Investigating the development of the autonomic nervous system in infancy through pupillometry.

We aim to investigate early developmental trajectories of the autonomic nervous system (ANS) as indexed by the pupillary light reflex (PLR) in infants with (i.e. preterm birth, feeding difficulties, or siblings of children with autism spectrum disorder) and without (controls) increased likelihood for atypical ANS development. We used eye-tracking to capture the PLR in 216 infants in a longitudinal follow-up study spanning 5 to 24 months of age, and linear mixed models to investigate effects of age and group on three PLR parameters: baseline pupil diameter, latency to constriction and relative constriction amplitude. An increase with age was found in baseline pupil diameter (F(3,273.21) = 13.15, p < 0.001, [Formula: see text] = 0.13), latency to constriction (F(3,326.41) = 3.84, p = 0.010, [Formula: see text] = 0.03) and relative constriction amplitude(F(3,282.53) = 3.70, p = 0.012, [Formula: see text] = 0.04). Group differences were found for baseline pupil diameter (F(3,235.91) = 9.40, p < 0.001, [Formula: see text] = 0.11), with larger diameter in preterms and siblings than in controls, and for latency to constriction (F(3,237.10) = 3.48, p = 0.017, [Formula: see text] = 0.04), with preterms having a longer latency than controls. The results align with previous evidence, with development over time that could be explained by ANS maturation. To better understand the cause of the group differences, further research in a larger sample is necessary, combining pupillometry with other measures to further validate its value.

Ethics of returning children's individual research findings: from principles to practice.

Little ethical recommendations on returning children's individual research findings are available for researchers in behavioral sciences, especially when compared to genetic research. Anecdotic evidence suggests that since parents are often interested in their child's individual research findings, researchers tend to offer this information as a form of compensation for research participation. Despite good intentions, these practices are not without potential harmful consequences for children. We were confronted with these difficulties and with the paucity of available guidance on this topic, being involved in a longitudinal, infant development study, i.e. tracking infants at risk for autism (TIARA). First, we review current ethical recommendations and discuss their limitations in the light of the TIARA study. Second, we will suggest to revise these recommendations, by identifying and applying the relevant bioethical principles and concepts at hand. Third, as an example of practical implementation, the adopted 'return of research findings'-policy for the TIARA-study is presented. The principles and concepts we engage with are the ancillary care responsibilities of the researcher, non-maleficence and beneficence, the right to an open future of the child, and the avoidance of therapeutic misconception. Ultimately, we present the concrete return of research findings policy implemented in the TIARA-study. Here, we suggest restricting the systematic return of children's individual research findings to cases where findings are considered clinically significant and actionable for the child. We discuss the broader implications for designing and conducting research in behavioral sciences with children.

Validation of the Language ENvironment Analysis (LENA) system for Dutch.

The validity of the Language ENvironment Analysis (LENA) System was evaluated for Dutch. 216 5-min samples (six samples per age per child) were selected from daylong recordings at 5, 10 and 14 months of age of native Dutch-speaking younger siblings of children with autism spectrum disorder (N = 6) and of typically developing children (N = 6). Two native Dutch-speaking coders counted the amount of adult words (AWC), child vocalisations (CVC) and conversational turns (CT). Consequently, correlations between LENA and human estimates were explored. Correlations were high for AWC at all ages (r = .73 to .81). Regarding CVC, estimates were moderately correlated at 5 months (r = .57) but the correlation decreased at 10 (r = .37) and 14 months (r = .14). Correlations for CT were low at all ages (r = .19 to .28). Lastly, correlations were not influenced by the risk status of the children.

Language growth in very young siblings at risk for autism spectrum disorder.

