Creation of a Virtual Reality Telesimulation Program in Response to Mandatory COVID-19 Social Distancing During the Pandemic: A Primer for Those considering VR Simulation and Application to a Group of

The broader autism phenotype (BAP) refers to mild autism traits in the domains of social and pragmatic language difficulties and restricted and repetitive behaviors and interests (RRBI) []. BAP traits are continuously distributed in the general population [] but are more common in child and adult relatives of individuals with autism spectrum disorder (ASD‐relatives) in whom they may reflect genetic and neurobiological mechanisms that increase ASD susceptibility [, ]. Thus, studying the BAP can inform our understanding of mechanisms contributing to ASD [], including its co‐occurrence with epilepsy []. There is a high rate of co‐occurrence of epilepsy and ASD, with population‐based studies suggesting a 6% rate of autism in epilepsy []. By definition, ASD manifests in childhood. In the past, there was debate about whether ASD in children with epilepsy was primarily due to the secondary effects of seizures. It is now understood that for an important subset of children, this is not the primary cause of autistic traits since epilepsy often presents several years after the onset of autism []. This pattern supports shared causal mechanisms of epilepsy and autism and means that one should expect an elevated rate of the BAP not only in pediatric epilepsy but also before seizure onset in later childhood to adulthood. In people with epilepsy (PWE), individual BAP traits spanning the three domains are overrepresented compared with the general population [, , ]. In considering their etiology, epilepsy‐related factors including age at seizure onset and seizure type and frequency have been found to have no or only weak associations with BAP traits. This suggests BAP traits, like ASD traits, are not purely secondary to the effects of repeated seizures but may instead reflect shared susceptibility mechanisms for epilepsy and ASD. The self‐report version of the Broad Autism Phenotype Questionnaire (BAPQ) [] has been widely used to assess the BAP in the general population and in ASD‐relatives [, ]. However, previous studies have demonstrated that such minimal phenotyping measures under‐identify the BAP [] and have therefore stressed the importance of using a multi‐measure, multi‐informant phenotyping approach to fully capture the BAP [, , ]. The BAP may also be assessed as a continuous or categorical construct. While the former approach may increase statistical power in quantitative trait analyses [], classifying individuals with a level of BAP trait expression above a cutoff is considered a more specific marker of ASD susceptibility mechanisms [, , ].