Ned T. Sahin

Sequential Processing of Lexical, Grammatical, and Phonological Information Within Broca’s Area

Seeing the Brains One, Two, Three Taking advantage of the rare opportunity to record neuronal activity in the human brain using intracranial electrodes, Sahin et al. (p. 445; see the Perspective by Hagoort and Levelt) document the spatial and temporal pattern of neuronal populations within Brocas area as patients thought of a single word, changed its tense (for verbs) or number (for nouns), and articulated the word silently. For these three stages, they detected activity at 200, 320, and 450 milliseconds, moving in a caudal to rostral direction. These data fit neatly within the roughly 600 milliseconds required for the onset of speech and map the distinct neural computations within an area of the brain, known for almost a century and a half, as important for the production of language. Intracranial electrodes record activity in a language-associated area of the brain as words are identified and produced. Words, grammar, and phonology are linguistically distinct, yet their neural substrates are difficult to distinguish in macroscopic brain regions. We investigated whether they can be separated in time and space at the circuit level using intracranial electrophysiology (ICE), namely by recording local field potentials from populations of neurons using electrodes implanted in language-related brain regions while people read words verbatim or grammatically inflected them (present/past or singular/plural). Neighboring probes within Broca’s area revealed distinct neuronal activity for lexical (~200 milliseconds), grammatical (~320 milliseconds), and phonological (~450 milliseconds) processing, identically for nouns and verbs, in a region activated in the same patients and task in functional magnetic resonance imaging. This suggests that a linguistic processing sequence predicted on computational grounds is implemented in the brain in fine-grained spatiotemporally patterned activity.TRCs, with taste at the periphery proposed to be encoded via labeled lines [i.e., a sweet line, a sour line, a bitter line, etc. (21)]. Given that Car4 is specifically tethered to the surface of sour-sensing cells, and thus ideally poised to provide a highly localized acid signal to the sour TRCs, we reasoned that carbonation might be sensed through activation of the sour-labeled line. A prediction of this postulate is that prevention of sour cell activation should eliminate CO2 detection, even in the presence of wild-type Car4 function. To test this hypothesis, we engineered animals in which the activation of nerve fibers innervating sour-sensing cells was blocked by preventing neurotransmitter release from the PKD2L1-expressing TRCs. In essence, we transgenically targeted expression of tetanus toxin light chain [TeNT, an endopeptidase that removes an essential component of the synaptic machinery (34–36)] to sour-sensing TRCs, and then monitored the physiological responses of these mice to sweet, sour, bitter, salty, umami and CO2 stimulation. As predicted, taste responses to sour stimuli were selectively and completely abolished, whereas responses to sweet, bitter, salty and umami tastants remained unaltered (Fig. 4 and fig. S5). However, these animals also displayed a complete loss of taste responses to CO2 even though they still expressed Car4 on the surface of PKD2L1 cells. Together, these results implicate the extracellular generation of protons, rather than intracellular acidification (15), as the primary signal that mediates the taste of CO2, and demonstrate that sour cells not only provide the membrane anchor for Car4 but also serve as the cellular sensors for carbonation. Why do animals need CO2 sensing? CO2 detection could have evolved as a mechanism to recognize CO2-producing sources (18, 37)—for instance, to avoid fermenting foods. This view would be consistent with the recent discovery of a specialized CO2 taste detection in insects where it mediates robust innate taste behaviors (38). Alternatively, Car4 may be important to maintain the pH balance within taste buds, and might gratuitously function as a detector for carbonation only as an accidental consequence. Although CO2 activates the sour-sensing cells, it does not simply taste sour to humans. CO2 (like acid) acts not only on the taste system but also in other orosensory pathways, including robust stimulation of the somatosensory system (17, 22); thus, the final percept of carbonation is likely to be a combination of multiple sensory inputs. Nonetheless, the “fizz” and “tingle” of heavily carbonated water is often likened to mild acid stimulation of the tongue, and in some cultures seltzer is even named for its salient sour taste (e.g., saurer Sprudel or Sauerwasser).

