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The Spectrum of Social Time. Front Cover. Georges Gurvitch. Reidel, - Time - CHAPTER IIITHE DEPTH LEVELS AND SOCIAL TIME. Copyright.
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Carol and her therapy dog, Lily, also provide enrichment to students by visiting classrooms. Carol has presented at national, state, and local conferences and is a board member of the Harrisburg chapter of the Autism Society. Additionally, Kelly is co-founder of Destination Friendship which is an organization providing fun, community-based opportunities targeted at developing friendship skills in children, adolescents, and teenagers with ASD.

She has presented at numerous national, state and local conferences. Kelly resides with her family in York, PA. She has presented locally and at the national level. Alice and her co-authors offer evening Destination Friendship groups in the community targeted at developing friendship skills in children and adolescents.

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Levels of autism: Everything you need to know

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Signs of the condition are usually present at a young age, but occasionally people do not receive a diagnosis until adulthood. According to the Diagnostic and Statistical Manual of Mental Disorders 5 DSM-5 , doctors categorize autism by assigning level 1, 2, or 3 to two of the domains of symptoms. One severity score is for impairment in social function, while a second severity score is for restrictive, repetitive behaviors. The levels the doctor assigns depend on the severity of the symptoms. A correct autism diagnosis that includes the levels of severity can help doctors and other specialists work with the individual to provide the right treatment and support.

In this article, learn more about the levels of autism. The DSM-5 states that there are three levels of autism:. Level 1 is the least severe autism diagnosis. People in this category have social difficulties that require some support. They can find it difficult to initiate conversations with others and may respond inappropriately or lose interest quickly.

As a result, it can be challenging for them to make friends, especially without the right support. People with level 1 autism may also show inflexible behaviors. It can be difficult for them to cope with changing situations or contexts, such as new environments. They may need help with organization and planning. People in this category need more support than those with a level 1 diagnosis. They have more severe social deficits that make holding a conversation very challenging.

Even with support, they may struggle to communicate coherently and are more likely to respond inappropriately to others. They may speak in short sentences or only discuss very specific topics. These individuals may also have issues with nonverbal communication and might display behaviors such as facing away from the person with whom they are communicating. People with a level 2 diagnosis may also have inflexible behaviors that can interfere with daily functioning.

They typically do not cope very well with changes, which can cause them significant distress. Level 3 is the most severe autism diagnosis. People with a level 3 diagnosis have significant impairments in their verbal and nonverbal communication. They will often avoid interactions with others, but they may interact in a limited way if they must respond to others or communicate a need. Their behaviors are highly inflexible and repetitive.

They may react strongly to changes and become highly distressed in a situation that requires them to alter their focus or task. Autism can be challenging to diagnose because it is a spectrum disorder. The symptoms of spectrum disorders can range from mild to severe, and the types of symptom will differ among individuals.

The email address of the cantonal ethics committee for research of Geneva, which approved our protocol involving humans is: ccer etat.

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The funding sources had no role in the design of the study, data collection and analysis, interpretation of data or writing of the manuscript. Competing interests: The authors have declared that no competing interests exist. The intrinsic ability to orient to our surrounding social environment has been found to be impaired in very young children with autism spectrum disorders ASD [ 1 — 3 ]. Furthermore, reduced social orienting in children with ASD has been generally related to behavioral features of ASD e. Typically developing TD newborns pay special attention to socially relevant cues, such as faces and eyes e.

By contrast, research in the field of autism has demonstrated that young children who go on to be diagnosed with ASD show important differences very early on when responding to socially salient cues. For example, retrospective video analysis demonstrates that compared to their TD counterparts, children who are later diagnosed with autism focus less frequently on people and faces during their early years [ 9 ].

This hypothesis is further supported by a study showing that attention to the eyes of a face declines between the ages of two and six months in infants at-risk for developing autism [ 10 ]. Reduced attention to the social world may partially explain other social and cognitive features of autism [ 11 ], for a review see 7. These preverbal shared attention experiences, or joint attention JA behaviors, represent key precursors for the early socio-communicative development of children with ASD [ 11 ].

