Severe ASD Research Articles

HLH in a patient with post-surgical Ebstein’s anomaly: Case report

This case was interesting as it presents a rare complication in a rare congenital anomaly. We present it to raise awareness about serious fatal complications that could occur in a CHD postoperative patient which may not be related to their surgery. The heart surgery was successful but the patient passed away from complications which arose postoperatively. A 34-year-old male with Ebstein’s anomaly and severe tricuspid regurgitation status post ASD closure, atrialized ventricular plication and tricuspid annuloplasty at 6 years old presented with symptoms of congestive heart failure. He underwent tricuspid valve replacement and insertion of epicardial dual chamber pacemaker. Patient developed recurrent high fevers on the first night following surgery that were unresponsive to antibiotics and antipyretics. Evaluation revealed hyperferritinemia, thrombocytopenia, anemia and splenomegaly consistent with Hemophagocytic Lymphohistiocytosis (HLH). EVB titers were found to be elevated as a possible inciting infection. He was treated with Dexamethasone, Etoposide and Cyclopsorine, however he developed Heparin Induced Thrombocytopenia (HIT) followed by Disseminated Intravascular Coagulopathy (DIC) and died from a presumed pulmonary embolism. Conclusion: Surgical intervention outcomes in complex congenital heart disease patients can be complicated by infectious and hematological complications. If more cases of cardiac bypass related HLH are identified, the presence or absence of cold agglutinins as a factor should be studied. Timely recognition will prevent unnecessary mortality and morbidity.

Preliminary analysis of a clinical trial of children with autism spectrum disorder treated with DHA-rich marine Schizochytrium sp. oil and multi-vitamin/mineral complex

BackgroundAutism spectrum disorder (ASD) is a syndrome characterized by alterations in social interaction and communication, frequently associated with stereotyped patterns, such as repetitive behavior. Inflammation and oxidative stress are frequently observed in patients, and natural products that control these aspects can be an alternative for ASD treatment.Method:In this prospective case series study, we administered in 2–12 years-old children (n = 12) with severe ASD a commercial extract of marine Schizochytrium sp. oil, composed by 200 mg DHA and 2 mg eicosapentaenoic acid, associated to a multi-vitamin/mineral complex, daily for 12 weeks. Patients were evaluated by Childhood Autism Rating Scale (CARS) and Adaptive Behavior Assessment System Third Edition (ABAS-3) scales before and after the treatment, and had the urine analyzed.Results:Values obtained from CARS, general adaptive composite and social domains from ABAS-3 were statistically different after treatment. Although not statistically significant, conceptual and practical domains from ABAS-3 had the score increased in several patients after the intervention. Among these domains, communication and visual contact improved in all patients, and vocabulary, interaction, feeding, and food selectivity were enhanced in some of them. The total antioxidant capacity in urine increased after treatment, as well as some metabolites, like amino acids, which were exclusive in all patient’s urine after the administration of the product.Conclusions:These preliminary data show that the continuous use of marine Schizochytrium sp. oil and multi-vitamin/mineral complex can help control characteristic symptoms of ASD in children.

Emotional problems in preschool and school-aged children with neurodevelopmental disorders in Spain: EPINED epidemiological project

BackgroundChildren with neurodevelopmental disorders (NDD) are often at risk of developing emotional problems. Aims and methodsThe co-occurrence of anxiety and depression with ASD and/or ADHD was determined by exploring the association with children’s clinical and neuropsychological functioning and their parent’s mental health. To this end, we assessed 295 preschoolers (PRE; 4–5 years old) and 486 school-aged children (SCH; 10–11 years old) in Tarragona, Spain. NDD diagnoses were based on DSM-5. Emotional problems were assessed using Achenbach’s scales. ResultsEmotional problems (PRE: 36%−78%; SCH: 32%−81%) were more common and more severe in participants with NDD than in controls and children in the ASD + ADHD school-aged group were the most affected. In ADHD, emotional problems were associated with more severe symptoms of attention deficit (PRE) and hyperactivity/impulsivity (SCH). In ASD + ADHD, emotional problems showed a trend of association with more severe ASD repetitive behaviours and impaired working memory, whereas in ASD were associated with greater overall ASD severity. Conclusions and implicationsChildren with NDD are vulnerable to emotional problems, which become more prevalent and interfering with age. Early detection and intervention aimed at tackling emotional problems can improve NDD prognosis.

