Connie Kasari, PhD, details what contemporary research reveals about supporting non-speaking or minimally verbal autistic children. She highlights how far the field has come in the past two decades and emphasizes the need for contemporary research to focus on what strategies benefit whom and why. The speaker discusses JASPER, a modular intervention based on social communication. She outlines recent studies and video examples showing positive language outcomes for JASPER on its own and in tandem with other interventions. Kasari underscores the usefulness of AAC devices in spoken language development, noting the lack of interventions that use even low-tech augmentative supports. The speaker summarizes her presentation and focus for future research before the Q&A.

Handouts are online HERE

In this webinar

2:00 – Early intervention in autism
7:00 – Core challenges: Video
14:16 – Study: JASPER intervention outcomes
26:00 – Intervention trajectories
31:50 – Study: Intervention combinations and AAC
36:11 – Implications for practice
45:45 – AAC case studies
46:45 – Summary
48:00 – Q&A

Early intervention and social communication

Kasari explains that nearly all autistic children will require support/intervention on engagement, imitation, joint attention, and play (2:00). She states that the goal of early intervention is to reduce the number of autistic children who have significant language impairment by the time they start school. Language ability remains one of the strongest predictors of positive long-term outcomes, making support strategies that target social communication skills—such as joint attention, engagement, and play—especially critical (4:00). Importantly, Kasari notes that research hasn’t focused on for whom an intervention works or why a particular intervention provides benefit for certain people. Understanding this is critical to expanding care and assessment across the board (5:30).

The speaker discusses core challenges that may trigger an intervention and shows videos comparing social communication in an autistic and a non-autistic child at 18 months old. Kasari highlights differences between the videos, noting the child with autism is more interested in looking at the objects than communicating (7:00). She explains how this pattern often translates to parent play, making it feel frustrating or not enjoyable for many parents/caregivers, and discusses two video examples of this (9:30).

Social Communication Research

The speaker says we know the least about children who are most delayed in development, who have limited language skills, and those whose families have less access to information about studies in their communities. She explains that most autistic children have never been in a research study. As a result, our evidence base does not represent the entire spectrum of autism (13:15). Kasari and her team focus on researching interventions for non-speaking and minimally verbal autistic children that can be conducted in community settings.

JASPER: Joint Attention, Symbolic Play, Engagement, and Regulation

The presenter describes JASPER, a comprehensive social communication/language intervention that can float inside other interventions, be used on its own or used sequentially (14:60). Kasari presents one of her recent publications comparing outcomes in 164 children, 3 -5 years old, across three sites after four months receiving Discrete Trial Training (DTT) or JASPER (video examples) (19:00). Results from the study show that both groups made significant language gains, and 45% moved toward phrased speech (putting words together).

Intervention trajectories

The goal of the intervention was to avoid the label of minimally verbal or profound autism by school age. Kasari defines profound autism as children with a developmental quotient (DQ) below 50, aged 8 or older, with poor adaptive skills (often minimally verbal or non-speaking). She notes that this is a relatively new term and considers how early we can predict these outcomes (26:00). The speaker reviews DQ data for a group of 264 children at very young ages. By age 8, 47% did not meet criteria for profound autism, although 25% of this group had a DQ lower than 50 at age 4 (28:30).

Kasari summarizes study takeaways, noting that DQ can help predict later development but is not a perfect predictor on its own. She reiterates the importance of early intervention and highlights understanding the 25% who moved off trajectory as a critical next step (29:25).

Combination interventions and assistive technology (AAC)

The presenter reiterates the heterogeneity in response to interventions, underscoring the need to personalize, tailor, and target interventions according to each person. This will also help us address for whom the intervention works and why. Kasari defines adaptive intervention designs as a sequence of decision rules that specify whether, how, when (timing), and based on which measures, to alter the dosage (duration, frequency, or amount), type, or delivery of treatment(s) at decision stages in the course of care – this is what her group employs (29:45).

Kasari details a study with 61 children, 5-8 years old, who are minimally verbal and had received 2 years of intensive early intervention (most ABA). All children received JASPER plus EMT, a spoken language intervention. Half of the children were randomized to receive AAC devices to test if these supports help with spoken language. Children attended two sessions per week, and at the 12-week follow-up, those assessed as slow responders were re-randomized to either add AAC or to up to 3 sessions per week. Outcomes for socially communicative utterances were assessed after another 12 weeks (31:50). Those who used AAC devices from the beginning showed significant increases and also had more novel words and joint attention language. Those with only JASPER and EMT made slow but steady progress. Researchers also found that from entry to midpoint to exit, parent-initiated engagement stayed the same while child-initiated engagement increased (34:15).

Implications for practice

The speaker notes that assistive technology are still not used regularly with children, be it a device, sign language, or another low-tech augmentative device; they are not being used as much as they should (36:11). Kasari returns to the child from the first video and describes how they changed tactics the second day by lowering the play level and adding an AAC device with button-words (video provided) (40:00). She notes that this child entered regular education at age 7, speaking full sentences. He used the AAC for a few years as a transition to spoken language. The presenter describes another case in which a child used AAC to support communication. He made progress over time, eventually asking the therapist to put phrases that he hears in the AAC device so he can listen to them and learn the sounds. In a follow-up video, the child is speaking in full sentences (45:45).

Kasari summarizes her presentation, highlighting that we can improve social communication and language outcomes for delayed autistic children and that these early skills need to be direct targets for support/intervention strategies. She reiterates how research must inform practice and, therefore, focus on answering questions about personalized interventions (how long do we wait, what do we change to?) (46:45) before the Q&A (48:00).

Laurie A. Vismara, Ph.D., BCBA-D, R.B.A. (Ont.) details caregiver strategies for building infant social interaction. She introduces the Infant Start Manual, an extension of the Early Start Denver Model. The speaker outlines contemporary research on early-in-life autism support strategies and underscores the need for collaborative, family-centered support tactics for parents and caregivers. Vismara details six (6) infant learning characteristics, how they present, and what caregivers can do to foster these social communication skills during infancy.

