Conversational correlates of rapid social judgments of children and adolescents with and without ASD.

Autism spectrum disorder (ASD) is characterized by deficits in social communication, and even children with ASD with preserved language are often perceived as socially awkward. We ask if linguistic patterns are associated with social perceptions of speakers. Twenty-one adolescents with ASD participated in conversations with an adult; each conversation was then rated for the social dimensions of likability, outgoingness, social skilfulness, responsiveness, and fluency. Conversations were analysed for responses to questions, pauses, and acoustic variables. Wide intonation ranges and more pauses within children's own conversational turn were predictors of more positive social ratings while failure to respond to one's conversational partner, faster syllable rate, and smaller quantity of speech were negative predictors of social perceptions.

Emerging Impact of Malnutrition on Surgical Patients: Literature Review and Potential Implications for Cystectomy in Bladder Cancer.

PURPOSE: Malnutrition is emerging as a significant factor in patient outcomes. A contemporary review of malnutrition has not been performed for the urologist. We review the available literature and current standards of care for malnutrition screening, assessment and intervention, focusing on patients with bladder cancer treated with cystectomy. MATERIALS AND METHODS: Our multidisciplinary team searched PubMed® for available literature on malnutrition, focusing on definition and significance, importance to urologists, screening, assessment, diagnosis, immunological and economic impacts, and interventions. RESULTS: The prevalence of malnutrition in hospitalized patients is estimated to range from 15% to 60%, reaching upward of 71% in those with cancer. Malnutrition has been shown to increase inflammatory markers, further intensifying catabolism and weight loss. Bladder cancer is catabolic and patients undergoing cystectomy have increased resting energy expenditure postoperatively. Data are emerging on the impact of malnutrition in the cystectomy population. Recent studies have identified poor nutritional status based on low albumin or sarcopenia (loss of muscle) as having an adverse impact on length of hospitalization, complications and survival. The current standard of care malnutrition assessment tool, the 2012 consensus statement of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition, has not been evaluated in the urological literature. Perioperative immunonutrition in patients undergoing colorectal surgery has been associated with significant decreases in postoperative complications, and recent pilot work has identified the potential for immunonutrition to positively impact the cystectomy population. CONCLUSIONS: Malnutrition has a significant impact on surgical patients, including those with bladder cancer. There are emerging data in the urological literature regarding how best to identify and improve the nutritional status of patients undergoing cystectomy. Additional research is needed to identify malnutrition in these patients and interventions to improve surgical outcomes.

First-Person Perspectives of Gender-Affirming Voice Feminization Training: A Mixed Methods Approach.

OBJECTIVES: Despite evidence for the validity of using client-led outcome measures in gender-affirming voice training (GAVT), the existing body of research on voice feminization relies heavily on acoustic-perceptual measures without additional qualitative exploration of client experience. Additionally, the authors are not aware of any existing studies prompting client input on the voice feminization methods they find most helpful in achieving their voice goals. The current study focuses on crucial client perceptions of GAVT for voice feminization and identifies the methods clients find most helpful. METHODS: Using a mixed-methods approach, we gathered numeric and qualitative survey data from 21 individuals who engaged in GAVT supporting voice feminization. We conducted follow-up interviews with five survey participants to gather additional qualitative data on client experiences and perceptions of GAVT. RESULTS: Quantitative and qualitative data reveal that clients are satisfied with GAVT supporting voice feminization, perceive their clinicians as being culturally inclusive, and identify oral/forward resonance work as one of the most helpful voice training methods. Interestingly, however, frequency of work on oral/forward resonance during training did not predict voice satisfaction post-training. CONCLUSIONS: Clients identified oral/forward resonance as one of the most helpful methods of voice feminization and found their GAVT experiences to be supportive of their voice goals. These findings emphasize the importance and value of client-led outcome measures when investigating effective approaches to GAVT.

Analysis of Noun Phrase Ambiguity in Narratives Reveals Differences in Referential Establishment But Not Cohesion for Older Autistic Children.

