Quantitative analysis of heterogeneity in academic achievement of children with autism

Cognitive heterogeneity in Attention Deficit Hyperactivity Disorder: Implications for maths

This study investigated whether cognitive function better predicted maths test performance than a clinical diagnosis of attention deficit hyperactivity disorder (ADHD). Forty-four drug naïve children (Mage = 101.34 months, SD = 19.39; 30% girls) were recruited from clinical ADHD referral waiting lists. Children underwent assessment of Executive Functions (EF), lower-level cognitive processes, and maths performance. Children were grouped using a categorical approach comprising (1) children with a clinical ADHD diagnosis and (2) children without a diagnosis (i.e., subthreshold ADHD). Secondly, hierarchical cluster analysis generated subgroups of children using EF scores. Children were compared on cognition, maths, and parent-rated symptoms of ADHD and co-occurring difficulties. Children's diagnostic outcomes did not differentiate maths performance. By contrast, EF subgroups generated meaningful cognitive clusters which differentiated maths test scores. This suggests that cognitive patterns of performance, rather than children's diagnostic outcomes, are more informative for identifying meaningful groups with variable maths performance which has implications for remedial support.

Atypical pattern separation memory and its association with restricted interests and repetitive behaviors in autistic children

LAY ABSTRACT

Memory challenges remain understudied in childhood autism. Our study investigates one specific aspect of memory function, known as pattern separation memory, in autistic children. Pattern separation memory refers to the critical ability to store unique memories of similar stimuli; however, its role in childhood autism remains largely uncharted. Our study first uncovered that the pattern separation memory was significantly reduced in autistic children, and then showed that reduced memory performance was linked to their symptoms of repetitive, restricted interest and behavior. We also identified distinct subgroups with profiles of reduced and increased generalization for pattern separation memory. More than 72% of autistic children showed a tendency to reduce memory generalization, focusing heavily on unique details of objects for memorization. This focus made it challenging for them to identify commonalities across similar entities. Interestingly, a smaller proportion of autistic children displayed an opposite pattern of increased generalization, marked by challenges in differentiating between similar yet distinct objects. Our findings advance the understanding of memory function in autism and have practical implications for devising personalized learning strategies that align with the unique memory patterns exhibited by autistic children. This study will be of broad interest to researchers in psychology, psychiatry, and brain development as well as teachers, parents, clinicians, and the wider public.

Magnitude representation of preschool children with autism spectrum condition

LAY ABSTRACT

The mathematical abilities of children with autism spectrum condition have been understudied. Magnitude representation (e.g. presenting the number of a collection of objects) is a fundamental numerical ability presented since early infancy and is correlated with children's later learning of formal mathematics. It remains unclear about whether children with autism spectrum condition differ from their peers without autism spectrum condition in precision of magnitude representations. This study compared preschool children with and without autism spectrum condition in their precision of magnitude representation with an approximate number comparison task, in which children compared two sets of dots without counting and chose the set with more dots. Children with autism spectrum condition exhibited the lower numerical comparison accuracy (i.e. the weaker magnitude representation) than their peers without autism spectrum condition. This difference existed even when multiple general cognitive abilities (working memory, inhibitory control, and nonverbal intelligence) and language abilities were statistically controlled. Moreover, the individual difference of the numerical comparison accuracy was larger in children with autism spectrum condition than without autism spectrum condition. These findings suggest that children with autism spectrum condition are at risk of weaker magnitude representation from an early age, emphasizing the need for specialized mathematics education or interventions to support their learning. In addition, the large variance in the precision of their magnitude representation suggests that individualized mathematics interventions are needed for children with autism spectrum condition.

Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder

Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.

Comparison of Mathematics Problem-Solving Abilities in Autistic and Non-autistic Children: the Influence of Cognitive Profile

This study examines relationships between mathematical problem-solving performance (in terms of strategies used and accuracy) and the main cognitive domains associated with mathematical learning (i.e. executive functions, verbal comprehension and social perception) of children with and without autism spectrum disorder (ASD and non-ASD resp.). The study involved 26 ASD and 26 non-ASD children without intellectual disabilities, between 6 and 12 years old, matched by sex, age and school (grade and classroom). The results show a higher percentage of ASD children with problem solving difficulties than non-ASD (57% vs. 23% resp.). Poor performing ASD children showed comparatively lower scores in inhibition, theory of mind and verbal comprehension. Implications for the design of mathematical interventions for ASD students are discussed.