Abstract Grammatical Processing of Nouns and Verbs in Broca's Area: Evidence from fMRI

The role of Brocas area in grammatical computation is unclear, because syntactic processing is often confounded with working memory, articulation, or semantic selection. Morphological processing potentially circumvents these problems. Using event-related functional magnetic resonance imaging (fMRI), we had 18 subjects silently inflect words or read them verbatim. Subtracting the activity pattern for reading from that for inflection, which indexes processes involved in inflection (holding constant lexical processing and articulatory planning) highlighted left Brodmann area (BA) 44/45 (Brocas area), BA 47, anterior insula, and medial supplementary motor area. Subtracting activity during zero inflection (the hawk; they walk) from that during overt inflection (the hawks; they walked), which highlights manipulation of phonological content, implicated subsets of the regions engaged by inflection as a whole. Subtracting activity during verbatim reading from activity during zero inflection (which highlights the manipulation of inflectional features) implicated distinct regions of BA 44, 47, and a premotor region (thereby tying these regions to grammatical features), but failed to implicate the insula or BA 45 (thereby tying these to articulation). These patterns were largely similar in nouns and verbs and in regular and irregular forms, suggesting these regions implement inflectional features cutting across word classes. Greater activity was observed for irregular than regular verbs in the anterior cingulate and supplementary motor area (SMA), possibly reflecting the blocking of regular or competing irregular candidates. The results confirm a role for Brocas area in abstract grammatical processing, and are interpreted in terms of a network of regions in left prefrontal cortex (PFC) that are recruited for processing abstract morphosyntactic features and overt morphophonological content.

Feasibility of an Autism-Focused Augmented Reality Smartglasses System for Social Communication and Behavioral Coaching

Background Autism spectrum disorder (ASD) is a childhood-onset neurodevelopmental disorder with a rapidly rising prevalence, currently affecting 1 in 68 children, and over 3.5 million people in the United States. Current ASD interventions are primarily based on in-person behavioral therapies that are both costly and difficult to access. These interventions aim to address some of the fundamental deficits that clinically characterize ASD, including deficits in social communication, and the presence of stereotypies, and other autism-related behaviors. Current diagnostic and therapeutic approaches seldom rely on quantitative data measures of symptomatology, severity, or condition trajectory. Methods Given the current situation, we report on the Brain Power System (BPS), a digital behavioral aid with quantitative data gathering and reporting features. The BPS includes customized smartglasses, providing targeted personalized coaching experiences through a family of gamified augmented-reality applications utilizing artificial intelligence. These applications provide children and adults with coaching for emotion recognition, face directed gaze, eye contact, and behavioral self-regulation. This preliminary case report, part of a larger set of upcoming research reports, explores the feasibility of the BPS to provide coaching in two boys with clinically diagnosed ASD, aged 8 and 9 years. Results The coaching intervention was found to be well tolerated and rated as being both engaging and fun. Both males could easily use the system, and no technical problems were noted. During the intervention, caregivers reported improved non-verbal communication, eye contact, and social engagement during the intervention. Both boys demonstrated decreased symptoms of ASD, as measured by the aberrant behavior checklist at 24-h post-intervention. Specifically, both cases demonstrated improvements in irritability, lethargy, stereotypy, hyperactivity/non-compliance, and inappropriate speech. Conclusion Smartglasses using augmented reality may have an important future role in helping address the therapeutic needs of children with ASD. Quantitative data gathering from such sensor-rich systems may allow for digital phenotyping and the refinement of social communication constructs of the research domain criteria. This report provides evidence for the feasibility, usability, and tolerability of one such specialized smartglasses system.

An Augmented Reality Social Communication Aid for Children and Adults with Autism: User and caregiver report of safety and lack of negative effects.

