Pubmed du 20/01/21

mercredi 20 janvier 2021

1. Botha M, Hanlon J, Williams GL. Does Language Matter ? Identity-First Versus Person-First Language Use in Autism Research : A Response to Vivanti. J Autism Dev Disord ;2021 (Jan 20):1-9.

In response to Vivanti’s ’Ask The Editor…’ paper [Journal of Autism and Developmental Disorders, 50(2), 691-693], we argue that the use of language in autism research has material consequences for autistic people including stigmatisation, dehumanisation, and violence. Further, that the debate in the use of person-first language versus identity-first language should centre first and foremost on the needs, autonomy, and rights of autistic people, so in to preserve their rights to self-determination. Lastly, we provide directions for future research.

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2. Cast TP, Boesch DJ, Smyth K, Shaw AE, Ghebrial M, Chanda S. An Autism-Associated Mutation Impairs Neuroligin-4 Glycosylation and Enhances Excitatory Synaptic Transmission in Human Neurons. J Neurosci ;2021 (Jan 20) ;41(3):392-407.

Neuroligins (NLGNs) are a class of postsynaptic cell adhesion molecules that interact with presynaptic neurexins (NRXNs) and regulate synapse function. NLGN4 is a member of the NLGN family and consists of a unique amino acid sequence in humans that is not evolutionarily well conserved in rodents. The human-specific NLGN4 gene has been reported to be mutated in many patients with autism and other neurodevelopmental disorders. However, it remained unclear how these mutations might alter the molecular properties of NLGN4 and affect synaptic transmission in human neurons. Here, we describe a severely autistic male patient carrying a single amino acid substitution (R101Q) in the NLGN4 gene. When expressed in HEK293 cells, the R101Q mutation in NLGN4 did not affect its binding affinity for NRXNs or its capacity to form homodimers. This mutation, however, impaired the maturation of NLGN4 protein by inhibiting N-linked glycosylation at an adjacent residue (N102), which is conserved in all NLGNs. As a result, the R101Q substitution significantly decreased the surface trafficking of NLGN4 and increased its retention in the endoplasmic reticulum and Golgi apparatus. In human neurons derived from male stem cell lines, the R101Q mutation also similarly reduced the synaptic localization of NLGN4, resulting in a loss-of-function phenotype. This mutation-induced trafficking defect substantially diminished the ability of NLGN4 to form excitatory synapses and modulate their functional properties. Viewed together, our findings suggest that the R101Q mutation is pathogenic for NLGN4 and can lead to synaptic dysfunction in autism.

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3. Chan HL, Hsieh YH, Lin CF, Liang HY, Lee SS, Weng JC, Lee MJ, Chen YL, Chen VC, Gossop M. Lower Risk of Burn Injury in Children and Adolescents with Autism Spectrum Disorder : A Nationwide Population-Based Study. J Autism Dev Disord ;2021 (Jan 20)

Little research has examined burn injury in the pediatric population with autism spectrum disorder (ASD). We used data from Taiwan’s National Health Insurance Research Database to identify 15,844 participants aged <18 years with ASD and 130,860 participants without ASD. Our results revealed that the hazard ratios differed across three age ranges. The ASD group had a lower risk of burn injury than the non-ASD group when they were less than 6 years of age, a higher risk from 6 years to 12 years of age, and no difference when they were older than 12 years of age. More research is required to study the characteristics and causes of burn injury in the pediatric population with ASD.

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4. Dahiya AV, DeLucia E, McDonnell CG, Scarpa A. A systematic review of technological approaches for autism spectrum disorder assessment in children : Implications for the COVID-19 pandemic. Res Dev Disabil ;2021 (Jan 8) ;109:103852.

BACKGROUND : Screening and diagnostic assessments tools for autism spectrum disorder (ASD) are important to administer during childhood to facilitate timely entry into intervention services that can promote developmental outcomes across the lifespan. However, assessment services are not always readily available to families, as they require significant time and resources. Currently, in-person screening and diagnostic assessments for ASD are limited due to the COVID-19 pandemic and will continue to be a concern for situations that limit in-person contact. Thus, it is important to expand the modalities in which child assessments are provided, including the use of technology. AIMS : This systematic review aims to identify technologies that screen or assess for ASD in 0-12 year-old children, summarizing the current state of the field and suggesting future directions. METHODS : An electronic database search was conducted to gather relevant articles to synthesize for this review. OUTCOMES AND RESULTS : 16 studies reported use of novel technology to assess children suspected of ASD. CONCLUSIONS AND IMPLICATIONS : Results strongly supported live-video evaluations, video observations, and online or phone methods, but there is a need for research targeting the feasibility of these methods as it applies to the stay-at-home orders required by the pandemic, and other situations that limit clients from seeing providers in-person.

