Associations between social anxiety, physiological reactivity, and speech disfluencies in autistic young adults and controls.

INTRODUCTION: The aim of this study was to examine possible associations of social anxiety (SA) and speaking-related physiological reactivity with the frequencies of a) total disfluencies, b) typical disfluencies, and c) stuttering-like disfluencies, as well as d) stuttering-severity in autistic young adults and controls. METHODS: Thirty-two autistic young adults and 35 controls participated in this study. Participants were presented with video clips (viewing condition) and were then asked to talk about the videos (narrating condition). SA was measured by the self-report Social Phobia and Anxiety Inventory (SPAI). Speaking-related physiological reactivity was measured by the electrodermal activity (EDA), an index of emotional arousal. The speech samples from the narrating condition were analyzed for type and frequency of speech disfluencies and used for determining the stuttering severity. SA and speaking-related physiological reactivity were compared between the groups. Correlation between SA, physiological reactivity, disfluency frequencies, and stuttering severity were tested separately for both groups. RESULTS: No between-group differences were found in the overall SA, yet differences were found in SPAI subscales of social interaction, group interaction, and avoidance, as well as in agoraphobia. Both groups had higher physiological arousal in narrating condition in comparison to the video viewing condition, yet there was no between-group difference in the reactivity. No associations were found between SPAI measures, physiological reactivity, disfluency frequencies, and stuttering severity in the autistic group. In the control group, a negative association was found between physiological reactivity and total and typical disfluency frequencies. CONCLUSIONS: SA or speaking-related physiological reactivity were not associated with disfluency frequencies or stuttering severity in autistic persons. Negative association between physiological reactivity and disfluency frequencies found in the control group may indicate that the physiological arousal may impact the speech production process by reducing the overt disfluencies.

Co-activation pattern alterations in autism spectrum disorder-A volume-wise hierarchical clustering fMRI study.

INTRODUCTION: There has been a growing effort to characterize the time-varying functional connectivity of resting state (RS) fMRI brain networks (RSNs). Although voxel-wise connectivity studies have examined different sliding window lengths, nonsequential volume-wise approaches have been less common. METHODS: Inspired by earlier co-activation pattern (CAP) studies, we applied hierarchical clustering (HC) to classify the image volumes of the RS-fMRI data on 28 adolescents with autism spectrum disorder (ASD) and their 27 typically developing (TD) controls. We compared the distribution of the ASD and TD groups' volumes in CAPs as well as their voxel-wise means. For simplification purposes, we conducted a group independent component analysis to extract 14 major RSNs. The RSNs' average z-scores enabled us to meaningfully regroup the RSNs and estimate the percentage of voxels within each RSN for which there was a significant group difference. These results were jointly interpreted to find global group-specific patterns. RESULTS: We found similar brain state proportions in 58 CAPs (clustering interval from 2 to 30). However, in many CAPs, the voxel-wise means differed significantly within a matrix of 14 RSNs. The rest-activated default mode-positive and default mode-negative brain state properties vary considerably in both groups over time. This division was seen clearly when the volumes were partitioned into two CAPs and then further examined along the HC dendrogram of the diversifying brain CAPs. The ASD group network activations followed a more heterogeneous distribution and some networks maintained higher baselines; throughout the brain deactivation state, the ASD participants had reduced deactivation in 12/14 networks. During default mode-negative CAPs, the ASD group showed simultaneous visual network and either dorsal attention or default mode network overactivation. CONCLUSION: Nonsequential volume gathering into CAPs and the comparison of voxel-wise signal changes provide a complementary perspective to connectivity and an alternative to sliding window analysis.

Emotion recognition from the eye region in children with and without Autism Spectrum Disorder in Arab and Scandinavian countries.