There is growing interest in the use of augmented reality (AR) to assist children and adults with autism spectrum disorders (ASD); however, little investigation has been conducted into the safety of devices for AR such as smartglasses. The objective of this report was to assess the safety and negative effects of the Brain Power Autism System (BPAS), a novel AR smartglasses-based social communication aid for people with ASD. A sequential series of 18 children and adults aged 4.4 to 21.5 years (mean 12.2 years) with clinically diagnosed ASD of varying severity used the BPAS. Users and caregivers were interviewed about perceived negative effects and design concerns. Most users were able to wear and use the BPAS (n=16/18, 89%), with most of them reporting no negative effects (n=14/16, 87.5%). Two users reported temporary negative effects: eye strain, dizziness, and nasal discomfort. Caregivers observed no negative effects in users (n=16/16, 100%). Most users (77.8%) and caregivers (88.9%) had no design concerns. This report found no major negative effects in using an AR smartglasses-based social communication aid across a wide age and severity range of people with ASD. Further research is needed to explore longer-term effects of using AR smartglasses in this population.Background: Interest has been growing in the use of augmented reality (AR) based social communication interventions in ASD, yet little is known about their safety or negative effects, particularly in head-worn digital smartglasses. Research to understand the safety of smartglasses in people with ASD is crucial given that these individuals may have altered sensory sensitivity, impaired verbal and non-verbal communication, and may experience extreme distress in response to changes in routine or environment. Methods: A sequential series of 18 children and adults (mean age 12.2-years-old, range 4.4-21.5-years-old) with clinically diagnosed ASD were given the opportunity to use the BPAS to learn emotion recognition, face-directed gaze, and managing transitions. Users and caregivers were interviewed about perceived negative effects of using BPAS, and had an opportunity to highlight any hardware or software design issues. Objective: The objective of this report was to assess the safety and negative effects of the Brain Power Autism System (BPAS), a novel AR smartglasses-based social communication aid for children and adults with ASD. BPAS uses emotion-based artificial intelligence and a smartglasses hardware platform that keeps users engaged in the social world by keeping users looking heads-up, unlike tablet- or phone-based apps. Results: The majority of users were able to wear and use the BPAS (n=16, 89%). Caregivers reported no perceived negative effects in users during or after use of the BPAS. Three users each reported one temporary negative effect, these were eye strain, dizziness, and nasal discomfort due to the smartglasses nose stabilizers. Most users and caregivers did not have any design concerns regarding the smartglasses hardware or software (users 77.8%, caregivers 88.9%). The only reported design concern was that the smartglasses became warm to the touch during extended use. Conclusions: It is important to conduct research to understand the feasibility and safety associated with new emerging technologies for vulnerable populations such as ASD. This report found no significant negative effects in using an AR smartglasses based social communication aid across a wide age range of children and adults with ASD. Further research is needed to explore the efficacy and longer term effects of such novel interventions.

Case Study of a Digital Augmented Reality Intervention for Autism in School Classrooms: Associated With Improved Social Communication, Cognition, and Motivation via Educator and Parent Assessment

Background: Impairment in social communication is the primary deficit in school-aged children with autism spectrum disorder (ASD). There are efficacious interventions to address social communication deficits, yet their delivery is hampered by the lack of human and time resources. Emerging assistive technologies, such as smartglasses, may be able to help augment the social communication interventions currently provided by human educators and therapists. While emerging research suggests assistive socio-emotional coaching smartglasses can be effective and usable in research settings, they have yet to be studied amidst the complex social, physical, and time-constrained environment of the school classroom. This structured case study reports on the feasibility and efficacy of 16 intervention sessions of the Empowered Brain Face2Face module, a smartglasses-based social communication intervention. Methods: A 13-year-old fully-verbal adolescent male student with a diagnosis of ASD received a total of 16 smartglasses-aided intervention sessions over a two-week period. Interventions occurred twice-daily during school days and were facilitated by school professionals in a middle school in Massachusetts, USA. Outcomes were measured using the Social Responsiveness Scale 2 (SRS-2), a commonly used validated measure of social communication in children with ASD, by the participant’s parent, paraprofessional, and two teachers. Difficulties in usability during the study were recorded through observation notes. Results: The participant completed the three-week study (one pre-intervention week (baseline) and two intervention weeks) without any observations of adverse effects or usability concerns. The parent and three educators completed the SRS-2 for the baseline and intervention weeks, and results demonstrated significant improvement in social communication after the intervention relative to baseline. The parent, special education teacher, and general education teacher noted marked reductions in SRS-2 total T score, with improvement in SRS-2 social communication, social motivation, social cognition, and restricted interests and repetitive behavior subscales. Conclusion: Smartglasses are a novel assistive technology that can help facilitate social communication and behavioral coaching for students with ASD. The use of the Face2Face module by educators over a two-week period was associated with improvements in social communication. This study supports the use of this novel technology to deliver assistive social communication and behavioral coaching in schools.