PURPOSE: Stories told by autistic narrators often contain relatively frequent use of ambiguous references. However, it remains unclear whether this ambiguity is driven by ambiguous character establishment (e.g., "Once upon a time, she/the girl…") and/or ambiguous cohesion (e.g., "Two girls lived in a castle. She/The girl…"). In this study, we directly compared rates of each type of ambiguity within and between narratives told by autistic and non-autistic children, to determine which type of ambiguity is relatively more common in narratives told by autistic children. METHOD: Thirty-three 10- to 17-year-old autistic participants (n = 17) and non-autistic peers (n = 16), who were not statistically different in age, standardized language scores, and IQ scores (p > .8 for all), watched two short animated videos alone and then described the videos' events to two listeners who were openly unfamiliar with the videos. We transcribed video recordings of narratives and coded all referential noun phrases (NPs) as either clear or ambiguous. We further categorized ambiguous NPs as either ineffective introduction or ineffective cohesion. RESULTS: Autistic children produced significantly higher rates of ambiguous establishment than non-autistic peers, whereas between-group comparisons' rates of ambiguous cohesion were not statistically significant. CONCLUSIONS: Older children on the autism spectrum show differences in the way they introduce characters, selecting NP types that are only appropriate when their listener is already familiar with the referent. In contrast, once they have introduced characters, they show cohesive skills that are comparable to those of non-autistic peers. Findings support theories arguing that autistic children show differences in their application of social pragmatic principles (listener/context-specific pragmatic rules), whereas their use of linguistic pragmatics (context-independent rules) is similar to that of non-autistic peers.

Like, it's important: The frequency and use of the discourse marker like in older autistic children.

Background & Aims: Discourse markers, such as well or like, serve a variety of functions to support conversational reciprocity: filling pauses, aiding word-finding, and modulating turn-taking by holding the conversational floor. Previous research shows that autistic individuals use discourse markers less frequently than non-autistic (NonAu) peers; however, the discourse marker like has not been included in that research, despite its ubiquitous use by NonAu individuals, and despite the fact that like serves important pragmatic functions that are not encoded by any other discourse marker. Specifically, like signals to the listener that the content of upcoming speech is 1) Important/new; 2) Loose/approximate; 3) Reformulative; or 4) Quotative. The current study addresses this gap in the literature by comparing the frequency of discourse marker like use between older autistic and non-autistic children as well as exploring patterns of usage between the four like functions. Methods: Twenty-one 10-to-17-year-old children on the autism spectrum and 20 NonAu peers-statistically matched on age, sex, IQ and language scores-engaged in a semi-structured interview with a researcher. Uses of discourse-marker like were identified from written transcripts of interviews and each use was categorized into one of the four functions. Results: There were no significant differences in like frequencies between groups, nor were there differences in relative proportions of functions used by each group. Conclusions: Research consistently indicates that autistic individuals use discourse markers significantly less often than their NonAu counterparts, but the findings from our study suggest that this pattern does not persist to all such markers. This group of older autistic children use like as often as their peers and use it to signify similar information about upcoming speech to their listener.

Comparing Frequency of Listener Responses Between Adolescents with and Without ASD During Conversation.

In conversation, the listener plays an active role in conversation success, specifically by providing listener feedback which signals comprehension and interest. Previous work has shown that frequency of feedback positively correlates with conversation success. Because individuals with ASD are known to struggle with various conversational skills, e.g., turn-taking and commenting, this study examines their use of listener feedback by comparing the frequency of feedback produced by 20 adolescents with ASD and 23 neurotypical (NT) adolescents. We coded verbal and nonverbal listener feedback during the time when participants were listening in a semi-structured interview with a research assistant. Results show that ASD participants produced significantly fewer instances of listener feedback than NT adolescents, which likely contributes to difficulties with social interactions.

Toward a cumulative science of vocal markers of autism: A cross-linguistic meta-analysis-based investigation of acoustic markers in American and Danish autistic children.

