Attentional skills during the first 6 months of age in autism spectrum disorder

OBJECTIVE: To study the quality of early attention in autism spectrum disorder (ASD) through home movies. METHOD: Fifteen home movies from the first 6 months of life of children who later received a diagnosis of ASD were compared with home movies of 15 normal children. The diagnosis was performed after the third year of life of children by two senior child and adolescent psychiatrists using a checklist of symptoms according to the. The films of the two groups were mixed and rated by blind observers through a Grid for the Assessment of Attentional Skills in Infants, composed of 13 items grouped into three developmental areas. RESULTS: Using multivariate analysis of variance, the authors found significant differences between the two groups for the items in the social attention and the social behavior areas; on the contrary, there were no differences in nonsocial attention. CONCLUSIONS: The authors pose some hypotheses about a specific early-appearing impairment of attention in ASD in which children shift their spontaneous attention mainly toward nonsocial stimuli rather than toward social stimuli. The importance of this finding for early diagnosis and treatment is underlined.     

Age Trends in Visual Exploration of Social and Nonsocial Information in Children with Autism

Because previous studies of attention in autism spectrum disorders (ASD) have been restricted in age range examined, little is known about how these processes develop over the course of childhood. In this study we examined cross-sectional age effects on patterns of visual attention to social and nonsocial information in 43 typically developing children and 51 children with ASD ranging in age from 2 to 18. Results indicated a sharp increase in visual exploration with age and a decrease in perseverative and detail-focused attention for both groups of children. However, increased age was associated with greater increases in visual exploration for typically developing children than for those children with ASD. The developmental differences were most pronounced for attention to certain nonsocial stimuli as children with ASD demonstrated a disproportionate attentional bias for these stimuli from very early in life. Disproportionate visual attention to certain nonsocial objects relative to social stimuli in ASD spanned from early to late childhood, and thus may represent both an early and a persistent characteristic of the disorder.     

Children with Autism Fail to Orient to Naturally Occurring Social Stimuli

Children with autism were compared to developmentally matched children with Down syndrome or typical development in terms of their ability to visually orient to two social stimuli (name called, hands clapping) and two nonsocial stimuli (rattle, musical jack-in-the-box), and in terms of their ability to share attention (following another's gaze or point). It was found that, compared to children with Down syndrome or typical development, children with autism more frequently failed to orient to all stimuli, and that this failure was much more extreme for social stimuli. Children with autism who oriented to social stimuli took longer to do so compared to the other two groups of children. Children with autism also exhibited impairments in shared attention. Moreover, for both children with autism and Down syndrome, correlational analyses revealed a relation between shared attention performance and the ability to orient to social stimuli, but no relation between shared attention performance and the ability to orient to nonsocial stimuli. Results suggest that social orienting impairments may contribute to difficulties in shared attention found in autism.     

Nonverbal Communication Skills in Young Children with Autism

Objective The study was to examine nonverbal communication in young children with autism. Methods The participants were 23 young children with autism (mean CA = 32.79 months), 23 CA and MA-matched children with developmental delay and 22 18–20-month-old, and 22 13–15-month-old typically developing toddlers and infants. The abbreviated Early Social Communication Scales [Mundy et al. 1996, Early social communication scales (ESCS)] were used to test three types of nonverbal communicative skills, i.e., joint attention, requesting, and social interaction. Both frequency and proportion analyses were done in group comparisons. Results (1) Two- to three-year-old children with autism displayed deficits in joint attention ability, especially high-level skills. (2) The deficit in terms of frequency of communication was marked even compared with typically developing infants with younger mental age. (3) Young children with autism had different nonverbal communication profile compared with all three comparison groups. Conclusion Early social-communicative difficulties in autism involve early triadic communications involving joint attention and possibly dyadic turn-taking skills, which has implications for both early screening and early intervention.     

