1. Agarwala S, Naik B, Ramachandra NB. Mucosa-associated specific bacterial species disrupt the intestinal epithelial barrier in the autism phenome. Brain, behavior, & immunity – health. 2021; 15: 100269.

Gut-Brain Axis provides a bidirectional communicational route, an imbalance of which can have pathophysiological consequences. Differential gut microbiome studies have become a frontier in autism research, affecting 85% of autistic children. The present study aims to understand how gut microbiota of autism subjects differ from their neurotypical counterparts. This study would help to identify the abundance of bacterial signature species in autism and their associated metabolites. 16S rRNA metagenomic sequence datasets of 30 out of 206 autism subjects were selected from the American Gut Project Archive. First, the taxonomic assignment was inferred by similarity-based methods using the Quantitative Insights into Microbial Ecology (QIIME) toolkit. Next, species abundance was characterized, and a co-occurrence network was built to infer species interaction using measures of diversity. Thirdly, statistical parameters were incorporated to validate the findings. Finally, the identification of metabolites associated with these bacterial signature species connects with biological processes in the host through pathway analysis. Gut microbiome data revealed Akkermansia sp. and Faecalibacterium prausnitzii to be statistically lower in abundance in autistic children than their neurotypical peers with a five and two-fold decrease, respectively. While Prevotella sp. and Sutterella sp. showed a five and a two-fold increase in cases, respectively. The constructed pathway revealed succinate and butyrate as the significant metabolites for the bacterial signature species identified. The present study throws light on the role of mucosa-associated bacterial species: Veillonella sp., Prevotella sp., Akkermansia sp., Sutterella sp., Faecalibacterium prausnitzii, Lactobacillus sp., which can act as diagnostic criteria for detection of gut dysbiosis in autism.

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2. Alhelo H, Kulesza RJ. Brainstem motor neuron dysmorphology and excitatory/inhibitory imbalance in an animal model of autism. Folia morphologica. 2021.

Autism spectrum disorder (ASD) is a developmental disorder associated with in utero exposure to the antiepileptic valproic acid (VPA) in humans, and similar exposure serves as a validated animal model. Animals exposed to VPA in utero have a number of structural, function and behavioral deficits associated with ASD. Furthermore, VPA-exposed animals have shorter body lengths, lower body and brain weights. This difference in body weight may result from impaired caloric intake due to impaired oropharyngeal function. Specifically, it is hypothesized that in utero VPA exposure results in fewer lower motor neurons associated with feeding behaviors, that surviving neurons will exhibit dysmorphology and altered balance of excitatory and inhibitory inputs. Further, it is hypothesized that VPA exposure will result in altered oropharyngeal musculature that will impact skull morphology. These hypotheses were investigated using quantitative morphometrics and immunofluorescence. Results support dysmorphology and excitatory/inhibitory imbalance and these alterations may contribute to dysphagia and poor weight gain in VPA-exposed animals.

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3. Bhat A. Analysis of the SPARK study COVID-19 parent survey: Early impact of the pandemic on access to services, child/parent mental health, and benefits of online services. Autism research : official journal of the International Society for Autism Research. 2021; 14(11): 2454-70.

Children with ASD receive a multitude of educational, medical, and therapeutic services. At the onset of the COVID-19 pandemic, all of these services came to a complete halt following strict lockdowns. Many services have resumed in a hybrid format using face to face and virtual modes of delivery. This study describes findings from the COVID-19 impact survey administered at the onset of the pandemic in a subgroup of families from the SPARK cohort (N = 6393), one of the largest ASD cohorts in the US. The differential early impact of COVID-19 on various subgroups of children with ASD and their families was examined. Caregivers of children and adolescents with ASD between 19 months and 18 years completed an online survey inquiring about the impact of COVID-19 pandemic on access to services, parent concerns about the same, impact on child’s ASD-related behaviors, child, and parent mental health, and the benefits/potential benefits of online/future online services. Analysis revealed that certain demographic (age, income/SES) and child-related factors (repetitive behaviors, language, functional, cognitive, and motor impairments, and child’s understanding), as well as parent’s past mental health were associated with/predicted greater service disruptions, greater ASD-related behaviors, and greater negative impact on parent mental health. In conclusion, younger children, children from low-income families, and children with greater impairment severity (more severe repetitive behaviors, language, cognitive, function, language, and motor impairments) were more negatively impacted by the pandemic through service disruptions, increased ASD-related behaviors, parent health/family impact, and found online interactions to be less beneficial. LAY SUMMARY: The SPARK study impact survey shows that at the onset of the COVID-19 pandemic, parents reported significant service disruptions, negative impact on their child’s ASD-related behaviors as well as their own mental health; which was greater in families with younger children, children with greater ASD severity, and children from low-income families. Majority of families did not report significant benefits of online services whereas some families did. Low-income families were hopeful about receiving benefits through future online services. Overall, these findings have important implications for future clinical care delivery and healthcare policies to ensure that healthcare services are not interrupted during a potential resurgence of COVID-19 or other pandemics. A combination of in-person and online healthcare and family support services must be implemented to prevent negative health impacts in the future.

