Technique May Provide Reliable Brain Biomarkers of Improvements in Social Skills in Children with ASD

Anjana Bhat, Ph.D.

University of Delaware, Newark, DE

Grant Program:

Clinical Neuroscience Research

Funded in:

September 2018, for 3 years

Funding Amount:


Lay Summary

Technique may provide reliable brain biomarkers of improvements social skills in children with ASD

This study will assess the reliability of a new brain imaging technique that captures the brain correlates of children with Autism Spectrum Disorder (ASD) as they imitate and synchronize activities with others. Children with ASD have problems making eye contact with others and in planning and coordinating their movements making it difficult to imitate and synchronize their actions with others. Referred to as “Interpersonal Synchrony” (IPS) this deficit makes it hard for them to observe family members and friends in order to learn social skills—from pointing and gesturing—to functional skills like tying shoelaces.

Various types of interventions are being used in these children. These investigators, for instance, conducted a pilot randomized controlled trial in children with ASD as they participated in either music or robotic imitation/IPS interventions or in usual (control) social situations. Children in both intervention groups showed improved social and motor skills: they smiled more, paid more attention and imitated others, and those in the music group also showed more accurate imitation and verbalization. The investigators want to know whether the neural processes that underlie improvements can be reliably assessed with a new brain imaging technique that can be used in children while they participate in certain imitation/IPS tasks. If so, this technique could be used to assess the neural impact of future imitation/synchrony interventions.

Neural correlates of imitation/IPS in the brain are called “mirror neuron systems.” The neurons are so named because they are active when mirroring actions/states of others. Neuroscientists using fMRI in adults have found that mirror neurons are active when people observe, execute, and imitate an action (such as following a dance instructor’s movements). This system is known to be impaired in children with ASD.

It is difficult to use fMRI in young children in natural environments as they interact with others. The researchers will see, therefore, whether a similar brain imaging technique, called fNIRS (functional near-infrared spectroscopy) can provide a reliable way to correlate the children’s mirror neuron system activation patterns with their responses to imitation/IPS activities. If so, fNIRS could provide brain biomarkers for future imitation/IPS interventions. Mirror neurons are in the frontal portion of the brain, as well as in the parietal and temporal areas. fNIRS measures the changes in near-infrared light in an active brain region when there is increased blood flow there. fNIRS is safe, relatively non-invasive, low cost and portable.

The investigators hypothesize that fNIRS is a reliable method to assess activation of the brain’s mirror neuron system and that the system’s activation patterns can serve as an objective biomarker of imitation/IPS changes in children with ASD. They will use fNIRS twice in a group of 40 typically developing children and 40 children with ASD and see if the monitoring results are consistent. Children and an adult will do a motor task (reaching-grasping an object) and a social task (gestures: waves, thumbs up). Children will first observe the adult, then do the task and then imitate the adult as both do the task. Tasks vary in their social complexity.

They anticipate that: 1) both by doing the task alone and together with the adult (imitation), fNIRS will show more complex mirror neuron system activation, linked to and influenced by the task’s motor aspects; and 2) children with ASD will show different patterns of mirror neuron system activation (i.e., lower frontal and temporal activity and greater parietal area activity) compared to typically developing children. So far their data suggest that children with ASD show both deficient and compensatory patterns of mirror neuron activation when performing imitation activities with others.

Investigator Biographies

Anjana Bhat, Ph.D.

Dr. Bhat studies the relationship between motor and social communication impairments of children with autism spectrum disorder (ASD) with the goal of developing effective intervention approaches to positively impact the overall development of children with ASD. She completed her PhD in Biomechanics and Movement Sciences at the University of Delaware, a post-doctoral fellowship at the Center for Autism Related Disorders at the Kennedy Krieger Institute, and later joined the University of Connecticut as tenure-track faculty. In Fall 2014, she transitioned to the University of Delaware as an Associate Professor in Physical Therapy. Her lab has completed a NIH and Autism Speaks-funded Randomized Controlled Trial (RCT) comparing the effects of novel interventions robotic and rhythm-based interventions to study its effects on the social communication and motor skills of children with ASD. They found improvements in interpersonal synchrony (IPS), imitation, and verbalization in the rhythm and robot groups compared to the control, sedentary play group. The results of this study prompted them to examine the underlying brain activation patterns associated with imitation/interpersonal synchrony in hopes of identifying reliable neurobiomarkers to explain the brain changes following such interventions. Dr. Bhat continues to study effects of various novel interventions to promote skills in children with ASD including dance, yoga, and hippotherapy. She also uses a safe, non-invasive brain imaging tool called functional near-infrared spectroscopy (fNIRS) to pick up brain activity as children engage in various social and motor behaviors. Currently, her lab has various ongoing fNIRS studies examining imitation, dance-like sway, and social cooperative building games between children and adults with ASD and age-matched, healthy social partners. The ultimate goal of this research is to develop creative and effective, evidence-based interventions to promote social and functional skills of children and adults with ASD.


