Characteristics Of Vocalization In Infants With High-risk Autism Spectrum Disorder During The Still-face Paradigm

【Objective】To study the early characteristics of vocalization in infants with High-Risk Autism Spectrum Disorder(HR-ASD)during Still-face Paradigm(SFP)and further to explore the correlation between these characteristics and clinical symptoms.To provide theoretical support for the search for behavioral markers for early diagnosis of ASD.【Methods】Study 1:Characteristics of vocalization in the Still-face Paradigm of infants with High-Risk Autism Spectrum DisorderA total of 42 HR-ASD infants were consecutive sampling from outpatient clinic of Nanjing Brain Hospital Since January 2018 to July 2019,and 37 typical development(TD)infants,aged 7-23 months,in the same period were recruited as TD group from Nanjing.Participants of two groups were completed SFP videotapes to mearsure vocalization and Gesell developmental schedules to assess developmental levels.All the infants of HR-ASD complete Communication and Symbolic Behavior Scales Developmental Profile-Infant Toddler Checklist(CSBS-DP-ITC)to assess ASD symptoms.The HR-ASD infants were followed up to the age of 2 years and assessed for diagnosis using the Autism Diagnostic Observation Schedule(ADOS)and Childhood Autism Rating Scale(CARS).At the same time,two senior children psychiatrists made a second clinical diagnosis according to DSM-5 and 34 infants were diagnosed with ASD.The software of Observer XT 12.0 was used to code the frequencies and duration of typical vocalization and social intention vocalization during SFP still-face period and compare the differences of vocalization characteristics between ASD and TD.Spearman correlation analysis was used to analyze the correlation between the vocalization characteristics and age,development level and ASD symptom severity of infants in the ASD group.Lastly,logistic regression model was used to analyze the indicators of differentiated vocal behavior.Study 2:Characteristics of vocalization at 6～12 months of age in siblings of Autism Spectrum DisorderA total of 64 ASD siblings aged 6～12 months were recruited from Nanjing and surrounding areas since April 2018 to January 2020 and at the same time to completed SFP videotapes.Gesell developmental schedules was to assess developmental levels and CSBS-DP-ITC was assess the clinical symptoms of ASD.According to the the delay of social development milestone,ASD siblings were divided into the group with HRA~+(25 cases)and the group without HRA~-(39 cases).The software of Observer XT12.0 was used to code the frequencies and duration of typical vocalization,the vocalization with social intention and emotional expression during SFP.To analyze the characteristics of vocalization and its correlation with age,development level and clinical symptoms of ASD in the two groubs at 6～12 months of age,and futher to explore whether there are gender differences in these vocal behavior characteristics.【Result】Study 1:Characteristics of vocalization in the Still-face Paradigm of infants with High-Risk Autism Spectrum Disorder1.There were statistically significant differences in the duration and frequency of speech-like vocalization and social vocalization,the duration of non-social vocalization between ASD and TD group during SFP still-face period(Z=-2.102,- 2.491,-2.864,-3.627,-2.313,P<0.05).2.Spearman correlation analysis showed that the duration and frequency of speech- like vocalization,social vocalizations and non-social vocalizations were negatively correlated with the score of social interaction in ADOS(r_s=-0.477、- 0.446、-0.471、-0.450、-0.410、-0.389,P<0.05).The duration and frequency of vocalizations of speech-like vocalization and social vocalizations were negatively correlated with the score of play in ADOS(r_s=-0.396、-0.376、-0.438、-0.432, P<0.05).The frequency of social vocalization was negatively correlated with the score of restricted and repetitive behavior in ADOS(r_s=-0.456,P<0.05).The duration and frequency of speech-like vocalization,the frequency of social vocalizations and non-social vocalizations were negatively correlated with the score of CARS.The duration and frequency of speech-like vocalization and social vocalizations were positive correlated with the social score of CSBS-DP-ITC (r_s=0.451、0.478、0.368、0.391,P<0.05).The duration and frequency of speech- like vocalization were positive correlated with the speech(r_s=0.440、0.482,P< 0.05)and symbolic score of CSBS-DP-ITC(r_s=0.359、0.383,P<0.05).The duration and frequency of speech-like vocalization and the frequency of social vocalizations were positive correlated with the total score of CSBS-DP- ITC(r_s=0.488、0.522、0.354,P<0.05).3.Logistic regression showed that the frequency of social vocalization(OR=2.579, 95%CI:1.126～5.906,P=0.025)and the duration of non-social vocalization (OR=0.890,95%CI:0.083～0.987,P=0.028)could distinguish between ASD and TD.Study 2:Characteristics of vocalization at 6～12 months of age in siblings of Autism Spectrum Disorder1.During SFP interaction period,the difference in duration and frequency of positive emotion vocalization between HRA~+group and HRA~-group was statistically significant(Z=-2.056,-0.266,P<0.05).During the SFP still-face period,the differences in the duration and frequency of social vocalization and the duration of negative emotion vocalization between HRA~+group and HRA-group were statistically significant(Z=-2.438、-2.142、-2.341,P<0.05).2.During SFP still-face period,Spearman correlation analysis showed that the duration of non-social vocalization and the duration of negative emotion vocalization were negative correlation with symbolic score of CSBS-DP-ITC(r_s =-0.450、-0.493、-0.484,P<0.05).3.During SFP still-face period,there were significant gender differences in the duration of social vocalization(Z=-2.018,P<0.05).【Conclusion】1.HR-ASD infants have lower characteristics of typical vocalization and vocalization accompanied social intention,which are closely related to the clinical symptoms of ASD.Among them,vocalization accompanied social intention has distinguishing efficacy.2.Infants with delayed social development milestones in ASD siblings had lower characteristics of social intention and emotional expression in their vocalization behaviors from 6～12 months of age,and vocalization behaviors were associated with clinical symptoms of ASD during the SFP still-face period.Among them, male ASD siblings have lower social intention to vocalization during SFP still-face period.