Babies and Autism: Advances in Research and Clinical Care

May 12, 2022

Information

February 23, 2022

In the first of a new series of webinars for YCSC Associates, this virtual “fireside chat” included YCSC faculty members Kasia Chawarska, PhD; Suzanne Macari, PhD; and Kelly Powell, PhD. The session involved an overview of lab resources and pilot studies, fetal/neonatal imaging, supporting parents of newly diagnosed babies, diversity and inclusion initiatives, and more. For more information about this work, please visit the YCSC website at: https://medicine.yale.edu/lab/chawarska/.

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00:00Well, why don't we go ahead
00:03and let's say get started?
00:06On so I'm really glad to see see all of you
00:10here and thanks so much for joining us.
00:13We're trying these.
00:14We actually have a mixed metaphor here.
00:16We're trying these fireside chats.
00:19And a series of these just to give a chance
00:23to have more smaller group discussions
00:25and meeting with members of our faculty.
00:28And we've got several of them planned,
00:30but the mixed metaphor is that we
00:32think of these as salon type events,
00:34so they're fireside jets salon type
00:37events that bring members of the faculty
00:40together who are working at intersections
00:42of science and care and and you'll really,
00:45I hope we also really would
00:47value your input for this.
00:49So as we're sitting
00:51around this virtual table,
00:52there's three members of our faculty.
00:54I think you know who work with babies
00:57and toddlers with autism and and develop
01:00known disabilities and doctor Kashiwabara.
01:03Cotrip and wife who is the beauty
01:05professor of Charles Skytree and
01:08directs the social and Affective
01:10Neuroscience Autism program and
01:13director of the Yale Toddler Disability
01:16Developmental Disabilities Clinic.
01:17Then we have Suzanne Mccardie.
01:19Suzanne can you wife?
01:22Research scientist and Co.
01:23Director of the Yale Social and
01:25Affective Neuroscience of Autism
01:27program and then Kelly Kelly.
01:29Doctor Kelly Powell,
01:30who is an assistant professor and Co.
01:33Director of the the Toddler
01:36Developmental Disabilities Clinic.
01:38So this group,
01:38they're going to talk about
01:40some innovations in the lab,
01:41especially around emotional development
01:43and how they partner with families.
01:45And it's just,
01:46I know I have heard things that
01:47they're going to talk about,
01:49and it's really very exciting
01:50and I'm glad we can do this.
01:52Salon Slash Fireside Chat
01:54because we're a small group,
01:57we're going to really actually
01:59encourage comments and questions
02:00during the presentation.
02:02I'll monitor the chat and I'll also
02:05monitor the raising your virtual hand.
02:07And then at the end we'll just tap.
02:09We'll have also time for
02:10additional questions,
02:11but if you want to just put
02:13something in the chat or raise
02:14your hand while we're talking,
02:15that'd be great.
02:17So Kasha can I turn to you.
02:20OK, well welcome and thank you
02:23very much for joining us today
02:26and thank you Linda and Susanna
02:29for organizing this gathering.
02:32Let me let me just.
02:35Share my screen so we can move
02:39towards. The actual presentation.
02:46I'm sorry, I'm just going to.
02:48Unshared injured when we're
02:49doing because there's one step.
02:51No, it's going good.
02:55We all have learned that there are multiple
02:58steps that we now need to take all right.
03:00So now by now you should be
03:02seeing my screen and the title.
03:04Is that looks great.
03:06Kasha everybody's there.
03:08OK perfect so so again thank you.
03:12Thank you for being here today
03:15and I'm done here with Susan
03:17Susan McCartney and Kelly Powell.
03:19And I will tell you a little bit about.
03:22Most recent developments in our
03:25research and clinical program.
03:28We're going to.
03:29I'll start as well by talking about
03:32very recent sort of innovations
03:35involving both the questions we
03:37are asking and also the methods
03:40we're using to study them.
03:42Susan will talk a little bit about emotional
03:45development in children with autism,
03:47focusing particularly on joy,
03:49and Karen Kelly will talk about sort of
03:53a long term partnerships that we have
03:56established many years ago with parents.
03:58And and now we want to take take
04:00it to the next level.
04:04So some of our most exciting research
04:08work has been focused lately on
04:13identifying perinatal markers of autism.
04:17And this work is based on on a basic
04:21premise or or hypothesis that autism is
04:24caused by alterations in genetic makeup.
04:28And then these genes begin to
04:32impact how neurons develop,
04:35communicate for networks very early
04:39during during first weeks of gestation.
04:43So by the time babies are born,
04:45it is quite possible.
04:47That their brains are tuned up
04:50somewhat differently than in those
04:53who do not eventually develop autism,
04:55and this differential tune up is
04:58going to affect how the children are
05:01going to develop social relationships.
05:05Now, in order to to study this,
05:09we are currently recruiting
05:10a sample of children who,
05:13due to genetic factors,
05:14are at risk for developing autism and
05:17we are studying their brain connectivity
05:19very shortly after birth and then we.
05:24Try to link it up with later outcomes
05:26to see if indeed there are any
05:29differences in how the brains are tuned
05:32at birth and what kind of effects
05:35they may have on later development.