Acoustic atypicalities in speech production are argued to be potential markers of clinical features in autism spectrum disorder (ASD). A recent meta-analysis highlighted shortcomings in the field, in particular small sample sizes and study heterogeneity. We showcase a cumulative (i.e., explicitly building on previous studies both conceptually and statistically) yet self-correcting (i.e., critically assessing the impact of cumulative statistical techniques) approach to prosody in ASD to overcome these issues. We relied on the recommendations contained in the meta-analysis to build and analyze a cross-linguistic corpus of multiple speech productions in 77 autistic and 72 neurotypical children and adolescents (>1000 recordings in Danish and US English). We used meta-analytically informed and skeptical priors, with informed priors leading to more generalizable inference. We replicated findings of a minimal cross-linguistically reliable distinctive acoustic profile for ASD (higher pitch and longer pauses) with moderate effect sizes. We identified novel reliable differences between the two groups for normalized amplitude quotient, maxima dispersion quotient, and creakiness. However, the differences were small, and there is likely no one acoustic profile characterizing all autistic individuals. We identified reliable relations of acoustic features with individual differences (age, gender), and clinical features (speech rate and ADOS sub-scores). Besides cumulatively building our understanding of acoustic atypicalities in ASD, the study shows how to use systematic reviews and meta-analyses to guide the design and analysis of follow-up studies. We indicate future directions: larger and more diverse cross-linguistic datasets, focus on heterogeneity, self-critical cumulative approaches, and open science. LAY SUMMARY: Autistic individuals are reported to speak in distinctive ways. Distinctive vocal production can affect social interactions and social development and could represent a noninvasive way to support the assessment of autism spectrum disorder (ASD). We systematically checked whether acoustic atypicalities highlighted in previous articles could be actually found across multiple recordings and two languages. We find a minimal acoustic profile of ASD: higher pitch, longer pauses, increased hoarseness and creakiness of the voice. However, there is much individual variability (by age, sex, language, and clinical characteristics). This suggests that the search for one common "autistic voice" might be naive and more fine-grained approaches are needed.

Reliability of Multifrequency Bioelectrical Impedance Analysis to Quantify Body Composition in Patients After Musculoskeletal Trauma.

Background: Changes in body composition, especially loss of lean mass, commonly occur in the orthopedic trauma population due to physical inactivity and inadequate nutrition. The purpose of this study was to assess inter-rater and intra-rater reliability of a portable bioelectrical impedance analysis (BIA) device to measure body composition in an orthopedic trauma population after operative fracture fixation. BIA uses a weak electric current to measure impedance (resistance) in the body and uses this to calculate the components of body composition using extensively studied formulas. Methods: Twenty subjects were enrolled, up to 72 hours after operative fixation of musculoskeletal injuries and underwent body composition measurements by two independent raters. One measurement was obtained by each rater at the time of enrollment and again between 1-4 hours after the initial measurement. Reliability was assessed using intraclass correlation coefficients (ICC) and minimum detectable change (MDC) values were calculated from these results. Results: Inter-rater reliability was excellent with ICC values for body fat mass (BFM), lean body mass (LBM), skeletal muscle mass (SMM), dry lean mass (DLM), and percent body fat (PBF) of 0.993, 0.984, 0.984, 0.979, and 0.986 respectively. Intra-rater reliability was also high for BFM, LBM, SMM, DLM, and PBF, at 0.994, 0.989, 0.990, 0.983, 0.987 (rater 1) and 0.994, 0.988, 0.989, 0.985, 0.989 (rater 2). MDC values were calculated to be 4.05 kg for BFM, 4.10 kg for LBM, 2.45 kg for SMM, 1.21 kg for DLM, and 4.83% for PBF. Conclusion: Portable BIA devices are a versatile and attractive option that can reliably be used to assess body composition and changes in lean body mass in the orthopedic trauma population for both research and clinical endeavors. Level of Evidence: III.

Vocal markers of autism: Assessing the generalizability of machine learning models.

