Heart rate increase predicts challenging behavior episodes in preschoolers with autism.

Identifying triggers for challenging behavior is difficult in some children with autism because of their limited communication abilities. Physiological indicators of stress may provide important insights. This study examined whether heart rate (HR) predicts challenging behavior in children with autism. While wearing an electrocardiograph monitor, 41 children with autism aged 2- to 4-years participated in tasks designed to induce low-level stress (e.g. waiting for a snack). Coders identified 106 time periods during which challenging behaviors occurred and also coded 106 randomly selected time samples that did not include challenging behaviors. Thirteen (32%) participants exhibited challenging behaviors and were included in the study. Baseline-corrected HR was computed for each behavior/time sample. On average, children with autism showed a 22 ± 16% HR increase from baseline 58 ± 22 seconds before the onset of a challenging behavior episode. Peak HR change had moderate predictive utility (area under the curve = .72, p < .001). The increase in HR before challenging behaviors was similar for children of different characteristics (age, autism severity, expressive language ability, overall developmental ability). Results highlight the promise of using physiological stress to predict challenging behavior in preschoolers with autism; although, they need to be replicated in larger samples. Given recent advances in wearable biosensing, it may be useful to incorporate HR monitoring in autism intervention. Lay summary In children with autism, changes in heart rate (HR) may help us predict when challenging behavior is about to occur - but this hypothesis has not been well studied. In this study, HR increase moderately predicted challenging behavior in preschoolers with autism. Given recent advances in wearable sensors, it may be useful to incorporate HR monitoring in autism intervention.

Evaluating commercially available wireless cardiovascular monitors for measuring and transmitting real-time physiological responses in children with autism.

Commercially available wearable biosensors have the potential to enhance psychophysiology research and digital health technologies for autism by enabling stress or arousal monitoring in naturalistic settings. However, such monitors may not be comfortable for children with autism due to sensory sensitivities. To determine the feasibility of wearable technology in children with autism age 8-12 years, we first selected six consumer-grade wireless cardiovascular monitors and tested them during rest and movement conditions in 23 typically developing adults. Subsequently, the best performing monitors (based on data quality robustness statistics), Polar and Mio Fuse, were evaluated in 32 children with autism and 23 typically developing children during a 2-h session, including rest and mild stress-inducing tasks. Cardiovascular data were recorded simultaneously across monitors using custom software. We administered the Comfort Rating Scales to children. Although the Polar monitor was less comfortable for children with autism than typically developing children, absolute scores demonstrated that, on average, all children found each monitor comfortable. For most children, data from the Mio Fuse (96%-100%) and Polar (83%-96%) passed quality thresholds of data robustness. Moreover, in the stress relative to rest condition, heart rate increased for the Polar, F(1,53) = 135.70, p < 0.001, ηp2  = 0.78, and Mio Fuse, F(1,53) = 71.98, p < 0.001, ηp2  = 0.61, respectively, and heart rate variability decreased for the Polar, F(1,53) = 13.41, p = 0.001, ηp2  = 0.26, and Mio Fuse, F(1,53) = 8.89, p = 0.005, ηp2  = 0.16, respectively. This feasibility study suggests that select consumer-grade wearable cardiovascular monitors can be used with children with autism and may be a promising means for tracking physiological stress or arousal responses in community settings. LAY SUMMARY: Commercially available heart rate trackers have the potential to advance stress research with individuals with autism. Due to sensory sensitivities common in autism, their comfort wearing such trackers is vital to gathering robust and valid data. After assessing six trackers with typically developing adults, we tested the best trackers (based on data quality) in typically developing children and children with autism and found that two of them met criteria for comfort, robustness, and validity.