nonverbal creative means are considered; secondly, the psychophysiological processes set in motion through sensory-motor experiences are deliberated; and thirdly, the emergence of "moments of meeting" and spontaneously generated playful group activities are enlightened.

Communication interventions for autism spectrum disorder in minimally verbal children

BACKGROUND

Autism spectrum disorder (ASD) has an estimated prevalence of around 1.7% of the population. People with ASD often also have language difficulties, and about 25% to 30% of children with ASD either fail to develop functional language or are minimally verbal. The ability to communicate effectively is an essential life skill, and difficulties with communication can have a range of adverse outcomes, including poorer academic achievement, behavioural difficulties and reduced quality of life. Historically, most studies have investigated communication interventions for ASD in verbal children. We cannot assume the same interventions will work for minimally verbal children with ASD.

OBJECTIVES

To assess the effects of communication interventions for ASD in minimally verbal children.

SEARCH METHODS

We searched CENTRAL, MEDLINE and Embase as well as 12 other databases and three trials registers in November 2017. We also checked the reference lists of all included studies and relevant reviews, contacting experts in the field as well as authors of identified studies about other potentially relevant ongoing and unpublished studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of communication-focused interventions for children (under 12 years of age) diagnosed with ASD and who are minimally verbal (fewer than 30 functional words or unable to use speech alone to communicate), compared with no treatment, wait-list control or treatment as usual.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological procedures.

MAIN RESULTS

This review includes two RCTs (154 children aged 32 months to 11 years) of communication interventions for ASD in minimally verbal children compared with a control group (treatment as usual). One RCT used a verbally based intervention (focused playtime intervention; FPI) administered by parents in the home, whereas the other used an alternative and augmentative communication (AAC) intervention (Picture Exchange Communication System; PECS) administered by teachers in a school setting.The FPI study took place in the USA and included 70 participants (64 boys) aged 32 to 82 months who were minimally verbal and had received a diagnosis of ASD. This intervention focused on developing coordinated toy play between child and parent. Participants received 12 in-home parent training sessions for 90 minutes per session for 12 weeks, and they were also invited to attend parent advocacy coaching sessions. This study was funded by the National Institute of Child Health and Human Development, the MIND Institute Research Program and a Professional Staff Congress-City University of New York grant. The PECS study included 84 minimally verbal participants (73 boys) aged 4 to 11 years who had a formal diagnosis of ASD and who were not using PECS beyond phase 1 at baseline. All children attended autism-specific classes or units, and most classes had a child to adult ratio of 2:1. Teachers and parents received PECS training (two-day workshop). PECS consultants also conducted six half-day consultations with each class once per month over five months. This study took place in the UK and was funded by the Three Guineas Trust.Both included studies had high or unclear risk of bias in at least four of the seven 'Risk of bias' categories, with a lack of blinding for participants and personnel being the most problematic area. Using the GRADE approach, we rated the overall quality of the evidence as very low due to risk of bias, imprecision (small sample sizes and wide confidence intervals) and because there was only one trial identified per type of intervention (i.e. verbally based or AAC).Both studies focused primarily on communication outcomes (verbal and non-verbal). One of the studies also collected information on social communication. The FPI study found no significant improvement in spoken communication, measured using the expressive language domain of the Mullen Scale of Early Learning expressive language, at postintervention. However, this study found that children with lower expressive language at baseline (less than 11.3 months age-equivalent) improved more than children with better expressive language and that the intervention produced expressive language gains in some children. The PECS study found that children enrolled in the AAC intervention were significantly more likely to use verbal initiations and PECS symbols immediately postintervention; however, gains were not maintained 10 months later. There was no evidence that AAC improved frequency of speech, verbal expressive vocabulary or children's social communication or pragmatic language immediately postintervention. Overall, neither of the interventions (PECS or FPI) resulted in maintained improvements in spoken or non-verbal communication in most children.Neither study collected information on adverse events, other communication skills, quality of life or behavioural outcomes.

AUTHORS' CONCLUSIONS

There is limited evidence that verbally based and ACC interventions improve spoken and non-verbal communication in minimally verbal children with ASD. A substantial number of studies have investigated communication interventions for minimally verbal children with ASD, yet only two studies met inclusion criteria for this review, and we considered the overall quality of the evidence to be very low. In the study that used an AAC intervention, there were significant gains in frequency of PECS use and verbal and non-verbal initiations, but not in expressive vocabulary or social communication immediately postintervention. In the study that investigated a verbally based intervention, there were no significant gains in expressive language postintervention, but children with lower expressive language at the beginning of the study improved more than those with better expressive language at baseline. Neither study investigated adverse events, other communication skills, quality of life or behavioural outcomes. Future RCTs that compare two interventions and include a control group will allow us to better understand treatment effects in the context of spontaneous maturation and will allow further comparison of different interventions as well as the investigation of moderating factors.