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5. Fu SC, Lee CH, Wang H. Exploring the Association of Autism Spectrum Disorders and Constipation through Analysis of the Gut Microbiome. Int J Environ Res Public Health ;2021 (Jan 14) ;18(2)

Over the past two decades, research into the role of the gut microbiome in regulating the central nervous system has rapidly increased. Several neurodevelopmental diseases have been linked to the unbalance of gut microbiota, including autism. Children on the autism spectrum often suffer from gastrointestinal symptoms, including constipation, which is four times more prevalent than it is in children without autism spectrum disorders (ASD). Although studies in animals have shown the crucial role of the microbiota in key aspects of neurodevelopment, there is currently no consensus on how the alteration of microbial composition affects the pathogenesis of ASD, let alone how it exerts an impact on the following comorbidities. In our study, we were able to control the effects of constipation on gut dysbiosis and distinguish neuropathological-related and gastrointestinal-related bacteria in ASD patients separately. By analyzing published data, eight additional bacteria significantly altered in autistic individuals were identified in our study. All of them had a decreased relative abundance in ASD patients, except Lactobacillaceae and Peptostreptococcaceae. Eighteen and eleven bacteria were significantly correlated with ASD symptoms and constipation, respectively. Among those, six bacteria were overlapped between the groups. We have found another six bacteria highly associated with constipation status in ASD patients only. By conducting Welch’s t-test, we were able to demonstrate the critical roles of microbes in ASD core and gastrointestinal symptoms and raised the hypotheses of their confounding and mediating effects on the relationship between the two symptoms.

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6. Graña M, Silva M. Impact of Machine Learning Pipeline Choices in Autism Prediction From Functional Connectivity Data. Int J Neural Syst ;2021 (Jan 20):2150009.

Autism Spectrum Disorder (ASD) is a largely prevalent neurodevelopmental condition with a big social and economical impact affecting the entire life of families. There is an intense search for biomarkers that can be assessed as early as possible in order to initiate treatment and preparation of the family to deal with the challenges imposed by the condition. Brain imaging biomarkers have special interest. Specifically, functional connectivity data extracted from resting state functional magnetic resonance imaging (rs-fMRI) should allow to detect brain connectivity alterations. Machine learning pipelines encompass the estimation of the functional connectivity matrix from brain parcellations, feature extraction, and building classification models for ASD prediction. The works reported in the literature are very heterogeneous from the computational and methodological point of view. In this paper, we carry out a comprehensive computational exploration of the impact of the choices involved while building these machine learning pipelines. Specifically, we consider six brain parcellation definitions, five methods for functional connectivity matrix construction, six feature extraction/selection approaches, and nine classifier building algorithms. We report the prediction performance sensitivity to each of these choices, as well as the best results that are comparable with the state of the art.

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7. Green CC, Smith J, Bent CA, Chetcuti L, Sulek R, Uljarević M, Hudry K. Differential predictors of well-being versus mental health among parents of pre-schoolers with autism. Autism ;2021 (Jan 20):1362361320984315.

Raising a child with autism has been linked to mental health difficulties. Poor parental mental health is likely influenced by various factors - including child-, parent-, and family/socioeconomic characteristics. However, little is known about what influences and promotes well-being (as opposed to mental health) among parents of young, newly diagnosed autistic children who may be particularly vulnerable. We examined child-, parent-, and family/socioeconomic factors associated with each of mental health and well-being in a sample of 136 parents of pre-school-aged children. Parental mental health was linked to both child- (i.e. autism symptom severity) and parent-related factors (i.e. personality traits reflecting a tendency to experience negative emotions). By contrast, in additional to mental health difficulties, which were linked to well-being, only other parent-related characteristics (and not child characteristics) were related to well-being. These included personality traits reflecting a tendency to be more extraverted/sociable, and also mindfulness. Other child-related and family/socioeconomic context factors (including household income, parental education level) were not linked to parental mental health or well-being in this sample. These results support the idea that poorer mental health and well-being are not simply the opposite of one another. That is, while these two factors were related, they were linked to different personal characteristics. Perhaps most importantly, the link between well-being and mindfulness - a personal characteristic that parents can improve - suggests mindfulness-based interventions may be helpful in directly supporting parental well-being in the context of raising a young child with autism.

