Caitlin Clements’ day at work might involve analyzing research data, teaching a class, or even facilitating a game of peek-a-boo.

For the assistant professor of psychology, simple childhood games can provide critical insight into understanding the development and behavior of autistic children.

To continue this groundbreaking work, Clements has received the Brain & Behavior Research Foundation’s Young Investigator Grant, a prestigious show of support for promising researchers in their early careers.

“This is a really nice affirmation that our research and ideas are meaningful and going in a direction that people are excited about,” she said. “I'm so excited and grateful to be able to do this work.”

Over the next two years, Clements’ Breakthrough Research on Autism & Inclusive Neurodevelopment (BRAIN) Lab will use the grant funding to examine children’s responses to rewarding stimuli, by using variations of games like peek-a-boo and bubbles.

Clements, a child clinical psychologist by training, developed these tests for 3- to 5-year-olds, and hopes the next project will extend the tests to toddlers and infants when autism develops and is newly diagnosed.

“We talk about motivation and reward processing a lot in older kids and people with fewer support needs, but that's not when autism is developing, and that's not when we do early intervention,” she said. “We still have a long way to go with research and understanding how autistic brains work and what they need to be successful, so I'm really hoping that this study can make a small contribution to that goal.”

Supporting children through research

Autism spectrum disorder can affect how people communicate, socialize, and act. It affects 1 in 36 children in the United States, and researchers are still learning about its development.

Psychologists hypothesize that children who eventually receive an autism diagnosis pay less attention to social cues as infants, Clements said, and they miss out on critical social learning opportunities thus finding social stimuli less rewarding. The neural responses at this critical age, however, have not been studied before.

“Part of the reason why we don't understand why autistic kids under the ages of 4 or 5 — and why we don't understand how they process rewards — is because we don't have the tools to assess reward processing in those young populations,” Clements said.

Existing research on the reward processing of autistic individuals focuses on older children and involves more complex games or tasks.

“That might give us a clue about who's going to excel in their early intervention goals.”

Clements’ study will use two novel tests designed for younger children — ePeekaboo, a computerized version of the classic game peek-a-boo, and pressMORE, which involves tapping a button to release musical bubbles. These engaging tests will be administered to 60 young children, half of whom have an autism diagnosis. Effort and reward responses will be examined at behavioral and neural levels to understand if autistic children process rewards differently.

Clements first created ePeekaboo while she was a postdoctoral fellow at Boston Children’s Hospital and Harvard Medical School. While watching a video of their caregiver playing peekaboo, the children are connected to an electroencephalogram net, which monitors electrical activity caused by neurons firing at the same time in the same direction.

The second test, pressMORE, assesses how much effort children are willing to exert by pressing a button in order to get a reward of musical bubbles.

Early intervention strategies for autistic children often include speech or physical therapy, which involves some level of effort and reward. Clements said that understanding children’s behavior with pressMORE may offer insight into the value of their participation in these programs.

“That might give us a clue about who's going to excel in their early intervention goals,” she said.

Understanding every individual’s learning style

Clements first conducted research on autism as an undergraduate at Yale University, when she joined a psychology research lab her sophomore year. Since then, the conversation around the complex brain development diagnosis has grown — within the research community and beyond.

After working in the field for more than 15 years, Clements is passionate about using research to support children with autism and their families. Her research is not about “fixing” autistic brains, but rather finding the ideal ways for every person to learn and grow.

“We’re trying to understand them so that we can better support their learning in the way that their beautiful brain is,” she said.

“We’re trying to understand them so that we can better support their learning in the way that their beautiful brain is."

Clements’ BRAIN Lab — which includes a team of staff, graduate students, and undergraduates — is currently analyzing pilot data from the tests, and the full study is anticipated to be complete by next spring or summer.

At that point, Clements hopes the study will unlock opportunities for personalized care and “precision medicine” for autistic children in early intervention. She also hopes that her two new tests are proven effective and will open up possibilities to reach younger children in further autism-related research.

“Once we establish reliability and validity, then we can use the tests to do a longitudinal study, starting in infancy and following kids repeatedly until they reach the age of an autism diagnosis,” Clements said. “Can we predict at all who went on to get the diagnosis, or can we predict who's doing well in early intervention and who's struggling?”

Originally published by Hailey Oppenlander at al.nd.edu on January 10, 2025.