A comparison of visual attention to pictures in the Autism Diagnostic Observation Schedule in children and adolescents with ADHD and/or autism.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are neurodevelopmental conditions which frequently co-occur. The Autism Diagnostic Observation Schedule (ADOS) is commonly used to aid with diagnostic assessment of ASD but was not originally designed for use in those with comorbid ADHD. Visual attention to social stimuli has been often studied in ASD using eye-tracking, to obtain quantitative indices of how attention is deployed to different parts of a social image/scene. As the ADOS includes tasks that rely on attending to and processing images of social scenes, these measures of visual attention could provide useful additional objective measurement alongside ADOS scores to enhance the characterisation of autistic symptoms in those with ADHD. Methods: Children with ASD, comorbid ASD and ADHD, ADHD and Neurotypical (NT) controls were recruited (n=84). Visual attention was measured using eye-tracking during free viewing of social scenes selected from the ADOS. The full ADOS was then administered. Stimulant medication was temporarily withdrawn during this assessment. Research diagnoses were based on the Development and Wellbeing Assessment (DAWBA), ADOS, Social Communication Questionnaire (SCQ, a measure of ASD severity) and Conners' Rating Scales (CRS-3, a measure of ADHD severity) following clinical consensus. Results: Using factorial ANOVAs to model ADHD, Autism and their interaction, we found that fixation duration to faces was reduced in those with ASD (ASD and ASD+ADHD) compared to those without ASD (ADHD and NT). Reduced visual attention to faces in the whole sample was associated with Autism symptom severity (SCQ subscale scores) but not ADHD symptom severity (CRS-3 scores). Discussion: Our findings provide preliminary evidence in support of implementing visual attention measurement during assessment of ASD in the context of comorbidity with ADHD. For example, if a child with ADHD was found to reduce attention to faces in ADOS pictures this may suggest additive difficulties on the autism spectrum. Replication across a larger sample would be informative. This work has future potential in the clinic to help with complex cases, including those with co-occurring ADHD and ASD.

Relationship between autonomic arousal and attention orienting in children and adolescents with ADHD, autism and co-occurring ADHD and autism.

INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) may be characterized by different profiles of visual attention orienting. However, there are also many inconsistent findings emerging from the literature, probably due to the fact that the potential effect of autonomic arousal (which has been proposed to be dysregulated in these conditions) on oculomotor performance has not been investigated before. Moreover, it is not known how visual attention orienting is affected by the co-occurrence of ADHD and autism in people with a double diagnosis. METHODS: 99 children/adolescents with or without ADHD and/or autism (age 10.79 ± 2.05 years, 65% boys) completed an adapted version of the gap-overlap task (with baseline and overlap trials only). The social salience and modality of stimuli were manipulated between trials. Eye movements and pupil size were recorded. We compared saccadic reaction times (SRTs) between diagnostic groups and investigated if a trial-by-trial association existed between pre-saccadic pupil size and SRTs. RESULTS: Faster orienting (shorter SRT) was found for baseline compared to overlap trials, faces compared to non-face stimuli and-more evidently in children without ADHD and/or autism-for multi-modal compared to uni-modal stimuli. We also found a linear negative association between pre-saccadic pupil size and SRTs, in autistic participants (without ADHD), and a quadratic association in children with ADHD (without autism), for which SRTs were slower when intra-individual pre-saccadic pupil size was smallest or largest. CONCLUSION: Our findings are in line with previous literature and indicate a possible effect of dysregulated autonomic arousal on oculomotor mechanisms in autism and ADHD, which should be further investigated in future research studies with larger samples, to reliably investigate possible differences between children with single and dual diagnoses.

Prevalence of Victimisation in Autistic Individuals: A Systematic Review and Meta-Analysis.