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8. Greene SM, Sanchez YR, Pathapati N, Davis GN, Gould GG. Assessment of autism-relevant behaviors in C57BKS/J leptin receptor deficient mice. Horm Behav ;2021 (Jan 20) ;129:104919.

Gestational diabetes mellitus (GDM) was associated with greater autism risk in epidemiological studies. Disrupted leptin signaling may contribute to their coincidence, as it is found in both disorders. Given this we examined leptin receptor (Lepr) deficient (BKS.Cg-Dock7(m) +/+ Lepr(db)/J diabetic (db)) heterozygous (db/+) mice for autism-relevant behaviors. BKS db/+ females are lean with normal blood glucose, but they develop GDM while pregnant. We hypothesized BKS db/+ offspring might exhibit physiological and behavior traits consistent with autism. Adolescent body weight, fasting blood glucose, serum corticosterone, social preferences, self-grooming, marble burying, social dominance and cognitive flexibility of BKS db/+ mice was compared to C57BLKS/J (BKS) and C57BL/6J (BL6) mice. Male db/+ weighed more and had higher blood glucose and corticosterone relative to BL6, but not BKS mice. Also, male db/+ lacked social interaction preference, explored arenas less, and buried more marbles than BL6, but not BKS males. Male and female db/+ were more dominant and made more mistakes in water T-mazes locating a sunken platform after its position was reversed than BL6, but not BKS mice. Overall BKS db/+, particularly males, exhibited some autism-like social deficits and restrictive-repetitive behaviors relative to BL6, but BKS strain contributions to BKS db/+ behaviors were evident. Since BKS db/+ and BKS behavioral and physiological phenotypes are already so similar, it will be difficult to use these models in studies designed to detect contributions of fetal GDM exposures to offspring behaviors.

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9. Halstead EJ, Jones A, Esposito G, Dimitriou D. The Moderating Role of Parental Sleep Knowledge on Children with Developmental Disabilities and Their Parents’ Sleep. Int J Environ Res Public Health ;2021 (Jan 16) ;18(2)

BACKGROUND : Children with intellectual and developmental difficulties often experience sleep problems, which in turn may impact parental sleep patterns. This study explored the role of parental sleep knowledge as a moderator on the relationship between child sleep and parental sleep impairment. METHODS : 582 parents or caregivers (92.6% mothers) of children with different developmental disabilities (Age M = 9.34, 29.5% females) such as Down’s syndrome, participated in an online survey. Multiple regression analysis was conducted. RESULTS : Parental sleep knowledge of child sleep was a moderating variable in the relationship between child sleep nocturnal duration and parental sleep impairment. Although overall, sleep knowledge was high in this sample, two specific knowledge gaps were identified namely child sleep duration requirements, and the recognition of signs of a well-rested child. CONCLUSION : This study has provided evidence that increased parental sleep knowledge can positively impact both child and parental sleep outcomes.

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10. Hand BN, Gilmore D, Coury DL, Darragh AR, Moffatt-Bruce S, Hanks C, Garvin JH. Effects of a Specialized Primary Care Facility on Preventive Service Use Among Autistic Adults : a Retrospective Claims Study. J Gen Intern Med ;2021 (Jan 19)

