Predicting Social Competence in Autistic and Non-Autistic Children: Effects of Prosody and the Amount of Speech Input.

PURPOSE: Autistic individuals often face challenges perceiving and expressing emotions, potentially stemming from differences in speech prosody. Here we explore how autism diagnoses between groups, and measures of social competence within groups may be related to, first, children's speech characteristics (both prosodic features and amount of spontaneous speech), and second, to these two factors in mothers' speech to their children. METHODS: Autistic (n = 21) and non-autistic (n = 18) children, aged 7-12 years, participated in a Lego-building task with their mothers, while conversational speech was recorded. Mean F0, pitch range, pitch variability, and amount of spontaneous speech were calculated for each child and their mother. RESULTS: The results indicated no differences in speech characteristics across autistic and non-autistic children, or across their mothers, suggesting that conversational context may have large effects on whether differences between autistic and non-autistic populations are found. However, variability in social competence within the group of non-autistic children (but not within autistic children) was predictive of children's mean F0, pitch range and pitch variability. The amount of spontaneous speech produced by mothers (but not their prosody) predicted their autistic children's social competence, which may suggest a heightened impact of scaffolding for mothers of autistic children. CONCLUSION: Together, results suggest complex interactions between context, social competence, and adaptive parenting strategies in driving prosodic differences in children's speech.

Negative first impression judgements of autistic children by non-autistic adults.

Introduction: Although autism inclusion and acceptance has increased in recent years, autistic people continue to face stigmatization, exclusion, and victimization. Based on brief 10-second videos, non-autistic adults rate autistic adults less favourably than they rate non-autistic adults in terms of traits and behavioural intentions. In the current study, we extended this paradigm to investigate the first impressions of autistic and non-autistic children by non-autistic adult raters and examined the relationship between the rater's own characteristics and bias against autistic children. Method: Segments of video recorded interviews from 15 autistic and 15 non-autistic children were shown to 346 undergraduate students in audio with video, audio only, video only, transcript, or still image conditions. Participants rated each child on a series of traits and behavioural intentions toward the child, and then completed a series of questionnaires measuring their own social competence, autistic traits, quantity and quality of past experiences with autistic people, and explicit autism stigma. Results: Overall, autistic children were rated more negatively than non-autistic children, particularly in conditions containing audio. Raters with higher social competence and explicit autism stigma rated autistic children more negatively, whereas raters with more autistic traits and more positive past experiences with autistic people rated autistic children more positively. Discussion: These rapid negative judgments may contribute to the social exclusion experienced by autistic children. The findings indicate that certain personal characteristics may be related to more stigmatised views of autism and decreased willingness to interact with the autistic person. The implications of the findings are discussed in relation to the social inclusion and well-being of autistic people.

Examining the Relations Between Social Competence, Autistic Traits, Anxiety and Depression in Autistic and Non-Autistic Children.

The current study examined whether social competence and autistic traits are related to anxiety and depression in autistic and non-autistic children. Parents of 340 children aged 6 to 12 years old, including 186 autistic and 154 non-autistic children completed the Autism Spectrum Quotient (AQ) to assess their child's autistic traits, the Multidimensional Social Competence Scale (MSCS) to assess their child's social competence, and the Behaviour Assessment Scale for Children 2 (BASC-2) to assess their child's internalizing symptoms of depression and anxiety, and children were administered the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) to assess their intellectual abilities. Hierarchical multiple regression analyses were conducted to investigate the relations between social competence, autistic traits, anxiety, and depression. Social competence was related to anxiety and depression symptoms in autistic children, but only depression symptoms in non-autistic children, above and beyond the effects of autistic traits, IQ and age. Autistic children were also reported to experience more severe anxiety and depression symptoms, and more autistic traits were related to higher levels of anxiety and depression in both groups. These findings suggest that social competence and internalizing symptoms are intricately connected in autistic children and need to be jointly considered in both assessment and intervention. The social implications are discussed with an emphasis on acceptance of diverse social styles as a viable avenue to reduce children's internalizing symptoms.

Brief Report: Alexithymia Trait Severity, Not Autistic Trait Severity, Relates to Caregiver Reactions to Autistic Children's Negative Emotions.

