The Physiological and Clinical-Behavioral Effects of Heart Rate Variability Biofeedback in Adolescents with Autism: A Pilot Randomized Controlled Trial.

Adolescents with autism present lower levels of cardiac vagal modulation. It was hypothesized that Heart Rate Variability Biofeedback (HRVB) increases cardiac vagal modulation in adolescents with autism, resulting in positive effects on physiological and psychosocial parameters. It was also hypothesized that home-based HRVB training is feasible. In a single-blind, randomized sham-controlled pilot trial, adolescents with autism performed supervised HRVB (n = 24) or sham training (n = 20). Subsequently, half of the adolescents received HRVB training at home, whereas the other subset did not practice. Physiological, cortisol and behavioral data were collected during stress-provoking assessments before and after each training period. Supervised HRVB resulted in a late increase in cardiac vagal modulation in adolescents with autism. Heart rate increased and cortisol decreased significantly immediately after supervised HRVB, but none of these effects remained after follow-up. Following supervised HRVB, no significant change in psychosocial functioning was found. Home-based HRVB was feasible, adolescents reported lower symptoms of stress, but a significant decrease in compliance rate was found. HRVB is feasible and effective in adolescents with autism given the late-emerging increases in cardiac vagal modulation and decrease in stress symptoms. Replicating this study with a larger sample and further exploration of the working mechanisms of HRVB are recommended. ClinicalTrials.gov , NCT04628715.

A Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum.

Background: The goal of this systematic review was to provide an overview of self-report measures of stress in populations on the autism spectrum. In addition, information regarding psychometric properties was discussed as well. Methods: Four databases were systematically searched following the PRISMA guidelines and using strict eligibility criteria. Risk of bias assessment was performed using the COSMIN checklist. Results: Eight questionnaires were previously used in populations on the autism spectrum, reported over 31 studies. Discussion: Future research should focus more on examining psychometric properties of these self-report measures in this population as current evidence is scarce. In addition, it is important to consider which concept of stress one aims to measure as not all questionnaires cover the same aspects of stress. Supplementary Information: The online version contains supplementary material available at 10.1007/s40489-021-00293-4.

Physical activity correlates in children and adolescents with autism spectrum disorder: a systematic review.

PURPOSE: This systematic review examined correlates of physical activity (PA) at all levels of the socio-ecological model (i.e., intrapersonal, interpersonal, environmental and policy level) in children and adolescents with autism spectrum disorder (ASD). MATERIALS AND METHODS: Major electronic databases were searched from inception until March 23rd, 2021. A summary coding was used to analyze the data for children (3-12 years) and adolescents (13-18 years) with ASD separately. RESULTS: Out of the 79 potential PA correlates, retrieved from 32 studies (991 657 children; 3857 adolescents), only five correlates were consistently examined as a PA correlate (i.e., examined in four or more studies) in children and adolescents with ASD. Only age was inversely associated with PA in children and adolescents with ASD. Data on gender, body mass index, autism severity level and day of the week being physically active in children with ASD were mixed. CONCLUSIONS: We only found consistent evidence for age being inversely related to PA. Our review indicates that more research is needed to explore intrapersonal, interpersonal, environmental and policy-related correlates of PA in children and adolescents with ASD.IMPLICATIONS FOR REHABILITATIONRehabilitation programs should take into account that in particular older children and adolescents with autism spectrum disorder are at risk for physical inactivity.Boys and girls with autism spectrum disorder need the same care when motivating them to be more physically active.

Evaluation of the Developmental Coordination Questionnaire (DCDQ) as a Screening Instrument for Co-occurring Motor Problems in Children with Autism Spectrum Disorder.

Although motor problems are highly prevalent in children with autism spectrum disorder (ASD), they remain underdiagnosed. Questionnaire-based screening for motor problems could optimize current clinical practice. This study aimed to examine the psychometric properties of the developmental coordination disorder questionnaire (DCDQ) to screen for co-occurring motor problems in individuals with ASD (n = 115; aged 5-15 years). Results indicated an excellent internal consistency; concurrent and discriminant validity with the Movement Assessment Battery for Children, second edition. Sensitivity was excellent, but specificity was lower. The positive and negative predictive values indicate that the DCDQ can be used to detect motor problems in children with ASD and can exclude the presence of developmental coordination disorder.

Evaluating the potential of respiratory-sinus-arrhythmia biofeedback for reducing physiological stress in adolescents with autism: study protocol for a randomized controlled trial.

BACKGROUND: Prior evidence points towards lower cardiac vagal modulation in individuals with autism spectrum disorder (ASD) as compared to control groups. A cross-sectional phase in this study will gather more evidence concerning this topic. A longitudinal phase will explore the efficacy of a biofeedback intervention based on respiratory sinus arrhythmia (RSA) in adolescents with ASD. Finally, a feasibility study will focus on a non-supervised RSA biofeedback intervention in this population. METHODS: The cross-sectional phase includes the comparison of adolescents with ASD (n=38) and age- and gender-matched typically developing peers. A standardized assessment will be used which contains physiological, cortisol, and behavioral measurements. The longitudinal phase contains a randomized, single-blinded, and sham-controlled design to determine the efficacy of supervised RSA biofeedback in adolescents with ASD (n=128). A follow-up phase of 5 weeks is included to evaluate the presence of retention effects. During the latter, a feasibility study will focus on a non-supervised intervention (n=64). Assessments as described previously are scheduled after the intervention and the follow-up phase. DISCUSSION: First, more conclusive evidence will be provided for the presence of lower cardiac vagal modulation in adolescents with ASD as well as the association between these lower values and physiological and behavioral indices. Second, the supervised intervention in adolescents with ASD is hypothesized to upregulate this cardiac vagal modulation and positively change behavioral and physiological parameters. Third, evidence regarding the feasibility and acceptability of a non-supervised intervention may open novel avenues for home-based interventions in this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT04628715 . Registered on 13 November 2020.