Handouts are online HERE (.zip)

In this webinar: 

1:30 – Introduction
6:10 – Infant Start Manual
11:40 – Research findings
17:55 – Infant learning characteristics
20:25 – Attentional flexibility
27:10 – Object use
33:00 – Prelinguistic development
36:55 – Combined, pragmatic communication
42:25 – Speech
47:30 – Social attention and engagement
54:20 – Tips for baby learning
58:00 – Resources

Introduction

Vismara introduces the Infant Start Manual, an extension of the Early Start Denver Model that focuses on infant social interactions (1:30). She highlights the need for innovative, flexible approaches to support strategies that match the needs, goals, and priorities of parents and caregivers. The speaker outlines specific language used in the talk and notes presentation learning objectives (4:20). The vision of the Infant Start Manual is to facilitate families in their caregiving journey with interactive early-in-life topics aimed at infant social communication vulnerabilities (6:10). The manual provides supports through family-centered coaching and does not substitute for a diagnosis, fix, or cure. The Infant Start Model can be accessed freely at esdmonline.com/about in the Encouraging Infant Communication and Play Manual (Rogers & Vismara). Free access is for personal use only and should not be posted online. 

What the research says

Research on the efficacy of early-in-life autism supports is still emerging. Studies show mixed results across high (10-15 hrs/week) and low-intensity (0.5 – 3 hrs/week) supports delivered by parents and clinicians. All studies aim to teach caregiving skills for social and joint engagement through play and other activities. Results show improvements in caregiving domains, infant proximal behaviors, and interactive styles for caregivers. In contrast, infant autism domains show minimal changes (13:00). One pilot study of the Infant Start has been published. Overall, caregivers shared positive perspectives on content and delivery techniques, and infant vulnerability around social characteristics diminished over time compared to families that did not participate (11:40). 

Vismara posits that the cumulative benefits of small initial changes in interaction become more apparent over time, meaning the full impact of these interventions cannot yet be measured. However, these studies provide an opportunity to understand the acceptability of these support mechanisms from diverse caregiver perspectives, which will allow for the creation of individualized, culturally aligned support systems (15:00). 

Autism Treatment in the First Year of Life: A Pilot Study of Infant Start, a Parent-Implemented Intervention for Symptomatic Infants (Rogers et al., 2014)

Autistic and autism community perspectives on infant and family support in the first two years of life: Findings from a community consultation survey (Bent et al., 2024)

A Developmental Social Neuroscience Perspective on Infant Autism Interventions (Dawson et al., 2023)

Feasibility and acceptability of a caregiver-mediated early support program, delivered online, for infants at elevated familial likelihood for autism: A feasibility randomized controlled trial (Meera et al., 2024)

The Earlier, the Better? An In-Depth Interview Study on the Ethics of Early Detection with Parents of Children at an Elevated Likelihood for Autism (Jan-Vanaken et al., 2023)

Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis (Hampton et al., 2021)

Efficacy of very early interventions on neurodevelopmental outcomes for infants and toddlers at increased likelihood of or diagnosed with autism: A systematic review and meta-analysis (McGlade et al., 2023)

Parent-Mediated Interventions for Infants under 24 Months at Risk for Autism Spectrum Disorder: A Systematic Review of Randomized Controlled Trials (Law et al., 2022)

Infant learning characteristics

The presenter emphasizes that babies come ready to explore, learn, and respond just as caregivers have intuitive skills to nurture, love, and protect. Both shape and influence the others’ actions, resulting in a communication “dance” of synchronized rhythmic steps and movements. No matter who is leading, both sides must be aware of the other and sensitive to each other’s movements and what they mean (17:55). When there is a “misstep,” the dance may stop, and working to regain that attention and engagement is where the Early Start Manual comes in. Vismara outlines six (6) infant learning characteristics, how they present in infants, and how to strengthen caregiver-baby social interactions. 

Attentional flexibility

Attentional flexibility refers to babies’ ability to pay attention to people, objects, and experiences that they find interesting, even when there are distractions. Babies do this when they pick up and explore objects, move from one toy to the next, watch people doing things, or shift focus when something new is introduced (20:25). Attentional flexibility helps babies gather information, build on their learning experiences, and filter out distractions to stay on task.

The speaker provides play recommendations for supporting attentional flexibility (23:15). She suggests offering toys or materials that encourage exploration and interactive play. Holding pieces to your face and naming or commenting about them before you give them to the baby can help them orient your voice to your face. She suggests helping babies complete goals, adding playful sounds, hand gestures, or body movements to help call attention back to you, and giving babies choices for which objects they want to play with (25:15). 

Object use

Babies are naturally curious about objects, and playing with them allows them to explore, try out new behaviors, express ideas, and receive feedback. Vismara explains that babies develop play through patterns of repeated actions, called schemas, which are constantly changing and overlapping (27:10). During play, she suggests taking turns with the same object(s) to create a back-and-forth dance (baby does, you do – repeat) which encourages skill adoption and lets babies know that you are part of the activity/conversation. It is also helpful to be face-to-face during play, to set up toys and spaces in visually clear ways that are not over-stimulating, and to follow babies’ play before leading with your own (29:10). The speaker provides a resource table with play schema definitions and ideas (31:20).

Prelinguistic development

Vismara explains that baby communication begins with crying, which lets caregivers know the baby is hungry, uncomfortable, or upset. This quickly develops into “talking bodies” communication, where babies use their facial expressions, bodies, actions, and gestures to communicate in many different ways (33:00). We chat back to babies when we name and describe things, hold or point to things, copy sounds and expressions, and add silly sounds, hand gestures, or movements to play routines.

To support prelinguistic development, the speaker again suggests playing face-to-face with the baby and talking about everything. Describe what you are doing as you go through routines and make your own “talking body” stand out to babies with playful sounds and exaggerated facial expressions and movements (34:15). It is important to give babies time to respond and for you to put words to their communication methods (35:35). The presenter shows a resource table with activity ideas for strengthening talking bodies.