Alexithymia impacts an individual's ability to recognize and understand emotions and frequently co-occurs with autism. This study investigated the relationship between children's alexithymia, autistic traits, and caregiver reactions to their child's negative emotions. Caregivers of 54 autistic and 51 non-autistic children between the ages of 7 and 12 years rated their child's alexithymia and autistic trait severity and their reactions to their child's negative emotions. Caregivers of autistic children reported greater supportive reactions and fewer restrictive/controlling reactions to their child's negative emotions when their child had more alexithymia traits. This study extends previous research by demonstrating that caregivers of autistic children with co-occurring alexithymia traits represent a specific subgroup of caregivers that respond more positively to their child's negative emotions.

Transdiagnostic Patterns of Sensory Processing in Autism and ADHD.

Sensory processing abilities are highly variable within and across people diagnosed with autism and attention-deficit/hyperactivity disorder (ADHD). This study examined the transdiagnostic nature of sensory processing abilities, and their association with features of autism and ADHD, in a large sample of autistic people (n = 495) and people with ADHD (n = 461). Five similar data-driven sensory phenotypes characterized sensory processing abilities, and showed similar patterns of association with features of autism and ADHD, across both diagnostic groups. These results demonstrate the transdiagnostic nature of sensory processing abilities, while contributing to a growing body of literature that suggests the autism and ADHD diagnostic labels have poor explanatory power.

Effects of an Educational Presentation About Autism on High School Students' Perceptions of Autistic Adults.

Background: Social communication difficulties are a clinical characteristic of autism, but social interactions are reciprocal in nature and autistic individuals' social abilities may not be the only factor influencing their social success. Nonautistic individuals' social perceptions and behavior also contribute to autistic individuals' social difficulties. Previous research has identified that nonautistic individuals' perception of autistic individuals is influenced by autism knowledge and the quantity and quality of exposure to autistic people. The current research aimed to examine how autistic adults are perceived by high school students, assess whether quality and quantity of autism contact predicts these perceptions, and explore whether these perceptions are malleable. Methods: One hundred fifty-one senior high school students (15-19 years old) completed the First Impression Scale after viewing video recordings of 20 autistic and 20 nonautistic adults in social situations, either before or after viewing a 50-minute educational presentation detailing the everyday experiences of autistic people and participating in a question-and-answer session. We assessed students' prior experiences with autistic people using the Quantity and Quality of Contact Scale and their own self-perceived social competence using the Multidimensional Social Competence Scale. Results: Consistent with previous studies, students rated autistic adults less favorably than nonautistic adults. However, the educational presentation produced modest but significant improvements on these ratings, with students who viewed the presentation rating autistic adults as more attractive and likable and reporting greater social interest in them compared to those who had not yet viewed the presentation. Furthermore, consistent with a double empathy framework, exploratory analyses indicated that self-reports of greater social competence among students was associated with greater bias against autistic adults, whereas reports of higher quality interactions with autistic people were associated with less bias. Conclusion: Previous research has demonstrated that nonautistic adults evaluate autistic people less favorably and report lower social interest in them relative to nonautistic controls. In this study, we extend these findings to adolescents but find these biases are somewhat malleable, with education about autism exerting some modest benefits. Changing nonautistic attitudes about autistic differences may provide an avenue for improving interactions for autistic individuals without putting the onus on autistic individuals to change or mask their behavior and identity.

