#JHFA Intern Research

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Article Summary: Hyperacusis in Autism Spectrum Disorders

Written by Kevin Bandel

Hyperacusis is the condition in which sounds which are not considered threatening or uncomfortable to most are perceived as intolerable. These reactions are to sound in general rather than a dislike of particular sounds. This report explores the prevalence of hyperacusis in the autistic population, the etiology (study of a condition’s causes) of hyperacusis in autism, and possible symptom management.

The exact cause of hyperacusis is unknown, but there are theories about what may increase its likelihood. One theory is that there is an increased synchronization between the auditory cortex and neurons that typically respond to loud sounds, which means the neurons would activate from lower intensity sounds. Another theory is an alteration between the limbic system (part of the brain responsible for emotional responses) or the auditory pathway. In observing those with hyperacusis, scientists have used Magnetic Resonance Imaging (MRI) on these subjects and detected elevated auditory activity in the midbrain, thalamus, and cortex.

While it is suspected that a significant portion of the autistic population experiences hyperacusis, studies have been inconsistent on how widespread it is. In 1999, one study reported an 18% prevalence for hyperacusis in children and adolescents with autism. Another study conducted in 2016 reported an increased sound sensitivity in 37% of the autistic children and adolescents it observed. The highest rate of hyperacusis was from a study in 2015, which tested autistic individuals ages 4 to 42, found that 69% of the participants were in the reported hyperacusis range.

Despite how large and inconsistent the estimated of range of hyperacusis in autistic individuals, a range of 18%-69% is a noticeable difference from the general population that possibly has hyperacusis, which is 3.2% to 17.1% The other important factor was of a study of 61 children with hyperacusis, 46% of them had a concurrent neurodevelopmental condition, with the most common being autism. The prevalence of concurrent autism and hyperacusis was likely influenced by autism influencing differences in sensory processing.

The article recommended three approaches to managing hyperacusis. One was habituation training, which involves playing a list of sounds the patient finds bothersome at a low level, with a gradual increase to the volume each week. Another was Cognitive Behavioral Therapy (CBT), which attempts to reframe a patient’s negative thoughts and behaviors. The last one was Auditory Integration Training (AIT), which plays an audio recording that filters out the sounds that the subject finds most intolerable, adding them back into the recording at a slow increase in volume. Of the three approaches, the article provided studies that Auditory Integration Training was the least supported in its effectiveness of dealing with hyperacusis.

An issue in assessing and coping with hyperacusis is the difficulty to measure and define it. Since it is a combination of both sound sensitivity and personal experience, studies would need to account for both dimensions of the condition. Subjective emotions are very challenging to measure precisely, but are a crucial part of hyperacusis since one’s perspective of sounds affects how much one can tolerate them.

While much is undetermined about hyperacusis, it appears to explain and conceptualize struggles that many autistic people face, especially since pursuing music involves a high exposure to sound.

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Article Summary: Sweet spot in music—Is predictability preferred among persons with psychotic-like experiences or autistic traits?

 Written by Kevin Bandel

(Note: Just because “psychotic-like experiences” and autism are used in the same sentence, it does not mean they are similar. For example, the sentence, “Dangerous psychopaths and morally upstanding people need water to survive,” does not mean that dangerous psychopaths and morally upstanding people are comparable in most ways.  Furthermore, having a psychosis does not make a person “bad.”)

It is often assumed that music listeners prefer a balance of predictability. The ideal is that music is not so predictable that it becomes uninteresting, but not so unpredictable that it is jarring and incomprehensible. Individuals can vary in how they perceive a specific level of predictability. Some may find a piece of music monotonous; some may find the same piece chaotic, and others may have an opinion in between.

The authors of this article wondered if psychosis or autism would influence the amount of preferred predictability in their musical taste. Some symptoms of psychosis include paranoid ideas and difficulty telling reality from fantasy, which often leads to increased distress in unpredictable situations and an increased comfort with the familiar. Autistic people tend to experience heightened emotional arousal from the less known and may specialize in areas they are most focused on, which may also lead to an inclination toward a more consistent and regular lifestyle. The authors of this article were curious to see if these general behaviors applied to musical taste.

However, there are factors that can influence preferences to predictability in music outside of psychosis or autism. Individuals may be exposed to certain types of music most frequently, which may establish the baseline of predictability in music a person uses. Pieces often have conventions that can be observed across other pieces of the same genre, which would increase the level of perceived predictability for those familiar with a specific genre.

321 participants with either autism or psychosis were recruited from Prolific.co (a website designed to connect researchers and participants) and the Arctic University of Norway. The average years of music training (either formal or self-taught) was 5.69 with a standard deviation of 7.6. Participants rated various music excerpts on a scale of 0 (disliked very much) to 100 (liked very much). A panel of 8 music experts measured predictability of each excerpt and gave them a 1-10 rating, with 1 being the most predictable/least complex and 10 being the most difficult to anticipate/most complex. The average of the participants’ enjoyment of the excerpts was compared to the complexity score that the panel of experts gave the music.

