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.     

Parent-Reported Temperament Trajectories Among Infant Siblings of Children with Autism

Temperament atypicalities have been documented in infancy and early development in children who develop autism spectrum disorders (ASD). The current study investigates whether there are differences in developmental trajectories of temperament between infants and toddlers with and without ASD. Parents of infant siblings of children with autism completed the Carey Temperament Scales about their child at 6, 12, 18, 24, and 36 months of age. Temperament trajectories of children with ASD reflected increases over time in activity level, and decreasing adaptability and approach behaviors relative to high-risk typically developing (TD) children. This study is the first to compare temperament trajectories between high-risk TD infants and infants subsequently diagnosed with ASD in the developmental window when overt symptoms of ASD first emerge.     

Computer-based intervention for inferring facial expressions from the socio-emotional context in two children with autism spectrum disorders

Difficulties in understanding others’ emotions have been widely reported in autism spectrum disorders (ASDs). Many methodologies for evaluating the emotion recognition can be analyzed by matching-to-sample (MTS) procedures. When using movies of socio-emotional situations as sample stimuli, children with ASD have been found to have difficulties in understanding them. Furthermore, there are few intervention studies that have targeted understanding of socio-emotional situations in children with ASD. The present study examined whether two young children with ASD can acquire the relationships between movies of socio-emotional situations and pictures of facial expressions through computer-based MTS training. The movies of situations and pictures of facial expressions represented happy, surprised, angry and sad emotions. The child with ASD was required to select the picture of facial expression when presented with the movie of socio-emotional situations as a sample stimulus, and if so, whether these skills can be generalized to untrained stimuli. We used a multiple baseline design across participants, and the results demonstrated that both children learned the relationships and improved their performance with untrained stimuli. These findings are discussed in terms of procedures to increase the understanding of others’ emotions at an early developmental stage.     

Validation of the phenomenon of autistic regression using home videotapes

CONTEXT: To date, there has been no objective validation of the phenomenon of autistic regression early in life. OBJECTIVE: To validate parental report of autistic regression using behavioral data coded from home videotapes of children with autism spectrum disorder (ASD) vs typical development taken at 12 and 24 months of age. DESIGN: Home videotapes of 56 children's first and second birthday parties were collected from parents of young children with ASD with and without a reported history of regression and typically developing children. Child behaviors were coded by raters blind to child diagnosis and regression history. A parent interview that elicited information about parents' recall of early symptoms from birth was also administered. SETTING: Participants were recruited from a multidisciplinary study of autism conducted at a major university. PARTICIPANTS: Fifteen children with ASD with a history of regression, 21 children with ASD with early-onset autism, and 20 typically developing children and their parents participated. MAIN OUTCOME MEASURES: Observations of children's communicative, social, affective, repetitive behaviors, and toy play coded from videotapes of the toddlers' first and second birthday parties. RESULTS: Analyses revealed that infants with ASD with regression show similar use of joint attention and more frequent use of words and babble compared with typical infants at 12 months of age. In contrast, infants with ASD with early onset of symptoms and no regression displayed fewer joint attention and communicative behaviors at 12 months of age. By 24 months of age, both groups of toddlers with ASD displayed fewer instances of word use, vocalizations, declarative pointing, social gaze, and orienting to name as compared with typically developing 24-month-olds. Parent interview data suggested that some children with regression displayed difficulties in regulatory behavior before the regression occurred. CONCLUSION: This study validates the existence of early autistic regression.     

Understanding early communication signals in autism: a study of the perception of infants' cry

Background Previous studies have highlighted that episodes of crying of children with autistic disorder (AD) were perceived as inexplicable from their parents who could not identify causative factors. These results supported the view of AD as related to a problem of expressing and sharing emotions. Moreover, no evidence has been presented on which characteristics of a cry episode influence the adult perception. Aim of our research is to investigate how acoustical features of crying episodes modulate their perception of infants with ASD compared with infants with typical development (TD) and infants with developmental delay (DD). Methods Two studies were employed. In study 1, we artificially modified structural parameters (fundamental frequency, duration of the pauses, waveform modulation) of a cry episode, and then 50 adults (parents and non‐parents) were asked to judge the level of distress elicited. In study 2, acoustic analysis was applied to episodes of crying selected from retrospective home videos of 42 children with AD, TD and DD at 18 months. Results The results showed that (1) differences in the fundamental frequency and in other structural parameters of the cry lead parents and non‐parents to perceive an episode of crying as more aversive and (2) at 18 months of age, AD episodes of crying have higher fundamental frequency (f0). Conclusion Our findings offer support for the hypothesis that acoustic characteristics of episodes of crying of children with autism, especially higher fundamental frequencies, may account for mental states of uneasiness in the listener.     