Brief Report: Circumscribed Attention in Young Children with Autism

School-aged children and adolescents with autism demonstrate circumscribed attentional patterns to nonsocial aspects of complex visual arrays (Sasson et al. 2008). The current study downward extended these findings to a sample of 2–5 year-olds with autism and 2–5 year-old typically developing children. Eye-tracking was used to quantify discrete aspects of visual attention to picture arrays containing combinations of social pictures, pictures of objects frequently involved in circumscribed interests in persons with autism (e.g., trains), and pictures of more commonplace objects (e.g., clothing). The children with autism exhibited greater exploration and perseverative attention on objects related to circumscribed interests than did typically developing children. Results suggest that circumscribed attention may be an early emerging characteristic of autism.     

Response to Joint Attention in Toddlers at Risk for Autism Spectrum Disorder: A Prospective Study

Response to joint attention (RJA) is impaired in preschoolers with autism spectrum disorder (ASD) and is pivotal to social and communication development. Response to joint attention was examined at 14 and 24 months in 51 children at high risk for autism (siblings of children with autism). Outcome groups at age 3 years included ASD (n = 16), broader autism phenotype (n = 8), and non-broader autism phenotype (n = 27). The ASD group made minimal improvement in RJA between 14 and 24 months, but stability of RJA across tasks increased for all three groups. Significantly, lower RJA was observed for the ASD group at 24 months. Response to joint attention performance at 14 months predicted ASD outcome. Response to joint attention is an important screening and early intervention target.     

What studies of family home movies can teach us about autistic infants: A literature review

The current study reviewed all prior studies conducted on family home movies of infants who would be later diagnosed with autism spectrum disorder (ASD). Out of 41 original reports found since 1975, we retained 18 studies (317 films, maximum), sorted according to their methodological design using a quality grid. In the first 2 years of life, signs that differentiated children with ASD from children with developmental delays were as follows: less of a response to their name, less looking at others, lower eye contact quality and quantity, less positive facial expression and intersubjective behaviors (e.g., showing shared attention). Studies focusing on regression confirmed the clinical validity of the phenomena. We conclude that findings from home movies studies along with prospective studies have created the bases for identification of infants and toddlers at risk of developing ASD before the 18–24-month period, despite early diagnosis of autism remains a complex challenge.     

Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified

Purpose: Autism Spectrum Disorders (ASD) are a group of conditions characterized by symptoms that onset in early childhood. Deficits in social skills and communication are two of the core features of ASD and, if not remediated, can lead to poor long-term outcomes. Few researchers have examined characteristics of social skills and communication in infants with ASD.

Method: The social skills and communicative ability of 886 infants and toddlers 17–37 months of age with autism, PDD-NOS or ‘at risk’ for other developmental delays were evaluated using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were used to test for significance.

Results: Infants and toddlers with autism, followed by PDD-NOS, had greater social and communication deficits than children ‘at risk’ for developmental delays. Items which distinguished between these diagnostic groups were determined.

Conclusions: Outcomes suggest that social and communication deficits can be identified at early ages in a population of developmentally delayed toddlers. Implications are that pinpointing emerging social and communicative autistic traits earlier will allow for more accurate assessment and diagnosis in infants with ASD. This translates into earlier intervention and more effective treatment practices.     

Early behavioral development in autistic children: the first 2 years of life through home movies

OBJECTIVE: The main aim of the research is to study the early behavioral development in autistic children through home movies. METHODS: fifteen home movies, regarding the first 2 years of life of autistic children are compared with the home movies of 15 normal children. The films of the two groups were mixed and rated by blind ratings with the Grid for the Assessment of Normal Behavior in Infants and Toddlers. The grid is composed of 17 items grouped into three developmental areas: social competence, intersubjectivity and symbolic activity. For every area, we have identified specific children's behaviors. RESULTS: Significant differences between the two groups are found both in the range of age 0-6 for intersubjectivity, and in the ranges of age 6-12 and 18-24 for symbolic activity. CONCLUSIONS: The authors pose some hypotheses about an early-appearing impairment of intersubjectivity, the ability to represent other's state of mind, in subjects with autistic disorder.     