Replicable Patterns of Memory Impairments in Children With Autism and Their Links to Hyperconnected Brain Circuits

BACKGROUND

Memory impairments have profound implications for social communication and educational outcomes in children with autism spectrum disorder (ASD). However, the precise nature of memory dysfunction in children with ASD and the underlying neural circuit mechanisms remain poorly understood. The default mode network (DMN) is a brain network that is associated with memory and cognitive function, and DMN dysfunction is among the most replicable and robust brain signatures of ASD.

METHODS

We used a comprehensive battery of standardized episodic memory assessments and functional circuit analyses in 25 8- to 12-year-old children with ASD and 29 matched typically developing control children.

RESULTS

Memory performance was reduced in children with ASD compared with control children. General and face memory emerged as distinct dimensions of memory difficulties in ASD. Importantly, findings of diminished episodic memory in children with ASD were replicated in 2 independent data sets. Analysis of intrinsic functional circuits associated with the DMN revealed that general and face memory deficits were associated with distinct, hyperconnected circuits: Aberrant hippocampal connectivity predicted diminished general memory while aberrant posterior cingulate cortex connectivity predicted diminished face memory. Notably, aberrant hippocampal-posterior cingulate cortex circuitry was a common feature of diminished general and face memory in ASD.

CONCLUSIONS

Our results represent a comprehensive appraisal of episodic memory function in children with ASD and identify extensive and replicable patterns of memory reductions in children with ASD that are linked to dysfunction of distinct DMN-related circuits. These findings highlight a role for DMN dysfunction in ASD that extends beyond face memory to general memory function.

What can neurodiversity tell us about inner speech, and vice versa? A theoretical perspective

Inner speech refers to the experience of talking to oneself in one's head. While notoriously challenging to investigate, it has also been central to a range of questions concerning mind, brain, and behaviour. Posited as a key component in executive function and self-regulation, inner speech has been claimed to be crucial in higher cognitive operations, self-knowledge and self-awareness. Such arguments have traditionally been supported with examples of atypical development. But variations in inner speech - and in some cases, significant diversity - in fact pose several key challenges to such claims, and raises many more questions for, language, thought and mental health more generally. In this review, we will summarise evidence on the experience and operation of inner speech in child and adult neurotypical populations, autistic people and other neurodivergent groups, and people with diverse experiences of linguistic and sensory development, including deafness. We will demonstrate that the relationship between inner speech and cognitive operations may be more complex than first assumed when explored through the lens of cognitive and neurological diversity, and the implications of that for understanding the developing brain in all populations. We discuss why and how the experience of inner speech in neurodivergent groups has often been assumed rather than investigated, making it an important opportunity for researchers to develop innovative future work that integrates participatory insights with cognitive methodology. Finally, we will outline why variations in inner speech - in neurotypical and neurodivergent populations alike - nevertheless have a range of important implications for mental health vulnerability and unmet need. In this sense, the example of inner speech offers us both a way of looking back at the logic of developmental psychology and neuropsychology, and a clue to its future in a neurodiverse world.

Atypical cognitive training-induced learning and brain plasticity and their relation to insistence on sameness in children with autism

Children with autism spectrum disorders (ASDs) often display atypical learning styles; however, little is known regarding learning-related brain plasticity and its relation to clinical phenotypic features. Here, we investigate cognitive learning and neural plasticity using functional brain imaging and a novel numerical problem-solving training protocol. Children with ASD showed comparable learning relative to typically developing children but were less likely to shift from rule-based to memory-based strategy. While learning gains in typically developing children were associated with greater plasticity of neural representations in the medial temporal lobe and intraparietal sulcus, learning in children with ASD was associated with more stable neural representations. Crucially, the relation between learning and plasticity of neural representations was moderated by insistence on sameness, a core phenotypic feature of ASD. Our study uncovers atypical cognitive and neural mechanisms underlying learning in children with ASD, and informs pedagogical strategies for nurturing cognitive abilities in childhood autism.

Executive function as a generalized determinant of psychopathology and functional outcome in school-aged autism spectrum disorder: a case-control study

BACKGROUND

Individuals with autism spectrum disorder (ASD) are challenged not only by the defining features of social-communication deficits and restricted repetitive behaviors, but also by a myriad of psychopathology varying in severity. Different cognitive deficits underpin these psychopathologies, which could be subjected to intervention to alter the course of the disorder. Understanding domain-specific mediating effects of cognition is essential for developing targeted intervention strategies. However, the high degree of inter-correlation among different cognitive functions hinders elucidation of individual effects.

