One of the core features of Autism Spectrum Disorder (ASD), social communication impairment, presents in a variety of ways, including reduced functional language use and social initiations, which often warrant intensive intervention services. Additionally, parents of children with ASD demonstrate increased levels of parenting stress when compared to parents of typically developing children and children with developmental delays (Hayes and Watson, 2013). Elevated parenting stress has been shown to diminish positive treatment outcomes (Osborne et al., 2008), which lends support to develop methodologies to concomitantly target child and parent behaviors. The current randomized control trial (RCT) uses a dual-pronged approach to directly target both child communication deficits and parenting stress within a group format. This RCT combined an empirically supported behavioral therapy, Pivotal Response Treatment (PRT), with components from Acceptance and Commitment Therapy and Mindful Parenting for reducing parenting stress. Fifteen pairs of caregivers and their minimally or pre-verbal child with diagnosed or suspected ASD were randomly assigned to one of the following supplemental conditions: mindfulness-enhanced PRT (mPRT; n = 8) or psychoeducation-enhanced PRT (pPRT; n = 7) as an active control condition. Of these, five pairs completed each condition. The current study assessed feasibility and acceptability in addition to demonstrating proof of concept in regard to additive effects of mPRT compared to pPRT. Results provided mixed support for feasibility and efficacy of a multi-component group treatment approach. There was a low retention rate and the small sample sizes significantly decreased power. However, parents endorsed high satisfaction, demonstrated fidelity of PRT implementation, and children significantly increased their expressive language abilities. In regard to group-level analyses for primary and exploratory aims, the mPRT group showed significant decreases in parenting stress and increases in mindfulness. At the individual level, some parents in both groups showed positive changes in mindfulness, positive feelings toward child, and child problem behavior. Future directions should continue to explore the additive effects of mindfulness-based intervention on group-based parent-mediated treatments using larger sample sizes. / Doctor of Philosophy / Social communication difficulties are one of the core components of Autism Spectrum Disorder (ASD) and many treatments are specifically designed to target these challenges. Additionally, parents of children with ASD report higher levels of parenting stress when compared to parents of typically developing children and children with developmental delays (Hayes & Watson, 2013). High parenting stress has been shown to decrease the likelihood of positive treatment outcomes (Osborne et al., 2008). As a result, creating a treatment that targets both parent and child difficulties simultaneously may lead to important outcomes for the family unit. The current study combined treatments that have been shown to increase child language and decrease parenting stress. Fifteen pairs of caregivers and their child with language delays and ASD were randomly assigned (i.e., similar to a flip of a coin) to receive Pivotal Response Treatment (PRT) and one of the following: mindfulness (mPRT; n = 8) or psychoeducation (pPRT; n = 7). Ten total families completed the treatment (5 per group). The current study measured the practicality and usefulness of adding either mindfulness or psychoeducation to PRT. Results provided mixed support for the practicality of a group treatment approach that combined two treatments. Approximately two-thirds of the families who started treatment finished treatment. The parents who completed treatment showed high satisfaction ratings and demonstrated that they could accurately perform the treatment techniques taught in group sessions. In addition, children increased their language abilities. Parents in the mindfulness group showed significant decreases in parenting stress and increases in mindfulness. At the individual level, some parents in both groups showed positive changes in mindfulness, positive feelings toward child, and child problem behavior. Future directions include measuring these changes with a larger number of families.