05:38This kind of work would not be possible
05:42without coming together with a very
05:44large with a very strong group of experts.
05:47We've partner in these studies with
05:50foremost experts in imaging taught
05:53Constable desk in China House with
05:56our colleague and friend Laura Ment,
05:59who's a pediatric neurologist and also
06:02with our colleague and determine of
06:05the statistics department Joe Chang,
06:07who is a.
06:08World expert in data science and
06:10you know the the work we are doing
06:13here in terms of studying, mapping,
06:16functional connectivity from fetal to
06:19neonatal period in high risk babies
06:23would not be really possible without
06:26this group of experts coming together.
06:29And and that Yale is one of the
06:31few places when it's possible.
06:34And and you know the testament to
06:37that is that they're probably less
06:39than a handful of groups around the
06:42world that are studying autism during
06:45such early developmental periods.
06:50So how do we? How do we study
06:54brain development in young AIDS
06:56or brain connectivity in neonates?
06:58We are studying it using approach called
07:02resting state functional neuroimaging,
07:05which allows us to study
07:07intrinsic brain connectivity
07:09patterns while babies are asleep.
07:11It's a very safe and noninvasive approach,
07:15and the way we do it is we bring babies
07:18to our imaging center and we feed them.
07:21We burp them, we wrap them,
07:23make sure they are comfortable,
07:25and then we wait for them to fall asleep.
07:28When they do,
07:29we very gently slide them into the scanner,
07:32and while they are taking a nap,
07:34we're taking measurements of their
07:37brain structure and and measure
07:39how there is brain structure
07:41collective with one another.
07:43And after half an hour we are done.
07:45Babies are waking up and they go home.
07:49This kind of research provides us with
07:52incredible amount of information about.
07:55Functional into infrastructure of the
07:57brain that supports the functions
08:00that are very important for autism,
08:02and these include salience detection,
08:04emotion processing, allostatic regulation,
08:07language and and social attention.
08:12So in the study that we're just
08:15about to submit for publication,
08:16probably this afternoon.
08:20We examine a brain connectivity
08:22in in in in this group of neonates
08:25with and without autism.
08:27But the first question was, you know,
08:29brain is a very large and complex organ.
08:32So the question is which?
08:35Where do we start, where, where?
08:36Which brain areas are we are?
08:38Are we going to focus on and for
08:41this first study from for this first
08:45analysis from our prospective study,
08:48we selected.
08:49A specific brain area that's
08:51located on either side of the brain
08:54that's called anterior insula.
08:56You can see it here in blue.
09:01You can see it here in in blue.
09:04The reason why we focused on zero
09:07then on anterior insula is that.
09:09Unlike many other cortical structure,
09:13in solar matures extremely early,
09:15it's structurally ready to go already
09:17in the second trimester of pregnancy
09:20and shows very advanced functional
09:23maturity even before babies are born.
09:26Which suggests that this particular brain
09:28area is very important for survival.
09:33What's also important that insula is
09:35also heavily connected with other
09:38cortical and subcortical structures,
09:40which means that it facilitates
09:44communication between the structure and
09:47internal integration of information
09:49across the variety of structures.
09:53Functionally,
09:54it's involved heavily in emotion processing,
09:57facilitate salience detection,
10:00integration of sensory information,
10:03and preparation from action.
10:05So, in a way, insula is like a very
10:09important communicative habits you can.
10:11You can compare it to an airport in
10:13Atlanta if everything goes well in Atlanta,
10:16everything goes well with the
10:17rest of the country,
10:18but if something is off in Atlanta,
10:20we feel it at other.
10:22There was as well,
10:23and for that reason it is very
10:25important to understand whether
10:27insulin functions tunes sort of in
10:30a typical way shortly after birth.
10:34In kids who have genetic
10:36risk for developing autism.
10:38More recently,
10:39people suggested that insula also
10:41plays a critical role in development
10:44of social bonding and motivation,
10:46which is very important for our
10:50question relating to autism.
10:52Now, there have been a number of
10:54studies in older kids with autism,
10:56school age kids,
10:58adolescents that involve.
11:01Examining connectivity of of this
11:03brain regions with other regions,
11:05and there's a consensus that in
11:08older kids with autism insula
11:10is under connected does not
11:12communicate as much as this.
11:14This should be with other brain areas,
11:18but of course because these studies
11:19have been done on all the kids,
11:21we don't really know whether these
11:24kind of differences are primary
11:26in autism or whether they emerge
11:28secondary is an effect of having it.
11:31Social disability.
11:34So in order to sort it out,
11:36we enrolled a group of kids.
11:40Babies, neonates, newborns who do
11:43not have any family members with what
11:47autism we call them low risk sample,
11:49and we recruited a group of babies who
11:52have an older sibling with autism.
11:55So which means that they have elevated risk
11:59for developing autism if in low risk sample.
12:03We expect about 1% of kids to develop autism.
12:07In high risk. Example, we expect.
12:09About 20 or so percent of kids to
12:13develop about this and what we did.
12:16We examined using seed based
12:18functional connectivity approach.
12:20We examine brain activation
12:23or coactivation patterns.