METHODS

In the Philadelphia Neurodevelopmental Cohort, 218 individuals with ASD were matched with 872 non-ASD controls on sex, age, race, and socioeconomic status. Participants of this cohort were deeply and broadly phenotyped on neurocognitive abilities and dimensional psychopathology. Using structural equation modeling, inter-correlation among cognitive domains were adjusted before mediation analysis on outcomes of multi-domain psychopathology and functional level.

RESULTS

While social cognition, complex cognition, and memory each had a unique pattern of mediating effect on psychopathology domains in ASD, none had significant effects on the functional level. In contrast, executive function was the only cognitive domain that exerted a generalized negative impact on every psychopathology domain (p factor, anxious-misery, psychosis, fear, and externalizing), as well as functional level.

CONCLUSIONS

Executive function has a unique association with the severity of comorbid psychopathology in ASD, and could be a target of interventions. As executive dysfunction occurs variably in ASD, our result also supports the clinical utility of assessing executive function for prognostic purposes.

Math abilities in autism spectrum disorder: A meta-analysis

BACKGROUND

Studies focusing on math abilities in autism spectrum disorder (ASD) are limited and often provide inconsistent results.

AIM

This meta-analysis was conducted to investigate math abilities in people with autism spectrum disorder (ASD) compared to typically developing (TD) participants.

METHODS AND PROCEDURES

According with PRISMA guidelines, a systematic search strategy was adopted. First, 4405 records were identified through database searching; then, the title-abstract screening led to the identification of 58 potentially relevant studies and, finally, after the full-text screening, 13 studies were included.

OUTCOMES AND RESULTS

Results shows that the group with ASD (n = 533) performed lower than the TD group (n = 525) with a small-to-medium effect (g=0.49). The effect size was not moderated by task-related characteristics. Instead, sample-related characteristics, specifically age, verbal intellectual functioning, and working memory, were significant moderators.

CONCLUSIONS AND IMPLICATIONS

This meta-analysis shows that people with ASD have poorer math skills than their TD peers, suggesting the importance of investigating math abilities in autism, taking into account the role of moderating variables.

Atypical cognitive training-induced learning and brain plasticity and their relation to insistence on sameness in children with autism

Children with autism spectrum disorders (ASD) often display atypical learning styles, however little is known regarding learning-related brain plasticity and its relation to clinical phenotypic features. Here, we investigate cognitive learning and neural plasticity using functional brain imaging and a novel numerical problem-solving training protocol. Children with ASD showed comparable learning relative to typically developing children but were less likely to shift from rule-based to memory-based strategy. Critically, while learning gains in typically developing children were associated with greater plasticity of neural representations in the medial temporal lobe and intraparietal sulcus, learning in children with ASD was associated with more stable neural representations. Crucially, the relation between learning and plasticity of neural representations was moderated by insistence on sameness, a core phenotypic feature of ASD. Our study uncovers atypical cognitive and neural mechanisms underlying learning in children with ASD, and informs pedagogical strategies for nurturing cognitive abilities in childhood autism.

Reading ebooks and printed books with parents: A case study of children with autism spectrum disorders

Background and aims

Ebooks have become a ubiquitous presence in many classrooms today. Yet, empirical evidence on literacy development has not been well produced, especially for children with autism spectrum disorder (ASD). This mixed-method case study aimed to explore how four children with ASD interact with ebooks and printed books with parents at home.

Methods

Four children (age 5-7 years) with ASD and their parents read one animated ebook and another printed book over four separate sessions. Parents also explained preselected word meanings to their children. In this mixed-method case study, we examined multiple quantitative and qualitative sources of evidence related to reading with parents at home.

Results

Quantitatively, all four children with ASD learned more word meanings from ebook than from the printed book, and three demonstrated a higher engagement with ebook than the printed book reading. Qualitatively, the majority of parents felt their children's engagement was higher with ebook than with printed book. Children with ASD tend to have tactile-related experiences while reading the printed book and auditory-related experiences during the ebook reading. Qualitative data also demonstrated a particular feature reported to be beneficial in previous research could be distracting for some children with ASD.

Implications

When parents are trained to explain critical word meanings to their children, animated ebooks can effectively improve the meaning-making skills of children with ASD. Findings also highlight the importance of individualized attention when choosing and using ebooks for children with ASD.