Perception of moral violations and people’s misbehaviours are crucial elements that allow people to live in the society. The literature suggested that both explicit and implicit processes are involved in the moral cognition (Cameron et al., 2012). However still nowadays, the majority of the literature focused only on the explicit aspects of morality, while scarce attention was given to the study of implicit moral attitudes (Cameron et al., 2018). Furthermore, researchers on morality are currently attracting by the investigation of moral cognition in people with impairments in social cognition (e.g., people with autism spectrum disorder; ASD) who may process the moral violations differently compared neurotypical people (see e.g., Gallese, 2006), However, this line of research is at the beginning stage, and the use of implicit measures to understand the mechanisms underpinning the morality in autism (or in people with high autistic traits) have not yet been considered in previous studies. The present dissertation aimed to investigate important aspects of moral cognition that currently are still under-investigated in literature, offering a wider view on implicit aspects of morality in autism. Through six experiments, this work wanted to provide new empirical findings concerning the implicit mechanisms underpinning moral cognition in both neurotypical and autistic people without intellectual disability. Experiment 1 and 2 According to Moral Foundation Theory (Graham et al., 2013) specific emotions are associated to different types of moral violations. For instance, when people perceive that a victim is physically or emotionally harmed by someone else, they feel anger against the perpetrator. By contrast, people feel disgust when they perceive that someone ate inedible food or made blasphemous practices (Haidt et al., 1993). However, empirical finding that assessed the link between different types of moral violations and specific emotions showed mixed results. Indeed, it was suggested that other important factors might also modulate the relations between different moral violations and emotions (Atari et al., 2020; Kemper & Newheiser, 2018). Specifically, the benign violation hypothesis (McGraw & Warren, 2010) claimed that sometimes people could perceive moral violations as amusing, and this specific emotion seems elicited by specific contextual (e.g., psychological distance) as well as interpersonal factors (e.g., humor traits). However, previous studies never tested whether people perceive amusement in response to all types of moral violation, or whether amusement emerged only in response to specific norm violations (e.g., purity violations). Furthermore recently, Dempsey and colleagues (2020a) emphasized the importance to test the assumptions of Moral Foundation Theory in autistic spectrum disorder (ASD). Interviewing six autistic participants, the authors found that the participants endorsed all moral domains as morally relevant. However, the relations between emotional reaction and moral domains in autism have never been tested, as well as whether autistic people perceive moral violations as benign and amusing. In the first two experiments of this thesis, it was assessed the amusement reaction in response to different types of moral violations (purity vs. harm) and extending such investigation involving a group of autistic participants. Furthermore, the studies conducted so far on moral cognition has prevalently used explicit methodology. By contrast, in these experiments it was assessed the emotional reaction in response to different types of moral violations analysing the spontaneous facial expressions in neurotypical people (experiment 1), and the cardiac response of both typical and autistic individuals (experiment 2). The aim of these experiments was to investigate whether neurotypical people perceive specific types of moral violations as benign and amusing, and then whether autistic people expressed different emotions compared neurotypical people in response to different types of moral violations. Experiment 3, 4 and 5 As opposite of Moral Foundation Theory, the Dyadic Model claimed that a sine qua non for moral perception is the implicit activation of harm (Gray et al., 2012). In other words, always immorality automatically activates perceptions of harm regardless of someone is harmed (acts which involve physical and emotional damage; harm violations) or not (i.e., acts which involve impure and degradation behaviour; purity violations). Indeed, empirical evidence suggested that, during the reading of a scenario depicting a harmless moral violation in the domain of purity, people nevertheless implicitly infer that harm was involved. Across three experiments, we tested whether ostensibly harmless moral violations activated implicitly the harm concept. In all these three experiments the participants’ implicit attitude in response to moral violations was tested by using the affective misattribution paradigm (AMP; Payne et al., 2014), which is one of the most reliable methods to assess individual unconscious mental processes in psychology (Znanewitz et al., 2018). Specifically, Experiment 3 aimed to replicate previous findings which highlighted the implicit role of harm in response to harmless moral violations (Gray et al., 2014). Experiment 4 extended previous results with an investigation aimed to verify whether people with high autistic traits showed less implicit activation of harm in response to harmless scenarios than people with low autistic traits. Finally, Experiment 5 aimed to investigate whether autistic people (without intellectual disability) implicitly activated the harm concept in response to harmless scenarios as well as neurotypicals. Experiment 6 The majority of the studies which investigated the moral cognition in autism started to the premise that autistic people have a selective impairment in Theory of Mind (ToM; Moran et al., 