Children with autism spectrum disorder (ASD) have difficulties in gestural communication during social interactions. However, the neural mechanisms involved in naturalistic gestural communication remain poorly understood. In this study, cortical activation patterns associated with gestural communication were examined in thirty-two children with and without ASD (mean age: 11.0 years, SE: 0.6 years). Functional near-infrared spectroscopy (fNIRS) was used to record cortical activation while children produced, observed, or imitated communicative gestures. Children with ASD demonstrated more spatial and temporal errors when performing and imitating communicative gestures. Although both typically developing (TD) children and children with ASD showed left-lateralized cortical activation during gesture production, children with ASD showed hyperactivation in the middle/inferior frontal gyrus (MIFG) during observation and imitation, and hypoactivation in the middle/superior temporal gyrus (MSTG) during gesture production compared to their TD peers. More importantly, children with ASD exhibited greater MSTG activation during imitation than during gesture production, suggesting that imitation could be an effective intervention strategy to engage cortical regions crucial for processing and producing gestures. Our study provides valuable insights into the neural mechanisms underlying gestural communication difficulties in ASD, while also identifying potential neurobiomarkers that could serve as objective measures for evaluating intervention effectiveness in children with ASD.

Background/Objectives: Children with Autism Spectrum Disorder (ASD) experience difficulties with interpersonal synchrony (IPS). While creative movement (CM) interventions have shown benefits for social, cognitive, and motor skills in children with ASD, the neural mechanisms underlying these improvements remain unclear. This pilot randomized control trial examined the behavioral and neural effects of CM, general movement (GM), and sedentary play (SP) interventions. Methods: Twenty-two children with ASD (Mean Age ± SE = 8.7 ± 1.9) participated. Functional Near-Infrared Spectroscopy (fNIRS) was used to measure cortical activation during a drumming synchrony task before and after 8 weeks of intervention. Results: The CM group demonstrated significant improvements in IPS and the most widespread increases in socially enhanced activation across the left middle frontal gyrus (MFG), inferior frontal gyrus (IFG), and superior temporal sulcus (STS). The GM group showed increased activation in the left IFG, while the SP group showed enhanced activation in the left STS. Children with lower baseline adaptive functioning and social responsiveness showed greater IPS improvement. Conclusions: These findings provide preliminary evidence for the efficacy of CM in improving IPS in children with ASD and support the use of fNIRS to capture neural effects following interventions.

Children with autism spectrum disorder (ASD) have difficulties with tool use and pantomime actions. The current study utilized functional near-infrared spectroscopy (fNIRS) to examine the neural mechanisms underlying these gestural difficulties. Thirty-one children with and without ASD (age (mean ± SE) = 11.0 ± 0.6) completed a naturalistic peg-hammering task using an actual hammer (hammer condition), pantomiming hammering actions (pantomime condition), and performing meaningless actions with similar joint motions (meaningless condition). Children with ASD exhibited poor praxis performance (praxis error: TD = 17.9 ± 1.7; ASD = 27.0 ± 2.6, p < 0.01), which was significantly correlated with their cortical activation (R = 0.257 to 0.543). Both groups showed left-lateralized activation, but children with ASD demonstrated more bilateral activation during all gestural conditions. Compared to typically developing children, children with ASD showed hyperactivation of the inferior parietal lobe and hypoactivation of the middle/inferior frontal and middle/superior temporal regions. Our findings indicate intact technical reasoning (typical left-IPL activation) but atypical visuospatial and proprioceptive processing (hyperactivation of the right IPL) during tool use in children with ASD. These results have important implications for clinicians and researchers, who should focus on facilitating/reducing the burden of visuospatial and proprioceptive processing in children with ASD. Additionally, fNIRS-related biomarkers could be used for early identification through early object play/tool use and to examine neural effects following gesture-based interventions.

Aims: We compared the efficacy, fidelity, acceptability, and feasibility of a creative movement (CM) intervention for children with autism spectrum disorder (ASD), delivered face-to-face (F2F) or through telehealth (TH). Methods: Fifteen children with ASD received the CM intervention F2F or through TH. Motor assessments were used to evaluate effects of F2F and TH interventions on children's motor skills, while video coding was used to assess affect, socially directed verbalization, interpersonal synchrony, and motor coordination during training. Stakeholder feedback and training fidelity data on the intervention were also collected. Results: Children in both subgroups showed similar baseline performance and training-related improvements in motor skills, positive/interested affect, socially directed verbalization, interpersonal synchrony, and dual/multilimb coordination. Parents in the TH subgroup considered the intervention feasible and acceptable; however, they reported greater effort to supervise and redirect their child's attention compared to the F2F subgroup. Trainers for the TH subgroup reported more communication difficulties, technological issues, and longer session lengths, but found greater parental involvement compared to the F2F subgroup. Conclusions: CM interventions are consistent, acceptable, feasible, and effective in improving social, behavioral-affective, and motor skills of children with ASD, regardless of the method of delivery. Clinicians should make efforts to reduce communication/technological issues and parental burden when delivering CM interventions through TH. ClinicalTrials.Gov Study ID-NCT04258254.