An exploration of symmetry in early autism spectrum disorders: analysis of lying

Background: Early identification of children with autism spectrum disorders (ASD) is recognized as a critical aspect of their medical management and treatment. Movement disorders are considered one of the first signs which probably precede social or linguistic abnormalities. Objectives: to verify, through observational methods, the possibility of distinguishing infants with ASD from infants with typical development or with mental retardation by movement. Methods: The Eshkol-Wachman movement analysis system, which analyses static symmetry (SS) and dynamic symmetry (DS) during lying, was applied to retrospective home videos regarding the first 5 months of life of children with ASD (n = 18), typical development (n = 18), or developmental delay (n = 12). Results: Significant differences between ASD and the two control groups were found for both SS (p < .001) and DS (p < .01). Within ASD two groups of infants could be differentiated on the basis of the higher (HLS) or the lower (LLS) levels of symmetry. Early onset ASD are more likely to belong to the LLS group. Conclusion: We suggest that motor functioning may define specific subgroups of early ASD which are related to different pathways to the syndrome. LLS could be used as an early indicator of potential autism since the first months of life.     

Autism Spectrum Disorder Symptoms in Infants with Fragile X Syndrome: A Prospective Case Series

No studies to date have prospectively examined early autism spectrum disorder (ASD) markers in infants with fragile X syndrome (FXS), who are at elevated risk for ASD. This paper describes the developmental profiles of eight infants with FXS from 9 to 24 months of age. Four meet diagnostic criteria for ASD at 24 months of age, and four do not. Trends in these case studies suggest that early social-communicative deficits differentiate infants with and without later ASD diagnoses in ways that are similar to later-born siblings of children with ASD. Repetitive behaviors and cognitive and adaptive impairments are present in all FXS infants throughout development, suggesting that these deficits reflect the general FXS phenotype and not ASD in FXS specifically.     

Early signs of autism and family films: a new study by informed evaluators and those unaware of the diagnosis

Since the initial individualization of infantile autism by Kanner, subsequent work has attempted to define the age at which disorders appear, their symptomatology and their specificity. Initially, retrospective studies based on questionnaires and interviews with parents were conducted in order to determine the age of at which the first signs appeared. Combined with interviews, clinical observations have provided incontestable aid for describing the early signs of autism. The study of home movies taken by parents before their infant's disorders were recognized has led to a new approach to the initials signs of autism. Our study is a continuation of work in our Child Psychiatry Unit under way since 1984. The aim of this work is the symptomatological and comparative analysis of home movies of 14 autistic and 10 normal infants, during the first two years of their life. Each film was scored for the 0-8, 9-17 and 18-24 month periods. Based on the use of the Infant Behavioral Summarized Evaluation (IBSE), this study confirms prior data and also shows the emergence of very early disorders, perceptible within the first few months even by blind evaluators: a docile baby, showing no overt manifestations, not seeking contact, with an absence of pre-language. Even so, the results require caution when interpreting for methodological reasons which are discussed.     

The moderating effects of intellectual development on core symptoms of autism and PDD-NOS in toddlers and infants

Little research has been conducted on whether deficits in developmental functioning affect the range of core symptoms for autism spectrum disorders (ASD). This study represents a first attempt to determine whether developmental level has an effect on the expression of ASD symptoms in infants and toddlers. Eight hundred and fifty-three infants were evaluated with respect to the nature and extent of their ASD symptoms and developmental functioning. Young children with autism displayed a higher number of symptoms than those with PDD-NOS on all three domains of impairment (social, communication, repetitive behaviors). As expected, children without an ASD evinced far fewer symptoms than both these groups. Developmental level was not found to be a moderator for expression of ASD symptoms for the entire sample, or individual diagnostic groups. Higher developmental level was associated with lower severity of evinced ASD symptoms in the sample.     

Head Circumference as an Early Predictor of Autism Symptoms in Younger Siblings of Children with Autism Spectrum Disorder

Siblings of children with autism have an increased risk for autism spectrum disorders (ASD). As children with autism often exhibit an atypical trajectory of head circumference (HC) growth, HC may be an indicator of vulnerability to autism. This study investigated whether infant siblings of children with ASD (n = 77) with an atypical trajectory of HC growth were more likely than those without an atypical HC trajectory to develop autism symptoms. Results showed that infants who had larger HC at 12 months, and whose HC growth rate decelerated more rapidly between 12 and 24 months were more likely to exhibit autism symptoms than infants with more typical HC trajectories. Among infant siblings of children with autism, atypical HC growth might alert pediatricians to provide screening and/or referral for further evaluation.     