Sleep architecture is associated with core symptom severity in autism spectrum disorder.

While caregiver-reported sleep disturbances are common in children and adolescents with autism spectrum disorder (['), few studies have measured objective sleep in ASD compared to controls, and their findings are mixed. We investigated (1) differences in sleep architecture, specifically slow-wave sleep (SWS) and rapid eye movement (REM) sleep, between ASD and typically developing controls (TD); and (2) if any observed differences in sleep were associated with core ASD symptoms. We used ambulatory polysomnography (PSG) in 53 participants with ASD (ages 4-18) and 66 age-matched TD in their home sleeping environment. The primary outcome measures were SWS and REM sleep. Core behavioral ASD symptoms were assessed using the Autism Diagnostic Interview-Revised (ADI-R). Spectral power bands during sleep, and additional behavioral measures, were examined in exploratory analyses. Compared to TD, participants with ASD exhibited a higher SWS ratio and lower REM sleep ratio. Within the ASD group, higher SWS was associated with more severe symptoms on the Restricted, Repetitive, and Stereotyped Behaviors subscale of the ADI-R. No association was observed between REM sleep ratio and any ASD symptom. Increased SWS and reduced REM sleep ratio differentiated ASD from TD. However, only increased SWS was associated with more severe core ASD symptoms. Increased SWS may reflect neuronal immaturity specific to ASD in this age group. These findings may inform the underlying mechanisms of clinical symptoms observed in children and adolescents with ASD.

Novel clinical, molecular and bioinformatics insights into the genetic background of autism

BackgroundClinical classification of autistic patients based on current WHO criteria provides a valuable but simplified depiction of the true nature of the disorder. Our goal is to determine the biology of the disorder and the ASD-associated genes that lead to differences in the severity and variability of clinical features, which can enhance the ability to predict clinical outcomes.MethodNovel Whole Exome Sequencing data from children (n = 33) with ASD were collected along with extended cognitive and linguistic assessments. A machine learning methodology and a literature-based approach took into consideration known effects of genetic variation on the translated proteins, linking them with specific ASD clinical manifestations, namely non-verbal IQ, memory, attention and oral language deficits.ResultsLinear regression polygenic risk score results included the classification of severe and mild ASD samples with a 81.81% prediction accuracy. The literature-based approach revealed 14 genes present in all sub-phenotypes (independent of severity) and others which seem to impair individual ones, highlighting genetic profiles specific to mild and severe ASD, which concern non-verbal IQ, memory, attention and oral language skills.ConclusionsThese genes can potentially contribute toward a diagnostic gene-set for determining ASD severity. However, due to the limited number of patients in this study, our classification approach is mostly centered on the prediction and verification of these genes and does not hold a diagnostic nature per se. Substantial further experimentation is required to validate their role as diagnostic markers. The use of these genes as input for functional analysis highlights important biological processes and bridges the gap between genotype and phenotype in ASD.