Oxytocin facilitates reciprocity in social communication

Synchrony in social groups may confer significant evolutionary advantages by improving group cohesion and social interaction. However, the neurobiological mechanisms translating social synchrony into refined social information transmission between interacting individuals are still elusive. In two successively conducted experiments involving a total of 306 healthy volunteers, we explored the involvement of the neuropeptide oxytocin (OXT) in reciprocal social interaction. First, we show that synchronous social interactions evoke heightened endogenous OXT release in dyadic partners. In a second step, we examined the consequences of elevated OXT concentrations on emotion transmission by intranasally administering synthetic OXT before recording emotional expressions. Intriguingly, our data demonstrate that the subjects' facial and vocal expressiveness of fear and happiness is enhanced after OXT compared with placebo administration. Collectively, our findings point to a central role of social synchrony in facilitating reciprocal communication between individuals via heightened OXT signaling. Elevated OXT concentrations among synchronized individuals seem to augment the partners' emotional expressiveness, thereby contributing to improved transmission of emotional information in social communication.

A systematic review and evaluation of procedures for the induction of speech among persons with developmental disabilities

OBJECTIVE

Deficits in vocal speech are common among those with developmental disabilities. This review examines interventions for teaching speech to individuals who presented as nonspeaking, or with low levels of vocalizations at baseline, and assesses evidence-based practice in this area.

METHODS

Systematic searches identified 78 studies suitable for inclusion. These studies were evaluated in terms of (a) participants, (b) intervention, (c) intervention setting, (d) intervention agent, (e) treatment efficacy, (f) generalization and maintenance of treatment effects, and (g) research rigor.

RESULTS

A variety of interventions, primarily behavioral, intended to induce vocal speech were delivered to participants with developmental disabilities aged between six months and 57 years. Treatment efficacy was variable (PND M = 52.9%; range 0%-100%); however, results indicated that behavioral interventions constituted evidence-based practice. Non-behavioral strategies were shown to have received insufficient research evaluation to date.

CONCLUSION

Results indicate that a number of procedures can induce speech among individuals with developmental disabilities.

Through the Kinesthetic Lens: Observation of Social Attunement in Autism Spectrum Disorders

This paper will present a movement-informed perspective to social attunement in Autism Spectrum Disorders (ASD).

BACKGROUND

Dance movement therapy (DMT) is a psychotherapeutic intervention that is used with participants with ASD in various settings. Regular clinical outcome monitoring in an outpatient setting in the Netherlands had shown positive effects on social attunement capacities in young people with ASD. However, a systematic study of the development of social attunement movement behaviors of participants with ASD throughout a DMT intervention was not yet available.

METHODS

A series of individual cases of DMT with young people with ASD (mean age 12.2 years.) were analyzed for changes in interpersonal movement behaviors employing video-based retrospective observation.

RESULTS

The findings were summarized in an observation scale for interpersonal movement behaviors. This scale was then tested for its applicability for the monitoring of social attunement behaviors throughout therapy.

DISCUSSION

A movement-informed perspective may be helpful to inventory changes in social attunement behaviors in participants with ASD. The relevance of a movement-informed perspective for the concept of social attunement in ASD will be discussed.

The Social Effect of "Being Imitated" in Children with Autism Spectrum Disorder

There is evidence that “being imitated” has social effects, and that the imitation of the child's actions may be used as a strategy to promote social engagement in children with autism spectrum disorder (ASD). The observation of someone that imitates us recruits, indeed, neural areas involved in social cognition. We reviewed studies exploring the behavioral consequences of “being imitated” in children with ASD. We aimed at assessing what are the social skills targeted by this strategy, and the factors that may improve the response. The “being imitated” strategy improves social gazes, proximal social behaviors, and play skills, particularly in children with low developmental level, and also when the strategy is implemented by children's mothers. The “being imitated” may be used as a tool in early intervention to improve social skills, helping to assess the effects of intervention at both behavioral and neural level.