 Combined, pragmatic communication

Bundling communication behaviors is a critical step in the infant communication journey. Combining face, body, and voice makes communication more efficient and complex, allowing for information retention, skill expansion, and relationship building. Caregivers naturally encourage bundling when we model back-and-forth conversations with babies. For example, when a baby smiles and makes a sound, a caregiver can comment on what excited them (36:55). Vismara suggests giving babies time to think of what they want to say and going with the communication methods that the baby is naturally using. The speaker suggests starting with any two bundles (voice and body, face and voice, etc.) and being flexible, remembering you can always try again later. She warns against holding out for specific communication bundles and underscores working with the babies’ strengths (39:30). The speaker provides another resource table on encouraging bundling through daily routines. 

Speech

Baby babbling is a universal aspect of early speech development that unfolds across several stages and serves as a stepping stone to first words. Babbling is a continuous string of sounds that express babies’ emotions and desire to talk. They often mimic words and language qualities such as tone, pitch, and accent (42:25). To support speech development, Vismara suggests talking to babies and then pausing for them to listen and respond. It’s essential to interpret the intent of what babies say and to keep the conversation going as long as they wish to babble. Helpful tips include mouthing games, imitating baby, and using props to encourage sounds (44:45). The presenter shares a resource table with activities that encourage baby sounds and potential props that you can use to promote conversations. 

Social attention and engagement

Human beings are born with the need and desire to connect with the people around us. We can see this social-emotional connection through babies’ visual attention to people, desire for attention, and drive to start interactions (47:30). Early signs of the social-emotional journey include turning toward familiar faces, turning away when overwhelmed, following faces or objects, and responding to people in their environment. Caregivers can foster this bonding by pausing an activity to cue a response from the baby. For example, hold out a toy, show the play action, and wait for baby to say, “I like this, do it again” (reach, look, smile, move body, make sound) (50:00). 

The speaker reminds viewers to respect babies’ preferences and that it may take some detective work to find their comfort zone inside activities. It helps to repeat your actions when babies are watching and read their cues for what makes them smile. Tips for finding their comfort zone include changing movement pace, adjusting voice and animation, and moving closer or backing up until they feel comfortable. Once you find their smile, create a predictable routine for setting up the fun and pausing for a reaction from the baby before continuing the action (51:15). 

Tips for baby learning

The presenter reminds viewers to build on babies’ interests and experiences with other ideas only after you can follow their play patterns. Building on their preferences can include showing different ways to play with their favorite toys, increasing interaction, and introducing new toys and songs they may like. She notes that not all ideas are winners on the first try but that bridging their interests with new ideas will create understanding and participation through which their skills can expand. Vismara underscores the importance of active play and urges caregivers to expand their involvement in baby interactions (54:20). 

The speaker reiterates that the Infant Start Model is about supporting families with programs and resources that build off of dynamic, authentic early learning experiences. She asserts the need for researchers, families, and clinicians to think deeply about what early autism care looks like and to listen intently to what families are telling us to create collaborative, culturally-informed strategies (55:41). Vismara provides links to manuals, videos, and other resources as well as an Infant Start workshop for professionals (58:55).

Originally posted on October 8, 2024

Megan MacDonald, Ph.D., and Megan McClelland, Ph.D., discuss emerging research on the relationship between motor skill development and executive function in autism. They define motor skills and executive function, discuss their long-term impact on health and academic success, and consider their co-development during childhood and adolescence. The speakers highlight the importance of EF and motor skills in daily life, underscoring their malleability and potential for learning and building new skills. MacDonald and McClelland consider the effect of cultural contexts on skill development before the Q&A session. 

Handouts are online HERE

In this webinar: 

2:45 – Presentation overview
3:20 – Executive function
6:25 – Motor Skills
9:20 – Motor skills and autism
13:30 – Motor skill development
19:00 – Executive function and motor skills
22:20 – Cultural contexts
28:13 – Conclusions
30:20 – Q&A

Executive function

McClelland defines executive function (EF) as cognitive processes/skills like attention, working memory, and inhibitory control that lay the foundation for self-regulation (3:20). She explains that EF skills have emerged as a key indicator for a variety of short and long-term behaviors, including social competence in children and academic success throughout adolescents and early adulthood (4:55). She notes a recent publication that found that children with strong attention/persistence at age four had nearly 50% greater odds of completing university by age 25, underscoring long-term health, educational, and employment outcomes associated with EF (6:10). 

• Self-regulation in childhood as a predictor of future outcomes: A meta-analytic review. (Robson et al., 2020)
• Predictors of early growth in academic achievement: the head-toes-knees-shoulders task (McClelland et al., 2013)

Motor skills

MacDonald discusses gross motor skills, highlighting their importance for everyday activities like walking, running, lifting, and throwing. Both EF and motor skills are foundational for learning and early development, and children begin to have a core set of motor skills between seven and eleven years old (6:25). The speaker relates motor skills to a mountain of motor development, where each level builds on top of the last (8:15). Fine motor skills involve coordinating perceptions with motor movements (visuomotor integration), allowing us to control handwriting, buttoning shirts, drawing, and coloring in the lines. Visuomotor integration has also been linked to children’s academic success (8:25). 

Motor skills in autism

The presenter briefly reviews key autistic characteristics and prevalence rates, highlighting the role of gross motor skills in social and physical development during childhood (9:20). She cites references to motor skill deficits dating back to the first descriptions of autism. MacDonald explains that early delays in motor development milestones (i.e., walking and crawling) are common in autistic children and that parents/caregivers may start noticing delays between fourteen and twenty-four months (10:50). Motor skills used by school-aged children are different and center around social interactions and sports (12:48). 

