Reduced delay of gratification and effortful control among young children with autism spectrum disorders

The effect of tDCS on inhibitory control and its transfer effect on sustained attention in children with autism spectrum disorder: An fNIRS study

BACKGROUND

Individuals with autism spectrum disorder (ASD) have inhibitory control deficits. The combination of transcranial direct current stimulation (tDCS) and inhibitory control training produces good transfer effects and improves neuroplasticity. However, no studies have explored whether applying tDCS over the dlPFC improves inhibitory control and produces transfer effects in children with ASD.

OBJECTIVE

To explore whether multisession tDCS could enhance inhibitory control training (response inhibition), near-transfer (interference control) and far-transfer effects (sustained attention; stability of attention) in children with ASD and the generalizability of training effects in daily life and the class, as reflected by behavioral performance and neural activity measured by functional near-infrared spectroscopy (fNIRS).

METHODS

Twenty-eight autistic children were randomly assigned to either the true or sham tDCS group. The experimental group received bifrontal tDCS stimulation at 1.5 mA, administered for 15 min daily across eight consecutive days. tDCS was delivered during a computerized Go/No-go training task. Behavioral performance in terms of inhibitory control (Dog/Monkey and Day/Night Stroop tasks), sustained attention (Continuous Performance and Cancellation tests), prefrontal cortex (PFC) neural activity and inhibitory control and sustained attention in the class and at home were evaluated.

RESULTS

Training (response inhibition) and transfer effects (interference control; sustained attention) were significantly greater after receiving tDCS during the Go/No-go training task than after receiving sham tDCS. Changes in oxyhemoglobin (HbO) concentrations in the dlPFC and FPA associated with consistent conditions in the Day/Night Stroop and Continuous Performance test were observed after applying tDCS during the inhibitory control training task. Notably, transfer effects can be generalized to classroom environments.

CONCLUSION

Inhibitory control training combined with tDCS may be a promising, safe, and effective method for improving inhibitory control and sustained attention in children with ASD.

Irritability as a Transdiagnostic Risk Factor for Functional Impairment in Autistic and Non-autistic Toddlers and Preschoolers

Trait irritability in toddlerhood is a powerful risk factor for later internalizing and externalizing challenges in non-autistic children, but the predictive clinical utility of irritability is unknown in autism. Irritability is a trait-level emotional response (i.e., frustration) to a blocked goal and is one source of disruptive behavior. Irritability has two facets: Frustration is the degree to which emotion is elevated after a blocked goal, while soothability is the rate of recovery from peak distress. We aimed to: (1) compare and describe the two facets of irritability in non-autistic and young autistic children, and (2) assess whether children's reward sensitivity and executive function moderate the relation between irritability and clinical symptoms. Participants were 90 autistic (n=43) and non-autistic (n = 47) 2- and 4-year-olds. Autistic children did not have different levels of frustration but were more difficult to soothe compared to non-autistic children, according to parents. Further, frustration and soothability were less strongly correlated for autistic compared to non-autistic children. For all children, executive function (specifically, inhibition) moderated, or ameliorated the strength of, the relation between irritability (both soothability and frustration) and externalizing challenges. This study provides evidence for irritability as a transdiagnostic risk factor for clinically significant emotion regulation challenges. Further, the effect of trait irritability may be ameliorated by children's executive function in a transdiagnostic manner. Future work should examine the unique aspects of soothability to how irritability presents within autism, as well as evaluate and modify emotion regulation interventions for autistic toddlers and preschoolers.