Machine learning (ML) approaches show increasing promise in their ability to identify vocal markers of autism. Nonetheless, it is unclear to what extent such markers generalize to new speech samples collected, for example, using a different speech task or in a different language. In this paper, we systematically assess the generalizability of ML findings across a variety of contexts. We train promising published ML models of vocal markers of autism on novel cross-linguistic datasets following a rigorous pipeline to minimize overfitting, including cross-validated training and ensemble models. We test the generalizability of the models by testing them on (i) different participants from the same study, performing the same task; (ii) the same participants, performing a different (but similar) task; (iii) a different study with participants speaking a different language, performing the same type of task. While model performance is similar to previously published findings when trained and tested on data from the same study (out-of-sample performance), there is considerable variance between studies. Crucially, the models do not generalize well to different, though similar, tasks and not at all to new languages. The ML pipeline is openly shared. Generalizability of ML models of vocal markers of autism is an issue. We outline three recommendations for strategies researchers could take to be more explicit about generalizability and improve it in future studies. LAY SUMMARY: Machine learning approaches promise to be able to identify autism from voice only. These models underestimate how diverse the contexts in which we speak are, how diverse the languages used are and how diverse autistic voices are. Machine learning approaches need to be more careful in defining their limits and generalizability.

Structural and Contextual Cues in Third-Person Pronoun Interpretation by Children with Autism Spectrum Disorder and Their Neurotypical Peers.

This study investigates the use of structural and discourse contextual cues in the interpretation of third-person pronouns by children and adolescents with autism and their neurotypical peers. Results show that referent-biasing contextual information influences pronominal interpretation and modulates looking patterns in both groups compared to a context-neutral condition. These results go against the predictions of Weak Central Coherence and the notion that pragmatics in general is impaired in ASD, since the ASD group was able to use details in discourse context to influence the pronominal interpretation process. However, although discourse context influenced looking patterns in both groups, the groups nevertheless diverged in the nature of these patterns, suggesting that behavioral differences may emerge in more complicated discourse tasks.

Autism-specific parenting self-efficacy: An examination of the role of parent-reported intervention involvement, satisfaction with intervention-related training, and caregiver burden.

LAY ABSTRACT: What is already known about the topic?Parents of children with autism experience enormous challenges managing the complex needs of caring for their children. This includes coordinating multiple and complex therapies and acting as partners in treatment. Parenting self-efficacy is the confidence a person has in their ability to manage the tasks that are part of raising a child. People who have more confidence, or greater parenting self-efficacy, often feel less stressed and are more able to manage the demands of family life. This is particularly important for parents with children who have autism spectrum disorder, since they experience more parenting pressures. Although a lot is known about parenting self-efficacy in parents of neurotypical children, we do not know enough about how to help parents of children with autism spectrum disorder develop greater parenting self-efficacy.What this paper adds?This study shows that parents gain a greater sense of parenting self-efficacy when they feel more involved in their child's therapy and are more satisfied with the training they receive as part of these therapies. We also find that feeling pressure related to being a caregiver of a child with autism spectrum disorder can undermine autism-specific parenting self-efficacy. However, parents' sense of confidence was not limited by the severity of their child's symptoms.Implications for practice, research, or policyThe results suggest that there is an opportunity to help parents develop a greater sense of confidence in their ability to manage the complexities of raising a child with autism spectrum disorder by helping them feel more involved in treatment and by creating intervention-related training experiences that are more satisfying. Providers might also help by taking time to address the challenges and pressures that parents are experiencing, and helping them find ways to deal with these challenges. We suggest that there needs to be more research exploring how providers can best design interventions that support autism-specific parenting self-efficacy as a way of improving parental and child well-being.

Raising awareness of Medicare member rights among seniors and caregivers in California.

Many Medicare recipients do not understand their health care rights. Lumetra, formerly California's Medicare quality improvement organization, developed a multifaceted outreach program to increase beneficiary awareness of its services and of the right to file quality-of-care complaints and discharge appeals. Layered outreach activities to Medicare members and their caregivers in 2 targeted counties consisted of paid media, direct mailings, community outreach, and online marketing. Calls to Lumetra's helpline and visits to its Web site--measures of beneficiary awareness of case review services--increased by 106% and 1214%, respectively, in the targeted counties during the 4-month outreach period. Only small increases occurred in nontargeted counties. Increases in quality-of-care complaints and discharge appeal rates were detected during a longer follow-up period.

Slipped lips: onset asynchrony detection of auditory-visual language in autism.