Cool Enough for School: Second Version of Google Glass Rated by Children Facing Challenges to Social Integration as Desirable to Wear at School

Background On July 18th, 2017, X, a subsidiary of Alphabet Inc. announced the successor to Google Glass. Glass Enterprise Edition could function as an assistive technology for autism spectrum disorder (ASD), yet its acceptability, desirability, and the willingness of children with ASD to wear it, are not known. The authors review key issues surrounding smartglasses and social communication, child development, and the school environment. Methods The smartglasses were evaluated by eight children with ASD, who ranged from moderately non-verbal to verbal, in the context of whether they would desire to wear it and use it as an assistive device each day at their respective schools. Children represented the full range of school ages (6 – 17yrs). Results All eight children responded that they would want to wear and use Glass Enterprise Edition at school. Additionally, all eight parents said their child had fun during the testing session, and six of eight parents said the experience went better than they had thought. Conclusion The results show that children with ASD are willing to use Glass Enterprise Edition in a school setting, highlighting its desirability and social acceptability in this population, as well as its future potential as an assistive technology.

Safety and Lack of Negative Effects of Wearable Augmented-Reality Social Communication Aid for Children and Adults with Autism

There is a growing interest in the use of augmented reality (AR) to assist children and adults with autism spectrum disorders (ASD); however, little investigation has been conducted into the safety of AR devices, such as smartglasses. The objective of this report was to assess the safety and potential negative effects of the Empowered Brain system, a novel AR smartglasses-based social communication aid for people with ASD. The version of the Empowered Brain in this report utilized Google Glass (Google, Mountain View, CA, USA) as its hardware platform. A sequential series of 18 children and adults, aged 4.4 to 21.5 years (mean 12.2 years), with clinically diagnosed ASD of varying severity used the system. Users and caregivers were interviewed about the perceived negative effects and design concerns. Most users were able to wear and use the Empowered Brain (n = 16/18, 89%), with most of them reporting no negative effects (n = 14/16, 87.5%). Caregivers observed no negative effects in users (n = 16/16, 100%). Most users (77.8%) and caregivers (88.9%) had no design concerns. This report found no major negative effects in using an AR smartglasses-based social communication aid across a wide age and severity range of people with ASD. Further research is needed to explore longer-term effects of using AR smartglasses in this population.

