Previous research on emotion identification in Autism Spectrum Disorders (ASD) has demonstrated inconsistent results. While some studies have cited a deficit in emotion identification for individuals with ASD compared to controls, others have failed to find a difference. Many studies have used static photographs that do not capture subtle details of dynamic, real-life facial expressions that characterize authentic social interactions, and therefore have not been able to provide complete information regarding emotion identification. The current study aimed to build upon prior research by using dynamic, talking videos where the speaker expresses emotions of happiness, sadness, fear, anger, and excitement, both with and without a voice track. Participants included 10 children with ASD between the ages of four and 12, and 10 gender- and mental age-matched children with typical development between six and 12. Overall, both ASD and typically developing groups performed similarly in their accuracy, though the group with typical development benefited more from the addition of voice. Eye tracking analyses considered the eye region and mouth as areas of interest (AOIs). Eye tracking data from accurately identified trials resulted in significant main effects for group (longer and more fixations for participants with typical development) and condition (longer and more fixations on voiced emotions), and a significant condition by AOI interaction, where participants fixated longer and more on the eye region in the voiced condition compared to the silent condition, but fixated on the mouth approximately the same in both conditions. Treatment implications and directions for future research are discussed. / Master of Science

Anxiety is an area of documented challenge for people with Autism Spectrum Disorder (ASD). Despite this, some studies state that those with ASD and language deficits have lower reported anxiety than those without language deficits. This effect may be due to the complicated task of appropriately evaluating anxiety in those with compromised language. Using biomarkers of anxiety, such as reduced Heart Rate Variability (HRV) and increased Heart Rate (HR), may improve anxiety assessment but more research is necessary. Specifically, it would be helpful to understand if the relationship between HRV/HR and anxiety is moderated by language abilities in children with ASD, and whether HRV/HR can discriminate between anxiety and other emotions, like anger, in children with ASD. This study examined the relationship between baseline HRV/HR, language ability, and different emotional states (i.e., anxiety and anger) in a sample of 23 children with ASD. It was hypothesized that receptive language would moderate the relationship between decreased HRV/increased HR and increased anxiety but not the relationship between decreased HRV/increased HR and increased anger. Multiple regression analyses indicated that HRV and HR were not significant predictors of anxiety or anger, and language was not a significant moderator. Future studies may wish to take new approaches to determining the role of language in the relationship between HRV/HR and anxiety. / Master of Science / Anxiety is an area of documented challenge for people with Autism Spectrum Disorder (ASD). Despite this, some studies state that those with ASD and language deficits have lower reported anxiety than those without language deficits. This effect may be due to the complicated task of appropriately evaluating anxiety in those with compromised language. Using biomarkers of anxiety, such as reduced Heart Rate Variability (HRV) and increased Heart Rate (HR), may improve anxiety assessment but more research is necessary. Specifically, it would be helpful to understand if the relationship between HRV/HR and anxiety is moderated by language abilities in children with ASD, and whether HRV/HR can discriminate between anxiety and other emotions, like anger, in children with ASD. This study examined the relationship between baseline HRV/HR, language ability, and different emotional states (i.e., anxiety and anger) in a sample of 23 children with ASD. It was hypothesized that receptive language would moderate the relationship between decreased HRV/increased HR and increased anxiety but not the relationship between decreased HRV/increased HR and increased anger. Multiple regression analyses indicated that HRV and HR were not significant predictors of anxiety or anger, and language was not a significant moderator. Future studies may wish to take new approaches to determining the role of language in the relationship between HRV/HR and anxiety.

Previous research showed that children with Autism Spectrum Disorders (ASD) tend to experience high levels of anxiety and anger. Some of the deficits that children with ASD experience are due their difficulty expressing and understanding their own and others' emotions. Thus, the purpose of this pilot study was to assess the feasibility and efficacy of an intervention to teach young children with high functioning autism (HFASD) to recognize their emotions and use emotion regulation strategies to self-soothe. We implemented a group therapy that emphasized children's understanding and knowledge of emotions and coping strategies related to anger and anxiety. Eleven 5-7 year-old children were randomly assigned to either an experimental or delayed-treatment control group. The Emotion Regulation Checklist, Behavior Monitoring Sheet, What Makes My Child Angry/Anxious Questionnaires, and anger- and anxiety-related emotions vignettes were used to measure children's emotion regulation abilities. Finally, maternal confidence of their own and their child's ability to regulate their emotions were measured by the Self-Confidence Rating Scale. Children in the experimental group demonstrated more knowledge of emotion regulation strategies, had fewer negative emotional responses, and showed lower frequency and intensity ratings of anger and anxiety related episodes after treatment. All mothers reported higher levels of confidence in their own and their child's ability to deal with anger and anxiety related emotions after treatment. These findings suggest that teaching young children with HFASD about emotion regulation strategies to manage anger and anxiety emotional states may increase their knowledge about emotion regulation strategies, and improve their emotion regulation abilities. Training mothers about emotion regulation strategies may increase maternal confidence in their own and their child's ability to deal with emotions related to anger and anxiety. Limitations and implications of this study will be discussed. / Master of Science