Contingent imitation increases verbal interaction in children with autism spectrum disorders

Several studies have suggested that contingent adult imitation increase nonverbal communication, such as attention and proximity to adults, in children with autism spectrum disorders. However, few studies have shown the effect of contingent imitation on verbal communication. This study examined whether children with autism were able to promote verbal interaction such as vocal imitation, vocalization, and vocal turn-taking via contingent imitation. We used an alternating treatment design composed of the conditions of contingent imitation and control for six children with autism (aged 33-63 months). For contingent imitation condition, adults imitated children's vocalization immediately. For control condition, adults did not imitate but gave a vocal response immediately. Results showed that in contingent imitation condition, all children increased the number of vocal imitations and vocal turn-takings compared with control condition. The number of vocalizations increased in both condition for all children. Overall, it is suggested that all children promote verbal interaction via contingent imitation.

Neuroendocrine and behavioral response to social rupture and repair in preschoolers with autism spectrum disorders interacting with mother and father

Background

Preschoolers with autism spectrum disorder (ASD) exhibit difficulties in handling social stress and utilizing efficient emotion regulation (ER) strategies to manage high arousal. While researchers called to assess ER in ASD, few studies utilized direct observations. We tested children’s behavioral and cortisol response to maternal and paternal unavailability and hypothesized that children with ASD will employ less complex ER strategies and their parents would show increased regulation facilitation effort to accommodate their child’s difficulties.

Methods

Forty preschoolers with ASD were matched with 40 typically developing (TD) preschoolers. Children were seen twice for identical battery with mother or father in the face-to-face-still-face paradigm, a three-episode paradigm where parent-child play (free play (FP)) is interrupted by elimination of communication (still face (SF)) followed by resuming play (reunion (RE)). Micro-coding of parent and child’s social behavior and ER strategies was conducted. Parent and child’s cortisol was assessed at baseline, following stress, and at recovery.

Results

Children with ASD exhibited the typical SF effect, indexed by an increase in negative affect and decrease in positive communications, but employed more simple regulatory behavior (self-soothing, proximity-seeking) and less complex strategies involving attention redirection and substitutive play. Their parents used more regulation-facilitation behavior, both simple and complex. All children showed initial cortisol response to novelty, which declined over time. However, maternal presence suppressed initial cortisol response in children with ASD.

Conclusions

Children with ASD form typical expectations of parental availability and their parents increase effort to help repair social rupture. Among children with ASD, maternal presence and regulation facilitation provide social buffering for the child’s HPA stress response in a manner similar to mammalian neonates. Results highlight the importance of assessing ER by combining direct observations and physiological measures and including fathers in empirical studies and intervention efforts for children with ASD during sensitive periods for social growth.

Electronic supplementary material

The online version of this article (doi:10.1186/s13229-015-0007-2) contains supplementary material, which is available to authorized users.

An Evaluation of Imitation Recognition Abilities in Typically Developing Children and Young Children with Autism Spectrum Disorder

Previous work has indicated that both typically developing children and children with Autism Spectrum Disorder (ASD) display a range of imitation recognition behaviors in response to a contingent adult imitator. However, it is unknown how the two groups perform comparatively on this construct. In this study, imitation recognition behaviors for children with ASD and typically developing children were observed during periods of contingent imitation imbedded in a naturalistic imitation task. Results from this study indicate that children with ASD are impaired in their ability to recognize being imitated relative to typically developing peers as demonstrated both by behaviors representing basic social attention and more mature imitation recognition. Display of imitation recognition behaviors was independent of length of contingent imitation period in typically developing children, but rate of engagement in imitation recognition behaviors was positively correlated with length of contingent imitation period in children with ASD. Exploratory findings also suggest a link between the ability to demonstrate recognition of being imitated and ASD symptom severity, language, and object imitation for young children with ASD.

Imitation promotes affiliation in infant macaques at risk for impaired social behaviors

Parental responsiveness and synchronization during early face-to-face interactions between mother and infant have been theorized to affect a broad spectrum of positive developmental outcomes in social and cognitive infant growth and to facilitate the development of a sense of self in the baby. Here we show that being imitated can significantly affect the behavior of nursery-reared infant monkeys, which are at an increased risk for developing aberrant social behaviors. Infants look longer and lipsmack more at an experimenter both during imitation and after being imitated. These results demonstrate that from early in life imitation might be used as a privileged form of communication by adults to enhance infants' visual engagement and their social communication. Imitation may therefore be useful to counteract the negative effects of early social adversities.