Standing balance assessment using a head-mounted wearable device

Background: The presence of accelerometers in smartphones has enabled low-cost balance assessment. Smartglasses, which contain an accelerometer similar to that of smartphones, could provide a safe and engaging platform for virtual and augmented reality balance rehabilitation; however, the validity of head-mounted measurement of balance using smartglasses has not been investigated. Objective: To perform preliminary validation of a smartglasses-based balance accelerometry measure (BAM) compared with previously validated waist-based BAM. Methods: 42 healthy individuals (26 male, 16 female; mean age ± SD = 23.8 ± 5.2 years) participated in the study. Following the BAM protocol, each subject performed two trials of six balance stances while accelerometer and gyroscope data were recorded from smartglasses (Google Glass). Test-retest reliability and correlation were determined relative to waist-based BAM as used in the NIH Standing Balance Toolbox. Results: Balance measurements obtained using a head-mounted wearable were highly correlated with those obtained through a waist-mounted accelerometer (Spearman’s rank correlation coefficient = 0.85). Test-retest reliability was high (ICC = 0.85, 95% CI 0.81-0.88), and in good agreement with waist balance measurements (ICC = 0.84, 95% CI 0.80-0.88). Taking into account the total NPL magnitude improved inter-device correlation (0.90) while maintaining test-retest reliability (0.87, 95% CI 0.83-0.90). All subjects successfully completed the study, demonstrating the feasibility of using a head-mounted wearable to assess balance in a healthy population. Conclusion: Balance measurements derived from the smartglasses-based accelerometer were consistent with those obtained using a waist-mounted accelerometer. Given this and the potential for smartglasses in vestibular rehabilitation, the continued development and validation of balance assessment measurements obtained via smartglasses is warranted. This research was funded in part by Department of Defense/Defense Health Program (#W81XWH-14-C-0007, SBIR Phase II contract awarded to TIAX, LLC).

Improvement of Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in School-Aged Children, Adolescents, and Young Adults With Autism via a Digital Smartglasses-Based Socioemotional Coaching Aid: An Efficacy Study

Introduction People with autism spectrum disorder (ASD) commonly experience attention hyperactivity deficit disorder (ADHD) related symptoms, including hyperactivity, inattention, and impulsivity. One third of ASD cases may be complicated by the presence of ADHD. These dually diagnosed individuals face greater barriers to accessing treatment for ADHD, and respond less positively to primary pharmacological interventions. Non-pharmacological technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. This preliminary study describes the changes to ADHD-related symptoms in children and adolescents with ASD after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. Methods Eight children and adults with ASD (M:F ratio of 7:1, mean age 15 years, range 11.7-20.5 years) were recruited through a web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n = 4, ABC-H ≥ 13) and a low ADHD-related symptom group (n = 4, ABC-H < 13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. Caregiver-reported ABC-H scores were then calculated at 24- and 48-hours post-session. Results All eight participants were able to complete the intervention session. ABC-H scores were lower post-intervention for most participants at 24 hours (n = 6, 75%), and for all participants at 48 hours (n = 8, 100%). At 24-hours post-session, average ABC-H scores decreased by 54.4% in high ADHD symptom group and by 20% in the low ADHD symptom group. At 48-hours post-session ABC-H scores compared to baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusion This study provides initial evidence for the efficacy of the Empowered Brain in reducing ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children and adolescents with ASD. There is potential to use this digital smartglasses intervention to target a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand clinical importance of these observed changes, and to conduct longitudinal studies