2011), which is also a fundamental skill to understand the moral behaviours (e.g., Hamlin, 2015). However, the literature is far to show the role of Theory of Mind in the moral processing. Recently, it was suggested that ToM is a cognitive skill that involves both explicit and implicit processes (e.g., Southgate et al., 2007). The born of new implicit measures to assess the ToM brought an initial enthusiasm in this area of study. For instance, studies on clinical psychology, using both explicit and implicit ToM measures in order to understand selective ToM difficulties by autistic individuals without intellectual disability showed that, although this population presented high performance to explicit ToM tasks, they showed lower performance in the newer implicit ToM tasks compared to neurotypical participants (e.g., Schuwerk et al., 2015; Senju et al., 2009). Late unfortunately, these interesting results were put into question by other studies, which argued against the reliability of these new implicit measures (Kulke et al., 2018b). Moreover, another important gap in implicit ToM literature was that, while previous models in developmental psychology and psychopathology have suggested a link between attachment and the development of ToM, the relationship between attachment and implicit ToM has been so far neglected. In this experiment, we assessed both implicit and explicit mental state attribution, by means of a new implicit ToM task, as well as some attachment dimensions, comparing a group of autistic participants, without intellectual disability, and a control group. Specifically, in this experiment it was investigated participants’ spontaneous anticipatory look in response to false beliefs tasks using the eye-tracking methodology (one of the most used implicit ToM paradigms in literature). This study aimed to investigate the Theory of Mind (ToM) at both explicit and implicit level (Southgate et al., 2007), investigating possible differences between neurotypical individuals and autistic people. Furthermore, in the same study it was also investigated the link between the participants’ attachment and the explicit and implicit ToM skills. Moral cognition is a complex object of study that should be investigated with a multi-dimensional approach. In the experiments described in this thesis it was proposed a combined methodology that allowed to gather both explicit and implicit cognitive and emotional mechanisms that stay at the root of the moral judgment. Thanks to this approach it was found that deliberate and involuntary processes did not present convergent responses in the moral cognition of participants. Indeed, self-reported emotions seem to show divergent responses compared to the spontaneous facial expressions and the cardiac response to moral violations. These results support extant literature that raises concerns about the intuitionist assumptions of the moral cognition based on the assessment of only explicit responses of participants (e.g., Gutierrez & Giner-Sorolla, 2007; Nosek, 2007). Furthermore, this thesis highlighted the importance of studying the moral cognition in people affected by the autism spectrum disorder. Despite the social impairments that this neurodevelopmental disorder presents, we found that autistic people with cognitive level in average with the typical population, did not show any differences compared to the control group in both explicit and implicit mechanisms of moral cognition. These interesting findings may bring important theoretical reflections in moral and clinical psychology.

Sammanfattning Syftet med studien är att undersöka hur några lärare, speciallärare och specialpedagoger organiserar läsförståelseundervisning för elever med autismspektrumtillstånd för att identifiera framgångsfaktorer. Studien har utgått från forskningsfrågorna: 1.  Hur kan läsförståelseundervisning organiseras för att barn med AST i åldrarna 6-10 år ska få tillgång till en gynnsam undervisning och utveckla sin läsförståelse?  2. Hur kan grundlärare samverka med speciallärare och specialpedagoger på svenska grundskolor för att erbjuda elever med AST i åldrarna 6-10 år en gynnsam läsförståelseundervisning?  Studien har en kvalitativ ansats med semistrukturerade intervjuer med 2 specialpedagoger, 2 speciallärare och 2 klasslärare på grundskolor i södra Sverige. Intentionen är att bidra med kunskaper kring framgångsfaktorer som framkommit i lärares och speciallärares/specialpedagogers berättelser. Materialet analyserades utifrån en tematisk analys. Analysen har en deduktiv ansats och utgick från ett sociokulturellt perspektiv där lärande sker genom samspel och kommunikation med andra. Resultatet visar att samtliga lärare belyser vikten av att vara tydlig och explicit i sin undervisning för att hantera utmaningar med de exekutiva förmågorna. Resultatet visar även att flera respondenter beskriver samlärandet som en gynnsam metod för att hantera svårigheter med att koppla läsningen till egna erfarenheter, där eleverna kan lära av varandra och ta del av varandras erfarenheter. Vikten av en god samverkan mellan klasslärare, specialpedagog och speciallärare framkommer även av studiens resultat. / Abstract The purpose of this study is to examine how some teachers, special teachers and special educators organize their teaching regarding reading comprehension for students with Autism spectrum disorder in order to identify success factors. The study is based on the following research questions:  1. How do we organize reading comprehension teaching for students with ASD aged 6-10 in order to generate the most favourable conditions to develop their reading comprehension? 