Testing the mid-range model: Attachment in a high risk sample.

Infant attachment is a key predictor of later socioemotional functioning, but it is not clear how parental responsivity to infant expressive behavior is associated with attachment outcomes. A mid-range model of responsivity holds that both unresponsive and highly reactive parental behaviors lead to insecure and disorganized attachment. We examined the relationship between maternal (and infant) contingent responsivity and attachment in a high-risk sample. Participants were 625 infant-mother pairs from a longitudinal study of children with and without prenatal drug exposure and variable levels of associated social risks. Infant-mother pairs participated in the Face-to-Face/Still-Face paradigm (FFSF) at 4-months and in the Strange Situation Procedure (SSP) at 18-months. A model incorporating both linear and quadratic responsivity effects indicated that mothers who were either very high (reactive) or very low (unresponsive) in responsivity were more likely to have infants with disorganized attachment outcomes. While maternal responsivity was associated with attachment disorganization, no associations between maternal responsivity, and attachment security/insecurity were detected. Infant responsivity to mother was not associated with attachment outcomes. The findings suggest the importance of mid-range levels of maternal responsivity in the development of organized attachment among infants facing high levels of prenatal and social risk.

Maternal and infant affect at 4 months predicts performance and verbal IQ at 4 and 7 years in a diverse population.

Using existing longitudinal data from 570 infants in the Maternal Lifestyle Study, we explored the predictive value of maternal and infant affect and maternal vocalizations during 2 minutes of face-to-face interactions at 4 months on IQ scores at 4.5 and 7 years. After controlling for demographic factors, maternal depression, and prenatal drug exposure, maternal positive affect and maternal positive vocalizations emerged as predictors of both verbal and performance IQ at 4.5 and 7 years. Although infant positive affect during the interaction with the mother was not predictive of these outcome measures, infant positive affect towards an examiner predicted verbal but not performance IQ at 4.5 years. These results suggest that maternal positive affect may index emotional engagement in interaction that facilitates both verbal and nonverbal cognitive development, while infant social positive affect is specifically related to the acquisition of verbal reasoning abilities. These findings are significant because they are based on a discrete snapshot of observable behavior in infancy (just 2 minutes of interaction), because they extend the range of maternal behaviors and characteristics known to support positive developmental outcomes, and because they are derived from high-risk infants where prevention efforts may be beneficial. Potential mechanisms for these associations are discussed, as are the clinical implications for identifying dyads most in need of targeted interventions.

Attention to the mouth and gaze following in infancy predict language development.

We investigated longitudinal relations among gaze following and face scanning in infancy and later language development. At 12 months, infants watched videos of a woman describing an object while their passive viewing was measured with an eye-tracker. We examined the relation between infants' face scanning behavior and their tendency to follow the speaker's attentional shift to the object she was describing. We also collected language outcome measures on the same infants at 18 and 24 months. Attention to the mouth and gaze following at 12 months both predicted later productive vocabulary. The results are discussed in terms of social engagement, which may account for both attentional distribution and language onset. We argue that an infant's inherent interest in engaging with others (in addition to creating more opportunities for communication) leads infants to attend to the most relevant information in a social scene and that this information facilitates language learning.

Exploring communicative competence in autistic children who are minimally verbal: The Low Verbal Investigatory Survey for Autism (LVIS).

LAY ABSTRACT: Approximately one in three autistic children is unable to communicate with language; this state is often described as minimally verbal. Despite the tremendous clinical implications, we cannot predict whether a minimally verbal child is simply delayed (but will eventually develop spoken language) or will continue to struggle with verbal language, and might therefore benefit from learning an alternative form of communication. This is important for clinicians to know, to be able to choose the most helpful interventions, such as alternative forms of communication. In addition, the field lacks a standard definition of "minimally verbal." Even when we do agree on what the term means (e.g. fewer than 20 words), describing a child based on their lack of words does not tell us whether that child is communicating in other ways or how they are using those 20 words. To address these concerns, we developed the Low Verbal Investigatory Survey (LVIS), a one-page parent-report measure designed to help us characterize how minimally verbal autistic children are communicating. Parents of 147 children (aged 1-8 years) completed the LVIS. Here, we ask (1) whether the survey measures what it was designed to measure, that is, communicative ability in children without much spoken language, and (2) how the LVIS relates to cognitive and language ability, and symptoms of autism. Results suggest that this survey, which takes only 5 min to complete, is a good estimate of the child's communication skills. Furthermore, LVIS survey scores are correlated with other measures of language and cognitive abilities as well as autism symptomatology. The LVIS has the potential to save time and money in both clinical and research efforts to assess communication skills in minimally verbal autistic children.

Distance from Typical Scan Path When Viewing Complex Stimuli in Children with Autism Spectrum Disorder and its Association with Behavior.