Emerging research suggests that many adults with Autism Spectrum Disorder (ASD) experience impairing Social Anxiety Disorder (SAD) or social anxiety symptoms (e.g., Joshi et al., 2013; Kleinhans et al., 2010), yet there is little guidance or agreement about how to best assess social anxiety in this population. Direct examination of overt eye gaze patterns may help determine if the attentional biases often reported in people with SAD also operate in those with ASD and co-occurring social anxiety. This study sought to assess the influence of social anxiety on gaze patterns in adults with ASD. An exploratory aim was to better understand the phenomenology of SAD within ASD. Three groups of participants were included: adults with ASD (n = 25), adults with SAD (n = 25), and adults without ASD or SAD (n = 25). As hypothesized, a large subset (n = 11; 44%) of the participants with ASD met diagnostic criteria for SAD. Contrary to study hypotheses related to gaze patterns, however, there was no evidence for gaze vigilance followed by avoidance for socially threatening stimuli in either the ASD or SAD groups, and there was no relationship between fear of negative evaluation and gaze duration toward socially threatening stimuli within the ASD group. Possible reasons for these null findings are considered. Clinical implications and suggestions for future research are also discussed. / Ph. D.

Although clinically significant symptoms of anxiety or depression are present in nearly one in two people with autism spectrum disorder (ASD), little is known about how these symptoms may relate to social motivation, a key construct in the etiology of ASD. The aim of the current study was to examine patterns of anxiety, depression, ASD symptomatology, and social motivation in youth with ASD. Using a large public dataset of well-characterized youth with ASD (N = 195), we examined varying patterns of these symptoms via latent profile analysis (LPA). Three distinct classes emerged: one with moderate ASD severity and low levels of comorbid psychopathology, a second with more severe ASD symptoms and similarly low anxiety and depression, and a third with significantly elevated anxiety and depression. Neither sex nor age differed significantly among these classes, and indices of social interest early in development did not predict class membership. Implications of these symptom patterns for assessment and treatment of comorbidity in ASD are discussed. / Doctor of Philosophy / A large proportion of individuals with autism spectrum disorder (ASD) experience symptoms of anxiety and depression. Anxiety and depression might be related to social motivation, which is a key concept associated with the development of ASD. The current study examined variation in anxiety, depression, social motivation, and ASD symptom severity in a large sample of youth with ASD. Individuals in the sample were classified in groups by a statistical model. Models produced three separate groups: one group with moderate symptoms of ASD and relatively low levels of anxiety and depression, a second with more severe ASD symptoms and similarly low anxiety and depression, and a final group with moderate ASD symptoms and high anxiety and depression. Social motivation was strongest in the first and second groups, and low social motivation was strongly associated with anxiety and depression symptoms. Age and sex did not predict group membership, nor did items measuring social motivation early in development. Implications of these symptom patterns for the assessment and treatment of anxiety and depression in ASD are discussed.

Prior studies have identified diminished attending to faces, and in particular the eye region, in individuals with Autism Spectrum Disorder (ASD), which may contribute to the impairments they experience with emotion recognition and expression. The current study evaluated the acceptability, feasibility, and preliminary effectiveness of an attention modification intervention designed to attenuate deficits in facial emotion recognition and expression in children with ASD. During the 10-session experimental treatment, children watched videos of people expressing different emotions with the facial features highlighted to guide children's attention. Eight children with ASD completed the treatment, of nine who began. On average, the children and their parents rated the treatment to be acceptable and helpful. Although treatment efficacy, in terms of improved facial emotion recognition (FER), was not apparent on task-based measures, children and their parents reported slight improvements and most parents indicated decreased socioemotional problems following treatment. Results of this preliminary trial suggest that further clinical research on visual attention retraining for ASD, within an experimental therapeutic program, may be promising. / PHD / Previous studies have shown that individuals with Autism Spectrum Disorder (ASD) show lower looking at faces, especially the eyes, which may lead to the difficulties they show with ability to recognize other’s emotions and express their own emotions. This study looked at a new treatment designed to decrease the difficulties in emotion recognition and expression in children with ASD. The study looked at whether the treatment is possible, acceptable to children and their parents, and successful in decreasing the difficulty with emotion recognition. During the 10-session treatment, children watched videos of people making different expressions. The faces of the actors in the videos were highlighted to show the children the important area to look at. Eight children with ASD completed the treatment, of nine who started the treatment. On average, the children and their parents said that the treatment is acceptable and helpful. While the treatment was not successful in improving ability to recognize emotions on other’s faces on several tasks, children and their parents reported slight improvements. In addition, most parents reported less problems with social skills and emotion recognition and expression after the treatment. These results suggest that more clinical research may be needed to evaluate usefulness of such attention retraining for children with ASD.

