Vocal cues embed speech with crucial emotional expression. Recognizing subtle changes in intonation, pitch and prosody provides rich social information and cues for responding in everyday interactions — cues that may be missed by individuals with differences in sensory processing and social development, such as those with autism. Although atypical auditory processing in autism is well-established in the literature, the contribution of these sensory differences to emotional prosody recognition requires further investigation. This study examined whether the associations of auditory abilities and social cognition with emotional prosody recognition differ between autistic and non-autistic children. Twenty-eight autistic children and twenty-eight non-autistic children completed tasks assessing rapid auditory processing (RAP), pitch discrimination, social cognition (SC), and emotional prosody recognition (EPR) of spoken words and sentences. Autistic children demonstrated better RAP but lower SC performances compared to non-autistic children. No group differences were found in pitch discrimination or emotional prosody recognition. Across both groups, better RAP was associated with better emotional prosody recognition. In contrast, pitch discrimination was positively associated with emotional prosody recognition of low-intensity emotional words only in autistic children. The findings highlight the important association between RAP and emotional prosody recognition in both autistic and non-autistic children, while indicating a distinct association between pitch discrimination and emotional prosody recognition in autistic children. The results suggest the need for further research into the role of auditory processing in emotional speech perception in autism, and the potential benefits of interventions targeting pitch discrimination and RAP.

Background & Aims Autistic children have difficulties establishing and maintaining eye contact. Previous interventions for eye gaze rely on human professionals, who may be too costly or even inaccessible to many families of autistic children. These challenges have led to the application of technology, such as social robots, the use of which in autism therapy is theory-driven. Thus, the present study examined whether robot-based intervention (RBI) and human-based intervention (HBI) improved autistic children's eye gaze. Methods In this randomized controlled trial study, 121 Chinese-speaking autistic children aged 4–9 years (34 females) participated and were randomly assigned to three conditions: RBI, HBI, and waitlist control. The robot/human experimenter narrated stories while detecting the eye gaze of the autistic children. They prompted the child if he/she lost eye contact with the robot/human continuously for more than 5 s. Children's eye gaze abilities were evaluated in both the experimental setting and parental report. Results Our experimental data showed that the children in the RBI had their eye gaze improved 1 month after the intervention. Their parents also perceived their autistic children to have better eye contact immediately and 1 month after intervention. Parents of the children in the HBI reported an improvement in eye gaze 1 month after intervention, which was not evident in the experimental setting. Children in the waitlist group did not show any improvement. Conclusion The present study showed that RBI could promote the eye gaze of autistic children under the conditions studied. Implication Our innovative design for RBI addresses clinicians’ concerns about the capacity to interact with autistic children in real time. Specific hands-on training workshops should be offered to enhance clinicians’ knowledge and skills in using robots in the clinical context. This randomized controlled trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR2300073238).

While a great deal of research has been conducted to investigate the parenting experiences of parents with autistic children, much of this research focuses on Western societies; very little is known about the everyday difficulties of and the strategies adopted in raising an autistic child in China, where the prevalence of autism is increasing. The present study is an investigation of Chinese parents' perceptions of their parenting experiences with their autistic children, including the difficulties they face and the strategies they use during daily interactions and their relationships with their children. In this study, we use semi-structured and open-ended interviews with parents to collect qualitative data. Nineteen parents with autistic children were interviewed, with each interview lasting for about 30 min. The interpretative phenomenological analysis approach is used to generate themes. Ten themes were identified under three categories: daily difficulties, parents' coping strategies and parents' perspectives of their relationships with their children. These themes are used to address the research questions. The results indicate that Chinese parents of autistic children face tremendous struggles in daily interactions with their children, especially regarding understanding their children's behaviours and intentions. The findings highlight the need to educate parents about their autistic children's behaviours and characteristics, which would facilitate their emotional regulation.

