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Attention-deficit/hyperactivity disorder (ADHD) symptoms affect 40–60% of autistic children and have been linked to differences in adaptive behavior. It is unclear whether adaptive behavior in autistic youth is directly impacted by co-occurring ADHD symptoms or by another associated feature of both autism and ADHD, such as increased irritability. The current study examined relationships between irritability, ADHD symptoms, and adaptive behavior in 3- to 7-year-old autistic children. Results suggest that, after adjusting for co-occurring ADHD symptoms, higher levels of irritability are associated with differences in social adaptive behavior specifically. Understanding relationships between irritability, ADHD, and adaptive behavior in autistic children is critical because measures of adaptive behavior, such as the Vineland Scales of Adaptive Functioning, are often used as a proxy for global functioning, as well as for developing intervention plans and measuring outcomes as primary endpoints in clinical trials. [ABSTRACT FROM AUTHOR]

We report preliminary results of computer vision analysis of caregiver–child interactions during free play with children diagnosed with autism (N = 29, 41–91 months), attention-deficit/hyperactivity disorder (ADHD, N = 22, 48–100 months), or combined autism + ADHD (N = 20, 56–98 months), and neurotypical children (NT, N = 7, 55–95 months). We conducted micro-analytic analysis of 'reaching to a toy,' as a proxy for initiating or responding to a toy play bout. Dyadic analysis revealed two clusters of interaction patterns, which differed in frequency of 'reaching to a toy' and caregivers' contingent responding to the child's reach for a toy by also reaching for a toy. Children in dyads with higher caregiver responsiveness had less developed language, communication, and socialization skills. Clusters were not associated with diagnostic groups. These results hold promise for automated methods of characterizing caregiver responsiveness in dyadic interactions for assessment and outcome monitoring in clinical trials. [ABSTRACT FROM AUTHOR]

Autistic children's play provides insights into social, communication, and other skills; however, methods for measuring these observations can be labor-intensive and rely on subjective judgment. This study explored whether children's movement and location during play measured via automated video tracking correlates with clinical features. Movement tracking metrics of 164 autistic children (27–96 months old) during free play were analyzed in relation to standard assessments of cognitive, language, social-communication, and adaptive skills. Children with higher cognitive and language abilities were more likely to spend time in the center toy region and more slowly or never approached the region without toys. Children with higher autism-related features spent less time in the center. Children with lower daily living skills spent more time near the caregiver and those with lower overall adaptive and language skills approached the caregiver more quickly. Over 90% of autistic children representing a range of ages and skills provided analyzable movement data during play and those with higher cognitive, language, and adaptive skills displayed movement tracking patterns that reflect more sustained focus on toy play and independence from the caregiver. Results suggest that automated movement tracking is a promising complementary, objective method for assessing clinical variation during autistic children's play. Play-based observations allow researchers to observe autistic children across a wide range of ages and skills. We recorded autistic children playing with toys in the center of a room and at a corner table while a caregiver remained seated off to the side and used video tracking technology to track children's movement and location. We examined how time children spent in room regions and whether or not they approached each region during play related to their cognitive, social, communication, and adaptive skills to determine if tracking child movement and location can meaningfully demonstrate clinical variation among autistic children representing a range of ages and skills. One significant finding was that autistic children who spent more time in the toy-containing center of the room had higher cognitive and language abilities, whereas those who spent less time in the center had higher levels of autism-related behaviors. In contrast, children who spent more time in the caregiver region had lower daily living skills and those who were quicker to approach the caregiver had lower adaptive behavior and language skills. These findings support the use of movement tracking as a complementary method of measuring clinical differences among autistic children. Furthermore, over 90% of autistic children representing a range of ages and skills in this study provided analyzable play observation data, demonstrating that this method allows autistic children of all levels of support needs to participate in research and demonstrate their social, communication, and attention skills without wearing any devices. [ABSTRACT FROM AUTHOR]

Background: Despite the high number of children living with neurodevelopmental disabilities in sub–Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI—whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes. Methods: We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2. Results: Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication—9/10 improved, Foundations of Learning—10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication—9/10 improved, Socialization—6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers. Conclusions: This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes. [ABSTRACT FROM AUTHOR]