Why is this an important issue?: Nonautistic people often have negative views or biases about autistic differences. These biases contribute to the "Double Empathy Problem," where the attitudes, misunderstandings, and behaviors of nonautistic people can add to the social challenges faced by autistic people. However, we do not know how and why these negative biases develop, and more research is needed to understand when they appear, what factors contribute to them, and whether they can be changed. What was the purpose of this study?: We wanted to look at whether nonautistic teenagers at high school share the same biases toward autistic people that have previously been shown in adults. We then wanted to see if we could improve nonautistic teenagers' views of autistic people by teaching them about what being autistic means. We were also curious whether high school students who have spent more time with autistic people would view autistic people more positively. Finally, we were interested in whether nonautistic people's views of autistic people depend on how they viewed their own social skills. What did the researchers do?: High school students (15­19 years old) viewed an educational presentation describing the everyday experiences of autistic people and took part in a question-and-answer session about autism. They also made judgments about 20 autistic and 20 nonautistic adults in videos, such as whether they thought the person in the video was likable or awkward, and if they would hang out with them or not. Half of the students made these judgments before viewing the presentation and the other half did this after viewing the presentation. This allowed us to see whether the educational presentation could change high school students' attitudes about autistic people. The high school students also filled out questionnaires about their experiences with autistic people and their own social skills, so we could assess whether these things were associated with attitudes about autistic people. What were the results of this study?: Students viewing the educational presentation first rated autistic adults as more attractive, likable, and said they would be more interested in hanging out with them compared with the students who had not yet viewed the presentation. Students who reported higher quality experiences with autistic people in the past judged autistic people in the videos more positively, but those who thought they personally had strong social skills judged the autistic adults more negatively. What do these findings add to what was already known?: We previously knew that nonautistic adults have negative attitudes toward autistic people. In this study, we show that nonautistic high school students also show negative attitudes toward autistic people. More importantly, we also find that these views can be improved somewhat by a presentation about autism. We also show that nonautistic adolescents who say they are the most socially skilled rate autistic people the most negatively. This may be because they are the most likely to value "typical" or "normative" social skills and be more judgmental about those who socialize in a different way. What are the potential weaknesses in the study?: Students only rated autistic people from videos. We are not sure if the results would have been the same if the students were judging autistic people in real life or directly interacting with them. We also do not know if the judgments would be different if we had used different autistic adults or a more diverse sample. For instance, none of the autistic adults in the videos had an intellectual disability. How will these findings help autistic adults now or in the future?: These findings suggest that educating about autistic lives and high-quality contact with autistic people may be tools for improving the attitudes of nonautistic adolescents. This stage in life may be particularly important for improving the acceptance and inclusion of autistic people, as late adolescence is when many autistic people are beginning the transition to adulthood and their well-being may be increasingly affected by their experiences with nonautistic people.

Family Experiences of Decreased Sound Tolerance in ASD.

Decreased sound tolerance (DST) is the most common sensory difficulty experienced by autistic individuals. Parents of 88 autistic children and young adults between the ages of 3 and 30 described coping strategies and physical and emotional responses used to deal with distressing sounds, and their impact on daily activities. Loud, sudden, and high-pitched sounds were most commonly endorsed as distressing, most often causing autistic children and young adults to cover their ears or yell, while producing stress, irritation, fear, and anxiety. Parents reported warning their child, providing breaks, or avoiding noisy settings as the most used coping strategies. Overall, findings indicate that DST leads to fewer opportunities for autistic children and young adults to participate at home, at school, and in the community. Further, results suggest hyperacusis, misophonia, and phonophobia, subtypes of DST, are present in autistic children and young adults.

Exploring sensory phenotypes in autism spectrum disorder.

BACKGROUND: Atypical reactions to the sensory environment are often reported in autistic individuals, with a high degree of variability across the sensory modalities. These sensory differences have been shown to promote challenging behaviours and distress in autistic individuals and are predictive of other functions including motor, social, and cognitive abilities. Preliminary research suggests that specific sensory differences may cluster together within individuals creating discrete sensory phenotypes. However, the manner in which these sensory differences cluster, and whether the resulting phenotypes are associated with specific cognitive and social challenges is unclear. METHODS: Short sensory profile data from 599 autistic children and adults between the ages of 1 and 21 years were subjected to a K-means cluster analysis. Analysis of variances compared age, adaptive behaviour, and traits associated with autism, attention-deficit and hyperactivity disorder, and obsessive and compulsive disorder across the resultant clusters. RESULTS: A five-cluster model was found to minimize error variance and produce five sensory phenotypes: (1) sensory adaptive, (2) generalized sensory differences, (3) taste and smell sensitivity, (4) under-responsive and sensation seeking, and (5) movement difficulties with low energy. Age, adaptive behaviour, and traits associated with autism, attention-deficit and hyperactivity disorder, and obsessive and compulsive disorder were found to differ significantly across the five phenotypes. LIMITATIONS: The results were based on parent-report measures of sensory processing, adaptive behaviour, traits associated with autism, attention-deficit and hyperactivity disorder, and obsessive and compulsive disorder, which may limit the generalizability of the findings. Further, not all measures are standardized, or psychometrically validated with an autism population. Autistic individuals with an intellectual disability were underrepresented in this sample. Further, as these data were obtained from established records from a large provincial database, not all measures were completed for all individuals. CONCLUSIONS: These findings suggest that sensory difficulties in autistic individuals can be clustered into sensory phenotypes, and that these phenotypes are associated with behavioural differences. Given the large degree of heterogeneity in sensory difficulties seen in the autistic population, these sensory phenotypes represent an effective way to parse that heterogeneity and create phenotypes that may aid in the development of effective treatments and interventions for sensory difficulties.

