Investigation of multisensory processing and structural brain differences in Autism Spectrum Disorder

This thesis is an investigation of structural brain abnormalities, as well as multisensory and unisensory processing deficits in autistic traits and Autism Spectrum Disorder (ASD). To achieve this, structural and functional magnetic resonance imaging (fMRI) and psychophysical techniques were employed. ASD is a neurodevelopmental condition which is characterised by the social communication and interaction deficits, as well as repetitive patterns of behaviour, interests and activities. These traits are thought to be present in a typical population. The Autism Spectrum Quotient questionnaire (AQ) was developed to assess the prevalence of autistic traits in the general population. Von dem Hagen et al. (2011) revealed a link between AQ with white matter (WM) and grey matter (GM) volume (using voxel-based-morphometry). However, their findings revealed no difference in GM in areas associated with social cognition. Cortical thickness (CT) measurements are known to be a more direct measure of cortical morphology than GM volume. Therefore, Chapter 2 investigated the relationship between AQ scores and CT in the same sample of participants. This study showed that AQ scores correlated with CT in the left temporo-occipital junction, left posterior cingulate, right precentral gyrus and bilateral precentral sulcus, in a typical population. These areas were previously associated with structural and functional differences in ASD. Thus the findings suggest, to some extent, autistic traits are reflected in brain structure - in the general population. The ability to integrate auditory and visual information is crucial to everyday life, and results are mixed regarding how ASD influences audiovisual integration. To investigate this question, Chapter 3 examined the Temporal Integration Window (TIW), which indicates how precisely sight and sound need to be temporally aligned so that a unitary audiovisual event can be perceived. 26 adult males with ASD and 26 age and IQ-matched typically developed males were presented with flash-beep (BF), point-light drummer, and face-voice (FV) displays with varying degrees of asynchrony and asked to make Synchrony Judgements (SJ) and Temporal Order Judgements (TOJ). Analysis of the data included fitting Gaussian functions as well as using an Independent Channels Model (ICM) to fit the data (Garcia-Perez & Alcala-Quintana, 2012). Gaussian curve fitting for SJs showed that the ASD group had a wider TIW, but for TOJ no group effect was found. The ICM supported these results and model parameters indicated that the wider TIW for SJs in the ASD group was not due to sensory processing at the unisensory level, but rather due to decreased temporal resolution at a decisional level of combining sensory information. Furthermore, when performing TOJ, the ICM revealed a smaller Point of Subjective Simultaneity (PSS; closer to physical synchrony) in the ASD group than in the TD group. Finding that audiovisual temporal processing is different in ASD encouraged us to investigate the neural correlates of multisensory as well as unisensory processing using functional magnetic resonance imaging fMRI. Therefore, Chapter 4 investigated audiovisual, auditory and visual processing in ASD of simple BF displays and complex, social FV displays. During a block design experiment, we measured the BOLD signal when 13 adults with ASD and 13 typically developed (TD) age-sex- and IQ- matched adults were presented with audiovisual, audio and visual information of BF and FV displays. Our analyses revealed that processing of audiovisual as well as unisensory auditory and visual stimulus conditions in both the BF and FV displays was associated with reduced activation in ASD. Audiovisual, auditory and visual conditions of FV stimuli revealed reduced activation in ASD in regions of the frontal cortex, while BF stimuli revealed reduced activation the lingual gyri. The inferior parietal gyrus revealed an interaction between stimulus sensory condition of BF stimuli and group. Conjunction analyses revealed smaller regions of the superior temporal cortex (STC) in ASD to be audiovisual sensitive. Against our predictions, the STC did not reveal any activation differences, per se, between the two groups. However, a superior frontal area was shown to be sensitive to audiovisual face-voice stimuli in the TD group, but not in the ASD group. Overall this study indicated differences in brain activity for audiovisual, auditory and visual processing of social and non-social stimuli in individuals with ASD compared to TD individuals. These results contrast previous behavioural findings, suggesting different audiovisual integration, yet intact auditory and visual processing in ASD. Our behavioural findings revealed audiovisual temporal processing deficits in ASD during SJ tasks, therefore we investigated the neural correlates of SJ in ASD and TD controls. Similar to Chapter 4, we used fMRI in Chapter 5 to investigate audiovisual temporal processing in ASD in the same participants as recruited in Chapter 4. BOLD signals were measured while the ASD and TD participants were asked to make SJ on audiovisual displays of different levels of asynchrony: the participants’ PSS, audio leading visual information (audio first), visual leading audio information (visual first). Whereas no effect of group was found with BF displays, increased putamen activation was observed in ASD participants compared to TD participants when making SJs on FV displays. Investigating SJ on audiovisual displays in the bilateral superior temporal gyrus (STG), an area involved in audiovisual integration (see Chapter 4), we found no group differences or interaction between group and levels of audiovisual asynchrony. The investigation of different levels of asynchrony revealed a complex pattern of results indicating a network of areas more involved in processing PSS than audio first and visual first, as well as areas responding differently to audio first compared to video first. These activation differences between audio first and video first in different brain areas are constant with the view that audio leading and visual leading stimuli are processed differently.