From early markers to neuro-developmental mechanisms of autism

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Studies of infants at-risk could reveal the developmental origin of autism.

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Behavioral and brain markers differentiate infants that develop autism symptoms from controls, during the first year of life.

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Little evidence for decreased social orienting or social motivation.

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Some evidence for multiple developmental pathways to autism.

A fast growing field, the study of infants at risk because of having an older sibling with autism (i.e. infant sibs) aims to identify the earliest signs of this disorder, which would allow for earlier diagnosis and intervention. More importantly, we argue, these studies offer the opportunity to validate existing neuro-developmental models of autism against experimental evidence. Although autism is mainly seen as a disorder of social interaction and communication, emerging early markers do not exclusively reflect impairments of the “social brain”. Evidence for atypical development of sensory and attentional systems highlight the need to move away from localized deficits to models suggesting brain-wide involvement in autism pathology. We discuss the implications infant sibs findings have for future work into the biology of autism and the development of interventions.

Attenuation of the contingency detection effect in the extrastriate body area in autism spectrum disorder

Detection of the contingency between one's own behavior and consequent social events is important for normal social development, and impaired contingency detection may be a cause of autism spectrum disorder (ASD). To depict the neural underpinnings of this contingency effect, 19 adults with ASD and 22 control participants underwent functional MRI while imitating another's actions and their actions being imitated by the other. As the extrastriate body area (EBA) receives efference copies of one's own movements, we predicted that the EBA would show an atypical response during contingency detection in ASD. We manipulated two factors: the congruency of the executed and observed actions, and the order of action execution and observation. Both groups showed the congruency effect in the bilateral EBA during imitation. When action preceded observation, the left EBA of the control group showed the congruency effect, representing the response to being imitated, indicating contingency detection. The ASD group showed a reduced contingency effect in the left EBA. These results indicate that the function of the EBA in the contingency detection is altered in ASD.

Social behaviors increase more when children with ASD are imitated by their mother vs. an unfamiliar adult

Previous research suggests that being imitated by an adult increases the social behaviors of children with an autism spectrum disorder (ASD). In the current study, we examined whether familiarity with the imitating social partner modulates this effect. Ten children with ASD and their mothers participated. The children's social behaviors were observed prior to and following a 3-min period in which an adult social partner imitated everything they did. In one condition the partner was the child's mother, and in the other condition the partner was an unfamiliar experimenter. The results revealed significant increases in distal social behaviors (gazes toward the adult, vocalizing) following imitation by both partners. There was a significantly greater increase in proximal social behaviors (including approach, being physically close, and touching) and a greater decrease in playing alone when the imitator was the child's mother as opposed to the experimenter. The findings suggest that the experience of being imitated creates an atmosphere of mutuality and rapport between children with ASD and their social partners, which increases their sociability even in interactions with already familiar adults.

Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD)

BACKGROUND

The 'Theory of Mind' (ToM) model suggests that people with autism spectrum disorder (ASD) have a profound difficulty understanding the minds of other people - their emotions, feelings, beliefs, and thoughts. As an explanation for some of the characteristic social and communication behaviours of people with ASD, this model has had a significant influence on research and practice. It implies that successful interventions to teach ToM could, in turn, have far-reaching effects on behaviours and outcome.

OBJECTIVES

To review the efficacy of interventions based on the ToM model for individuals with ASD.

SEARCH METHODS

In August 2013 we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Social Services Abstracts, AutismData, and two trials registers. We also searched the reference lists of relevant papers, contacted authors who work in this field, and handsearched a number of journals.

SELECTION CRITERIA

Review studies were selected on the basis that they reported on an applicable intervention (linked to ToM in one of four clearly-defined ways), presented new randomised controlled trial data, and participants had a confirmed diagnosis of an autism spectrum disorder. Studies were selected by two review authors independently and a third author arbitrated when necessary.

DATA COLLECTION AND ANALYSIS

Risk of bias was evaluated and data were extracted by two review authors independently; a third author arbitrated when necessary. Most studies were not eligible for meta-analysis, the principal reason being mis-matching methodologies and outcome measures. Three small meta-analyses were carried out.

