Comparing Digital Stimulus Prompts to Teach Conditional Discriminations to Children With Autism Spectrum Disorder

Background: Eye-tracking has been used to investigate social perception in autism spectrum disorder (ASD) with variable results. This heterogeneity may be due to the types of stimuli used. In this study, we investigated whether the use of moving vs static stimuli or human actors vs cartoons characters would be more sensitive in detecting gaze abnormalities and discriminating children with ASD from typically developing children. Methods: We studied 18 children with ASD (mean age = 12.9 ± 2.9) and 21 typically developing controls (mean age = 11.3 ± 2.5). Gazes were tracked using Tobii-T120 eye-tracker. Four different types of stimuli were presented: movie with human actors, cartoon movie, picture with human actors and cartoon picture. To identify the type of stimuli that best discriminate the ASD group from the control group, a two-way ANOVA was performed using ecological dimension [human-actors/cartoon] and presentation form [movie/picture] as factors. Results: Children with ASD presented significantly less fixations to eyes and faces in the movie with human actors and in the picture with human actors. Children with ASD also presented significantly more fixations to non-social backgrounds in the movie with human actors and in the cartoon movie. A significant ecological effect was observed for the reduction in fixations to the eyes [human-actors > cartoon]. A significant presentation form effect was observed for the increased fixations to the non-social background [movie > picture]. Conclusions: The direct comparison of gaze behavior across four different types of stimuli demonstrates that gaze abnormalities in ASD depend on the type of stimuli that is used. Our results suggest that general gaze abnormalities in children with ASD are better detected when using dynamic stimuli, and finer details of these abnormalities, especially looking less to the eyes, are better detected in a more ecologically relevant situation presenting human characters.

<p style="text-align: justify;"><strong>Objectives</strong>. The effectiveness of typing as an alternative and augmentative communication (AAC) tool for problem behavior management and the development of vocal request skill has been underexplored. This study compares the effects of two alternative communication systems—the Picture Exchange Communication System (PECS) and typing via a tablet application—on reducing problem behavior episodes and increasing vocal requests in a child with autism spectrum disorder (ASD).</p> <p style="text-align: justify;"><strong>Methods</strong>. From 2018 to 2020, a problem behavior intervention was implemented for a 10-year-old child with ASD who had difficulties using vocal speech. The primary method used was functional communication training (FCT) combined with an extinction procedure. Two AAC tools were applied sequentially: PECS with reinforcement of vocal requests; Typing requests in a tablet app, also with reinforcement of vocal requests..</p> <p style="text-align: justify;"><strong>Results</strong>. When using the AAC system based on typing, the average percentage of problem behavior relative to all responses (both functional communication and problem behavior) was 12%, compared to 25% when using PECS. The average number of vocal requests per school day was 25.9 when using typing in the app, compared to 8.8 with PECS.</p> <p style="text-align: justify;"><strong>C</strong><strong>onclusions</strong>. The acquisition of phrase-typing skills for requests in a specialized app led to greater reductions in problem behavior and a higher frequency of vocal requests compared to PECS. Further research is needed to explore the effectiveness of typing in a tablet app as an AAC tool for problem behavior management and vocal request development in children with ASD and speech impairments. Additionally, a possible mediating relationship should be investigated, where a change in AAC format may lead to an increase in vocal requests, which in turn contributes to a reduction in problem behavior.</p>

Autism Spectrum Disorder (ASD) prevalence rates are increasing and serious games have shown a valuable potential to aid the treatment of autistic individuals. Hence, a Systematic Literature Review was conducted aiming at categorizing serious games for ASD children regarding which skills they aim to develop, how their activities were operationalized, and which customization options they provide to users. Our results showed that a large number of serious games aimed at developing distinct skills in ASD children have been proposed, with their main focus being on social and socio-emotional skills. Nonetheless, for each skill we characterize the existing games according to their features, that is the platform they are developed for, I/O devices used, required users’ action, audiovisual elements, and number of players. We also identify strategies adopted in the games regarding specific features and skills that emerged from the analysis. Finally, our results highlight that offering broader customization options in the games could expand their applicability and utility to their users. This work provides a thorough examination of research on games for ASD children, contributing both to researchers interested in the topic, by identifying existing contributions and open issues for research, and to professionals interested in developing serious games for this public.