12:25In both sample and,
12:27what we found was what we expected
12:30that in silicon EXPAREL strongly
12:32with other areas of the brain,
12:34including anterior cingulate cortex,
12:36which in which it forms the salience network
12:40as well as amygdala and and hippocampus,
12:44which are very important
12:46structure from motion processing,
12:47learning, and memory.
12:50What we did next.
12:52We compared the strength of the
12:53activation in these two groups to see
12:56if there are any differences amongst
12:58those who do or don't have risk for
13:00autism and what we found was that
13:03babies who are carrying genetic risk
13:07for autism show hyperactivation.
13:10Of the connectivity between anterior
13:13insula and amygdala and amygdala is
13:16another structure that tremendously
13:18important for emotion processing,
13:20learning, and memory.
13:21It's also heavily connected with
13:24other brain structures,
13:25so if insula is like Atlanta.
13:29Magalys like Chicago.
13:31So imagine that something wrong goes
13:34wrong with both of these airports.
13:36Communication across the entire
13:39country or entire brain.
13:41In this case,
13:42that might be quite disrupted in
13:45ways that are difficult to predict.
13:49So.
13:51But we also did we follow these
13:53babies we we scanned them at
13:55birth and we follow them again.
13:58When they were about 18 months old.
14:00And at that point we evaluated.
14:03What is the severity?
14:05Of behaviors we typically
14:08associate with autism.
14:10And then we correlated the strength
14:12of the connectivity between ends,
14:14insula, and amygdala.
14:15With that measure of of social
14:19vulnerabilities in our sound when all
14:21we saw was something very interesting
14:24and and encouraging in some ways.
14:27Is that there was a very strong
14:30association between lower
14:31connectivity at birth and higher
14:34autism symptoms at 18 months.
14:38So this was a striking and and novel
14:42presentation novel novel discovery of
14:45weakening of the very important circuitry
14:49that supports emotion processing,
14:51stealing detection and learning in autism.
14:54What we also demonstrate for the first
14:57time that some of the hyper activations
15:00that we see in older kids with autism
15:03may in fact be present already at
15:06birth when babies are just entering.
15:09The game of figuring out what their
15:12social and non social environment is.
15:15So we are very, very excited about now.
15:18This study we are working on,
15:21continuing it, accruing the samples.
15:24But as always,
15:25we are also thinking about the future.
15:27What is the what are the next step?
15:29How how do we want to capitalize or
15:32leverage this finding for future discovery?
15:36And and one of the lines of
15:38research they would like to pursue
15:41is to actually evaluate empirical.
15:43What is the specific impairment?
15:46How is the specific impairment at
15:49birth affect development of social
15:51motivation and social bonding?
15:53Because there's a hypothesis that there
15:55are some links between monsula and those two,
15:58but but we would like to be able to
16:01show it and paper in our samples.
16:05The second thing that we would like
16:07to do is to expand our investigation,
16:10broaden our investigation so so
16:12when we scan babies,
16:13we collect information from the entire brain.
16:17There's tons of information and and
16:18and we know that kids without this and
16:21not only have social difficulties,
16:23but actually they have.
16:25A lot of concurring conditions that have
16:28to do with with regulation of attention,
16:31regulation of emotions,
16:33language development, cognitive processing.
16:36And each of them contributes independently
16:40to long term outcomes in our kids.
16:44So what?
16:47Investigate if we can detect mechanisms or
16:50predictors of of these outcomes as well,
16:53but the idea of hopefully identifying
16:56better ways of intervening or understanding
16:59the underlying mechanisms. And finally.
17:04The the circuitry between amygdala
17:08and insula identify here is is very
17:12well conserved and and develops very,
17:16very early in during pregnancy,
17:18and so we would like to download extent.
17:21Our imaging findings in newborns to
17:24the last trimester of pregnancy,
17:27and to better understand the developmental
17:30dynamic of this of this circuitry.
17:33And also to see if there are
17:37potentially any alterations that
17:38that occur already before birth.
17:41And and I can talk a little bit more
17:43about it if you have questions further.
17:48So, so this is a tremendously
17:51exciting and and but part of part
17:55of the excitement of our work has
17:59to do with constant innovation.
18:01In terms of developing better methods of.
18:06Recording and quantifying.
18:10Characteristics that are related to
18:13neurodevelopmental office to the new
18:16developmental disorders including autism.
18:20And I would like to just tell you
18:22very briefly about two of these.
18:24These these new developments.
18:26So if you know past three years we've
18:29spent under pandemic conditions,
18:31we've been all affected by them in
18:35in so many different ways personally
18:38and and and professionally,
18:39and our research was affected to some extent,
18:43probably less than than in other groups,
18:45but we had to.
18:46We decided very early in the
18:49pandemic that we are going to.
18:51Spend this time innovating,
18:53developing new labs and and this work it was.
18:57It has been really led by Doctor Angelina
19:01Vernetti who is our former postdoc.
19:05She came here five years ago and now
19:07she's an associate research scientist,
19:09and so we validated 22 specific
19:12methods for studying outcomes in our
19:14our babies home with kind of art.
19:17One of them involves recording
19:20gaze behaviors or attention.
19:22During the life interaction
19:24face to face interaction,
19:26some of you might be familiar with
19:29the work we do in in our lab that
19:31involves studying attention by
19:33presenting children with with various
19:36images on the flat computer screen,
19:38presenting them with videos
19:41with speech stimuli.