A limitation of the study is that it did not measure the perceived predictability of the participants, only their enjoyment. Perceived predictability and enjoyment could be linked. Furthermore, age was not linked to participant responses to preserve anonymity. Age could impact both perceived predictability and enjoyment. With all aspects of the study considered, the authors concluded while research in the area is incomplete, there was insufficient evidence to suggest autism or psychosis affected the “sweet spot” for preferred predictability in music.

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Research Summary of the Article: Impacts of using a social robot to teach music to children with low-functioning autism

Written by: Lawrence Lynn

Keywords:

Autism: a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication

Music education: a field of practice in which educators are trained for careers as elementary or secondary music teachers. It is also a research area in which scholars research on ways of teaching and learning music. It touches on learning domains such as: development of skills, acquisition of knowledge, and learner's willingness to receive, internalise, and share what is learned.

Social Robot: an artificial intelligence system that is designed to interact with humans and other robots

Why are they doing this? What are they trying to find out?

The researchers were exploring the "impact of conducting robot-assisted music-based intervention sessions for children with low-functioning (LF) autism." As a continuation of their previous work, “Teaching music to children with autism: a social robotics challenge,” this particular study takes places focus on low-functioning autistic individuals as the previous work's focal point was, coincidentally, high-functioning (HF) autistic individuals. They in particular wanted to answer 3 research questions:

Does a teacher-assistant humanoid robot have the ability to teach music rhythms and notes to children with LF autism?

Does a robot assisted music-based education have an impact on the social and cognitive skills of children with LF autism?

Can robot-assisted interventions affect the stress levels of the LF participants' parents during music-education classes?

Additionally, they also wanted to do a comparison on the results of this test as to their previous work

What is the hypothesis? How did they do this?

Their hypothesis was that, when applied assisting a human therapist, the social robot could positively impact children with LF autism in the areas of music learning as well as their social and cognitive skills. Additionally, as observed by their previous study, the robot could reduce the stress levels of the LF participants' parents during the music education classes.

What did they do?

4 low functioning autistic children participated in a 22 week program that had several phases including one session of Baseline (Week #1), a Pre-Test (Week #6 before starting the first music intervention session), nine robot-assisted music-based educational sessions (Weeks #6–14), a Post-Test (Week #14 after the last music session), and a Follow-up Test (Week #22, 2 months after the last session). A drum/xylophone playing robot, along with a present and highly engaged human teacher, is used to teach basic concepts of how to play the instruments to four participants with LF autism during nine educational 20-30 minute sessions. Throughout the study, in order to answer their research questions, two kinds of assessments were used. Firstly, developmental assessments which assess imitation, joint attention of the participants as well as musical learning ability. Secondly, four questionnaires were given to the parents of the participants to to see how the sessions affected the children outside of the sessions as well as the parents' stress levels. Cohen's d effect size was used to measure the effects of the sessions on the participants.

What are the results? Did it support or disprove the hypothesis?

The main findings were that the stereotyped behaviours of all the subjects decreased during the course of the program with an approximate large Cohen’s d effect size, meaning quantitatively the sessions had a large effect on the participants. Moreover, the children showed some improvement in imitation, joint attention, and social skills from the Pre-Test to Post-Test, especially in communication. They also answered their research questions: 

"Social robots do have the ability to teach music rhythms to children with LF ASD; however, it has not been proven if robots can teach music notes and phrases to LF subjects"

They "concluded that robot-assisted music education classes could slightly improve the social and cognitive skills of children with LF ASD, but the amount of improvement regarding the music education for the LF subjects are not comparable to the HF participants’ performances previously performed/presented" in their previous work.

They "conclude that robot-assisted music-based interventions could reduce the stress levels of the parents of children with LF ASD (with a large effect size)"

What is the takeaway for everyone to know? What can we do with this information?

As an exploratory endeavour, the study illustrates the potential of integrating a social robot into music education for children in the autistic spectrum disorder. Although not as sole teachers and instructors, they could be useful tools or as teaching aids for human teachers and instructions. The promising results acts as further incentive for further research. 

In your opinion, how is this helpful or not helpful?  What are the issues of the study/article, if any? What other moderators or factors that could have affected the results. etc.

Admittedly, the study has little practicality in present implementation. It's helpfulness pertains towards the future. While the study show promise for the potential positive effect the social robot has on the children and their parents, the small number of participants, lack of a control group, and small number of sessions limit the study as a exploratory one and not conclusive. Additionally, the participants may have also been affected by other education outside the control of the researchers. That said, the study does show the potential promise of combining social robots and music education for children in ASD and further study should be done with an expanded scope.

Bibliography:

Taheri, A., Shariati, A., Heidari, R., Shahab, M., Alemi, M. & Meghdari, A. (2021). Impacts of using a social robot to teach music to children with low-functioning autism. Paladyn, Journal of Behavioral Robotics, 12(1), 256-275. https://doi.org/10.1515/pjbr-2021-0018

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Research Summary of the Article: Impacts of using a social robot to teach music to children with low-functioning autism

Written by: Lawrence Lynn

Keywords:

Autism: a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication

Music education: a field of practice in which educators are trained for careers as elementary or secondary music teachers. It is also a research area in which scholars research on ways of teaching and learning music. It touches on learning domains such as: development of skills, acquisition of knowledge, and learner's willingness to receive, internalise, and share what is learned.