Cultural citizenship and its implications for citizenship education: Chinese university students’ civic experience in relation to mass media and the university citizenship curriculum

A growing body of research has argued that university citizenship curricula are inefficient in promoting civic participation, while there is a tendency towards a broader citizenship understanding and new forms of civic engagements and citizenship learning in everyday life. The notion of cultural citizenship in this thesis concentrates on media practices’ relation to civic expression and civic engagement. This research thus argues that not enough attention has been paid to the effects of citizenship education policy on students and students’ active citizenship learning in China. This thesis examines the civic experience of university students in China in the parallel contexts of widespread adoption of mass media and of university citizenship education courses, which have been explicitly mandatory for promoting civic morality education in Chinese universities since 2007. This research project raises significant questions about the meditating influences of these two contexts on students’ perceptions of civic knowledge and civic participation, with particular interest to examine whether and how the notion of cultural citizenship could be applied in the Chinese context and whether it could provide certain implications for citizenship education in China. University students in one university in Beijing contributed to this research by providing both quantitative and qualitative data collected from mixed-methods research. 212 participants contributed to the questionnaire data collection and 12 students took part in interviews. Guided by the theoretical framework of cultural citizenship, a central focus of this study is to explore whether new forms of civic engagement and civic learning and a new direction of citizenship understanding can be identified among university students’ mass media use. The study examines the patterns of students’ mass media use and its relationship to civic participation, and also explores the ways in which mass media shape students and how they interact and perform through the media use. In addition, this study discusses questions about how national context, citizenship tradition and civic education curricula relate to students’ civic perceptions, civic participation and civic motivation in their enactment of cultural citizenship. It thus tries to provide insights and identify problems associated with citizenship courses in Chinese universities. The research finds that Chinese university students can also identify civic issues and engage in civic participation through the influence of mass media, thus indicating the application of cultural citizenship in the wider higher education arena in China. In particular, the findings demonstrate that students’ citizenship knowledge has been influenced by their entertainment experiences with TV programs, social networks and movies. However, the study argues that the full enactment of cultural citizenship in China is conditional with regards to characteristics related to two prerequisites: the quality of participation and the influence of the public sphere in the Chinese context. Most students in the study are found to be inactive civic participants in their everyday lives, especially in political participation. Students express their willingness to take part in civic activities, but they feel constrained by both the current citizenship education curriculum in universities and the strict national policy framework. They mainly choose to accept ideological and political education for the sake of personal development rather than to actively resist it, however, they employ creative ways online to express civic opinions and conduct civic discussion. This can be conceptualised as the cultural dimension of citizenship observed from students who are not passively prescribed by traditional citizenship but who have opportunities to build their own civic understanding in everyday life. These findings lead to the conclusion that the notion of cultural citizenship not only provides a new mode of civic learning for Chinese students but also offers a new direction for configuring citizenship in China. This study enriches the existing global literature on cultural citizenship by providing contemporary evidence from China which is a developing democratic country, as well as offering useful information for Chinese university practitioners, policy makers and citizenship researchers on possible directions for citizenship understanding and citizenship education. In particular, it indicates that it is important for efforts to be made to generate a culture of authentic civic participation for students in the university as well as to promote the development of the public sphere in the community and the country generally.

