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.     

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.     

Effects of Different Attentional Cues on Responding to Joint Attention in Younger Siblings of Children with Autism Spectrum Disorders

We compared responding to joint attention (RJA) in younger siblings of children with ASD (SIBS-ASD; n = 46) and younger siblings of children developing typically (SIBS-TD; n = 35). Children were tested between 12 and 23 months of age in a situation in which an experimenter directed the child’s attention to one of 8 targets. Each child responded to 10 different combinations of verbal and nonverbal cues containing varying levels of attention-specifying information. SIBS-ASD had significantly lower overall RJA scores than SIBS-TD. Moderately redundant cues were most difficult for SIBS-ASD relative to SIBS-TD; adding a point to moderately redundant cues improved RJA for SIBS-ASD, bringing them to a level of RJA commensurate with SIBS-TD.     

A brief report: Quantifying and correlating social behaviors in children with autism spectrum disorders

The current study investigated social behaviors, including initiating joint attention (IJA), responding to joint attention (RJA), social orienting, and imitation in 14 children with an autism spectrum disorder (ASD) compared to 12 typically developing children (TD). Results indicated that IJA and RJA were positively correlated with social orienting in both groups, replicating previous results with greater precision through the use of eye-tracking technology. Additionally, results supported the novel hypothesis that social orienting and imitation would be positively correlated in the ASD group, but not in the TD group. Joint attention and imitation were not significantly correlated in either group. Through the use of objective and automated eye gaze measurement more precise information is provided concerning the relation among commonly impaired social behaviors in children with ASD.     

Exploring the Nature of Joint Attention Impairments in Young Children with Autism Spectrum Disorder: Associated Social and Cognitive Skills

It is generally accepted that joint attention skills are impaired in children with autism spectrum disorder (ASD). In this study, social preference, attention disengagement and intention understanding, assumed to be associated with the development of joint attention, are explored in relation to joint attention skills in children with ASD at the age of 36 months. Response to joint attention was related to intention understanding, whereas the number of joint attention initiations was associated with attention disengagement, and somewhat less stronger with social preference. The level on which children initiated joint attention was related to social preference. Possible interpretations of these findings are discussed.     

“You’re telling me!” The prevalence and predictors of pronoun reversals in children with autism spectrum disorders and typical development

Social and linguistic explanations have been proposed for pronoun reversals in young typically developing (TD) children and those with autism spectrum disorders (ASD). The current study breaks new ground in investigating both explanations, comparing 18 TD toddlers and 15 children with ASD at similar language levels. Spontaneous speech was sampled every four months for six visits. Vocabulary and joint attention were also measured. Both groups produced pronoun reversals at low rates. The ASD group produced somewhat more reversals than the TD group, overall and at multiple visits. In the ASD group, early language and joint attention scores contributed significantly and independently to the incidence of reversal. Both linguistic and social factors seem implicated; moreover, reversals seem to occur when children’s language and social abilities develop asynchronously. These findings can help clinicians devise both linguistic and social interventions for the relevant children.     

Play and Developmental Outcomes in Infant Siblings of Children with Autism

We observed infant siblings of children with autism later diagnosed with ASD (ASD siblings; n = 17), infant siblings of children with autism with and without other delays (Other Delays and No Delays siblings; n = 12 and n = 19, respectively) and typically developing controls (TD controls; n = 19) during a free-play task at 18 months of age. Functional, symbolic, and repeated play actions were coded. ASD siblings showed fewer functional and more non-functional repeated play behaviors than TD controls. Other Delays and No Delays siblings showed more non-functional repeated play than TD controls. Group differences disappeared with the inclusion of verbal mental age. Play as an early indicator of autism and its relationship to the broader autism phenotype is discussed.     

The First Year Inventory: Retrospective Parent Responses to a Questionnaire Designed to Identify One-Year-Olds at Risk for Autism

The First Year Inventory (FYI) is a parent questionnaire designed to assess behaviors in 12-month-olds that suggest risk for an eventual diagnosis of autism. We examined the construct validity of the FYI by comparing retrospective responses of parents of preschool children with autism spectrum disorders (ASD; n = 38), other developmental disabilities (DD; n = 15), and typical development (TD; n = 40). Children with ASD were rated at significantly higher risk on the FYI than children with DD or TD. The DD group was at intermediate risk, also significantly higher than the TD group. These retrospective data strengthen the validity of the FYI and have implications for refining the FYI to improve its utility for prospective screening of 12-month-olds.     

