Anjana N. Bhat, Ph.D. - US grants

DESCRIPTION (provided by applicant): The rising incidence of Autism Spectrum Disorders (ASD) challenges researchers to develop novel intervention techniques for children with ASD. Nevertheless, the majority of the research on ASD interventions is focused on traditional and contemporary Applied Behavioral Analysis approaches that target a child's language, cognitive, and preacademic skills. These approaches typically require a child with ASD to engage in intensive 1:1 intervention for 30-40 hours per week. In contrast, administering robot child interactions as an intervention technique may be a significant innovation for various reasons. A robot could serve as an adjunct to a clinician to administer components of an assessment or treatment protocol with some level of standardization and may assist in the data collection process. The programmability of a robot allows us to systematically increase the complexity of social interactions within treatment. Evidence also suggests that children with ASD enjoy interacting with robots due to their simple and predictable behaviors. Most of all, robots are embodied beings that encourage a child with ASD to engage in whole body interactions involving imitation, turn taking, and joint attention bids. Aims: The overall goal of this research is to develop novel intervention techniques for children diagnosed with ASD. Specifically, the proposed project will examine the efficacy of robot child interactions for enhancing social, communication, and perceptuo-motor skills of children with high and low functioning ASD. Our preliminary data on typically developing (TD) children who underwent short-term training with a humanoid robot suggested that all children enjoyed interacting with the robot. The young children performed behaviors such as looking at the robot, greeting the robot, and talking to the robot. They also imitated the complex limb movements performed by the robot. In terms of non-verbal communication, they engaged in turn taking and joint attention behaviors with their teachers and peers. In the proposed project, we have two phases of study. In the first R21 phase we examine robot child interactions in three different projects: a) interactions of TD children between 4 and 8 years of age during short-term training, b) interactions of the same group during interpersonal synchrony tasks, c) Robotic systems development and d) a 5-week intervention for children with ASD using a single subject design. In the R33 phase, we conduct a group design study in which 12 children with ASD between 4 and 8 years of age will receive a 10-week robot child interaction protocol and be compared to a control group of children with ASD. Pre- and post-training assessments will include the PDD- Behavioral Inventory, Movement-ABC, and the Florida Apraxia Battery. We expect the children in the training group to demonstrate advances general social communication measures as well as specific improvements in imitation, nonverbal communication, as well as motor coordination during robot-child interactions. Overall, robot based social intervention is an uncharted, promising intervention tool for enhancing social, communication and motor skills in children with ASD. PUBLIC HEALTH RELEVANCE: This project proposes using robot child interactions as an intervention tool for children with autism spectrum disorders (ASD) to enhance their social, communication, and motor skills. The project results will determine the various parameters of treatment and the feasibility of long-term robot training for children with ASD.

PROJECT SUMMARY Introduction: The rising incidence of autism spectrum disorders (ASD) charges researchers with a sense of urgency to develop sensitive tools for early identification. Recent advances allow experts to identify ASD in the second year through an array of social communication and motor coordination deficits. This project attempts to extend this work into infancy. Aims: The broad objectives of this research are to develop novel tools for early identification of motor, social, and cognitive deficits of Autism Spectrum Disorders (ASD) within the first six months of life. In this proposal, reaching, object exploration, and associative learning tasks are used as powerful contexts to identify impairments related to ASD and the broader autism phenotype (BAP) within the first six months of life. We will longitudinally compare two groups: 1) infant siblings of children with autism (AU Sibs), who are a cohort at high genetic risk to develop ASD and BAP impairments, and 2) typically developing, infant siblings of children with no family history of ASD (TD Sibs) at 3 and 6 months along with follow-up screening at 16 months. Methods: During reaching and object exploration, infants will be observed during single-rattle or multi-rattle conditions to probe their reaching, grasping, and visual attention/exploration patterns. In addition, during associative learning, infants will learn the relationship between their arm movements and the activation of a musical toy. We will code for learning, pattern of toy activation, and visual attention patterns. Fine-motor measures such as reaching and rhythmic arm movements will be quantified using a portable electromagnetic motion tracking system. Preliminary Findings: Our preliminary data suggest that AU Sibs tested at 3 and 6 months have reaching and grasping coordination deficits as well as excessive visual exploration during reaching and object exploration tasks. Moreover, AU Sibs show difficulty shifting visual attention during an associative learning task. Through this proposal, we build on our preliminary data and expand our database on fine-motor coordination and visual attention impairments of the AU Sibs population. Significance: This project will vastly add to our understanding of the early developmental processes that lead to the core deficits of ASD. In addition, if the aims are achieved it will identify reliable behavioral markers for early diagnosis of ASD. Specifically, the results of this study would implicate that early detection of ASD and the BAP is possible between 3 and 6 months of age through fine-motor and visual attention markers. It would also emphasize that infant siblings of children with autism are at risk for general sensori-motor delays and need sensori-motor interventions.

