Fully robotic social environment for teaching and practicing affective interaction: Case of teaching emotion recognition skills to children with autism spectrum disorder, a pilot study.

21st century brought along a considerable decrease in social interactions, due to the newly emerged lifestyle around the world, which became more noticeable recently of the COVID-19 pandemic. On the other hand, children with autism spectrum disorder have further complications regarding their social interactions with other humans. In this paper, a fully Robotic Social Environment (RSE), designed to simulate the needed social environment for children, especially those with autism is described. An RSE can be used to simulate many social situations, such as affective interpersonal interactions, in which observational learning can take place. In order to investigate the effectiveness of the proposed RSE, it has been tested on a group of children with autism, who had difficulties in emotion recognition, which in turn, can influence social interaction. An A-B-A single case study was designed to show how RSE can help children with autism recognize four basic facial expressions, i.e., happiness, sadness, anger, and fear, through observing the social interactions of two robots speaking about these facial expressions. The results showed that the emotion recognition skills of the participating children were improved. Furthermore, the results showed that the children could maintain and generalize their emotion recognition skills after the intervention period. In conclusion, the study shows that the proposed RSE, along with other rehabilitation methods, can be effective in improving the emotion recognition skills of children with autism and preparing them to enter human social environments.

Associations between Symptom Severity of Autism Spectrum Disorder and Screen Time among Toddlers Aged 16 to 36 Months.

There is growing evidence that prevalence rates of autism spectrum disorder (ASD) are increasing. A number of factors appear to contribute to this increase, including excessive screen time. Screen time seems to be linked to the severity of the symptoms of ASD. Given this, the aim of the present cross-sectional study was to investigate the association between early screen time and ASD symptoms severity in the first 36 months of life. To this end, sixty-eight Iranian toddlers (mean age: 27.09 months; 22.1% females) with ASD were recruited. Parents completed the modified checklist for autism in toddlers (M-CHAT), the Repetitive Behavior Scale-Revised (RBS-R), and a lifestyle checklist. Next, parents rated children's daily exposure to content specifically designed (foreground media) and not specifically designed (background media) for children, along with their daily exposure to social interaction. Per day, toddlers spent 5.12 h (±3.77) with foreground media, 3.72 h (±3.57) with background media, and 2.89 h (±2.74) in interaction with other people (parents). To test the hypotheses, we performed a series of Pearson's correlations and multiple regression analyses. Toddlers' higher severity scores for ASD symptoms were associated with longer foreground (r = 0.234, p = 0.001) and longer background (r = 0.180, p = 0.012) media duration, and with shorter duration of interaction with others (r = 0.192, p = 0.009). Toddlers spending 1 h more in foreground screen time and background screen time have 0.38 and 0.29 more units in the ASD symptom severity scale, respectively, while toddlers spending 1 h more in social interactions have 0.42 fewer units in the ASD symptom severity scale. The screen time and interaction duration are related to ASD symptoms severity of toddlers. The cross-sectional study design precludes causal associations, although bi-directional relationships appear plausible.

Differentiating Post-Digital Nannying Autism Syndrome from Autism Spectrum Disorders in Young Children: A Comparative Cross-Sectional Study.

Excessive exposure of young children to digital devices has increased in recent years. Much research has shown that early excessive screentime is associated with autistic-like symptoms. This study aimed to differentiate children with Post-Digital Nannying Autism Syndrome (PDNAS) from children with autism spectrum disorders (ASD) and typically developing children (TDC), both behaviorally and cognitively. This study is comparative and cross-sectional and included three groups of children. The first group consisted of 15 young children with subthreshold autism symptoms. They had not received a formal diagnosis of ASD and had been exposed to digital devices for more than half of their waking time. The second group consisted of 15 young children with ASD, and the third group consisted of 15 young TDC. A lifestyle checklist, a modified checklist for autism in toddlers (M-CHAT), a behavioral flexibility rating scale-revised (BFRS-R), the Gilliam autism rating scale (GARS-2), and a behavior rating inventory of executive functioning-preschool version (BRIEF-P) were used to compare the three groups. The results showed that executive functions and behavioral flexibility were more impaired in children with ASD than in children with PDNAS and in TDC. Also, we found that there was no significant difference in the severity of autism symptoms between the children with ASD and the children with PDNAS. Early excessive exposure to digital devices may cause autism-like symptoms in children (PDNAS). Children with PDNAS are different from children with ASD in executive functions and behavioral flexibility. Further research is needed in this area.

Internet-based versus face-to-face intervention training for parents of young children with excessive screen-time and autism spectrum disorder-like symptoms: a comparative study.