19:43A variety of emotional stimuli and
19:45recording where they are looking and
19:47then based on the patterns of looking,
19:49inferring what's happening in their brain.
19:53We've been very successful with this work.
19:57To a number of discoveries,
19:59but it always sort of.
20:01There was an always a question in sort of
20:03in the back of our mind is what happens if.
20:07How can we better evaluate the trials
20:11attentional choices when they are actually
20:14interacting with someone face to face?
20:16And this technology has become available
20:19in the past couple of years and we were
20:22able to purchase it and establish the
20:25entire lab and the way it looks that
20:27the kiddo is sitting either in a hard cut,
20:30high high chair or parents lab
20:33across the table from an examiner,
20:36with or without toys.
20:37And there's a low.
20:39Low eye tracking setup that's
20:41designed to to capture the child's
20:44attention as they look at the
20:46person who's interacting with them,
20:49and it may look like that this
20:51morning I had to wear my hat and
20:55my coat and my mittens and a scarf.
21:00I bet you are a cold this morning too.
21:03Every Dieter cooked OHA dinosaur coat.
21:07I have a blue coat.
21:08And I also heard that it might snow.
21:12I have my old friend.
21:14You have your own life hat.
21:16So as you can see,
21:18as the child is interacting with.
21:21With mom or in this case,
21:23Megan the examiner,
21:24we are able to track very precisely
21:28where the child is looking
21:30at all times and the
21:32significance of that is that when
21:34we then take the amount of time,
21:37the proportion of time the kids spent
21:39looking at the examiner's face and we
21:42correlated with severity of autism symptoms,
21:44we see that there's a very,
21:46very strong association.
21:48Between the two, let's looking at the face,
21:51higher severity of autism symptoms
21:53with the idea that so So what?
21:56What? It tells us.
21:57Basically, this task is a wonderful,
21:59wonderful proxy for assessing very
22:02quickly and in a very naturalistic way.
22:06Severity of social difficulties the
22:09children experience and and we are
22:12very excited to take this this this
22:16this particular outcome measure.
22:17To the next level with our imaging studies,
22:21there's a second lab that we
22:23developed during the pandemic.
22:24This is in collaboration with our
22:26colleagues at the Haskins Labs,
22:27specifically Doctor Richard Aslin,
22:31who's foremost most most world renowned
22:36neurodevelopmental psychologist
22:39and we developed a way to actually
22:42not just study attention in their
22:45context of real-world face to face.
22:48Their action,
22:49but actually looking into the brain
22:51and seeing what is the what are the
22:54activation patterns in response to the
22:56child's interaction with the outside world.
22:59We use it using some we we do it using
23:02something that's called functional
23:04near infrared spectroscopy or years,
23:07which is a non invasive imaging technique
23:11that can be implemented anywhere and
23:15involves wearing this very handsome.
23:18That,
23:19and you might think it's hard to put on,
23:22and it might be,
23:24but we we have developed a lot
23:26of expertise in doing so.
23:27So hey,
23:30hey.
23:31Wow I
23:33love this hat Cecilia.
23:35I love this hat. Good job.
23:39And and then the child can watch something
23:42on the screen or interact with mom.
23:45And as they are doing it,
23:47we can record brain activity.
23:51The child's brain activity.
23:53And you know, in a way that's quite
23:56similar to what we would do in the magnet.
23:59It's very hard to keep a
24:01toddler and the magnet awake.
24:03So so we are tremendously excited
24:05with these two new developments.
24:08And we are already employing them.
24:10In our studies,
24:11and we actually last week submitted
24:13a grant application that will rely
24:16very heavily on both of these
24:18labs or all of these methods.
24:21And with hey,
24:24with that I would like to thank you very
24:27much for your attention and from all of us,
24:31including the babies who who who come
24:34to our studies or to our clinics.
24:36And I would also like to thank
24:39you for your support because your
24:42support allows us to allows us
24:45freedom to take risks and invest
24:48into the most cutting edge.
24:51And and.
24:53An exciting questions and
24:56methodologies so thank you so much.
25:01Kasha might I turn to Suzanne doctor Mccart.
25:08Unless they do, we have questions for Kasha
25:10right at this moment?
25:14I actually have a question.
25:15Can you hear me?
25:17It's Prescott, it's been a while.
25:20I was wondering, given that
25:21you were looking at the high risk
25:23sibs, were their older brother
25:27or sister? Do they all have
25:29the low connectivity and the in the. Anterior
25:36insula and given the heterogeneity
25:39of autism, how prevalent is that
25:41feature and does that correlate to
25:43a certain phenotype?
25:46So we know from studies of older kids that
25:50their reports of atypical connectivity
25:53between these two specific areas,
25:55so it has been it has been reported earlier.
26:00We don't know exactly whether the
26:02older sets of of of our kids had
26:05similar feature brain features.
26:07We were not able to.
26:08This is this is something that we
26:11discovered in the past two months so,
26:13but it would be very interesting
26:16to see and if in genetically
26:20similar family Members this
26:24particular feature carries through.
26:26I agree that.
26:37Any other questions?
26:41Doctor mccard
26:51and you can you see my screen
26:53look perfect OK? Great.