? DESCRIPTION (provided by applicant): Currently we have multiple ongoing NIH funded studies at the University of Delaware (UD) to examine the effects of various behavioral interventions developed for pediatric and adult neurologically affected special populations. We feel there is an urgent need to understand the neural mechanisms of change underlying the behavioral improvements we notice in our populations of interest. Additionally, we are interested in studying the neural substrates for a wide range of behaviors that are an area of emphasis for NIH including working memory in children with Autism, interpersonal synchrony in children with Autism and Oppositional Defiant Disorder, balance in children with Cerebral Palsy, mobility in children with Down Syndrome, arm function in infants with Brain Injury, locomotion in patients with Stroke, and psychosocial symptoms related to Chronic Low Back Pain in older adults. In this proposal, we are requesting funds to purchase a Hitachi functional infrared spectroscopy (fNIRS) system (Model: ETG-4000) to advance our clinical and translational research programs as well as interdisciplinary collaborations between researchers working in the areas of pediatric/adult neurorehabilitation, developmental psychopathologies, and motor, social, and cognitive neuroscience. Common neuroimaging approaches such as functional Magnetic Resonance Imaging (fMRI) and electrophysiological approaches such as Electroencephalography (EEG) are limited to tasks in reclined or seated positions with minimal to no movement, making these applications ineffective in obtaining brain activation data in the presence of movement and during naturalistic interactions. If the fNIRS system were to become available at UD, it would allow us to examine part or whole brain activation during a variety of functional motor tasks such as reaching and walking as well as naturalistic and play-based interactions between individuals. This makes the fNIRS technology truly translational and transformational in understanding brain-behavior relationships within real-world settings when working with a diverse set of pediatric and adult special populations including Adult with Stroke and Chronic Low Back Pain, Children with Autism, Cerebral Palsy, Oppositional Defiant Disorder, and Down Syndrome as well as High-risk infants.

PROJECT SUMMARY Motor impairments are pervasive in school-age children with Autism Spectrum Disorder (ASD); however, they are often ignored and remain undiagnosed and untreated. Approximately 87% of the SPARK cohort of children with Autism Spectrum Disorder (ASD), the largest ASD cohort in the US, is at-risk for a motor impairment/DCD based on findings from the Developmental Coordination Disorder (DCD) Questionnaire (Bhat, 2020). Yet, motor impairments are not part of the diagnostic criteria or specifiers for ASD per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V). Although motor domain was added to the NIMH research domain criteria (RDoC) for mental disorders only last year, motor issues have not been discussed as part of the RDoC for ASD. It is unclear if a unique pattern of motor impairments and multisystem impairments (motor, social communication, and repetitive behavior) are present in children with ASD. Do these patterns of impairment change across the ASD spectrum for certain sub- phenotypes or are they generalized across sex, age, comorbid diagnoses, and levels of impairment? In the proposed project, we will study the associations between motor impairment, autism severity, and comorbidities in children with ASD. Specifically, we will determine the risk for motor impairment in children with ASD and how that changes with increasing social communication impairment, repetitive behavior severity, comorbidities, and levels of impairment using parent report measures: DCD-Q, Social Communication Questionnaire (SCQ), and Repetitive Behavior Scale-Revised (RBS-R). Our analyses will also provide further evidence for generalized but unique patterns of motor impairments in children with ASD and if present, the presence of multisystem symptom clusters and sub-phenotypes of ASD. We will also highlight the issue of differential access to various therapies (OT, PT, recreational) for children with ASD and how those do not relate to a child?s risk for motor impairment, thus revealing under-diagnosis and under-treatment for motor issues in ASD using PT and recreational therapies. As the COVID crisis evolves and we wait for reliable treatments and vaccines, resuming pediatric face to face research will take a long time. Using large databases such as the SPARK study dataset to answer critical research questions is therefore, timely and essential.