Internet-based intervention approach is one novel strategy to train. However, only a few clinical trials have compared internet-based parent training intervention with an equal face-to-face intervention for children with autism spectrum disorder (ASD)-like symptoms. The primary aim of this study was to compare treatment outcomes of an internet-based intervention with a face-to-face intervention for young children with excessive screen-time and ASD-like symptoms. A total of 40 mother-young children with excessive screen-time and ASD-like symptoms dyads were assigned to the Internet-based (n = 20) and to the face-to-face intervention (n = 20). Parents in both groups received intervention that involves 7 sessions (one session per week). Primary outcome measures were the Gilliam autism rating scale - second edition (GARS-2), repetitive behavior scale- revised (RBS-R) and parenting stress index (PSI). The analysis yielded no significant between-group difference for any of the pre- to post-intervention measurements. At post-intervention both intervention conditions revealed significant symptoms changes compared to before the intervention. Also, the parental stress was significant related to the child's autism symptoms and repetitive behaviors severity. Internet-based parent training intervention for young children with excessive screen-time and ASD-like symptoms and their parents is equally beneficial to regular face-to-face parent training intervention. These findings support the potential for using telehealth to provide research-based parent training interventions to any family that has access to the Internet.

Executive functions predict restricted and repetitive behaviors in toddlers under 36 months old with autism spectrum disorder.

BACKGROUND: Executive functions (EFs) and restricted and repetitive behaviors (RRBs) have been studied mainly in older individuals with autism spectrum disorder (ASD), while little is known about the relationship between EFs and RRBs in toddlers. AIMS: The purpose of this study was to investigate the relationship between EFs and RRBs of toddlers with ASD symptoms. In addition, we tested whether EFs were predictive of RRBs in toddlers. METHODS: Cross-sectional data were collected from parents of forty-five toddlers under 36 months old. The modified checklist for autism in toddlers (M-CHAT), the Gilliam autism rating scale (GARS-2), the behavior rating inventory of executive functioning-preschool version (BRIEF-P), and the repetitive behavior scale- revised (RBS-R) administered to parents. RESULTS: We found significant associations between EFs and (1) stereotyped behaviors, (2) self-injurious behaviors, (3) ritualistic behaviors, (4) sameness behaviors, (5) restricted behaviors, (6) compulsive behaviors, and (7) repetitive behaviors total score. Increases in EFs differences predicted an increase in RRBs. CONCLUSIONS: Our results indicate a link between EFs and RRBs. Future research on RRBs in ASD may benefit from focusing on specific EFs rather than general categories.

Assessment of miR-181b-5p, miR-23a-3p, BCL-2, and IL-6 in Peripheral Blood Mononuclear Cells of Autistic Patients; Likelihood of Reliable Biomarkers.

Autism is a neurodevelopmental disorder that is recognized by stereotypic and repetitive behaviors after 2 years of old. Dysregulation of the immune system, especially inflammation which is mostly regulated by IL-6, imposes a deficit in CNS development. Along with this crucial biomarker, researchers have proposed BCL-2, micro RNA-23a-3p (miR-23a-3p), miR-181b-5p as other probable biomarkers involved in inflammation and apoptosis. The aim of the study was to evaluate the alteration in the expression of these biomarkers in a group of autism spectrum disorder (ASD) children. Peripheral blood mononuclear cells (PBMCs) were obtained from 37 autistic patients. After RNA extraction with precipitation method, the Syber green qReal-time Polymerase Chain Reaction (PCR) was performed in order to evaluate the possible alteration in the expression of IL-6, BCL-2, miR-181b-5p, and miR-23a-3p. The results were compared with healthy controls. IL-6 was significantly upregulated in ASD patients (p=0.003). On the other hand, miR-23a was upregulated and BCL-2 downregulated in ASD patients but the changes were not significant. In initial evaluations, expression changes of miR-181b-5p were not statistically significant. However, when Patients were divided into two groups of upregulated and downregulated, re-evaluation showed that both up- (p=0.005) and down-regulation (p=0.004) (i.e. changes regardless of the direction) of miR-181b were significant in autistic children. IL-6 and miR-181b-5p can have proper diagnostic values and are reliable biomarkers with high sensitivity and specificity. On the other hand, PBMC can be utilized for such studies and also evaluation of patients' condition instead of brain tissue as it is less accessible.

Bias Toward Drug-Related Stimuli Is Affected by Loading Working Memory in Abstinent Ex-Methamphetamine Users.