Some studies supporting reduced social orienting in ASD hypothesize that the social world is important for the development of sharing behaviors. As previously explained by Posner [ 16 ] and discussed in Mundy and Newell [ 12 ], RJA in early development emerges as a consequence of an automatic orientation process toward biologically meaningful stimuli, such as eye and head movements, which underlies shared attention. Also, work by Adamson et al. In summary, ASD development may be partly characterized by a lack of social orienting contributing to decreased social stimulation, and as a result, to diminished occurrences of joint attention behaviors, thereby affecting socio-communication skills.

Several studies have demonstrated the effectiveness of eye-tracking for quantifying social orienting. Pierce et al. Because the side of the screen where DSI and DGI videos were presented was not counterbalanced within the task, the paradigm used by Pierce and collaborators [ 6 , 18 ] cannot answer this question. In this study, we were interested in improving our understanding of the relationship between time spent on DSI and JA abilities, and the way in which social orienting and JA are related to sociocommunicative skills in children with ASD.

Specifically, we aimed to measure social orienting and then relate it to JA behaviors in a population of young children with ASD. To measure social orienting, we created an eye-tracking task similar to the task used by Pierce and colleagues [ 6 , 18 ]. This offered the additional benefit of allowing us to observe the location of the initial fixation, as an additional measurement of automatic orienting to DSI or DGI. We predicted that social orienting, quantified as the amount of time spent on DSI, would be reduced in our sample of children with ASD compared to TD children, as we already observed in a subgroup of the sample of children with ASD included in the present study [ 23 ].

Second, we postulated that social orienting would positively correlate with the amount of JA behaviors in toddlers with ASD. Finally, we predicted that social orienting and JA behaviors would positively correlate with communication skills. A total of 36 participants 31 males with ASD were included in the study. Three participants with ASD all males were excluded from analyses and from participant description because of lack of quality in data collection. Participants ranged in age from 19 to 51 months see Table 1. Participants with ASD were recruited through French-speaking parent associations and specialized clinical centers.

To allow for comparisons between scores from different modules, we applied Gotham et al. The mean severity score of the participants was 7. Six other children were evaluated using the ADOS-2 toddler module. At time of evaluation, five fell in the moderate to severe range of concern and one fell in the mild to moderate range. ADOS assessments were administered and scored by psychologists who had met the requirements for research reliability. Before they were included in our research protocol, most participants had already been diagnosed with an ASD.

Twenty-seven TD children 15 males aged 14 to 57 months participated in the study. The mean severity score from their assessments was 1. TD participants were recruited through announcements in the Geneva community. As with the ASD participants, parents gave their informed consent prior to inclusion in the study. There was no difference in age between the ASD and TD groups, but gender distribution was significantly different see Table 1. Their performance on the Early Social-Communication Scale [ 21 ] revealed impaired joint attention in the children with autism as a group compared the TD children.

See Table 1 for a summary. This passive 1-minute task consists of simultaneous presentations of dynamic geometric images DGI and dynamic social images DSI on either side of the screen of an eye-tracking machine. For the DGI, we used moving geometrical shapes that are similar to the classic abstract screen savers.

ON THE SPECTRUM: Kookabuk Social Stories (behind the book)

DSI were sequences of children moving and dancing solo Fig 1. The DSI stimuli in Pierce et al. The task was administered using Tobii Studio software www. The sampling rate was 60Hz for the T60XL and Hz for the TX, but the video resolution and screen size were identical for both devices x, inch displays. The Tobii machine can tolerate moderate head movement up to 60cm from the screen.

For the analyses, we used Tobii Studio software, version 3. A I-VT filter was enabled during analysis. The merge fixations option was further enabled Max. For each kind of stimuli DSI and DGI , we calculated several variables: the total fixation duration total summed looking time , the mean duration of each fixation fixation length , and the number of saccades per second movement of the eye between fixation points.