Brief Report: Autism Symptoms in Infants with Fragile X Syndrome

Fragile X syndrome (FXS) is the most common known genetic cause of autism spectrum disorder (ASD). Although 50–75?% of children with FXS meet ASD criteria, no studies have compared ASD symptoms in infants with FXS versus other high risk groups, such as siblings of children with ASD (ASIBs). Using the Autism Observation Scale for Infants, our findings indicate that 53?% of 12-month infants with FXS fall in the “at risk” category compared to 17 and 6?% for age-matched ASIBs and controls, respectively. Elevated atypical motor behaviors were associated with elevated risk for FXS. Cross-syndrome comparisons are essential to understanding the heterogeneity of ASD and identifying candidate markers that will facilitate differential diagnosis of ASD in genetic disorders such as FXS.     

A review of the quality of primary caregiver-implemented communication intervention research for children with ASD

BackgroundMost children with autism spectrum disorder (ASD) spend most of their waking hours at home with their caregivers; thus, involving caregivers in interventions may increase communication interaction opportunities across time and settings.MethodIn this review, an analysis of the quality of the research on communication interventions implemented or mediated by caregivers of children with ASD was conducted based on the What Works Clearinghouse guidelines (Kratochwill et al., 2010) and adapted by Maggin et al. (2013).ResultsAbout one-third of studies included in this review were found to meet the design standards, indicating that those studies utilized a high quality of research design. The studies that failed to meet the design standards were primarily those that lacked sufficient interobserver agreement data collected in each condition, thus, not meeting the minimum quality thresholds. To evaluate an overall effectiveness, a total of 31 single-case experiments were evaluated with the evidence standards. As a result, about half of the experiments were found to have either strong or moderate evidence of an effect.ConclusionsThe findings in this review suggest issues that need to be addressed in the field related to quality of designs in single-case research on primary caregiver-implemented communication interventions for children with ASD. Limitations and implications for future research and for practitioners are discussed.     

Behavioral Profiles of Affected and Unaffected Siblings of Children with Autism: Contribution of Measures of Mother–Infant Interaction and Nonverbal Communication

We investigated whether deficits in social gaze and affect and in joint attention behaviors are evident within the first year of life among siblings of children with autism who go on to be diagnosed with autism or ASD (ASD) and siblings who are non-diagnosed (NoASD-sib) compared to low-risk controls. The ASD group did not differ from the other two groups at 6 months of age in the frequency of gaze, smiles, and vocalizations directed toward the caregiver, nor in their sensitivity to her withdrawal from interaction. However, by 12 months, infants in the ASD group exhibited lower rates of joint attention and requesting behaviors. In contrast, NoASD-sibs did not differ from comparison infants on any variables of interest at 6 and 12 months.     

Speech Preference is Associated with Autistic-Like Behavior in 18-Months-Olds at Risk for Autism Spectrum Disorder

We examined whether infants’ preference for speech at 12 months is associated with autistic-like behaviors at 18 months in infants who are at increased risk for autism spectrum disorder (ASD) because they have an older sibling diagnosed with ASD and in low-risk infants. Only low-risk infants listened significantly longer to speech than to nonspeech at 12 months. In both groups, relative preference for speech correlated positively with general cognitive ability at 12 months. However, in high-risk infants only, preference for speech was associated with autistic-like behavior at 18 months, while in low-risk infants, preference for speech correlated with language abilities. This suggests that in children at risk for ASD an atypical species-specific bias for speech may underlie atypical social development.     

Parent-infant interaction in infant siblings at risk of autism

Recent models of the early emergence of autism spectrum disorder (ASD) propose an interaction between risk susceptibility and the infant's social environment, resulting in a progressively atypical developmental trajectory. The infant's early social environmental experience consists mostly of interaction with caregivers, yet there has been little systematic study of early parent-infant interaction in infants at risk of ASD. This study examined the global characteristics of parent-infant interaction in 6- to 10-month-old infants with an older sibling diagnosed with ASD (at-risk sibs), in comparison with a group of infants with no family history of ASD (low-risk sibs). As part of the British Autism Study of Infant Siblings (BASIS), 6-min videotaped unstructured play interactions of mother-infant dyads (45 at-risk sibs and 47 low-risk sibs) were rated on global aspects of parent-infant interaction, blind to participant information. Differences in global characteristics of interaction were observed in both infant and parent contributions in the at-risk group compared to low-risk controls. In analyses adjusted for age and developmental level, at-risk sib infants were less lively, and their parents showed higher directiveness, and lower sensitive responding (as a trend after adjustment). Level of infant liveliness was independent of other interactive behaviour. Consistent with reports in previous literature in older children with autism and in other neurodevelopmental disorders, our findings may suggest that infants at genetic risk are exposed to a more directive interactive style relatively early in infancy. We discuss possible explanations for these findings and implications for further developmental study and intervention.     

