The current study tests VisAVis, a non-commercial web-based software program designed for children and adolescents (ages 7-16) with mild retardation. VisAVis targets working memory, emotion recognition, and focusing on the eyes of the face: core weaknesses in both autism and 22q11.2 deletion syndrome (22q11DS). While much is known about the impact of impaired face processing on emotion recognition and social skills, there is a paucity of tools that can be used to teach faces and emotions to school-age children. We designed VisAVis to target socio-emotional deficits and cerebral hypoactivation in individuals with autism (ASD) and 22q11DS.
To evaluate whether the VisAVis program contributes to changes in reasoning, facial emotion recognition, behavior, and BOLD response during functional MRI.
Nineteen (high and low functioning) previously diagnosed participants with ASD and 16 participants with 22q11.2 deletion syndrome were compared with 14 individuals with developmental delay (all aged 7-16). All participants completed the twelve-week VisAVis program and underwent cognitive-behavioral evaluations and functional MRI at pre-remediation (preR), post-remediation (postR), and 12 weeks post-remediation (post-rest).
The autistic and 22q11DS groups showed marked improvement in nonverbal reasoning (measured by the Raven Matrices) after remediation at postR and post-rest (preR < postR & post-rest: F(2, 88)=3.467, p=.037), and recognition of facial emotional expressions at postR and post-rest (preR < postR & post-rest: (F(2, 88)=107.768, p<.001). We also observed decreased problem behaviors (total and internalizing as measured by the CBCL) at postR in all groups (total: (F(2, 86)=4.102, p=.028); internalizing: (F(2, 86)=4.866, p=.014). During a block design task comprised of photos from multiple visual categories, functional imaging analyses showed increased BOLD response in the fusiform gyrus to faces in ASD at postR and in the superior temporal gyrus at postR and post-rest for the 22q11DS group.
To our knowledge, VisAVis is the first software program to be piloted and subsequently studied using standardized behavioral and neuroimaging measures in multiple diagnostic groups. Our findings support VisAVis as a tool for working on socio-emotional impairments in ASD and 22q11DS during middle childhood, and bolster previous studies showing changes in BOLD response in the fusiform gyrus after teaching individuals with ASD to focus on the eyes of the face.
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