Eye-tracking is often used to study attention in children with autism spectrum disorder (ASD). Previous research has identified multiple atypical patterns of attention in children with ASD based on areas-of-interest analysis. Fewer studies have investigated gaze path, a measure which is dependent on the dynamic content of the stimulus presented. Here, rather than looking at proportions of looking time to areas of interest, we calculated mean fixations frame-by-frame in a group of typically developing children (36 to 72 months) and determined the distance from those typical fixations for 155 children with ASD (27-95 months). Findings revealed that distance from the typical scan path among the children with ASD was associated with lower communication abilities and greater ASD symptomatology.

A Six-Minute Measure of Vocalizations in Toddlers with Autism Spectrum Disorder.

To improve early identification of autism spectrum disorder (ASD), we need objective, reliable, and accessible measures. To that end, a previous study demonstrated that a tablet-based application (app) that assessed several autism risk behaviors distinguished between toddlers with ASD and non-ASD toddlers. Using vocal data collected during this study, we investigated whether vocalizations uttered during administration of this app can distinguish among toddlers aged 16-31 months with typical development (TD), language or developmental delay (DLD), and ASD. Participant's visual and vocal responses were recorded using the camera and microphone in a tablet while toddlers watched movies designed to elicit behaviors associated with risk for ASD. Vocalizations were then coded offline. Results showed that (a) children with ASD and DLD were less likely to produce words during app administration than TD participants; (b) the ratio of syllabic vocalizations to all vocalizations was higher among TD than ASD or DLD participants; and (c) the rates of nonsyllabic vocalizations were higher in the ASD group than in either the TD or DLD groups. Those producing more nonsyllabic vocalizations were 24 times more likely to be diagnosed with ASD. These results lend support to previous findings that early vocalizations might be useful in identifying risk for ASD in toddlers and demonstrate the feasibility of using a scalable tablet-based app for assessing vocalizations in the context of a routine pediatric visit. LAY SUMMARY: Although parents often report symptoms of autism spectrum disorder (ASD) in infancy, we are not yet reliably diagnosing ASD until much later in development. A previous study tested a tablet-based application (app) that recorded behaviors we know are associated with ASD to help identify children at risk for the disorder. Here we measured how children vocalize while they watched the movies presented on the tablet. Children with ASD were less likely to produce words, less likely to produce speechlike sounds, and more likely to produce atypical sounds while watching these movies. These measures, combined with other behaviors measured by the app, might help identify which children should be evaluated for ASD. Autism Res 2020, 13: 1373-1382. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Autism Heterogeneity in a Densely Sampled U.S. Population: Results From the First 1,000 Participants in the RI-CART Study.

The objective of this study was to establish a large, densely sampled, U.S. population-based cohort of people with autism spectrum disorder (ASD). The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by ASD. Diagnosis was based on direct behavioral observation via the Autism Diagnostic Observation Schedule, Second Edition. For the first 1,000 participants, ages ranged from 21 months to 64 years. Using Geographic Information System and published prevalence rates, the overall cohort is estimated to represent between 20% and 49% of pediatric age persons in Rhode Island with ASD, with demographics representative of U.S. Census. We observed a high rate of co-occurring medical and psychiatric conditions in affected individuals. Among the most prominent findings of immediate clinical importance, we found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD. In summary, this is the first analysis of a large, population-based U.S. cohort with ASD. Given the depth of sampling, the RI-CART study reflects an important new resource for studying ASD in a representative U.S. population. Psychiatric and medical comorbidities in ASD constitute a substantial burden and warrant adequate attention as part of overall treatment. Our study also suggests that new strategies for earlier diagnosis of ASD in females may be warranted. Autism Res 2020, 13: 474-488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by autism spectrum disorder (ASD). In this article, we provide results from the first 1,000 participants, estimated to represent >20% of affected families in the state. Importantly, we find a later age at first diagnosis of ASD in females, which potentially calls attention to the need for improved early diagnosis in girls. Also, we report a high rate of co-occurring medical and psychiatric conditions in affected individuals.

Perception of Cry Characteristics in 1-Month-Old Infants Later Diagnosed with Autism Spectrum Disorder.

This study investigates parental perceptions of cries of 1-month-old infants later diagnosed with autism spectrum disorder (ASD) and non-ASD controls. Parents of children with and without ASD listened to cry recordings of infants later diagnosed with ASD and comparison infants and rated them on cry perception scales. Parents completed the Broad Autism Phenotype Questionnaire (BAPQ) to assess the potential relations between traits associated with autism and cry perception. Across parents, ASD infant cries were rated as more distressed, less typical, and reflecting greater pain, with no significant differences between parent groups. Parents of children with ASD scored higher on the BAPQ compared to parents of children without ASD. Follow up analyses explored the relations between BAPQ score and cry ratings.

Sensitivity to audio-visual synchrony and its relation to language abilities in children with and without ASD.