Self-Regulation and Academic Learning in Preschoolers with Autism Spectrum Disorder: Links to School Engagement and Levels of Autism Characteristics

Children with autism spectrum disorder often demonstrate self-regulation challenges and academic difficulties. Although self-regulation has been well documented as an important factor for academic achievement in neurotypical children, little is known about how it is related to academic learning in autistic children, especially during preschool, a critical developmental period for both emergent academic skills and self-regulatory abilities. It is also unclear whether school engagement or autism characteristics influence the relation between self-regulation and academic learning in autistic children during preschool. Thirty-two autistic preschoolers participated in this study. Direct measures and parent reports were used to measure three dimensions of self-regulation, including executive function, effortful control, and emotion regulation. Classroom-based data from multiple academic programs were used to reflect their average rates of achieving new literacy and mathematics learning goals. Teachers reported the participants' levels of school engagement, and their autism characteristics were measured directly. Emotion regulation was significantly linked to the rate of meeting literacy learning goals in autistic preschoolers, whereas multiple executive function skills, including inhibitory and attentional control and working memory, were associated with their mathematics learning rate. Emotion regulation demonstrated a stronger association with literacy learning when autistic children were more engaged in classroom activities. Levels of autism characteristics did not mediate or moderate the association between self-regulation and academic learning. Future interventions and teaching should consider fostering self-regulation and facilitating school engagement for autistic preschoolers besides targeting their learning performance on specific academic content to promote their current and future academic success.

Altered neural mechanisms of deception in individuals with autistic traits

A successful deception involves making a decision, acting on it, and evaluating results. Here, we investigated deception in a non-clinical sample (n = 36) with varying autism traits using a coin-toss paradigm of active deception. The subjects were asked to react to the instructions by clicking one of the two boxes that could mislead their opponents, followed by feedback on their success or failure. During this reaction, their EEG activity was recorded, and the results suggested that people with high autistic traits exhibited longer reaction times and lower amplitude of P3 in the decision-making stage compared to individuals with low autistic traits. The feedback evaluation stage in the high autistic trait group elicited lower amplitude of FRN and P3. Overall, these results indicated that people with high autistic traits experienced difficulties in deceiving, which could be related to atypical neural mechanisms.

Resting frontal alpha asymmetry as a predictor of executive and affective functioning in children with neurodevelopmental differences

The relative difference of resting EEG frontal alpha activation between left and right hemispheres (FAA; i.e., asymmetry) correlates with global approach and avoidance tendencies. FAA may relate to problems with executive and affective functioning in children with neurodevelopmental differences, including autism and ADHD. We (1) characterize relative left vs. right FAA in autistic, ADHD, and neurotypical children (NT) and (2) investigate whether FAA predicts "hot" executive function or emotion dysregulation. Participants were 97 7- to 11-year-old autistic, ADHD, and NT Children. Children with ADHD displayed greater left (relative to right) FAA compared to autistic and neurotypical children. Children with ADHD displayed greater challenges with "hot" EF on a gambling task than autistic children, whereas children with co-occurring autism and ADHD had greater parent-reported emotion dysregulation than NT and autism-only groups. Greater left FAA predicted worse hot EF for all children but was not significantly related to emotion dysregulation. Regardless of clinical diagnosis, relatively greater left FAA relates to hot EF. While hot EF deficits may be specific to ADHD rather than autism, both together confer additive risk for emotion dysregulation. Future research should explore the functional relation between FAA, reward processing, and affect for children with different EF-related neurodevelopmental differences.

Inhibitory Control in Autism Spectrum Disorders: Meta-analyses on Indirect and Direct Measures

This manuscript aimed to advance our understanding of inhibitory control (IC) in autism spectrum disorders (ASD), adopting a meta-analytic multilevel approach. The first meta-analysis, on 164 studies adopting direct measures, indicated a significant small-to-medium (g = 0.484) deficit in the group with ASD (n = 5140) compared with controls (n = 6075). Similar effect sizes between response inhibition and interference control were found, but they were differentially affected by intellectual functioning and age. The second meta-analysis, on 24 studies using indirect measures, revealed a large deficit (g = 1.334) in the group with ASD (n = 985) compared with controls (n = 1300). Presentation format, intellectual functioning, and age were significant moderators. The effect of comorbidity with ADHD was not statistically significant. Implications are discussed for IC research and practice in autism.