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As an additional measure for automatic orienting to social stimuli, we calculated the percentage of segments for each participant, when the first fixation was on the DSI. This percentage was calculated by dividing the number of first fixations on DSI by the number of the segments Before administering the task, all participants completed a five-point calibration procedure adapted to toddlers to verify accurate and complete eye motion and eye gaze detection. The procedure consisted of following an image of a pet animal on the screen with both eyes.

Calibration was repeated until each participant hit all five points with both eyes. Successful RJA is quantified during 14 examiner-prompted opportunities. Each video was double-coded and discussed until the raters reached consensus. Given that scoring is based on the frequency of behaviors during the entire task, we excluded the eight participants from ESCS analyses.

For the TD group, we were able to use data for 23 out of 27 participants. We used the Vineland Adaptive Behavior Scales, 2 nd edition [ 22 ] to measure communication. Visual exploration on the DSI-TASK was operationalized in the following ways: 1 percentage of fixation time spent on each stimulus type DSI and DGI was calculated by dividing the number of fixations on each half of the screen by stimulus type by the total number fixations on the entire screen; 2 the percentage of first fixation on DSI was calculated by dividing the number of segments during which the first fixation was on the DSI image by the total number of segments 10 ; 3 fixation length was measured by calculating the mean fixation duration for each kind of stimulus DSI and DGI ; 4 the number of saccades per second was calculated by dividing the total number of saccades by the total fixation time on each stimulus type.

Next, we used correlation analysis Pearson or Spearman according to the distribution to test for a relationship between joint attention on the ESCS , mean fixation duration or the number of saccades per second and the percentage of time spent on DSI. The percentage of time spent on DSI was Among the 33 youngsters with autism, 21 of them Accordingly, they spent Out of 27 TD children, only three Results are summarized in Fig 2.

Participants represented in the grey zone preferred DGI. These results are summarized in Table 2. To explore if the amount of time spent on DSI was correlated with exploration patterns, we analyzed the mean fixation duration and the average number of saccades per second on DSI for the ASD and the TD groups. Given that the gender ratio in our sample was not equally distributed Table 1 , we checked our results in the previous sections while using only the male participants from the ASD and TD groups. All results presented in the previous sections remained significant in male-only samples.

In this study, we observed reduced orienting through dynamic social images DSI in young children with ASD compared to typically developing TD children, though the ASD group showed pronounced heterogeneity. Correlations between time spent on DSI and visual exploration patterns mean fixation duration and number of saccades per second showed that children with ASD who spent more time on DSI also showed increased visual engagement with DSI longer fixations and lesser saccades. In the current study, we replicate Pierce et al.

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The fact that we were able to observe similar results using a different sample and a slightly modified paradigm provides clear evidence for reduced social orienting in autism [ 1 , 2 , 7 , 11 ]. Moreover, the similarity between our results and those reported by Pierce and collaborators [ 18 ] also adds support for eye-tracking technology as a valid method for measuring social orienting.

Furthermore, children with ASD who spent more time on DSI also showed more advanced verbal and non-verbal communication skills. This finding may be helpful for understanding both reported differences in time spent on social stimuli [ 27 , 28 ] among young children on the autism spectrum, as well as poor engagement with the social environment in autism [ 29 ].

Pierce and colleagues [ 6 , 18 ] observed disparate visual exploration patterns between the group of children with ASD who preferred the DGI and the one who preferred DSI. Participants with a preference for DGI demonstrated fewer saccades on DGI, which fits the pattern for enhanced visual attention as well as a certain difficulty disengaging from DGI.

Our correlation analyses show that children with autism who spend less time on DSI show less visual engagement shorter mean fixation duration and more saccades per second. These results support the idea that children with autism with superior social orienting are likely to demonstrate greater visual engagement when observing a social scene.

Our results suggested relationships between time spent on DSI, quantity of JA behaviors and socio-communicative learning. In our study, we observed that social orienting in preschoolers with ASD is positively related to the amount of JA behaviors that they exhibit.


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JA represents the sharing of attention and experience, both of which are necessary for learning social cognition skills [ 33 ]. Mundy et al. In the current study, social orienting is positively correlated with both IJA and show a clear tendency toward significance with RJA.

Our results also suggest better communication in children with stronger JA skills.