Social Robot: an artificial intelligence system that is designed to interact with humans and other robots

Why are they doing this? What are they trying to find out?

The researchers were exploring the "impact of conducting robot-assisted music-based intervention sessions for children with low-functioning (LF) autism." As a continuation of their previous work, “Teaching music to children with autism: a social robotics challenge,” this particular study takes places focus on low-functioning autistic individuals as the previous work's focal point was, coincidentally, high-functioning (HF) autistic individuals. They in particular wanted to answer 3 research questions:

Does a teacher-assistant humanoid robot have the ability to teach music rhythms and notes to children with LF autism?

Does a robot assisted music-based education have an impact on the social and cognitive skills of children with LF autism?

Can robot-assisted interventions affect the stress levels of the LF participants' parents during music-education classes?

Additionally, they also wanted to do a comparison on the results of this test as to their previous work

What is the hypothesis? How did they do this?

Their hypothesis was that, when applied assisting a human therapist, the social robot could positively impact children with LF autism in the areas of music learning as well as their social and cognitive skills. Additionally, as observed by their previous study, the robot could reduce the stress levels of the LF participants' parents during the music education classes.

What did they do?

4 low functioning autistic children participated in a 22 week program that had several phases including one session of Baseline (Week #1), a Pre-Test (Week #6 before starting the first music intervention session), nine robot-assisted music-based educational sessions (Weeks #6–14), a Post-Test (Week #14 after the last music session), and a Follow-up Test (Week #22, 2 months after the last session). A drum/xylophone playing robot, along with a present and highly engaged human teacher, is used to teach basic concepts of how to play the instruments to four participants with LF autism during nine educational 20-30 minute sessions. Throughout the study, in order to answer their research questions, two kinds of assessments were used. Firstly, developmental assessments which assess imitation, joint attention of the participants as well as musical learning ability. Secondly, four questionnaires were given to the parents of the participants to to see how the sessions affected the children outside of the sessions as well as the parents' stress levels. Cohen's d effect size was used to measure the effects of the sessions on the participants.

What are the results? Did it support or disprove the hypothesis?

The main findings were that the stereotyped behaviours of all the subjects decreased during the course of the program with an approximate large Cohen’s d effect size, meaning quantitatively the sessions had a large effect on the participants. Moreover, the children showed some improvement in imitation, joint attention, and social skills from the Pre-Test to Post-Test, especially in communication. They also answered their research questions: 

"Social robots do have the ability to teach music rhythms to children with LF ASD; however, it has not been proven if robots can teach music notes and phrases to LF subjects"

They "concluded that robot-assisted music education classes could slightly improve the social and cognitive skills of children with LF ASD, but the amount of improvement regarding the music education for the LF subjects are not comparable to the HF participants’ performances previously performed/presented" in their previous work.

They "conclude that robot-assisted music-based interventions could reduce the stress levels of the parents of children with LF ASD (with a large effect size)"

What is the takeaway for everyone to know? What can we do with this information?

As an exploratory endeavour, the study illustrates the potential of integrating a social robot into music education for children in the autistic spectrum disorder. Although not as sole teachers and instructors, they could be useful tools or as teaching aids for human teachers and instructions. The promising results acts as further incentive for further research. 

In your opinion, how is this helpful or not helpful?  What are the issues of the study/article, if any? What other moderators or factors that could have affected the results. etc.

Admittedly, the study has little practicality in present implementation. It's helpfulness pertains towards the future. While the study show promise for the potential positive effect the social robot has on the children and their parents, the small number of participants, lack of a control group, and small number of sessions limit the study as a exploratory one and not conclusive. Additionally, the participants may have also been affected by other education outside the control of the researchers. That said, the study does show the potential promise of combining social robots and music education for children in ASD and further study should be done with an expanded scope.

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Article Summary: Mental representations of speech and musical pitch contours reveal a diversity of profiles in autism spectrum disorder

Written by Kevin Bandel

Numerous studies have tested the pitch processing of those on the autism spectrum. However, results have been mixed, as findings have suggested either increased, typical, or reduced pitch recognition. The study featured in the article tested the pitch processing of 32 Mandarin-speaking autistic individuals and 32 non-autistic individuals. The conclusions were that the average pitch processing of the autistic and non-autistic groups were similar. The authors believe that pitch representation in speech and music for autistic individuals is domain-general, meaning that pitch may be processed in the same way and area of the brain as many different types of information. This has implications for how the brain develops pitch recognition skills.

While autism has a variety of symptoms and severity of those symptoms across individuals, challenges with language and communication are common among many of those on the spectrum. However, exceptional musical abilities, especially in musical memory and sensitivity to musical pitch, have been reported among autistic people. The disconnect between these skill sets has garnered attention from researchers. They investigate how frequently this characteristic is present among the autistic population and how neurologically connected speech and music are. The debate about the extent that speech and music are separate or linked continues today, and autistic people with impaired speech but enhanced music processing are an illuminating part of this discussion.

