Translational Virtual Reality and Electrophysiologic Investigation of Audiovisual Spatial Attention in ASD and ADHD - ABSTRACT Children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) often struggle to understand speech in noisy environments, impairing community participation. Despite the high prevalence of these auditory processing disorders, evidence-based interventions remain limited due to gaps in understanding neural mechanisms and the impact of clinical heterogeneity. This project addresses these gaps through a series of translational aims that combine electrophysiology (EEG), virtual reality (VR), neuropsychological phenotyping, and community-engaged research to inform the development of targeted interventions. Prior work has implicated audiovisual integration of lip movements with speech sounds as a contributing mechanism to auditory processing disorders but has largely overlooked the confounding role of spatial attention deficits. Disambiguating their contributions is critical for designing mechanism-targeted interventions. This project tests the hypothesis that disrupted visual and/or auditory spatial attention mechanisms negatively impact audiovisual speech-in-noise perception in specific subpopulations of children with neurodevelopmental disorders and serve as a promising target for mechanism-informed VR interventions. In Aim 1, we will use EEG to compare neural signatures of audiovisual integration and spatial attention in school-age children with TD, ADHD-only, ASD-only, and ASD+ADHD, clarifying mechanisms driving auditory processing challenges. In Aim 2, we will conduct deep phenotyping across cognitive, attentional, and sensory domains and perform neural-phenotypic correlations to examine how the neural differences from Aim 1 relate to heterogeneity in clinical presentation. In Aim 3, we will leverage an existing ADHD cohort for whom we have already demonstrated spatial attention deficits to develop a prototype VR-based spatial attention training via a user-centered design process. This work will improve precision in identifying subgroups of children with ASD and ADHD who may benefit from targeted interventions, bridging the gap between neuroscience and clinical application. It also centers family and stakeholder perspectives, ensuring real-world feasibility. As an early-stage investigator trained in developmental-behavioral pediatrics and neuroscience, the PI is well-positioned to benefit from leading this translational work. The PI has strong mentorship at the University of Rochester Medical Center across neuroscience and pediatrics departments and external collaborators in VR design at the nearby Rochester Institute of Technology. The training plan will develop the PI’s skills in qualitative research and clinical trial design, fostering a research program focused on the translation of mechanistic understanding into evidence-based intervention.
