Background: Research suggests that individuals with autism spectrum disorder (ASD) have difficulties in emotion recognition (ER), which could lead to social difficulties. ER can be enhanced through targeted interventions, but generalization to everyday functioning poses a challenge. Using dynamic multimodal emotional expressions for training may increase similarities to everyday situations. This pilot study investigated the feasibility of internet-based multimodal emotion recognition training (iMERAT) for adolescents with ASD.Method: Eight adolescents with ASD and nine typically developing (TD) adolescents took part in the iMERAT intervention, which included brief online training sessions conducted each weekday during a 3-week period. Training was performed on dynamic facial, vocal and multimodal emotional expressions, with outcome feedback provided after each response. A survey was conducted to explore participants' experiences of the training. ER was measured pre- and post-training using a multimodal ER test.Results: Participants reported that the training was moderately difficult, instructions were relatively easy to understand, and the duration of training was appropriate. Content analysis of open-ended responses suggested further adaptations, such as providing more explanations of emotions and further tailoring content and language for adolescents. ER increased from pre- to post-intervention, with large effect sizes for both ASD and TD adolescents.Conclusion: Results suggest that the iMERAT intervention is feasible for adolescents with ASD. Gains in ER ability were observed, but the small sample size and lack of a control group render these findings tentative. Further research is required to assess the effectiveness of the iMERAT and possible impact on broader social skills.

Social skills group training is frequently used to support autistic children and adolescents in coping with everyday social demands and expectations. Meta-analytic studies suggest small to medium effect sizes. Effect moderators must be better understood to inform implementation and allow optimization of intervention protocols. Using data from two pragmatic randomized trials (N = 241) of the KONTAKT™ social skills group training program as an add-on to standard care in clinical settings, we aimed to explore the moderating role of co-occurring attention-deficit hyperactivity disorder in children (7–12 years) and adolescents (13–18 years). Two distinct response criteria were defined based on the parent-rated Social Responsiveness Scale: reliable improvement (⩾25 points) and clinically relevant improvement (⩾10 points). Moderator analyses indicated that the intervention effect was moderated by co-occurring attention-deficit hyperactivity disorder and age group. Logistic regressions stratified by co-occurring attention-deficit hyperactivity disorder showed significant effects among those without attention-deficit hyperactivity disorder (n = 63), both in terms of reliable improvement (odds ratio: 11.85, p = 0.002) and clinically relevant improvement (odds ratio: 10.00, p = 0.001). In contrast, no significant effects were observed in those with co-occurring attention-deficit hyperactivity disorder (n = 178). Explorative analyses further stratified by age suggested significant effects in adolescents, but not children, with co-occurring attention-deficit hyperactivity disorder. The findings preliminarily suggest that autistic children with attention-deficit hyperactivity disorder may need other or additional support. Lay abstract: Social skills group training can help some autistic children and adolescents improve their social life. Still, the positive effects may be less clear for those who also have attention-deficit hyperactivity disorder. We used data from two previous projects evaluating the effects of a social skills group training program called KONTAKT™ as an addition to the common healthcare provided. Our study included 241 children (8–12 years) and adolescents (13–18 years). To determine whether the participants had improved their social skills, we used ratings provided by the parents before and after the training and 3 months later. We then explored if KONTAKT led to improvement for autistic children and adolescents with and without attention-deficit hyperactivity disorder. Autistic children and adolescents often struggle to understand others and express themselves in everyday social situations. These challenges can create barriers to well-being and future life chances. Social skills group training can improve social skills in some autistic youths, but not all will benefit equally from the training. It is therefore important to better understand whether some groups need more support or other forms of assistance. Many autistic children and adolescents also have attention-deficit hyperactivity disorder, which can make the training of social skills more complicated. We found that both children and adolescents can benefit from KONTAKT. Still, preadolescent autistic children with attention-deficit hyperactivity disorder did not seem to improve as a result of the training. Based on these findings, it is important to find additional strategies to support this specific group of autistic children in handling social situations.