Autistic individuals are at an increased risk of experiencing victimisation. Previous reviews have focussed specific types of victimisation. Thus, a clearer picture considering the range of victimisation experiences autistic people face is required. This systematic review aims to identify the prevalence of victimisation in autistic individuals considering a variety of victimisation types (e.g., bulling, sexual victimisation, and crime) in both adults and children from clinical and community settings. Through systematic searches of relevant databases, 291 studies met the criteria for review. Of those, 34 studies met the inclusion criteria: a) quantitative studies, b) involving autistic individuals, c) reporting prevalence rates of victimisation. Meta-analysis found a pooled prevalence rate of victimisation of 44% in autistic individuals. Subgroup analysis examined moderating factors as high heterogeneity was present. This found the pooled prevalence rates for bullying to be 47%, 16% for child abuse, 40% for sexual victimisation, 13% for cyberbullying, and 84% for multiple forms of victimisation in autistic individuals, though heterogeneity remained. Correction for participants' age, reporter used, and the population which the sample was recruited from did not reduce heterogeneity. Although heterogeneity impedes the definitive interpretation of the findings, this review illustrates the need for strategies and interventions to reduce the incidence of victimisation.

Dimensions of Self-Reported Driving Difficulty in Autistic and Non-Autistic Adults and their Relationship with Autistic Traits.

A survey asked autistic and non-autistic people about the driving difficulties they experience and their autistic traits. Principle components analysis was used to identify how reported difficulties clustered together in each group, and regression was used to determine which subscales of the Autism Spectrum Quotient predict these factors. For autistic drivers three factors of driving difficulty emerged: a Driving Executive factor, predicted by Attention Switching; a Driving Understanding factor, predicted by Communication; and a Driving Social Interaction factor, predicted by Attention Switching. For non-autistic drivers only one Driving General factor emerged, predicted by Communication. This suggests autistic people may experience at least three distinct domains of difficulty when driving which may relate to their particular profile of autistic features.

A Scoping Review of Studies Comparing Outcomes for Children With Severe Hearing Loss Using Hearing Aids to Children With Cochlear Implants.

OBJECTIVES: Clinical practice regarding children's candidature for cochlear implantation varies internationally, albeit with a recent global trend toward implanting children with more residual hearing than in the past. The provision of either hearing aids or cochlear implants can influence a wide range of children's outcomes. However, guidance on eligibility and suitability for implantation is often based on a small number of studies and a limited range of speech perception measures. No recent reviews have catalogued what is known about comparative outcomes for children with severe hearing-loss using hearing aids to children using cochlear implants. This article describes the findings of a scoping review that addressed the question "What research has been conducted comparing cochlear implant outcomes to outcomes in children using hearing aids with severe hearing-loss in the better-hearing ear?" The first objective was to catalogue the characteristics of studies pertinent to these children's candidature for cochlear implantation, to inform families, clinicians, researchers, and policy-makers. The second objective was to identify gaps in the evidence base, to inform future research projects and identify opportunities for evidence synthesis. DESIGN: We included studies comparing separate groups of children using hearing aids to those using cochlear implants and also repeated measures studies comparing outcomes of children with severe hearing loss before and after cochlear implantation. We included any outcomes that might feasibly be influenced by the provision of hearing aids or cochlear implants. We searched the electronic databases Medline, PubMed, and CINAHL, for peer-reviewed journal articles with full-texts written in English, published from July 2007 to October 2019. The scoping methodology followed the approach recommended by the Joanna Briggs Institute regarding study selection, data extraction, and data presentation. RESULTS: Twenty-one eligible studies were identified, conducted across 11 countries. The majority of children studied had either congenital or prelingual hearing loss, with typical cognitive function, experience of spoken language, and most implanted children used one implant. Speech and language development and speech perception were the most frequently assessed outcomes. However, some aspects of these outcomes were sparsely represented including voice, communication and pragmatic skills, and speech perception in complex background noise. Two studies compared literacy, two sound localization, one quality of life, and one psychosocial outcomes. None compared educational attainment, listening fatigue, balance, tinnitus, or music perception. CONCLUSIONS: This scoping review provides a summary of the literature regarding comparative outcomes of children with severe hearing-loss using acoustic hearing aids and children using cochlear implants. Notable gaps in knowledge that could be addressed in future research includes children's quality of life, educational attainment, and complex listening and language outcomes, such as word and sentence understanding in background noise, spatial listening, communication and pragmatic skills. Clinician awareness of this sparse evidence base is important when making management decisions for children with more residual hearing than traditional implant candidates. This review also provides direction for researchers wishing to strengthen the evidence base upon which clinical decisions can be made.