BACKGROUND: Difficulties in facial emotion recognition (ER) skills are linked to autism spectrum disorder (ASD) in studies performed in Western and Eastern Asian countries. However, there is a paucity of research examining ER skills in Arab countries, where face-covering veils are more common than in Western countries. OBJECTIVE: Our aim was to examine basic ER and ER error patterns in Egyptian and Finnish children with and without ASD. METHOD: We employed the eye-submodule of the Frankfurt Test and Training of Facial Affect Recognition (FEFA) and the Autism Spectrum Screening Questionnaire (ASSQ). RESULTS: Arab children with ASD (n = 34, M age = 8.6 years, FSIQ = 96.7) recognized correctly fewer emotions than did Scandinavian children with ASD (n = 32, M age = 12.5 years, FSIQ = 102.8) and Arab typically developing (TD) children (n = 34, M age = 10.3 years, FSIQ = 123.4) in general and specifically on surprise, disgust and neutral scales as well as on a blended emotion scale. Scandinavian children with ASD demonstrated a lower ability to recognize emotions in general and specifically happiness than did Scandinavian TD children. There were no differences between Arab and Scandinavian (n = 28, M age = 13.9 years) TD children in ER accuracy. We found country specific differences in ER error patterns in happiness, sadness and anger: Arab children interpreted these emotions more often as another emotion (happiness = sadness, sadness = anger, anger = sadness and surprise), whereas Scandinavian children interpreted happiness and sadness as neutral expression and anger as disgust. Arab children with ASD labeled sadness and anger in their ER error patterns more negatively than did Arab TD children, but there were no differences between Scandinavian children with ASD and TD in ER error patterns. CONCLUSIONS: The differences between the Arab and Scandinavian children may reflect cultural differences in ER and ER error patterns.

Assessing social-pragmatic inferencing skills in children with autism spectrum disorder.

By utilizing the Pragma test this study investigated how sixteen five- to ten-year-old children with autism spectrum disorder (ASD) and sixteen typically developing (TD) children comprehended contextually challenging scenarios demanding 1) contextual inference with theory of mind (ToM), 2) contextual inference without ToM, 3) relevant use of language, 4) recognition of feelings, and 5) understanding false beliefs. The study also compared children's ability to explain their own correct answers. In addition, this study evaluated the sensitivity of three different methods for discriminating the children with ASD from the TD children: 1) the Pragma test, 2) the Social Interaction Deviance Composite (SIDC) of Children's Communication Checklist-2 (CCC-2), and 3) the Theory of Mind subtest of the Developmental Neuropsychological Assessment, Second edition (NEPSY-II). The results showed that children with ASD differed from TD children in questions demanding context utilization. However, the demand of mind-reading in utterance interpretation increased the difference between groups. Compared to TD children, children with ASD had more difficulties in explaining how they had used context to arrive at the correct answer. The discrimination power for detecting children with ASD from TD children was excellent in the Pragma test, good in the SIDC CCC-2 and fair in the Theory of Mind subtest of NEPSY-II. This study showed that by using contextually sensitive materials, such as the Pragma test, it is possible to detect the social-pragmatic inferencing difficulties of high-functioning children with ASD in structured test situations and not only in real-life situations or by using parental reports.

Neuropsychological performance of Finnish and Egyptian children with autism spectrum disorder.

