Framework for adaptive multimodal serious games for early intervention of autistic children

Purpose Autism is a prevalent childhood neurodevelopmental condition with a high hereditary likelihood, and it manifests as a clinical syndrome with varying impairments in language and social behavior as well as the existence of constrictive interests and repetitive behaviors. It is essential for both early diagnosis and intervention to comprehend how autistic people behave visually when exposed to human facial expressions and emotions. The purpose of this study is to investigate how autistic individuals visually respond to human facial expressions and emotions, with the aim of supporting early diagnosis and intervention. Design/methodology/approach In this eye-tracking study, children from two different groups neurotypical (NT) children and autistic (AP) children – were compared in terms of their visual behavior. The authors showed them pictures of people with faces placed in the center, on the left and on the right of the stimuli to gauge how they were focusing on them. The study used eye-tracking technology to accurately capture and examine their eye gaze movements. Furthermore, the study investigated their reactions to sad emotions by showing dynamic stimuli with gradual changes in neutral to sad facial expressions, encompassing both male and female faces. Findings The research showed that when children with NT and AP were exposed to scenarios with human faces, there were substantial differences in their visual behavior. Notably, in contrast to NT children’s concentrated attention, AP children showed less interest in the facial region as seen by prolonged fixations on nonfacial locations. Furthermore, our examination of emotional responses revealed a major difference: NT children mainly focused on the eyes and mouth regions of sad faces, whereas AP children showed a lack of interest in these regions, frequently shifting their gaze from the facial stimuli. Originality/value This study offers important new understandings of the distinctive visual behavior displayed by autistic children when exposed to human faces and emotional stimuli. These findings have important implications for the early diagnosis and support of autism spectrum disorder (ASD). Eye-tracking technology has the potential to be a diagnostic tool that can help identify and support children with ASD early on, ultimately increasing their quality of life and fostering the growth of key sociocognitive abilities. This study helps lay the groundwork for additional investigations and diagnostic models geared toward solving the difficulties faced by people with autism spectrum disorders.

Autism is a serious threat to an individual's physical and mental health. Early screening, diagnosis, and intervention can effectively reduce the level of deficits in individuals with autism. However, traditional methods of screening, diagnosis, and intervention rely on the professionalism of psychiatrists and require a great deal of time and effort, resulting in a large proportion of individuals with autism being diagnosed after the age of 6. Artificial intelligence (AI) combined with machine learning is being used to improve the efficiency of early screening, diagnosis, and intervention of autism in young children. This review aims to summarize AI-assisted methods for early screening, diagnosis, and intervention of autism in young children (infants, toddlers, and preschoolers). To achieve early screening and diagnosis of autism in young children, AI methods have built predictive models to improve the automation of early behavioral diagnosis, analyzed brain imaging and genetic data to break the age barrier for diagnosis, and established intelligent screening systems for early mass screening. For early intervention of autism in young children, AI methods built intelligent education systems to optimize the teaching and learning environment and provide individualized interventions, constructed intelligent monitoring systems for dynamic tracking, and created intelligent support systems to provide continuous support and meet the diverse needs of young children with autism. As AI continues to develop, further research is needed to build a large and shared database on autism, to generalize and migrate the effects of AI interventions, and to improve the appearance and performance of AI-powered robots, to reduce failure rates and costs of AI technologies.

In this paper, we are looking at the differences between autistic and normal children in term of fine motor movement. Previous findings have shown that there are differences between autistic children and normal children when performing a simple motor movement tasks. Imitating a finger tapping and clinching a hand are two examples of a simple motor movement tasks. Our study had adopted one of the video stimuli for clinching the hand from Brainmarkers. 6 selected autistic children and 6 selected normal children were involved in this study. The data collection is using EEG device and will be analyzed using Gaussian mixture model (GMM) and Multilayer perceptron (MLP) as classifier to discriminate between autistic and normal children. Experimental result shows the potential of verifying between autistic and normal children with accuracy of 92%. The potential of using these techniques to identify autistic children can help early detection for the purpose of early intervention. Moreover, the spectrums of the signals also present big differences between the two groups.

Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers' attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.