Temperament in individuals with Autism Spectrum Disorder: A systematic review

The study of temperament in Autism Spectrum Disorder (ASD) has the potential to provide insight regarding variability in the onset, nature, and course of both core and co-morbid symptoms. The aim of this systematic review was to integrate existing findings concerning temperament in the context of ASD. Searches of Medline, PsychInfo and Scopus databases identified 64 relevant studies. As a group, children and adolescents with ASD appear to be temperamentally different from both typically developing and other clinical non-ASD groups, characterized by higher negative affectivity, lower surgency, and lower effortful control at a higher-order level. Consistent with research on typically developing children, correlational findings and emerging longitudinal evidence suggests that lower effortful control and higher negative affect are associated with increased internalizing and externalizing problems in ASD samples. Longitudinal studies suggest there may be temperamental differences between high familial risk infants who do and do not develop ASD from as early as 6-months of age. Limitations of existing research are highlighted, and possible directions for future research to capitalize on the potential afforded through the study of temperament in relation to ASD are discussed.

Effortful Control and Prefrontal Cortex Functioning in Children with Autism Spectrum Disorder: An fNIRS Study

Effortful control (EC) is an important dimension of temperament, but is impaired in autism spectrum disorder (ASD). While EC is associated with the prefrontal cortex (PFC) functioning in typically developing (TD) children, it is unclear whether EC deficits are associated with PFC dysfunction in ASD. This study examines the relationship between EC and PFC activation and connectivity in children with high-functioning ASD. Thirty-nine right-handed children (ASD: n = 20; TD: n = 19) aged 8–12 years were recruited. The EC level was assessed with the Early Adolescent Temperament Questionnaire—Revised (EATQ-R), and PFC functioning, in terms of activation and connectivity during a frontal-sensitive (n-back) task, was assessed using functional near-infrared spectroscopy (fNIRS). Children with ASD showed a significant deficit in EC and its related constructs (i.e., executive, and socioemotional functions) compared to TD controls. They also showed significantly increased overall PFC activation and reduced right frontal connectivity during the n-back task. Among children with ASD, the EC level correlated significantly with neither PFC activation nor connectivity; it significantly correlated with social functioning only. This study demonstrated EC deficits and altered PFC functioning in children with ASD, but the exact neural basis of EC deficits remains to be determined.

Social endophenotypes in autism spectrum disorder: A scoping review

Endophenotypes are measurable markers of genetic vulnerability to current or future disorder. Autism spectrum disorder (ASD) is well-suited to be examined within an endophenotype framework given past and current emphases on the broader autism phenotype and early detection. We conducted a scoping review to identify potential socially-related endophenotypes of ASD. We focused on paradigms related to sociality (e.g., theory of mind (TOM), social attention), which comprise most of this literature. We integrated findings from traditional behavioral paradigms with brain-based measures (e.g., electroencephalography, functional magnetic resonance imaging). Broadly, infant research regarding social attention and responsivity (Research Domain Criteria (RDoC) domain of affiliation) and attention to faces and voices (social communication) finds consistent abnormality in vulnerable infant siblings. Several additional paradigms that have shown differences in vulnerable infants and young children include animacy perception tasks (perception and understanding of others), measures of recognition and response to familiar faces (attachment), and joint attention and false-belief tasks (understanding mental states). Research areas such as alexithymia (the perception and understanding of self), empathic responding, and vocal prosody may hold interest; however, challenges in measurement across populations and age ranges is a limiting factor. Future work should address sex differences and age dependencies, specificity to ASD, and heterogeneous genetic pathways to disorder within samples individuals with ASD and relatives.

