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Front. Physiol. | doi: 10.3389/fphys.2018.00467

Heart Rate Variability during a joint attention task in toddlers with Autism Spectrum Disorders

 Lucia Billeci1*,  Alessandro Tonacci1,  Antonio Narzisi2,  Zaira Manigrasso3, Maurizio Varanini1,  Francesca Fulceri2, Caterina Lattarulo4, Sara Calderoni2, 5 and  Filippo Muratori2, 5
  • 1Istituto di Fisiologia Clinica (CNR), Italy
  • 2Fondazione Stella Maris (IRCCS), Italy
  • 3Università degli Studi di Pisa, Italy
  • 4Ospedale Madonna Delle Grazie, Italy
  • 5Department of Clinical and Experimental Medicine, University of Pisa, Italy

Autism Spectrum Disorders (ASD) are a heterogeneous group of neurodevelopmental disorders featuring early impairments in social domain, with autonomic nervous system (ANS) unbalance possibly representing a useful marker for such disturbances. Impairments in joint attention (JA) are one of the earliest markers of social deficits in ASD. In this study, we assessed the feasibility of using wearable technologies for characterizing the ANS response in ASD toddlers during the presentation of joint attention (JA) stimuli.
Twenty ASD toddlers and twenty age- and gender-matched typically developed (TD) children were recorded at baseline and during a JA task through an unobtrusive chest strap for ECG. Specific algorithms for feature extraction, including Heart Rate (HR), Standard Deviation of the Normal-to-Normal Intervals (SDNN), pNNx, Low-to-High Frequency Ratio (LF/HF), and Respiratory Sinus Arrhythmia (RSA) were applied to the ECG signal and a statistical comparison between the two groups was performed.
Considering the phase and group interaction, RSAn was not changed from baseline to task among TDs, whereas it was increased among ASDs. Furthermore, the normalized LF signal was increased in both groups during the task, with a greater change among TD subjects (TD: 0.17±0.05 vs 0.23±0.05, p=0.01; ASD: 0.24±0.06 vs 0.28±0.06, p=0.06).
As for the single phases, SDNN was increased at baseline in ASD (p=0.020), similarly to pNNx, which was also different (p=0.038), with an increase at baseline in ASD (p=0.045).
The results of this study indicate the feasibility of characterizing the ANS response in ASD toddlers through a minimally obtrusive tool, allowing to quantify several parameters related to ANS from the single-lead acquisition of the ECG signal. Our analysis showed an increase of sympathetic activation in ASD, suggesting a possible autonomic dysregulation for the toddlers with such condition here evaluated at baseline. Taken together, such findings foster the application of the proposed approach for evaluating physiological correlates of JA response impairments very early in ASD.

Keywords: Autonomic Nervous System, joint attention, Autism Spectrum Disorders, wearable sensors, Eye-tracking

Received: 31 Jul 2017; Accepted: 13 Apr 2018.

Edited by:

Jakub S. Gąsior, Kazimierz Pułaski University of Technology and Humanities in Radom, Poland

Reviewed by:

Estate M. Sokhadze, University of South Carolina, United States
Rachael A. Muscatello, Vanderbilt University, United States
GANG YAO, University of Missouri, United States  

Copyright: © 2018 Billeci, Tonacci, Narzisi, Manigrasso, Varanini, Fulceri, Lattarulo, Calderoni and Muratori. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Lucia Billeci, Istituto di Fisiologia Clinica (CNR), Pisa, Italy,