BACKGROUND: Children with autism spectrum disorder (ASD) show substantial variability in their language development. Language problems are highly prevalent in these children. In addition, the quality of early language abilities contributes to the overall development of these children and is highly predictive of their adult outcome. Yet, little is known about language development in children at risk of ASD during the first years of life. AIMS: To compare early receptive language (RL) and expressive language (EL) development in children at risk of ASD and determine predictors of language development. METHODS & PROCEDURES: Developmental trajectories of RL and EL were investigated from 10 to 36 months of age in younger siblings of typically developing children (LR-sibs, N = 30) and in younger siblings of children with ASD (HR-sibs, N = 31) using the Mullen Scales of Early Learning. Furthermore, both child and demographic characteristics were examined as possible predictors of language development. OUTCOMES & RESULTS: Both groups showed similar growth curves for RL and EL and the majority of the children showed average (within ±1.5 SD of the mean) or above-average language abilities. Nevertheless, the mean growth of EL was lower and the variation in growth of both RL and EL was higher in HR-sibs than in LR-sibs. Furthermore, early child characteristics were predictive of language development in both groups. Yet, some child characteristics seemed to be of more importance in HR-sibs than in LR-sibs. Consequently, lower non-verbal abilities at 10 months in both groups and a higher degree of ASD characteristics at 14 months in HR-sibs may be indicative of difficulties in language development. CONCLUSIONS & IMPLICATIONS: HR-sibs show more variation in their language development than LR-sibs during the first 3 years of life. The majority of HR-sibs, however, did not present with below-average language abilities. Yet, early characteristics of ASD may be a red flag for difficulties in the language development of HR-sibs.

Extremely Preterm Born Children at Very High Risk for Developing Autism Spectrum Disorder.

This study aimed to provide a more comprehensive picture of the prevalence of autism spectrum disorder (ASD) in a geographic cohort of extremely preterm born adolescents by using established diagnostic instruments in addition to screening instruments. 53 participants passed a screening procedure with two screening instruments and a diagnostic evaluation with a semi-structured assessment and a parent interview. 28 % of the adolescents had a community based clinical diagnosis of ASD. When research diagnoses were also taken into account, this rate increased to 40 %. Intellectual disability, language impairment and behavioural difficulties are characteristic for these children with ASD. This study is to our knowledge the first to use ASD-specific diagnostic instruments to confirm ASD diagnoses in extremely preterm born children in early adolescence. The study expands findings of previous research and raises the need for follow-up into late childhood and early adolescence.

Prevalence and correlates of use of complementary and alternative medicine in children with autism spectrum disorder in Europe.

UNLABELLED: This study examined the prevalence and correlates of use of complementary and alternative medicine (CAM) among a sample of children with autism spectrum disorder (ASD) < 7 years in 18 European countries (N = 1,680). Forty-seven percent of parents reported having tried any CAM approach in the past 6 months. Diets and supplements were used by 25 % of the sample and mind-body practices by 24 %; other unconventional approaches were used by 25 % of the families, and a minority of parents reported having tried any invasive or potentially harmful approach (2 %). Parents in Eastern Europe reported significantly higher rates of CAM use. In the total sample, children with lower verbal ability and children using prescribed medications were more likely to be receiving diets or supplements. Concurrent use of high levels of conventional psychosocial intervention was significantly associated with use of mind-body practices. Higher parental educational level also increased the likelihood of both use of diets and supplements and use of mind-body practices. CONCLUSION: The high prevalence of CAM use among a sample of young children with ASD is an indication that parents need to be supported in the choice of treatments early on in the assessment process, particularly in some parts of Europe. WHAT IS KNOWN: • Use of complementary and alternative medicine (CAM) in children with autism spectrum disorder is common. • In non-EU samples, parents with higher educational level and parents of low functioning children are more likely to use CAM with their children. What is New: • This study provides the first data on prevalence and correlates of use of CAM approaches in a large sample of young children with autism in Europe (N = 1,680). • Rates of CAM use were particularly high in Eastern Europe and correlates of use varied by type of CAM across Europe.

Social-communicative abilities as treatment goals for preschool children with autism spectrum disorder: the importance of imitation, joint attention, and play.

Autism spectrum disorder (ASD) is a pervasive developmental disorder with a lifelong impact on multiple domains of functioning. Often, a diagnosis is possible by 3 years of age. Given the benefits of early intervention, it is advisable to start treatment as soon as possible after the diagnosis has been made. Among other factors, early intervention should focus on social-communicative abilities such as imitation, joint attention, and play. In this review, the typical developmental course and functions of these social-communicative abilities are described, and the problems young children with ASD experience in this domain. In addition, different approaches to promoting these abilities are explained. The authors recommend the inclusion of imitation, joint attention, and play as treatment goals in community settings for children with ASD.