on this intervention with larger sample sizes.Introduction People with autism spectrum disorder (ASD) commonly experience symptoms of hyperactivity, inattention, and impulsivity, and a third of people on the spectrum may be diagnosed with attention hyperactivity deficit disorder (ADHD). These individuals often face barriers to having their ADHD symptoms treated. Non-pharmacological technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. This preliminary report describes the impact on hyperactivity symptoms in children and adults with ASD after use of the Brain Power Autism System (BPAS), a behavioral and social communication aid for ASD based on augmented-reality smartglasses. Methods Eight children and adults with ASD were recruited through a web-based research signup form. Four of these participants had a history of ADHD. The baseline score on the hyperactivity subscale of the aberrant behavioral checklist (ABC-H) determined their classification into a high ADHD symptom group (n = 4, ABC-H ≥ 13) and a low ADHD symptom group (n = 4, ABC-H < 13). All participants attended a coaching session with BPAS, where they used BPAS social communication and behavioral apps while interacting with their caregiver. Caregiver-reported ABC-H scores were calculated at 24- and 48-hours post-session. Results Mean ABC-H scores were lower in both low and high ADHD groups at 24- and 48-hours post-session. At 24-hours post-session, average ABC-H scores decreased by 54.4% in high ADHD symptom group and by 20% in the low ADHD symptom group. At 48-hours post-session ABC-H scores compared to baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusion The use of BPAS, a novel smartglasses-based behavioral and social communication aid for children and adults with ASD, was associated with reduced short-term symptoms of hyperactivity. While on the one hand, there may be a placebo effect to novel technology, on the other hand, people with ASD may react negatively to transitions or new experiences. The effects are likely to be temporary, and further research is required to understand clinical importance of these observed changes. Future research should focus on longer-term monitoring, and involve a larger sample size.Background: People with autism spectrum disorder (ASD) commonly experience symptoms related to attention-deficit/hyperactivity disorder (ADHD), including hyperactivity, inattention, and impulsivity. One-third of ASD cases may be complicated by the presence of ADHD. Individuals with dual diagnoses face greater barriers to accessing treatment for ADHD and respond less positively to primary pharmacologic interventions. Nonpharmacologic technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. Objective: The objective of this preliminary study was to describe the changes in ADHD-related symptoms in children, adolescents, and young adults with ASD after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. Methods: We recruited 8 children, adolescents, and young adults with ASD (male to female ratio of 7:1, mean age 15 years, range 11.7-20.5 years) through a Web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n=4, ABC-H ≥13) and a low ADHD-related symptom group (n=4, ABC-H <13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. We then calculated caregiver-reported ABC-H scores at 24 and 48 hours after the session. Results: All 8 participants were able to complete the intervention session. Postintervention ABC-H scores were lower for most participants at 24 hours (n=6, 75%) and for all participants at 48 hours (n=8, 100%). At 24 hours after the session, average participant ABC-H scores decreased by 54.9% in the high ADHD symptom group and by 20% in the low ADHD symptom group. At 48 hours after the session, ABC-H scores compared with baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusions: This study provides initial evidence for the efficacy of the Empowered Brain system in reducing ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children, adolescents, and young adults with ASD. This digital smartglasses intervention can potentially be targeted at a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand the clinical importance of these observed changes and to conduct longitudinal studies on this intervention with larger sample sizes.