Developmental disorders such as Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and Developmental Dyslexia (DD) are reported to have more visual problems, oral language difficulties, and diminished reading skills in addition to their different diagnostic features. Moreover, these conditions also have increased internal noise and probably an impaired ability of external noise filtering. The aim of the present study was to compare the reading performance of these groups in the presence of external visual noise which disrupts the automatic reading processes through the degradation of letters. Sixty-four children and adolescents in four groups, ASD, ADHD, DD, and TD, participated in the study. Two types of stimuli were used - unrelated words and pseudowords. The noise was generated by exchanging a fixed number of pixels between the black symbols and the white background distorting the letters. The task of the participants was to read aloud the words or pseudowords. The reading time for a single letter string, word or pseudoword, was calculated, and the proportion of errors was assessed in order to describe the reading performance. The results obtained showed that the reading of unrelated words and pseudowords differs in the separate groups of participants and is affected differently by the added visual noise. In the no-noise condition, the group with TD had the shortest time for reading words and short pseudowords, followed by the group with ASD, while their reading of long pseudowords was slightly slower than that of the ASD group. The noise increase evoked variations in the reading of groups with ASD and ADHD, which differed from the no-noise condition and the control group with TD. The lowest proportion of errors was observed in readers with TD. The reading performance of the DD group was the worst at all noise levels, with the most prolonged reading time and the highest proportion of errors. At the highest noise level, the participants from all groups read the words and pseudowords with similar reading speed and accuracy. In reading words and pseudowords, the ASD, ADHD, and DD groups show difficulties specific for each disorder revealed in a prolonged reading time and a higher proportion of errors. The dissimilarity in reading abilities of the groups with different development is most evident when the accuracy and reading speed are linked together. The use of noise that degrades the letter structure in the present study allowed us to separate the groups with ASD, ADHD, and DD and disclose specifics in the reading process of each disorder. Error type analysis may provide a basis to improve the educational strategies by appropriately structuring the learning process of children with TD, ASD, ADHD, and DD.

The Perception of Integrated Events in Autism Spectrum Disorders: The Role of Semantic Relatedness and Timing

Impaired predictive coding has been proposed as a framework to explain discrepancies between expectations and outcomes in autism spectrum disorder (ASD) that may contribute to core symptoms of the disorder. However, no eye tracking study has directly addressed this framework in the context of visual predictions of social and nonsocial stimuli. The current study used eye tracking to examine violations of learned visual associations of both social and nonsocial stimuli. Twenty-six adolescents with ASD and 18 typically developing control (TDC) adolescents completed an outcome expectation eye tracking task in which predictive cues correctly (80% of trials) or incorrectly (20% of trials) indicated the location (left or right) of forthcoming social or nonsocial stimuli. During violation trials, individuals with ASD focused their gaze relatively more often on stimuli presented on locations that violated the learned association and less often on locations that corresponded with the learned association. This finding was not moderated by stimulus type (i.e., social vs. nonsocial). Additionally, participants who looked at incorrectly predicted locations more often had significantly greater ASD symptom severity. These results are consistent with theories that characterize ASD as a disorder of prediction and have potential implications for understanding symptoms related to prediction errors in individuals with ASD. Autism Res 2019, 12: 878-883. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) exhibit impairments making predictions that may impact learning. In this study, we used eye tracking methodology and found that individuals with ASD were less likely to look at the predicted location when a visual routine was violated. This pattern was evident for both social and nonsocial images and was associated with greater ASD symptom severity. These findings provide additional support for predictive challenges in ASD.

The presence of vowel exaggeration in infant-directed speech (IDS) may adapt to the age-appropriate demands in speech and language acquisition. Previous studies have provided behavioral evidence of atypical auditory processing towards IDS in children with autism spectrum disorders (ASD), while the underlying neurophysiological mechanisms remain unknown. This event-related potential (ERP) study investigated the neural coding of formant-exaggerated speech and nonspeech in 24 4- to 11-year-old children with ASD and 24 typically-developing (TD) peers. The EEG data were recorded using an alternating block design, in which each stimulus type (exaggerated/non-exaggerated sound) was presented with equal probability. ERP waveform analysis revealed an enhanced P1 for vowel formant exaggeration in the TD group but not in the ASD group. This speech-specific atypical processing in ASD was not found for the nonspeech stimuli which showed similar P1 enhancement in both ASD and TD groups. Moreover, the time-frequency analysis indicated that children with ASD showed differences in neural synchronization in the delta-theta bands for processing acoustic formant changes embedded in nonspeech. Collectively, the results add substantiating neurophysiological evidence (i.e., a lack of neural enhancement effect of vowel exaggeration) for atypical auditory processing of IDS in children with ASD, which may exert a negative effect on phonetic encoding and language learning. LAY SUMMARY: Atypical responses to motherese might act as a potential early marker of risk for children with ASD. This study investigated the neural responses to such socially relevant stimuli in the ASD brain, and the results suggested a lack of neural enhancement responding to the motherese even in individuals without intellectual disability.