The present study examined heterogeneity in gesture production and its semantic integration among autistic children. Although previous studies have examined gesture-speech combinations in autism, less is known about whether there are individual variations in how autistic children gestured in relation to speech. Cantonese-speaking autistic children (N = 97; 79 boys, 18 girls, M age = 5 years, 2 months) were invited to participate in a 15-min parent-child interaction task. Autism characteristics were measured using the ADOS-2 comparison score, intellectual ability was indexed by overall IQ, and receptive language ability was measured using age-equivalent scores from the Mullen Scales of Early Learning. Hierarchical cluster analyses were conducted separately for reinforcing gestures, disambiguating gestures, supplementary gestures, and gestures without speech, together with selected child-based variables. Distinct clusters were identified for each type of gesture. Specifically, profiles with higher disambiguating gesture production tended to include children with fewer autism characteristics and stronger receptive language ability. Profiles with higher supplementary gesture production tended to include children with fewer autism characteristics. Other types of gestures did not show consistent profile patterns with child-based variables. These findings highlight the heterogeneous nature of multimodal communication in autism. In particular, examining the individual variations in how gestures reinforce, clarify, or add semantic information to speech may document a more fine-grained gesture-speech profile among autistic children.

A total of 82 Chinese-speaking children with autism aged 4–9 years were assigned to an HBI or an RBI group through stratified randomization. Before the intervention, the children’s autism severity, verbal comprehension, and Theory of Mind skills were assessed. Each child received four 30-min training sessions over 4 weeks, during which they watched four dramas performed by human or robot actors, in which one character shared an event with another character, who then displayed an empathic response. Parents completed a questionnaire before, immediately after, and 1 month after the intervention, and children’s cognitive empathy (CE), affective empathy (AE), and prosocial behavior (PB) were evaluated in an experimental task. Both RBI and HBI training promote empathy skills, specifically CE, AE, and PB, as evaluated through children’s verbal responses in story tasks. RBI empathy training demonstrates comparable reliability and effectiveness to human teaching, suggesting that RBIs can assist human therapists in promoting empathy in children with autism. Our randomized controlled trial was registered in the Chinese Clinical Trial Registry (no. ChiCTR2300077745, https://www.chictr.org.cn ).

Chinese parents of autistic children experience elevated stress. However, the number of resilience interventions is limited. In this study, we aimed to examine the efficacy of an 8-week resilience-focused group intervention. In this quasi-experimental study, 92 Chinese parents of autistic children assigned to the intervention condition and 51 wait-list control. We evaluated the effectiveness of resilience-focused intervention using ANOVAs. Then, a cluster analysis was performed to identify subgroups of Chinese parents to examine whether the effectiveness of the intervention differed among those clusters and the factors accounting for these variations. There was no overall significant improvement in the parents' resilience after intervention but there were individual variations in their intervention outcomes. Four clusters were identified. Cluster 1 featured parents in with moderate levels of family quality of life, parental stress, and child behavioral problems. Clusters 2 and 4 had similarly high levels of satisfaction with their family quality of life, and relatively low parental stress. Cluster 3 represented the most troubled parents and had the lowest level of family quality of life, the highest parental stress, and the most child behavioral problems. Cluster 1 but not others benefited from our resilience intervention. It is recommended that interventions be allocated to the most receptive target groups or tailor made for different parent profiles to maximize the effectiveness.

Given the higher demands on parenting and the limited resources available, parents of autistic children experience high levels of parental stress. Chinese parents of autistic children experience elevated levels of parental stress. Prolonged and severe stress may lead to distress, which adversely affects their mental well-being. In this cross-sectional study, 112 Chinese primary caregivers of autistic children were invited to complete online questionnaires, including the Parental Stress Index, the Kessler Psychological Distress Scale, the Difficulties in Emotion Regulation Scale, the Experiences in Close Relationship Scale, and the Child-Parent Relationship Scale. Nine separate bootstrap moderation analyses were conducted. Parental stress significantly and positively predicted distress (ps < 0.001). The effect of parental stress on distress was moderated by the non-acceptance of emotional responses (B = -0.202, SE = 0.089, p = 0.026) and attachment anxiety (B = -0.176, SE = 0.081, p = 0.032). To conclude, there was a significant association between parental stress and distress. High acceptance of emotional responses and low attachment anxiety moderated the relationship, exerting protective effects.