Autism Spectrum Disorders and Symptoms in Children with Molecularly Confirmed 22q11.2 Deletion Syndrome

In this study, we assessed the presence of autism spectrum disorders (ASD) among children with a confirmed 22q11.2 deletion (n = 98). The children’s caregivers completed screening measures of ASD behaviors, and for those whose scores indicated significant levels of these behaviors, a standardized diagnostic interview (Autism Diagnostic Interview-Revised; ADI-R) was administered. Results demonstrated that over 20% of children (n = 22) were exhibiting significant levels of autism spectrum symptoms based on the screening measures. Based upon the ADI-R, 14 children qualified for a diagnosis of an ASD, and for 11 of those children a diagnosis of autism was most appropriate. These findings increase our knowledge of developmental disorders associated with the 22q11.2 deletion and point to avenues for future investigation.     

Patterns of Complementary and Alternative Medical Therapy Use in Children Diagnosed with Autism Spectrum Disorders

Previous studies suggest that complementary and alternative medical (CAM) therapy use in children with chronic illnesses is higher than in children in the general population. In this study, we investigated patterns of CAM therapy use in children diagnosed with autism spectrum disorders (ASD, n = 50) as compared to a control population of children with no ASD (n = 50). Over half of the parents in the ASD group reported using, or had used at least one CAM therapy for their child (52%) as compared to 28% of the control group (P = 0.024). Seventy percent of therapies used in the ASD group were biologically based therapies comprised of special diets or supplements, and parents felt that 75% of the therapies used were beneficial.     

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.     

Structural and functional connectivity of the human brain in autism spectrum disorders and attention‐deficit/hyperactivity disorder: A rich club‐organization study

Attention‐deficit/hyperactive disorder (ADHD) and autism spectrum disorders (ASD) are two of the most common and vexing neurodevelopmental disorders among children. Although the two disorders share many behavioral and neuropsychological characteristics, most MRI studies examine only one of the disorders at a time. Using graph theory combined with structural and functional connectivity, we examined the large‐scale network organization among three groups of children: a group with ADHD (8–12 years, n = 20), a group with ASD (7–13 years, n = 16), and typically developing controls (TD) (8–12 years, n = 20). We apply the concept of the rich‐club organization, whereby central, highly connected hub regions are also highly connected to themselves. We examine the brain into two different network domains: (1) inside a rich‐club network phenomena and (2) outside a rich‐club network phenomena. The ASD and ADHD groups had markedly different patterns of rich club and non rich‐club connections in both functional and structural data. The ASD group exhibited higher connectivity in structural and functional networks but only inside the rich‐club networks. These findings were replicated using the autism brain imaging data exchange dataset with ASD (n = 85) and TD (n = 101). The ADHD group exhibited a lower generalized fractional anisotropy and functional connectivity inside the rich‐club networks, but a higher number of axonal fibers and correlation coefficient values outside the rich club. Despite some shared biological features and frequent comorbity, these data suggest ADHD and ASD exhibit distinct large‐scale connectivity patterns in middle childhood. Hum Brain Mapp 35:6032–6048, 2014. © 2014 Wiley Periodicals, Inc.     

Social and communication development in toddlers with early and later diagnosis of autism spectrum disorders

CONTEXT: To our knowledge, no prospective studies of the developmental course of early and later diagnosis of autism spectrum disorders from 14 months of age exist. OBJECTIVE: To examine patterns of development from 14 to 24 months in children with early and later diagnosis of autism spectrum disorders. DESIGN: Prospective, longitudinal design in which 125 infants at high and low risk for autism were tested from age 14 to 36 months. Comprehensive standardized assessments included measures of social, communication, and play behavior. SETTING: Testing occurred at a major medical and research institution as part of a large, ongoing longitudinal study. PARTICIPANTS: Low-risk controls (n = 18) and siblings of children with autism, grouped on the basis of outcome diagnostic classification at 30 or 36 months: autism spectrum disorders (early diagnosis, n = 16; later diagnosis, n = 14), broader autism phenotype (n = 19), and non-broader autism phenotype (n = 58). MAIN OUTCOME MEASURES: Social, communication, and symbolic abilities were assessed. RESULTS: Social, communication, and play behavior in the early-diagnosis group differed from that in all other groups by 14 months of age. By 24 months, the later-diagnosis group differed from the non-autism spectrum disorder groups in social and communication behavior, but not from the early-diagnosis group. Examination of growth trajectories suggests that autism may involve developmental arrest, slowing, or even regression. CONCLUSION: This study provides insight into different patterns of development of children with early vs later diagnosis of autism spectrum disorders.     