Objectives: This study aimed to identify sleep quality profiles of children with autism spectrum disorder (ASD), to compare these profiles with those of typically developing (TD) children, and to verify whether there are differences between them in terms of language skills. Methods: We evaluated the sleep quality and language skills of 47 children with ASD without intellectual disability (ID) and 32 children with TD. Using a hierarchical cluster analysis, we identified two sleep quality ASD profiles (poor and good). We then performed a series of MANCOVAs and ANOVAs to compare the sleep quality and language skills of the two ASD clusters and the TD group. Results: A main group effect (TD, “poor” cluster, and “good” cluster) was found in the total sleep quality and all its dimensions. Significant differences were revealed between the “good” and “poor” clusters in the total structural language score (F1,46 = 10.75, p < 0.001) and three of its subscales (speech: F1,46 = 9.19, p < 0.001; syntax, F1,46 = 8.61, p = 0.001; coherence: F1,46 = 11.36, p < 0.001); the total pragmatic language score (F1,46 = 7.00, p = 0.001) and three of its subscales (inappropriate initiation: F1,46 = 8.02, p = 0.001; use of context: F1,46 = 8.07, p = 0.001; nonverbal communication: F1,46 = 7.35, p = 0.001); and the social relations score (F1,46 = 9.97, p = 0.003). Conclusions: Sleep quality in children with ASD (especially a subgroup) is worse than in children with TD. There is an association between sleep quality and language skills, both at the pragmatic and structural levels.

Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are two often co-occurring neurodevelopmental conditions. Nevertheless, there is limited research about symptom differences between ASD and ASD + ADHD groups. This study examined differences in social interaction and communication between children and adolescents with ASD and with ASD + ADHD. A total of 112 participants were identified from two clinical trials. Fifty-six children and adolescents with ASD aged 8–17 years were matched for age, gender and general intelligence quotient with fifty-six children and adolescents with ASD + ADHD. Group differences in scores on the Autism Diagnostic Observation Schedule were analysed. Our results showed that participants with ASD and with ASD + ADHD had similar profiles of social communication interaction challenges and restricted behaviour. However, items assessing gestures: Conventional, Instrumental or Informational Gestures and Empathic or Emotional gestures showed significant differences between the groups suggesting that the ASD + ADHD group used descriptive gestures to communicate to a greater extent than the ASD group. These findings suggest that children and adolescents in both groups have similar difficulties in social communication and interaction with observed differences in the use of gestures. Possible reasons and implications for the differences in the use of gestures are discussed.  

Background: Individuals with autism spectrum disorder (ASD) often have sleep disturbances, executive functioning difficulties, and learning problems. The aim of this study was twofold. First, to examine the quality of sleep in children with ASD without intellectual disability and typically developing (TD) children. Second, to explore the implication of sleep disturbances in the association between daily executive functioning and learning problems in children with ASD without intellectual disability.Method: The sample included 47 children with autism without intellectual disability and 32 TD children. Parent-reported questionnaires were used to assess participants' sleep disturbances, daily executive functions, and learning problems. All statistical analyses performed were adjusted for age, IQ, and medication.Results: As expected, the prevalence of sleep disturbances was significantly higher in the ASD group than in the TD group. Regarding the second aim of the study, the total score of sleep disturbances was significantly associated with learning problems and the metacognition subdomain of executive functioning in children with autism without intellectual disability. In turn, executive functions and learning problems were also significantly associated. Finally, sleep disturbances were found to mediate the relationship between global executive functioning and learning problems in children with ASD without intellectual disability.Conclusions: The findings suggest that sleep disturbances are common in children with autism, and that they play a mediating role in the association between executive functions and learning problems. Therefore, sleep should be a crucial aspect of interventions to improve the learning and academic performance of school-aged children with ASD without intellectual disability.