ABSTRACT Objective To investigate the relationship between parental self‐efficacy and parent–child relationships in families including children with autism and to identify the potential family‐based moderators. Background More families in China are being affected by autism. Parents often have difficulties establishing positive relationships with their children with autism. Parental self‐efficacy positively influences the relationship with typically developing children. However, this association and its potential moderators are understudied in families that include children with autism. Method Chinese caregivers of children with autism completed standardized instruments on parental self‐efficacy, parent–child relationships, children's behavioral problems, parents' endorsement of autism stigma, and spouse support. Moderation analyses were conducted. Results Parental self‐efficacy was positively associated with parent–child relationships. Children's psychosomatic problems and parents' endorsement of autism stigma were the only significant moderators. More psychosomatic problems dampened the positive relationship between parental self‐efficacy and parent–child relationships, and less endorsement on autism stigma strengthened such relationship. Conclusion Caregivers with a greater sense of parental self‐efficacy will have better parent–child relationships. Such relationships were stronger when caregivers tended not to endorse autism stigma and weakened when children with autism exhibited more psychosomatic symptoms. Implications Chinese parents' lack of endorsement of autism stigma may offer a protective role for parent–child relationships, while psychosomatic problems of children with autism may serve as a risk factor. Our findings shed light on the direction of interventions for families including children with autism. In particular, it is necessary to identify those families whose parents endorse autism stigma and their children with autism who have psychosomatic problems. An intervention to help these families understand autism and accept their children is crucial for improving the parent–child relationship.

Objective:An objective and standardized assessment for assessing autism is needed. This study aimed to develop and validate robotic detection technology for assessing autism. The robot HUMANE, installed with computer vision and linked with face and motion recognition technology, autonomously detected atypical eye gaze and repetitive motor movements, two of the features of autism, while narrating stories. It autonomously prompted the child if they did not establish eye gaze with the robot or produced motor movements for five seconds continuously. Method:The study involved 119 children aged between three and six years old (M=4.53, SD=1.89; 38 females) and included children confirmed or not confirmed with autism. They all received the Autism Diagnostic Observation Schedule-second edition (ADOS‑2), the standard diagnostic tool for autism. HUMANE's detection performance - the number of robot prompts and the cumulative duration of inattentiveness/improper posture - was then evaluated against the calibrated severity score of ADOS-2. Results:Our results showed that the average sensitivity and specificity of the detection reached 0.80, the Diagnostic Odds Ratio was beyond 30, and the AUC was .85. Discussion:These results indicate that the robotic detection technology of atypical eye gaze and repetitive motor movements can contribute to the diagnostic process to identify the presence or absence of autism.

PURPOSE:Gesture delay in autistic infants and toddlers has been widely reported. The developmental trajectory of gesture production during early childhood is understudied. Thus, little is known about the possible changes of gesture production over time. The present study aimed to document the development of gesture production in autistic children and examine whether child-based factors (chronological age and initial language skills) predicted gesture development. METHOD:A total of 33 Chinese-speaking autistic children (Mage = 56.39 months, SD = 8.54 months) played with their parents at four time points over a 9-month period. Their speech was transcribed, and their gestures were coded from parent-child interaction. Multilevel modeling analysis was used to investigate the development of gesture and its associated factors. RESULTS:The total number of gestures produced by autistic children decreased over time. Among different factors, children's initial age significantly and negatively predicted children's gesture production, while initial language positively predicted children's gesture production. CONCLUSIONS:Gesture delay persists in preschool age. The decline in gesture production was associated with children's age and initial language ability. These findings shed light on the difficulties surrounding gesture use in autistic children.

The present exploratory cross-sectional case-control study sought to develop a reliable and scalable screening tool for autism using a social robot. The robot HUMANE, installed with computer vision and linked with recognition technology, detected the direction of eye gaze of children. Children aged 3-8 (M = 5.52; N = 199) participated, 87 of whom had been confirmed with autism, 55 of whom were suspected to have autism, and 57 of whom were not considered to cause any concern for having autism. Before a session, a human experimenter instructed HUMANE to narrate a story to a child. HUMANE prompted the child to return his/her eye gaze to the robot if the child looked away, and praised the child when it re-established its eye gaze quickly after a prompt. The reliability of eye gaze detection was checked across all pairs of human raters and HUMANE and reached 0.90, indicating excellent interrater agreement. Using the pre-specified reference standard (Autism Spectrum Quotient), the sensitivity and specificity of the index tests (i.e., the number of robot prompts and duration of inattentiveness) reached 0.88 or above and the Diagnostic Odds Ratios were beyond 190. These results show that social robots may detect atypical eye patterns, suggesting a potential future for screening autism using social robots.