Exploring the Social Impact of Being a Typical Peer Model for Included Children with Autism Spectrum Disorder

This study examined the social impact of being a typical peer model as part of a social skills intervention for children with autism spectrum disorder (ASD). Participants were drawn from a randomized-controlled-treatment trial that examined the effects of targeted interventions on the social networks of 60 elementary-aged children with ASD. Results demonstrated that typical peer models had higher social network centrality, received friendships, friendship quality, and less loneliness than non-peer models. Peer models were also more likely to be connected with children with ASD than non-peer models at baseline and exit. These results suggest that typical peers can be socially connected to children with ASD, as well as other classmates, and maintain a strong and positive role within the classroom.     

Self-face and self-body recognition in autism

The advantage in responding to self vs. others’ body and face-parts (the so called self-advantage) is considered to reflect the implicit access to the bodily self representation and has been studied in healthy and brain-damaged adults in previous studies. If the distinction of the self from others is a key aspect of social behaviour and is a precursory ability of later conceptual self development, it is interesting to investigate these functions in children with autism spectrum disorder (ASD). Here we investigate the implicit access to self representation in children with autism spectrum disorder (ASD) and in children with typical development (TD). Children with ASD were submitted to a visual matching-to-sample task with stimuli depicting their own or other people's body or face-parts. Participants were required to decide which of the two vertically aligned images matched the central target stimulus. The performance of children with ASD was compared to the performance of children with typical development (TD). Children with ASD were less accurate compared to children with typical development. Interestingly, children with ASD performed the task better when they visually matched their own, compared to others’ stimuli showing the self-advantage effect, as well as children with TD.     

Eye tracking in early autism research

Eye tracking has the potential to characterize autism at a unique intermediate level, with links ‘down’ to underlying neurocognitive networks, as well as ‘up’ to everyday function and dysfunction. Because it is non-invasive and does not require advanced motor responses or language, eye tracking is particularly important for the study of young children and infants. In this article, we review eye tracking studies of young children with autism spectrum disorder (ASD) and children at risk for ASD. Reduced looking time at people and faces, as well as problems with disengagement of attention, appear to be among the earliest signs of ASD, emerging during the first year of life. In toddlers with ASD, altered looking patterns across facial parts such as the eyes and mouth have been found, together with limited orienting to biological motion. We provide a detailed discussion of these and other key findings and highlight methodological opportunities and challenges for eye tracking research of young children with ASD. We conclude that eye tracking can reveal important features of the complex picture of autism.     

The effect of emotional intensity on responses to joint attention in preschoolers with an autism spectrum disorder

BackgroundResponding to joint attention (RJA) is reduced in young children with ASD despite being vital to the early development of social communication. For this reason, RJA is a frequent target in early intervention programs. Clinical guidelines suggest that exaggerating facial expressions or gestural pointing may improve RJA in children with autism by clarifying the meaning of the gaze or gesture. In the current study, we investigate the effect of intensity of emotional expression on RJA in preschoolers with ASD.MethodTwenty-five preschoolers with ASD and 21 typically developing peers were administered a specifically designed eye-tracking task in which an actor directs attention to a moving object by looking at it with an expression that was either neutral, mildly surprised or intensely surprised. In a supplementary condition, gestural pointing was accompanied by a neutral gaze shift.ResultsCommensurate with previous studies, children with ASD oriented less to the face of the actor and were less responsive to RJA when compared to their typically developing peers. However, children with autism differed in their response to RJA according to the different task conditions. They demonstrated more frequent responses to RJA when the actor’s facial expression was either intense or supported by gestural pointing.ConclusionsWe report initial evidence for the importance of clarifying content cues in order to help preschoolers with autism adhere to receptive joint attention (RJA) opportunities. Our findings inform knowledge about early treatment and attention to emotional expressions in autism and improve our understanding of how early interventions may work to increase RJA in young children with ASD.     

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