BACKGROUND: Previous studies investigating neuropsychological functioning of children with autism spectrum disorder (ASD) have only analysed certain abilities, such as executive functions or language. While comprehensive assessment of the neuropsychological profile of children with ASD has been the focus of recent research, most of the published evidence originates from single centres. Though studies on differences in neuropsychological features of children with ASD across countries are essential for identifying different phenotypes of ASD, such studies have not been conducted. OBJECTIVE: Our goal was to assess the neuropsychological abilities of children with ASD in northern Finland and Egypt and to examine the effect of age and intelligence quotient (IQ) on these abilities. DESIGN: Selected verbal and non-verbal subtests of the neuropsychological assessment NEPSY were used to examine 88 children with ASD in northern Finland (n=54, age M=11.2, IQ M=117.1) and Egypt (n=34, age M=8.4, IQ M=96.6). RESULTS: Finnish ASD children scored significantly higher than their Egyptian counterparts on the verbal NEPSY subtests Comprehension of Instructions (p<0.001), Comprehension of Sentence Structure (p<0.01), Narrative Memory (p<0.001) and Verbal Fluency (p<0.05) and on the non-verbal NEPSY subtest Design Fluency (p<0.01). Finnish and Egyptian ASD children did not differ on the subtests Memory for Faces, Object Recognition and Object Memory. In addition, we found that age and verbal IQ can have significant influence on neuropsychological performance. CONCLUSIONS: Our results suggest a possible cultural impact on verbal and visuomotor fluency. However, the ability to recognize and memorize objects and the disability to remember faces appear to be typical for ASD and culturally independent.

Attention and Working Memory in Adolescents with Autism Spectrum Disorder: A Functional MRI Study.

The present study examined attention and memory load-dependent differences in the brain activation and deactivation patterns between adolescents with autism spectrum disorders (ASDs) and typically developing (TD) controls using functional magnetic resonance imaging. Attentional (0-back) and working memory (WM; 2-back) processing and load differences (0 vs. 2-back) were analysed. WM-related areas activated and default mode network deactivated normally in ASDs as a function of task load. ASDs performed the attentional 0-back task similarly to TD controls but showed increased deactivation in cerebellum and right temporal cortical areas and weaker activation in other cerebellar areas. Increasing task load resulted in multiple responses in ASDs compared to TD and in inadequate modulation of brain activity in right insula, primary somatosensory, motor and auditory cortices. The changes during attentional task may reflect compensatory mechanisms enabling normal behavioral performance. The inadequate memory load-dependent modulation of activity suggests diminished compensatory potential in ASD.

Theory of mind and emotion recognition skills in children with specific language impairment, autism spectrum disorder and typical development: group differences and connection to knowledge of grammatical morphology, word-finding abilities and verbal working memory.

BACKGROUND: Social perception skills, such as understanding the mind and emotions of others, affect children's communication abilities in real-life situations. In addition to autism spectrum disorder (ASD), there is increasing knowledge that children with specific language impairment (SLI) also demonstrate difficulties in their social perception abilities. AIMS: To compare the performance of children with SLI, ASD and typical development (TD) in social perception tasks measuring Theory of Mind (ToM) and emotion recognition. In addition, to evaluate the association between social perception tasks and language tests measuring word-finding abilities, knowledge of grammatical morphology and verbal working memory. METHOD & PROCEDURES: Children with SLI (n = 18), ASD (n = 14) and TD (n = 25) completed two NEPSY-II subtests measuring social perception abilities: (1) Affect Recognition and (2) ToM (includes Verbal and non-verbal Contextual tasks). In addition, children's word-finding abilities were measured with the TWF-2, grammatical morphology by using the Grammatical Closure subtest of ITPA, and verbal working memory by using subtests of Sentence Repetition or Word List Interference (chosen according the child's age) of the NEPSY-II. OUTCOMES & RESULTS: Children with ASD scored significantly lower than children with SLI or TD on the NEPSY-II Affect Recognition subtest. Both SLI and ASD groups scored significantly lower than TD children on Verbal tasks of the ToM subtest of NEPSY-II. However, there were no significant group differences on non-verbal Contextual tasks of the ToM subtest of the NEPSY-II. Verbal tasks of the ToM subtest were correlated with the Grammatical Closure subtest and TWF-2 in children with SLI. In children with ASD correlation between TWF-2 and ToM: Verbal tasks was moderate, almost achieving statistical significance, but no other correlations were found. CONCLUSIONS & IMPLICATIONS: Both SLI and ASD groups showed difficulties in tasks measuring verbal ToM but differences were not found in tasks measuring non-verbal Contextual ToM. The association between Verbal ToM tasks and language tests was stronger in children with SLI than in children with ASD. There is a need for further studies in order to understand interaction between different areas of language and cognitive development.

