Towards Motor-Based Early Detection of Autism Red Flags: Enabling Technology and Exploratory Study Protocol

Motor Control Adherence to the Two-thirds Power Law Differs in Autistic Development

Autistic individuals often exhibit motor atypicalities, which may relate to difficulties in social communication. This study utilized a smart tablet activity to computationally characterize motor control by testing adherence to the two-thirds power law (2/3 PL), which captures a systematic covariation between velocity and curvature in motor execution and governs many forms of human movement. Children aged 4-8 years old participated in this study, including 24 autistic children and 33 typically developing children. Participants drew and traced ellipses on an iPad. We extracted data from finger movements on the screen, and computed adherence to the 2/3 PL and other kinematic metrics. Measures of cognitive and motor functioning were also collected. In comparison to the typically developing group, the autistic group demonstrated greater velocity modulation between curved and straight sections of movement, increased levels of acceleration and jerk, and greater intra- and inter-individual variability across several kinematic variables. Further, significant motor control development was observed in typically developing children, but not in those with autism. This study is the first to examine motor control adherence to the 2/3 PL in autistic children, revealing overall diminished motor control. Less smooth, more varied movement and an indication of developmental stasis in autistic children were observed. This study offers a novel tool for computational characterization of the autism motor signature in children's development, demonstrating how smart tablet technology enables accessible assessment of children's motor performance in an objective, quantifiable and scalable manner.

The Design and Development of Instrumented Toys for the Assessment of Infant Cognitive Flexibility

The first years of an infant's life represent a sensitive period for neurodevelopment where one can see the emergence of nascent forms of executive function (EF), which are required to support complex cognition. Few tests exist for measuring EF during infancy, and the available tests require painstaking manual coding of infant behaviour. In modern clinical and research practice, human coders collect data on EF performance by manually labelling video recordings of infant behaviour during toy or social interaction. Besides being extremely time-consuming, video annotation is known to be rater-dependent and subjective. To address these issues, starting from existing cognitive flexibility research protocols, we developed a set of instrumented toys to serve as a new type of task instrumentation and data collection tool suitable for infant use. A commercially available device comprising a barometer and an inertial measurement unit (IMU) embedded in a 3D-printed lattice structure was used to detect when and how the infant interacts with the toy. The data collected using the instrumented toys provided a rich dataset that described the sequence of toy interaction and individual toy interaction patterns, from which EF-relevant aspects of infant cognition can be inferred. Such a tool could provide an objective, reliable, and scalable method of collecting early developmental data in socially interactive contexts.

Motor impairments in Chinese toddlers with autism spectrum disorder and its relationship with social communicative skills

OBJECTIVE

Motor impairments are prevalent in children with autism spectrum disorder (ASD) and persistent across age. Our current study was designed to investigate motor deficits in Chinese toddlers with ASD and to explore the relationships between motor deficits and social communication skills.

METHODS

For this cross-sectional study, we recruited a total of 210 Chinese toddlers with ASD aged between 18 and 36 months in the study during December 2017 to December 2020. Griffiths Developmental Scales-Chinese (GDS-C), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and Communication and Symbolic Behavior Scales Developmental Profile-Infant-Toddler Checklist (CSBS-DP-ITC) were administered in these toddlers to evaluate their development, social communicative skills, and autism severity. We compared the developmental and social communicational profiles of ASD toddlers in different gross and fine motor subgroups, and explored potential associated factors. The univariate generalized linear model tested the relationship of fine and gross motor skills and social communicative skills.

RESULTS

The prevalence of gross and fine motor deficits were 59.5 and 82.5%, respectively, which are almost equivalent in boys and girls. The motor impairments tended to be more severe with age in toddlers. After adjusting for age, sex, non-verbal development quotient (DQ) and restricted, repetitive behaviors, severer gross motor impairments were significantly related to higher comparison score of ADOS-2 and higher social composite score of CSBS-DP-ITC, without interactions with other variables. Meanwhile, lower fine motor skills were associated with more deficits of social communication and higher severity of ASD, also depending on non-verbal DQ. In the lower non-verbal DQ subgroup, both fine motor deficits and restricted repetitive behaviors (RRBs) might have effects on autism symptomology.

CONCLUSION

Motor impairments are common in Chinese toddlers with ASD. Toddlers with weaker gross and fine motor skills have greater deficits in social communicative skills. Gross motor impairment might be an independent predictor of the severity of autism and social communication skills, while the effect of fine motor deficits might be affected by non-verbal DQ and RRBs of toddlers with ASD. We provide further justification for the inclusion of motor impairments in the early intervention for toddlers with ASD.

Digital Biomarkers in Living Labs for Vulnerable and Susceptible Individuals: An Integrative Literature Review

PURPOSE

The study aimed to identify which digital biomarkers are collected and which specific devices are used according to vulnerable and susceptible individual characteristics in a living-lab setting.

MATERIALS AND METHODS

A literature search, screening, and appraisal process was implemented using the Web of Science, Pubmed, and Embase databases. The search query included a combination of terms related to "digital biomarkers," "devices that collect digital biomarkers," and "vulnerable and susceptible groups." After the screening and appraisal process, a total of 37 relevant articles were obtained.

RESULTS

In elderly people, the main digital biomarkers measured were values related to physical activity. Most of the studies used sensors. The articles targeting children aimed to predict diseases, and most of them used devices that are simple and can induce some interest, such as wearable device-based smart toys. In those who were disabled, digital biomarkers that measured location-based movement for the purpose of diagnosing disabilities were widely used, and most were measured by easy-to-use devices that did not require detailed explanations. In the disadvantaged, digital biomarkers related to health promotion were measured, and various wearable devices, such as smart bands and headbands were used depending on the purpose and target.

CONCLUSION

As the digital biomarkers and devices that collect them vary depending on the characteristics of study subjects, researchers should pay attention not only to the purpose of the study but also the characteristics of study subjects when collecting and analyzing digital biomarkers from living labs.

PANI-Based Wearable Electrochemical Sensor for pH Sweat Monitoring

Nowadays, we are assisting in the exceptional growth in research relating to the development of wearable devices for sweat analysis. Sweat is a biofluid that contains useful health information and allows a non-invasive, continuous and comfortable collection. For this reason, it is an excellent biofluid for the detection of different analytes. In this work, electrochemical sensors based on polyaniline thin films deposited on the flexible substrate polyethylene terephthalate coated with indium tin oxide were studied. Polyaniline thin films were abstained by the potentiostatic deposition technique, applying a potential of +2 V vs. SCE for 90 s. To improve the sensor performance, the electronic substrate was modified with reduced graphene oxide, obtained at a constant potential of −0.8 V vs. SCE for 200 s, and then polyaniline thin films were electrodeposited on top of the as-deposited substrate. All samples were characterized by XRD, SEM, EDS, static contact angle and FT-IR/ATR analysis to correlate the physical-chemical features with the performance of the sensors. The obtained electrodes were tested as pH sensors in the range from 2 to 8, showing good behavior, with a sensitivity of 62.3 mV/pH, very close to a Nernstian response, and a reproducibility of 3.8%. Interference tests, in the presence of competing ions, aimed to verify the selectivity, were also performed. Finally, a real sweat sample was collected, and the sweat pH was quantified with both the proposed sensor and a commercial pH meter, showing an excellent concordance.