26:58It's a great pleasure to be
27:00here today to speak to you
27:02all about some of our work.
27:04I'll be talking today about
27:07emotional development,
27:08and in particular, joy.
27:10So emotions play a major role in
27:13how children experience the world,
27:15but the majority of behavioral
27:17research on autism has focused
27:20mainly on its core symptoms and
27:22very little attention has been paid
27:25to other aspects like children's
27:27emotional experiences or have
27:29children with autism learn.
27:31So today I'll tell you a little
27:33bit about our research program on
27:35emotions in young children with autism.
27:40So emotions influence a really broad
27:43range of cognitive processes as well
27:46as emotional and even physical health.
27:48Different types of early emotional
27:50reactivity are associated not only
27:52with later developmental skills,
27:54but also the likelihood of various
27:57emotional and behavioral problems.
28:03A common picture of the lives of
28:05children with autism is 1 where
28:08negative emotions dominate.
28:10For example, children with
28:11autism have a lot of tantrums.
28:13Children with autism are anxious,
28:15they're sad, and they generally have
28:18trouble regulating their emotions.
28:20This may all have some truth to it,
28:23but this is where the little
28:25research on emotion has focused
28:27on the negative emotions.
28:31But we really know close to nothing
28:33about how they experience the positive
28:35end of the emotional spectrum.
28:37And this is a huge gap in knowledge
28:39because positive emotions like
28:41joy are incredibly important.
28:43Positive emotion increases levels of the
28:45neurotransmitter dopamine in the brain,
28:48which is important to processes
28:50like motivation, reinforcement,
28:51learning and problem solving.
28:54Joy is also related to sociability
28:58and overall adjustment,
28:59at least in the general
29:01population of children.
29:02This is what we know.
29:07Because no one had investigated this,
29:09we designed a study to examine how
29:12Tyler's thought TISM experience
29:14emotion in everyday situations,
29:17and the results were very different,
29:19more complex than we expected.
29:23So first we were not too surprised to
29:26see that in the anchor condition that
29:30we created in the lab that there was
29:34more frustration for the kids with
29:36autism compared to their developmentally
29:38delayed and typically developing peers
29:40in situations like being in a car seat.
29:44But in situations where we presented
29:47them with unusual toys or novel objects,
29:49they were actually less fearful than others,
29:53and that was not an expectation we had,
29:56but very interesting were the results from
29:59the joy condition, and we know that it.
30:01Sometimes it can be difficult to get
30:03a smile out of some kids with autism,
30:06but when we presented them with things
30:08like a puppet show and bubbles,
30:10we observed just as much smiling
30:13and laughter.
30:14From them compared to their peers,
30:16so it looks like during situations
30:19that are typically fun for little
30:21children like a puppet show,
30:23there is a lot of positive affect.
30:27Now overall, if we take this all together,
30:29we see a more complex landscape.
30:33If you will,
30:34of emotional expression and very
30:36young children with autism now.
30:38Next we took a closer look at
30:41the Puppet Show task to see not
30:43only what children expressed,
30:45but also how they shared it.
30:49And there were more surprises here.
30:51So during this fun activity which
30:53didn't have a lot of social demands,
30:56they shared their enjoyment with their
30:59parent just as often as the kids who had,
31:02who were typically developing and now shared.
31:05Enjoyment is something that we generally
31:07see less of in children with autism,
31:10and it's something that we like
31:12to foster whenever possible.
31:14So this puppet activity kind of intrigued us.
31:17It seems to be a sort of normalizing
31:20context where children with autism
31:23experience positive emotions,
31:25and they shared them as much
31:27as other children.
31:28So why this response to puppets?
31:30Do we have any understanding of of
31:33puppets and and can we explain why they
31:36might elicit this kind of a response?
31:43So we had heard some anecdotal
31:45reports that children with autism
31:47can become very interested in
31:49puppets and public characters,
31:51and the study that I just described suggests
31:54that puppets are a source of pleasure.
31:57So to take just a little bit of
32:00a step back as you just heard.
32:02From Kasha and from knowing maybe a
32:05little bit more about our studies,
32:07one of our areas of expertise
32:10is social attention.
32:11We know from our many studies
32:13of infants and young children
32:15that social attention is greatly
32:17impacted and autism early on.
32:19So what do we know about
32:20attention to puppets?
32:26So in this very recent study we
32:29presented preschoolers with a brief
32:31video in which a person and a puppet
32:34engaged in a conversation when the
32:36person was speaking children with autism
32:40did not attend particularly well,
32:42but when the puppets spoke,
32:44there were high levels of
32:45attention to the puppets face,
32:46much like what we saw with the
32:50typically developing children.
32:51Also a very important finding in the
32:54study was that the preference for
32:56the puppet speaker was not associated
32:58with severity of autism symptoms,
33:00so children who were severely
33:02impacted by autism were just as
33:04likely to attend to puppets as those
33:07with less severe autism symptoms.
33:09So, given all of these results,
33:11it seems that puppets might be a
33:13very effective way to introduce
33:16social communication to kids
33:18in therapeutic contexts.
33:20In other words,
33:21interacting with puppets may help
33:23toddlers with autism develop better
33:25engagement skills with human social partners.