Background: There is a trade-off between drug-related impulsive process and cognitive reflective process among ex-drug abusers. The present study aimed to investigate the impulsive effects of methamphetamine-related stimuli on working memory (WM) performance by manipulating WM load in abstinent ex-methamphetamine users. Methods: Thirty abstinent ex-methamphetamine users and 30 nonaddict matched control participants were recruited in this study. We used a modified Sternberg task in which participants were instructed to memorize three different sets of methamphetamine-related and non-drug-related words (three, five, or seven words) while performing a secondary attention-demanding task as an interference. Results: Repeated-measures ANOVA revealed that reaction times of abstinent ex-methamphetamine users increased during low WM load (three words) compared to the control group (p = 0.01). No significant differences were observed during high WM loads (five or seven words) (both p's > 0.1). Besides, reaction times of the experimental group during trials with high interference (three, five, or seven words) were not significantly different compared to the control group (p > 0.2). Conclusion: These findings imply that increasing WM load may provide an efficient buffer against attentional capture by salient stimuli (i.e., methamphetamine-related words). This buffer might modify the effect of interference bias. Besides, presenting methamphetamine-related stimuli might facilitate the encoding phase due to bias toward task-relevant stimuli. This finding has an important implication, suggesting that performing concurrent demanding tasks may reduce the power of salient stimuli and thus improve the efficiency of emotional regulation strategies.

Measurement of serum hepatitis B surface antibody levels in Iranian autistic children and evaluation of immunological memory after booster dose injection in comparison with controls.

BACKGROUND: Responsiveness to hepatitis B vaccine among patients with autism spectrum disorders (ASD) has not been evaluated worldwide. We aimed to determine the anti-HBs antibody duration in autistic and healthy children few years after primary vaccination and evaluate their immunological memory against hepatitis B virus (HBV) vaccine with booster dose administration. METHODS: One hundred seven and 147 HBsAg-negative children from ASD and normal population were recruited, respectively. HBV seromarkers (HBc-Ab, HBsAg, and HBs-Ab) were assessed and subsequently, molecular tests were used on all the subjects. A booster dose of vaccine was injected for those who showed low levels (<10 mIU/mL) of anti-HBs and their antibody levels was measured 4 weeks later. RESULTS: The mean ages of ASD and control groups were 7.14 ± 2.42 and 8.68 ± 1.96, respectively. Seven (6.5%) of the ASD group were positive for anti-HBc and one child was positive for occult hepatitis B infection (HBsAg negative, HBV DNA positive). In ASD, 54 (50.4%) and 53 (49.6%) had adequate (>10 mIU/mL) and low anti-HBs levels, respectively. Among control group, 74 (50.4%) and 73 (49.6%) had sufficient and low antibody levels, respectively. After injection of a booster dose for all children with low antibody, 100% of ASD and 92% (59 of 64) of control pupils contained >10 mIU/mL of antibody, respectively. In both the groups, the HBs-Ab titer increased similarly in response to the booster injection (P < 0.05). CONCLUSION: Despite previous investigations regarding immune impairment in individuals with autism, the immune system of these individuals was able to manage the hepatitis B vaccine challenge.

Optogenetic Stimulation of the Anterior Cingulate Cortex Ameliorates Autistic-Like Behaviors in Rats Induced by Neonatal Isolation, Caudate Putamen as a Site for Alteration.

Epigenetic agents, such as neonatal isolation during neurodevelopmental period of life, can change various regions of the brain. It may further induce psychological disorders such as autistic-like phenomena. This study indicated the role of chronic increased anterior cingulate cortex (ACC) output on alteration of caudate putamen (CPu) as a main behavior regulator region of the brain in adult maternal deprived (MD) rats. For making an animal model, neonates were isolated from their mothers in postnatal days (PND 1-10, 3 h/day). Subsequently, they bilaterally received pLenti-CaMKIIa-hChR2 (H134R)-mCherry-WPRE virus in ACC area via stereotaxic surgery in PND50. After 22 days, these regions were exposed to blue laser (473 nm) for six consecutive days (15 min/day). Then, behavioral deficits were tested and were compared with control group in the following day. Animals were immediately killed and their brains were prepared for tissue processing. Results showed that neonatal isolation induces autistic-like behaviors and leads to overexpression of NMDAR1 and Nox2-gp91phox proteins and elevation of catalase activity in the CPu regions of the adult offspring compared with control group. Chronic optogenetic stimulation of ACC neurons containing (ChR2+) led to significant reduction in the appearance of stereotypical behavior and alien-phobia in MD rats. The amount of NMDAR1 and Nox2-gp91phox expression and the catalase activity in CPu were reduced after this treatment. Therefore, autistic-like behavior seems to be related with elevation of NMDAR1 and Nox2-gp91phox protein levels that enhance the effect of glutamatergic projection on CPu regions. Optogenetic treatment also could ameliorate behavioral deficits by modulating these protein densities.