Attention capture by trains and faces in children with and without autism spectrum disorder.

This study examined involuntary capture of attention, overt attention, and stimulus valence and arousal ratings, all factors that can contribute to potential attentional biases to face and train objects in children with and without autism spectrum disorder (ASD). In the visual domain, faces are particularly captivating, and are thought to have a 'special status' in the attentional system. Research suggests that similar attentional biases may exist for other objects of expertise (e.g. birds for bird experts), providing support for the role of exposure in attention prioritization. Autistic individuals often have circumscribed interests around certain classes of objects, such as trains, that are related to vehicles and mechanical systems. This research aimed to determine whether this propensity in autistic individuals leads to stronger attention capture by trains, and perhaps weaker attention capture by faces, than what would be expected in non-autistic children. In Experiment 1, autistic children (6-14 years old) and age- and IQ-matched non-autistic children performed a visual search task where they manually indicated whether a target butterfly appeared amongst an array of face, train, and neutral distractors while their eye-movements were tracked. Autistic children were no less susceptible to attention capture by faces than non-autistic children. Overall, for both groups, trains captured attention more strongly than face stimuli and, trains had a larger effect on overt attention to the target stimuli, relative to face distractors. In Experiment 2, a new group of children (autistic and non-autistic) rated train stimuli as more interesting and exciting than the face stimuli, with no differences between groups. These results suggest that: (1) other objects (trains) can capture attention in a similar manner as faces, in both autistic and non-autistic children (2) attention capture is driven partly by voluntary attentional processes related to personal interest or affective responses to the stimuli.

Alexithymia is related to poor social competence in autistic and nonautistic children.

Alexithymia is characterized by difficulties identifying and describing one's own emotions and the emotions of others. These challenges with understanding emotions in people with alexithymia may give rise to difficulties with social interactions. Given that alexithymia frequently co-occurs with autism spectrum disorder (ASD), and that both populations have difficulties with social interactions, it is of interest to determine whether alexithymia can help to parse some of the heterogeneity in social competence in autistic and nonautistic individuals. The caregivers of 241 children (6-14 years old), including 120 autistic, and 121 nonautistic, rated their child's social competence using the Multidimensional Social Competence Scale (MSCS), autism traits using the Autism Spectrum Quotient (AQ), and alexithymia traits using the Children's Alexithymia Measure (CAM). Regression analyses indicated that age, IQ, sex, AQ, and CAM scores accounted for 40.2% of the variance in autistic children's, and 68.2% of the variance in nonautistic children's, parent-reported social competence. Importantly, after controlling for age, IQ, sex, and AQ scores, CAM scores alone accounted for an additional 16.2% of the variance in autistic children's, and 17.4% of the variance in nonautistic children's social competence. These results indicate that higher alexithymia traits predict lower levels of social competence, suggesting that increased difficulty in identifying and describing one's own emotions and the emotions of others is associated with poorer social competence. Furthermore, CAM scores were found to partially mediate the relationship between autistic traits and social competence, suggesting that comorbid alexithymia traits may be partially responsible for poor social competence in individuals with high autistic traits. This research contributes to the understanding of the factors associated with the development of social competence and highlights alexithymia as a potential target for identification and intervention to improve social competence. LAY SUMMARY: Alexithymia is a condition where people find it hard to think and talk about their (and others') feelings. About 50% of autistic people have alexithymia. This might be why they have social and emotional difficulties. Parents answered questions about alexithymia and social difficulties their children have. Children with more alexithymia problems had poorer social skills. Thus, alexithymia may be related to social problems faced by autistic and nonautistic children.

