Face-to-face live eye-tracking in toddlers with autism: Feasibility and impact of familiarity and face covering.

Studies utilizing eye-tracking methods have potential to promptly capture real-world dynamics of one of the core areas of vulnerability in autism spectrum disorders (ASD), selective social attention. So far, no studies have successfully reported utilizing the method to examine social attention in toddlers with neurodevelopmental vulnerabilities in real world and challenging settings such as an interactive face-to-face. This study examined the feasibility and validity of live eye-tracking method in response to live interaction occurring in several contexts in toddlers with and without ASD. Forty-seven toddlers with ASD, with atypical development (ATYP), or typically developing (TD), underwent a 30-s live eye-tracking procedure during a face-to-face interaction with a masked stranger using child-directed-speech (16 ASD, 14 ATYP, 17 TD; Mage = 23.44 months, SD = 6.02). Out of this group of toddlers, 29 (10 ASD, 8 ATYP, 11 TD, Mage = 21.97 months, SD = 5.76) underwent the same procedure with one of their maskless parent. Task completion rate, calibration accuracy, and affective response (feasibility measures) as well as attention to the task and the social partner (validity measures) were examined. Task completion rate and calibration accuracy were excellent. Despite the challenging context of face-to-face interaction, the toddlers exhibited a neutral affect, and high attention to the task and the speaker. As anticipated, toddlers with ASD looked less at the social partner compared with control groups. However, attention was comparable between the Stranger and Parent conditions, indicating that the effect was consistent regardless of presence of face covering or the familiarity of the interactive partner. The study demonstrates the high feasibility and validity of a live eye-tracking task involving face-to-face interaction in neurodiverse toddlers with social vulnerabilities. The effect of diminished attention to social partners in toddlers with autism is robust and present when interacting with an unfamiliar person and parent. The results suggest that a brief live eye-tracking method constitutes a promising ecologically valid candidate biomarker and potential intervention outcome in autism.

Hypoconnectivity between anterior insula and amygdala associates with future vulnerabilities in social development in a neurodiverse sample of neonates.

Altered resting state functional connectivity (FC) involving the anterior insula (aINS), a key node in the salience network, has been reported consistently in autism. Here we examined, for the first time, FC between the aINS and the whole brain in a sample of full-term, postmenstrual age (PMA) matched neonates (mean 44.0 weeks, SD = 1.5) who due to family history have high likelihood (HL) for developing autism (n = 12) and in controls (n = 41) without family history of autism (low likelihood, LL). Behaviors associated with autism were evaluated between 12 and 18 months (M = 17.3 months, SD = 2.5) in a subsample (25/53) of participants using the First Year Inventory (FYI). Compared to LL controls, HL neonates showed hypoconnectivity between left aINS and left amygdala. Lower connectivity between the two nodes was associated with higher FYI risk scores in the social domain (r(25) = -0.561, p = .003) and this association remained robust when maternal mental health factors were considered. Considering that a subsample of LL participants (n = 14/41) underwent brain imaging during the fetal period at PMA 31 and 34 weeks, in an exploratory analysis, we evaluated prospectively development of the LaINS-Lamy connectivity and found that the two areas strongly coactivate throughout the third trimester of pregnancy. The study identifies left lateralized anterior insula-amygdala connectivity as a potential target of further investigation into neural circuitry that enhances likelihood of future onset of social behaviors associated with autism during neonatal and potentially prenatal periods.

Elevated symptoms of executive dysfunction predict lower adaptive functioning in 3-year-olds with autism spectrum disorder.

Executive functioning (EF) deficits co-occur frequently with autism spectrum disorder (ASD) and have a long-term detrimental impact on quality of life of children and their families. Timely identification of risk for EF vulnerabilities may hasten access to early intervention and alleviate their long-term consequences. This study examines (1) if EF deficits are elevated in toddlers with ASD compared to nonautistic siblings of children with ASD, typically developing (TYP) toddlers, and toddlers with atypical developmental presentation; and (2) if EF deficits have a detrimental effect on adaptive functioning in ASD. Participants were recruited between September 2014 and October 2019 and included 73 toddlers with ASD, 33 nonautistic siblings of children with ASD, 35 toddlers with atypical development, and 28 TYP toddlers matched on chronological age (M = 39.01 months, SD = 3.11). EF deficits were measured using the BRIEF-P; adaptive skills were measured using the VABS-II. Whenever appropriate, analyses were controlled for MSEL verbal and nonverbal developmental quotient, ADOS-2 autism severity scores, and sex. Analyses revealed that toddlers with ASD exhibited elevated BRIEF-P scores across all domains compared to each of the three comparison groups. Higher BRIEF-P scores were associated with lower adaptive social, communication, and daily living skills while controlling for symptom severity, verbal and nonverbal functioning, and sex. In conclusion, marked vulnerabilities in EF are already present in 3-year-old toddlers with ASD and are predictive of the level of adaptive functioning in ASD. EF vulnerabilities in toddlers should be targeted for intervention to improve long-term outcomes in ASD. LAY SUMMARY: Many children with autism experience vulnerabilities in executive functioning (EF), which may include challenges with inhibition, working memory, cognitive flexibility, and planning. The study shows that these vulnerabilities can already be detected at age three and that their presence is linked with lower social, communication, and daily living skills. Screening children with ASD for EF challenges and helping those who have difficulties may improve their long-term outcomes.