For this study, 32 autistic and 32 non-autistic individuals ages 7 to 15 years old participated. All participants were native Mandarin speakers, and the non-autistic subjects had no suspected history of neurological divergences. The average time of musical training was one year with a standard deviation of 1.37 years.

Both groups of participants were assessed in areas of speech (Mandarin is a tonal language), complex tone, and melody. For speech, participants would be provided 400 pairs of words and answered which of the two words best matched a specific meaning. For complex tones, 400 pairs of words were given, which subjects would identify which of the tones best matched a rising tone. For melody, participants would judge which of 300 pairs of randomly manipulated song fragments best resembled the melody of the Chinese nursery rhyme “Two Tigers.”

The average results of both the autistic and non-autistic participants did not differ significantly in speech, complex tone, or melody. However, the variability in the autistic participants’ results was noticeably higher than the non-autistic group. Of particular note, there was a subset of autistic individuals with exceptional pitch sensitivity, which is perhaps why the perception of the “musically gifted” autistic person exists.

The study did not test adults, participants from non-Chinese language backgrounds, or more complex pitch recognition, so those factors can still be investigated. The authors of the article suggest that the autistic participants showed similar processing between speech and music, which could help the development of social skills of autistic people.

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Article Summary: “Camouflaging” by adolescent autistic girls who attend both mainstream and specialist resource classes: Perspectives of...

Written by Kevin Bandel

An autistic person motivated to navigate mainstream social settings may feel the need to “hide” autistic behaviors to fit in with others. Interviews were held for 8 autistic girls, their parents, and their school staff. The results from the interview revealed that the girls used camouflaging to hide their autism and learning needs. Unfortunately, these attempts were often unsuccessful. Although camouflaging helped these girls meet social expectations, they found doing so to be exhausting, distressing, and negatively impact their relationships, learning and mental health. The purpose of the research is to increase awareness of camouflaging and ways to support autistic girls fully participate and learn in school.

The interviews revealed several different attempts at camouflaging. To appear “normal,” the girls would employ some combination of appearing busy on their phones, planning conversation scripts in advance, hiding their interests, pretending to understand social norms, and researching normative social interactions. Their parents and educators noted that these strategies were not always effective and consistent, especially in more challenging and unexpected social situations.

With these attempts at camouflaging, the girls did not feel they fit in either the mainstream or the resource base classes (Individualized Education Plan students). While they felt less need to camouflage in resource base classes, being a part of these classes would isolate them from their mainstream peers at times. Because the girls were seeking to build friendships with mainstream peers, they felt not fully included in either the mainstream or the resource base classes.

Those interviewed described the exhaustion the girls would reveal when leaving school. The girls would further express anxiety regarding how successful their camouflaging was and fear of failing. Their parents shared their worries that camouflaging would have on their identity along with the difficulty of them being accepted if they do not meet social expectations. Contributing to the exhaustion was that many teachers were unaware of their autistic students’ learning struggles, as they would hide their learning struggles out of fear of looking “stupid.” Attempting to learn without addressing holes in understanding would both reinforce anxieties about appearing unintelligent and the draining experience of attending school.

However, the study includes a small sample size and does not examine how autistic boys or other kinds of students may experience negative effects from camouflaging. While it is a known issue for autistic females, it is not only limited to them. Second, the information of the study is almost entirely qualitative, so some information is not present. Still, the study’s findings are reflected in other research, so it likely has validity. It would be beneficial to investigate how to best support students who experience hardship from camouflaging and apply this knowledge beyond just autistic girls.

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Article Summary: How Well Do We Understand Autistic Savant Artists: A Review of Various Hypotheses and Research Findings to Date

Written by Kevin Bandel

In fictional works, savants are sometimes portrayed as also being on the autism spectrum. This has helped increase the public perception about the capabilities of autistic people. However, it is important to understand that being an individual with autism and being a savant are not synonymous even if they may overlap. The article includes three studies mentioned in the article that had different results about the overlap between savant syndrome and autism. One study estimated around a 50% overlap, another reported 30% of autistic individuals exhibited savant traits, and yet another said 1 in 200 of autistic people were savants. While the last study was criticized for its faulty estimation, the discrepancy can suggest that there may be inconsistencies with definitions of “savant”, methodologies in measuring savant characteristics, or both.

Furthermore, savant traits are most often recognized in memory, science, and mathematics, but they also can exist in fields of art such as drawing, music, and theater. Perhaps the reason for this in certain areas such as memory can be more clearly measured than artistic ability. This places more ambiguity on what qualifies as a savant characteristic. Still, the authors of the article include a set of qualities they believe to be needed for someone to be an autistic savant. Some of those rules are:

A)     Savant skills lie on a spectrum. Some categories include the “talented savant,” whose level of expertise contrasts inordinately with their overall level of disability. Another is the “prodigious savant” whose ability advantages them even over a “non-impaired” individual.

B)     Special skills must be accompanied by prodigious memory.

C)     Savant syndrome can be genetic or acquired.