Autistic People Do Enhance Their Selves

We investigated whether autistic people are less prone to self-enhance (i.e., portray themselves in socially desirable ways). Autistic (N = 130) and non-autistic (N = 130) participants first responded to social desirability items using the standard instruction to endorse each item as true or false about themselves. Then, all participants read an explanation of what social desirability items measure before responding again to the social desirability items. Self-enhancement was operationalized as participants endorsing more social desirability items before learning the explanation than after. All participants endorsed significantly more social desirability items before learning the explanation than after, F _subjects(1,258) = 57.73, p < .001, η² _p = .183; F _items(1,34) = 43.04, p < .001, η² _p = .559). However, autistic and non-autistic participants did not significantly differ in how many items they endorsed, either before or after reading the explanation, indicating that autistic people are as susceptible to social desirability and self-enhancement as non-autistic people are. Our results challenge the claim that autistic people are immune to reputation management.

Changes in temperament over time in young children with autism spectrum disorder and other developmental delays: a follow-up comparison study

BACKGROUND

Although in the last decade some research has emerged on temperament in autism spectrum disorder (ASD), this research has primarily focused on the differences between children with ASD and their typically developing peers rather than the stability or change in temperament in this population. Thus, the goal of this study was to examine temperament over time in children with ASD, developmental delays (DD) and typical development (TD). Temperament differences were also compared among the three groups.

METHODS

To accomplish this, parents rated children's temperament at Time 1 (T1) and Time 2 (T2) using the Carey Temperament Scales (CTS).

RESULTS

Results from the study showed that at T1, parents of children with ASD rated their children as more withdrawn (i.e. approach), and emotionally negative (i.e. mood), and less distractible and adaptable than parents of children with TD and DD. Also, children with ASD were rated as more intense and children with DD as less distractible than their TD peers. Similarly, at T2, children with ASD were rated more withdrawn, and emotionally negative, and less persistent, rhythmic, adaptable and distractible than children with TD and DD. Also, children with ASD were rated as more active than their DD peers. Regarding stability, parent ratings of temperament appeared stable over time in the TD group, but ratings varied substantially in the ASD or DD groups. That is, for the ASD group, activity and approach at T1 were significantly associated with their corresponding dimensions at T2. However, for the TD group, rhythmicity, approach, intensity and mood at T1 were significantly associated with those dimensions at T2. No associations were found in the DD group. Regarding change, parents reported change in rhythmicity, persistence and threshold between T1 and T2 in the ASD group. Similarly, parents reported change in rhythmicity, approach and threshold between T1 and T2 in the DD group. Lastly, parents of TD children reported change in adaptability, persistence and distractibility between T1 and T2.

CONCLUSIONS

These findings are novel in that children with ASD appear to have less stable temperament profile and different change patterns than children with TD or DD. Similar to previous research, children with ASD were described by their parents as experiencing more temperamental difficulties.

Temporal Reward Discounting in Children with Attention Deficit/Hyperactivity Disorder (ADHD), and Children with Autism Spectrum Disorder (ASD): A Systematic Review

Children with ADHD and ASD may present differences in the affective-motivational processes. We systematically review the literature regarding temporal discounting in children up to 12 years with ADHD and ASD. Six articles were included, five studies with ADHD children (n = 231), one with ASD children (n = 21), all including typically developing children as controls (n = 210). Five studies (four with ADHD and one with ASD) found greater temporal reward discounting for clinical groups. Occurrence of ADHD appears to rush even more the decision-making process at this stage of development, but there is still a lack in the literature, especially evaluating individuals with ASD.