BACKGROUND : While in some studies, the patient-centered medical home has been linked with increased receipt of preventive services among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. OBJECTIVE : To compare the receipt of preventive services by patients at a patient-centered medical home specifically designed for autistic adults (called the Center for Autism Services and Transition "CAST") to US national samples of autistic adults with private insurance or Medicare. DESIGN : Retrospective study of medical billing data. SAMPLE : The study sample included CAST patients (N = 490) who were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years old, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES : The primary outcome measure was the receipt of any preventive service, as defined by the Medicare Learning Network and AAPC (formerly the American Academy of Professional Coders). Secondary outcome measures included receipt of specific preventive service types (i.e., general health and wellness services, screenings, counseling and therapies, vaccinations, and sexual/reproductive health services). KEY RESULTS : CAST patients had significantly greater odds of receiving any preventive service than Medicare-enrolled (OR = 10.3 ; 95% CI = 7.6-13.9) and privately insured (OR = 3.1 ; 95% CI = 2.3-4.2) autistic adults. CAST patients were also significantly more likely to receive screenings and vaccinations than either Medicare beneficiaries (screenings OR = 20.3 ; 95% CI = 14.7-28.0 ; vaccinations OR = 5.5 ; 95% CI = 4.3-7.0) or privately insured beneficiaries (screenings OR = 2.0 ; 95% CI = 1.6-2.5 ; vaccinations OR = 3.3 ; 95% CI = 2.6-4.1). CONCLUSIONS : Autistic adults receiving care through CAST were significantly more likely to recieve preventive care services than national samples of autistic adults. Future comparative effectiveness trials are needed to rigorously assess the impact of primary care-based initiatives to improve care for autistic adults.

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11. Hoang N, Yuen RKC, Howe J, Drmic I, Ambrozewicz P, Russell C, Vorstman J, Weiss SK, Anagnostou E, Malow BA, Scherer SW. Sleep phenotype of individuals with autism spectrum disorder bearing mutations in the PER2 circadian rhythm gene. Am J Med Genet A ;2021 (Jan 20)

The Per family of genes functions as a primary circadian rhythm maintenance in the brain. Mutations in PER2 are associated with familial advanced sleep-phase syndrome 1 (FASPS1), and recently suggested in delayed sleep phase syndrome and idiopathic hypersomnia. The detection of PER2 variants in individuals with autism spectrum disorder (ASD) and without reported sleep disorders, has suggested a role of circadian-relevant genes in the pathophysiology of ASD. It remains unclear whether these individuals may have, in addition to ASD, an undiagnosed circadian rhythm sleep disorder. The MSSNG database was used to screen whole genome sequencing data of 5,102 individuals with ASD for putative mutations in PER2. Families identified were invited to complete sleep phenotyping consisting of a structured interview and two standardized sleep questionnaires : the Pittsburgh Sleep Quality Index and the Morningness-Eveningness Questionnaire. From 5,102 individuals with ASD, two nonsense, one frameshift, and one de novo missense PER2 variants were identified (0.08%). Of these four, none had a diagnosed sleep disorder. Three reported either a history of, or ongoing sleep disturbances, and one had symptoms highly suggestive of FASPS1 (as did a mutation carrier father without ASD). The individual with the missense variant did not report sleep concerns. The ASD and cognitive profiles of these individuals varied in severity and symptoms. The results support a possible role of PER2-related circadian rhythm disturbances in the dysregulation of sleep overall and sometimes FASPS1. The relationship between dysregulated sleep and the pathophysiology of ASD require further exploration.

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12. Howlin P. Adults with Autism : Changes in Understanding Since DSM-111. J Autism Dev Disord ;2021 (Jan 20)

Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.

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13. Jones DR, DeBrabander KM, Sasson NJ. Effects of autism acceptance training on explicit and implicit biases toward autism. Autism ;2021 (Jan 20):1362361320984896.

Autistic adults face prejudice from non-autistic people. They are often judged unfairly and left out of social activities because of their differences. This can make it difficult for autistic people to make friends and find jobs. Some training programs have tried to teach autistic people to act more like non-autistic people to help them gain acceptance. Fewer have focused on teaching non-autistic people how to be more autism friendly. In this study, we used a short training video that teaches people about autism. The video was created with the help of autistic adults and included clips of real autistic people. We found that non-autistic people who watched this video had better knowledge about autism and showed more autism-friendly attitudes than those who watched a video about mental health or those who did not watch any video. They were more open to having a relationship with an autistic person and had more positive beliefs about autism. However, our video did not affect people’s unconscious attitudes about autism. People in our study connected autism with unpleasant traits, even if they had watched the autism training video. This suggests that teaching non-autistic people about autism may promote more autism-friendly attitudes, but some beliefs may be harder to change.