MAIN RESULTS

Twenty-two randomised trials were included in the review (N = 695). Studies were highly variable in their country of origin, sample size, participant age, intervention delivery type, and outcome measures. Risk of bias was variable across categories. There were very few studies for which there was adequate blinding of participants and personnel, and some were also judged at high risk of bias in blinding of outcome assessors. There was also evidence of some bias in sequence generation and allocation concealment. Not all studies reported data that fell within the pre-defined primary outcome categories for the review, instead many studies reported measures which were intervention-specific (e.g. emotion recognition). The wide range of measures used within each outcome category and the mixed results from these measures introduced further complexity when interpreting results.Studies were grouped into four main categories according to intervention target/primary outcome measure. These were: emotion recognition studies, joint attention and social communication studies, imitation studies, and studies teaching ToM itself. Within the first two of these categories, a sub-set of studies were deemed suitable for meta-analysis for a limited number of key outcomes.There was very low quality evidence of a positive effect on measures of communication based on individual results from three studies. There was low quality evidence from 11 studies reporting mixed results of interventions on measures of social interaction, very low quality evidence from four studies reporting mixed results on measures of general communication, and very low quality evidence from four studies reporting mixed results on measures of ToM ability.  The meta-analysis results we were able to generate showed that interventions targeting emotion recognition across age groups and working with people within the average range of intellectual ability had a positive effect on the target skill, measured by a test using photographs of faces (mean increase of 0.75 points, 95% confidence interval (CI) 0.22 to 1.29 points, Z = 2.75, P < 0.006, four studies, N = 105). Therapist-led joint attention interventions can promote production of more joint attention behaviours within adult-child interaction (mean increase of 0.55 points, 95% CI 0.11 to 0.99 points, Z = 2.45, P value = 0.01, two studies, N = 88). Further analysis undermines this conclusion somewhat by demonstrating that there was no clear evidence that intervention can have an effect on joint attention initiations as measured using a standardised assessment tool (mean increase of 0.23 points, 95% CI -0.48 to 0.94 points, Z = 0.63, P value = 0.53, three studies, N = 92). No adverse effects were apparent.

AUTHORS' CONCLUSIONS

While there is some evidence that ToM, or a precursor skill, can be taught to people with ASD, there is little evidence of maintenance of that skill, generalisation to other settings, or developmental effects on related skills. Furthermore, inconsistency in findings and measurement means that evidence has been graded of 'very low' or 'low' quality and we cannot be confident that suggestions of positive effects will be sustained as high-quality evidence accumulates. Further longitudinal designs and larger samples are needed to help elucidate both the efficacy of ToM-linked interventions and the explanatory value of the ToM model itself. It is possible that the continuing refinement of the ToM model will lead to better interventions which have a greater impact on development than those investigated to date.

The Interacting Body: Intra- and Interindividual Processes During Imitation

Cognition involving others, or social cognition, is often conceptualized as the solitary, third-person computation of mental states. Relatively, little attention has been paid to how individuals use their cognitive capacities at the behavioral and brain levels in social exchanges. We introduce imitation as a valuable model of dynamic social interactive phenomena and describe laboratory procedures for studying it in behavioral and neuroimaging contexts. We review research that reveals behavioral and neural synchronization of individuals engaged in imitation. In the latter case, brain activity is correlated in imitative partners, but the pattern expressed by an individual depends on the individual’s role (i.e., model or imitator). We link these findings to theoretical notions about mirroring and mentalizing brain systems and then describe how mirroring and mentalizing support the notion of prospective cognition, even in basic forms of communication such as reciprocal imitation.

Prospective Social Entrainment: Imitation Interventions in Children With Autism

Imitation provides the basis for acquiring knowledge, as well as providing a foundation for the development of reciprocal social skills. Children with autism spectrum disorders (ASD) do not naturally imitate others, and it is hypothesized that deficits in imitation may impede their ability to develop both academically and socially. Early imitation intervention studies, using traditional direct teaching (e.g., teacher-directed discrete trial training), focused on the learning function of imitation and were successful in improving skill acquisition but had little impact on the development of socially successful interactions. More recently, imitation interventions have targeted reciprocal or synchronous imitation (e.g., child-directed reciprocal imitation training), focused on the social function of imitation and have resulted in gains in imitation abilities and concomitant improvements in social engagement. This article explores imitation deficits in individuals with ASD, describes basic and applied research focusing on improving imitation skills, discusses implications for clinical intervention, and provides a synthesis of the current literature within the framework of prospective cognition.