D)     There is no single explanation for all savants.

Since this article is a review of other studies, it summarizes some of the research findings of some studies. It stated that there were a limited number of assessments for artistic savant traits, and they are still being developed. It also mentions disagreements between different researchers about how much and whether an increase in savant traits in autistic people affects social communication ability.

The authors of the article hypothesize that a significant number of non-savant autistic people still possess latent abilities but disagree that the degree of the latent and/or savant characteristics are related to decreased social communication skills.  They argue that if these underlying skills are in the arts, they can be leveraged to understand emotions and enter a flow state, potentially assisting in transforming autistic individuals’ sociability.

Some of areas the authors suggest need future research are to further develop assessment of artistic ability and do so by autistic standards rather than neurotypical ones. Longitudinal and neurobiological studies will also be essential, as they can help test if savant syndrome is consistent throughout a person’s life. From a broader perspective, the authors believe that understanding what leads to artistic savant characteristics can help illuminate what are the neurobiological triggers that influence humans into perceiving something as artistic and/or beautiful.

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Article Summary: Rhythmic Relating: Bidirectional Support for Social Timing in Autism Therapies

Written by Kevin Bandel

Rhythmic Relating is a system to promote bidirectional social interaction and complement existing therapies. The main parameters used are pulse, quality, and narrative. They are intended to replicate and understand natural predictive flow and emphases on specific sounds, which is as relevant to music as it is to conversation. The four different therapies of Rhythmic Relating are Dance Movement, Improvisational Music, Play, and Musical Interaction.

Some specific guidelines of Rhythmic Relating are to use direct concrete language, short simple chunks of speech, verbalize emotions, clarify goals and minimize non-communicative body language. It uses mirroring exercises, divided into selective mirroring (initial), selective mirroring (modified), and mirroring (vitality). Selective mirroring (initial) means to imitate a certain movement or sound. The movement or sound would be altered one aspect at a time, and the goal is to maintain connection between the client and practitioner with these changes. Lastly, mirroring (vitality) requires using a whole-body, whole-sound-sound replication of the “essence” of the other person.

Rhythmic exercises are also employed. The practitioner keeps a steady pulse to “anchor” the timing of the client’s expressions. The pulse is established by the practitioner inherent to the client's movement or sound. If the client becomes comfortable with that beat, slight variations to rhythms and accents (which sound is emphasized). There are also periods of time called “jazz gaps,” which are extended pauses in the beats. This is to allow for moments of rhythmic freedom into an otherwise rhythmically consistent form and also simulate giving individuals (both oneself and others) time to respond in a typical conversation.

The article states that Rhythmic Relating is largely child-centered and requires more research, especially in the realm of neurobiology and neuromotor psychology. The improvements made by the study’s participants were measured by recorded observations, making them more qualitative than quantitative. Despite these limitations, the article stated Rhythmic Relating is predicted to increase self-regulation, co-regulation (managing emotions with the support of another individual), trust, and decrease anxiety. It could be worthwhile to test the effects of Rhythmic Relating for other age ranges and in other areas.

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Article Summary: Effects of Creative Movement Therapies on Social Communication, Behavioral-Affective, Sensorimotor, Cognitive, and Functional...

Written by Kevin Bandel

There is increasing evidence that whole-body activities can help autistic people develop beneficials skills related to their condition. Creative movement therapies (CMT) address these areas. Some CMTs included music, dance, yoga, theater, and martial arts. Dance is also considered to be a CMT, but has limited research supporting it currently. This systematic review presented in this article examines 72 studies which included 1,939 participants ages 3 to 65.

67 of the 72 studies recruited neurodiverse individuals with only autism, with the remaining 5 included autistic students as well as ADHD, anxiety disorders, learning disabilities, sensory processing disorder, emotional disorders, and behavioral disorders. The article claims that there were significant, non-zero effects of CMT. Specifically, 30-33% suggested medium-to-large improvements in social communication skills, behavioral domain, and motor outcomes. For cognitive skills, there were medium-to-large improvements in cognitive skills from over 65% of the studies.

Though the article seems to suggest promising effects of CMT, the authors claim that their review is a call to conduct additional research about the effects of CMT for autistic people, particularly in affective and sensory functioning after ending the therapy. There was limited evidence to support the positive impact of CMT in these areas. Another limitation was that some of the observed studies used conventional autism support with added CMT rather than only CMT. This may distort how much the true effects of some of the interventions are from the traditional supports and how much is from CMT.

Still, there are positive and significant results from the more purely CMT-focused interventions. It is also important to consider how these therapies can have positive effects in multiple areas.

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Article Summary: Prevalence of Autism Spectrum Disorder in China: A Nationwide Multi-center Population-based Study Among Children Aged 6 to 12 Years

Written by Kevin Bandel

This study was the first national estimate for the presence of autism in Chinese children aged 6 to 12 years old. 142,086 children participated in this study, with 363 considered to be autistic (0.26%). Of those autistic children, 43.3% of them had not been diagnosed with autism previously. The boy-to-girl ratio of children with autism was 4.3:1. The last findings summarized in the abstract was that 90.4% of the autistic children attended standard schools and 68.8% had another neurodiverse condition.