Heart Rate Variability in Children and Adolescents with Autism, ADHD and Co-occurring Autism and ADHD, During Passive and Active Experimental Conditions.

Despite overlaps in clinical symptomatology, autism and ADHD may be associated with opposite autonomic arousal profiles which might partly explain altered cognitive and global functioning. We investigated autonomic arousal in 106 children/adolescents with autism, ADHD, co-occurring autism/ADHD, and neurotypical controls. Heart rate variability was recorded during resting-state, a 'passive' auditory oddball task and an 'active' response conflict task. Autistic children showed hyper-arousal during the active task, while those with ADHD showed hypo-arousal during resting-state and the passive task. Irrespective of diagnosis, children characterised by hyper-arousal showed more severe autistic symptomatology, increased anxiety and reduced global functioning than those displaying hypo-arousal, suggesting the importance of considering individual autonomic arousal profiles for differential diagnosis of autism/ADHD and when developing personalised interventions.

What is the Effect of Stimulus Complexity on Attention to Repeating and Changing Information in Autism?

Slower habituation to repeating stimuli characterises Autism, but it is not known whether this is driven by difficulties with information processing or an attentional bias towards sameness. We conducted eye-tracking and presented looming geometrical shapes, clocks with moving arms and smiling faces, as two separate streams of stimuli (one repeating and one changing), to 7-15 years old children and adolescents (n = 103) with Autism, ADHD or co-occurring Autism+ADHD, and neurotypical children (Study-1); and to neurotypical children (n = 64) with varying levels of autistic traits (Study-2). Across both studies, autistic features were associated with longer looks to the repeating stimulus, and shorter looks to the changing stimulus, but only for more complex stimuli, indicating greater difficulty in processing complex or unpredictable information.

Social context facilitates visuomotor synchrony and bonding in children and adults.

Interpersonal synchrony is a fundamental part of human social interaction, with known effects on facilitating social bonding. Moving in time with another person facilitates prosocial behaviour, however, it is unknown if the degree of synchronisation predicts the degree of social bonding. Similarly, while people readily fall in synchrony even without being instructed to do so, we do not know whether such spontaneous synchronisation elicits similar prosocial effects as instructed synchronisation. Across two studies, we investigated how context (social vs non-social stimulus) and instruction (instructed vs uninstructed) influenced synchronisation accuracy and bonding with the interaction partner in adults and children. The results revealed improved visuomotor synchrony within a social, compared to non-social, context in adults and children. Children, but not adults, synchronised more accurately when instructed to synchronise than when uninstructed. For both children and adults, synchronisation in a social context elicited stronger social bonding towards an interaction partner as compared to synchronisation in a non-social context. Finally, children's, but not adults', degree of synchrony with the partner was significantly associated with their feelings of social closeness. These findings illuminate the interaction of sensorimotor coupling and joint action in social contexts and how these mechanisms facilitate synchronisation ability and social bonding.

The Relative Contributions of Visual and Proprioceptive Inputs on Hand Localization in Early Childhood.

Forming an accurate representation of the body relies on the integration of information from multiple sensory inputs. Both vision and proprioception are important for body localization. Whilst adults have been shown to integrate these sources in an optimal fashion, few studies have investigated how children integrate visual and proprioceptive information when localizing the body. The current study used a mediated reality device called MIRAGE to explore how the brain weighs visual and proprioceptive information in a hand localization task across early childhood. Sixty-four children aged 4-11 years estimated the position of their index finger after viewing congruent or incongruent visuo-proprioceptive information regarding hand position. A developmental trajectory analysis was carried out to explore the effect of age on condition. An age effect was only found in the incongruent condition which resulted in greater mislocalization of the hand toward the visual representation as age increased. Estimates by younger children were closer to the true location of the hand compared to those by older children indicating less weighting of visual information. Regression analyses showed localizations errors in the incongruent seen condition could not be explained by proprioceptive accuracy or by general attention or social differences. This suggests that the way in which visual and proprioceptive information are integrated optimizes throughout development, with the bias toward visual information increasing with age.

Is autonomic function during resting-state atypical in Autism: A systematic review of evidence.