Utilising presence in places to support mobile interaction

Physical places are given contextual meaning by the objects and people that make up the space. Presence in physical places can be utilised to support mobile interaction by making access to media and notifications on a smartphone easier and more visible to other people. Smartphone interfaces can be extended into the physical world in a meaningful way by anchoring digital content to artefacts, and interactions situated around physical artefacts can provide contextual meaning to private manipulations with a mobile device. Additionally, places themselves are designed to support a set of tasks, and the logical structure of places can be used to organise content on the smartphone. Menus that adapt the functionality of a smartphone can support the user by presenting the tools most likely to be needed just-in-time, so that information needs can be satisfied quickly and with little cognitive effort. Furthermore, places are often shared with people whom the user knows, and the smartphone can facilitate social situations by providing access to content that stimulates conversation. However, the smartphone can disrupt a collaborative environment, by alerting the user with unimportant notifications, or sucking the user in to the digital world with attractive content that is only shown on a private screen. Sharing smartphone content on a situated display creates an inclusive and unobtrusive user experience, and can increase focus on a primary task by allowing content to be read at a glance. Mobile interaction situated around artefacts of personal places is investigated as a way to support users to access content from their smartphone while managing their physical presence. A menu that adapts to personal places is evaluated to reduce the time and effort of app navigation, and coordinating smartphone content on a situated display is found to support social engagement and the negotiation of notifications. Improving the sensing of smartphone users in places is a challenge that is out-with the scope of this thesis. Instead, interaction designers and developers should be provided with low-cost positioning tools that utilise presence in places, and enable quantitative and qualitative data to be collected in user evaluations. Two lightweight positioning tools are developed with the low-cost sensors that are currently available: The Microsoft Kinect depth sensor allows movements of a smartphone user to be tracked in a limited area of a place, and Bluetooth beacons enable the larger context of a place to be detected. Positioning experiments with each sensor are performed to highlight the capabilities and limitations of current sensing techniques for designing interactions with a smartphone. Both tools enable prototypes to be built with a rapid prototyping approach, and mobile interactions can be tested with more advanced sensing techniques as they become available. Sensing technologies are becoming pervasive, and it will soon be possible to perform reliable place detection in-the-wild. Novel interactions that utilise presence in places can support smartphone users by making access to useful functionality easy and more visible to the people who matter most in everyday life.

Investigating assistive technology to support memory for people with cognitive impairments

Technologies such as automobiles or mobile phones allow us to perform beyond our physical capabilities and travel faster or communicate over long distances. Technologies such as computers and calculators can also help us perform beyond our mental capabilities by storing and manipulating information that we would be unable to process or remember. In recent years there has been a growing interest in assistive technology for cognition (ATC) which can help people compensate for cognitive impairments. The aim of this thesis was to investigate ATC for memory to help people with memory difficulties which impacts independent functioning during everyday life. Chapter one argues that using both neuropsychological and human computing interaction theory and approaches is crucial when developing and researching ATC. Chapter two describes a systematic review and meta-analysis of studies which tested technology to aid memory for groups with ABI, stroke or degenerative disease. Good evidence was found supporting the efficacy of prompting devices which remind the user about a future intention at a set time. Chapter three looks at the prevalence of technologies and memory aids in current use by people with ABI and dementia and the factors that predicted this use. Pre-morbid use of technology, current use of non-tech aids and strategies and age (ABI group only) were the best predictors of this use. Based on the results, chapter four focuses on mobile phone based reminders for people with ABI. Focus groups were held with people with memory impairments after ABI and ABI caregivers (N=12) which discussed the barriers to uptake of mobile phone based reminding. Thematic analysis revealed six key themes that impact uptake of reminder apps; Perceived Need, Social Acceptability, Experience/Expectation, Desired Content and Functions, Cognitive Accessibility and Sensory/Motor Accessibility. The Perceived need theme described the difficulties with insight, motivation and memory which can prevent people from initially setting reminders on a smartphone. Chapter five investigates the efficacy and acceptability of unsolicited prompts (UPs) from a smartphone app (ForgetMeNot) to encourage people with ABI to set reminders. A single-case experimental design study evaluated use of the app over four weeks by three people with severe ABI living in a post-acute rehabilitation hospital. When six UPs were presented through the day from ForgetMeNot, daily reminder-setting and daily memory task completion increased compared to when using the app without the UPs. Chapter six investigates another barrier from chapter 4 – cognitive and sensory accessibility. A study is reported which shows that an app with ‘decision tree’ interface design (ApplTree) leads to more accurate reminder setting performance with no compromise of speed or independence (amount of guidance required) for people with ABI (n=14) compared to a calendar based interface. Chapter seven investigates the efficacy of a wearable reminding device (smartwatch) as a tool for delivering reminders set on a smartphone. Four community dwelling participants with memory difficulties following ABI were included in an ABA single case experimental design study. Three of the participants successfully used the smartwatch throughout the intervention weeks and these participants gave positive usability ratings. Two participants showed improved memory performance when using the smartwatch and all participants had marked decline in memory performance when the technology was removed. Chapter eight is a discussion which highlights the implications of these results for clinicians, researchers and designers.