In spite of the close relationship between gestures and expressive language, little research has examined the roles of the parents’ and children’s gestures in the development of expressive language abilities in autistic children. Previous findings are also inconclusive. In the present study, we coded the gestures produced by the parents and their autistic children in parent-child interactions and compared the influence of their gestures on the children’s expressive language abilities (N = 35; M = 4;10). Autistic children’s deictic gestures positively predicted their Mean Length Utterance (MLU), word types, and word tokens whereas parents’ deictic gesture inputs negatively predicted MLU and word types. The findings shed light on the importance of the gestures made by autistic children, which may trigger parents’ gesture-to-word translation.

EDITORIAL article Front. Psychiatry, 01 November 2023Sec. Autism Volume 14 - 2023 | https://doi.org/10.3389/fpsyt.2023.1304178

Children with autism face challenges in various skills (e.g., communication and social) and they exhibit challenging behaviours. These challenging behaviours represent a challenge to their families, therapists, and caregivers, especially during therapy sessions. In this study, we have investigated several machine learning techniques and data modalities acquired using wearable sensors from children with autism during their interactions with social robots and toys in their potential to detect challenging behaviours. Each child wore a wearable device that collected data. Video annotations of the sessions were used to identify the occurrence of challenging behaviours. Extracted time features (i.e., mean, standard deviation, min, and max) in conjunction with four machine learning techniques were considered to detect challenging behaviors. The heart rate variability (HRV) changes have also been investigated in this study. The XGBoost algorithm has achieved the best performance (i.e., an accuracy of 99%). Additionally, physiological features outperformed the kinetic ones, with the heart rate being the main contributing feature in the prediction performance. One HRV parameter (i.e., RMSSD) was found to correlate with the occurrence of challenging behaviours. This work highlights the importance of developing the tools and methods to detect challenging behaviors among children with autism during aided sessions with social robots.

Purpose: The heterogeneity of autism is well documented, but few studies have studied the heterogeneity of gesture production ability in autistic children. The present study aimed to identify subgroups of autistic children who displayed heterogeneous gesture production abilities and explore the underlying factors, including autism characteristics, intellectual ability, and language ability, that were associated with the heterogeneity. Methods: A total of 65 Chinese autistic children (mean age = 5;3) participated. Their autism characteristics and intellectual ability were assessed by standardized measurements. Language output and gesture production were captured from a parent-child interaction task. Results: We conducted a hierarchical cluster analysis and identified four distinct clusters. Cluster 1 and Cluster 2 both had low gesture production whereas Cluster 3 and Cluster 4 had high gesture production. Both Clusters 1 and 2 had relatively strong autism characteristics, in comparison to Clusters 3 and 4. Conclusions: Our findings revealed that children with stronger autism characteristics may gesture less often than those with weaker characteristics. However, the relationship between language ability and intellectual ability and gesture production was not clear. These findings shed light on the directions of intervention on gesture production for autistic children, especially those with stronger autism characteristics.

Background:Children with autism have impairments in initiation of joint attention (IJA) and response to joint attention (RJA).Aims:The present study compared the learning effectiveness of robot-based intervention (RBI) with that of content-matched human-based intervention (HBI) in improving joint attention (JA). We examined whether RBI would enhance RJA, in comparison to HBI. We also examined whether RBI would increase IJA, in comparison to HBI.Methods and procedures:Thirty-eight Chinese-speaking children with autism aged 6 to 9 years were randomly assigned to RBI and HBI groups. Before intervention, their autism severity, cognitive abilities, and language skills were assessed. Each child received six 30-min training sessions over 3 weeks. During training, he/she watched one or two robot/human dramas twice where two robot/human actors demonstrated eye contact and RJA.Outcomes and results:Children in the RBI (but not HBI) group produced more RJA and IJA behaviors in the delayed post-test than in the pre-test. Parents of the RBI children rated the program more positively than those of the HBI children.Conclusions and implications:RBI may be more effective than HBI in promoting JA in autistic children with high support needs. Our findings shed light on the application of robot dramas in enhancing social communication skills.

