Sylvie Serret

Facing the challenge of teaching emotions to individuals with low- and high-functioning autism using a new Serious game: a pilot study

BackgroundIt is widely accepted that emotion processing difficulties are involved in Autism Spectrum Conditions (ASC). An increasing number of studies have focused on the development of training programs and have shown promising results. However, most of these programs are appropriate for individuals with high-functioning ASC (HFA) but exclude individuals with low-functioning ASC (LFA). We have developed a computer-based game called JeStiMulE based on logical skills to teach emotions to individuals with ASC, independently of their age, intellectual, verbal and academic level.The aim of the present study was to verify the usability of JeStiMulE (which is its adaptability, effectiveness and efficiency) on a heterogeneous ASC group. We hypothesized that after JeStiMulE training, a performance improvement would be found in emotion recognition tasks.MethodsA heterogeneous group of thirty-three children and adolescents with ASC received two one-hour JeStiMulE sessions per week over four weeks. In order to verify the usability of JeStiMulE, game data were collected for each participant. Furthermore, all participants were presented before and after training with five emotion recognition tasks, two including pictures of game avatars (faces and gestures) and three including pictures of real-life characters (faces, gestures and social scenes).ResultsDescriptive data showed suitable adaptability, effectiveness and efficiency of JeStiMulE. Results revealed a significant main effect of Session on avatars (ANOVA: F (1,32) = 98.48, P < .001) and on pictures of real-life characters (ANOVA: F (1,32) = 49.09, P < .001). A significant Session × Task × Emotion interaction was also found for avatars (ANOVA: F (6,192) = 2.84, P = .01). This triple interaction was close to significance for pictures of real-life characters (ANOVA: F (12,384) = 1.73, P = .057). Post-hoc analyses revealed that 30 out of 35 conditions found a significant increase after training.ConclusionsJeStiMulE appears to be a promising tool to teach emotion recognition not only to individuals with HFA but also those with LFA. JeStiMulE is thus based on ASC-specific skills, offering a model of logical processing of social information to compensate for difficulties with intuitive social processing.Trial registrationComité de Protection des Personnes Sud Méditerranée V (CPP): reference number 11.046 (https://cpp-sud-mediterranee-v.fr/).

Lithium as a rescue therapy for regression and catatonia features in two SHANK3 patients with autism spectrum disorder: case reports.

BackgroundPhelan-Mc Dermid syndrome is a contiguous disorder resulting from 22q13.3 deletion implicating the SHANK3 gene. The typical phenotype includes neonatal hypotonia, moderate to severe intellectual disability, absent or delayed speech, minor dysmorphic features and autism or autistic-like behaviour. Recently, point mutations or micro-deletions of the SHANK3 gene have been identified, accompanied by a phenotype different from the initial clinically description in Phelan McDermid syndrome.Case presentationHere we present two case studies with similar psychiatric and genetic diagnosis as well as similar clinical history and evolution. The two patients were diagnosed with autism spectrum disorders in childhood and presented regression with catatonia features and behavioural disorders after a stressful event during adolescence. Interestingly, both patients presented mutation/microdeletion of the SHANK3 gene, inducing a premature stop codon in exon 21. Different pharmacological treatments (antipsychotics, benzodiazepines, mood stabilizer drugs, antidepressants, and methylphenidate) failed to improve clinical symptoms and lead to multiple adverse events. In contrast, lithium therapy reversed clinical regression, stabilized behavioural symptoms and allowed patients to recover their pre-catatonia level of functioning, without significant side effects.ConclusionThese cases support the hypothesis of a specific SHANK3 phenotype. This phenotype might be linked to catatonia-like deterioration for which lithium use could be an efficient treatment. Therefore, these cases provide an important contribution to the field of autism research, clinical genetics and possible pharmacological answers.

Serious games to teach social interactions and emotions to individuals with autism spectrum disorders (ASD)

The use of information communication technologies (ICTs) in therapy offers new perspectives for treating many domains in individuals with autism spectrum disorders (ASD) because they can be used in many different ways and settings and they are attractive to the patients. We reviewed the available literature on serious games that are used to teach social interactions to individuals with ASD. After screening the Medline, Science Direct and ACM Digital Library databases, we found a total of 31 serious games: 16 that targeted emotion recognition or production and 15 that targeted social skills. There was a significant correlation between the number of reports per year and the year of publication. Serious games appeared promising because they can support training on many different skills and they favour interactions in diverse contexts and situations, some of which may resemble real life. However, the currently available serious games exhibit some limitations: (i) most of them are developed for High-Functioning individuals; (ii) their clinical validation has rarely met the evidence-based medicine standards; (iii) the game design is not usually described; and, (iv) in many cases, the clinical validation and playability/game design are not compatible.

Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel

The use of Serious Games (SG) in the health domain is expanding. In the field of neurodegenerative disorders (ND) such as Alzheimer’s disease, SG are currently employed both to support and improve the assessment of different functional and cognitive abilities, and to provide alternative solutions for patients’ treatment, stimulation, and rehabilitation. As the field is quite young, recommendations on the use of SG in people with ND are still rare. In 2014 we proposed some initial recommendations (Robert et al., 2014). The aim of the present work was to update them, thanks to opinions gathered by experts in the field during an expert Delphi panel. Results confirmed that SG are adapted to elderly people with mild cognitive impairment (MCI) and dementia, and can be employed for several purposes, including assessment, stimulation, and improving wellbeing, with some differences depending on the population (e.g., physical stimulation may be better suited for people with MCI). SG are more adapted for use with trained caregivers (both at home and in clinical settings), with a frequency ranging from 2 to 4 times a week. Importantly, the target of SG, their frequency of use and the context in which they are played depend on the SG typology (e.g., Exergame, cognitive game), and should be personalized with the help of a clinician.