Eleven‐year clinical outcome of schizophrenia in Bali

OBJECTIVE: To describe early development of children with regressive autism. METHOD: Home movies from the first 18 months of life of three groups of children with early onset autism (EOA), regressive autism (RA) and typical development (TD) were rated through the Grid for Attention in Infants in three age ranges. Different ANOVA and post hoc-tests were conducted on frequencies of behaviours. RESULTS: Differently from TD, for both RA and EOA non-social attention is higher than social attention across ages. While EOA is characterized by an early deficit in social attention, in RA social attention increases until the first birthday when its decrease proceeds at the same rate as the increase of non-social attention. CONCLUSION: We hypothesize that the intense interest towards objects can be the first sign of an atypical development also in RA; this distinguishing feature lead us to believe that regression, based on the assumption of a previous normal development, is only apparent.     

Study of the onset of autism through home movies

The authors describe the natural history and the beginning of pervasive developmental disorders (PDD) by the observation of home movies. The sample is composed of 26 children aged 18 months to 5 or 6 years at the first consultation. The methodology used in the observation of home movies includes: (1) application of the ERC-A-III scale for recognizing the precocious symptoms of autism; (2) analysis of the coming out and coming off of social, emotional and cognitive competences. The authors, starting from the analysis of these data, describe three kinds of onset and courses of PDD: progressive, regressive and fluctuating. The authors present some conclusive considerations on the different age of PDD onset in home movies, in anamnestic reconstruction and in recall for diagnosis. Copyright Copyright 1999 S. Karger AG, Basel     

What symptoms predict the diagnosis of autism or PDD-NOS in infants and toddlers with developmental delays using the Baby and Infant Screen for aUtIsm Traits

Purpose: Autism Spectrum Disorders (ASD) are characterized by life-long and severe symptoms such as stereotypies, social skills deficits and language delays. Previous research has demonstrated that children who receive early intensive behavioural intervention have a better prognosis than those who do not receive services. It is for this reason that assessments designed specifically for early identification of ASD are of paramount important.

Method: In Study 1, 957 infants with autism, PDD-NOS and atypical development were evaluated using an assessment screener for ASD traits, the Baby and Infant Screen for aUtIsm Traits (BISCUIT). In Study 2, only those with an autism or PDD-NOS diagnosis were evaluated.

Results: The BISCUIT was found to have an excellent overall classification rate for children in the target population. A sub-set of BISCUIT items was found that distinguished children with ASD from atypically developing children. Items were also found which could accurately predict autism vs PDD-NOS diagnosis.

Conclusions: These data suggest that the core features of ASD are distinct and can be identified early in life. Furthermore, the presence of specific core behaviours can allow for a more accurate clinical and diagnostic picture for young children with autism or PDD-NOS vs general developmental delays.     

An Investigation of Attention and Affect in Children with Autism and Down Syndrome

Longitudinal videotape recordings of six young children with autism and six age- and language-matched children with Down syndrome in structured play with their mothers at home were coded for the focus of the child's visual attention for four bimonthly visits and for facial affect for two of the four visits. The main finding was that the children with autism showed reduced expression of positive affect in a familiar social context. The autistic group attended to the mother's face and the researchers only about half as much as the Down syndrome group, but these differences did not reach statistical significance. Compared to the Down syndrome group, the autistic group displayed a smaller proportion of their total positive affect toward the mother's face and toward the researcher, but only the latter group difference reached statistical significance. Although limited by the small sample size, these findings suggest that autistic children's known deficits in attention and affective responsiveness to others persist even in structured interactions with a familiar partner in the home.     