Improvement of ADHD symptoms in School Age Children and Adolescents with Autism via a Digital Smartglasses-based Socio-emotional Coaching Aid

Introduction People with autism spectrum disorder (ASD) commonly experience attention hyperactivity deficit disorder (ADHD) related symptoms, including hyperactivity, inattention, and impulsivity. One third of ASD cases may be complicated by the presence of ADHD. These dually diagnosed individuals face greater barriers to accessing treatment for ADHD, and respond less positively to primary pharmacological interventions. Non-pharmacological technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. This preliminary study describes the changes to ADHD-related symptoms in children and adolescents with ASD after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. Methods Eight children and adults with ASD (M:F ratio of 7:1, mean age 15 years, range 11.7-20.5 years) were recruited through a web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n = 4, ABC-H ≥ 13) and a low ADHD-related symptom group (n = 4, ABC-H < 13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. Caregiver-reported ABC-H scores were then calculated at 24- and 48-hours post-session. Results All eight participants were able to complete the intervention session. ABC-H scores were lower post-intervention for most participants at 24 hours (n = 6, 75%), and for all participants at 48 hours (n = 8, 100%). At 24-hours post-session, average ABC-H scores decreased by 54.4% in high ADHD symptom group and by 20% in the low ADHD symptom group. At 48-hours post-session ABC-H scores compared to baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusion This study provides initial evidence for the efficacy of the Empowered Brain in reducing ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children and adolescents with ASD. There is potential to use this digital smartglasses intervention to target a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand clinical importance of these observed changes, and to conduct longitudinal studies on this intervention with larger sample sizes.Introduction People with autism spectrum disorder (ASD) commonly experience symptoms of hyperactivity, inattention, and impulsivity, and a third of people on the spectrum may be diagnosed with attention hyperactivity deficit disorder (ADHD). These individuals often face barriers to having their ADHD symptoms treated. Non-pharmacological technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. This preliminary report describes the impact on hyperactivity symptoms in children and adults with ASD after use of the Brain Power Autism System (BPAS), a behavioral and social communication aid for ASD based on augmented-reality smartglasses. Methods Eight children and adults with ASD were recruited through a web-based research signup form. Four of these participants had a history of ADHD. The baseline score on the hyperactivity subscale of the aberrant behavioral checklist (ABC-H) determined their classification into a high ADHD symptom group (n = 4, ABC-H ≥ 13) and a low ADHD symptom group (n = 4, ABC-H < 13). All participants attended a coaching session with BPAS, where they used BPAS social communication and behavioral apps while interacting with their caregiver. Caregiver-reported ABC-H scores were calculated at 24- and 48-hours post-session. Results Mean ABC-H scores were lower in both low and high ADHD groups at 24- and 48-hours post-session. At 24-hours post-session, average ABC-H scores decreased by 54.4% in high ADHD symptom group and by 20% in the low ADHD symptom group. At 48-hours post-session ABC-H scores compared to baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusion The use of BPAS, a novel smartglasses-based behavioral and social communication aid for children and adults with ASD, was associated with reduced short-term symptoms of hyperactivity. While on the one hand, there may be a placebo effect to novel technology, on the other hand, people with ASD may react negatively to transitions or new experiences. The effects are likely to be temporary, and further research is required to understand clinical importance of these observed changes. Future research should focus on longer-term monitoring, and involve a larger sample size.Background: People with autism spectrum disorder (ASD) commonly experience symptoms related to attention-deficit/hyperactivity disorder (ADHD), including hyperactivity, inattention, and impulsivity. One-third of ASD cases may be complicated by the presence of ADHD. Individuals with dual diagnoses face greater barriers to accessing treatment for ADHD and respond less positively to primary pharmacologic interventions. Nonpharmacologic technology-aided tools for hyperactivity and inattention in people with ASD are being developed, although research into their efficacy and safety remains limited. Objective: The objective of this preliminary study was to describe the changes in ADHD-related symptoms in children, adolescents, and young adults with ASD after use of the Empowered Brain system, a behavioral and social communication aid for ASD running on augmented reality smartglasses. Methods: We recruited 8 children, adolescents, and young adults with ASD (male to female ratio of 7:1, mean age 15 years, range 11.7-20.5 years) through a Web-based research signup form. The baseline score on the hyperactivity subscale of the Aberrant Behavioral Checklist (ABC-H), a measure of hyperactivity, inattention, and impulsivity, determined their classification into a high ADHD-related symptom group (n=4, ABC-H ≥13) and a low ADHD-related symptom group (n=4, ABC-H <13). All participants received an intervention with Empowered Brain, where they used smartglasses-based social communication and behavioral modules while interacting with their caregiver. We then calculated caregiver-reported ABC-H scores at 24 and 48 hours after the session. Results: All 8 participants were able to complete the intervention session. Postintervention ABC-H scores were lower for most participants at 24 hours (n=6, 75%) and for all participants at 48 hours (n=8, 100%). At 24 hours after the session, average participant ABC-H scores decreased by 54.9% in the high ADHD symptom group and by 20% in the low ADHD symptom group. At 48 hours after the session, ABC-H scores compared with baseline decreased by 56.4% in the high ADHD symptom group and by 66.3% in the low ADHD symptom group. Conclusions: This study provides initial evidence for the efficacy of the Empowered Brain system in reducing ADHD-related symptoms, such as hyperactivity, inattention, and impulsivity, in school-aged children, adolescents, and young adults with ASD. This digital smartglasses intervention can potentially be targeted at a broader array of mental health conditions that exhibit transdiagnostic attentional and social communication deficits, including schizophrenia and bipolar disorder. Further research is required to understand the clinical importance of these observed changes and to conduct longitudinal studies on this intervention with larger sample sizes.