• Developing together: The role of executive function and motor skills in children’s early academic lives. (McClelland & Cameron, 2019)
• Fine motor skills and early comprehension of the world: two new school readiness indicators (Grissmer et al., 2010)
• Fine Motor Skills and Executive Function Both Contribute to Kindergarten Achievement (Cameron et al., 2012)

Motor skill development

MacDonald outlines one of her publications on gross motor development across the first three years of life in autistic children (13:30). Gross motor skill development for autistic children showed consistent delays at each check-up, with children being nearly one year behind expected development targets by age three (14:15). Similarly findings for fine motor skill development in autistic children was slightly more than one year behind expected development by age three (15:15). Another study on school-aged children found that kids between ten and twelve years old were chronologically about half their age in terms of motor skill development (16:05). Therefore, the speaker asserts that gross and fine motor skill development in autism is delayed in autism from early life at least through childhood. 

Despite these delays, the speaker remains hopeful and iterates to viewers that motor skills are incredibly malleable and can be taught and improved with time (17:15). McClelland cites accumulating research suggesting that EF skills are a vital buffer/protective factor for children experiencing early risk factors. She reiterates that EF and motor skills are highly malleable and that we can do a lot to improve these aspects of development in autistic children (18:00). 

• Motor skills of toddlers with autism spectrum disorders (Lloyd et al., 2013)
• Fundamental Movement Skills and Autism Spectrum Disorders (Staples & Reid, 2010)
• School Readiness and Self-Regulation: A Developmental Psychobiological Approach (Blair & Raver, 2015)
• Relations between early family risk, children’s behavioral regulation, and academic achievement (Sektnan et al., 2010)
• Developing together: The role of executive function and motor skills in children’s early academic lives. (McClelland & Cameron, 2019)

Executive function and motor skills

McClelland discusses contemporary evidence suggesting the co-development of EF and motor skills in young children. She explains that some brain regions are involved in both EF and motor skill development, and certain EF traits (e.g., memory and inhibitory control) are related to fine motor skills (19:00). McDonald notes that, until very recently, motor skills and EF were studied independently. She highlights contemporary collaborative research and its importance in understanding autism (20:50). 

• Behavioral self-regulation and executive function both predict visuomotor skills and early academic achievement (Becker et al., 2014)
• Visuomotor integration and inhibitory control compensate for each other in school readiness (Cameron et al., 2015)
• Exercise improves executive function and achievement and alters brain activation in overweight children: A randomized, controlled trial (Davis et al., 2010)
• Prefrontal cortex development and development of cognitive functions (Diamond, 2000)
• Relations of Preschoolers’ Visual-Motor and Object Manipulation Skills With Executive Function and Social Behavior (MacDonald et al., 2016)

Cultural contexts

McDonald states that fine motor skills are associated with cognitive flexibility but that much of the research is based in the U.S. or other Western countries (22:20). A recent study found that Chinese children exhibit better fine motor skill performance while U.S. students have better object control skills (23:00). Similarly, gross motor skills of pre-schoolers in China were significantly lower than pre-schoolers in the U.S. Such findings, the speaker asserts, suggest that different cultures emphasize different skill sets in early life (fine vs gross) (24:15). 

The speaker outlines a recent survey study on EF and motor skills in autistic children from Taiwan and the U.S. (24:45). She outlines data collection and analysis methods, including regressions and covariates (26:10). Results show that motor skills are associated with EF across countries. Further, the relationship between EF and motor skills is culturally comparable, with significant and positive correlations of magnitude in both countries. She asserts that this preliminary evidence suggests the relationship between EF and motor skills is not specific to region or culture (27:15). 

• Association between motor skills and executive function of children with autism spectrum disorder in Taiwan and the United States (Sung et al., 2024)

Conclusions

McClellan reviews the presentation, highlighting that EF and motor skills contribute to healthy development and academic success for children from diverse backgrounds. She reiterates the malleability of these skills and their importance for daily activities. The speaker considers how improvements in EF may impact motor skills and vice versa (28:13). She gives thanks and acknowledgments before the Q&A, where the presenters discuss the impact of COVID on EF, intervention options, monitoring EF supports in daily life, the importance of routine and planning, and much more (30:20). 

Originally published on May 7, 2024

Dr. Gray Atherton, Ph.D., explores the connection between autism and anthropomorphism. She provides a brief historical and social context for anthropomorphism in our daily lives before diving into the prevalence and advantages of anthropomorphism in autism. The speaker details recent studies that challenge prevalent theories about socialization, Theory of Mind, and anthropomorphism in autism. Atherton asserts that many autistic people use anthropomorphism prolifically in everyday life and often outperform their non-autistic peers in this aspect of Theory of Mind. The presenter highlights anthropomorphism as a strength for many autistic individuals and suggests using it to support learning and interventions for autism. 

Handouts are online (.pdf) HERE

In this webinar:

1:58 – What is anthropomorphism?
5:00 – Importance of anthropomorphism
8:05 – Autism and anthropomorphism
10:00 – Social Motivation Theory of Autism
14:00 – Study 1: Theory of mind processes in autistic adolescents
18:50 – Study 2: Review of studies with anthropomorphic stimuli
23:45 – Study 3: Reading the Mind in the Eyes Test – anthropomorphized
29:00 – Study 4: Intellectual disability and emotion recognition
32:25 – Study 5: Verbal anthropomorphism and theory of mind
35:30 – Study 6: Pets and anthropomorphism in everyday life
39:50 – Recap
41:30 – Flip the narrative
46:00 – Applications and interventions
48:20 – Q & A session

History and importance of anthropomorphism

Atherton defines anthropomorphism as the attribution of human-like qualities, emotions, or behaviors to non-human entities, such as animals or objects (1:58). Examples of anthropomorphism are seen throughout history in our deities and legends, who often assume human characteristics. The speaker explains the importance of anthropomorphism in religion, connection, and socialization. She explains that wanting to understand something that isn’t human drives us to anthropomorphize and highlights that anthropomorphism is frequently related to loneliness (5:00). Atherton touches on the presence of anthropomorphism in childhood media and notes its increasing use in contemporary care work and technology (6:25). 