Systematic review of interventions to promote social-emotional development in young children with or at risk for disability

This systematic review synthesized the research on interventions used by occupational therapy practitioners to promote social-emotional development in young children (birth-5 yr) with or at risk for disabilities. After a comprehensive search of the research literature, 23 studies were reviewed and then synthesized into five themes: (1) touch-based interventions to enhance calming and parent-infant bonding, (2) relationship-based interventions to promote positive caregiver-child interactions, (3) joint attention interventions, (4) naturalistic preschool interventions to promote peer-to-peer engagement, and (5) instruction-based interventions to teach children appropriate social behaviors. The interventions for infants primarily involved coaching parents in specific strategies to promote positive interactions; interventions for preschool-age children typically involved encouraging peer support, instructing children, and applying naturalistic behavioral techniques to develop higher-level social competence. The studies demonstrated low to moderate positive effects for interventions used by occupational therapy practitioners to improve social-emotional development across ages, diagnoses, and settings.

An exploration of imitation recognition in young children with autism spectrum disorders

The ability to recognize when one is being imitated has been hypothesized to be an important developmental process related to the emergence of more advanced social-cognitive skills. While a series of behaviors indicating progressively more mature imitation recognition (IR) skills has been assessed in typically developing children, empirical work with children with autism spectrum disorders (ASDs) has largely focused on basic social responses to an imitative adult (e.g. increases in eye contact). Limited work has explored more mature IR behaviors in this population. This study compared the degree to which children with ASD engage in different behaviors thought to be indicative of IR during a naturalistic imitation task and the relationship between different types of IR behaviors and social-cognitive skills (i.e. imitation, language, social reciprocity, and joint attention). Thirty children with ASD were administered standardized measures of cognitive level, language, joint attention, social reciprocity, and imitation. IR behaviors were observed during periods of contingent imitation by an adult. Participants engaged more frequently in less mature (e.g. looking at the experimenter's toy or face) than more mature IR behaviors (e.g. testing the experimenter's intent to imitate). After controlling for developmental level, social reciprocity, object imitation, and gesture imitation were positively correlated with more mature IR. These findings suggest that the development of more mature IR skills is related to the development of other social-cognitive skills in children with ASD and provide additional empirical support for reports of more mature IR observed in this population. , Inc.

Embodiment and sense-making in autism

In this article, I sketch an enactive account of autism. For the enactive approach to cognition, embodiment, experience, and social interaction are fundamental to understanding mind and subjectivity. Enaction defines cognition as sense-making: the way cognitive agents meaningfully connect with their world, based on their needs and goals as self-organizing, self-maintaining, embodied agents. In the social realm, the interactive coordination of embodied sense-making activities with others lets us participate in each other's sense-making (social understanding = participatory sense-making). The enactive approach provides new concepts to overcome the problems of traditional functionalist accounts of autism, which can only give a piecemeal and disintegrated view because they consider cognition, communication, and perception separately, do not take embodied into account, and are methodologically individualistic. Applying the concepts of enaction to autism, I show: How embodiment and sense-making connect, i.e., how autistic particularities of moving, perceiving, and emoting relate to how people with autism make sense of their world. For instance, restricted interests or preference for detail will have certain sensorimotor correlates, as well as specific meaning for autistic people.That reduced flexibility in interactional coordination correlates with difficulties in participatory sense-making. At the same time, seemingly irrelevant "autistic behaviors" can be quite attuned to the interactive context. I illustrate this complexity in the case of echolalia. An enactive account of autism starts from the embodiment, experience, and social interactions of autistic people. Enaction brings together the sensorimotor, cognitive, social, experiential, and affective aspects of autism in a coherent framework based on a complex non-linear multi-causality. This foundation allows to build new bridges between autistic people and their often non-autistic context, and to improve quality of life prospects.

Evaluation of a Sibling-Mediated Imitation Intervention for Young Children with Autism

Parents and peers have been successful at implementing interventions targeting social interactions in children with autism; however, few interventions have trained siblings as treatment providers. This study used a multiple-baseline design across six sibling dyads (four children with autism) to evaluate the efficacy of sibling-implemented reciprocal imitation training. All six typically developing siblings were able to learn and use contingent imitation, four of the six siblings were able to learn and use linguistic mapping, and all six siblings increased their use of at least one component of the imitation training procedure. Three of the four children with autism showed increases in overall imitation and all four showed evidence of increases in joint engagement. Parents and siblings reported high satisfaction with the intervention and ratings by naïve observers indicated significant changes from pre- to post-treatment. These results suggest that sibling-implemented reciprocal imitation training may be a promising intervention for young children with autism.