Psychophysical Evidence for Impaired Magno, Parvo, and Konio-cellular Pathways in Dyslexic Children.

PURPOSE: Dyslexia is one of the most common learning disabilities affecting millions of people worldwide. Although exact causes of dyslexia are not well-known, a deficit in the magnocellular pathway may play a role. We examined possible deficiency of magnocellular, as compared to parvocellular and koniocellular pathway function by measuring luminance and color perception. METHODS: Visual stimuli consisted of a series of natural images, divided into layers of luminance, red-green and blue-yellow, which probed magnocellular, parvocellular, and koniocellular pathways, respectively. Thirteen children with dyslexia and 13 sex- and age- matched controls performed three psychophysical tasks. In the first task, subjects were instructed to match the contrast of luminance (magno) and red-green (parvo) images to that of the blue-yellow (konio) images. In the second task, subjects detected the isoluminant point of red-green images to probe parvocellular pathway. In the third task, temporal processing was assessed by measuring reaction time and percentage of correct responses in an identification task using four categories of images, activating all three pathways. RESULTS: The dyslexic group had significantly elevated luminance and color contrast thresholds and higher isoluminant point ratio in comparison to the control group. Furthermore, they had significantly less correct responses than the control group for the blue-yellow images. CONCLUSION: We may suggest that dyslexic subjects might suffer from both magnocellular and parvocellular deficits. Moreover, our results show partial impairment of the koniocellular pathway. Thus, dyslexia might be associated with deficits in all three visual pathways.

Attention training in rehabilitation of children with developmental stuttering.

BACKGROUND: Attention and executive function play an important role in fluent speaking. The aim of the present study is to evaluate effect of attention training in rehabilitation of stuttering. METHOD: In this random clinical trial 30 children with developmental stuttering participate in a random allocation sampling in case or control group. In case group, we trained patient with NEurocognitive Joyful Attentive Training Intervention (NEJATI) in 12 sessions. Riley Stuttering severity instrument-3 (SSI-3), Wisconsin Card Sorting Test (WCST), and Stroop Color Word Test (SCWT) are used for evaluation of executive function before and after intervention. Dependent T-Test was used for analysis. RESULTS: Comparing case group before and after intervention showed a significant enhancement in executive function and reduced stuttering severity. CONCLUSION: Attention training propose as a non lingual method of language and speech rehabilitation in developmental stuttering.

The polarity-dependent effects of the bilateral brain stimulation on working memory.

INTRODUCTION: Working memory plays a critical role in cognitive processes which are central to our daily life. Neuroimaging studies have shown that one of the most important areas corresponding to the working memory is the dorsolateral prefrontal cortex (DLFPC). This study was aimed to assess whether bilateral modulation of the DLPFC using a noninvasive brain stimulation, namely transcranial direct current stimulation (tDCS), modifies the working memory function in healthy adults. METHODS: In a randomized sham-controlled cross-over study, 60 subjects (30 Males) received sham and active tDCS in two subgroups (anode left/cathode right and anode right/cathode left) of the DLPFC. Subjects were presented working memory n-back task while the reaction time and accuracy were recorded. RESULTS: A repeated measures, mixed design ANOVA indicated a significant difference between the type of stimulation (sham vs. active) in anodal stimulation of the left DLPFC with cathodal stimulation of the right DLPFC [F(1,55)= 5.29, P=0.019], but not the inverse polarity worsened accuracy in the 2-back working memory task. There were also no statistically significant changes in speed of working memory [F(1,55)= 0.458,P=0.502] related to type or order of stimulation. DISCUSSION: The results would imply to a polarity dependence of bilateral tDCS of working memory. Left anodal/ right cathodal stimulation of DLPFC could impair working memory, while the reverser stimulation had no effect. Meaning that bilateral stimulation of DLFC would not be a useful procedure to improve working memory. Further studies are required to understand subtle effects of different tDCS stimulation/inhibition electrode positioning on the working memory.

Validity and reliability of a Persian translation of the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS).

Cognitive dysfunction is common in multiple sclerosis (MS) and validated batteries are limited in languages other than English. We aimed to translate, cross-culturally adapt, validate, and assess reliability of Minimal Assessment of Cognitive Function in MS (MACFIMS) in Persian. The MACFIMS is a well-constructed battery in the MS literature. The battery was adapted to Persian in accordance with available guidelines. A total of 158 MS patients and 90 controls underwent neuropsychological assessment. For reliability assessment the battery was re-administered in a subset of 41 patients after a short interval using alternate forms to mitigate practice effects (approximately 10 days). Patients performed significantly worse than controls in all cognitive tests, supporting discriminant validity of our adapted battery. Approximately half of patients (46.2%) showed cognitive impairment as defined by the impairment in two or more tests. The Symbol Digit Modalities Test was the most robust test by ROC analysis. All tests showed acceptable to good level of reliability. This is the first validation of gold-standard cognitive testing in Persian. The Persian MACFIMS shows nearly the same psychometrics as its English counterpart.