Increasing evidence suggests that early motor impairments are a common feature of autism. Thus, scalable, quantitative methods for measuring motor behavior in young autistic children are needed. This work presents an engaging and scalable assessment of visual-motor abilities based on a bubble-popping game administered on a tablet. Participants are 233 children ranging from 1.5 to 10 years of age (147 neurotypical children and 86 children diagnosed with autism spectrum disorder [autistic], of which 32 are also diagnosed with co-occurring attention-deficit/hyperactivity disorder [autistic+ADHD]). Computer vision analyses are used to extract several game-based touch features, which are compared across autistic, autistic+ADHD, and neurotypical participants. Results show that younger (1.5-3 years) autistic children pop the bubbles at a lower rate, and their ability to touch the bubble's center is less accurate compared to neurotypical children. When they pop a bubble, their finger lingers for a longer period, and they show more variability in their performance. In older children (3-10-years), consistent with previous research, the presence of co-occurring ADHD is associated with greater motor impairment, reflected in lower accuracy and more variable performance. Several motor features are correlated with standardized assessments of fine motor and cognitive abilities, as evaluated by an independent clinical assessment. These results highlight the potential of touch-based games as an efficient and scalable approach for assessing children's visual-motor skills, which can be part of a broader screening tool for identifying early signs associated with autism. [ABSTRACT FROM AUTHOR]

Prior eye-tracking studies involving autistic individuals have focused on total looking time or proportion of looking time to key regions of interest. These studies have not examined another important feature, the ability to sustain attention to stimuli. In particular, the ability to sustain attention to a dynamic social stimulus might reflect more advanced self)regulatory skills that may enhance engagement with and comprehension of social information. In a sample of 155 autistic children (2–8 years of age), we examined children’s average look duration while they viewed a complex, dynamic stimulus containing both social and nonsocial elements. After accounting for children’s age and intelligence quotient, we found that shorter average look duration was associated with increased autism spectrum disorder severity across multiple clinical measures. To calculate average look duration, we divided the length of total looking time in seconds by the total number of uninterrupted looks to the video media. Thus, the ability to sustain attention while viewing complex dynamic information could be important for comprehending dynamic social information. [ABSTRACT FROM AUTHOR]

Background: This study is part of a larger research program focused on developing objective, scalable tools for digital behavioral phenotyping. We evaluated whether a digital app delivered on a smartphone or tablet using computer vision analysis (CVA) can elicit and accurately measure one of the most common early autism symptoms, namely failure to respond to a name call. Methods: During a pediatric primary care well‐child visit, 910 toddlers, 17–37 months old, were administered an app on an iPhone or iPad consisting of brief movies during which the child's name was called three times by an examiner standing behind them. Thirty‐seven toddlers were subsequently diagnosed with autism spectrum disorder (ASD). Name calls and children's behavior were recorded by the camera embedded in the device, and children's head turns were coded by both CVA and a human. Results: CVA coding of response to name was found to be comparable to human coding. Based on CVA, children with ASD responded to their name significantly less frequently than children without ASD. CVA also revealed that children with ASD who did orient to their name exhibited a longer latency before turning their head. Combining information about both the frequency and the delay in response to name improved the ability to distinguish toddlers with and without ASD. Conclusions: A digital app delivered on an iPhone or iPad in real‐world settings using computer vision analysis to quantify behavior can reliably detect a key early autism symptom—failure to respond to name. Moreover, the higher resolution offered by CVA identified a delay in head turn in toddlers with ASD who did respond to their name. Digital phenotyping is a promising methodology for early assessment of ASD symptoms. [ABSTRACT FROM AUTHOR]

Purpose Pain is a comorbid and aggravating symptom that in many conditions can be perceived differently and should therefore be managed accordingly. Numerous factors, both social and cultural, are thought to influence the analgesic prescription. However, elucidation of such areas is limited. We therefore conducted a systematic literature review to test the hypothesis that variations in provider characteristics predict the prescription of pain medication. Methods A MEDLINE and Psyc INFO database search from 1960 to 2009 was conducted using the search terms of 'pain' or 'pain treatment' along with culture, ethnicity, race, minority, gender/sex, knowledge, attitudes, physician-patient relationship, stereotype, and physician practices. Twelve original research articles based on predefined inclusion criteria were identified and analyzed to test the hypothesis of provider characteristics influencing analgesics prescription. Results Of the 12 studies, 11 were cross-sectional in design, and 10 used a survey instrument or clinical vignettes to measure different pain management responses. A randomized sampling methodology was used in 5 of the studies. The majority of providers were male (64.9% in 8 studies), white (73.5% in 5 studies), internal medicine physicians (37.4% in 11 studies), and located in the United States (75% across all 12 studies). Ten studies identified at least one provider characteristic that influenced prescription practices; age, level of experience, as well as sex were listed most frequently as contributing factors. The interplay of the sex of the provider and patient characteristics were found to be important variables in pain management. Conclusions Our systematic review of existing literature highlights that provider's age, sex, experience, specialty, and the interplay between provider and patient characteristics are important variables in pain management. However, generalizations relating to these findings are limited by the heterogeneity of the studies and the paucity of literature in this field. [ABSTRACT FROM AUTHOR]