33:32We know that teaching kids with
33:34autism can be very challenging.
33:36Our work suggests that there are
33:38ways to normalize both attention and
33:40joy and young kids on the spectrum,
33:43with puppets being one Ave to reach children
33:45with significant learning difficulties,
33:48and there are sure to be others.
33:50Activities that elicit solid
33:53attention and inspire.
33:54Smiling and laughter are likely to
33:56facilitate cognitive processes involved
33:58in learning and problem solving as
34:00well as better social engagement.
34:06So in some future directions,
34:08we are really interested in
34:10how the experience of joy may
34:12enhance social engagement,
34:13learning and generalization
34:15for children with autism.
34:17Links have been documented in the
34:19general population and we think
34:21that these principles may also be
34:23operating in children with autism,
34:25but this is an area that we are
34:27very excited to investigate further.
34:34I would like to give special thanks to
34:37all the associates because it would
34:39not be possible to do some of this
34:43innovative work without you. Thank you.
34:47Thank you Susan. Ohh I love the images
34:51that you show. Any any questions?
34:58I would just make it a comment that.
35:01Can you show the Sesame Street characters?
35:05So I wonder whether there's
35:07any difference between
35:10the recognition the the joy,
35:13the the, the, the feeling.
35:16If it's a puppet
35:17that they may have seen
35:19before, there is a familiar
35:21puppet as opposed
35:22to some other kind of puppet.
35:26You probably look at that.
35:28That's a great question. It is.
35:31I'll just note that the in this
35:33in the study where I showed the
35:35the image of the conversation
35:36between the puppet and the person.
35:38This was actually a novel puppet
35:40that is not one of the standard.
35:43You know, characters that that are
35:44that are shown on TV or in on the
35:47Internet or anything like that.
35:48So in this case it was actually
35:51a novel puppet.
35:51Certainly it has some of the
35:54some similar features to some
35:57Sesame Street characters.
35:58You know, maybe there are some.
36:01There are probably similarities,
36:02but that's that's a great question.
36:05Actually, the the puppets were sort
36:08of custom design for our study.
36:10And we we had Cheryl Hanson and some of
36:15the puppeteers from her group to come to
36:19Yale with with bags full of materials,
36:22and they assemble the puppets
36:25here on the on the spot,
36:27and we recorded the videos.
36:29We are now using in in number of studies,
36:32not just the study that Suzanne mentioned.
36:34That which is published.
36:36But a number of studies and these are
36:40the most beautiful and amazing stimuli
36:43you can ever wish for in a study.
36:46To the extent that actually you know the
36:49the kids are absolutely mesmerized by them,
36:51the puppets always wins over a person.
36:56Even even informal babies,
36:58does that continue because
37:00I've had the experience granted
37:02just with my daughter where she's focused,
37:05focused, focused for one day,
37:06and the next day she wants to
37:08have nothing to do with it.
37:10So I'm curious as to whether you've seen that
37:12pattern. Was it just her?
37:15Well it it. It depends what we
37:17do with the puppets, right?
37:19So so one of the hypothesis that we
37:23have is that it's it's possible that
37:26puppets have for whatever reasons
37:28they have a capacity to make kids
37:31with autism excited and joyful,
37:34which raises their arousal level,
37:36raises their neurotransmitter levels,
37:38and makes them probably more receptive
37:42to engage, sustain attention and
37:44learn and return what they learn.
37:46This is a hypothesis we have
37:48not been able to test it.
37:50But we we are hoping to do it
37:53at some point in the future,
37:55because if so,
37:57that would be a such a natural way.
38:00Of imbuing therapeutic interaction
38:03with something that's I mean who
38:06doesn't like puppets right with
38:08something that's inexpensive,
38:09easy to operate.
38:11It's highly interactive, right?
38:13It can be.
38:14It can change the script on the
38:17fly depending on the child's level
38:19of interest or motivation or.
38:22Can mirror the mood.
38:23It can counter the mood.
38:25It can introduce new topics,
38:27distractions in a way that's
38:29not related to the person.
38:31So so in in that respect.
38:34It would be really,
38:36really cool and exciting if if
38:38that was a medium that we could
38:41introduce into brother practice.
38:43In fact,
38:45tomorrow we are meeting with the
38:46heads of the birth to three system.
38:50The new there's a new new team and they're
38:53tremendously excited about our work.
38:55We are going to talk about it.
38:57And see if they would be interested
39:00in adopting some of these strategies
39:01in a sort of more intuitive way
39:03in their intervention programs.
39:09The puppets talk, yes. They have a voice.
39:13They have a voice,
39:15how similar to a human voice.
39:18This is me. It was a female.
39:20Was it high? Is it low?
39:21I mean do these things have any effect?
39:25To mend this. Tremendous and that's
39:28why they can be individualized to
39:31the child's preferences and likes.
39:34So some might prefer you
39:36know very high pitched voice.
39:38I I don't want to do the
39:40packets here that we have a.
39:41We have a collection of
39:43pockets here actually,
39:44but you don't want me to be a puppet.
39:46You don't want to see me being a puppeteer,
39:49but but you can adjust the voice
39:51depending on the child's preference.
39:53It can be low.
39:53It can be high, it can be quiet,
39:56compassionate.