Teaching Literacy Skills to French Minimally Verbal School-Aged Children with Autism Spectrum Disorders with the Serious Game SEMA-TIC: An Exploratory Study

Learning to read is very challenging for children with Autism Spectrum Disorders (ASD), but also very important, as it can give them access to new knowledge. This is even more challenging in minimally verbal children, who do not have the verbal abilities to learn through usual methods. To address the learning of literacy skills in French minimally verbal school-aged children with ASD, we designed the serious game SEMA-TIC, which relies on non-verbal cognitive skills and uses specific learning strategies adapted to the features of autistic individuals. This study investigated the usability of SEMA-TIC (in terms of adaptability, efficiency, and effectiveness) for the acquisition of literacy skills in French minimally verbal school-aged children with ASD. Twenty-five children with ASD and no functional language participated in the study. Children in the training group received the SEMA-TIC training over 23 weeks (on average), while no intervention was provided to children in the non-training group. Results indicated that SEMA-TIC presents a suitable usability, as all participants were able to play (adaptability), to complete the training (efficiency) and to acquire significant literacy skills (effectiveness). Indeed, the literacy skills in the training group significantly improved after the training, as measured by specific experimental tasks (alphabet knowledge, word reading, word-non-word discrimination, sentence reading and word segmentation; all p ≤ 0.001) compared to the non-training group. More importantly, 3 out of 12 children of the training group could be considered as word decoders at the end of the intervention, whereas no children of the non-training group became able to decode words efficiently. The present study thus brings preliminary evidence that French minimally verbal school-aged children with ASD are able to learn literacy skills through SEMA-TIC, a specific computerized intervention consisting in a serious game based on non-verbal cognitive skills.

Children Facial Expression Production: Influence of Age, Gender, Emotion Subtype, Elicitation Condition and Culture

The production of facial expressions (FEs) is an important skill that allows children to share and adapt emotions with their relatives and peers during social interactions. These skills are impaired in children with Autism Spectrum Disorder. However, the way in which typical children develop and master their production of FEs has still not been clearly assessed. This study aimed to explore factors that could influence the production of FEs in childhood such as age, gender, emotion subtype (sadness, anger, joy, and neutral), elicitation task (on request, imitation), area of recruitment (French Riviera and Parisian) and emotion multimodality. A total of one hundred fifty-seven children aged 6–11 years were enrolled in Nice and Paris, France. We asked them to produce FEs in two different tasks: imitation with an avatar model and production on request without a model. Results from a multivariate analysis revealed that: (1) children performed better with age. (2) Positive emotions were easier to produce than negative emotions. (3) Children produced better FE on request (as opposed to imitation); and (4) Riviera children performed better than Parisian children suggesting regional influences on emotion production. We conclude that facial emotion production is a complex developmental process influenced by several factors that needs to be acknowledged in future research.

2263 – Can a training with video game of social cognition enhance neurocognitive processes of emotional perception in autism spectrum? Insights of event-related potentials

Introduction Deficits in social cognition are major descriptors of the autism spectrum disorder (ASD). Measurable effects of training methods and psychological treatments have been reported in some psychiatric disorders, but few studies were conducted in the domain of neurodevelopmental disorders. Objectives The aims of the study were: 1) to investigate the use of event-related potentials (ERPs) as valuable markers of neurocognitive basis of emotional face processing in children with and without ASD; 2) to explore whether components of the ERPs can be used as potential markers of enhanced emotional processing in children with ASD who benefited from interactive computer training focused on emotion comprehension. Methods ERPs were recorded during an implicit emotion recognition task in 19 children with ASD and 11 paired controls, along with other clinical and cognitive measures. Another recording session was conducted after a two-week training with a multisensory video game performed by 12 children from the ASD group. Results Preliminary results showed that before the training, children with ASD exhibited abnormal P100 and N170 ERP components which reflect abnormal face perception strategies. After training, some of the children exhibited normalized ERP components and enhanced ERP components’ modulation by emotions. Conclusions The results are promising although the training was short and not intensive.

P03-262 - Comparison of pragmatic and cognitive functioning in adolescents with childhood onset schizophrenia and Asperger syndrome: common and differential patterns

Introduction Adolescents with childhood onset schizophrenia (COS) and adolescents with Asperger syndrome (AS) are characterized by impairments in pragmatics and in cognition. Objectives The study of the specificity of pragmatic and cognitive deficits in COS and in AS is important to highlight some fundamental areas to each disorder and to refine behavioural phenotypes which may provide a link to gene-brain-behaviour. Aims The present study directly compares the pragmatic and cognitive functions in adolescents with COS and AS. Methods Twelve adolescents with COS and 14 adolescents with AS, matched on general IQ, verbal IQ and performance IQ, were compared. Pragmatics was explored by the Childrens Communication Checklist, a parental report of language and communication in naturalistic context. Cognition was explored by Wechsler Intelligence Scale and by several specific tasks: Theory of Mind (ToM), Figurative Language Comprehension, executive functions (WCST), mental flexibility and working memory (TMT) and inhibition (Stroop). Results Compared to adolescents with COS, adolescents with AS exhibited more severe pragmatic impairments in naturalistic context and had more reduced figurative comprehension. In contrast, compared to AS, adolescents with COS exhibited impaired inhibition and deficit in verbal reasoning (subtest “Similarities” of the Wechsler). Both groups had similar results on ToM, WCST and TMT tasks, and on the all other Wechsler’s subtests. Conclusions Despite some similarities, adolescents with AS and with COS differed when pragmatics was evaluated in naturalistic context. Cognitive impairments observed in inhibition and in verbal reasoning may be specifically related to thought disorder, a core feature of schizophrenia.