Background: Autistic children always encounter difficulties in engaging in various play acts. Their parents can play a critical role in their play development. Among the different strategies adopted by parents, modelling, which involves parents demonstrating play acts to their children, can help the latter to develop play skills through observation and imitation. However, very little is known about whether modelling during parent-child spontaneous interactions might influence the production of play acts in autistic children, in comparison to other strategies, such as suggestion, command, and imitation. The present study addressed this issue, and we hypothesized that parents' modelling of play acts was positively associated with autistic children's production of play acts. Method: Thirty-seven autistic children aged between 73 and 114 months (M = 92.1) from a special school in Hong Kong and their parents were recruited for this study. The parents were instructed to play freely with their children for 20 min. The sessions were videotaped and coded. The children's play acts were categorized into sensory, relational, functional, and symbolic play, while the parents' play strategies were categorized into modelling, command, suggestion, and imitation. Results: After controlling for chronological age, autism severity and intelligence, the multiple linear regression showed that the parents' modelling strategy was significantly and positively associated with the number of their children's play acts (B =.217, p = .046). Conclusion: The modelling of play acts by the parents is associated with their autistic children's play acts. It is advisable for parents to demonstrate play activities in daily-life interactions.

Studies of language development in children with autism spectrum disorder (ASD) have been primarily focused on the influence of child-based factors such as autism traits, IQ, and initial language skills. Yet the findings of these studies are inconclusive. There has, moreover, been little research compared the relative influences of child-based factors with environmental factors, (e.g. parental inputs). The current study attempts to fill this research gap by examining a range of both child-based factors and parental inputs. We measured the structural language abilities manifested in parent-child interactions over four time points across nine months in 42 Chinese-speaking autistic children ( M = 57.42 months, SD = 11.39). Our results showed that children’s mean length of utterance (MLU), word types, and word tokens grew rapidly, but their development trajectories varied. Initial expressive language ability was a significant predictor of children’s language outcomes, while nonverbal IQ and autism traits did not relate to children’s language abilities when controlling for initial expressive language ability. Parents’ MLU, word tokens, and word types did not associate with children’s structural language abilities. The findings shed lights on the importance of one of the child-based factors in particular, that is, initial expressive language skills, in the language development of autistic children. Lay abstract Language impairment is one of the early signs of Autism Spectrum Disorder (ASD) that alerts parents to take their children for early diagnosis and intervention. Little is known about how children’s autism traits, IQ, initial language abilities and parental inputs influence their language abilities. In addition, only a few studies have compared the relative influence of these factors. The present study addressed these issues by examining the structural language in parent-child spontaneous interactions. Forty-two Cantonese (Chinese)-speaking autistic children aged four to eight were recruited. Their expressive language skills grew rapidly more than 9 months, but their development trajectories varied. Initial expressive language ability is the only significant predictor of child language outcomes and language growth trajectories. In contrast, nonverbal cognition, autism traits, and parents’ input do not affect language outcomes in children with ASD. Therefore, early language intervention is crucial for autistic children at all severity and IQ levels.

Children with autism spectrum disorder (ASD) have conversation deficits, yet the growth of conversation abilities is understudied, especially in Chinese-speaking populations. Little is known about whether their parents' verbal responsiveness and redirectives are related to their conversation skills. Children with ASD (N = 37; M = 5;5) and their parents contributed their language samples. These children interacted with their parents at four time points over nine months. The number of conversational turns and the proportion of child-initiated conversation (but not the proportion of children's appropriate responses) grew over nine months. After controlling for time, autism severity, and language skills, parents' verbal responsiveness positively predicted children's appropriate responses. Parents' redirectives negatively predicted the proportion of children's appropriate responses and the number of conversational turns.