Support for autistic children early in life should help them to lead flourishing lives. However, many of the early intervention programmes for young autistic children are time-consuming and costly for families. These programmes are also often conducted in settings that are not closely matched to real life. We spoke to 23 parents (of 22 autistic children) to understand their experiences of their children's involvement in early intervention. Parents told us they were grateful for the opportunity, that they had 'hit the jackpot', and their children had 'gained so much' from the programme. They seemed to value the service because it made them feel safe and secure during an uncertain time in their children's lives. Parents told us they trusted staff, felt that they weren't 'doing it alone', and this 'took that pressure off' and helped them feel empowered. They also spoke of feelings of safety from being linked to the university research programme which offered 'accountability' and 'integrity'. Parents' comments showed a strong commitment to the early intervention model and staff - but also common feelings of abandonment and disempowerment as their child's time with the programme came to an end and they went 'back to the real world' and needed to find new supports for their children. These parents' insights should help to inform the design and delivery of community supports for preschool-aged autistic children and their families, which match the reality of their lived experiences.

Many autistic children require support to meet their learning needs. Given the heterogeneity within the autism spectrum it is plausible that different types of support might be better suited to different children. However, knowledge on what interventions work best for which children is limited. We examined the outcomes of autistic preschool-aged children receiving one of two community early intervention approaches. Our main objective was to understand which baseline child characteristics might be associated with the degree of individual response to intervention—whether prognostically (i.e., irrespective of intervention received) or predictively (i.e., specifically in the context of one or other EI approach). Participants comprised two matched groups of preschool-aged autistic children receiving either Group-based Early Start Denver Model (G-ESDM; n = 42) delivered in a 1:3–4 staff:child ratio or an Early Intensive Behavioural Intervention (EIBI; n = 40) delivered in combination of 1:1 and 1:2 staff:child ratio. Over an approximate one-year follow-up period, children in both groups made significant gains in Developmental Quotient (DQ) scores, and trend-level gains in adaptive behaviour composite scores. Higher attention to a playful adult measured via an eye-tracking task was prognostically indicative of better verbal DQ and adaptive behaviour outcomes for the cohort overall. Moderation analyses indicated a single predictive effect—of pre-program sustained attention for subsequent NVDQ outcomes specific to those children receiving G-ESDM. These findings suggest that fine-grained measures of learning skills offer promise towards the selection and tailoring of intervention approaches to meet individual children’s learning needs.

Many autistic individuals experience social challenges that may stem from negative perceptions held by their non-autistic peers. This study aimed to examine school-aged children's first impressions of autistic and non-autistic children based on viewing brief videos. The central research question was whether autistic children are perceived differently in terms of social traits and how these perceptions affect willingness to engage with them. Thirty-seven children aged 5-12 years old viewed brief (10s) videos of both autistic and non-autistic children discussing their interests. Participants then rated each child on social traits (i.e., strange, confident, honest, mean, likeable, smart) and indicated their behavioral intentions (i.e., willingness to live near, sit near, hang out with and talk to) towards the children in the videos. Autistic videos were rated as appearing more awkward, more aggressive, and less likeable compared to non-autistic videos. However, participants reported a similar willingness to interact with both groups. Importantly, these negative perceptions were not associated with the rater child's age, IQ, sex, autistic traits, or social competence. The findings suggest that school-aged children hold biased perceptions of autistic children, independent of their own personal characteristics. This underscores the need for early educational interventions in schools to address stereotypes about and biases against autism. Teaching children about autism could reduce stigma, foster inclusion, and improve social interactions between autistic and non-autistic peers.

Autism prevalence is increasing, with current estimates at 1/68-1/50 individuals diagnosed with autism. Diagnosis is based on behavioral assessments. Early diagnosis and intervention are known to greatly improve functional outcomes in people with autism. Diagnosis, treatment monitoring, and prognosis of autistic children's symptoms could be facilitated with biomarkers to complement behavioral assessments. The aim of this study is to compare and evaluate salivary zinc concentration in saliva samples of autistic and healthy children in mixed dentition age group. Cross-sectional comparative study carried out in dental college and special child school. Unstimulated whole saliva collected for finding a biomarker. Unstimulated whole saliva sample was collected from 10 autistic and 10 healthy children in mixed dentition age group. Diluted saliva sample was then subjected to inductively coupled plasma emission spectroscopy for the estimation of salivary zinc concentration. Mann-Whitney U-test. In children with autism salivary zinc concentration showed a linear equation when compared to healthy children. The low salivary zinc concentration in autistic children can reveal the pathogenesis of autism.