Neural correlates of response to joint attention in 2-to-5-year-olds in relation to ASD and social-communicative abilities: An fNIRS and behavioral study.

Autism spectrum disorder (ASD) is associated with life-long challenges with social cognition, and one of its earliest and most common manifestations is atypical joint attention, which is a pivotal skill in social-cognitive and linguistic development. Early interventions for ASD children often focus on training initiation of joint attention (IJA) and response to joint attention bids (RJA), which are important for social communication and cognition. Here, we used functional near-infrared spectroscopy and behavioral measures to test typically developing (TD, n = 17) and ASD children (n = 18), to address the relationship between the neural correlates of RJA and social-communicative behavior. Group-level differences were present for RJA-specific activation over right temporal sites, where TD children showed higher levels of activation during RJA than ASD children, whereas the two groups did not differ in the control condition. Correlations between neural activation and behavioral traits suggest that, in ASD children, neural activation during RJA is related to the frequency of RJA behavior when the former is measured over left temporal sites, and to social affect symptoms when considered for right temporal sites. Possible implications of the evidenced correlations are discussed.

Infants' mu suppression during the observation of real and mimicked goal-directed actions.

Since their discovery in the early 1990s, mirror neurons have been proposed to be related to many social-communicative abilities, such as imitation. However, research into the early manifestations of the putative neural mirroring system and its role in early social development is still inconclusive. In the current EEG study, mu suppression, generally thought to reflect activity in neural mirroring systems was investigated in 18- to 30-month-olds during the observation of object manipulations as well as mimicked actions. EEG power data recorded from frontal, central, and parietal electrodes were analysed. As predicted, based on previous research, mu wave suppression was found over central electrodes during action observation and execution. In addition, a similar suppression was found during the observation of intransitive, mimicked hand movements. To a lesser extent, the results also showed mu suppression at parietal electrode sites, over all three conditions. Mu wave suppression during the observation of hand movements and during the execution of actions was significantly correlated with quality of imitation, but not with age or language level.

The Impact of School Strategies and the Home Environment on Home Learning Experiences During the COVID-19 Pandemic in Children With and Without Developmental Disorders.

Using the Opportunity-Propensity Model (Byrnes in Dev Rev 56:100911, 2020; Byrnes & Miller in Contemp Educ Psychol 32(4);599-629, 2007), the current study investigated which factors helped predicting children's home learning experiences during the COVID-19 pandemic, thereby examining differences between children with (DD; n = 779) and without (TD; n = 1443) developmental disorders. MANCOVA results indicated more negative experiences for DD children and their parents. SEM-results revealed the alignment between different teachers and autonomous motivation in children as the most important predictors for the outcome variables. Less predictors were significant for DD as compared to TD children which suggests other factors are at play in the DD group. Limitations, strengths and suggestions for future research are being discussed, together with some implications for classroom practices and remote learning approaches.

Play in Relation to Autism Traits in Young Children at Elevated Likelihood for Autism Spectrum Disorder.

Play of younger siblings of children with autism spectrum disorder (ASD) (siblings; n = 44), very preterm children (preterms; n = 44), and children at typical likelihood for ASD (n = 36) was observed at 24 months. Children with ASD and atypical development engaged less in spontaneous (pre-)symbolic play than typically developing children. Total duration of spontaneous and elicited (pre-)symbolic play was associated with later ASD traits in siblings. However, no association between most play variables and ASD traits was found in preterms. This suggests possible different ASD-trajectories between siblings and preterms. Thus, spontaneous (pre-)symbolic play may be indicative of developmental challenges across several populations, and results highlight the need to move beyond studying only siblings in order to broaden our understanding of ASD.

The association between working memory, teacher-student relationship, and academic performance in primary school children.