The Responses of Autistic Children to the Distress of Others

The behavior of preschool children from five groups (developmental language disordered, high-functioning autistic, low-functioning autistic, mentally retarded, and normally developing) were coded in three situations: presentation of a nonsocial orienting stimulus (an unfamiliar noise) and two social situations involving simulated distress on the part of an adult with whom they were playing. Cognitive level was correlated with level of responsiveness to stimuli only for the two retarded groups (mentally retarded and low-functioning autistic). Girls showed more prosocial behavior than boys in both social situations, independent of diagnosis. The language-disordered children showed only mild and subtle social deficits. The low-functioning autistic children showed pronounced deficits in responding in all situations. The mentally retarded and high-functioning autistic children showed good awareness of all situations, but were moderately impaired in their ability to respond prosocially; they rarely initiated prosocial behavior, but did respond to specific prompts. The behavioral feature that marked both autistic groups, in contrast to all other groups, was a lack of social referencing; they did not tend to look toward an adult in the presence of an ambiguous and unfamiliar stimulus. Results are discussed in terms of variability between and among high- and low-functioning autistic children, and implications for the core deficits in autism.     

Atypical brain activation patterns during a face‐to‐face joint attention game in adults with autism spectrum disorder

Joint attention behaviors include initiating one's own and responding to another's bid for joint attention to an object, person, or topic. Joint attention abilities in autism are pervasively atypical, correlate with development of language and social abilities, and discriminate children with autism from other developmental disorders. Despite the importance of these behaviors, the neural correlates of joint attention in individuals with autism remain unclear. This paucity of data is likely due to the inherent challenge of acquiring data during a real‐time social interaction. We used a novel experimental set‐up in which participants engaged with an experimenter in an interactive face‐to‐face joint attention game during fMRI data acquisition. Both initiating and responding to joint attention behaviors were examined as well as a solo attention (SA) control condition. Participants included adults with autism spectrum disorder (ASD) (n = 13), a mean age‐ and sex‐matched neurotypical group (n = 14), and a separate group of neurotypical adults (n = 22). Significant differences were found between groups within social‐cognitive brain regions, including dorsal medial prefrontal cortex (dMPFC) and right posterior superior temporal sulcus (pSTS), during the RJA as compared to SA conditions. Region‐of‐interest analyses revealed a lack of signal differentiation between joint attention and control conditions within left pSTS and dMPFC in individuals with ASD. Within the pSTS, this lack of differentiation was characterized by reduced activation during joint attention and relative hyper‐activation during SA. These findings suggest a possible failure of developmental neural specialization within the STS and dMPFC to joint attention in ASD. Hum Brain Mapp 34:2511–2523, 2013. © 2012 Wiley Periodicals, Inc.     

Effect of Sensory Feedback on Immediate Object Imitation in Children with Autism

This study examined the effect of sensory feedback (e.g., flashing lights and sound) on the imitation performance of children with autism and typical children group-matched for mental age. Participants were administered an immediate object-imitation task with six novel toys constructed for this study: three with a sensory effect that could be activated by imitating the modeled action and three without a sensory effect. Although overall imitation performance did not differ significantly between the two groups, the imitation performance of the participants with autism was significantly higher with sensory toys than with nonsensory toys. Typical participants' imitation performance did not differ between the two sets of toys. Both groups played significantly more with the sensory toys during free play, indicating that sensory toys were more reinforcing for both groups. Additional results demonstrated that typical children used significantly more social behaviors during imitation than children with autism, but they did not differ in object-oriented behaviors, replicating previous findings. It is argued that children with autism may be less motivated to imitate by social interaction, but may be motivated to imitate to receive a nonsocial reward (sensory feedback).     