BACKGROUND: Theories of differences in resting-state arousal in autistic individuals are influential. Differences in arousal during resting-state would impact engagement and adaptation to the environment, having a cascading effect on development of attentional and social skills. OBJECTIVES: We systematically evaluated the evidence for differences in measures of autonomic arousal (heart rate, pupillometry or electrodermal activity) during resting-state in autistic individuals; to understand whether certain contextual or methodological factors impact reports of such differences. DATA SOURCES: We searched PsycInfo, MEDLINE and EMBASE databases for papers published until 16th May 2019. Of 1207 titles initially identified, 60 met inclusion criteria. RESULTS AND CONCLUSIONS: Of the 51 studies that investigated group differences between neurotypical and autistic participants, 60.8 % found evidence of group differences. While findings of hyperarousal were more common, particularly using indices of parasympathetic function, findings of hypo-arousal and autonomic dysregulation were also consistently present. Importantly, experimental context played a role in revealing such differences. The evidence is discussed with regard to important methodological factors and implications for future research are described.

Neurotype-Matching, but Not Being Autistic, Influences Self and Observer Ratings of Interpersonal Rapport.

The Double Empathy Problem suggests that communicative difficulties between autistic and non-autistic people are due to bi-directional differences in communicative style and a reciprocal lack of understanding. If true, there should be increased similarity in interaction style, resulting in higher rapport during interactions between pairs of the same neurotype. Here, we provide two empirical tests of rapport, with data revealing whether self- and observer- rated rapport varies depending on the match or mismatch in autism status within a pair. An additional opportunity afforded by these data is to examine the effect of the autism status of the rater on the perceived rapport between matched and mismatched pairs. In Study 1 72 participants were allocated to one of three dyad conditions: autistic pairs (n = 24), non-autistic pairs (n = 24) and mixed pairs (n = 12 autistic; n = 12 non-autistic). Each participant completed three semi-structured interactions with their partner, rating rapport after each interaction. Non-autistic pairs experienced higher self-rated rapport than mixed and autistic pairs, and autistic pairs experienced higher rapport than mixed pairs. In Study 2 (n = 80) autistic and non-autistic observers rated interactional rapport while watching videoed interactions between autistic pairs, non-autistic pairs, and mixed pairs (n = 18, a subset of participants in Study 1). Mixed pairs were rated significantly lower on rapport than autistic and non-autistic pairs, and autistic pairs were rated more highly for rapport than non-autistic pairs. Both autistic and non-autistic observers show similar patterns in how they rate the rapport of autistic, non-autistic, and mixed pairs. In summary, autistic people experience high interactional rapport when interacting with other autistic people, and this is also detected by external observers. Rather than autistic people experiencing low rapport in all contexts, their rapport ratings are influenced by a mismatch of diagnosis. These findings suggest that autistic people possess a distinct mode of social interaction style, rather than demonstrating social skills deficits. These data are considered in terms of their implications for psychological theories of autism, as well as practical impact on educational and clinical practice.

Distinct neural correlates of social and object reward seeking motivation.

The "Choose-a-Movie-CAM" is an established task to quantify the motivation for seeking social rewards. It allows participants to directly assess both the stimulus value and the effort required to obtain it. In the present study, we aimed to identify the neural mechanisms of such cost-benefit decision-making. To this end, functional Magnetic Resonance Imaging data were collected from 24 typical adults while they completed the CAM task. We partly replicated the results from our previous behavioural studies showing that typical adults prefer social over object stimuli and low effort over higher effort stimuli but found no interaction between the two. Results from neuroimaging data suggest that there are distinct neural correlates for social and object preferences. The precuneus and medial orbitofrontal cortex, two key areas involved in social processing are engaged when participants make a social choice. Areas of the ventral and dorsal stream pathways associated with object recognition are engaged when making an object choice. These activations can be seen during the decision phase even before the rewards have been consumed, indicating a transfer the hedonic properties of social stimuli to its cues. We also found that the left insula and bilateral clusters in the inferior occipital gyrus and the inferior parietal lobule were recruited for increasing effort investment. We discuss limitations and implications of this study which reveals the distinct neural correlates for social and object rewards, using a robust behavioural measure of social motivation.