Behavioral differences in responding to tactile and auditory stimuli are widely reported in individuals with autism spectrum disorder (ASD). However, the neural mechanisms underlying distinct tactile and auditory reactivity patterns in ASD remain unclear with theories implicating differences in both perceptual and attentional processes. The current study sought to investigate (1) the neural indices of early perceptual and later attentional factors underlying tactile and auditory processing in children with and without ASD, and (2) the relationship between neural indices of tactile and auditory processing and ASD symptomatology. Participants included 14, 6–12-year-olds with ASD and 14 age- and non-verbal IQ matched typically developing (TD) children. Children participated in an event-related potential (ERP) oddball paradigm during which they watched a silent video while being presented with tactile and auditory stimuli (i.e., 80% standard speech sound/a/; 10% oddball speech sound/i/; 10% novel vibrotactile stimuli on the fingertip with standard speech sound/a/). Children’s early and later ERP responses to tactile (P1 and N2) and auditory stimuli (P1, P3a, and P3b) were examined. Non-parametric analyses showed that children with ASD displayed differences in early perceptual processing of auditory (i.e., lower amplitudes at central region of interest), but not tactile, stimuli. Analysis of later attentional components did not show differences in response to tactile and auditory stimuli in the ASD and TD groups. Together, these results suggest that differences in auditory responsivity patterns could be related to perceptual factors in children with ASD. However, despite differences in caregiver-reported sensory measures, children with ASD did not differ in their neural reactivity to infrequent touch-speech stimuli compared to TD children. Nevertheless, correlational analyses confirmed that inter-individual differences in neural responsivity to tactile and auditory stimuli were related to social skills in all children. Finally, we discuss how the paradigm and stimulus type used in the current study may have impacted our results. These findings have implications for everyday life, where individual differences in responding to tactile and auditory stimuli may impact social functioning.

ABSTRACTThe use of serious games (SGs) to provide intervention for various skills to children with autism spectrum disorder (ASD) has increased in the recent years. However, the potential of these games has not been utilized to provide learning of vocabulary to children with ASD. In designing games for children with ASD, there is a need to consider components specifically from the perspectives of ASD and the generic components that can support from the theoretical, content, and game design aspects. In the absence of any existing framework to design games for children with ASD, this article first introduces a framework named serious game design framework (SGDF), constructed to provide support throughout the design process. This framework was constructed based on the extensive review of the literature on ASD and existing SGDFs. The article then focuses on the design and development of a SG prototype based on SGDF. An experimental evaluation prototype was conducted to examine the effectiveness using the withdrawal design of single-subject research design (SSRD) in improving the receptive identification of vocabulary items among children with autism before and after using the prototype. The receptive identification of vocabulary items is measured in terms of the number of correct responses given and the number of attempts made to identify the correct response. The pre- and post-evaluations of the SG prototype show that learning of vocabulary items among children with ASD improved after using the game and they retained items at the end of weeks 1 and 2 following the withdrawal of intervention.

The extent to which affective empathy is impaired in Autism Spectrum Disorder (ASD) remains unclear, as some-but not all-previous neuroimaging studies investigating empathy for pain in ASD have shown similar activation levels to those of neurotypicals individuals. These inconsistent results could be due to the use of different empathy-eliciting stimuli. While some studies used pictures of faces exhibiting a painful expression, others used pictures of limbs in painful situations. In this study, we used fMRI to compare activation in areas associated with empathy processing (empathy network) for these two types of stimuli in 31 participants (16 with ASD, 15 controls). We found a group difference in the inferior frontal gyrus (IFG) and the thalamus when participants viewed stimuli of limbs in painful situations, but not when they viewed face stimuli with a painful expression. Both groups of participants activated their empathy network more when viewing pictures of limbs in painful situations than when viewing pictures of faces with a painful expression; this increased activation for limbs versus faces was significantly enhanced in controls relative to ASD participants, especially in the secondary somatosensory cortex (SII). Our findings suggest that empathy defect of people with ASD is contingent upon the type of stimuli used, and may be related to the level of Mirror Neuron System involvement, as brain regions showing group differences (IFG, SII) underlie embodiment. We discuss the potential clinical implications of our findings in terms of developing interventions boosting the empathetic abilities of people with ASD.