2. How can the collaboration between teachers, special teachers and special educators look like at Swedish schools in order to offer students with ASD aged 6-10 a favourable teaching in reading comprehension? The study has a qualitative approach with semi-structured interviews with 2 special educators, 2 special teachers and 2 teachers at elementary schools in the south part of Sweden. The intention is to contribute with knowledge of success factors which the respondents have pointed out in their answers. Thematic analysis was used during analyzing the data. The analysis has a deductive approach and is based on a sociocultural perspective in which learning takes place through interaction and communication with others. The results showed that all teachers described the importance of being explicit in their teaching in order to handle challenges with the executive abilities. Another similarity was that several respondents described co-learning as a beneficial method for dealing with difficulties in connecting the reading to their own experiences, in which students can learn from each other and take part in each other’s experiences. Moreover, the result also indicated the importance of a well-functioning collaboration between teachers and teachers with special pedagogical knowledge.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25198号 / 医博第5084号 / 新制||医||1072(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 阪上 優, 教授 松村 由美, 教授 山本 洋介 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Applied behavior analysis (ABA) is the gold standard treatment for autism spectrum disorder (ASD), and caregivers can learn to use ABA strategies to teach skills to their children with ASD. However, some families may not be able to access synchronous training due to cost, time, or location. Asynchronous modalities, such as DVDs or internet modules, remove some of these barriers. Other asynchronous options like podcasts need additional efficacy research. We evaluated a brief podcast about positive reinforcement with three caregivers and their children with ASD. We measured correct implementation of positive reinforcement and percentage correct on a multiple-choice quiz. The caregiver's implementation of positive reinforcement was assessed with a confederate and their child before and after listening to the podcast. If the caregiver's performance did not reach the mastery criterion, we provided modeling and coaching. Two of the caregivers implemented positive reinforcement at mastery after listening to the podcast. One caregiver needed modeling and coaching. All three responded correctly to more questions on the quiz after the podcast. These preliminary data suggest that a podcast may teach ABA strategies like positive reinforcement to caregivers of children with ASD, which could reduce some barriers to accessing training.

Attention Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are heterogeneous neurodevelopmental disorders with similar functional impairments. Specifically, working memory (WM) deficits have been found in studies of both ADHD and ASD and social competence has been identified as an area in which these individuals also struggle. The purpose of this study was (a) to identify which components of working memory (WM; based on Baddeley's 2000 model) are deficient and (b) to explore how WM deficits contribute to social problems in individuals with varying levels of ADHD symptoms and ASD traits. It was hypothesized that visuospatial (VS) WM deficits would be evident in the three analogue clinical groups, phonological (PH) WM and central executive (CE) deficits would be more evident in groups with high ADHD symptoms, all three analogue clinical groups would have lower social competence, and WM abilities would moderate the relationship between ADHD symptoms and social competence. In Phase I, 1311 undergraduate students participated in an online survey on general psychopathology, ADHD symptoms, and ASD traits. From this sample, a subgroup (n = 60) completed Phase II, an in-lab session that included WM tasks, a brief cognitive assessment, and social conversation task. Although WM deficits were not identified for any group, all participants demonstrated worse performance on the VS WM task than the PH WM task. However, WM abilities did not moderate the relationship between ADHD symptoms and social competence. Exploratory analyses were conducted with similar results. Limitations and suggestions for future research are discussed. / Ph. D.

The default mode network (DMN) is active in the absence of task demands and during self-referential thought. Considerable evidence suggests that the DMN is involved in normative aspects of social cognition, and as such, disruptions in the function of DMN would be expected in disorders characterized by alterations in social function. Consistent with this notion, work in autism spectrum disorder (ASD) and social anxiety disorder (SAD) has demonstrated altered activation of several core regions of the DMN relative to neurotypical controls. Despite emergent evidence for alterations within the same brain systems in SAD and ASD, as well as a behavioral continuum of social impairments, no study to date has examined what is unique and what is common to the brain systems within these disorders. Therefore, the primary aim of the current study is to precisely characterize the topology of neural connectivity within the DMN in SAD and ASD and neurotypical controls in order to test the following hypotheses through functional and structural connectivity analyses of the DMN. Our analyses demonstrate increased coavtivation of the dorsomedial prefrontal cortex in ASD and SAD compared to controls, as well as over and under connectivity in structural brain connectivity in ASD. These results may reflect general deficits in social function at rest, and disorder specific alterations in structural connectivity in ASD. / Master of Science

