High-Risk Siblings without Autism: Insights from a Clinical and Eye-Tracking Study

Joint attention (JA)—the human ability to coordinate our attention with that of other people—is impaired in the early stage of Autism Spectrum Disorder (ASD). However, little is known about the JA skills in the younger siblings of children with ASD who do not develop ASD at 36 months of age [high-risk (HR)-noASD]. In order to advance our understanding of this topic, a prospective multicenter observational study was conducted with three groups of toddlers (age range: 18–33 months): 17 with ASD, 19 with HR-noASD and 16 with typical development (TD). All subjects underwent a comprehensive clinical assessment and an eye-tracking experiment with pre-recorded stimuli in which the visual patterns during two tasks eliciting initiating joint attention (IJA) were measured. Specifically, fixations, transitions and alternating gaze were analyzed. Clinical evaluation revealed that HR-noASD subjects had lower non-verbal cognitive skills than TD children, while similar levels of restricted and repetitive behaviors and better social communication skills were detected in comparison with ASD children. Eye-tracking paradigms indicated that HR-noASD toddlers had visual patterns resembling TD in terms of target-object-to-face gaze alternations, while their looking behaviors were similar to ASD toddlers regarding not-target-object-to-face gaze alternations. This study indicated that high-risk, unaffected siblings displayed a shared profile of IJA-eye-tracking measures with both ASD patients and TD controls, providing new insights into the characterization of social attention in this group of toddlers

Initiating joint attention in typical and atypical development: an eye tracking study

BACKGROUND Joint attention (JA) is the human ability to coordinate our attention with that of other people. It has been established that joint attention is impaired early in Autism Spectrum Disorder (ASD). The aim of this eye-tracking study was to evaluate the visual patterns during tasks eliciting responding joint attention and initiating joint attention in High Risk – non ASD (HR-nASD) subjects as compared to ASD and typical development (TD) children. METHODS Fifty-two children participated in the study: 17 ASD, 19 HR-nASD and 16 TD. The sample age range was 18-33 months. All subjects enrolled underwent a comprehensive clinical assessment and eye tracking experiments using three tasks: one for responding JA (RJA) and two tasks for initiating joint attention (IJA-1 and IJA-2). Fixations, Transitions and alternating gaze were analyzed. RESULTS In the RJA task only the number of transitions from face to non- target object was significantly different between the HR- nASD and ASD subjects (p=0,004) with lower values for the HR-nASD group. In the IJA1 task alternating gaze between target object and the model’s face was statistically different between HR-nASD and ASD subjects (p<0,001) as well as between TD and ASD subjects (p= 0,029). Alternating gaze between the non-target object and the model’s face and between non-target object and target object differed significantly between the HR-nASD and TD groups (p= 0,012 and p= 0,003, respectively) with lower values for the HR- nASD population. In the IJA2 task alternating gaze between face and target object differed significantly between HR-nASD and ASD subjects (p <0,001) as well as between the TD and ASD groups (p= 0,004). Moreover, in ASD group reduced alternating gaze between the face and the target object was associated with more core ASD symptoms (p=0,004), in particular social and communicative impairment (p= 0,015). CONCLUSIONS Siblings who do not develop later ASD show lower non-verbal cognitive skills than typical development children and similar levels of restricted and repetitive behaviors and better social and communicative skills as compared to ASD children. During eliciting initiating joint attention tasks, HR-nASD toddlers exhibit visual patterns similar to TD in terms of target-object-to-face gaze alternations, while their looking behavior was similar to ASD toddlers regarding not-target-object-to-face gaze alternations. In ASD reduced alternating gaze target object-to-face is associated with elevated social affect impairment. The study of alternating gaze in typical and atypical development can provide us with valuable information about how children begin to visually explore the world around them and how they share interest in objects and/or events with other people

Application of the Repetitive Behavior Scale-Revised - Italian version - in preschoolers with autism spectrum disorder

Restricted repetitive and stereotyped patterns of behavior, interests, and activities (RRB) are mandatory features for a diagnosis of Autism Spectrum Disorder (ASD) according to the Diagnostic and Statistical Manual of mental disorders - fifth edition (DSM-5). Despite the strong diagnostic role of RRB, their expressiveness and their relationship with other clinical/demographic features in ASD is not fully elucidated. The Italian version of the Repetitive Behavior Scale-Revised (RBS-R) was applied in a relatively large sample of preschool-aged children with ASD who underwent a comprehensive clinical assessment. The relationship between RRB and sex, age, non-verbal IQ, autism severity, as well as the diagnostic accuracy of the RBS-R were explored. Stereotyped and Ritualistic/Sameness behaviors were the most common RRB in preschoolers with ASD, without no widespread differences between males and females. No significant correlations between RRB and chronological age, or non-verbal IQ were detected. The expressiveness of ritualistic/sameness behaviors positively correlated with autism severity, assessed through the Calibrated Severity Score (CSS) derived from the Autism Diagnostic Observation Schedule (ADOS). Receiver Operator Characteristic (ROC) analysis showed high diagnostic accuracy using the Global Rating Score, which represents the judgment of the parents of as the RRB affect the child's life. However, while the Global Rating Score performed well, the remaining subscales did not. This investigation extends the limited research on early pattern and associated features of RRB in young children with ASD. The use of the RBS-R may increase the knowledge of the RRB complexity and variability and in turn improve the diagnostic and therapeutic procedures within the autistic spectrum