Introduction: Early relationships with teachers play an important role in children's development and significantly influence students' cognitive and academic performance. Studies suggest that working memory (WM) is a strong predictor of academic achievement, especially of reading and arithmetic outcomes. The associations between teacher-student relationship (TSR) quality, children's WM skills and their academic performance have been reported in numerous observational studies. However, the potentially bidirectional and temporal nature of the relationships between these constructs is understudied. Methods: The purpose of this study was to investigate the relationships between primary school children's WM and TSR by applying a cross-lagged design and measuring these constructs at three time points throughout the academic year. More exploratively, this study investigated how WM and TSR bidirectionally relate to children's academic performance. Results: The findings of this study revealed a temporal relationship between WM and TSR: between WM-related problems in the classroom at baseline and conflict at 3-month follow-up, and between closeness at 3-month follow-up and WM-related problems in the classroom at 5-month follow-up. Moreover, the findings showed a bidirectional relationship between arithmetic performance and WM-related problematic behaviour. Discussion: This study highlights that relationships between the teacher and students play an important role in supporting students' cognitive and academic development. Importantly, this study suggests that children with WM problems may benefit from interventions that focus on improving their relationships with teachers. Additionally, the findings propose that interventions targeting WM may also have positive effects on children's academic performance.

The Earlier, the Better? An In-Depth Interview Study on the Ethics of Early Detection with Parents of Children at an Elevated Likelihood for Autism.

Autism is increasingly viewed as an expression of neurodiversity deserving accommodation, rather than merely as a disorder in need of remediation or even prevention. This reconceptualization has inspired calls to broaden the ethical debate on early autism care beyond matters of efficient screenings and effective interventions. We conducted 14 in-depth interviews with 26 parents of infants at an increased likelihood for autism (siblings, preterms and children with persistent feeding difficulties) to understand which benefits and risks these parents see for the implementation of a systematic, early autism detection program in our region. With this study, we aim to contribute empirically to the ethical debate on good and just early autism care in the age of neurodiversity. Data were analyzed according to the QUAGOL-methodology. Three main themes emerged from our analysis. In their evaluation of early autism detection, parents discussed how a diagnosis helps gain a different perspective fostering understanding and recognition for both child and parent. Second, a diagnosis supports parents in adjusting their parenting practices, to justify this deviation from "normal" parenting and to strive for such adjusted environments beyond the nuclear family. Third, an autism diagnosis induces ambiguities parents need to navigate, involving questions on whether and when to mobilize the diagnostic label and which language to use to talk about autism. We discuss the complex position of parents of a (potentially) autistic child in terms of moving back and forth across the ab/normal binary and describe implications for the ethical debate on early autism detection.

How useful are screening instruments for toddlers to predict outcome at age 4? General development, language skills, and symptom severity in children with a false positive screen for autism spectrum disorder.

Screening instruments for autism spectrum disorder (ASD) often generate many false positives. It is argued that these children may have other developmental difficulties and are also in need of thorough assessment and early intervention. The current study looked at the predictive validity of positive screens on the Checklist for Early Signs of Developmental Disorders (CESDD) and the Early Screening of Autistic Traits questionnaire (ESAT) at age 2 towards language, cognitive function, and symptom severity at age 4. Children who screened positive on the ESAT scored lower for both language and cognitive functioning at age 4 compared with children who screened negative on the ESAT. Also, the more signs of ASD that were recognized on the CESDD or ESAT, the lower the scores for language and cognitive functioning at age 4. False positive screens could be differentiated from true positive screens on the CESDD only in symptom severity score on the Autism Diagnostic Observation Schedule (ADOS). It seems that early screeners for ASD also detect children with other developmental disorders and that diagnostic instruments such as the ADOS are warranted to differentiate between children with ASD and other developmental problems.

Can infants' orientation to social stimuli predict later joint attention skills?

From the moment infants are born, they seem to prefer orienting to social stimuli, over objects and non-social stimuli. This preference lasts throughout adulthood and is believed to play a crucial role in social-communicative development. By following up a group of infants at the age of 6, 8, and 12 months, this study explored the role of social orienting in the early development of joint attention skills. The expected association between social orienting and joint attention was partially confirmed. Social orienting in real-life photographs of everyday situations was not related to later joint attention skills, however fixation to the eyes in a neutral face was related to response to joint attention skills, and fixation to the eyes in a dynamic video clip of a talking person was predictive of initiating joint attention skills. Several alternative interpretations of the results are discussed.

