Symposia at the 2017 ESCAP Congress (Geneva) on autism, organized by the Swiss National Centre of Competence in Research – Synapsy.
Understanding mechanisms of change in children with ASD who receive intervention
Chair: Marie Schaer, Co-Chair: Christine M. Freitag.
Autism spectrum disorders are a heterogeneous group of pervasive neurodevelopmental disorders that affects up to 1 in 68 children. ASD manifest with deficits in social communication, and the presence of repetitive behaviors or restricted interests, appearing before the age 3. To date, behavioral interventions have proven effective to get the most optimal long-term benefits, either with early intensive intervention for preschoolers or cognitive remediation for school-age children and adolescents with ASD. However, we still don’t understand well the neurodevelopmental mechanisms by which these interventions work. In this symposium, researchers will present different ways of measuring how much and by which mechanisms behavioral intervention might help affected children.
Original Synapsys Symposium abstract by Christine Freitag (Autism Research and Intervention Center of Excellence, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe-Universität, Deutschordenstr. 50, 60528 Frankfurt am Main, Germany) on The low intensive, complex, naturalistic developmental behavioural intervention A-FFIP: one year case-control, and two-year pre-post effects (ESCAP 2017 Congress in Geneva, Switzerland).
The Autism-specific Frankfurt early intervention program A-FFIP has been developed and manualized over approximately 8 years as a low intensive early intervention with 2 hrs / week 2:1 work of two therapists with one child, also involving parents and kindergarten teachers. It is based on current knowledge on early development of typically developing and children with Autism Spectrum Disorder, and implements naturalistic behavioural methods increasing the child’s motivation to learn, play, socially interact and communicate. Here, we present 1-year case-control data of N=40 toddlers and preschool age children with ASD (N=20 receiving A-FFIP, N=20 matched children receiving treatment as usual; TAU), and 2-year pre-post data on N=27 ASD children receiving A-FFIP, with a mean age of 55.5 (SD 12.2) months at start of intervention.
Children were diagnosed according to gold standard by ADI-R and ADOS. The following outcome measures were obtained: ADOS-severity score (blinded), Social Responsiveness Scale (SRS), Child Behaviour Checklist (CBCL), standardized developmental (Bayley-II) or intelligence (SON 2½-7) test (blinded), Vineland Adaptive Behavior Scales.
Case-control data showed a medium effect size of improvement of autism specific symptoms by the ADOS severity scores (ES=0.61 A-FFIP compared to TAU; p=0.071). Two-year pre-post effects showed a pre-post ES=0.67 (p=0.011), which is similar to the 2-year effects of the high-intensity Early Start Denver Model Intervention. Cognitive gains also were achieved, however, with a smaller effect size.
The low-intensity, complex, naturalistic behavioural intervention A-FIPP, which has been manualized (Teufel, Valerian, Wilker, Freitag: Autismus-spezifische Therapie im Vorschulalter. Berlin, Springer 2017) shows encouraging results, especially with regard to improvement of core autistic symptoms, which need to be studied by a larger scale randomized controlled trial.
Original Synapsys Symposium abstract by Holger Sperdin (Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva, Switzerland) et al. on Alteration in the neural processing of dynamic animated social interactions and naturalistic stimuli depicting biological motion in young children with ASD measured by high-density EEG (ESCAP 2017 Congress in Geneva, Switzerland).
Holger Franz Sperdin1, Reem Jan2, Ana Coito2, Tonia Rihs2, Martina Franchini1, Nada Kojovic1, Anna Custo2, Miralena I. Tomescu2, Serge Vulliémoz2, Gijs Plomp 3, Stéphan Eliez1, Christoph Michel 2, Marie Schaer1
1. Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva , Switzerland.
2. Functional Brain Mapping Laboratory, Department of Fundamental Neuroscience, University Medical School, Geneva, Switzerland.
3. Department of Psychology, University of Fribourg, Fribourg, Switzerland.
The social motivation hypothesis (Chevallier, Kohls et al. 2012) posits that the specialized brain functions implicated in social information processing are developing differently in individuals with autism leading to a reduced interest for socially relevant stimuli at an early age already. It is currently unknown how early in the development brain network alterations in response to social stimuli can be observed. Here, we aim to characterize the differences in the social brain network activations between very young children with ASD and TD controls when watching dynamic visual stimuli having social contingencies.
In experiment 1, we used EEG and high-resolution eye-tracking to study differences in the neural processing of dynamic cartoons containing human-like social interactions between young children with ASD and age-matched TD controls. In experiment 2, we used EEG to study alterations of functional connectivity between ASD and TD toddlers when watching naturalistic stimuli depicting biological motion. We expected impaired activation and altered connectivity in brain structures implicated in social information processing in the young children with ASD.