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14. Krishnan V, Krishnakumar P, Gireeshan VK, George B, Basheer S. Early Social Experience and Digital-Media Exposure in Children with Autism Spectrum Disorder. Indian J Pediatr ;2021 (Jan 20)

OBJECTIVE : To study the early social experience and digital media exposure in children with autism spectrum disorder (ASD) in comparison with typically developed children. METHODS : Details of digital-media exposure and early social experience in 65 children with ASD were compared with those in a control group of equal number of typically developed children, matched for age and gender. Prenatal and perinatal factors were also studied. The diagnosis of ASD was based on the International Clinical Epidemiology Network (INCLEN) diagnostic tool and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnostic criteria. Variables which were biologically relevant and has a P value of < 0.05 in the univariate analysis were analyzed by logistic regression to obtain the adjusted effect measures. RESULTS : Children with ASD were exposed to digital media at an earlier age and spent significantly more time with digital media and less time with their mothers, compared to typically developed children. Exposure to digital media before 21 mo was associated with risk of ASD and the risk increased when mothers spent less than 6.5 h per day with the baby. Family history of epilepsy and developmental delay, maternal stress during the antenatal period, and absence of exclusive breastfeeding during the first 6 mo were significantly more in children with ASD. CONCLUSION : There are significant differences in the early life social experience and digital-media exposure in children with ASD compared to typically developed counterparts. Given the reported rise in prevalence of ASD, these findings stress the need for further prospective studies to explore these potentially modifiable risk factors.

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15. Lauer E, Lindgren S, Momany E, Cope T, Royer J, Cogan L, McDermott S, Armour B. Health Service Utilization Patterns Among Medicaid-Insured Adults With Intellectual and Developmental Disabilities : Implications for Access Needs in Outpatient Community-Based Medical Services. J Ambul Care Manage ;2021 (Jan 20)

Limited existing evidence suggests that adults with intellectual and developmental disabilities (IDD) experience substantial disparities in numerous areas of health care, including quality ambulatory care. A multistate cohort of adults with IDD was analyzed for patterns of inpatient admissions and emergency department utilization. Utilization was higher (inpatient [RR = 3.2], emergency department visits [RR = 2.6]) for adults with IDD, particularly for ambulatory care-sensitive conditions (eg, urinary tract [RR = 6.6] and respiratory infections [RRs = 5.5-24.7]), and psychiatric conditions (RRs = 5.8-15). Findings underscore the importance of access to ambulatory care skilled in IDD-related needs to recognize and treat ambulatory care-sensitive conditions and to manage chronic medical and mental health conditions.

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16. Low HM, Wong TP, Lee LW, Makesavanh S, Vongsouangtham B, Phannalath V, Che Ahmad A, Lee ASS. Can pictorial narration offer a solution to teacher training on the effective inclusion of students with autism spectrum disorder in low-resource settings ? Investigation on knowledge and stigma change. Autism ;2021 (Jan 19):1362361320984899.

In this study, we explored whether pictorial narration could offer a solution to teacher training on effective inclusion of students with autism spectrum disorder in the Lao People’s Democratic Republic. For this purpose, pre- and post-training knowledge data were collected from 87 Laotian teachers who participated in teacher training using a pictorial narrative e-module called The Story of Khamdy(TM). The teachers’ knowledge test results and feedback were analyzed. The findings indicated that teachers’ acceptance toward the training method had positive effects on their knowledge changes and supported the use of a pictorial narration approach in imparting knowledge about inclusive education and autism spectrum disorder to teachers in a least developed country.

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17. MA AL, Alsaqr AM. A Comparative Study of Corneal Topography in Children with Autism Spectrum Disorder : A Cross-Sectional Study. Vision (Basel) ;2021 (Jan 15) ;5(1)

PURPOSE : To investigate the corneal characteristics in individuals with autism spectrum disorder (ASD) and age-matched typical development (TD) participants. METHODS : This cross-sectional, clinically based study compared children with ASD to age-matched TD participants. Corneal topography was measured with a portable EyeSys Vista system. The distance visual acuity (VA) and the contrast sensitivity (CS) were determined. The refractive error (RE) was assessed using a 2WIN autorefractometer. RESULTS : A total of 31 children with ASD (mean age : 12.78 ± 4.49 years), and 60 participants with TD (mean age : 13.65 ± 3.56 years) were recruited. The two groups were similar in age (t = -2.084, p = 0.075) and VA (t = -0.35, p = 0.32). Most of the children with ASD had a significant amount of refractive errors (REs ; range : +5.25 to -5.50 DS), and astigmatism was dominant (range : -0.25 to -4.50 DC). There was no statistically significant difference between both groups in terms of average corneal power (t = 1.12, p = 0.39). The children with ASD and participants with TD also did not differ significantly in terms of corneal shape descriptors (p > 0.05), such as corneal asphericity, inferior superior index, opposite sector index, and differential sector index. The spherical equivalent did not differ significantly between the ASD participants and participants with TD (t = 1.15, p = 0.15). There was a significant difference (p < 0.05) in the astigmatism component between the ASD participants and the participants with TD.