Parents of children and adolescents with Autism Spectrum Disorders (ASD) have been shown to experience increases in stress, depression, and anxiety, which are also associated with child behavior problems related to ASD, such as aggressive behaviors and tantrums. Literature examining potential mechanisms that underlie the relationship of child behavior problems and parental anxiety/depression are scarce. The current study seeks to examine the roles of parental stress, parent self-efficacy, and emotion coaching as mediators between child behavior problems and parental anxiety/depression. Using a sample of 134 mothers who completed an online survey, these potential mediators were tested with regression analyses. Parental self-efficacy was found to mediate parental stress and parental depression/anxiety. Parental self-efficacy was also found to moderate child conduct problems and parental emotion coaching. There was a positive relationship between conduct problems and emotion coaching for mothers with high self-efficacy. Implications and future research will be discussed. / Master of Science

Statistics show the prevalence of autism spectrum disorder (ASD), a developmental delay disorder, is now 1 in 110 children in the United States (Rice, 2009), nearing 1% of the population. Therefore, this study looked at ways modern technology could assist these children and their families. One deficit in ASD is the inability to respond to gaze referencing (i.e. follow the eye gaze of another adult/child/etc), a correlate of the responding to joint attention (RJA) process. This not only affects the way they appear to society, but it also affects social development, communication skills, and play skills later in life (Whalen & Schreibman, 2003), making early intervention of RJA is an integral part of a successful social skills program. This study developed design guidelines, as well as offered and evaluated a design framework, adding to the limited literature regarding technology and ASD intervention. The game was developed within behavior analytic framework, undergoing several iterations, developing a functional prototype that was analyzed in three parts. The first part identified which elements needed redesign in light of the study population. Second, a collaborative prototyping participatory design group was formed in which the elements from the previous part of the study were assigned guidelines. The final part of the study included an evaluation by those with ABA experience, evaluating if the game correctly encompassed and mirrored traditional face-to-face ABA interventions. The study's contributions were the finalized design guidelines and design framework, as well as additional research on harnessing technology in ASD interventions. / Master of Science

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that presents many challenges for parents and service providers. Unfortunately, there are limited examples of parent-mediated interventions for parents of children with ASD that can help manage behavioral problems, especially those that can be implemented in both urban and rural communities. COMPASS for Hope (C-HOPE) is an 8-week parent-mediated intervention that enhances parent knowledge, behavior management skills, and supportive strategies. Telehealth-based interventions can be especially effective for rural communities due to its ability to address common barriers of geographic location and lack of resources. When implementing this intervention, the ability to decrease child problem behaviors as well as increase parental activation, self-management, perceived competence, and knowledge are essential to determine the efficacy of this treatment. The purpose of the current study is to evaluate these outcomes in the implementation of C-HOPE via telehealth in rural versus urban communities. 20 parents with children from 3-12 years of age with a diagnosis of ASD were sampled from two rural sites and two urban sites in Kentucky. Few differences were noted between the participants in the rural versus urban group at pre-treatment. Following C-HOPE, in the urban area, there were significant treatment effects in parent knowledge outcomes. In the rural areas, a significant effect was found in change of parent self-management skills of toileting issues. Future directions for telehealth treatments for this population are discussed. / M.S. / ASD is a developmental disorder that presents many challenges for parents and providers. Unfortunately, there are limited behavioral treatment options for parents of children with ASD, especially those that can be utilized in both urban and rural communities. COMPASS for Hope (C-HOPE) is a parent intervention that improves parent knowledge, management, and supportive strategies. Technology-based interventions can be especially effective for rural communities due to its ability to address barriers of geographic location and lack of resources. In this intervention, the ability to decrease child problem behaviors as well as increase parental activation, self-management, competence, and knowledge are essential for this treatment to be effective. The current study evaluates these outcomes in C-HOPE using technology in rural versus urban communities. 20 parents with children with ASD, ranging from 3-12 years of age, were sampled from rural and urban areas in Kentucky. Few differences were noted between the participants in the rural versus urban group before treatment. After treatment, in the urban area, there were significant effects in parent knowledge outcomes. In the rural areas, a significant effect was found in change of parent self-management skills. Future directions for technology treatments for this population are discussed.