Autism and Anthropomorphism

The presenter discusses the Social Motivation Theory of Autism and outlines publications supporting the claim that autistic people are less socially motivated than their peers (9:00). Theory of Mind (ToM), or the capacity to ascribe emotions to other people based on facial expressions and personal characteristics, is closely related to anthropomorphism. Atherton outlines a study that tested ToM in relation to a video of moving shapes. Results showed that non-autistic respondents used human-like adjectives to describe the shape interactions, while autistic participants used more concrete descriptives and less mental state language (10:56). Given the contrast in responses, researchers concluded that autistic people have lower ToM and are less likely to anthropomorphize or use human-like descriptors. Atherton describes her own professional experiences with autistic individuals as totally contrary to these assumptions and asserts the need for further exploration into ToM and autism (12:10). 

Study 1: Theory of Mind processes in autistic adolescents 

To explore the Theory of Mind experiences of autistic adolescents, the speaker conducted an open-response interview and interpretive phenomenological analysis (14:00). The study revealed four overarching themes concerning how autistic people engage with ToM processes: honesty, humor, visualization, and anthropomorphism (15:00). Atherton presents sub-themes and quotes from participants that reflect their prolific use of anthropomorphism in daily life. She asserts that these findings challenge accepted notions that autistic people have low ToM and social motivation (17:23). 

Study 2: Review of investigations with anthropomorphic stimuli

Although anthropomorphism isn’t often explicitly studied, many investigations use anthropomorphic stimuli as a control in comparative studies (18:50). In reviewing such studies, the speaker found that autistic individuals perform significantly better on ToM tests when the stimuli are non-human instead of human (20:00). She outlines three publications that revealed:

1. Autistic people prefer anthropomorphized images over human ones.
2. Autistic people actually have an advantage in this area of ToM compared to their non-autistic peers.
3. This advantage may have to do with the expertise or familiarity that autistic people have with non-human social agents (22:30). 

Study 3: Reading the Mind in the Eyes test – anthropomorphized

Reading the Mind in the Eyes test (RME) is a classic ToM exercise where participants determine emotions based on photos of a person’s eyes. Atherton and colleagues created a cartoon (anthropomorphic) version of the RME and compared autistic and non-autistic group responses for both versions (23:45). Results showed that the non-autistic group had higher success on the human RME test but that the autistic participants outperformed their counterparts on the cartoon test (27:00). These results, the presenter posits, suggest that anthropomorphism may be a strength for autistic individuals, further challenging the preconceived notions that autistic people have low ToM and emotion recognition capabilities.

Study 4: Intellectual disability and emotion recognition

Around 40% of autistic individuals also have some co-occurring intellectual disability, and many are non-verbal. Atherton explains how communication barriers often exclude this part of the autistic community from research participation (28:00). She outlines a recent study that took these differences into account and assessed whether the prolific use of anthropomorphism revealed in previous studies defines the entire autism spectrum (29:00). Researchers used a combination of human faces and animal face filters to test ToM. They found a significant increase in correct answers for the photos with animal filters on them, suggesting participants better understand anthropomorphized stimuli compared to human faces (31:20). The presenter discusses study limitations, noting the aspect of visual salience. 

Study 5: Verbal anthropomorphism and theory of mind

To see if anthropomorphism extends beyond visual context, Atherton and colleagues used a verbal ToM Faux Pas test (32:25). They tested participants’ ability to determine whether someone said something awkward in both human and anthropomorphized stories provided in text. Similar results to previous studies were found: autistic people struggled with human-based wording but performed at the same level as, if not better than, the non-autistic group with anthropomorphized stories (34:00). Atherton asserts that these findings suggest anthropomorphism may play a critical role in how autistic people engage in perspective-taking and conceptualize ToM. 

Study 6: Pets and anthropomorphism in everyday life

As human beings, we often anthropomorphize our pets to relate to them and create connections. Atherton describes a study on differences between autistic and non-autistic groups in their anthropomorphism of pets. Results showed that the autistic group was equally attached to their pets and used similar amounts of anthropomorphism as their non-autistic counterparts. Interestingly, the presenter states, Autism Quotient scores correlated with anthropomorphism and autistic people were more likely to substitute pets for people (mediated by social avoidance) (35:30). Interpretive phenomenological analysis of 16 interviews with autistic pet owners showed that pets can often act as a social alternative and/or a social lubricant. Participants frequently noted that with animals, “you don’t have to wear a mask – they don’t know what social rules you may be breaking” (37:15). 

Atherton states that these real-life examples show how autistic individuals intentionally create anthropomorphic connections to compensate for social deficits or avoidance. These intentional connections manifest in various ways, from donating to animal charities to becoming a cat behaviorist. The speaker asserts that we need to understand anthropomorphism as a strength and something that autistic people may be particularly good at. Perhaps, she continues, they are engaging with and becoming experts in anthropomorphism because it’s a way to have connections that don’t feel judgmental or forced (39:00). 

The big picture

The speaker summarizes the presentation, highlighting that evidence suggests autistic people anthropomorphize at least to the same degree as their non-autistic peers and that anthropomorphism may play a role in the way autistic people conceptualize or engage in ToM and perspective-taking (39:50). She presents a diagram of the Social Motivation Theory and suggests that we flip the narrative. Instead of saying autistic people have decreased human/social motivation or recognition, we can say they have increased non-human attention to faces and understand non-humans much more (41:30). 

The presenter notes that anthropomorphism may vary across developmental stages and cites a multi-age study where anthropomorphism decreased with age (44:15). She suggests leveraging anthropomorphic stimuli, like cartoons, in educational and therapeutic settings with autistic individuals. For example, a pilot study using Hololens glasses is underway, which could allow for more meaningful interactions using anthropomorphism and digital projections (46:00). Atherton invites viewers to share their real-life experiences with anthropomorphism and provides her contact information (47:15) before beginning the Q & A session (48:20)

Dr. Rajesh Kana considers the intersection of language comprehension, neuroplasticity, and autism interventions. He discusses contemporary research illustrating distinct patterns in autistic brain activity and underscores the importance of neuroplasticity in everyday life. The speaker examines brain connectivity and its relation to language comprehension and behavior. Kana details an ongoing reading intervention study and analyzes preliminary data that show significant improvements in reading and language comprehension for autistic participants. He provides thanks and acknowledgments before the Q&A.