Autism Spectrum Disorder (ASD) is often accompanied by deficits in speech and language processing. Speech processing relies heavily on the integration of auditory and visual information, and it has been suggested that the ability to detect correspondence between auditory and visual signals helps to lay the foundation for successful language development. The goal of the present study was to examine whether young children with ASD show reduced sensitivity to temporal asynchronies in a speech processing task when compared to typically developing controls, and to examine how this sensitivity might relate to language proficiency. Using automated eye tracking methods, we found that children with ASD failed to demonstrate sensitivity to asynchronies of 0.3s, 0.6s, or 1.0s between a video of a woman speaking and the corresponding audio track. In contrast, typically developing children who were language-matched to the ASD group, were sensitive to both 0.6s and 1.0s asynchronies. We also demonstrated that individual differences in sensitivity to audiovisual asynchronies and individual differences in orientation to relevant facial features were both correlated with scores on a standardized measure of language abilities. Results are discussed in the context of attention to visual language and audio-visual processing as potential precursors to language impairment in ASD. Autism Res 2018, 11: 645-653. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Speech processing relies heavily on the integration of auditory and visual information, and it has been suggested that the ability to detect correspondence between auditory and visual signals helps to lay the foundation for successful language development. The goal of the present study was to explore whether children with ASD process audio-visual synchrony in ways comparable to their typically developing peers, and the relationship between preference for synchrony and language ability. Results showed that there are differences in attention to audiovisual synchrony between typically developing children and children with ASD. Preference for synchrony was related to the language abilities of children across groups.

Attempting to "Increase Intake from the Input": Attention and Word Learning in Children with Autism.

Previous work has demonstrated that social attention is related to early language abilities. We explored whether we can facilitate word learning among children with autism by directing attention to areas of the scene that have been demonstrated as relevant for successful word learning. We tracked eye movements to faces and objects while children watched videos of a woman teaching them new words. Test trials measured participants' recognition of these novel word-object pairings. Results indicate that for children with autism and typically developing children, pointing to the speaker's mouth while labeling a novel object impaired performance, likely because it distracted participants from the target object. In contrast, for children with autism, holding the object close to the speaker's mouth improved performance.

Infants' early visual attention and social engagement as developmental precursors to joint attention.

This study examined infants' early visual attention (at 1 month of age) and social engagement (4 months) as predictors of their later joint attention (12 and 18 months). The sample (n = 325), drawn from the Maternal Lifestyle Study, a longitudinal multicenter project conducted at 4 centers of the National Institute of Child Health and Human Development Neonatal Research Network, included high-risk (cocaine-exposed) and matched noncocaine-exposed infants. Hierarchical regressions revealed that infants' attention orienting at 1 month significantly predicted more frequent initiating joint attention at 12 (but not 18) months of age. Social engagement at 4 months predicted initiating joint attention at 18 months. Results provide the first empirical evidence for the role of visual attention and social engagement behaviors as developmental precursors for later joint attention outcome. (PsycINFO Database Record

Attention and word learning in autistic, language delayed and typically developing children.

Previous work has demonstrated that patterns of social attention hold predictive value for language development in typically developing infants. The goal of this research was to explore how patterns of attention in autistic, language delayed, and typically developing children relate to early word learning and language abilities. We tracked patterns of eye movements to faces and objects while children watched videos of a woman teaching them a series of new words. Subsequent test trials measured participants' recognition of these novel word-object pairings. Results indicated that greater attention to the speaker's mouth was related to higher scores on standardized measures of language development for autistic and typically developing children (but not for language delayed children). This effect was mediated by age for typically developing, but not autistic children. When effects of age were controlled for, attention to the mouth among language delayed participants was negatively correlated with standardized measures of language learning. Attention to the speaker's mouth and eyes while she was teaching the new words was also predictive of faster recognition of those words among autistic children. These results suggest that language delays among children with autism may be driven in part by aberrant social attention, and that the mechanisms underlying these delays may differ from those in language delayed participants without autism.

Increased focus on the mouth among infants in the first year of life: A longitudinal eye-tracking study.

The present study examines face-scanning behaviors of infants at 6, 9, and 12 months as they watched videos of a woman describing an object in front of her. The videos were created to vary information in the mouth (speaking vs. smiling) and the eyes (gazing into the camera vs. cueing the infant with head turn or gaze direction to an object being described). Infants tended to divide their attention between the eyes and the mouth, looking less at the eyes with age and more at the mouth than the eyes at 9 and 12 months. Attention to the mouth was greater on speaking trials than on smiling trials at all three ages, and this difference increased between 6 and 9 months. Despite consistent results within subjects, there was considerable variation between subjects. This raises the question of whether a developmental "norm" of face scanning in infancy ought to be pursued. Rather, these data add to emerging evidence suggesting that individual differences in face scanning might reliably predict aspects of later development.