Exploring the Relationship between Prosodic Control and Social Competence in Children with and without Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a developmental disorder characterized by persistent deficits in social communication and interaction. Speech is an important form of social communication. Prosody (e.g. vocal pitch, rhythm, etc.), one aspect of the speech signal, is crucial for ensuring information about the emotionality, excitability, and intent of the speaker, is accurately expressed. The objective of this study was to gain a better understanding of how auditory information is used to regulate speech prosody in autistic and non-autistic children, while exploring the relationship between the prosodic control of speech and social competence. Eighty autistic (M = 8.48 years, SD = 2.55) and non-autistic (M = 7.36 years, SD = 2.51) participants produced vocalizations while exposed to unaltered and frequency altered auditory feedback. The parent-report Multidimensional Social Competence Scale was used to assess social competence, while the Autism-Spectrum Quotient and the Autism Spectrum Rating Scales were used to assess autism characteristics. Results indicate that vocal response magnitudes and vocal variability were similar across autistic and non-autistic children. However, autistic children produced significantly faster responses to the auditory feedback manipulation. Hierarchical multiple regressions indicated that these faster responses were significantly associated with poorer parent-rated social competence and higher autism characteristics. These findings suggest that prosodic speech production differences are present in at least a subgroup of autistic children. These results represent a key step in understanding how atypicalities in the mechanisms supporting speech production may manifest in social-communication deficits, as well as broader social competence, and vice versa. Autism Res 2020, 13: 1880-1892. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: In this study, autistic and non-autistic children produced vowel sounds while listening to themselves through headphones. When the children heard their vocal pitch shifted upward or downward, they compensated by shifting their vocal pitch in the opposite direction. Interestingly, autistic children were faster to correct for the perceived vowel sound changes than their typically developing peers. Faster responses in the children with ASD were linked to poorer ratings of their social abilities by their parent. These results suggest that autistic and non-autistic children show differences in how quickly they control their speech, and these differences may be related to the social challenges experienced by autistic children.

Affective Prosody Perception and the Relation to Social Competence in Autistic and Typically Developing Children.

Individuals diagnosed with autism spectrum disorder (ASD) have difficulty perceiving and expressing emotions. Since prosodic changes in speech (i.e. changes in intonation, stress, rhythm, etc.) are crucial for extracting information about the emotional state of a speaker, an inability to perceive and interpret these prosodic changes may be related to impairments in social communication. This study used non-verbal emotional voice-clips to examine the ability of autistic and typically-developing children (7-13 years old) to extract affect from changes in prosody. This research also explored whether difficulty extracting affective intent from changes in prosody may be related to social competence. Autistic (n = 26) and typically-developing (n = 26) children accurately matched emotional voice-clips to emotion words, suggesting autistic children can accurately extract the affective meaning conveyed by changes in prosody. Autistic children were less accurate at matching the voice-clips to emotional faces, suggesting that autistic children may struggle to make use of prosodic information in a social context. Across both autistic and typically-developing children, prosody-face matching accuracy was found to predict overall social competence, as well as social inferencing abilities, suggesting that the inability to utilize affective information derived from a speaker's voice may interfere with effective social communication.

The Association Between Self-Reported Camouflaging of Autistic Traits and Social Competence in Nonautistic Young Adults.