BACKGROUND: It has frequently been suggested that individuals with autism spectrum disorder (ASD) have deficits in auditory-visual (AV) sensory integration. Studies of language integration have mostly used non-word syllables presented in congruent and incongruent AV combinations and demonstrated reduced influence of visual speech in individuals with ASD. The aim of our study was to test whether adolescents with high-functioning autism are able to integrate AV information of meaningful, phrase-length language in a task of onset asynchrony detection. METHODS: Participants were 25 adolescents with ASD and 25 typically developing (TD) controls. The stimuli were video clips of complete phrases using simple, commonly occurring words. The clips were digitally manipulated to have the video precede the corresponding audio by 0, 4, 6, 8, 10, 12, or 14 video frames, a range of 0-500ms. Participants were shown the video clips in random order and asked to indicate whether each clip was in-synch or not. RESULTS: There were no differences between adolescents with ASD and their TD peers in accuracy of onset asynchrony detection at any slip rate. CONCLUSION: These data indicate that adolescents with ASD are able to integrate auditory and visual components in a task of onset asynchrony detection using natural, phrase-length language stimuli. We propose that the meaningful nature of the language stimuli in combination with presentation in a non-distracting environment allowed adolescents with autism spectrum disorder to demonstrate preserved accuracy for bi-modal AV integration.

Perceptions of self and other: Social judgments and gaze patterns to videos of adolescents with and without autism spectrum disorder.

Neurotypical adults often form negative first impressions of individuals with autism spectrum disorder and are less interested in engaging with them socially. In contrast, individuals with autism spectrum disorder actively seek out the company of others who share their diagnosis. It is not clear, however, whether individuals with autism spectrum disorder form more positive first impressions of autistic peers when diagnosis is not explicitly shared. We asked adolescents with and without autism spectrum disorder to watch brief video clips of adolescents with and without autism spectrum disorder and answer questions about their impressions of the individuals in the videos. Questions were related to participants' perceptions of the social skills of the individuals in the video, as well as their own willingness to interact with that person. We also measured gaze patterns to the faces, eyes, and mouths of adolescents in the video stimuli. Both participant groups spent less time gazing at videos of autistic adolescents. Regardless of diagnostic group, all participants provided more negative judgments of autistic than neurotypical adolescents in the videos. These data indicate that, without being explicitly informed of a shared diagnosis, adolescents with autism spectrum disorder form negative first impressions of autistic adolescents that are similar to, or lower than, those formed by neurotypical peers.

Cross-Modal Coordination of Face-Directed Gaze and Emotional Speech Production in School-Aged Children and Adolescents with ASD.

Autism spectrum disorder involves persistent difficulties in social communication. Although these difficulties affect both verbal and nonverbal communication, there are no quantitative behavioral studies to date investigating the cross-modal coordination of verbal and nonverbal communication in autism. The objective of the present study was to characterize the dynamic relation between speech production and facial expression in children with autism and to establish how face-directed gaze modulates this cross-modal coordination. In a dynamic mimicry task, experiment participants watched and repeated neutral and emotional spoken sentences with accompanying facial expressions. Analysis of audio and motion capture data quantified cross-modal coordination between simultaneous speech production and facial expression. Whereas neurotypical children produced emotional sentences with strong cross-modal coordination and produced neutral sentences with weak cross-modal coordination, autistic children produced similar levels of cross-modal coordination for both neutral and emotional sentences. An eyetracking analysis revealed that cross-modal coordination of speech production and facial expression was greater when the neurotypical child spent more time looking at the face, but weaker when the autistic child spent more time looking at the face. In sum, social communication difficulties in autism spectrum disorder may involve deficits in cross-modal coordination. This finding may inform how autistic individuals are perceived in their daily conversations.

Motion-Capture Patterns of Voluntarily Mimicked Dynamic Facial Expressions in Children and Adolescents With and Without ASD.

Research shows that neurotypical individuals struggle to interpret the emotional facial expressions of people with Autism Spectrum Disorder (ASD). The current study uses motion-capture to objectively quantify differences between the movement patterns of emotional facial expressions of individuals with and without ASD. Participants volitionally mimicked emotional expressions while wearing facial markers. Recorded marker movement was grouped by expression valence and intensity. We used Growth Curve Analysis to test whether movement patterns were predictable by expression type and participant group. Results show significant interactions between expression type and group, and little effect of emotion valence on ASD expressions. Together, results support perceptions that expressions of individuals with ASD are different from-and more ambiguous than-those of neurotypical individuals'.