Exceptional abilities in autism: Theories and open questions

The vast majority of research on autism spectrum disorder (ASD) focuses on characterizing and addressing the social communication deficits and restricted, repetitive patterns of behavior that constitute the diagnostic criteria for the disorder. Yet, a small but significant portion of individuals diagnosed with ASD exhibit exceptional cognitive abilities in one or more domains. These "twice-exceptional" individuals often have unique skills that enable them to make significant contributions to the workforce, while at the same time facing unique challenges during the transition to independent living due to a lack of services and broad public misperceptions regarding their condition. Here we review the current literature on cognitive divergence in ASD, focusing on cognitive theories, neural substrates, and clinical and societal implications for increasing understanding of this phenomenon.

What Ability Can Predict Mathematics Performance in Typically Developing Preschoolers and Those with Autism Spectrum Disorder?

Research evaluating predictors of mathematics ability in preschoolers with autism spectrum disorder (ASD) is scarce and inconclusive. The present study first compared the mathematics ability and cognitive abilities of preschoolers with ASD and age-matched typically developing (TD) peers. Then, we examined the relative contributions of cognitive abilities to the mathematics ability of preschoolers with ASD and TD. The results show that compared to those of their age-matched TD peers, the mathematics and cognitive abilities of preschoolers with ASD were impaired. The predictors of mathematics ability were found to differ among preschoolers with ASD and their age-matched TD peers. For TD preschoolers, the domain-specific approximate number system (ANS) was the key predictor of mathematics ability. For preschoolers with ASD, domain-general working memory (WM) was most important.

Reading and Writing Skills in Adolescents With Autism Spectrum Disorder Without Intellectual Disability

The purpose of this study is to extend the knowledge about academic achievement in individuals with autism spectrum disorder (ASD). To this end, first, we analyzed differences in a wide range of reading and writing skills in adolescents with ASD without intellectual disability (ASD-WID) and adolescents with typical development (TD). Second, these two groups were compared on academic outcomes in core subjects and indicators of successful transition to secondary school. Third, the potential contribution of literacy skills to academic outcomes was examined in the two groups. Participants were 56 adolescents between 12 and 14 years old, 30 with ASD-WID and 26 with TD. Results showed no significant differences between the two groups on measures of reading fluency or literal and inferential comprehension. However, the performance of the group with ASD was significantly lower on reading comprehension processes that assess cognitive flexibility. Regarding their written expression skills, significant differences were observed between the group with ASD and the group with TD on most of the indicators analyzed as: productivity, lexical diversity, and overall coherence (resolution component). In addition, findings showed that the deficits in reading and writing observed in the adolescents with ASD significantly affected their academic achievement, which was lower than that of their peers with TD and below what would be expected based on their intellectual capacity. Moreover, their families' perceptions of the transition to high school reflected worse adjustment and lower self-esteem, confidence, and motivation.

Validation strategies for subtypes in psychiatry: A systematic review of research on autism spectrum disorder

Heterogeneity within autism spectrum disorder (ASD) is recognized as a challenge to both biological and psychological research, as well as clinical practice. To reduce unexplained heterogeneity, subtyping techniques are often used to establish more homogeneous subtypes based on metrics of similarity and dissimilarity between people. We review the ASD literature to create a systematic overview of the subtyping procedures and subtype validation techniques that are used in this field. We conducted a systematic review of 156 articles (2001-June 2020) that subtyped participants (range N of studies = 17-20,658), of which some or all had an ASD diagnosis. We found a large diversity in (parametric and non-parametric) methods and (biological, psychological, demographic) variables used to establish subtypes. The majority of studies validated their subtype results using variables that were measured concurrently, but were not included in the subtyping procedure. Other investigations into subtypes' validity were rarer. In order to advance clinical research and the theoretical and clinical usefulness of identified subtypes, we propose a structured approach and present the SUbtyping VAlidation Checklist (SUVAC), a checklist for validating subtyping results.

