A U T I S M , E L E C T R O D E R M A L A C T I V I T Y A N D T H E A M Y G D A L A

WHAT DOES YOUR RIGHT HAND KNOW THAT YOUR LEFT HAND

DOES NOT?

Frank Kelly

AGENDA

• Introduction & Background• Autism• Applied Behavioral Analysis• Challenges in Data Gathering• Pilot Project• Picard et al. Findings & the Neuroscience of fear &

anxiety• Wrap Up• Questions at any time

INTRODUCTION

• PhD in Computational Neuroscience (Boston Univ)• SW Engineer since 1998 • Work on highly-scalable systems in finance,

mobile payments and consumer mobile applications• Working on Big Data Analytics for Here.com

consumer apps (500M user objects, 1.5B events per month)

PARENT

JAN 31ST 2012

D, was diagnosed with Autism Spectrum Disorder at age 4.5

AUTISM

• “Autism is a neurodevelopmental disorder characterized by impaired social interaction, verbal and non-verbal communication, and restricted and repetitive behavior.” http://en.wikipedia.org/wiki/Autism

• DSM• Social-Emotional Reciprocity – conversations, turn-taking• Deficits in non-verbal cues – eye-contact, body-language• Deficits in relationship formation – or even interest in peers• Insistence on sameness – inflexibility• Fixated Interests• Hyper- or hypo-reactivity to sensory input or unusual interests

in sensory aspects of the environment

“CLASSIC” ASD COMORBIDITIES

• GI• Sleep• Depression/Anxiety• Emotional Regulation issues

• How is it treated?

APPLIED BEHAVIORAL ANALYSIS

• Universally* considered the best behavioral treatment for autism

• Understanding behavior and how it is affected by the environment

• Paradigm: Antecedent Behavior Consequence

• Uses reinforcement to bring about “meaningful and positive change in behavior”

* Unless you are a health insurance company cf. United HealthCare and several others

SOME DATA FROM SCHOOL

9/3/

14

9/15

/14

9/27

/14

10/9

/14

10/2

1/14

11/2

/14

11/1

4/14

11/2

6/14

12/8

/14

12/2

0/14

1/1/

15

1/13

/15

1/25

/15

2/6/

15

2/18

/15

3/2/

15

3/14

/15

3/26

/15

4/7/

15

4/19

/15

5/1/

15

5/13

/15

5/25

/15

6/6/

15

6/18

/15

6/30

/15

0

5

10

15

20

25

30

35

Total -ve10-d _x000d_moving _x000d_avg

THE DAY THE DATA FAILED

• Video

• “If the map and the terrain disagree, trust the terrain” – attributed to Swiss Army manual

• Data Gathering is subjective, context-dependent, fragmented view

• When the data don’t capture MAJOR events . . .

MORE CHALLENGES

• We get the data weeks AFTER the event• No feedback loop to PREDICT behavior• Poor Self Reporting (Alexithymia)• School Home School communication

• What do we want• Data Pattern Extraction Prediction Notification

Adaptation / Supports

THE GOAL

• How can we get a more objective and time-sensitive sense of when he is "stressed” to correlate antecedents with behavior?• 24 x 7• fMRI is out and so is EEG

WEARABLES!

STRESS BIOMETRICS

• Heart-rate can be used to measure “stress”• Electrodermal Activity is even better• Electrodermal Activity (EDA) == Galvanic Skin Response (GSR)

Source: DeSantos et al (2011) Real-Time Stress Detection by Means of Physiological. Chapter 2 of Recent Application in Biometrics

THE PILOT PROJECT

• Find an “off-the-shelf” wearable device that Declan will wear that measures EDA

1) Will he wear it (continuously)?2) How (accurate | reliable | consistent) is each

device?3) Sampling Frequency4) Can we get access to the raw data (in real

time?)5) Which wrist?

WHICH WRIST . . . . . SIMPLE RIGHT?

• Well, No• Picard et al (2015) “Multiple Arousal Theory and

Daily-Life Electrodermal Activity Asymmetry” Emotion Review.