39:56It could be very excited
39:58and and and and high.
40:01And and you can adjust the depending
40:03you know if you start losing the
40:05child's attention you can switch.
40:07Right, you can switch characters.
40:08You can switch voices,
40:10you can switch motions,
40:12and that's the incredible versatility
40:16of of the of that meeting.
40:22I think Suzanne's got a fun project.
40:27I agree.
40:29I would say there's several of us
40:31when there was their opportunity.
40:32We love to just go watch the puppets.
40:36Kelly, would you like
40:37to? Take us forward.
40:40Definitely.
40:42All right, you can see my screen
40:45and hear me as everyone said,
40:47it's just a real pleasure to be here today.
40:49Speaking with all of you,
40:51and I'll talk specifically about our
40:54approach in the lab to partnering
40:56with and also supporting our parents.
40:59As mentioned at the center of our research,
41:02aims are really the children families
41:03that we serve and we keep families
41:06in mind as we are planning our
41:08research questions and writing our
41:10grants to the strategies we end up
41:12using for recruitment and enrollment.
41:14And of course the care we provide when
41:17the families come to our lab for their
41:19visits and then we carry that feeling
41:21and that thought of the families all
41:23the way through the dissemination of
41:25our research findings and making sure
41:27that families can understand the science.
41:29They were doing.
41:31And we also understand the role we play
41:33as researchers and clinicians as families
41:35really do and trust us with their children,
41:39often their infants,
41:40and they end up allowing us to
41:42be even a small part of their
41:45child's developmental journey,
41:46and our goal is to have families
41:48feel welcomed, feel accepted,
41:50feel valued,
41:51and definitely to feel supported.
41:54And we believe that developing this
41:57partnership with families is the core
41:59of understanding the development of ASD.
42:02This is a real bidirectional
42:04relationship we have with families
42:06such that we are always trying to
42:08listen and learn from their experience
42:10and hear about their needs and be
42:12as responsive as possible to this.
42:16So I wanted to mention a story that
42:18was released about six months ago by
42:20Yale Medicine about a young man named
42:23Danny who was actually first evaluated
42:25by Kasha and other similar group when
42:27he was 2 1/2 years old through one of
42:31our research studies and Danny is now 18.
42:33Danny has graduated from high
42:35school in Connecticut last year
42:37and is currently studying marine
42:39biology at Eckerd College in St.
42:41Petersburg,
42:41FL.
42:41And I encourage you to take a look
42:44at this article and I wanted to
42:47specifically highlight something,
42:48Danny's mother said.
42:49She said that the recommendations
42:51from the Yale Child Study Center
42:54paved the way for her son's success,
42:56in part by equipping her to be a
42:59strong advocate for his needs.
43:01And in this article,
43:03Danny's mother also thanked Kasha
43:05specifically for listening to the
43:07family's concerns and helping them
43:09to further understand Denny's needs.
43:11And overall,
43:12the sentiment is that early
43:14diagnosis and recommendations for
43:16interventions that were specifically
43:18tailored to Danny had been key to
43:21his success and also was helping
43:23his parents become advocates for him,
43:26and this story is powerful in many levels.
43:28As you can imagine, but for me and our team.
43:32The idea of empowering families and
43:34helping them to fully understand their
43:37child's often complex profile of
43:39strengths and areas of vulnerability,
43:41as well as helping them find their
43:44advocacy voice is so crucial and
43:46clearly has a long lasting impact on
43:49the child's development.
43:51So one way we have tried to support
43:53families is by offering a monthly parent
43:56support group that has historically
43:58been in person and turned virtual
44:00during the pandemic and what has
44:02been incredible about this group in
44:04particular is that originally began
44:06with four families who had children
44:09around the age of two years old who
44:11were just diagnosed with autism,
44:13and these children are now nine years old.
44:16And the group has grown tremendously
44:18from these four original families to
44:20now having well over 100 families
44:22on our listserv,
44:23and sometimes upwards of twenty
44:26families are joining anyone
44:28meeting and during these meetings,
44:30I was able to witness first hand the
44:33power of familial connection and
44:35sharing stories with other parents who
44:37understood the journey the families were on.
44:40I learned,
44:40and I continue to learn so much
44:42from these families about their
44:45experience receiving a diagnosis.
44:47The hurdles they face trying to
44:49get services started the question.
44:51They asked each other about how to
44:54navigate conversations with families and
44:56friends about their child's diagnosis.
44:582 questions that they asked me about
45:01how to manage a child's behavior or
45:03how to help their child communicate.
45:06And another fascinating aspect of this.
45:08Parents support Group that has
45:10been able to witness over the years
45:12are parents becoming advocates and
45:15that transition to becoming their
45:17child's best advocate.
45:19And one of the biggest hurdles we
45:21hear from families all the time is
45:24insurance not covering something like
45:26applied behavioral analysis through
45:28the evidence based intervention and
45:30one of our original families paved
45:32the way for Yale to change its policy
45:35about covering ABA services for those
45:37enrolled in the Yale Health Plan.
45:39And not only was this a huge impact
45:41on the community,
45:43but inspired another parent who
45:44heard this mom's journey and she
45:47was a teacher in New Haven,
45:48so she decided to.