Family Involvement and Supports for Families of Severe ASD Students: A Scoping Review

본 연구는 중도 ASD 학생의 가족이 참여한 국내외 논문의 전반적 동향을 살펴보고, 가족 참여 및 가족 지원 관련 연구의 내용과 범위를 체계적으로 탐색함으로써 향후 중도 ASD 학생의 가족 관련 연구의 방향과 시사점을 도출하는 것을 목적으로 하였다. 본 연구의 분석을 위해 문헌연구의 한 방법인 범위연구(scoping review) 방법을 활용하였으며, 범위연구 방법의 절차에 따라 2000년부터 2021년까지 출판된 총 37편(국내 27편, 국외 10편)의 논문을 선정하고, 선정된 선행연구의 전반적 연구 동향과 하위 연구주제별 분석을 실행하였다. 문헌분석 결과를 요약하면 다음과 같다. 첫째, 국내연구에 비해 국외연구의 편수가 상대적으로 적었고, 유아기와 학령기 ASD 학생의 부모가 주로 연구에 참여하였다. 둘째, 지금까지 연구들은 가족 중심 중재, 가족의 경험, 가족 지원 요구라는 3가지 연구주제를 중심으로 이루어졌으며, 그 중 가족 중심 중재 관련 연구가 가장 많았고 이들은 주로 단일대상연구방법을 사용하였다. 본 연구의 분석결과를 토대로 가족 지원 실천 현장과 후속연구에 주는 시사점이 논의되었다.

Use of quantitative electroencephalography as a marker of severity of patients with autism spectrum disorder

Autism spectrum disorder is a neurodevelopmental disorder with increasing prevalence over the past years. Its grading depends on a time-consuming Scales like CARS, ADOS and GARS scales. Our aim is to study if quantitative EEG can be used as a marker of ASD severity. This is a cross sectional study conducted in the period from September 2021 till March 2022. It included 53 patients (41 males and12 females, with age ranging between 3 and 12 years) diagnosed by an experienced psychiatrist according to DSM5 criteria. Patients were recruited from 4 autism centers in Al-Hillah city. All patients were assessed by history, physical examination and Gilliam autism rating scale (GARS 3). Then they undergo quantitative electroencephalographic recording in awake state. The study results showed that spectral power of delta wave both total and regional were significantly increased as the severity of ASD symptoms increased, while alpha spectral power was decreased with increasing severity of ASD. Beta and theta spectral power was unchanged. Also, at cut off value of power spectrum of delta of =27 Mv, give 75% sensitivity and 100 specificity for grading severe ASD.

Lateral interbody release for fused vertebrae via transpsoas approach in adult spinal deformity surgery: a preliminary report of radiographic and clinical outcomes

BackgroundLateral interbody release (LIR) via a transpsoas lateral approach is a surgical strategy to address degenerative lumbar scoliosis (DLS) patients with anterior autofusion of vertebral segments. This study aimed to characterize the clinical and radiographic outcomes of this lumbar reconstruction strategy using LIR to achieve anterior column correction.MethodsData for 21 fused vertebrae in 17 consecutive patients who underwent LIR between January 2014 and March 2020 were reviewed. Demographic and intraoperative data were recorded. Radiographic parameters were assessed preoperatively and at final follow-up, including segmental lordotic angle (SLA), segmental coronal angle (SCA), bone union rate, pelvic incidence (PI), lumbar lordosis (LL), pelvic tilt, sacral slope, PI-LL mismatch, sagittal vertical axis, Cobb angle, and deviation of the C7 plumb line from the central sacral vertical line. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), visual analog scale (VAS) scores for low back and leg pain, and the short form 36 health survey questionnaire (SF-36) postoperatively and at final follow-up. Complications were also assessed.ResultsMean patient age was 70.3 ± 4.8 years and all patients were female. Average follow-up period was 28.4 ± 15.3 months. Average procedural time to perform LIR was 21.3 ± 9.7 min and was not significantly different from traditional lateral interbody fusion at other levels. Blood loss per single segment during LIR was 38.7 ± 53.2 mL. Fusion rate was 100.0% in this cohort. SLA improved significantly from − 7.6 ± 9.2 degrees preoperatively to 7.0 ± 8.8 degrees at final observation and SCA improved significantly from 19.1 ± 7.8 degrees preoperatively to 8.7 ± 5.9 degrees at final observation (P < 0.0001, and < 0.0001, respectively). All spinopelvic and coronal parameters, as well as ODI and VAS, improved significantly. Incidence of peri- and postoperative complications such as iliopsoas muscle weakness and leg numbness in patients who underwent LIR was as much as XLIF. Incidence of postoperative mechanical failure following LIR was also similar to XLIF. Reoperation rate was 11.8%. However, there were no reoperations associated with LIR segments.ConclusionsThe LIR technique for anterior column realignment of fused vertebrae in the context of severe ASD may be an option of a safe and effective surgical strategy.