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4. Brunson McClain M, Roanhorse TT, Harris B, Heyborne M, Zemantic PK, Azad G. School-based autism evaluations in the COVID-19 era. School psychology (Washington, DC). 2021; 36(5): 377-87.

School psychologists play a critical role in school-based Autism (AU) evaluations. Evidence-based AU evaluations should be multimodal, include multiple informants, and assess functioning across several domains. In the current era of COVID-19, school-based AU evaluations have become increasingly complex with school psychologists having to significantly adapt face-to-face evaluation procedures and/or conduct evaluations via teleassessment approaches. This poses profound challenges for some families, many of whom are from vulnerable groups. In the current article, we outline school psychologists’ traditional role in school-based AU evaluations and review best practice guidelines. We then discuss the impact of COVID-19 on these processes and provide a framework for school psychologists to use when conducting school-based AU evaluations during this unprecedented time. We also provide resources school psychologists may find useful as they conduct school-based AU evaluations during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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5. De Jaegher H. Seeing and inviting participation in autistic interactions. Transcultural psychiatry. 2021: 13634615211009627.

What does it take to see how autistic people participate in social interactions? And what does it take to support and invite more participation? Western medicine and cognitive science tend to think of autism mainly in terms of social and communicative deficits. But research shows that autistic people can interact with a skill and sophistication that are hard to see when starting from a deficit idea. Research also shows that not only autistic people, but also their non-autistic interaction partners, can have difficulties interacting with each other. To do justice to these findings, we need a different approach to autistic interactions-one that helps everyone see, invite, and support better participation. I introduce such an approach, based on the enactive theory of participatory sense-making and supported by insights from indigenous epistemologies. This approach helps counteract the homogenizing tendencies of the « global mental health » movement, which attempts to erase rather than recognize difference, and often precludes respectful engagements. Based in the lived experiences of people in their socio-cultural-material and interactive contexts, I put forward an engaged-even engaging-epistemology for understanding how we interact across difference. From this perspective, we see participatory sense-making at work across the scientific, diagnostic, therapeutic, and everyday interactions of autistic and non-autistic people, and how everyone can invite and support more of it.

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6. Gómez-Vallejo S, Leoni M, Ronald A, Colvert E, Happé F, Bolton P. Autism spectrum disorder and obstetric optimality: a twin study and meta-analysis of sibling studies. Journal of child psychology and psychiatry, and allied disciplines. 2021; 62(11): 1353-62.

BACKGROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with a strong genetic basis. Recent studies have suggested that its aetiology is also influenced by environmental factors. Some of the most examined environmental factors are obstetric complications. However, the results are inconsistent. METHODS: We aimed to explore the association between obstetric complications and autism in a population-based twin sample using the Obstetric Enquiry Scale (OES), a scale that measures the presence or absence of pre-, peri- and neonatal factors. Additionally, we report the meta-analytic results for obstetrical factors reported in previously published sibling studies. RESULTS: Our study included 115 cases pairs and 62 controls pairs and showed that children with autism and their unaffected co-twins present significantly more obstetric complications than controls (ASD vs. controls β 1.26, CI 95% 1.11-1.40 p < .001; unaffected co-twin vs. controls β 1.20, 95% CI 1.07-1.36 p < .003). However, we did not find statistically significant differences between children with ASD and their unaffected co-twins (β .96, 95% CI 0.85-1.09, p 0.55). Meta-analysis demonstrated that maternal hypertension (RR 1.35, CI 95% 1.23-1.48), uterine bleeding (RR 1.20 CI 95% 1.01-1.42) and exposure to antibiotic during pregnancy (1.11 CI 95% 1.00-1.22) increase risk of ASD. CONCLUSIONS: This study confirms that children with ASD and their unaffected twins show more obstetric complications than controls. However, these complications do not distinguish between ASD twins and their unaffected co-twins. In addition, the meta-analysis showed little influence of birth factors on ASD which suggests a shared familial liability for both obstetric complications and autism, rather than a causal association.