Background: The COVID-19 pandemic represented a disruptive global event that significantly impacted mental health, posing specific challenges for vulnerable groups such as individuals with Autism Spectrum Disorder (ASD). This group faced particular difficulties due to disrupted routines, limited access to therapies, and social isolation. This study examines the changes in mental health among individuals with ASD during and after the pandemic, highlighting contemporary challenges and the mitigation strategies implemented. Methods: A narrative review was conducted. The search was performed in scientific databases such as PubMed, Scopus, Web of Science, PsycINFO, Teseo, Dialnet, and Google Scholar using key terms such as "ASD", "mental health", and "pandemic". Studies published between 2020 and 2024 addressing the impact of COVID-19 on factors such as anxiety, depression, and stress, as well as therapeutic interventions, were selected. Results: Fifteen relevant studies were identified. The findings showed significant increases in the levels of anxiety and depression among individuals with ASD, which were primarily attributable to disrupted routines and social isolation. However, noteworthy innovations in virtual interventions were reported, demonstrating significant potential to mitigate the adverse effects of the pandemic. Conclusions: The pandemic exacerbated preexisting challenges in the mental health of individuals with ASD, revealing structural vulnerabilities in access to therapy and emotional regulation. Nevertheless, it spurred innovations in virtual interventions that could transform support for this group in the future. This analysis underscores the importance of implementing inclusive, sustainable, and adaptive policies to improve the quality of life of individuals with ASD, particularly in the context of global crises.

A growing body of evidence has indicated that individuals with autism spectrum disorder (ASD) exhibit abnormal reactions to sensory stimuli and impaired face processing. Although behavioral studies have reported that individual differences in sensory processing patterns are correlated with performance in face processing tasks, the neural substrates underlying the association between sensory processing patterns and face processing remain unknown. Using functional magnetic resonance imaging, the present study examined the relationships between sensory processing patterns assessed with the Adolescent/Adult Sensory Profile (AASP) and brain activity during a one‐back task with two types of stimuli (face or house pictures). We enrolled 18 Japanese adults with ASD and 19 age‐ and IQ‐matched controls. Sensation Avoiding scores, which were assessed using the AASP, were positively correlated with right fusiform activity during the presentation of pictures of faces in the ASD group, but not in the control group. This suggests that abnormal sensory processing patterns in ASD are associated with abnormal face‐related brain activity, possibly resulting in impaired face processing. Autism Res 2020, 13: 741–750. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.Lay SummarySensory abnormalities are one of the most common symptoms in people with autism spectrum disorder (ASD). This study shows that individuals with ASD who react abnormally to sensory stimuli also exhibit atypical brain activity when recognizing faces. Abnormal sensory processing may partly explain the difficulty that people diagnosed with ASD have in identifying others' faces.

Autism spectrum disorders (ASD) are associated with prepotent response inhibition difficulties. However, the large variation between studies suggests that understudied factors, such as interstimulus interval (ISI) and "stimulus-type" (both hypothesized proxies of stressors influencing arousal), might influence the inhibitory abilities of people with ASD. Using meta-analysis, we tested whether differences in prepotent response inhibition between people with and without ASD was influenced by ISI. There was not enough variation in "stimulus-type" between the studies to include it as a moderator. Thirty-seven studies met inclusion criteria, with a combined sample size of 950 people with ASD and 966 typically developing controls. Additionally, a qualitative review including studies comparing a neutral and an arousing condition in one experiment was performed to examine whether fast ISI or specific arousing stimuli directly influence prepotent response inhibition. The meta-analysis indicated that ISI was not a relevant moderator. The qualitative review showed that ISI and "stimulus-type" had the same effect for both groups. Although all studies regarding ISI indicated that fast ISI worsened performance, different types of stimuli had either a positive or a negative influence. This could suggest that distinctive stimuli might affect arousal differently. While we replicated the inhibition difficulties in people with ASD (g = .51), our results do not show strong ASD-specific effects of ISI or "stimulus-type" on inhibition. Nonetheless, ISI and "stimulus-type" do seem to influence performance. Future research focusing on potential underlying factors (e.g., baseline physiological arousal) is needed to examine why this is the case. Autism Res 2016, 9: 1124-1141. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

In this study, it was aimed to enable children with Autism Spectrum Disorder (ASD) who do not have the ability to engage themselves to acquire the skill of engaging in developmental games on a tablet using an activity schedule. The participants of the study were a 4-year-old girl and two 6-year-old boys who were receiving education in a special education center in Istanbul, Turkey. These children had functional speech limitations, did not know how to follow an activity schedule, and exhibited various behavioral problems. In the study, the skill of engaging in a set of developmental games (coloring, matching, role-playing as a doctor, solving puzzles, and finding hidden objects) using selected applications on the tablet was taught to each participant with the gradual reduction of the prompt method through the activity schedule. In the study, a multiple probe design across subjects, one of the single-subject research methods, was used. The results of the study showed that children with ASD acquired the skill of engaging in a set of developmental game activities on a tablet using an activity schedule within an average of 4–6 weeks. They were able to generalize this skill to different environments and maintain it during the second and fourth weeks after the end of the research process. Social validity results related to the research process and outcome were found to be positive.

Disentangling the Individual-Shared and Individual-Specific Subspace of Altered Brain Functional Connectivity in Autism Spectrum Disorder