45:50Advocate for her own child and to change the
45:53policy of not only the school she worked in,
45:55but ended up changing the policy
45:57for the whole city of New Haven.
45:59So she single handedly helped
46:01hundreds of families.
46:03So not just teachers,
46:04but parents who are employed as firefighters,
46:06police officers and other city
46:09employees who had children with autism
46:12who needed access to ABA services.
46:15But we feel like we could be doing more.
46:17We want to do more to help
46:19educate and empower families,
46:20and we want to expand this parent
46:23support group idea and the plan for
46:25this extension is really grounded
46:27in the years of work we have with
46:29families as well as our knowledge of
46:31various evidence based treatments and
46:33strategies that are currently available.
46:35So we plan to offer individual
46:37treatment to parents and really
46:39to cover kind of four main areas.
46:42So the first one is about providing
46:44a space for parents to process their
46:46own emotions following a diagnosis
46:48which we know can be highly varied
46:50and this can include reviewing
46:52various stress management and coping
46:55strategies to finding ways to talk to their
46:58family members and friends about autism
47:00or connecting them with other families.
47:03And the second theme is
47:05psychoeducation about autism.
47:06What it is, but also what it's not and
47:09about their own child's unique profile
47:12of strengths and areas of growth.
47:15And then the third is helping parents
47:17navigate the often complex systems
47:19involved in finding and then building
47:21their child's intervention team
47:23because it's usually more than just one
47:25clinician or one provider and helping
47:28parents decide who is the best team
47:30for their child can be incredibly.
47:32Critical in the child's development.
47:35And finally,
47:36we aim to teach parents various things
47:38that they can do during everyday
47:40routines and interactions with
47:42their child to help further promote
47:44communication and social development.
47:46So these can be strategies they can
47:49utilize during their daily kind of days.
47:51During meal time, diaper changes,
47:53bath time and so forth.
47:56And our intention in this type of
47:58treatment is to really bridge that gap
48:01between receiving a first time diagnosis
48:03and then the child actually beginning
48:05their early intervention program,
48:07which we know can take several months.
48:09So this treatment would be time limited.
48:12We suspect maybe three months in length.
48:15And again,
48:15the goal is to target this very,
48:17very transitional period for families.
48:20There's so much out there on the
48:22Internet and then the community and
48:24parents often don't know where to go
48:26or where to start on this journey.
48:28Therefore,
48:29we aim to really begin working with
48:31parents as soon as possible and the whole
48:34purpose of this type of intervention
48:36is once again empowering families to
48:39ensure families feel like they are
48:41getting the best head start that they
48:43can as they begin their journey of
48:45parenting a child with special needs,
48:48and we want them to feel knowledgeable,
48:50we want them to feel equipped to become
48:53their child's best advocate because we
48:55know that this is so incredibly important.
48:58So before I end,
48:59we also wanted to at least briefly
49:01mention that part of our labs mission
49:04is really to train that new generation
49:07of clinicians and researchers,
49:09and many from this group are from
49:10the past three to four years,
49:12others from a little while ago,
49:14but many of our trainees have gone
49:16on to study medicine, psychology,
49:18social work, public health,
49:20speech, language, pathology,
49:21epidemiology, and the list goes on.
49:24And as they transition into their
49:26chosen career path, we do provide.
49:29Ourselves in providing them with some
49:31foundational knowledge and experience
49:33regarding family centered clinical care,
49:36especially within a research program.
49:40And with that I want to thank you for
49:42your time and attention as well as your
49:44support of our work over the years.
49:45And my son Reed also says thank you.
49:51Thank you, Kelly.
49:53So questions or any discussion?
50:01Bravo. Thank you, janitor. I you know,
50:06as as a social worker by training,
50:09although I don't never put
50:11up my shingle, I think I'm
50:13a big, big big believer in support groups
50:16and family centered care and
50:19everything you just described.
50:20I think it's fabulous. Thank
50:23you, it really is at the
50:24heart of what we do. Yeah.
50:33Just looking to.
50:35See if any other.
50:37Questions in the chat or otherwise.
50:45If I if I just may add something
50:48to to the last slide that Kelly
50:50presented when she presented our
50:52investment into the future as I was
50:54as we were putting through the slide,
50:56I realized that both Suzanne and Kelly came
50:59to us as postdoctoral trainees, right?
51:04And and stay thankfully stayed
51:06with us and contributed their
51:08tremendous talent to this program.
51:12Good point.
51:17Well, we, we'd be very
51:19grateful for your feedback.
51:20Also, on this kind of fireside chat salon,
51:24just opportunity to get updates
51:26through zoom and using this format in
51:30any other topics you'd like to hear,
51:32or any questions that you might
51:34have after you get off from.
51:35I'm sure Costa and the team
51:37would be more than glad to.
51:39I have a discussion right kussion.
51:42Absolutely anytime.
51:47Contra, do you want to have the not last
51:49word but the transition word?
51:53Well, we truly appreciate
51:55your your your your.
51:57And coming here and helping us,
52:00you know, with some of us,
52:01we've had discussions in the past
52:03thinking about what is important.
52:05What are the priorities in the
52:07field and and your input is really
52:10tremendously important for us and
52:12and we are grateful and look
52:15forward to future discussions.