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18. McDevitt SE. While quarantined : An online parent education and training model for families of children with autism in China. Res Dev Disabil ;2021 (Jan 16) ;109:103851.

PURPOSE : In the wake of the COVID-19 outbreak, already limited services and resources for families of children with autism spectrum disorder (ASD) in China became even more scarce. This qualitative case study highlights one online parent education and training (PET) program developed during the pandemic to offer home-intervention strategies to parents of children with ASD in mainland China. This exploratory study sought to examine the emic perspectives of the trainers and parents who participated in the 12-week intensive training program while considering the cultural context in China and the transnational, remote nature of the program. METHODS : The primary data focused on the experiences of the trainers and parents within PET program’s structure and strategies, which were adapted from the Training of Trainers model, and were collected from semi-structured, in-depth individual and focus group interviews conducted virtually with trainers (n = 4). Supplemental data sources included training session materials and feedback forms collected from parents (n = 294) at the midpoint and end of the program. After the collected data were sorted and condensed, a thematic analysis was performed using the data analysis spiral to further organize and code the data, and the codes were finally collapsed into themes. FINDINGS : Three overarching themes were identified : (1) training as modeling with resources, (2) dilemmas in cultural contexts and expectations, and (3) cultivating parent support networks. CONCLUSION : The online PET program became a hub of support networks and learning spaces for parents of children with ASD in different regions in China during the pandemic. Through the interactive virtual training sessions, parents were supported by continuous feedback on their home intervention and coached to cultivate support networks among themselves despite tensions arising from cultural differences and to implement effective intervention strategies that were individualized and authenticated to their specific familial needs.

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19. Pandina G, Ness S, Trudeau J, Stringer S, Knoble N, Lenderking WR, Bangerter A. Qualitative evaluation of the Autism Behavior Inventory : use of cognitive interviewing to establish validity of a caregiver report scale for autism spectrum disorder. Health Qual Life Outcomes ;2021 (Jan 20) ;19(1):26.

PURPOSE : The Autism Behavior Inventory (ABI) is an observer-reported outcome scale measuring core and associated features of autism spectrum disorder (ASD). Extensive scale development (reported elsewhere) took place, in alignment with the Food and Drug Administration’s patient-reported outcome guidance, to address the need for instruments to measure change and severity of ASD symptoms. METHODS : Cognitive interviewing was used to confirm understanding and content validity of the scale prior to its use in clinical trials. Respondents were caregivers of individuals with ASD (N = 50). Interviews used a hybrid of the "think-aloud" and verbal probing approach to assess ABI’s content validity and participant understanding of the instrument, including : item clarity and relevance ; item interpretation ; appropriateness of response scales ; and clarity of instructions. Audio-recordings of the interviews were transcribed for qualitative data analysis. The scale was revised based on participant feedback and tested in a second round of interviews (round 1 N = 38, round 2 N = 12). RESULTS : In total, 67/70 items reached ≥ 90% understandability across participants. Caregivers were able to select an appropriate response from the options available and reported finding the examples helpful. Based on participant feedback, instructions were simplified, 8 items were removed, and 10 items were reworded. The final revised 62-item scale was presented in round 2, where caregivers reported readily understanding the instructions, response options, and 61/62 items reached ≥ 90% understandability. CONCLUSIONS : Cognitive interviews with caregivers of a diverse sample of individuals with ASD confirm the content validity and relevance of the ABI to assess core and associated symptoms of ASD.

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20. Pavlopoulou G. A Good Night’s Sleep : Learning About Sleep From Autistic Adolescents’ Personal Accounts. Front Psychol ;2020 ;11:583868.