Resting state fMRI reveals a default mode dissociation between retrosplenial and medial prefrontal subnetworks in ASD despite motion scrubbing.

In resting state functional magnetic resonance imaging (fMRI) studies of autism spectrum disorders (ASDs) decreased frontal-posterior functional connectivity is a persistent finding. However, the picture of the default mode network (DMN) hypoconnectivity remains incomplete. In addition, the functional connectivity analyses have been shown to be susceptible even to subtle motion. DMN hypoconnectivity in ASD has been specifically called for re-evaluation with stringent motion correction, which we aimed to conduct by so-called scrubbing. A rich set of default mode subnetworks can be obtained with high dimensional group independent component analysis (ICA) which can potentially provide more detailed view of the connectivity alterations. We compared the DMN connectivity in high-functioning adolescents with ASDs to typically developing controls using ICA dual-regression with decompositions from typical to high dimensionality. Dual-regression analysis within DMN subnetworks did not reveal alterations but connectivity between anterior and posterior DMN subnetworks was decreased in ASD. The results were very similar with and without motion scrubbing thus indicating the efficacy of the conventional motion correction methods combined with ICA dual-regression. Specific dissociation between DMN subnetworks was revealed on high ICA dimensionality, where networks centered at the medial prefrontal cortex and retrosplenial cortex showed weakened coupling in adolescents with ASDs compared to typically developing control participants. Generally the results speak for disruption in the anterior-posterior DMN interplay on the network level whereas local functional connectivity in DMN seems relatively unaltered.

Social anxiety in parents of high-functioning children with autism and Asperger syndrome.

We evaluated social anxiety (SA) symptoms in parents of children with autism spectrum disorders (ASDs; N = 131) and community parents (N = 597) using the Social Phobia and Anxiety Inventory (SPAI). SA was significantly more common in ASD than control mothers (15.6 vs. 6.7 %) and more equal between the ASD and control fathers (3.3 vs. 4.8 %). The ASD mothers scored significantly higher than control mothers on all SPAI scales. ASD fathers scored significantly higher than control fathers on the somatic, cognitive, avoidance and agoraphobic symptoms of SA. It is of clinical import to support ASD parents' well-being as their psychiatric features may contribute greatly to their children's emotional development and the well-being of the whole family.

Validation of the Finnish Autism Spectrum Screening Questionnaire (ASSQ) for clinical settings and total population screening.

We assessed the validity and determined cut-off scores for the Finnish Autism Spectrum Screening Questionnaire (ASSQ). A population sample of 8-year-old children (n = 4,408) was rated via the ASSQ by parents and/or teachers, and a subgroup of 104 children was examined via structured interview, semi-structured observation, IQ measurement, school observation, and medical records. Autism spectrum disorders (ASDs) were diagnosed following DSM-IV-TR criteria. A search for hospital-registered ASDs was performed. For Finnish higher-functioning primary school-aged, 7- to 12-year-olds, the optimal cut-off score was 30 in clinical settings and 28 in total population screening using summed ASSQ scores of parents' and teachers' ratings. Determining appropriate cut-off scores in ASD screening in different languages and in different cultures is of utmost importance.

Valence scaling of dynamic facial expressions is altered in high-functioning subjects with autism spectrum disorders: an fMRI study.

FMRI was performed with the dynamic facial expressions fear and happiness. This was done to detect differences in valence processing between 25 subjects with autism spectrum disorders (ASDs) and 27 typically developing controls. Valence scaling was abnormal in ASDs. Positive valence induces lower deactivation and abnormally strong activity in ASD in multiple regions. Negative valence increased deactivation in visual areas in subjects with ASDs. The most marked differences between valences focus on fronto-insular and temporal regions. This supports the idea that subjects with ASDs may have difficulty in passive processing of the salience and mirroring of expressions. When the valence scaling of brain activity fails, in contrast to controls, these areas activate and/or deactivate inappropriately during facial stimuli presented dynamically.