Social and delay discounting in autism spectrum disorder

Current literature is divided over whether and how processes such as perspective taking and reward sensitivity differ between individuals with autism spectrum disorder (ASD) versus neurotypical individuals. Discounting tasks may provide novel insight into how these processes operate. In delay discounting tasks, participants choose between smaller immediate rewards and larger delayed rewards, and in social discounting tasks, participants choose between a smaller monetary rewards for themselves versus a larger reward for partners of varied social distance (e.g., a close friend vs. an acquaintance). Delay and social discounting tasks thus implicitly measure the subjective value of rewards given to one's future self and to others, capturing constructs such as perspective taking, reward processing, and social closeness, all of which have been discussed as core cognitive mechanisms underlying ASD. Despite extensive research on discounting in other clinical populations, few studies have examined delay discounting in ASD and no research has examined social discounting in ASD. The goal of the current study was to assess delay and social discounting for monetary rewards in a single sample of adolescents and adults with ASD compared to a matched neurotypical sample. Overall, adults and adolescents with ASD valued both future rewards and rewards given to others less than their typical counterparts did, but rates of discounting were not significantly correlated across temporal and social domains. These results extend an important behavioral paradigm for understanding both perspective taking and reward processing to autism. Autism Res 2019, 12: 870-877. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Discounting tasks-which experimentally measure the subjective value of different rewards-have been used with a variety of clinical populations, but are underexplored in ASD. We found that compared to neurotypical individuals, individuals with ASD showed diminished subjective value for future rewards (compared to immediate rewards) and rewards for others (compared to rewards for self). This finding has implications for understanding perspective taking, reward processing, and social closeness in ASD.

Delay of gratification in preschoolers with and without autism spectrum disorder: Individual differences and links to executive function, emotion regulation, and joint attention

This study examined delay of gratification behaviors in preschool-aged children with and without autism spectrum disorder. Recent research has found that elementary-aged children with autism spectrum disorder showed challenges with delay of gratification and that there were individual differences in terms of children's behaviors during the wait. We extend this work to a younger sample of children with autism spectrum disorder to understand whether these difficulties emerge by the preschool years. Moreover, we assessed whether individual differences in other key self-regulatory capacities (i.e. effortful control, emotion regulation, executive function, and joint attention) were related to delay of gratification wait durations or behavioral strategies. Findings revealed that preschoolers with autism spectrum disorder waited for a shorter duration, demonstrated more temptation-focused behaviors, and expressed less positive affect than their typical peers during the delay of gratification task. At the full-sample level, individual differences in children's temptation-focused behaviors (i.e. visual attention and verbalizations focused on the temptation) were related to children's executive function, joint attention, and parents' ratings of emotion regulation. When we examined associations within groups, the associations were not significant for the autism spectrum disorder group, but for typically developing children, there was a positive association between temptation-focused behaviors and emotion regulation.

Rock drumming enhances motor and psychosocial skills of children with emotional and behavioral difficulties

Objectives: Drumming may have therapeutic and learning benefits but there exists little causal evidence regarding the benefits for children with emotional and behavioral difficulties (EBD) such as Autistic Spectrum Disorder. Methods: Six EBD pupils (EBD Drum) and six peers (Peer Drum) were given 2, 30-min rock drumming lessons per week, over 5 weeks. Six matched individuals received no drumming instruction (3 = EBD Control; 3 = Peer Control). An exploratory, mixed-methods analysis was used to explore quantitative changes in skills and qualitative perspectives of the teaching staff. All pupils were tested two times (pretest and posttest) on drumming ability and Motor skills (Movement Assessment Battery for Children, version 2). Teacher's rating of social behavior (Strength and Difficulties Questionnaire; SDQ) was tested two times (pretest and retention). Results: Significant differences in total SDQ difficulties between the four groups (χ2(3) = 8.210, p = 0.042) and the hyperactivity subscale (χ2(3) = 10.641, p = 0.014) were observed. The EBD Drum group had greater reductions in total difficulties compared to the Peer Drum (p = 0.009) group and specifically greater reductions in hyperactivity compared to Peer Drum (p = 0.046) and the EBD Control (p = 0.006) group. In follow-up interviews, staff spoke positively about changes in pupil's attitudes toward learning and social confidence. Conclusions: The positive changes to social and behavioral skills reported in this pilot study are similar to those recorded for other music modalities.

Interrelationship between insistence on sameness, effortful control and anxiety in adolescents and young adults with autism spectrum disorder (ASD)

BACKGROUND

Both self-regulation and insistence on sameness (IS) are related to anxiety, which is a common feature of individuals with autism spectrum disorder (ASD). Here, we aimed to characterise the IS-self-regulation-anxiety interrelationship by investigating the potential contribution made by self-regulation, assessed via effortful control (EC), to the IS-anxiety relationship in a sample of adolescents and young adults with ASD.