SOME DEFINITIONS

• Definitions: Emotional Arousal != Emotional Intensity • Calm = Low Arousal• Fist pumping Joy = High Arousal• Depression = Low Arousal (but emotionally “intense”)

• History of EDA• Goes back to 1879• EDA sensor worn on wrist is well correlated to traditional

EDA measures with gelled electrodes

INITIAL DISCOVERY

• In an attempt to cancel noise due to motion artifacts (with active children) they used 4 devices (2 x wrist, 2 x ankle)• “ . . . . . we found significant surprises”• Huge asymmetries come and go – aligned with

emotionally significant events

Picard et al (2015) Figure 1 Key periods of “anxiety”• Will event be called off (~9.15am) • Standing in line worrying (~11.15am)• Standing in line for ride (~11.30am)• Riding the ride (~11.45am)

EMOTIONAL PROCESSING

Source: http://en.wikipedia.org/wiki/Limbic_system

WHICH BRAIN REGIONS CONTRIBUTE TO EDA?

• From Boucsein (2012) Electrodermal Activity• A limbic-hypothalamic source – being thermoregulatory and

emotionally influenced• A premotor-basal ganglia source – preparation of motor actions• A reticular formation (brain stem) modulating EDA

• Direct brain stimulation (N=5) Mangina and Beuzeron-Mangina (1996)• Epilepsy patients• Stimulation of the eight limbic regions have strong EDA

responses on ipsilateral (same) side• Stimulation of cortical regions have small responses and

contralateral• Amygdala had the strongest EDA response

AMGYDALA

• Lanteaume et al (2007)• N=8 Epilepsy Patients• 100% of the electrical stimulations of the right amygdala

evoked negative emotion (fear, anxiety, sadness > anger, disdain, joy, happiness: p < 0.05)

• Left amygdala had mixed results (47% negative, 53% positive) • 100% of stimulations with emotional modifications induced skin

conductance response on the ipsilateral palm

• Brain imaging studies have also shown association between right amygdala and anxiety

• Expectation: If anxiety activates right amygdala more than left, expect EDA to go up more on right than left

THE RESULTS

• N=25 (10 male, 15 female; all but one right-handed)

Picard et al (2015) Figure 5

THEIR CONCLUSIONS

• “Underlying emotions such as fear or anxiety could contribute to right amygdala activation, and to right EDA, in a right-hander”

• Pilot Conclusion: Try the right first . . . . Then the left

DEVICES IN THE PILOT

FOLLOW-ON STEPS

1. Finalize device criteria1. Access to EDA data2. Declan will wear it (cf. Sensory sensitivities)3. Data (Accuracy | Reliability | Consistency)

2. Pick best two devices3. Get a Baseline

1. Replicate left / right wrist discrepancy2. Across devices3. Son vs Daughter

LESSONS LEARNED

• Be mindful of your assumptions (thanks to Prof. Eric Schwartz)• Do your literature search! • Sometimes the questions are more important

than the end-goal

• Is EDA baseline the same for NT vs ASD kids?• No• Hirstein et al (2001) Autonomic responses of

autistic children to people and objects.

HUGE POTENTIAL

• To measure treatment efficacy• Does EDA “improvement” precede behavioral

improvement and by how much?• Longitudinal studies – “optimal outcome” vs “sub-

optimal outcome”• Help parents / educational professionals

THANK YOU!

BACKUP & EXTRA SLIDES

EMOTIONAL REGULATION

Limbic Regions• Amygdala – “Basic” emotion processing• Anterior Cingulate – “is involved in assessing the

salience of emotion and motivational information”

Cortical regions• Insula – Emotion & Sensation & Homeostasis (Smell --

> Hunger)• vmPFC – "pure emotion regulation” • OFC - " main disorders associated with dysregulated

OFC connectivity/circuitry center around decision-making, emotion regulation, and reward expectation"

POTENTIAL FUTURE APPLICATIONS

• We know• The sensors will get better (more sensors, more accurate)• Data access has to get easier / faster• Analytics and Machine learning are becoming commoditized

(cf. Azure/AWS and Amplitude.com)• Knowledge of Genotype/Phenotypes continues to explode• Health care is just too expensive

• Imagine• Longitudinal Studies• Studies within families• Applications within Special Needs classrooms

• Who is already “there”• Financial world already has tons of history of stock prices /

bond prices / order history / economics data