Background: Autism spectrum disorder (ASD) is a prevalent neurodevelopmental condition that can be quite difficult to diagnose due to a lack of objective diagnostic methods in the currently used behavioral assessments. Recent work has shown that children with ASD have a higher incidence of motor control differences. A compilation of studies indicates that between 50% and 88% of the children with ASD have issues with movement control based on standardized motor assessments or parent-reported questionnaires. Objective: In this study, we assess a variety of deep learning approaches for the classification of ASD, utilizing data collected via inertial measurement unit (IMU) hand tracking during goal-directed arm movements. Methods: IMU hand tracking data were recorded from 41 school-aged children both with and without an ASD diagnosis to track their arm movements during a reach-to-clean up task. The IMU data were then preprocessed using a moving average and z score normalization to prepare the data for deep learning models. We evaluated the effectiveness of different deep learning models using the preprocessed data and a k-fold validation approach, as well as a patient-separated approach. Results: The best result was achieved with a convolutional autoencoder combined with long short-term memory layers, reaching an accuracy of 90.21% and an F ₁ -score of 90.02%. Once the convolutional autoencoder+long short-term memory was determined to be the most effective model for this datatype, it was retrained and evaluated with a patient-separated dataset to assess the generalization capability of the model, achieving an accuracy of 91.87% and an F ₁ -score of 93.66%. Conclusions: Our deep learning approach demonstrates that our models hold potential for facilitating ASD diagnosis in clinical settings. This work validates that there are significant differences between the physical movements of typically developing children and children with ASD, and these differences can be identified by analyzing hand-eye coordination skills. Additionally, we have validated that small-scale models can still achieve a high accuracy and good generalization when classifying medical data, opening the door for future research into diagnostic models that may not require massive amounts of data.

Background: Children with autism spectrum disorder (ASD) exhibit poor imitation, movement planning, and praxis skills that in turn compound their core social communication and behavioral difficulties. Objective: Our randomized controlled trial compares the effects of 2 whole-body movement interventions (creative movement [“Play”] and general exercise [“Move”]) to those of a seated play standard-of-care intervention (“Create”) on imitation and praxis skills in children with ASD. As part of this clinical trial, we also compare face-to-face (F2F) versus telehealth (TH) modes of intervention delivery in each of the three groups. Methods: A total of 44 children with ASD aged between 5 and 14 years participated in this 10-week study. Children were matched at baseline and assigned to the Play, Move, or Create groups (n=14-15/group). Approximately half of the children in each group were seen F2F, while the other half were seen via TH. Training was provided 2 times/week (60-90 minutes/session) for 8 weeks. We administered the Bilateral Motor Coordination (BMC) and Postural Praxis (PP) subtests of the Sensory Integration and Praxis Test (SIPT) at pretest and posttest and assessed spatial and temporal errors in movement execution during both tests. We calculated the percent total imitation error score for both subtests. Results: For the SIPT-PP, we found a reduction in percent total errors from pretest to posttest in the Play (pretest: mean 15.8%, SE 1.1%; posttest: mean 12.9%, SE 1.1%; P≤.05), Move (pretest: mean 17.1%, SE 1.4%; posttest: mean 14.8%, SE 1.2%; P≤.05), and Create groups (pretest: mean 16.5%, SE 1.5%; posttest: mean 12.7%, SE 1.7%; P≤.05). There were no statistically significant differences in the percent reduction in total errors among children seen F2F versus via TH in the Play (F2F: mean 3.4%, SE 1.5%; TH: mean 2.4%, SE 2.1%; P=.72), Move (F2F: mean 2.6%, SE 1.6%; TH: mean 2.1%, SE 1.5%; P=.84), and Create groups (F2F: mean 6.1%, SE 1.2%; TH: mean 3.4%, SE 1.8%; P=.22). For the SIPT-BMC, children significantly reduced their percent total error scores from pretest to posttest in the Play group (pretest: mean 8.6%, SE 2.4%; posttest: mean 3.9%, SE 0.7%; P≤.05) but not in the Move and Create groups. Specifically, children in the Play group improved on spatial errors (pretest: mean 9.1%, SE 1.9%; posttest: mean 5.4%, SE 1.2%; P≤.05) and also showed a nonsignificant trend for improvement in temporal errors (pretest: mean 9.2%, SE 3.3%; posttest: mean 3.1%, SE 0.6%; P=.06). Similar to the SIPT-PP, we found no significant differences in the percent reduction in total errors among children seen F2F versus via TH (F2F: mean 2.0%, SE 1.5%; TH: mean 7.3%, SE 3.8%; P=.23). Conclusions: Our pilot data suggest that imitation-based gross and fine motor training activities led to improved postural imitation skills in children with ASD across all 3 groups. However, only the Play group that received rhythmic movement practice improved on the BMC subtest of the SIPT. Our findings suggest that improvements in imitation and praxis skills are highly training-specific in children with ASD. The lack of significant differences between the F2F and TH modes across all groups suggests that TH could be a successful method of intervention delivery for promoting imitation and praxis skills in children with ASD. Conflicts of Interest: None declared.