BackgroundParents should be central to early supports for their autistic children, with parent involvement in and satisfaction with supports influencing child outcomes. Migrant parents likely experience different barriers to navigating and participating in early supports for their autistic children, but we have limited data here. MethodsThrough a community-partnered participatory approach, we conducted semi-structured interviews with 19 migrant Chinese parents of autistic children about their experiences of the diagnosis and early intervention (EI) process. Interviews were conducted in home languages by other parents. We analysed data using reflexive thematic analysis. ResultsParents described myriad obstacles to accessing early supports with many related to being a Chinese migrant in Australia. Parents reported difficulties accepting their children’s differences, faced language barriers, experienced stigmatisation/discrimination, and had limited knowledge of autism supports/systems. Funding issues, limited availability of supports and poorly coordinated services were additional challenges. Parents described having little choice and control over supports, often unable to access culturally-specific services. Nonetheless, parents explained how dedicated they were to their children and effectively utilised informal networks to better access supports for themselves and their children. Accessing EI gave parents hope, providing them with specific goals and strategies. ConclusionIt is recommended that professionals clearly communicate with migrant parents about autism and available post-diagnostic autism services/supports, including how to access these. Connecting parents with informal, community-specific services should especially be considered for migrant families. We recommend other potentially useful adaptations to better support migrant Chinese parents in navigating early supports for their autistic children.

The diverse developmental patterns of autism spectrum disorder can become noticeable from a very early age, sometimes accompanied by challenges in specific areas of functioning. Early interventions are widely considered beneficial for autistic children, as they can positively influence developmental progress, functioning and social skills. These interventions typically involve children’s caregivers, though their accessibility, intensity, and effectiveness can vary depending on factors such as available resources, support systems, and individual family needs, which may influence the overall outcomes. The present study aims to identify early educational interventions that may support the development of social skills in preschool and early school-age autistic children. A total of eight journal articles during the 2018–2024 period were identified after an exhaustive search in academic databases. The context and outcomes of these eight studies were coded and analysed. The results show that the social skills of autistic children in early childhood are positively affected by the implementation of early educational programmes.

Imitation is foundational to early social learning, yet autistic children often exhibit significant impairments in imitation, potentially impacting their social communication skills. This study examined the relationship between imitation abilities and social communication in autistic children and evaluated the effectiveness of the Early Start Denver Model (ESDM) intervention. The study included 52 autistic children aged 2–5, divided into an experimental group receiving ESDM intervention and a control group undergoing standard rehabilitation. We assessed the children’s imitation and social communication skills before and after the intervention. Results indicated a significant positive correlation between imitation and social communication skills both before and after the intervention. Specifically, various forms of imitation (e.g., vocal, gestural, object-related) were closely linked to different domains of social communication (e.g., expressive communication, joint attention, social skills). Baseline imitation levels and improvements in imitation were significant predictors of enhanced social communication, jointly accounting for over half of the observed improvements in social communication, with imitation improvement being the strongest predictor. Age positively moderated the relationship between imitation and social communication, with older children showing a stronger impact of imitation on social communication. Although these effects were evident across groups, the ESDM group showed greater gains in imitation skills compared to the control group. However, we did not find evidence of an intervention effect on social communication skills. This study underscores the critical role of imitation in the social communication development of autistic children. These findings support the enhancement of imitation skills in early interventions for autistic children, highlighting the effectiveness of ESDM in fostering imitation abilities.