Handouts are online HERE

In this webinar: 

0:45 – Conflict of interest
1:25 – Overview
2:10 – Introduction
5:30 – Descriptions of language and communication in autism
7:50 – Joint attention
10:30 – Difficult components of reading comprehension
13:35 – Brain, language & reading comprehension in autism
15:30 – Brain activity in autism
21:05 – Theory of mind and language comprehension
23:26 – Targeting brain plasticity in autism
25:05 – History and significance of neuroplasticity
30:25 – Neuroplasticity and reading comprehension
35:18 – Using reading intervention to change the brain
39:55 – Ongoing study: imagery reading intervention for language comprehension in autism
41:58 – Preliminary data trends
46:30 – Brain level changes and connectivity
51:40 – Summary and acknowledgments
54:05 – Q&A

Descriptions of language and communication in autism

Kana describes language and communication difficulties in autism and how they translate into social differences in everyday life (2:55). Descriptors of autistic communication within the literature include early language delays, atypical features (e.g., echolalia and jargon), failure to acquire spoken language across the lifespan, and discourse processing difficulties (5:30). The speaker lists conditions that commonly co-occur with language processing difficulties, emphasizing that these conditions often exacerbate obstacles to language comprehension (6:50). 

The presenter outlines a study that found that word comprehension plays a significant role in joint attention and that joint attention is critical to early language development (7:50). Two other studies suggest autistic children have strong decoding skills (11:30) but low language comprehension (9:15). Many components of reading comprehension, Kana explains, can be difficult for autistic children. Therefore, understanding how co-occurring conditions contribute to language and communication challenges is critical to implementing successful interventions (10:30). 

Brain, language, & reading comprehension in autism

Multiple studies on brain response to auditory word stimulations report higher activation of the right brain hemisphere (Wenicke’s area) in autistic groups compared to non-autistic controls (13:50) These findings, Kana continues, are supported by a recent meta-analysis, which also found lower activity in the left brain hemisphere (Broca’s area) of autistic participants compared to their non-autistic counterparts (18:10). The speaker asserts that these data show a distinct pattern of brain activity in autistic individuals.  

Sentence imagery findings indicate that autistic participants also have higher visual-spatial activation compared to controls, further evidencing that autistic people tend to be visually oriented (19:15). Kana cites a study that showed significant overlap in Theory of Mind and pragmatic (social) language processes between autistic and non-autistic groups. The study also found reduced activity in social cognitive networks in autistic groups compared to controls (21:05). These patterns in autistic brain activity can inform our general understanding and assessments of language and reading comprehension in autism (22:12). 

Targeting neuroplasticity in autism

The speaker uses the invention and development of reading to illustrate the human brain’s plasticity and capacity to learn (22:37). He reviews early brain plasticity studies (25:05) and explains how the discovery that new neurons can appear in the adult brain massively shifted our understanding of neuroplasticity (27:40). Kana describes differences in the brain structures of London taxi drivers (28:44) and meditative monks (29:50), highlighting the importance of brain plasticity in our everyday lives. Two studies on brain imagery and reading interventions in dyslexic children found changes in reading comprehension (30:25) and increased grey matter volume in participants following reading comprehension interventions (31:49). Kana ponders the creation and adoption of language, underlining the human brain’s capacity for change and how that can apply to evidence-based interventions (33:05). 

Using reading intervention to change the brain

The presenter describes an ongoing reading comprehension intervention trial, detailing study procedures (35:40), assessment protocol (38:00), and the Visualizing and Verbalizing for Language Comprehension and Thinking (V/V) Intervention Program (39:55). Preliminary data show significant improvement in comprehension skills for autistic participants (41:58) and that social cognition (43:40) and verbal working memory (45:15) may predict language comprehension. 

Kana discusses regional brain interactions (brain connectivity) and their use as a measure of changes in brain activity (47:55). Data from the ongoing reading comprehension study show (to this point) significant increases in local (51:00) and regional (49:00) brain connectivity, specifically between Broca’s and Wernicke’s areas. He notes that changes in connectivity are correlated to behavior function and advances in comprehension (49:40). These preliminary findings, the presenter asserts, provide an exciting peek at the potential of reading interventions in autism. 

The speaker summarizes initial data findings, highlighting the significant increases in comprehension following a reading intervention and how those changes are related to brain connectivity and neuroplasticity (51:40). He reiterates the parameters of the ongoing trial and provides information for interested participants (52:30) before the Q&A (54:05). 

Karen Heffler, MD, takes viewers on a comprehensive exploration of the relationship between early-life screen time exposure and autism risk. She delves into the intricate interplay of genetics, environmental factors, and development outcomes. The presentation highlights critical findings about screen time, social engagement, and autism symptoms. Heffler considers the potential consequences of screen media on young children’s development and discusses promising new intervention studies.

Printable handouts of the slides (pdf) are online HERE

A list of references from the talk (pdf) are online HERE

In this webinar: 

0:00 – Presenter introduction
3:40 – Background and positive developmental predictors
7:30 – Screen time and social experiences
9:20 – Video and television learning (Video deficit)
11:55 – Developmental outcome associated with early TV/Screen media viewing
13:25 – Brain differences in autism
16:48 – Brain plasticity, social development, and screen time
18:34 – Autism risk factors
21:35 – Study 1 – Association of early-life social and digital media experiences with the development of ASD-like symptoms
26:50 – Study strengths and limitations
28:20 – Literature review on early-life screen time and autism association studies
29:56 – Study 2 – Screen media and social intervention in autism: a 6-month pilot study
36:30 – Study strengths and limitations
37:54 – Literature review on intervention studies
39:12 – Case reports of interest
41:46 – Drivers and mechanisms of association of early-life screen time with autism
43:53 – Summary and next steps
45:45 – Q & A

Background

Autism risk is affected by both genetics and modifiable environmental factors such as verbal stimulation, parental responsiveness, and parental involvement in play (3:42). These factors have been linked to positive developmental and social outcomes, emphasizing the importance of early nurturing experiences (5:25). Conversely, Heffler explains, screen media is related to diminished parental responsiveness, hindered language development, and less toy play, all of which may contribute to adverse developmental outcomes (7:30). 