Clinical Characteristics Associated with Language Regression for Children with Autism Spectrum Disorders

We investigated correlates of language regression for children diagnosed with autism spectrum disorders (ASD). Using archival data, children diagnosed with ASD (N = 114, M age = 41.4 months) were divided into four groups based on language development (i.e., regression, plateau, general delay, no delay) and compared on developmental, adaptive behavior, symptom severity, and behavioral adjustment variables. Few overall differences emerged between groups, including similar non-language developmental history, equal risk for seizure disorder, and comparable behavioral adjustment. Groups did not differ with respect to autism symptomatology as measured by the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. Language plateau was associated with better adaptive social skills as measured by the Vineland Adaptive Behavior Scales. Implications and study limitations are discussed.     

Clinical correlates of brainstem dysfunction in autistic children

Children with the diagnosis of autism were tested for brainstem auditory evoked potentials (BAEP), and information was gathered on their medical and developmental histories and current developmental levels of symptomatology. On comparing the nine autistic children having abnormal BAEPs and the seven autistic children with normal BAEPs, the former were found to have exhibited greater pathology in the areas of attention and social accessibility. No differences were found between the groups on measures of language, motor, or perceptual functioning, or on previous diagnoses or medical history. It is suggested that social and attentional pathology may be more specifically associated with the brainstem pathology that may characterize autism than are symptoms in other developmental areas.This work was supported in part by the following grants: NS-12201 from NINCDS-NIH, K3-14,915 from NIMH-ADAMHA (Research Scientist Award to A. F. Mirsky), MHOO250 from NIMH-ADAMHA (Research Scientist Development Award to D. Fein), MH-15189 (NIMH, Research Training Grant to B. Skoff), and UHGRS-561 from University Hospital. We wish to thank Dr. Fred Krell, Joseph Piette, and the staff and students at the May Institute, Chatham, Massachusetts.     

Functional connectivity for an “Island of sparing” in autism spectrum disorder: An fMRI study of visual search

Although autism is usually characterized with respect to sociocommunicative impairments, visual search is known as a domain of relative performance strength in this disorder. This study used functional MRI during visual search in children with autism spectrum disorder (n = 19; mean age = 13;10) and matched typically developing children (n = 19; mean age = 14;0). We selected regions of interest within two attentional networks known to play a crucial role in visual search processes, such as goal‐directed selective attention, filtering of irrelevant distractors, and detection of behaviorally‐relevant information, and examined activation and connectivity within and between these attentional networks. Additionally, based on prior research suggesting links between visual search abilities and autism symptomatology, we tested for correlations between sociocommunicative impairments and behavioral and neural indices of search. Contrary to many previous functional connectivity magnetic resonance imaging studies of autism that reported functional underconnectivity for task domains of weakness, we found atypically increased connectivity within and between attentional networks in autism. Additionally, we found increased functional connectivity for occipital regions, both locally and for long‐distance connections with frontal regions. Both behavioral and neural indices of search were correlated with sociocommunicative impairment in children with autism. This association suggests that strengths in nonsocial visuospatial processing may be related to the development of core autistic sociocommunicative impairments. Hum Brain Mapp 34:2524–2537, 2013. © 2012 Wiley Periodicals, Inc.     

Functional Characteristics of Disruptive Behavior in Developmentally Disabled Children with and without Autism

Expanding on Reese et al. [2003], functional behavioral assessment interviews [O’Neill et al., 1997] concerning disruptive behavior were conducted with parents of 23 children with autism (6 females, 17 males, chronological ages [CA] 24–60 months) and 23 controls without autism pair-matched for CA, developmental age and sex. All children exhibited frequent disruptive behavior. The interviews suggested that matched control children’s disruptive behavior typically functioned to gain attention or items, or to escape demands in general. This was also true for girls with autism. For boys with autism, disruptive behavior more often functioned to (a) escape demands that interfere with repetitive behavior, (b) retain access to an item used in repetitive routines, or (c) avoid idiosyncratically aversive sensory stimuli (e.g., ordinary household noises). These results emphasize the importance of considering behavioral characteristics that are associated with sex and specific disorders or syndromes when conducting functional behavioral assessments.David M. Richman is now at the University of Maryland-Baltimore County.