Atypical brain network development of infants at elevated likelihood for autism spectrum disorder during the first year of life.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by behavioral features that appear early in life. Although studies have shown that atypical brain functional and structural connectivity are associated with these behavioral traits, the occurrence and initial alterations of brain networks have not been fully investigated. The current study aimed to map early brain network efficiency and information transferring in infants at elevated likelihood (EL) compared to infants at typical likelihood (TL) for ASD in the first year of life. This study used a resting-state functional near-infrared spectroscopy (fNIRS) approach to obtain the length and strength of functional connections in the frontal and temporal areas in 45 5-month-old and 38 10-month-old infants. Modular organization and small-world properties were detected in both EL and TL infants at 5 and 10 months. In 5-month-old EL infants, local and nodal efficiency were significantly greater than age-matched TL infants, indicating overgrown local connections. Furthermore, we used a support vector machine (SVM) model to classify infants with or without EL based on the obtained global properties of the network, achieving an accuracy of 77.6%. These results suggest that infants with EL for ASD exhibit inefficiencies in the organization of brain networks during the first year of life.

Expressed Emotion in Families of Children With and Without Autism Spectrum Disorder, Cerebral Palsy and Down Syndrome: Relations with Parenting Stress and Parenting Behaviors.

This study examined the family emotional climate as assessed by Five Minute Speech Samples and the relation with parenting stress and parenting behaviors among parents of children (6-17 years, 64.7% boys) with autism spectrum disorder, cerebral palsy, Down syndrome, and without any known disability (n = 447). The large majority of parents (79%) showed low levels of Expressed Emotion, an indicator of a positive family climate. In all groups, more Emotional Over-involvement, more Criticism and fewer expressions of Warmth were associated with higher levels of parenting stress. Across groups, Emotional Over-involvement was related to more autonomy-supportive parenting, Criticism to more psychologically controlling and overreactive parenting, and Warmth was associated with more responsive and less psychologically controlling and overreactive parenting.

Predicting cognitive development and early symptoms of autism spectrum disorder in preterm children: The value of temperament and sensory processing.

This study was the first to longitudinally explore the extent to which early temperament and sensory processing were of predictive value for cognitive development and Autism Spectrum Disorder (ASD) symptomatology in a sample of preterm children (N = 50, 22 girls, mean gestational age 27 weeks). At the corrected ages of 10, 18, and 24 months, sensory processing and temperament were assessed, as were cognitive development and ASD symptoms at 36 months. Better cognitive development was predicted by fewer hospitalisation days at birth and by lower Activity Level at 18 months. Temperamental subscales of Negative Affect showed associations with both parent-reported and observational measures of ASD symptomatology, whereas sensory processing only had predictive value for parent-reported symptoms of ASD. The usefulness of temperament and sensory processing for prediction of ASD symptom severity and cognitive outcomes became clear in the second year of life. The results indicate that this area of research is worth additional investigation in the extreme and very preterm population, to explore in further detail whether these two concepts might be able to provide information about which preterms are more likely to develop ASD or cognitive impairments.

Development of neural responses to hearing their own name in infants at low and high risk for autism spectrum disorder.

The own name is a salient stimulus, used by others to initiate social interaction. Typically developing infants orient towards the sound of their own name and exhibit enhanced event-related potentials (ERP) at 5 months. The lack of orientation to the own name is considered to be one of the earliest signs of autism spectrum disorder (ASD). In this study, we investigated ERPs to hearing the own name in infants at high and low risk for ASD, at 10 and 14 months. We hypothesized that low-risk infants would exhibit enhanced frontal ERP responses to their own name compared to an unfamiliar name, while high-risk infants were expected to show attenuation or absence of this difference in their ERP responses. In contrast to expectations, we did not find enhanced ERPs to own name in the low-risk group. However, the high-risk group exhibited attenuated frontal positive-going activity to their own name compared to an unfamiliar name and compared to the low-risk group, at the age of 14 months. These results suggest that infants at high risk for ASD start to process their own name differently shortly after one year of age, a period when frontal brain development is happening at a fast rate.