BACKGROUND : Sleep is a strong predictor of quality of life and has been related to cognitive and behavioral functioning. However, research has shown that most autistic people experience sleep problems throughout their life. The most common sleep problems include sleep onset delay, frequent night-time wakings and shorter total sleep time. Despite the importance of sleep on many domains, it is still unclear from first-hand accounts what helps autistic people to sleep. The purpose of this study is to explore together with autistic adolescents their sleep-related practices before bedtime and during the day which contribute to a good night’s sleep. METHODS : Fifty-four autistic adolescents collaborated with an academic researcher in a novel adapted photo-elicitation methodology, rooted in a Lifeworld framework. The adolescents were invited to collect and analyze their data. The data were also presented in a community knowledge exchange event. RESULTS : Several self-reported practices that facilitate better nocturnal sleep were identified. Those were organized into two thematics : Evening/bedtime factors and Day time factors. These included practices such as personalized sensory and relaxation tools before bed and during night-time, engaging in a range of physical activities during daytime and accommodating personal time to engage with highly preferred and intense focus activities and hobbies. It also included spending time in predictable and fun ways with family members before bedtime. CONCLUSION : This is the first time that a study uses a novel methodological approach based on personal accounts elicited by photos rooted in a Lifeworld framework to describe personal sleep-related practices before bedtime and during the day to identify a "good night of sleep" in autistic adolescents. The outcomes from the current study showed that sleep facilitating factors are in a direct contrast to the sleep hygiene recommendations. Therefore, it is thus important for the sleep practitioners and healthcare providers to move beyond providing standardized sleep hygiene interventions. A Lifeworld led care model that pays attention to personal experiences, promotes sense of agency, evaluates both autism-specific strengths and struggles could and should complement biomedical approaches. LAY SUMMARY : This is the first study to examine autistic adolescents’ self-reported sleep habits and factors which facilitate autistic adolescents’ sleep by employing adapted photo-elicitation interviews. This study is innovative in at least three ways. First, it examines the factors that may facilitate a good night’s sleep through personal accounts of autistic adolescents. Second, this is the first sleep study to adopt a collaborative, flexible approach to understanding positive sleep factors in the lives of autistic adolescents. This study employed a personalized approach into collecting, categorizing, coding, and analyzing qualitative data allowing autistic adolescents and the researcher to work together across key stages of data collection and data analysis. Third, we adopted a theoretical framework that allows us to consider autistic adolescents in both agency and vulnerability positions when it comes to their sleep difficulties. Our results highlight that sleep should be treated individually and in relation to the environmental and personal factors that affect each autistic person. Hence, researchers and professionals may benefit from working collaboratively with autistic adolescents with the aim to identify individual strengths and adopt a positive narrative around sleep. Furthermore, it is important to further examine both the daytime and evening factors that may affect bedtime and the quality and quantity of sleep as well as the role of intense focused interests and physical activities that cultivate positive feelings and help autistic people to relax before bedtime.

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21. Quan L, Zhao Y, Yi J, Shi XD, Zhong Y, Liu L. Serum adiponectin levels are reduced in autism spectrum disorder and association with severity of symptoms. Metab Brain Dis ;2021 (Jan 20)

Recent evidence highlights the role of adiponectin in the pathophysiology of autism spectrum disorder (ASD), yielding conflicting results. The aims of this study were (1) To assess the adiponectin levels of children with ASD and typical developing (TP) ; (2) To investigate the relationship between adiponectin levels and symptom severity of children with ASD. This is a single-center cross-sectional study from China. From December 2017 to November 2019, first-diagnosis and drug-naïve children with ASD were included. Same TP children who were matched with clinical groups by gender and age were included as the control group. The enzyme-linked immunosorbent assay (ELISA) kit was used to determine serum concentrations of adiponectin. We recorded 176 children (88 were ASD and 88 were TP children) and 77.3% (n = 136) were boys and the mean age was 4.3 years (standard deviations [S.D.] : 1.2). The mean (S.D.) levels of adiponectin were 9.01(2.19) and 11.55(2.32) μg/ml for those with ASD and TP subjects. The difference between those two groups was significant (t = 7.169, p < 0.001). There was a negative correlation between serum levels of adiponectin and Childhood Autism Rating Scale [CARS] score (r = -0.498, p < 0.001). At admission, 39 ASD (54.5%) had a minor autism (CARS<37). In these children, the mean (S.D.) adiponectin level was higher than that observed in children with moderate-to-severe clinical severity (10.09[2.32] vs.8.15[1.64] μg/ml, P < 0.001). This study shows that serum adiponectin. Levels are decreased in ASD when compared with in healthy children. The findings also indicate an inverse association between serum adiponectin levels and severity of symptoms in ASD.