Building Meaning: Meta-analysis of Component Skills Supporting Reading Comprehension in Children with Autism Spectrum Disorder

The ability to understand what one reads, or reading comprehension, is central to academic success. For many children with autism spectrum disorder (ASD), reading comprehension is a noted area of challenge. For children with typical development, it is well established that successful reading comprehension requires two broad skills: word reading and oral language. For children with ASD, word reading is often believed to be relatively intact, even in the face of poor reading comprehension, suggesting that deficits in oral language, more than in word reading, underlie reading comprehension deficits. Yet, extant research has suggested the importance of both skills. To clarify the role of these skills in the reading comprehension of children with ASD, we conducted a meta-analysis. ERIC, PsycINFO, PubMed, and Proquest Dissertation & Theses were searched for studies of reading comprehension in children with ASD, published up to May 2019. We identified 26 relevant studies about children with ASD (aged 6-18 years) that included both a measure of word reading and reading comprehension. Hunt-Schmidt Random Effects Models showed similar mean correlations between reading comprehension and the component skills of word reading (M r = 0.65 [0.27-1.03]) and oral language (M r = 0.61 [0.33-0.88]). These findings demonstrate that these skills are essential for reading comprehension in children with ASD, making contributions of similar size. This study advances our understanding of the mechanisms by which children with ASD understand what they read, providing a foundation on which to build programmatic research into each of these mechanisms. LAY SUMMARY: Academic progress is closely tied to children's ability to understand what they read. Yet reading comprehension is difficult for many children with autism spectrum disorder (ASD). We used a statistical method to summarize existing research on the skills that children with ASD use to understand what they read. We found that the reading comprehension of children with ASD was related to a similar extent to both their ability to read individual words and their oral language skills. These findings suggest that both areas should be assessed in order to determine appropriate interventions to support reading comprehension for children with ASD. Autism Res 2021, 14: 840-858. © 2021 International Society for Autism Research, Wiley Periodicals LLC.

Arithmetic in developmental cognitive disabilities

This paper reviews and discusses research on arithmetical strengths and weaknesses in children with specific developmental cognitive disabilities. It focusses on children with dyslexia, developmental language disorder, attention deficit hyperactivity disorder and autism. In general, studies show that arithmetical weaknesses are commoner in children with any of these disorders than in controls. Autism is sometimes associated with specific strengths in arithmetic; but even in autism, it is commoner for arithmetic to be a relative weakness than a relative strength. There may be some genetic reasons why there is an overlap between mathematical difficulties and other developmental learning difficulties; but much of the reason seems to be that specific aspects of arithmetic are often influenced by other factors, including language comprehension, phonological awareness, verbal and spatial working memory and long-term memory, and executive functions. The findings discussed here will be discussed in relation to Pennington's (2006) Multiple Deficit Model.

A Developmental Study of Mathematics in Children with Autism Spectrum Disorder, Symptoms of Attention Deficit Hyperactivity Disorder, or Typical Development

This study examined mathematics achievement in school-aged children with autism spectrum disorder (ASD), symptoms of attention-deficit/hyperactivity disorder (ADHD), or typical development (TD) over a 30-month period and the associations between cognitive and reading abilities with mathematics achievement in children with ASD. Seventy-seven children with ASD without intellectual disability (ASD-WoID), 39 children with ADHD, and 43 children with TD participated in this study. The results revealed that the ASD-WoID and ADHD samples displayed significant and comparable delays in problem solving and calculation abilities. Lower VIQ was related to lower math achievement across all subgroups. The ASD-WoID sample differed from comparison samples in terms of their pattern of mathematical achievement and the role of cognitive abilities in the development of mathematics competence.

Neural correlates of cognitive variability in childhood autism and relation to heterogeneity in decision-making dynamics

Heterogeneity in cognitive and academic abilities is a prominent feature of autism spectrum disorder (ASD), yet little is known about its underlying causes. Here we combine functional brain imaging during numerical problem-solving with hierarchical drift-diffusion models of behavior and standardized measures of numerical abilities to investigate neural mechanisms underlying cognitive variability in children with ASD, and their IQ-matched Typically Developing (TD) peers. Although the two groups showed similar levels of brain activation, the relation to individual abilities differed markedly in ventral temporal-occipital, parietal and prefrontal regions important for numerical cognition: children with ASD showed a positive correlation between functional brain activation and numerical abilities, whereas TD children showed the opposite pattern. Despite similar accuracy and response times, decision thresholds were significantly higher in the ASD group, suggesting greater evidence required for problem-solving. Critically, the relationship between individual abilities and engagement of prefrontal control systems anchored in the anterior insula was differentially moderated by decision threshold in subgroups of children with ASD. Our findings uncover novel cognitive and neural sources of variability in academically-relevant cognitive skills in ASD and suggest that multilevel measures and latent decision-making dynamics can aid in characterization of cognitive variability and heterogeneity in neurodevelopmental disorders.