Background: Autistic individuals often experience difficulties in social settings. Although autistic individuals may not intuitively know the "typical" way to behave in social settings, many autistic individuals have a desire to fit in so they develop techniques to "camouflage" their autistic traits. Although camouflaging may help individuals to navigate social environments, camouflaging has also been shown to produce negative psychological outcomes. This study aims to explore whether this "camouflaging" strategy is associated with poor social competence, an aspect of the autism diagnosis. Methods: In this study, 247 nonautistic adults completed the Multidimensional Social Competence Scale (MSCS) to assess their social competence, and the Camouflaging Autistic Traits Questionnaire (CAT-Q) to assess the extent to which they used strategies to compensate or mask behaviors characteristic of autism in social settings. Results: We found that over and above IQ, gender, and executive functioning scores, social competence (MSCS) scores reliably predicted the extent to which nonautistic individuals camouflaged, accounting for 25% of the variance in CAT-Q scores. Importantly, even when autistic traits were controlled for, social competence was still able to account for additional variance in CAT-Q scores. Conclusion: These results suggest that low social competency in nonautistic adults predicts camouflaging as a strategy in social situations. Given these camouflaging behaviors are being performed in an attempt to comply with an environmental demand to behave in a particular manner, these results also highlight the importance of conceptualizing the social challenges that autistic and nonautistic individuals face in a bidirectional manner, where the onus is not solely on the individual to comply with social conventions but also on society to accommodate diverse behavioral traits. Lay summary: Why was this study done?: Some autistic individuals try to hide their autistic traits to "fit in" with others, referred to as "camouflaging." Nonautistic adults also report camouflaging, but it is unclear whether this camouflaging is related to social difficulties that are not specific to autism. No research has been conducted to examine the relationship between social competence and camouflaging in nonautistic adults.What was the purpose of this study?: To further understand the factors that are related to camouflaging behaviors. More specifically, whether social abilities, and/or autism characteristics, are related to whether nonautistic adults camouflage.What did the researchers do?: We had 257 nonautistic adults complete various questionnaires, including ones that asked them about their camouflaging behaviors and social abilities. We examined the relationships between the scores from these questionnaires and the influence of other factors such as gender, intelligence, and executive functioning.What were the results of the study?: We found that both social abilities and autistic traits were related to camouflaging behaviors. Indeed, nonautistic adults who had poor social skills, and more autistic traits, engaged in more camouflaging. Social skills were associated with camouflaging even after we considered factors such as gender, intelligence, and executive functioning.What do these findings add to what was already known?: These findings help us understand camouflaging by demonstrating that it may be a common response to social difficulties in nonautistic, as well as autistic, adults. These results also indicate that camouflaging is related to low social competency, not just autism characteristics.What are the potential weaknesses in the study?: The participants in our study completed questionnaires through which they were required to pick from set answers, rather than describe their experiences. We may be missing important qualitative differences in the way nonautistic adults camouflage compared with autistic adults.How will these findings help autistic adults now or in the future?: By comparing what is shared and what is unique with nonautistic people who share traits with autistic people, a more precise definition and study of camouflaging behavior are possible. Rather than see camouflaging as a phenomenon that occurs exclusively in autistic people because of their disability, it may be that both autistic and nonautistic people use camouflaging when they perceive themselves to lack the necessary social competencies that are expected within their social contexts. Because both autistic traits and social competency are related to camouflaging behavior, we can begin to think about how to tease apart which characteristics are more likely to evoke camouflaging in autistic individuals and how this may be similar or different in nonautistic individuals. This knowledge will ultimately contribute to the development of more tailored approaches to prevent and/or reduce the negative impact of camouflaging behaviors for autistic adults.

Sensorimotor control of vocal production in early childhood.

Children maintain fluent speech despite dramatic changes to their articulators during development. Auditory feedback aids in the acquisition and maintenance of the sensorimotor mechanisms that underlie vocal motor control. MacDonald, Johnson, Forsythe, Plante, and Munhall (2012) reported that toddlers' speech motor control systems may "suppress" the influence of auditory feedback, since exposure to altered auditory feedback regarding their formant frequencies did not lead to modifications of their speech. This finding is not parsimonious with most theories of motor control. Here, we exposed toddlers to perturbations to the pitch of their auditory feedback as they vocalized. Toddlers compensated for the manipulations, producing significantly different responses to upward and downward perturbations. These data represent the first empirical demonstration that toddlers use auditory feedback for vocal motor control. Furthermore, our findings suggest toddlers are more sensitive to changes to the postural properties of their auditory feedback, such as fundamental frequency, relative to the phonemic properties, such as formant frequencies. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Systematic review of factors that may influence the outcomes and generalizability of parent-mediated interventions for young children with autism spectrum disorder.

Parent mediated interventions have the potential to positively influence the interactions and developmental outcomes of children with autism spectrum disorder (ASD). However, a range of factors relating to children, parents and caregivers, and study design may impact on outcomes and thus the generalizability of these interventions to the broader community. The objective of this review was to examine factors that may influence the feasibility, appropriateness, effectiveness, and generalizability of parent mediated interventions for children with ASD. We conducted a systematic review, yielding 41 articles. There was substantial variability in the intervention type, intensity, and study quality. Notably, 46 different inclusion/exclusion criteria were reported across studies including factors relating to children's development, access to other services, comorbidities, parental factors, and access to the intervention. Fifteen articles included examination of 45 different factors potentially associated with, or influencing, intervention outcomes including child (e.g., language skills, ASD severity, cognition) and parent (e.g., adherence and fidelity, education) factors. Although there is clear evidence for an increasingly sophisticated (e.g., systematic phased research for some interventions) and diverse (e.g., studies in geographical diverse contexts including low-resource communities) approach to research examining parent mediated interventions, there remains a need for improved study quality and measurement consistency in research, including a detailed examination of factors that may predict, moderate, and mediate intervention effectiveness for children and their parents. Autism Res 2019, 12: 1304-1321. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Parent mediated interventions-in which parents adapt their own behavior or deliver interventions to help their children learn-appear to be effective for some children with autism spectrum disorder. In this review, we identified a range of child, parent, and study design factors that may influence intervention outcomes and ultimately the uptake of these approaches in the community. We suggest that research in this area could be further improved by ensuring that studies include diverse groups of children and parents, and by using study designs that help to establish not only if interventions work, but for whom they work best and why.