Validation of Addenbrooke's cognitive examination (ACE) in a Persian-speaking population.

Use of reliable screening and diagnostic tests for assessment of cognitive abilities in neurological patients is rapidly increasing in clinical practice. This is due to the increase in the prevalence of dementias and the raised awareness of cognitive impairment in neurological disorders. Two well-known bedside screening tests for dementias among the English-speaking population are the Mini Mental State Examination (MMSE) and Addenbrooke's Cognitive Examination (ACE). However, such tests have not been developed for the Persian-speaking population, which is estimated at 120 million worldwide. In this study we developed the Persian ACE and MMSE, adopted from the English version. We also assessed the sensitivity and specificity of these tests in the identification of Alzheimer's disease (AD) and mild cognitive impairment (MCI). We found that the Persian ACE at a cutoff point of 84, has a sensitivity of 93% and a specificity of 91% in discriminating MCI from a normal population; at 78, the test has a sensitivity of 73% and a specificity of 93% in differentiating MCI from AD, and at a similar cutoff point has a sensitivity of 100% and specificity of 96% in discriminating AD from a normal population. We conclude that the Persian ACE is a valuable tool in clinical practice in the Persian-speaking population.

The effectiveness of group positive parenting program on parental stress of mothers of children with attention-deficit/hyperactivity disorder.

BACKGROUND: The present study examined the influence of group positive parenting program on parental stress of mothers of children with attention-deficient/hyperactivity disorder. Mothers of 13 children aged four to ten years, who met attention-deficient/hyperactivity disorder diagnosis by assessment of a child psychiatrist and clinical psychologist were selected from two child and adolescent psychiatric clinics of Tehran. To control the drug effects, researchers chose children who took methylphenidate (Ritalin) since six months before. METHODS: The group programs consisted of a six-weekly session of two hours duration, plus two telephone educational sessions, each one lasting 15 minutes. Group was run by an experienced clinician who followed a specific training manual to ensure a standard format. These sessions continued with eight participants, because five of 13 mothers did not attend the classes. RESULTS: The results indicated that group positive parenting program caused mothers to experience lower stress. A two-month follow-up showed the stable efficiency of the program. CONCLUSION: This study revealed that the competency feeling and couples' harmony--as intervening variables--about nurturing the child were improved.

An epidemiological survey of psychiatric disorders in Iran.

BACKGROUND: The nation-wide epidemiological survey of psychiatric disorders in term of lifetime prevalence is not adequately known in Iran. The prevalence of lifetime psychiatric disorders was estimated among the population of aged 18 and over on gender, age group, educational level, occupational status, marital status, and residential area. METHODS: The subjects were 25,180 individuals selected through a clustered random sampling method. The psychiatric disorders were diagnosed on the bases of Diagnostic and Statistical Manual of Mental Disorders-IV criteria. It is the first study in which the structured psychiatric interview administered to a representative sample of the Iranian population age 18 and over by the 250 trained clinical psychologist interviewers. The data was entered through EPI-Info software twice in an attempt to prevent any errors and SPSS-11 statistical software was also used for analyses. The odds ratios and their confidence intervals estimated by using logistic regression. RESULTS AND DISCUSSION: The prevalence of psychiatric disorders was 10.81%. It was more common among females than males (14.34% vs. 7.34%, P < 0.001). The prevalence of anxiety and mood disorders were 8.35% and 4.29% respectively. The prevalence of psychotic disorders was 0.89%; neuro-cognitive disorders, 2.78% and dissociative disorders, 0.77%. Among mood disorders, major depressive disorder (2.98%) and among anxiety disorders, phobic disorder (2.05%) had the higher prevalence. The prevalence of psychiatric disorders among divorced and separated 22.31%; residents of urban areas 11.77%; illiterates 13.80%; householders 15.48%; unemployed 12.33% that were more than other groups. CONCLUSION: The mental health pattern in Iran is similar to the western countries, but it seems that the prevalence of psychiatric disorders in Iran may be lower than these countries. It is estimated that at least about 7 millions of Iranian population suffer from one or more of the psychiatric disorders. It shows the importance of the role of the psychiatric disorders in providing preventive and management programs in Iran.