The study was led by Karen Pierce, PhD, professor of neurosciences at UC San Diego School of Medicine and co-director of the UC San Diego Autism Center of Excellence. CREDIT UC San Diego Health Sciences

We all do it: that high-pitched, sing-songy voice that spills out of your mouth whenever a baby is around. Caregivers have long used this playful, emotional, exaggerated form of speech — “motherese” — to capture their children’s attention. Now, scientists may be able to use it to diagnose autism ).

In a study published February 8, 2023 in JAMA Network Open, researchers at the University of California San Diego School of Medicine have developed a new eye-tracking test to quantify toddlers’ level of attention to motherese. Using these measurements, the scientists could reliably identify a subset of toddlers with autism, whose low levels of attention to motherese were also associated with weaker social and language abilities.

Studies have shown that motherese speech stimulates children’s attention and learning, helping them develop language skills and emotional reactivity. If toddlers with autism do not pay as much attention to this speech style, this might affect their social skills later in life. The eye-tracking test could thus be beneficial for early autism screening, diagnosis and prognosis and help clinicians identify the most beneficial treatments for the child.

“We know the earlier we can introduce treatment, the more effective it is likely to be, but most children don’t get a formal diagnosis until around age 3 or 4,” said corresponding author Karen Pierce, PhD, professor of neurosciences at UC San Diego School of Medicine and co-director of the UC San Diego Autism Center of Excellence. “There is a real need for easy and effective diagnostic tools that can be used on young children, and eye-tracking is a great place to start.” 

The study surveyed a group of 653 toddlers, aged 1 to 2 years old, with and without an autism diagnosis. In the experiment, each child was presented with two videos on a screen: one of a woman speaking in motherese and one non-human scene (either a busy highway or a movie of abstract shapes and numbers with accompanying electronic music). The videos were available for one minute, and the toddlers used their eyes to control which video played at a given time.

Toddlers without autism showed consistently high interest in motherese, spending approximately 80% of the experiment watching that video. But results were not as uniform in toddlers diagnosed with autism; their fixation levels spanned the full range from 0 to 100 per cent of the experimental time.

The subset of toddlers who fixated on motherese less than 30 per cent of the time could be accurately identified as having autism through this measurement alone. These children also showed lower scores on subsequent language and social skills tests.

Toddlers who had autism but still spent most of their time attending to motherese displayed greater social and language abilities, highlighting the diversity within the autistic population.

Whether less attention to motherese is the cause of these childrens’ reduced sociability or merely a symptom of it has yet to be determined, the authors note, but in either case, it appears to be a highly accurate biomarker for a subtype of autism .

“The fact that we can reliably identify children with autism using such a simple and rapid eye-tracking test is really remarkable,” said Pierce. “In the future, we hope to use a child’s attention to motherese as a clue for which treatments they may most benefit from, and as a tool for measuring how well those treatments work.”

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A University of Massachusetts Amherst researcher has been awarded a National Institutes of Health (NIH) grant to study bilingualism in children with autism whose household speaks a language other than English.

“This is a group that often is excluded from existing research or intervention studies,” says Megan Gross, assistant professor of communication disorders in the School of Public Health and Health Sciences. “And I think there’s still a lot of misinformation that can get out there to bilingual families about what language to speak at home with their child.”

The five-year, $755,000 career development grant will enable Gross to be mentored by a multidisciplinary team of experienced researchers from the fields of psychology, communication disorders and public health as she recruits 60 families in western Massachusetts for her sequential mixed-methods project, combining both quantitative and qualitative measures. 

“I’ve worked clinically with autistic children, but I have not done research in the area of autism, so I think this career development award will be really beneficial for gaining training in how to conduct research with this population responsibly,” Gross says.

Until relatively recently, bilingual families who have a child with autism were often encouraged by professionals to stick to one language in the home.

“I think they’re still getting advice that if language is hard for their child, two languages will be even harder, so they should just speak English,” Gross says. “And that has a lot of negative potential ramifications for the child’s positive development in terms of identity, their ability to communicate and interact with family members who may not speak English and so on. So, for a condition like autism, where communication is one of the areas that can be a source of challenge, adding to that by creating a language barrier between the child and their family member can be really problematic.”