The Role of Auditory Feedback at Vocalization Onset and Mid-Utterance.

Auditory feedback plays an important role in monitoring and correcting for errors during speech production. Previous research suggests that at vocalization onset, auditory feedback is compared to a sensory prediction generated by the motor system to ensure the desired fundamental frequency (F0) is produced. After vocalization onset, auditory feedback is compared to the most recently perceived F0 in order to stabilize the vocalization. This study aimed to further investigate whether after vocalization onset, auditory feedback is used strictly to stabilize speakers' F0, or if it is also influenced by the sensory prediction generated by the motor system. Event-related potentials (ERP) were recorded while participants produced vocalizations and heard the F0 of their auditory feedback perturbed suddenly mid-utterance by half a semitone. For half of the vocalizations, at vocalization onset, participants' F0 was also raised by half a semitone. Thus, half of the perturbations occurred while participants heard their unaltered auditory feedback, and the other half occurred in auditory feedback that had also been perturbed 50 cents at vocalization onset. If after vocalization onset auditory feedback is strictly used to stabilize speakers' F0, then similarly sized vocal and ERP responses would be expected across all trials, regardless of whether the perturbation occurred while listening to altered or unaltered auditory feedback. Results indicate that the perturbations to the participants' unaltered auditory feedback resulted in larger vocal and N1 and P2 ERP responses than perturbations to their altered auditory feedback. These results suggest that after vocalization onset auditory feedback is not strictly used to stabilize speakers' F0, but is also used to ensure the desired F0 is produced.

Detecting our own vocal errors: An event-related study of the thresholds for perceiving and compensating for vocal pitch errors.

Previous studies suggest that a perception-action dissociation exists for the cortical processing of vocal pitch, because speakers compensate for small vocal errors without awareness. In this event-related potential (ERP) study, participants vocalized while hearing their productions either altered or unaltered in pitch, and reported whether their auditory feedback was altered. Pitch alterations as small as 10 cents resulted in compensatory vocal responses, while participants reported hearing perturbations that were 15 cents and larger. Similarly, P1 ERP responses were elicited by perturbations 15 cents and larger, while N1 responses followed a linear trend with increasing perturbation magnitudes, and P2 responses were elicited by perturbations 30 cents and larger. Although their thresholds differed, both motor and perceptual responses were elicited by small frequency altered feedback (FAF) perturbations. Previous reports of a perception-action dissociation may reflect differences in the magnitude of vocal error required to elicit a motor response, and for an individual to report a pitch change, rather than to detect a pitch change (as reflected by ERP responses).

Attentional demands modulate sensorimotor learning induced by persistent exposure to changes in auditory feedback.

Hearing one's own voice is important for regulating ongoing speech and for mapping speech sounds onto articulator movements. However, it is currently unknown whether attention mediates changes in the relationship between motor commands and their acoustic output, which are necessary as growth and aging inevitably cause changes to the vocal tract. In this study, participants produced vocalizations while they heard their vocal pitch persistently shifted downward one semitone in both single- and dual-task conditions. During the single-task condition, participants vocalized while passively viewing a visual stream. During the dual-task condition, participants vocalized while also monitoring a visual stream for target letters, forcing participants to divide their attention. Participants' vocal pitch was measured across each vocalization, to index the extent to which their ongoing vocalization was modified as a result of the deviant auditory feedback. Smaller compensatory responses were recorded during the dual-task condition, suggesting that divided attention interfered with the use of auditory feedback for the regulation of ongoing vocalizations. Participants' vocal pitch was also measured at the beginning of each vocalization, before auditory feedback was available, to assess the extent to which the deviant auditory feedback was used to modify subsequent speech motor commands. Smaller changes in vocal pitch at vocalization onset were recorded during the dual-task condition, suggesting that divided attention diminished sensorimotor learning. Together, the results of this study suggest that attention is required for the speech motor control system to make optimal use of auditory feedback for the regulation and planning of speech motor commands.