In experiment 1, we found alterations in activation in the toddlers with ASD within brain regions of the social brain such as the prefrontal and cingulate cortices, the premotor, the parietal, the temporal, the occipital and cerebellar regions compared to TD children. These differences were stronger in children with control-dissimilar gaze patterns. In experiment 2, we observed a different driving in the toddlers with ASD within specific brain regions of the social brain such as the frontal cortices, the superior temporal gyrus and the dorsal anterior cingulate cortex. We also observed dissimilar network connectivity patterns between the groups. Importantly, correlation analysis between summed outflow and severity scores revealed a more prominent down-drive of activity within several regions in the most affected ASD toddlers.
The cumulated findings indicate the presence of functional impairments in brain regions involved in social visual information processing at an early age in autism spectrum disorders. This suggests that network alterations of the social brain may be present at a young age, justifying further investigation on how early therapeutic interventions targeting social orienting may help to remediate social brain development.
Original Synapsys Symposium abstract by Nada Kojovic (Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland) on Using eye-tracking to measure social cognition in preschoolers with ASD, developmental trajectories, and changes following early intervention (ESCAP 2017 Congress in Geneva, Switzerland).
Nada Kojovic1, Martina Franchini1,2, Tonia A. Rihs3, Reem K. Jan1,3, Holger F. Sperdin1 & Marie Schaer1
1.Office Médico-Pédagogique, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland.
2. University of Geneva, Department of Psychology, Geneva, Switzerland.
3. Functional Brain Mapping Laboratory, Dept. of Fundamental Neuroscience, University Medical school, Geneva, Switzerland.
Eye-tracking is highly adapted when studying social cognition in autism, as it is non-invasive and requires passive image/video viewing. Numerous studies using this technique have highlighted the atypical visual exploration pattern in individuals with ASD (e.g. less focus at eyes and faces compared to typically developing (TD) individuals (reviewed in Klin et al. 2003). The atypical attention deployment in autism has been linked with behavioral social difficulties as well as with the outcome (reviewed in Falck-Ytter et al. 2013). For the sake of ecological validity eye-tracking studies are intensively focusing on visual exploration during viewing complex naturalistic social interactions.
Our aim was to develop a method defining age-appropriate dynamic “norms” of visual exploration of complex social scenes, based on a group of TD children, for quantitative comparison with children with ASD. At a second time, we intend using it to quantify change in visual exploration in children with ASD with respect to age and intervention and potentially highlight a common visual exploration pattern in children showing favorable evolution.
A 3-minute cartoon was displayed on a Tobii eye-tracker device for 37 ASD males (aged 3.95±1.25) and 28 TD males (aged 3.10±1.30). Inspired by the concept of a heatmap, for each frame of the video we created “normative” gaze pattern distribution by employing kernel density distribution estimation on the raw gaze data of TD individuals (Botev et al., 2009). For each patient we then calculated the “distance” of his/hers gaze coordinates form this “norm”. Thus we obtained one measure per frame of Proximity from the “norm”, which was then averaged for the duration of the video. Higher values indicate the visual exploration of the individual is being more similar to the one of TD subjects. The “proximity” was further correlated with different clinical behavioral data.
We found positive correlation between the proximity from the “norm” and direct measures of verbal & nonverbal cognition (R2 = 0.19; p =. 008), language understanding (R2 = 0.18; p =. 01), language expression (R2 = 0.21; p =. 007) and imitation skills (R2 = 0.15; p =. 02) in PEP-3. We have also observed positive correlation between this measure and indirect measure of communication (R2 = 0.24; p =. 004) and socialization skills (R2 = 0.27; p =. 001), as parents reported them (VABS-II). Finally, a tendency toward negative correlation between the proximity and the severity of autistic symptoms (ADOS-2) was observed (p =. 0507).
Our results suggest that our method can be used as a valid measure for quantifying the dynamic visual exploration of complex social scenes based on a group of TD children, providing an age-appropriate manner to measure deviances in social cognition development in age-matched children with ASD. We further intend to use this measure in a longitudinal design.
Original Synapsys Symposium abstract by Andrea Samson, Alexandra Zaharia, and David Sander (Swiss Center for Affective Sciences, University of Geneva, Switzerland) on Positive Emotions in Individuals with Autism Spectrum Disorder and Possible Avenues for Interventions (ESCAP 2017 Congress in Geneva, Switzerland).
Autism Spectrum Disorder (ASD) is characterized by severe deficits in social interaction and communication and increased restricted and repetitive behaviors. However, emotional disturbances and associated comorbidities are of high prevalence in this population and are one of the main reasons why parents of children with ASD reach out for help. This talk will give an overview on emotional difficulties in ASD with a particular focus on positive emotions. Several studies using a multi-method approach to study positive emotions including humor will be reviewed in this talk. The findings will be discussed in light of a new psycho-educative emotion regulation training that aims at increasing positive emotions and reducing problematic behaviors in individuals with ASD.