The strengths of the study was that it had the largest sample size of all Chinese autism studies. It also collected subjects from 8 different locations in China and used two different diagnostic tools, the Modified Chinese Autism Spectrum Rating Scale and ADOS/ADI-R. However, the 8 different locations selected by the study were chosen by having prior research experience with autism, which may not represent every region of China equally. A similar issue of representation is that most subjects were urban residents. Future studies in China are recommended to include a ratio of urban participants closer to the true national proportion. Later studies could also expand the age range of those screened as well.

A noteworthy fact of this study is how the estimated Chinese prevalence of autism (0.29%) is significantly less than the estimates of other countries. The international estimates range from 1-2% of the population. Countries such as the United States, United Kingdom, Australia, and South Korea have around a 2% rate of autism. Lower percentages of autism are also believed to be reported in populations with low socioeconomic status, but other factors may also influence these results. For China, public awareness of autism was not considered to not have emerged until 2010, which may affect knowledge and willingness to get diagnosed.

While this study was conducted in China, it has worldwide implications for our understanding of autism. Several characteristics believed to be associated with autism, such as difficulty reading others, hypersensitivity, narrow attention, and repetitive behaviors, are relative. In every culture, the values imposed on its citizens will be varying degrees of similar and different from the standard model of autistic traits. Autistic attributes can be present in anyone, especially if a culture encourages its citizens to exhibit some of these features. If autism is diagnosed based on how different subjects are from “normal” people, then there are contexts in which the same person could be considered autistic in one environment and not the other. This further creates ambiguity if there is a clear dividing line between autistic and not autistic. Since science and psychology are always evolving, we must be open to possibilities that our perception of autism could change.

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Article Summary: Behavioral Training of High-Functioning Autistic Children by Music Education of Occupational Therapy

Written by Kevin Bandel

(Note: The language and sentiment of the article can be perceived as ableist. This may be influenced by coming from a culture in which autism is less recognized and supported. However, it does provide reason to believe in the potential of music education for those on the autism spectrum.)

In this study, three children with autism in music classes were observed, which changes in behavior were recorded and analyzed. The three children were referred to as Study Subject A, B, or C. Subjects A and C were five-year-old boys, and Subject B was a 6-year-old girl. While none of them had ever touched a musical instrument, Subjects B and C enjoyed listening to music, with Subject C frequently singing the words and notes of the song correctly. Subject A did not have a previously established interest in music.

All three were reported to not actively greet others and sometimes have difficulties focusing and participating in learning activities. All three were also considered to have moments of “inappropriate” behavior. Subject A remained generally emotionally stable and mostly appropriate behavior, Subject B was usually emotionally stable but would yell and cry when requests were not met, and Subject C was considered emotionally unstable, with a high instance of negative emotions with occasional crying, smashing objects, or hurting others.

The article states that music teaching activities created significant improvements in joint attention (two or more people focusing on the same detail or subject), movement/rhythm imitation, and cooperation. However, since the study follows a few students in great depth, it is difficult to have a large sample size. 3 is a much smaller sample size than needed to create valid results. A meta-analysis of many students in the same program would be needed to verify this data. It is also worth considering if the way the “inappropriate” behavior was dealt with has long-term positive effects on the students and is not only temporary suppression with later consequences. This study does not prove much on its own but can be the gateway to great discoveries in the future.

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Article Summary: Emotional self-awareness in autism: A meta-analysis of group differences and developmental effects

Written by Kevin Bandel

It is sometimes believed that many autistic people have difficulty recognizing and understanding their emotions. To evaluate the accuracy of this notion, this article reviews 47 studies that compare emotional self-awareness in autistic and non-autistic children and adults. While it appeared that autistic adults had lower emotional self-awareness, this was not the case for autistic children ages 12 years or younger. Difficulties with emotional self-awareness seemed to emerge during adolescence and increase with age.

This challenges the assumption that these hardships are inherent to autism, as they may arise from social and mental health barriers autistic people experience starting in adolescence. If this is at least partially true, the hypothesis of this meta-analysis may provide insight on how to better support autistic people in strengthening their emotional self-awareness.

It is important to assess how emotional self-awareness is measured in these studies. One measure is the Toronto Alexithymia Scale (TAS), a self-report evaluation in which the higher the score, the greater the emotional blindness. Higher scores are correlated with negative mental health states such as depression. It could be that higher TAS scores could influence psychological distress, psychological distress could influence higher TAS scores, or both.

Other assessments for emotional self-awareness were the Children’s Alexithymia Measure (observer-report rather than self-report) and behavioral measures such as the Multiple Emotions Task, Photo Emotion Differentiation Task, and the Emotion Sorting Task.

When accounting for the variety of measurements, there was no significant difference in emotional self-awareness between autistic and non-autistic children ages 12 years or younger. In adolescents ages 13-16, a moderate, significant difference was present.  The discrepancy increased in participants ages 17-30, and even further for those ages 31 and above. The disparity in the age groups was more influenced by the relative decline of the autistic sample than the increasing ability of the non-autistic sample.