Autistic peer-to-peer information transfer is highly effective.

LAY ABSTRACT: Sharing information with other people relies on the ability to communicate well. Autism is defined clinically by deficits in social communication. It may therefore be expected that autistic people find it difficult to share information with other people. We wanted to find out whether this was the case, and whether it was different when autistic people were sharing information with other autistic people or with non-autistic people. We recruited nine groups, each with eight people. In three of the groups, everyone was autistic; in three of the groups, everyone was non-autistic; and three of the groups were mixed groups where half the group was autistic and half the group was non-autistic. We told one person in each group a story and asked them to share it with another person, and for that person to share it again and so on, until everyone in the group had heard the story. We then looked at how many details of the story had been shared at each stage. We found that autistic people share information with other autistic people as well as non-autistic people do with other non-autistic people. However, when there are mixed groups of autistic and non-autistic people, much less information is shared. Participants were also asked how they felt they had got on with the other person in the interaction. The people in the mixed groups also experienced lower rapport with the person they were sharing the story with. This finding is important as it shows that autistic people have the skills to share information well with one another and experience good rapport, and that there are selective problems when autistic and non-autistic people are interacting.

'I never realised everybody felt as happy as I do when I am around autistic people': A thematic analysis of autistic adults' relationships with autistic and neurotypical friends and family.

LAY ABSTRACT: Although autistic people may struggle to interact with others, many autistic people have said they find interacting with other autistic people more comfortable. To find out whether this was a common experience, we did hour-long interviews with 12 autistic adults. We asked them questions about how it feels when spending time with their friends and family, and whether it felt different depending on whether the friends and family were autistic or neurotypical. We analysed the interviews and found three common themes in what our participants said. First, they found spending with other autistic people easier and more comfortable than spending time with neurotypical people, and felt they were better understood by other autistic people. Second, autistic people often felt they were in a social minority, and in order to spend time with neurotypical friends and family, they had to conform with what the neurotypical people wanted and were used to. Third, autistic people felt like they belonged with other autistic people and that they could be themselves around them. These findings show that having time with autistic friends and family can be very beneficial for autistic people and played an important role in a happy social life.

Exploring the autistic and police perspectives of the custody process through a participative walkthrough.

BACKGROUND: Research suggests that autistic individuals may be more likely to come into contact with police and have more negative experiences in police custody. However, limited information about the difficulties they experience during the custody process is available. AIMS: This study explores the experiences of autistic individuals and officers during a walkthrough of the custody process to identify specific difficulties in these encounters and what support is needed to overcome these. METHODS AND PROCEDURES: A participative walkthrough method was developed to provide autistic individuals and officers an interactive opportunity to identify areas where further support in the custody process was needed. Two autistic participants and three officers took part in the study. OUTCOMES AND RESULTS: Autistic participants reported negative experiences due to: i) the emotional impact of the physical setting and custody process ii) communication barriers leading to increased anxiety and iii) exposure to sensory demands. Officers highlighted three factors which limit their ability to support autistic individuals effectively: i) the custody context ii) barriers to communication and iii) knowledge and understanding of autism. CONCLUSIONS AND IMPLICATIONS: Adjustments are needed to the custody process and environment to support interactions between autistic individuals and officers and improve the overall wellbeing of autistic individuals.

Are you watching me? The role of audience and object novelty in overimitation.

This study tested whether overimitation is subject to an audience effect, and whether it is modulated by object novelty. A sample of 86 4- to 11-year-old children watched a demonstrator open novel and familiar boxes using sequences of necessary and unnecessary actions. The experimenter then observed the children, turned away, or left the room while the children opened the box. Children copied unnecessary actions more when the experimenter watched or when she left, but they copied less when she turned away. This parallels infant studies suggesting that turning away is interpreted as a signal of disengagement. Children displayed increased overimitation and reduced efficiency discrimination when opening novel boxes compared with familiar boxes. These data provide important evidence that object novelty is a critical component of overimitation.

Does stereopsis account for the link between motor and social skills in adults?