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7. Haggarty CJ, Moore DJ, Trotter PD, Hagan R, McGlone FP, Walker SC. Vicarious ratings of social touch the effect of age and autistic traits. Scientific reports. 2021; 11(1): 19336.

Tactile sensitivities are common in Autism Spectrum Conditions (autism). Psychophysically, slow, gentle stroking touch is typically rated as more pleasant than faster or slower touch. Vicarious ratings of social touch results in a similar pattern of velocity dependent hedonic ratings as directly felt touch. Here we investigated whether adults and children’s vicarious ratings vary according to autism diagnosis and self-reported autistic traits. Adults’ scoring high on the AQ rated stroking touch on the palm as less pleasant than a Low AQ group. However, in contrast to our hypothesis, we did not find any effect of autism diagnosis on children’s touch ratings despite parental reports highlighting significant somatosensory sensitivities. These results are discussed in terms of underpinning sensory and cognitive factors.

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8. Jenabi E, Ahmadi M, Maleki A. Is fetal nuchal cord associated with autism spectrum disorder? A meta-analysis. Clinical and experimental pediatrics. 2022; 65(3): 131-5.

PURPOSE: There is inconsistent evidence about the association between fetal nuchal cord and the risk of autism spectrum disorder (ASD). We performed a meta-analysis to investigate whether fetal nuchal cord is associated with an increased risk of ASD in offspring. METHODS: Three main English databases were searched until January 2021. The Newcastle-Ottawa Scale was used to assess study quality. Study heterogeneity was determined using the I2 statistic, while publication bias was assessed using Begg and Egger tests. Results are presented as odds ratios (ORs) and relative ratios with 95% confidence intervals (CI) and were determined by a random-effects model. RESULTS: Five articles (1 cohort, 4 case-control; 3,088 total children) were included in the present meta-analysis. Fetal nuchal cord was not a risk factor for ASD (OR, 1.11; 95% CI, 0.66-1.57). There was homogeneity among studies that reported a risk of ASD (I2=0.0%). CONCLUSION: Our results showed that fetal nuchal cord is not a risk factor for ASD. Future large cohort studies should confirm this finding.

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9. Kalalo RT, Yuniar S, Ariyanto FC. Effect of parental skills-based psychoeducation intervention on parental stress index and severity of children with autism spectrum disorders: A pilot study. Annals of medicine and surgery (2012). 2021; 70: 102873.

OBJECTIVE: Analyzing the effect of psychoeducation on parental stress index and the severity of children with autism spectrum disorders. METHODS: Participants in the study consisted of autism spectrum disorder children and their parents who were divided into 2 groups (treatment = 15 and control group = 20). Participants were given psychoeducation as many as 6 sessions for 14 weeks (7 weeks for each group). Participants were measured for the value of the childhood autism rating scale (CARS) and autism parenting stress index (APSI) pre-post psychoeducation. RESULTS: There were significant differences in the treatment group in terms of total CARS values (40.73 ± 7.17 vs -7.67 ± 4.91; p < 0.001), communications (5.60 ± 1.45 vs -4.73 ± 1.49; p = 0.001), social interactions (10.20 ± 2.18 vs 8.93 ± 2.66; p = 0.011), and psychomotor (18.33 ± 3.96 vs 14.27 ± 3.90; p < 0.001) before and after psychoeducation, whereas there were no significant differences in the control group (p > 0.05). In the treatment group, there were significant differences in total APSI values (17.33 ± 9.99 vs 12.20 ± 4.02; p = 0.001), social difficulties (8.73 ± 4.60 vs 6.00 ± 4.02; p = 0.002), and physical (4.13 ± 3.54 vs 2.27 ± 2.99; p = 0.013) before and after psychoeducation, while there were no significant differences in behavior (p = 0.443). There were no significant differences in the control group (p > 0.05). There was a significant influence between psychoeducation on parental stress index (p = 0.003) and the severity of children with autism spectrum disorders (p < 0.001). CONCLUSION: There is a decrease in parental stress index and severity of children with autism spectrum disorders after parental psychoeducation intervention.

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10. Kasdan A, Gordon RL, Lense MD. A neurodevelopmental disorders perspective into music, social attention, and social bonding. The Behavioral and brain sciences. 2021; 44: e101.

Our commentary addresses how two neurodevelopmental disorders, Williams syndrome and autism spectrum disorder, provide novel insights into the credible signaling and music and social bonding hypotheses presented in the two target articles. We suggest that these neurodevelopmental disorders, characterized by atypical social communication, allow us to test hypotheses about music, social bonding, and their underlying neurobiology.