As defined in this presentation, screen time encompasses TV, video, gaming, mobile apps with viewing on tablets or smartphones, and some electronic toys. The presenter highlights that video chatting with family and friends is social and considered differently (20:55). Research indicates that children do not learn well from screens as pre-recorded videos are not socially responsive to the child’s actions. Some developmental outcomes associated with early TV/screen media viewing include language delay, attention problems, executive function difficulties, and disorganization in the white matter of the brain (11:55). Joint attention, or when a child looks back and forth between an adult’s eyes and an object of interest, does predict learning (9:20). 

Brain development and plasticity

The presenter discusses differences in autistic brains and underscores the high correlation between superior auditory and visual processing abilities and autism. She notes, however, that this does not necessarily convey good overall brain function (13:20). Some abilities have been linked to autism symptom severity, and other developmental differences predict whole brain overgrowth and/or autism development (15:16). 

Brain plasticity is how the brain responds to one’s experiences, and brain connections are formed based on those experiences and responses. Social factors like eyes, voices, and smiles naturally react to young children and promote the development of social brain pathways. Contrastingly, non-social factors, like screens and electronics, likely promote highly sensory-oriented brain connectivity due to their lack of natural social features (16:48).  

Risk factors and recommendations

Heffler outlines a study that found early-life social experiences and early-life screen time are two important risk factors for autism. The study found that infants with autism traits who were exposed to both screen time and social training from their parents are less likely to develop autism (18:34). She explains that high-screen viewing is concerning in early life because electronic media distracts the child from people and distracts the parents/caregivers from the child, both of which may directly affect brain connectivity and attention mechanisms in autism. Heffler and her colleagues recommend no screen viewing before 18-24 months of age and no more than one hour of screen time per day through age five (20:20).

Drexel Studies

Study 1: Association of early-life social and digital media experiences with the development of ASD-like symptoms 

Using parental report data from the National Children’s Study, researchers investigated the association between TV/DVD exposure and social experiences on autism symptoms. Findings suggested that higher screen time (4 or more hours per day) correlated with an increased risk of autism symptoms at 12 months and two years of age and that autistic children reported more screen time (21:35). Researchers also found that when parents play with the child less than daily at 12 months, there was an 8.9% increase in autism symptoms. Screen exposure at 12 months was also associated with a 4.2% increase (24:15).

Study 2: A literature review on early-life screentime and autism association studies

Heffler defines the parameters of the literature review and discusses critical findings: Greater daily screentime was associated with autism diagnosis (9 studies), autism symptoms (7 studies), and symptom severity (4 studies). Similarly, earlier first screen-viewing was associated with autism diagnosis and symptoms, and less parent-child interaction was also associated with autism risk and severity (28:20). 

Study 3 – Screen media and social intervention in autism: a 6-month pilot study

In collaboration with Lori Frome, Dr. Heffler developed a parent training program to reduce screen time and enhance social engagement, particularly for young children with autism and high media exposure (29:56). The program was implemented over six months and included instruction on digital media and child development, parent-child interactions, and poor screen learning. Parents received weekly, 1-hour, in-home support and were encouraged to involve children in family routines like laundry and cleaning to support social and learning development (32:05). 

Results showed a significant reduction in screen time, from 5.6 hours per day to five minutes a day, over six months. There was also a 23% reduction in core autism symptoms and a 19% increase in adaptive behavior function (did not quite reach significance) (34:20). Parental stress declined by 37% (large effect size), and positive feedback indicated awareness and improvements in social and developmental outcomes. Heffler notes that changes in child behavior began almost immediately, which made it easier for parents to cut screen time and interact with their children (36:00). 

Study 4: A literature review on intervention studies

This review considered six studies, five of which included parent training on social engagement and screen time reduction; these five studies pointed to a correlation between reducing screen time to less than one hour per day and a statistically significant decrease in autism symptoms. Similarly, more than one hour of screen time per day negatively affected therapeutic outcomes. Overall, improvement correlated with screen time reduction, parent stress was significantly improved, and in one study, EEG patterns also improved (37:54). 

The speaker discusses the strengths and limitations of each study.

Case reports and summary

The speaker outlines three case reports that further demonstrate the positive impact of minimizing screentime during early development, including one where autism symptoms entirely resolved in 4 months after eliminating screens (39:12). Heffler reiterates the potential impact of reduced screentime on autism symptom development and lists driving factors and mechanisms of this association (41:46). The speaker highlights the difference between association and causation, noting that all studies presented show associations. 

She summarizes the presentation by reiterating the main findings and suggestions:

• More screen time in the first year of life is associated with the development of autism and autism symptoms. 
• Early-life parent-child social engagement is associated with a decreased risk of autism development.
• Interventions, including screen time reduction and parental support for social engagement, are associated with a rapid decrease in autism symptoms in children with high screen viewing.

Researchers assert the need for randomized controlled trials, measures of gene-environment interactions, and community-based parent education studies in the future (44:58). Heffler also urges viewers to help raise awareness of these findings among parents of young children and across healthcare providers, government agencies, and everyone in between. She provides thanks before the Q&A (45:45). 

Giacomo Vivanti, Ph.D., dives into the complexities of establishing evidence-based autism interventions. He describes the ever-changing state of intervention literature, noting that autistic individuals still experience health inequalities. The speaker discusses four aspects of the interplay between research and practice and details studies demonstrating each assertion. Vivanti calls for universal outcome metrics based on well-being and considers how behavioral therapies can impact core autism symptoms (i.e., communication). The presenter asserts the usefulness of public health frameworks in assessing disparities between research and practice. He summarizes the presentation before the Q&A.