Background: Experimental and longitudinal evidence suggests that motor proficiency plays an important role in the development of social skills. However, stereopsis, or depth perception, may also play a fundamental role in social skill development either indirectly through its impact on motor skills or through a more direct route. To date, no systematic study has investigated the relationship between social skills and motor ability in the general adult population, and whether poor stereopsis may contribute to this association. This has implications for clinical populations since research has shown associations between motor abnormalities and social skills, as well as reduced depth perception in autism spectrum disorder and developmental coordination disorder. Methods: Six hundred fifty adults completed three validated questionnaires, the stereopsis screening inventory, the Adult Developmental Coordination Disorder Checklist, and the Autism Spectrum Quotient. Results: An exploratory factor analysis on pooled items across all measures revealed 10 factors that were largely composed of items from a single scale, indicating that any co-occurrence of poor stereopsis, reduced motor proficiency, and difficulties with social interaction cannot be attributed to a single underlying mechanism. Correlations between extracted factor scores found associations between motor skill and social skill. Conclusions: Mediation analyses suggested that whilst fine motor skill and coordination explained the relationship between stereopsis and social skill to some extent, stereopsis nonetheless exerted a substantial direct effect upon social skill. This is the first study to demonstrate that the functional significance of stereopsis is not limited to motor ability and may directly impact upon social functioning.

Comparison of choose-a-movie and approach-avoidance paradigms to measure social motivation.

Social motivation is a subjective state which is rather difficult to quantify. It has sometimes been conceptualised as "behavioural effort" to seek social contact. Two paradigms: approach-avoidance (AA) and choose a movie (CAM), based on the same conceptualisation, have been used to measure social motivation in people with and without autism. However, in absence of a direct comparison, it is hard to know which of these paradigms has higher sensitivity in estimating preference for social over non-social stimuli. Here we compare these two tasks for their utility in (1) evaluating social seeking in typical people and (2) identifying the influence of autistic traits on social motivation. Our results suggest that CAM reveals a clear preference for social stimuli over non-social in typical adults but AA fails to do so. Also, social seeking measured with CAM but not AA has a negative relationship between autistic traits.

Body representation difficulties in children and adolescents with autism may be due to delayed development of visuo-tactile temporal binding.

Recent research suggests visuo-tactile binding is temporally extended in autism spectrum disorders (ASD), although it is not clear whether this specifically underlies altered body representation in this population. In the current study children and adolescents with ASD, and typically developing controls, placed their hand into mediated reality system (MIRAGE) and saw two identical live video images of their own right hand. One image was in the proprioceptively correct location (veridical hand) and the other was displaced to either side. While visuo-tactile feedback was applied via brushstroke to the participant's (unseen) right finger, they viewed one hand image receiving synchronous brushstrokes and the other receiving brushstrokes with a temporal delay (60, 180 and 300ms). After brushing, both images disappeared from view and participants pointed to a target, with direction of movement indicating which hand was embodied. ASD participants, like younger mental aged-matched controls, showed reduced embodiment of the spatially incongruent, but temporally congruent, hand compared to chronologically age-matched controls at shorter temporal delays. This suggests development of visuo-tactile integration may be delayed in ASD. Findings are discussed in relation to atypical body representation in ASD and how this may contribute to social and sensory difficulties within this population.

Social seeking declines in young adolescents.

The desire to engage with others is an important motivational force throughout our lifespan. It is known that social behaviour and preferences change from childhood to adulthood, but whether this change is linked with any changes in social motivation is not known. We evaluated 255 typically developing participants from ages 4-20 years on a behavioural paradigm 'Choose a Movie' (CAM). On every trial, participants had a choice between viewing social or non-social movies presented with different levels of effort (key presses/screen touch required). Hence, participants chose not only the movie they would watch but also how much effort they would make. The difference between the effort levels of the chosen and not chosen stimuli helps in quantifying the motivation to seek it. This task could be used with all the age groups with minimal adaptations, allowing comparison between the groups. Results showed that children (4-8 years), older adolescents (12-16 years) and young adults (17-20 years) made more effort to look at social movies. Counterintuitively, this preference was not seen in young adolescents (around 9-12 years), giving a U-shaped developmental trajectory over the population. We present the first evidence for non-monotonic developmental change in social motivation in typical participants.