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11. Lee V, Albaum C, Tablon Modica P, Ahmad F, Gorter JW, Khanlou N, McMorris C, Lai J, Harrison C, Hedley T, Johnston P, Putterman C, Spoelstra M, Weiss JA. The impact of COVID-19 on the mental health and wellbeing of caregivers of autistic children and youth: A scoping review. Autism research : official journal of the International Society for Autism Research. 2021; 14(12): 2477-94.

Caregivers and families of autistic people have experienced stress and increase in demands due to the COVID-19 pandemic that may have long-term negative consequences for both their own and their children’s mental health. A scoping review was conducted to identify pandemic related demands experienced by caregivers and families of autistic children and youth. The review also consolidated information on coping strategies and parenting-related guidelines that have emerged to help parents meet these demands. Search strategies were approved by a research librarian and were conducted in peer-reviewed and gray literature databases between May 2020 and February 2021. Additional resources were solicited through author networks and social media. All articles were published between December 2019 and February 2021. Article summaries were charted, and a thematic analysis was conducted with confirmation of findings with our knowledge users. Twenty-three published articles and 14 pieces of gray literature were included in the review. The majority of articles characterized and highlighted the increase in demands on caregivers of autistic children and youth during the pandemic globally. Both quantitative and qualitative studies suggest that parents have experienced an increase in stress and mental health-related symptoms during lockdown measures. Findings suggest that families are employing coping strategies, but there no evidence-based supports were identified. The review highlighted the potential long-term impact of prolonged exposure to increasing demands on the mental health and wellbeing of caregivers and families of autistic people, and pointed to a need for the rapid development and evaluation of flexible and timely support programs. LAY SUMMARY: Caregivers and families of autistic children and youth have faced increased demands due to pandemic-related lockdown measures. We reviewed the literature to outline sources of stress, links to their influence on caregiver mental health, and if support programs have emerged to help them. Our findings suggest a number of demands have increased caregivers’ risk to mental health challenges, and their potential impact on family wellbeing. Ongoing development of evidence-based supports of all families of autistic children and youth are needed.

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12. Liang D, Xia S, Zhang X, Zhang W. Analysis of Brain Functional Connectivity Neural Circuits in Children With Autism Based on Persistent Homology. Frontiers in human neuroscience. 2021; 15: 745671.

Autism spectrum disorder (ASD) is a complex neuropsychiatric disorder with a complex and unknown etiology. Statistics demonstrate that the number of people diagnosed with ASD is increasing in countries around the world. Currently, although many neuroimaging studies indicate that ASD is characterized by abnormal functional connectivity (FC) patterns within brain networks rather than local functional or structural abnormalities, the FC characteristics of ASD are still poorly understood. In this study, a Vietoris-Rips (VR) complex filtration model of the brain functional network was established by using resting-state functional magnetic resonance imaging (fMRI) data of children aged 6-13 years old [including 54 ASD patients and 52 typical development (TD) controls] from the Autism Brain Imaging Data Exchange (ABIDE) public database. VR complex filtration barcodes are calculated by using persistent homology to describe the changes in the FC neural circuits of brain networks. The number of FC neural circuits with different length ranges at different threshold values is calculated by using the barcodes, the different brain regions participating in FC neural circuits are discussed, and the connectivity characteristics of brain FC neural circuits in the two groups are compared and analyzed. Our results show that the number of FC neural circuits with lengths of 8-12 is significantly decreased in the ASD group compared with the TD control group at threshold values of 0.7, 0.8 and 0.9, and there is no significant difference in the number of FC neural circuits with lengths of 4-7 and 13-16 and lengths 16. When the thresholds are 0.7, 0.8, and 0.9, the number of FC neural circuits in some brain regions, such as the right orbital part of the superior frontal gyrus, the left supplementary motor area, the left hippocampus, and the right caudate nucleus, involved in the study is significantly decreased in the ASD group compared with the TD control group. The results of this study indicate that there are significant differences in the FC neural circuits of brain networks in the ASD group compared with the TD control group.

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13. Ma Y, Zhou Y, Liu Y, Ping Y, Wang Y, Hu X, Zhang C, Wang T, Zhou H. Urgency in Improving Child Health Care Workers’ Awareness and Knowledge of ASD: Findings From a Cross-Sectional Study in Southwest China. Frontiers in psychiatry. 2021; 12: 703609.