Functional mapping of dynamic happy and fearful facial expression processing in adolescents.

This paper assessed the neural systems involved in processing of dynamic facial expressions in adolescents. The processing of facial expressions changes as a function of age, and it is thus important to understand how healthy adolescent subjects process dynamic facial expressions prior to analyzing disease-related changes. We hypothesized that viewing of dynamic facial expressions with opposing valences (happy vs. fearful) induces differential activations and deactivations in the brain. 27 healthy adolescents (9 female, 18 male, mean age = 14.5 years; age range 11.6-17.3 years) were examined by using the ASSQ and K-SADS-PL and scanned with 1.5-T fMRI during viewing of dynamic facial expressions and mosaic control images. The stimuli activated the same areas as previously seen in dynamic facial expression in adults. Our results indicated that opposing-valence dynamic facial expressions had differential effects on many cortical structures but not on subcortical limbic structures. The mirror neuron system is activated more during viewing of fearful compared to happy expressions in bilateral inferior frontal gyrus (IFG) and superior temporal sulcus (STS) left dominantly. We also detected more deactivation in the ventral anterior cingulate gyrus (ACG), showing more automated attentional processing of fearful expressions during passive viewing. Females were found to deactivate the right frontal pole more than male adolescents during happy facial expressions, while there were no differences in fear processing between genders. No clear gender or age effects were detected. In conclusion fear induces stronger responses in attention and mirror neurons probably related to fear contagion.

Comorbid psychiatric disorders associated with Asperger syndrome/high-functioning autism: a community- and clinic-based study.

The present study identifies the prevalence and types of comorbid psychiatric disorders associated with Asperger syndrome (AS)/high-functioning autism (HFA) in a combined community- and clinic-based sample of fifty 9- to 16-year-old subjects using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version. The level of functioning was estimated using the Children's Global Assessment Scale. The results support common (prevalence 74%) and often multiple comorbid psychiatric disorders in AS/HFA; behavioral disorders were shown in 44%, anxiety disorders in 42% and tic disorders in 26%. Oppositional defiant disorder, major depressive disorder and anxiety disorders as comorbid conditions indicated significantly lower levels of functioning. To target interventions, routine evaluation of psychiatric comorbidity in subjects with AS/HFA is emphasized.

Alterations in regional homogeneity of resting-state brain activity in autism spectrum disorders.

Measures assessing resting-state brain activity with blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) can reveal cognitive disorders at an early stage. Analysis of regional homogeneity (ReHo) measures the local synchronization of spontaneous fMRI signals and has been successfully utilized in detecting alterations in subjects with attention-deficit hyperactivity disorder (ADHD), depression, schizophrenia, Parkinson's disease and Alzheimer's dementia. Resting-state brain activity was investigated in 28 adolescents with autism spectrum disorders (ASD) and 27 typically developing controls being imaged with BOLD fMRI and analyzed with the ReHo method. The hypothesis was that ReHo of resting-state brain activity would be different between ASD subjects and controls in brain areas previously shown to display functional alterations in stimulus or task based fMRI studies. Compared with the controls, the subjects with ASD had significantly decreased ReHo in right superior temporal sulcus region, right inferior and middle frontal gyri, bilateral cerebellar crus I, right insula and right postcentral gyrus. Significantly increased ReHo was discovered in right thalamus, left inferior frontal and anterior subcallosal gyrus and bilateral cerebellar lobule VIII. We conclude that subjects with ASD have right dominant ReHo alterations of resting-state brain activity, i.e., areas known to exhibit abnormal stimulus or task related functionality. Our results demonstrate that there is potential in utilizing the ReHo method in fMRI analyses of ASD.