Self-injurious behavior (SIB) is one of the most dangerous behavioral responses among individuals with autism spectrum disorder (ASD), often leading to injury and hospitalization. There is an ongoing need to measure the triggers of SIB to inform management and prevention. These triggers are determined traditionally through clinical observations of the child with SIB, often involving a functional assessment (FA), which is methodologically documenting responses to stimuli (e.g., environmental or social) and recording episodes of SIB. While FA has been a "gold standard" for many years, it is costly, tedious, and often artificial (e.g., in controlled environments). If performed in a naturalistic environment, such as the school or home, caregivers are responsible for tracking behaviors. FA in naturalistic environments relies on caregiver and patient compliance, such as responding to prompts or recalling past events. Recent technological developments paired with classification methods may help decrease the required tracking efforts and support management plans. However, the needs of caregivers and individuals with ASD and SIB should be considered before integrating technology into daily routines, particularly to encourage technology acceptance and adoption. To address this, the perspectives of SIB management and technology were first collected to support future technology design considerations (Chapter 2). Accelerometers were then selected as a specific technology, based on caregiver preferences and reported preferences of individuals with ASD, and were used to collect movement data for classification (Chapter 3). Machine learning algorithms with featureless data were explored, resulting in individual-level models that demonstrated high accuracy (up to 99%) in detecting and classifying SIB. Group-level classifiers could provide more generalizable models for efficient SIB monitoring, though the highly variable nature of both ASD and SIB can preclude accurate detection. A multi-level regression model (MLR) was implemented to consider such individual variability (Chapter 4). Both linear and nonlinear measures of motor variability were assessed as potential predictors in the model. Diverse classification methods were used (as in Chapter 3), and MLR outperformed other group level classifiers (accuracy ~75%). Findings from this research provide groundwork for a future smart SIB monitoring system. There are clear implications for such monitoring methods in prevention and treatment, though additional research is required to expand the developed models. Such models can contribute to the goal of alerting caregivers and children before SIB occurs, and teaching children to perform another behavior when alerted. / Doctor of Philosophy / Autism spectrum disorder (ASD) is a prevalent developmental disorder that adversely affects communication, social skills, and behavioral responses. Roughly half of individuals diagnosed with ASD show self-injurious behavior (SIB), including self-hitting or head banging), which can lead to injury and hospitalization. Clinicians or trained caregivers traditionally observe and record events before/after SIB to determine possible causes (“triggers”) of this behavior. Clinicians can then develop management plans to redirect, replace, or extinguish SIB at the first sign of a known trigger. Tracking SIB in this way, though, requires substantial experience, time, and effort from caregivers. Observations may suffer from subjectivity and inconsistency if tracked across caregivers, or may not generalize to different contexts if SIB is only tracked in the home or school. Recent technological innovations, though, could objectively and continuously monitor SIB to address the described limitations of traditional tracking methods. Yet, “smart” SIB tracking will not be adopted into management plans unless first accepted by potential users. Before a monitoring system is developed, caregiver needs related to SIB, management, and technology should be evaluated. Thus, as an initial step towards developing an accepted SIB monitoring system, caregiver perspectives of SIB management and technology were collected here to support future technology design considerations (Chapter 2). Sensors capable of collecting the acceleration of movement (accelerometers) were then selected as a specific technology, based on the reported preferences of caregivers and individuals with ASD, and were used to capture SIB movements from individuals with ASD (Chapter 3). These movements were automatically classified as “SIB” or “non-SIB” events using machine learning algorithms. When separately applying these methods to each individual, up to 99% accuracy in detecting and classifying SIB was achieved. Classifiers that predict SIB for diverse individuals could provide more generalizable and efficient methods for SIB monitoring. ASD and SIB presentations, however, range across individuals, which impose challenges for SIB detection. A multi-level regression model (MLR) was implemented to consider individual differences, such as those that may occur from diagnosis or behavior (Chapter 4). Model inputs included measures capturing changes of movement over time, and these were found to enhance SIB identification. Diverse classification models were also developed (as in Chapter 3), though MLR outperformed these (yielding accuracy of ~75%). Findings from this research provide groundwork for a smart SIB monitoring system. There are clear implications for monitoring methods in prevention, though additional research is required to expand the developed models. Such models can contribute to the goal of alerting caregivers and children before SIB occurs, and teaching children to perform another behavior when alerted.