Take the knowledge quiz for this webinar HERE

In this webinar: 

1:15 – Individual evidence-based care
2:50 – Landscape of autism early interventions
4:55 – Health inequities for autistic individuals
6:45 – Study: Early onset dementia in autism
9:00 – Interplay of science and information dissemination
11:40 – Issue 1: The gap between research and practice
13:30 – Study: Treatment fidelity impact on skill acquisition
16:23 – Community implementation
19:00 – Community-partnered participatory research (CPPR)|
20:02 – Issue 2: Disagreements on what counts as evidence
24:15 – Study: Behavior analysts’ knowledge on naturalistic strategies
27:10 – Issue 3: Disagreements on conceptual categories
28:15 – Study: Meta-analysis of ABA treatments
29:55 – U.S. state insurance coverage
32:47 – Issue 4: Disagreement on intervention goals
37:05 – Complexity of well-being and autism symptoms
40:00 – Study: Consensus on target mechanisms
42:53 – Study: Inclusive vs autism-specific classroom learning opportunities
46:05 – Conclusions
48:20 – Q&A

Introduction

More research on autism early interventions has been published in the last three years than over the previous four decades combined (2:50). Vivanti explains that while the quality of early interventions has increased substantially, our knowledge is still rapidly evolving (4:05). Despite this, autistic individuals continue to experience health inequalities that lead to preventable adverse outcomes associated with mental and physical health, self-realization and self-determination, community participation, and educational opportunities (4:55). The presenter cites a study that found the chance of early onset dementia (Alzheimer’s) in autistic individuals is double that of the non-autistic population. He posits that this is due to the continued lack of cognitive, social, and educational support for autistic adults (6:45). Vivanti specifies four complexities of establishing evidence-based interventions:

# 1 – The gap between research and practice

The speaker recalls that his mother was blamed for his brother’s autism diagnosis in the 1990s, even though “cold parenting” had been disproven in the 1960s (9:00). Therefore, he continues, the first main issue in establishing evidence-based interventions is the gap between research and practice (11:40). The speaker explains how intervention procedures in community settings are often different from the procedures used in clinical trials (11:40). Vivanti details a study that assessed the association between outcomes of the Early Start Denver Model (ESDM) and intervention fidelity (adherence) to clinical implementation. Researchers found a lot of implementation variation not only across practitioners but also across patients of each practitioner (13:30). Children with the best outcomes were treated by therapists implementing interventions at higher fidelity (15:35). The presenter considers feasibility and philosophical commitments as reasons for such variations in community implementation (16:23). He underscores that procedures should be flexible to the individuals but rigorous as well. The speaker highlights community-partnered participatory research (CPPR) (19:00). 

# 2 – Disagreements about what counts as evidence

Vivanit explains that practitioners rely on information from different agencies and reviews that analyze the literature. However, each agency/review adheres to its own guidelines and criteria for what qualifies as evidenced-based (e.g., randomized trial vs. single subject design) (20:02). Different agencies therefore come to different conclusions about evidence-based interventions. Such confusion around facts makes clinicians and caregivers hesitant to adopt new interventions, despite documented effectiveness (23:05). The speaker outlines a survey study of 901 board-certified behavior analysts’ knowledge of naturalistic developmental behavioral interventions (NDBI). Although significant evidence supports NDBI efficacy, few participants believed these practices were effective or appropriate (24:15). 

# 3 – Disagreements on conceptual categories

Review agencies generally classify interventions according to conceptual categories like ABA, NDBI, CBT, etc. Vivanti explains that, again, arbitrary criteria for each category result in different recommendations for the evidence-based status of interventions across agencies (27:10). He outlines a meta-analysis of ABA-based interventions that found ABA therapies in various categories in several meta-analyses and reviews (28:15). Most states in the U.S., he continues, have an insurance coverage mandate for autism that specifically mentions ABA. Although providers are often willing to incorporate new evidence-based practices like the ESDM, insurance companies frequently refuse treatments if they are not identified as ABA (29:55). Therefore, many natural-based models are not provided, thus highlighting the extremely practical consequences of conceptual disagreements (31:50). 

# 4 – Disagreements on intervention goals

Vivanti asserts that “any consensus of what to do must be based on a consensus of why we are doing it.” He remembers thinking that the goals for his brother’s interventions ought to be based on safety and support in daily environments and activities (32:47). However, intervention goals are highly debated, which leads patients/users to assume interventions prioritize conformity and compliance at the expense of neurodiversity and individualized care. The speaker asserts that this lack of a universal metric for “successful outcomes” keeps service providers from being able to specifically communicate what they want to achieve (34:00). He underscores using language and concepts based on freedom from distress, community participation, and well-being across the lifetime (37:05). Vivanti and his colleagues tried to generate a consensus on legitimate aspects of effective interventions that are respectful to the diversity and uniqueness of children but also rigorously empower individuals. Researchers found that interventions informed by this model emphasize agency, learning through positive interactions, engagement in novel and familiar schemas, and an interplay of comfort and challenge (40:00). Another study found that autistic children with more social attention had better outcomes in inclusive classrooms compared to autism-specific classrooms (42:53). Such findings underscore the importance of rigorous individualized interventions.

Conclusion

The speaker emphasizes that knowledge of evidence-based interventions is advancing at an unprecedented pace. However, autistic people still experience healthcare differences. This is due to the complex interplay of research and practice. Key factors include disagreements about what counts as evidence, behavioral interventions, and intervention goals. These and other factors impacting implementation and adoption must be scientifically addressed and researched. Vivanti highlights that a public health framework can help examine these factors and contextualize challenges and opportunities associated with autism in the broader context of research and practice (46:05). The speaker provides thanks and resources before the Q&A, where he discusses recommended interventions, various treatment concepts, how behavioral education programs impact autism neural structure, and much more (48:20).