METHOD

Seventy-one older adolescents and younger adults with ASD (49 males, 22 females; Mage = 18.71 years, SD = 2.51, range 14.42-24.81) completed the Adult Repetitive Behaviour Questionnaire-2, Effortful Control Scale of the Adult Temperament Questionnaire and the DSM-5 Dimensional Anxiety Scales.

RESULTS

IS was associated with both EC (r = -.39, p = .001) and anxiety (r = .45, p < .001), and anxiety was in turn associated with EC (r = -.44, p < .001). To characterise the nature of this interrelationship, two mediation analyses were performed using the serial mediation model in PROCESS with 5000 resamples in bootstrapping. There was a significant indirect effect of EC on anxiety, through IS (b = -.06; BCa 95% CI [-.13, -.02]), and indirect effect on anxiety through EC (b = 1.62; BCa 95% CI [.59, 3.24]) with the mediators accounting for 29.07 and 26.04% of the total effect, respectively.

CONCLUSIONS

Our study provides the first exploration of the IS-anxiety-self-regulation link in ASD. The finding that lower levels of self-regulation are related both to anxiety and IS behaviours points to self-regulation as a viable intervention target for both anxiety and IS behaviours.

μ opioid receptor, social behaviour and autism spectrum disorder: reward matters

The endogenous opioid system is well known to relieve pain and underpin the rewarding properties of most drugs of abuse. Among opioid receptors, the μ receptor mediates most of the analgesic and rewarding properties of opioids. Based on striking similarities between social distress, physical pain and opiate withdrawal, μ receptors have been proposed to play a critical role in modulating social behaviour in humans and animals. This review summarizes experimental data demonstrating such role and proposes a novel model, the μ opioid receptor balance model, to account for the contribution of μ receptors to the subtle regulation of social behaviour. Interestingly, μ receptor null mice show behavioural deficits similar to those observed in patients with autism spectrum disorder (ASD), including severe impairment in social interactions. Therefore, after a brief summary of recent evidence for blunted (social) reward processes in subjects with ASD, we review here arguments for altered μ receptor function in this pathology. This article is part of a themed section on Emerging Areas of Opioid Pharmacology. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.14/issuetoc.

Specificity, contexts, and reference groups matter when assessing autistic traits

Many of the personality and behavioral traits (e.g., social imperviousness, directness in conversation, lack of imagination, affinity for solitude, difficulty displaying emotions) that are known to be sensitive to context (with whom?) and reference group (according to whom?) also appear in questionnaire-based assessments of autistic traits. Therefore, two experiments investigated the effects of specifying contexts and reference groups when assessing autistic traits in autistic and non-autistic participants. Experiment 1 (124 autistic and 124 non-autistic participants) demonstrated that context matters when assessing autistic traits (F(1,244) = 267.5, p < .001, η²_p = .523). When the context of the Broad Autism Phenotype Questionnaire was specified as the participants’ out-group (e.g., “I like being around non-autistic people” or “I like being around autistic people”), both autistic and non-autistic participants self-reported having more autistic traits; when the context was specified as the participants’ in-group, participants reported having fewer autistic traits. Experiment 2 (82 autistic and 82 non-autistic participants) demonstrated that reference group matters when assessing autistic traits (F(2,160) = 94.38, p < .001, η²_p = .541). When the reference group on the Social Responsiveness Scale was specified as the participants’ out-group (e.g., “According to non-autistic people, I have unusual eye contact”), autistic participants reported having more autistic traits; when the reference group was their in-group, autistic participants reported having fewer autistic traits. Non-autistic participants appeared insensitive to reference group on the Social Responsiveness Scale. Exploratory analyses suggested that when neither the context nor the reference group is specified (for assessing autistic traits on the Autism-Spectrum Quotient), both autistic and non-autistic participants use the majority (“non-autistic people”) as the implied context and reference group.