The strength of this meta-analysis is that it observed multiple varieties of measurements of emotional self-awareness. However, there were still some limitations. The first is that not all studies included controlled for concurring mental health issues, which may compound weaknesses in emotional self-awareness. Furthermore, when it came to determining emotional self-awareness of children, the parent-report part of the evaluation tended to present lower perceptions of their child’s self-awareness if their child was autistic. It is unclear if this is from biases parents might have if they know their child is autistic and/or if parents of non-autistic children overestimated their child’s emotional self-awareness.

This meta-analysis suggests that emotional self-awareness difficulties are not necessarily inherent in autistic individuals, which is an encouraging message for the autistic community and their allies.

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Article Summary: Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science

Written by Kevin Bandel

In the early stages of its conception, autism research has been based on the conventional medical model focused on child psychiatry. In more recent times, autistic and nonautistic people alike have advocated for autism science to shift toward the neurodiversity model instead. The article claims the medical model overfocused on deficits of autism while underestimating its strengths. It also asserts that the medical model places too much emphasis on autistic individuals. By placing much of the blame on autistic people, it diminishes the effect of their surrounding environment and implies they are not capable of sharing their own understanding of autism. In contrast, the neurodiversity model portrays autism as a neutral difference from the “typical” range of development. The neurodiversity paradigm supports the existence of these variations in the human brain and rejects the view that deviating from the norm is a flaw that must be fixed.

The medical model’s focus on impairments draws attention away from the strengths of autistic people and biases the population toward the limitations of autistic people. This can be amplified by confirmation bias, which increases the tendency to reinforce beliefs that autism is a deficit and ignore its advantages. In some cases, conventional autism research can show how autistic people outperform nonautistic people in certain areas but still interpreted as the result of an “impairment.” Strengths and weaknesses are often connected and share root characteristics, so it distorts the truth to focus too much on one over the other.

The overemphasis of the individual in the medical model assumes that autism and its associated challenges are inherent to the individuals while ignoring the contexts autistic individuals face. The difficulties they experience at home, school, work, social communication, or the broader community are likely caused in part by the flaws in those environments in supporting those outside the norm. This individualistic approach pushes the harmful notions that autistic people are “at fault” for being “defective” and must “correct” their behavior. The goal of the medical model is to make autistic people indistinguishable from their “normal” peers, which is questionable by assuming “normal” appearances are always ideal.

By seeing autistic people as inherently disabled, first-person accounts from autistic people can be dismissed. Their own understanding of autism and its impact on their lives could provide valuable information, but this might be discredited if researchers question the validity of autistic people’s accounts into their own experiences.

The neurodiversity model addresses these issues by providing a more nuanced view of the challenges of autistic people. It presents disability as best understood by individuals’ unique characteristics not receiving the proper accommodations from their environment. As a result, they can often be seen as “less able” than their neurotypical peers who receive support that better meets their needs.

Switching from the medical model to the neurodiversity perspective allows for both the ideas that autistic people would benefit from accommodations but are also individuals with valuable strengths.

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Article Summary: Autism in Australia: Community Knowledge and Autistic People’s Experiences

As the rate in which people are diagnosed with autism rises, there is an increased public awareness of autism. This has led to the perception of an “autism epidemic,” which sparks explanations for this “expanded incidence” of autism. Some interpretations of this increase include higher public awareness of autism and changes in diagnostic criteria. For the changes in diagnostic criteria, this has had the greatest impact on the rise of diagnosing autistic people with lower support needs.

Unfortunately, the spread of knowledge about autism has not necessarily been sufficient and accurate. The phrase “autism epidemic” has a negative connotation, which implies autism is a condition to be pitied and cured instead of a neutral form of neurodiversity. The implications that autism is most prevalent in children ages 5 to 14 disguise the fact that autism is a lifelong condition that is not “grown out of” through treatment. Autistic adults still need appropriate accommodations.

To assess the knowledge of the general Australian population and the adequacy received by autistic people, two studies were distributed. Study One used an online panel to observe knowledge and perspectives about autism, and Study Two used a mail online survey to hear about the participants’ experiences with autism.

Study One consisted of 3204 non-autistic Australian adults (18 years and older) using email, SMS, or telephone surveys. 86.9% completed the survey online through an email or SMS link, and the remaining 13.1% had a telephone interview. The five key areas tested about autism were awareness, prevalence, causation, outcomes, and impact.

For Study Two, 1353 Australian adults who subscribe to Amaze (state-based autism organization) took a survey via an email invitation. They were either a family member of an autistic person (68.4%), cared for an autistic person (49.4%) or were autistic (5.8%). The majority of the sample were females, born in Australia, were over the age of 34, and had a household structure with children.

Comparing the results of the two studies, significant gaps in knowledge about autism were identified. Some of these include Study One participants’ lower awareness of the increase in diagnoses of autism in females, that around 20% of them believed or were unsure that autism is caused by vaccines, and almost half thought or were unsure if autism can be “cured.” Almost 20% believed or were unsure that autistic people are often violent despite several comprehensive studies suggesting autistic people are equally or less likely to commit violent crimes.