Case Report on Ebstein Anomaly

Introduction: Ebstein anomaly, also known as Ebstein malformation, is a congenital (existing at birth) heart defect that affects a small percentage of people. The tricuspid valve (the valve that connects the chambers on the right side of the heart) does not close properly in people with Ebstein abnormality [1].&#x0D; Patient History: A 25-years female patient was admitted in Acharya Vinoba Bhave Rural Hospital in medicine ward. She was admitted with the complaint of breathlessness on exertion, and weakness since 2 months. patient is a known case of severe ASD since birth. After coming to the ward all investigations done like blood test, ECG, 2D Echo, chest x-ray etc. then final diagnosis is conformed as severe ASD with Ebstein anomaly.&#x0D; Past History: Patient is a known case of ASD. And not having any other history of communicable disease, asthma, tuberculosis.&#x0D; Management: Tablet- Lasilactone (20/60)) A diuretic, Tablet- Neurobion Fort, Tablet- Pan 40mg a antacid are prescribed the doctor .&#x0D; Nursing Management: vital sign checked and documented, comfortable position given as patient having breathing difficulty. Fowlers position given. intake and output of patient recorded. Assessed the patient for anxiety, depression.&#x0D; Conclusion: Patient was admitted to the hospital with the major complaints of trouble breathing and generalised weakness, and her situation was critical. Immediate treatment was initiated by a member of the health team, and all available treatments were administered, and the patient's condition has improved.

NOVEL HOMOZYGOUS VARIANT OF TBC1 DOMAIN FAMILY MEMBER 8 GENE IN FOUR LIBYAN SIBLINGS WITH AUTISTIC SPECTRUM DISORDER AND INTELLECTUAL DISABILITY WITHOUT EPILEPSY

Objective: Recent progress in genetic analysis and investigations have enabled researchers to identify potential genetic changes that may play a role in ASD. The number of genes connected with autism is growing. Whole exome sequencing(WES) identified the homozygous TBC1D8 variant. Aim to report for the first time a TBC1D8 missense variant (c.1883G&gt;A, p. (Arg628Gln) in 4 Libyan children (3 homozygous,1 heterozygous) with severe neurodevelopmental phenotypes ASD and intellectual disability ID . Based on the data of HGMD and ClinVar, variants in only a few autosomal recessive intellectual disability ARID genes seem to be reported frequently. Method: Molecular genetic analysis of (WES) was carried out on blood samples from these children. The outcome of the genetic investigations was interpreted within the context of clinical finding, family history, and suspected mode of inheritance. Results: The number of genes associated with autism is increasing. WES identified the TBC1D8 variant. According to the longest isoform (NM_001102426.1),the nomenclature of this variant is c.1883G&gt;A, p. (Arg628Gln) in TBC1D8 which leads to an amino acid exchange. This variant has not previously reported or described in the literature (PubMed, HGMD). Conclusion: we have provided evidence for a connection between TBC1D8 variant and ASD and ID; however, this evidence should be considered preliminary in the context of a single case report and such findings need to be replicated to gain insight in order to determine if ASD and ID are a characteristic of this variant.