Early detection and intervention are crucial for optimal outcomes in autism spectrum disorder (ASD), but access to services is often lacking in rural communities. In fact, the average age of ASD diagnosis in rural communities is later than elsewhere, increasing the risk of missed early intervention and subsequently poorer outcomes. Caregivers in Southwest Virginia report that major barriers to ASD services include few providers with expertise in ASD, unaffordability of services, and geographic isolation; limited parent training or education about ASD emerges as a particular paucity in this region. To address these barriers, the current pilot study assessed the feasibility of delivering ASD assessment through a mobile clinic (n = 15). During COVID-19, the study shifted to pilot an ASD teleassessment protocol (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. Following a diagnostic feedback session, caregivers of children who received an ASD diagnosis (n = 28) were randomized to either attend psychoeducation sessions or receive comparable materials about ASD, with the goal of improving caregiver ASD knowledge and empowerment to seek and provide care for their child. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats exhibited high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment in the domains of family and the community improved after receiving assessment and psychoeducation services, as did total ASD knowledge (η2 = .114–.235, p < .05). / M.S. / Children with autism spectrum disorder (ASD) tend to achieve better outcomes with early intervention, which requires early assessment and diagnosis. However, families in rural areas typically have greater difficulty accessing such services, due to limited providers, high cost of services, and geographic distance from provider offices. This often results in children from rural regions being diagnosed with ASD at a later age than elsewhere, thereby missing opportunities for effective and timely treatment. To overcome these barriers, the current pilot study evaluated two novel service delivery formats: (1) mobile assessment through the Mobile Autism Clinic prior to the COVID-19 pandemic (n = 15); and (2) tele-assessment via a secure video platform during the pandemic (n = 15). Participants included 30 children between 1.7 and 14.9 years of age and one or both caregivers. After completing an assessment, caregivers attended a feedback session to review diagnoses and recommendations. If their child received an ASD diagnosis (n = 28), caregivers then either completed additional educational sessions about ASD or received similar informational materials, with the goal of improving caregiver knowledge and empowerment. Although flexibility in scheduling was necessary to accommodate families’ schedules, both delivery formats demonstrated high feasibility and strong caregiver satisfaction. The primary reason for rescheduling mobile assessments was weather-related, whereas teleassessments were rescheduled due to family emergencies and work-related conflicts. Caregiver empowerment within their family and community improved after receiving assessment and psychoeducation services, as did total ASD knowledge.

Mentalistic inference, the process of deducing others’ mental states from behaviour, is a key element of social interactions, especially when challenges arise. Just by observing an action or listening to a verbal description of it, adults and infants are able to make robust and rapid inferences about an agent’s intentions, desires, and beliefs. This thesis considers perspectives from Autism Spectrum Disorders (ASDs) and large language models, specifically GPT models. Individuals with ASDs struggle to read intentions from movements, but the mechanisms underlying these difficulties remain unknown. In a set of experiments, we employed combined motion tracking, psychophysics, and computational analyses to examine intention reading in ASDs with single-trial resolution. Single-trial analyses revealed that challenges in intention reading arise from both differences in kinematics between typically developing individuals and those with ASD, and a diminished sensitivity in reading intentions to variations in movement kinematics. This aligns with the idea that internal readout models are tuned to specific action kinematics, supporting the role of sensorimotor processes in shaping cognitive understanding and emphasizing motor resonance, a key aspect of embodied cognition. Targeted trainings may enhance and improve this ability. In a second set of experiments, we compared Theory of Mind, a core feature of mentalistic inference, in GPT models and a large sample of human participants. We found that GPT models exhibited human-level abilities in detecting indirect requests, false beliefs, and misdirection, but failed on faux pas. Rigorous hypothesis testing enabled us to show that this failure was apparent and was linked to a cautious approach in drawing conclusions rather than from an inference deficit. Collectively, the results presented in this thesis suggest that the convergence of insights from clinical research and advancements in technology is essential for fostering a more inclusive understanding of mentalistic inferences.

<p dir="ltr">Children with autism may have delayed language skills. Deficits in pragmatic language can affect social interaction with adults and peers and academic performance as more complex language becomes required for reading comprehension and analysis of information (Ibrahimagic et al., 2021 p. 251) This research supports the study question, how can educators prepare children with autism during this transition program? The survey was sent to fifteen participants addressing their insights and experiences of the transition to kindergarten process and the transition strategies that were used in the classroom. The results from the survey indicated that teachers do not know about the transition to kindergarten process. For the transitional practices, 36% of teachers said they used social stories, 9% of teachers used a photo book of new people and school environments, and 27% of teachers used observations of the student in the preschool classroom. This research assisted in the production of a handbook.</p>