Fundamental Movement Skills in Children Diagnosed with Autism Spectrum Disorders and Attention Deficit Hyperactivity Disorder

The purpose of this study was to compare the movement skills of children with autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), and those without disabilities. Ninety-one children (ASD, n = 28; ADHD, n = 29; control, n = 34), ages 6–10 years, were of average IQ participated. After controlling for age, both ASD and ADHD groups scored significantly lower than controls (p’s < .05) on overall gross motor development as well as locomotor and object control subtests, and the ASD group performed more poorly than the ADHD group (p’s < .01) on both subtests. Of the children with ASD and ADHD, only 16% had clinical levels of impairment. Potential underlying factors are discussed, with suggestions for future research.     

Adapting the Autistic Behavioural Indicators Instrument (ABII) as a parent questionnaire (ABII-PQ)

Background Both parent-report and clinician-administered autism spectrum disorder (ASD) screening instruments are important to accurately inform ASD risk ascertainment. The aim of this study was to adapt a clinician-administered ASD screening instrument, the Autistic Behavioural Indicators Instrument (ABII), as a parent questionnaire equivalent (ABII-PQ).

Method?The modification of ABII items into parent questions is described. The ABII-PQ was trialled in a sample of parents of children, aged between 12 months and 6 years, with an ASD (n?=?65, M child age?=?4.03 years) or typical development (n?=?37, M child age?=?2.09 years).

Results Internal consistency was high, α?=?.92. Receiver operator curves analysis identified the optimal ABII-PQ cut-off score, which yielded high sensitivity (.97) and specificity (.95). Classification accuracy was high for children across the autism spectrum (autistic disorder: n?=?35, 100%; Asperger syndrome: n?=?14, 93%; pervasive developmental disorder not otherwise specified: n?=?14, 93%).

Conclusion The ABII-PQ shows promise as a parent questionnaire version of the ABII.     

Change in autism classification with early intervention: Predictors and outcomes

The current study characterized stability and changes of autism diagnostic classification with intervention in very young children and examined pre-treatment predictors and post-intervention outcome. Sixty-eight children diagnosed with autism, aged 18–35 months (M = 25.4, SD = 4.0) participated in the study. Children underwent comprehensive evaluations at pre-intervention time (T1) and after 1 year of intervention (T2). The evaluation included autism classification based on Autism Diagnosis Observation Schedule (ADOS) original algorithm, cognitive abilities (Mullen) and adaptive skills evaluation (Vineland). At T2, two groups were identified: the Unchanged group (n = 53) remained in the same autism classification and the Improved group (n = 15) changed classification to Autism Spectrum Disorder (ASD) (n = 13) or Off Spectrum (n = 2). The verbal domain scores at T1 was the only significant variable that distinguished the two groups. Specifically, the Improved group had better receptive language scores than the Unchanged group. The Improved group gained significantly more than the Unchanged group in all the outcome measures (cognitive, adaptive and reduction of stereotyped behaviors). Two distinct subtypes of autism were identified, one with stable autism symptomatology, poor verbal abilities and limited cognitive and adaptive gains, and a second type with better baseline verbal abilities and overall better response to intervention.     

A Pilot Study of Maternal Sensitivity in the Context of Emergent Autism

Unstructured mother–toddler interactions were examined in 18-month-old high- and low-risk children subsequently diagnosed (n = 12) or not diagnosed (n = 21) with autism spectrum disorders (ASD) at 36 months. Differences in maternal sensitivity were not found as a function of emergent ASD status. A differential-susceptibility moderation model of child risk guided investigations linking maternal sensitivity to child behavior and language growth. Group status moderated the relation between sensitivity and concurrent child behavior problems, with a positive association present for children with emergent ASD. Maternal sensitivity at 18 months predicted expressive language growth from age 2 to 3 years among children with emergent ASD only. Findings underscore the importance of understanding parent–child interaction during this key period in the development of autism symptomatology.     

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.     

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.     

Comprehension of presuppositions in school-age Cantonese-speaking children with and without autism spectrum disorders

ABSTRACT

While an enormous amount of research has been done on the deficient conversation skills in individuals with autism spectrum disorders (ASD), little is known about their performance on presuppositions, a domain of knowledge that is crucial for successful communication. This study investigated the comprehension of four types of presupposition, namely existential, factive, lexical and structural presuppositions, in school-age Cantonese-speaking children with and without ASD. A group of children with ASD (n = 21), mean age 8.8, was compared with a group of typically developing children (n = 106). Knowledge of presuppositions was evaluated based on children’s ability to judge whether a given utterance was a correct presupposition of a preceding utterance. Children with ASD were found to show a deficit in the comprehension of presuppositions, even after controlling for differences in general language ability and non-verbal intelligence. The relative difficulty of the four types of presupposition did not differ between the two groups of children. The present findings provide new empirical evidence that children with ASD have a deficit in the comprehension of presuppositions. Future research should explore whether the deficit in the comprehension of presuppositions is related to the development of theory of mind skills in children with ASD.