An evaluation of an intervention sequence outline in positive behaviour support for people with autism and severe escape-motivated challenging behaviour

BACKGROUND

Positive behaviour support emphasises the impact of contextual variables to enhance participation, choice, and quality of life. This study evaluates a sequence for implementing changes to key contextual variables for 4 individuals. Interventions were maintained and data collection continued over a 3-year period.

METHOD

Functional assessments were conducted with 4 individuals with exceptionally severe challenging behaviours. Interventions were based on the multi-element model of behavioural support (LaVigna & Willis, 2005a). Dependent variables were behavioural ratings of (1) frequency, (2) episodic severity, (3) episodic management difficulty, and measures of (4) mental health status, and (5) quality of life. The intervention sequence was low arousal environment, rapport building, predictability, functionally equivalent skills teaching, and differential reinforcement strategies.

RESULTS

Substantial reductions in target behaviours were observed, along with incremental improvement in mental health scores and quality-of-life scores.

CONCLUSION

The study demonstrates the efficacy of positive behaviour support for people with exceptionally severe behaviour in individually designed services.

'Too withdrawn' or 'too friendly': considering social vulnerability in two neuro-developmental disorders

In some neuro-developmental disorders, the combined effect of intellectual disability and atypicalities of social cognition may put individuals at increased vulnerability in their social environment. The neuro-developmental disorders Williams syndrome, characterised by 'hypersociability', and autism spectrum disorders, characterised by 'social withdrawal', are at two extremes of atypical social functioning in humans. In this article, we use Williams syndrome and autism spectrum disorders as exemplars to demonstrate how atypicalities of social cognition may contribute to social vulnerability in these populations. The lives of individuals with both these disorders are marred by an increased risk of social isolation, bullying, unsteady relationships, employment difficulties and abuse. While different behavioural interventions have been tried to improve social functioning in these populations, there has been great variability in their success. Finally, we discuss different issues regarding social independence of these individuals; including employment, safety and decision making.

The speech aversion hypothesis has explanatory power in a Minimal Speech Approach to aloof, non-verbal, severe autism

In the search for 'pure autism', non-verbal children labeled aloof, Severely Autistic with Developmental Disabilities (ASA/DD), are routinely excluded from psychological research. This exclusion is predicated on the claim that they are indistinguishable from those with SLD/PMLD, which is refuted through a discussion of the extant literature. A novel, falsifiable, speech aversion hypothesis is proposed: "aloof, non-verbal young children (<7 years), with severe autism (CARS≥37), but without significant dysmorphic features, will show aversive reactions to complex speech (>2-3 words), but not to a silent interlocutor, or one imitating their vocalizations, in proximal encounters." Implications are examined by deconstructing the presenting symptoms of ASA/DD in response to the hypothesis. Supporting evidence is drawn from: Minimal Speech Approach (MSA) research showing high levels of spontaneous requests for social routines; a reinterpretation of still-face research as a still-(silent)-face paradigm; auditory processing MMN data employing EEG/MEG; and possible links to epileptiform activity and verbal auditory agnosia. Guidelines are established for future research. This hypothesis, if corroborated, would add to the auditory processing anomalies seen in severe autism and lead to synergies of existing and new areas of research, with significant theoretical, therapeutic, and educational implications.

Reciprocal imitation: toward a neural basis of social interaction

Social interaction is a coregulated coupling activity that involves at least 2 autonomous agents. Numerous methodological and technical challenges impede the production of natural social interaction within an Magnetic Resonance Imaging environment under controlled conditions. To overcome the obstacle, we chose a simple format of social interaction, namely "interactive imitation" through a double-video system. We registered blood oxygen level-dependent activity of 23 participants during 2 imitative conditions: free (F) and instructed (I) episodes of imitating (i) and of being imitated (bi). In addition to the areas classically reported in instructed imitation tasks, 2 activation patterns were found, which differentiate the subconditions. Firstly, brain areas involved during decisional and attentional processes (dorsolateral prefrontal cortex , dorsal part of anterior cingulate gyrus [dACC], pre-SMA) were activated during all conditions except for instructed imitation-classically used in neuroimaging studies of imitation. Second, a greater activation in dACC and insula combined with an increased deactivation in the default mode network was observed when subjects were imitated compared with when they imitated. We suggest that these 2 patterns reflect the anticipation of the other's behavior and the engagement with others required by social interaction.