Technique may provide reliable brain biomarkers of improvements social skills in children with ASD

Background: Our past research has shown that imitation and interpersonal synchrony (IPS)-based interventions enhanced social communication and motor skills in children with Autism Spectrum Disorder (ASD). Specifically, IPS activities led to highest levels of social attention and increase in amount of social verbalization as well as an increase in imitation accuracy and percent of interpersonal synchrony (IPS) following 8 weeks of intervention. While we are encouraged by the positive behavioral findings, we still do not know the brain mechanisms that facilitate social communication skills when children engage in socially synchronous movements. Certain brain structures within the superficial cortical layers, called the Mirror Neuron Systems (MNS) play an important role during imitation. In this study, we will study whether these cortical regions are activated during IPS behaviors during an object cleanup task. For this study we will use a non-invasive optical neuroimaging tool called functional near-infrared spectroscopy (fNIRS). fNIRS is especially suited for IPS tasks because it is robust in the presence of motion artifacts and allows for face to face interactions between people.

Objective: The long-term objective of this research is two-fold: a) to assess various therapeutic contexts or strategies that normalize fNIRS-based cortical activation and improve IPS performance in children with ASD. Specifically, in this study we have compared object-free, dyadic interactions and object-related, triadic interactions to examine differences in IPS accuracy and fNIRS-based activation between the two types of interactions and b) to validate fNIRS-based cortical activation as a predictor of treatment response following imitation/IPS interventions in children with ASD. The proposed project is an initial study to develop an fNIRS-based neuroscientific framework by comparing two different IPS tasks and its components of observing, moving, and their combination or IPS behavior within each task. Hypothesis: We hypothesize that cortical activation will be greater in the Do/Move & Together/IPS conditions compared to the Watch/Observe condition. We also expect to see greater cortical activation during the triadic task compared to the dyadic task. Children with ASD will show reduced frontal and temporal cortex activation and increased parietal cortex activation compared to the TD children. We will obtain good to excellent test-retest reliability for fNIRS activation values and the fNIRS probe placement locations.

Study Design: 80 children between 6 and 12 years (40 ASD and 40 non-ASD) will be observed over 4 to 5 visits. In the first two visits we will complete clinical psychology testing to confirm the ASD diagnosis and obtain an IQ measure. On Day 3 each child completes the triadic fNIRS task involving an object cleanup activity and a manual dexterity subtest. On Day 4 each child will complete the dyadic fNIRS task involving communicative gestures directed to the adult and an imitation test. On Day 5 half the children will return to complete the triadic task and the other half will return to complete the dyadic task to confirm test-retest reliability in terms of fNIRS activation as well as fNIRS probe placement. Impact: If our aims are achieved, we will evaluate the influence of various IPS components (observation, execution, and IPS) and changing social complexity (dyadic vs. triadic interactions) on cortical activation and IPS performance. In the long-term, we hope to use cortical activation as a neurobiomarker to predict intervention effects as well as evaluate different therapeutic contexts and their effects on brain activation and IPS performance.

Innovation: Given the recent advancements in biomedical imaging (i.e., hardware and signal processing tools), fNIRS is an excellent, safe and child-friendly alternative that deserves further exploration and validation. Past studies have reported MNS-based activation using fMRI during limited tasks involving finger/hand motions and 2D stimuli. For the first time we will implement fNIRS technology to study cortical activation in children with and without ASD during naturalistic interactions