Опыт использования арт-терапевтических техник в работе с учащимися с тяжелыми множественными нарушениями развития

The article presents the experience of the psychologist of the educational-correctional department of the Regional Center for Diagnosis and Counseling in Chelyabinsk. Art therapy techniques and activities for lessons on the program “Art Therapy” for students with severe multiple developmental disorders (moderate, severe mental retardation and ASD, RDA), mastering the adapted general education program of primary school for students with autism are described.

Vitamin and mineral levels in children with autism spectrum disorder

The aim of this study was to compare the vitamin and mineral values of the patients followed up in the Child Psychiatry Outpatient Clinic with the diagnosis of autism spectrum disorder to healthy controls in the same age group and to investigate whether vitamin-mineral values were related to autism weight (CARS score).Between September 2017 and September 2018, we worked at Bak?rköy Dr. Sadi Konuk Training and Research Hospital Children and Adolescent Mental Health and Diseases outpatient clinic with autism spectrum disorder patients with childhood autism assessment scale (CARS) was weighted. Age, gender, height, weight, blood Iron, Vitamin B12, Folate and 25 (OH) Vitamin D levels of all patients included in the study were recorded. Mann-Whitney U, Pearson chi-square and Fisher's exact test were used to evaluate the data. In this study, 108 patients with ASD were compared with 115 normal cases. There was no statistically significant decrease in Vitamin B12, Folate, Iron and Vitamin D levels in patients with ASD compared to normal patients. According to CARS score, there was no statistically significant difference in vitamin B12, Folate, Iron and Vitamin D levels in children with mild and severe ASD. In our study, it was concluded that vitamin B12, Folate, Iron and Vitamin D levels in children with ASD were not lower than healthy children, and there was no difference between mild and severe cases according to CARS score.

Prevalence and Characteristics of Sensory Processing Abnormalities and its Correlation with FDG-PET Findings in Children with Autism.

To study the prevalence and characteristics of Sensory processing abnormalities (SPAs) in children with autism and to study if there is any correlation between sensory processing abnormalities with FDG-PET findings in children with severe autism. One hundred children, aged 3-12 y, diagnosed as Autistic spectrum disorder; ASD (DSM-V) and 100 age and sex matched controls were studied. SPAs were detected using Short sensory profile (SSP) questionnaire. Children with progressive neurological diseases, active epilepsy and structural brain abnormalities were excluded. On Childhood Autism rating scale, 30 children had severe and 70 had mild-moderate autism. The pattern of sensory processing abnormalities in children with severe ASD was compared with mild-moderate ASD. FDG-PET scan was done in children with severe autism and correlated with SPAs. All children with severe autism had sensory processing abnormalities as compared to only 40% children with mild-moderate autism. Underresponsiveness/seeking-sensation was affected in all children with severe ASD and 82% had movement sensitivity. In children with mild-moderate ASD, 45% had auditory filtering, 30% hadmovement sensitivity and 27% hadunderresponsiveness/seeking-sensation. FDG-PET was abnormal in 17% of children with severe autism. Diffuse cerebral/ temporal lobe hypometabolism, increased bilateral frontal lobe uptake and moderate reduction in parietal lobe (Lt > Rt) was observed. All patients with severe autism had SPAs. However, they did not correlate with FDG-PET findings.

1.29 ASSESSING THE CONCURRENT VALIDITY OF IMPAIRMENT RATING SCALE (IRS) AND PROMIS PARENT SCALE – GLOBAL HEALTH 7 TO MEASURE GLOBAL HEALTH AND OVERALL IMPAIRMENT IN CHILDREN AND ADOLESCENTS DIAGNOSED WITH ASD

The goal of this session is to obtain preliminary evidence to support the concurrent validity of the Impairment Rating Scale (IRS) and PROMIS® Parent Proxy Scale version—Global Health 7 (PROMIS® GH-7) measures in participants ages 5–17 years with a diagnosis of ASD. We hypothesized that more severe ASD, as measured by the Social Responsiveness Scale, Second Edition (SRS-2), would be associated with higher scores on the IRS and lower scores on the PROMIS® GH-7.