While the sample size was large overall, there are some issues with the study. The participants were more educated than the average Australian population, which may underestimate gaps in knowledge. In Study Two, the source was from Amaze subscribers, which may not reflect the total autistic population.

The findings of this study match autism research in other countries and can add to the evidence to suggest the need for the general public to be more educated about autism. The article asserts that knowledge should be more “with” autistic people involved instead of being “about” autistic people.

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Article Summary: Quantity and quality of empathic responding by autistic and non-autistic adolescent girls and boys

Written by Kevin Bandel

Empathy is considered to be a part of social skills, and since autism is related to how social skills manifest, this study explores the empathic reactions of autistic adolescents. 193 adolescents, autistic, non-autistic boys/girls were observed in a task in which an experimenter hurt herself. The hypothesis was that there would be minimal difference between the two neurotypes in how often they would choose to comfort the experimenter.

The mean age of the children in the study was 11.51 years old with a range of 9 to 14 years old. Among the autistic participants, there were 16 girls and 53 boys. Among the non-autistic, there were 69 girls and 55 boys. The average age between the autistic and non-autistic groups had no significant differences (no more than a 0.21 difference in age in years). Participants had average IQ or higher for their age.

Participants were from Dutch primary schools. They were video recorded in a quiet room at school or home. Sessions lasted for approximately 1 hour. When the experimenter would harm her finger from closing a binder, the behavior of the subjects would be measured by a scoring system of 0-5 depending on the response.

Behavior was separated into 5 categories. The first, “attention”, was about how much focus participants gave to the situation. Second, “emotional arousal” indicated the amount of emotion expressed by the participants. Third, “pro-social empathic reaction” measured effort to provide comfort. Fourth, “emotion-focused” referred to verbal references to feelings. Fifth, “problem-focused” indicated suggestions to prevent future harm or offering to get a bandage. “Problem-focused” was given a lower maximum score than the other categories, as this kind of response can be seen as unempathetic and counterproductive in certain contexts.

Compared to the non-autistic adolescents, the autistic subjects showed less visible emotional arousal. Autistic boys were the group most likely to address the problem. However, the overall conclusion was that empathetic behavior was similar between the autistic and non-autistic boys and girls. Differences had more to do with the sex of the subject than their neurotype.

There were some limitations to this study. Physical pain is a simpler feeling to detect than complicated emotions, so it could be worthwhile to see how similar or different autistic and non-autistic people are in this context. The study also does not fully explore the effectiveness of the empathy demonstrated. For example, the effectiveness of problem-focused responses can vary depending on the situation. It is also possible that one may be overwhelmed by the other person’s emotions, making it harder to think clearly and communicate the truth of the circumstance. Empathy is not just about how much emotion a listener feels, but also how well they reflect, understand, and communicate those emotions.

Despite these limitations, it is beneficial to study empathy and question stereotypes about autistic peoples’ ability to empathize with others.

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Article Summary: Autistic parents’ views and experiences of talking about autism with their autistic children

In most studies of parents and their autistic children, the parent is neurotypical. This study explored the dynamic when both the parent and their children are autistic. This kind of interaction is underexplored because neurodiverse parents are underrepresented in these types of studies. On top of this, statistics support the idea that being on the autism spectrum can predict increased autistic traits in one’s biological family members.  Since it is suspected that hereditary factors increase the likelihood of autism, this increases the chance that both the parents and children are both autistic.

This study compared the attitudes of autistic and non-autistic parents in how they talk to their autistic children about autism. Using a sample of 34 autistic parents, the findings from this study were compared to the responses of other studies. The subjects provided their input through an online questionnaire.

Those eligible for the study were autistic parents in the United Kingdom. The purpose of keeping the participants within the United Kingdom was to increase the odds that the parents had a comparable background in experiencing cultural attitudes toward autism. Of the 34 autistic parents, 88.3% were female. 79.4% had a formal autism diagnosis, and 94.1% came from a white ethnic background. Of the autistic children, 61.8% were male, 79.4% were educated in mainstream schools, and were diagnosed with autism at an average age of 8 years old.

The autistic parents were compared with non-autistic parents that were supportive of their child’s neurodiversity. The purpose of this was to make the study more focused on the differences between autistic and non-autistic parents in talking to their children about autism and less about differences in parenting intentions of helping their children.

The similarities between both autistic and non-autistic parents were to instruct their autistic children to be open about the diagnosis, introduce it as early as possible, have discussions tailored to individual needs, and understand both the challenges and strengths of being autistic. The differences in the autistic parents’ approach were to use personal experiences to empathize with their children, focus more on the positives of an autism diagnosis, express less concern that these discussions could have negative consequences, and to believe professional support to talk about autism was not wanted or needed.

There were some limitations to the study. The sample was limited because it was recruited from autistic organizations, which may have biased the sample toward those that are more accepting of being autistic. Furthermore, the amount of data was low because only 34 of the 119 surveys taken were eligible. 85 of them (71.4%) were removed, often from the parents not being autistic or not being from the United Kingdom.