A Computational Study of Expressive Facial Dynamics in Children with Autism.

Several studies have established that facial expressions of children with autism are often perceived as atypical, awkward or less engaging by typical adult observers. Despite this clear deficit in the quality of facial expression production, very little is understood about its underlying mechanisms and characteristics. This paper takes a computational approach to studying details of facial expressions of children with high functioning autism (HFA). The objective is to uncover those characteristics of facial expressions, notably distinct from those in typically developing children, and which are otherwise difficult to detect by visual inspection. We use motion capture data obtained from subjects with HFA and typically developing subjects while they produced various facial expressions. This data is analyzed to investigate how the overall and local facial dynamics of children with HFA differ from their typically developing peers. Our major observations include reduced complexity in the dynamic facial behavior of the HFA group arising primarily from the eye region.

I Think We're Alone Now: Solitary Social Behaviors in Adolescents with Autism Spectrum Disorder.

Research into emotional responsiveness in Autism Spectrum Disorder (ASD) has yielded mixed findings. Some studies report uniform, flat and emotionless expressions in ASD; others describe highly variable expressions that are as or even more intense than those of typically developing (TD) individuals. Variability in findings is likely due to differences in study design: some studies have examined posed (i.e., not spontaneous expressions) and others have examined spontaneous expressions in social contexts, during which individuals with ASD-by nature of the disorder-are likely to behave differently than their TD peers. To determine whether (and how) spontaneous facial expressions and other emotional responses are different from TD individuals, we video-recorded the spontaneous responses of children and adolescents with and without ASD (between the ages of 10 and 17 years) as they watched emotionally evocative videos in a non-social context. Researchers coded facial expressions for intensity, and noted the presence of laughter and other responsive vocalizations. Adolescents with ASD displayed more intense, frequent and varied spontaneous facial expressions than their TD peers. They also produced significantly more emotional vocalizations, including laughter. Individuals with ASD may display their emotions more frequently and more intensely than TD individuals when they are unencumbered by social pressure. Differences in the interpretation of the social setting and/or understanding of emotional display rules may also contribute to differences in emotional behaviors between groups.

Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments.

Individuals with autism spectrum disorder (ASD), including those who otherwise require less support, face severe difficulties in everyday social interactions. Research in this area has primarily focused on identifying the cognitive and neurological differences that contribute to these social impairments, but social interaction by definition involves more than one person and social difficulties may arise not just from people with ASD themselves, but also from the perceptions, judgments, and social decisions made by those around them. Here, across three studies, we find that first impressions of individuals with ASD made from thin slices of real-world social behavior by typically-developing observers are not only far less favorable across a range of trait judgments compared to controls, but also are associated with reduced intentions to pursue social interaction. These patterns are remarkably robust, occur within seconds, do not change with increased exposure, and persist across both child and adult age groups. However, these biases disappear when impressions are based on conversational content lacking audio-visual cues, suggesting that style, not substance, drives negative impressions of ASD. Collectively, these findings advocate for a broader perspective of social difficulties in ASD that considers both the individual's impairments and the biases of potential social partners.

Judgments of social awkwardness from brief exposure to children with and without high-functioning autism.

We form first impressions of many traits based on very short interactions. This study examines whether typical adults judge children with high-functioning autism to be more socially awkward than their typically developing peers based on very brief exposure to still images, audio-visual, video-only, or audio-only information. We used video and audio recordings of children with and without high-functioning autism captured during a story-retelling task. Typically developing adults were presented with 1 s and 3 s clips of these children, as well as still images, and asked to judge whether the person in the clip was socially awkward. Our findings show that participants who are naïve to diagnostic differences between the children in the clips judged children with high-functioning autism to be socially awkward at a significantly higher rate than their typically developing peers. These results remain consistent for exposures as short as 1 s to visual and/or auditory information, as well as for still images. These data suggest that typical adults use subtle nonverbal and non-linguistic cues produced by children with high-functioning autism to form rapid judgments of social awkwardness with the potential for significant repercussions in social interactions.