Restricted, Repetitive, and Stereotypical Patterns of Behavior in Autism-an fMRI Perspective.

The main objective of this paper is to determine whether resting-state fMRI can identify functional connectivity differences between individuals with autism who experience severe issues with restricted, repetitive, and stereotypical behaviors, those who experience only mild issues, and controls. We use resting-state fMRI data from the ABIDE-I preprocessed repository, with participants grouped according to their ADI-R Restricted, Repetitive, and Stereotyped Patterns of Behavior Subscore. Three processing methods are used for analysis. A time-correlation approach establishes a basic baseline, and we introduce a method based on sliding time windows, with means across time adjusted to consider the fraction of time the correlation measure is above/below average. We complement these with a band-limited coherence approach. For completeness, preprocessing schemes with and without global signal regression are considered. Our results are in line with recent ones which find both over- and under-connectivities in the autistic brain. We find that there are indeed significant differences in connectivity between various regions that differentiate between ASD subjects with severe stereotypical/restrictive behavior issues, those with only mild issues, and controls. Interestingly, for some regions, the "signature" of subjects in the milder of the ASD groups appears to be distinct (i.e., over- or under-connected) relative to both the more severe ASD group and the controls.

Development and validation of DSM-5 based diagnostic tool for children with Autism Spectrum Disorder.

Diagnostic and Statistical Manual of mental disorder-IV (DSM-IV) TR based INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) is an established instrument for the diagnosis of ASD in Indian subcontinent and low-middle income countries (LMIC). The introduction of DSM-5 necessitated revision of existing INDT-ASD tool to incorporate the DSM-5 related changes. This study was undertaken to develop and validate the DSM-5 based All India Institute of Medical Sciences (AIIMS)-Modified-INDT-ASD Tool. The modifications were done using Delphi method and included: (a) rearrangement of questions from the previous tool; and (b) addition of new questions on sensory symptoms. The modified tool was validated against DSM-5 diagnostic criteria. In addition, receiver operating characteristic (ROC) curves were used to determine the cut-off for total score as compared to Childhood Autism Rating Scale (CARS) score to grade the severity of ASD. Two-hundred-twenty-five children (159 boys, median age = 47months) were enrolled. The modified tool demonstrated sensitivity of 98.4% and specificity of 91.7% to diagnose ASD. A score ≥14 on the tool was suggestive of severe ASD (CARS>36.5) with a sensitivity and specificity of 80% and 80.7% respectively [Area under the curve = 0.89]. AIIMS-Modified-INDT-ASD Tool is a simple and structured instrument based on DSM-5 criteria which can facilitate diagnosis of ASD with acceptable diagnostic accuracy.

Early childhood network alterations in severe autism.

To examine the differences in whole brain topology and connectivity in 17 children of the ages 3-8 years across severity of ASD, we performed resting state fMRI using a 3T MRI scanner and graph theoretical analysis of networks. Patients were partitioned into two cohorts based on the severity of ASD, determined using the Childhood Autism Rating Scale (CARS) scores (Mild, 30-36; Severe, 37+). Standard preprocessing pipeline was used, followed by independent component analysis (ICA) to identify regions of interest (ROIs) to construct subject-specific Z-correlation matrices representing the whole brain network. Following which, graph theory measures were calculated in the range of sparsity 6%-35% and statistically analyzed, and corrected for significance (FDR corrected, p < 0.05). Regional clustering coefficient that revealed significant between-group (mild vs. severe) differences were correlated against clinical scores (CARS). Children with severe ASD revealed significantly increased clustering coefficient and small-worldness compared to those with mild or moderate ASD. Region of interest analysis revealed altered clustering in the Heschl's gyrus that significantly correlated with CARS scores. The findings from the current study provide early stage evidence of aberrant brain connectivity appearing in severe ASD, prior to the effect of environmental bias and pruning mechanisms. The clustering of the Heschl's gyrus correlated to the severity of ASD symptoms and agrees with current literature on ASD-associated cortical changes, reflecting early changes to language processing regions.