Recent studies have shown that bilingual exposure is not detrimental to the development of children on the autism spectrum, Gross points out. “We need to move beyond that to understanding how we promote bilingual development in autistic children,” she says.

Gross will examine the type of bilingual environment to which children with autism , ages 4-6, are exposed, as well as the different factors that relate to their ability to speak or understand both Spanish and English. She will also consider the children’s social communication and social-cognitive skills, such as cognitive flexibility, as well as their ability to understand and communicate in two languages.

To make it possible to include children who do not speak, Gross will use innovative eye-tracking technology to analyze their ability to comprehend bilingual spoken language. A camera at the bottom of a laptop computer will track the child’s eye movement as a word or phrase in English and Spanish is played out loud.

“By following their eye movements over time, we can tell whether they’ve understood the word or phrase that they heard because they should look at the corresponding picture,” Gross says. “This is a group I’m especially interested in including in my study. Even if they are not speaking, we need a way to measure what they are understanding when people are speaking to them in Spanish and English. And what skills might they have that they aren’t able to show us through their spoken language?”

Gross will spend the first year of her research in training and preparing materials, and will start recruiting families in 2024. Ultimately, she will interpret the quantitative findings within the context of in-depth qualitative interviews, focusing on family perspectives and challenges. The long-term goal is to collaborate with families and support services to develop community-based programs that promote bilingual children’s linguistic and social-cognitive development across the autism spectrum.

“It’s been a great interest of mine to contribute to the evidence base at the intersection between dual-language learning and autism,” Gross says.

This piece uses both identity-first (autistic person) and person-first language (person with autism) out of respect for differing preferences expressed among autistic adults, family members and community advisory board members for this project.

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Documented cases of autism in the New York–New Jersey metro region increased by as much as 500 per cent between 2000 and 2016, with the highest increase among children without intellectual disabilities, according to a Rutgers study.

This is the opposite of past findings, which have suggested that autism typically co-occurs with intellectual impairment.

“One of the assumptions about autism is that it occurs alongside intellectual disabilities,” said Josephine Shenouda, an adjunct professor at the Rutgers School of Public Health and lead author of the study published in Pediatrics. “This claim was supported by older studies suggesting that up to 75 per cent of children with autism also have an intellectual disability.”

“Our paper shows that this assumption is not true,” Shenouda said. “In fact, in this study, two-in-three children with autism had no intellectual disability whatsoever.”

Using biannual data from the New Jersey Autism Study, researchers identified 4,661 8-year-olds with autism in four New Jersey counties (Essex, Hudson, Ocean and Union) during the study period. Of these, 1,505 (32.3 per cent) had an intellectual disability; 2,764 (59.3 per cent) did not.

Subsequent analysis found that rates of autism co-occurring with intellectual disability increased two-fold between 2000 and 2016 – from 2.9 per 1,000 to 7.3 per 1,000. Rates of autism with no intellectual disability jumped five-fold, from 3.8 per 1,000 to 18.9 per 1,000.

Shenouda said there might be explanations for the observed increases, though more research is needed to specify the precise causes.

“Better awareness of and testing for autism does play a role,” said Walter Zahorodny, associate professor at the Rutgers New Jersey Medical School and senior author of the study. “But the fact that we saw a 500 per cent increase in autism among kids without any intellectual disabilities – children we know are falling through the cracks – suggests that something else is also driving the surge.”

Autism prevalence is associated with race and socioeconomic status.  The Rutgers study identified that Black children with autism and no intellectual disabilities were 30 per cent less likely to be identified than White children. In comparison, kids living in affluent areas were 80 per cent more likely to be identified with autism and no intellectual disabilities than children in underserved areas.

Using New Jersey Autism Study data and U.S. census data, the researchers were able to estimate rates of autism undercounting in the four counties.

Shenouda said addressing the findings could help close identification gaps and eventually bring much-needed autism services to lower-income areas.

“With up to 72 per cent of the autism population having the borderline or average intellectual ability, emphasis should be placed on early screening, early identification and early intervention,” she said. “Because gains in intellectual functioning are proportionate with intense intervention at younger ages, it’s essential that universal screening is in place, especially in underserved communities.”