<p class="HeaderAbs"><em>The main challenge faced by children with autism is difficulty in social communication. Appropriate early intervention is crucial to help autistic children develop their communication skills. One increasingly popular tool in communication intervention for autistic children is Speech Generating Devices (SGD). This study aimed to explore the urgency of using SGD in social communication enhancement therapy for autistic children to improve social interaction and reduce maladaptive behaviour. This study employs a mixed-method research design to explore the urgency of using SGD in treatment to enhance the social communication of autistic children. The sample was taken using proportional random sampling, consisting of 80 teachers for autism and speech therapists in Surakarta. Data collection techniques in this study to explore the urgency of using SGD in therapy to improve the social communication of autistic children were conducted in two ways: through a questionnaire using Google Forms and interviews. The analysis results show that SGD is an essential tool for enhancing the social communication of autistic children, with 66.7% agreeing and 33.3% expressing a neutral stance. The interview results stated that SGD is needed to support autistic social communication. The conclusion drawn from these results indicates that SGD is a crucial element that can be used to improve the communication of autistic children in schools rapidly. The opinions of teachers and speech therapists suggest that the use of SGD can reduce communication challenges in autistic children. This is evident from the questionnaire results filled out by respondents, showing that 95% strongly agree and 5% agree. The use of speech generating devices (SGD) is of high urgency in supporting therapy to enhance the social communication of autistic children in inclusive schools, such as training in social interaction and reducing maladaptive behaviour in autistic children.</em></p>

Anxiety disorders in autistic children are associated with significant functional impairment. Few studies have examined impairing anxiety presentations in autistic preschool children (i.e., 3-5 years old). This cross-sectional study examined the phenomenology of impairing anxiety and the strongest correlates of anxiety in 75 autistic preschool children. Parents completed a diagnostic interview that assesses two anxiety types, DSM-5 anxiety disorders and impairing distinct anxiety presentations, and measures of anxiety correlates. An exploratory network analysis examined connections between anxiety and its correlates. Forty percent of children had impairing anxiety. Specific phobia followed by 'other social fear,' a type of distinct anxiety, were the most common anxiety types. Child intolerance of uncertainty (IU) was the only correlate that was associated with anxiety in a network analysis framework. Child IU linked anxiety to two other correlates, sensory over-responsivity and somatic symptoms. Findings emphasize the need for early intervention for anxiety and further research on its correlates.

Background: Autism spectrum disorder (ASD) is a heterogeneous behavioral disorder that is characterized by qualitative deficits in social communication and interaction and restricted, repetitive behavioral patterns, activities, and interests. For an optimum outcome in children with autism, early intervention (preferably before three years of age) is essential. Hence, there is a critical need to improve the awareness of ASD to enable earlier detection and intervention. The present study aims at achieving the following: (1) Investigating neural transmission within the visual system using visual evoked potentials (VEPs) as an index of the myelination process of the visual pathway. (2) Correlating the changes in the VEPs with the clinical severity of autism. (3) Investigating the possible gender differences in VEPs in autistic children. Materials and Methods: The study was conducted on 60 preschool children (11 females and 49 males) who were recruited from the autism center and the pediatric neurology ward and who met the DSM-V criteria for autism in the Pediatric Hospital for the period from 12 December 2019 to 1 June 2021. Their mean age was 4.5±1.17 years. Another 50 (40 males and 10 females) age- and gender-matched normally developed children served as the control group. Both groups were subjected to a detailed history, as well as complete physical and neurological examinations. The VEPs were assessed for all of them. The autistic children were excluded from the study if they had any motor, visual impairment, inborn errors of metabolism, epilepsy, other chronic medical or neurological disorders, or if they were taking medications during the period of study. Results: The P100 wave latency of the VEPs was significantly prolonged in both eyes of autistic children as compared with that of the control group. The N75-P100 amplitude was significantly lower in the left but not the right eye of patients when compared with those of normally developed children. Neither the P100 wave latency nor the N75-P100 amplitude of both eyes was associated with the gender or severity of illness. Conclusion: There are distinct changes in VEPs in autistic children, especially the abnormal prolongation of conduction time, suggesting that autistic children may have brainstem and visual pathway dysfunction. Gender and disease severity score have no impact on VEPs.

The knowledge of Public Health Midwives on Autism Spectrum Disorder in two selected districts of the Western Province of Sri Lanka.