Longitudinal Epidemiological Study of Autism Subgroups Using Autism Treatment Evaluation Checklist (ATEC) Score

Here we report the results of the subgroup analyses of an observational cohort of children whose parents completed the Autism Treatment Evaluation Checklist (ATEC) over the period of several years. A linear mixed effects model was used to evaluate longitudinal changes in ATEC scores within different patient subgroups. All groups decreased their mean ATEC score over time indicating improvement of symptoms, however there were significant differences between the groups. Younger children improved more than the older children. Children with milder ASD improved more than children with more severe ASD in the Communication subscale. There was no difference in improvement between females vs. males. One surprising finding was that children from developed English-speaking countries improved less than children from non-English-speaking countries.

A Pilot Study of the KIBO Robot in Children with Severe ASD

This pilot study explores the feasibility of using the KIBO Robot as an engaging platform to positively impact social and emotional development in children with ASD. KIBO is a programmable toy robot originally designed to teach coding and sequencing to neuro-typical children between 4 and 7 years of age. To assess its use in children with severe ASD, twelve participants were introduced to KIBO and engaged in a variety of activities with the robot over four consecutive days. Their interactions were observed on site by raters and simultaneously videotaped for later analysis. We performed a detailed quantitative and qualitative analysis in two subjects who completed six or more of the eight planned KIBO play sessions. We observed that most of the participants showed sustained interest in the KIBO robot and increased the frequency of their interactions with adults across play sessions. Although the participants demonstrated only a limited understanding of programming principles during the study, they managed to manipulate the KIBO appropriately, engaged socially with the adults in the room and interacted positively with the robot during individual play. The findings suggest that the KIBO robot warrants further study as an engaging educational platform for children with ASD.

Heart rate-defined sustained attention in infants at risk for autism

BackgroundAlthough aberrant visual attention has been identified in infants at high familial risk for autism, the developmental emergence of atypical attention remains unclear. Integrating biological measures of attention into prospective high-risk infant studies may inform more nuanced developmental trajectories, clarifying the onset and course of atypical attention and potentially advancing early screening or treatment protocols. Heart rate-defined sustained attention (HRDSA) is a well-validated biological measure of attentional engagement that, in non-clinical infant populations, provides incremental information about attentional engagement beyond looking behaviors alone. The present study aimed to examine the characteristics and clinical correlates of HRDSA in high-risk infants, informing whether HRDSA may operate as a promising biological measure of attention and clinical symptoms in this population.MethodsWe examined age-related patterns of HRDSA during a passive looking task in 5- to 14-month-old high-risk infant siblings of children with autism (n = 21) compared to low-risk controls (n = 21), with most participants contributing multiple assessments. Emergent autism features were measured using the Autism Diagnostic Observation Schedule at 24 months. Primary dependent variables included the proportion of time in behavioral attention, proportion of time in HRDSA, and average heart rate deceleration during HRDSA. For each variable, we used nested multilevel models to examine whether attention differed by group, as well as whether attention predicted emergent autism features among high-risk infant siblings.ResultsAs expected, HRDSA served as a global biological measure of attention in high-risk infants, predicting greater variability in group risk status than behavioral looking alone. Among high-risk infants, more severe ASD features were also associated with increasingly shallow heart rate deceleration during HRDSA across development, suggesting abnormal qualities of HRDSA may inform individual differences within this population.ConclusionsThese preliminary findings provide initial evidence that HRDSA may offer a sensitive, affordable, and portable biological measure of attention that may enhance understanding of atypical attention in high-risk infants. Using this method, we also provide initial evidence that atypical patterns of heart activity previously reported in children and adults with autism may emerge in the first year of life, warranting further study of how HRDSA may specifically inform attention profiles in ASD.