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22. Sergi L, Mingione E, Ricci MC, Cavallaro A, Russo F, Corrivetti G, Operto FF, Frolli A. Autism, Therapy and COVID-19. Pediatr Rep ;2021 (Jan 5) ;13(1):35-44.

While numerous treatments for ASD are available, intervention based on the principles and procedures of Applied Behavior Analysis (ABA) has garnered substantial scientific support. In this study we evaluated the effects of the lockdown during the COVID-19 pandemic outbreak, followed by quarantine provisions and during the three months after the resumption of activities. The study was conducted on a group of children taking part on a ABA-based intervention funded by the Local Health Authority (ASL) of the province of Caserta. In this study we considered a sample of 88 children who had been diagnosed with Autism Spectrum Disorder, aged between 18 and 30 months. The following inclusion criteria were observed : age at the time of diagnosis less than 30 months, absence of other neurological, genetic, or sensorineural pathologies, and severity level 1 measured by symptoms evaluation based on the ADOS 2 module T (used for diagnosis). During the lockdown children experienced improvements in communication, socialization, and personal autonomy. During the three months after the ABA treatment, the acquired skills were maintained but no significant improvement was demonstrated. In this study, we describe how parent training was significant in avoiding delays in the generalization of socially significant behaviors, following the drastic interruption of the treatment in this group of children.

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23. Tint A, Brown HK, Chen S, Lai MC, Tarasoff LA, Vigod SN, Parish S, Havercamp SM, Lunsky Y. Health characteristics of reproductive-aged autistic women in Ontario : A population-based, cross-sectional study. Autism ;2021 (Jan 19):1362361320982819.

While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women’s health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.

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24. van den Boogert F, Sizoo B, Spaan P, Tolstra S, Bouman YHA, Hoogendijk WJG, Roza SJ. Sensory Processing and Aggressive Behavior in Adults with Autism Spectrum Disorder. Brain Sci ;2021 (Jan 14) ;11(1)

Autism spectrum disorder (ASD) may be accompanied by aggressive behavior and is associated with sensory processing difficulties. The present study aims to investigate the direct association between sensory processing and aggressive behavior in adults with ASD. A total of 101 Dutch adult participants with ASD, treated in outpatient or inpatient facilities, completed the Adult/Adolescent Sensory Profile (AASP), the Reactive-Proactive Aggression Questionnaire (RPQ), and the Aggression Questionnaire-Short Form (AQ-SF). Results revealed that sensory processing difficulties are associated with more aggressive behavior (f2=0.25), more proactive (f2=0.19) and reactive aggression (f2=0.27), more physical (f2=0.08) and verbal aggression (f2=0.13), and more anger (f2=0.20) and hostility (f2=0.12). Evidence was found for an interaction of the neurological threshold and behavioral response on total aggression and hostility. Participants with higher scores in comparison to the norm group in sensory sensitivity had the highest risk of aggressive behavior. In conclusion, clinical practice may benefit from applying detailed diagnostics on sensory processing difficulties when treating aggressive behavior in adults with ASD.

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25. Yela-González N, Santamaría-Vázquez M, Ortiz-Huerta JH. Activities of Daily Living, Playfulness and Sensory Processing in Children with Autism Spectrum Disorder : A Spanish Study. Children (Basel) ;2021 (Jan 20) ;8(2)

The purposes of the study were to identify whether differences exist between Spanish children with ASD and neurotypical development in relation to Activities of Daily Living (ADL), playfulness, and sensory processing ; as well as to confirm whether a relation exists between those areas and sensory processing. STUDY DESIGN : A descriptive cross-sectional study. METHODS : Forty children, 20 with a diagnosis of ASD and 20 with neurotypical development, were recruited. The measurement tools used were the Pediatric Evaluation of Disability Inventory (PEDI), Test of Playfulness (ToP), and Sensory Processing Measure (SPM). RESULTS : The sensory processing of children with ASD were related to decreased functional skills performance of ADL (F = 94.4, p = 0.00) and playfulness (p = 0.00) than neurotypical children ; in addition, the problems of sensory reactivity were associated with worse development in these occupational areas (p = 0.00 for both Spearman correlations). CONCLUSIONS : Children with ASD present worse performance of functional skills and playfulness than neurotypical ones. Likewise, sensory reactivity is related to the development in the occupational areas.

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