Objective: To evaluate the levels of awareness and knowledge of ASD among child health care workers in China, we conducted a cross-sectional, questionnaire-based study to assess the participants’ awareness and knowledge of ASD. Methods: A total of 159 child health care workers from Southwest China participated in the survey and filled out the questionnaire.Descriptive analysis was conducted on the five parts of the questionnaire, including general knowledge, symptomology, screening and diagnosis, and intervention and treatment. Univariate analysis was used to assess impacts of the participants’ basic demographic characteristics on the questionnaire scores. Multivariate analysis was used to analyze association of the participants’ basic demographic characteristics and the questionnaire scores. Results: Less than 15% of the participants knew that ASD is a developmental, congenital and genetic disorder. Few participants knew that the symptoms include language disorder (38.4%) and social dysfunction (29.6%). A minority of the participants knew the diagnostic criteria (22.6%) and the age for early screening (14.5%). A total of 23.9% of the participants agreed that there are no effective drugs to treat ASD, and 6.3% agreed that ASD is incurable. A number of years in practice of ≥10 (OR = 0.3249, 95% CI: 0.1080-0.9189) was the main factor related to a high questionnaire score. Conclusions: Most participants had relatively low levels of awareness and knowledge of ASD, especially in terms of general knowledge as well as knowledge of intervention and treatment. Working for more than 10 years was a significant predictor of higher levels of awareness and knowledge of ASD. ASD-related training and knowledge dissemination are crucial for the early diagnosis and intervention of ASD. Child health care workers’ awareness and knowledge of ASD needs to be improved to help build public awareness about ASD.

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14. Pazhoohi F, Forby L, Kingstone A. Facial masks affect emotion recognition in the general population and individuals with autistic traits. PloS one. 2021; 16(9): e0257740.

Facial expressions, and the ability to recognize these expressions, have evolved in humans to communicate information to one another. Face masks are equipment used in healthcare by health professionals to prevent the transmission of airborne infections. As part of the social distancing efforts related to COVID-19, wearing facial masks has been practiced globally. Such practice might influence affective information communication among humans. Previous research suggests that masks disrupt expression recognition of some emotions (e.g., fear, sadness or neutrality) and lower the confidence in their identification. To extend the previous research, in the current study we tested a larger and more diverse sample of individuals and also investigated the effect of masks on perceived intensity of expressions. Moreover, for the first time in the literature we examined these questions using individuals with autistic traits. Specifically, across three experiments using different populations (college students and general population), and the 10-item Autism Spectrum Quotient (AQ-10; lower and higher scorers), we tested the effect of facial masks on facial emotion recognition of anger, disgust, fear, happiness, sadness, and neutrality. Results showed that the ability to identify all facial expressions decreased when faces were masked, a finding observed across all three studies, contradicting previous research on fear, sad, and neutral expressions. Participants were also less confident in their judgements for all emotions, supporting previous research; and participants perceived emotions as less expressive in the mask condition compared to the unmasked condition, a finding novel to the literature. An additional novel finding was that participants with higher scores on the AQ-10 were less accurate and less confident overall in facial expression recognition, as well as perceiving expressions as less intense. Our findings reveal that wearing face masks decreases facial expression recognition, confidence in expression identification, as well as the perception of intensity for all expressions, affecting high-scoring AQ-10 individuals more than low-scoring individuals.

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15. Strekalova T, Svirin E, Veniaminova E, Kopeikina E, Veremeyko T, Yung AWY, Proshin A, Walitza S, Anthony DC, Lim LW, Lesch KP, Ponomarev ED. ASD-like behaviors, a dysregulated inflammatory response and decreased expression of PLP1 characterize mice deficient for sialyltransferase ST3GAL5. Brain, behavior, & immunity – health. 2021; 16: 100306.

Gangliosides are glycosphingolipids, which are abundant in brain, are known to modulate ion channels and cell-to-cell communication. Deficiencies can result in aberrant myelination and altered immune responses, which can give rise to neurodevelopmental psychiatric disorders. However, to date, little mechanistic data is available on how ganglioside deficiencies contribute to the behavioural disorders. In humans, the loss of lactosylceramide-alpha-2,3-sialyltransferase (ST3Gal5) leads to a severe neuropathology, but in ST3Gal5 knock-out (St3gal5-/-) mice the absence of GM3 and associated a-, b- and c-series gangliosides is partially compensated by 0-series gangliosides and there is no overt behavioural phenotype. Here, we sought to examine the behavioural and molecular consequences of GM3 loss more closely. Mutants of both sexes exhibited impaired conditioned taste aversion in an inhibitory learning task and anxiety-like behaviours in the open field, moderate motor deficits, abnormal social interactions, excessive grooming and rearing behaviours. Taken together, the aberrant behaviours are suggestive of an autism spectrum disorder (ASD)-like syndrome. Molecular analysis showed decreased gene and protein expression of proteolipid protein-1 (Plp1) and over expression of proinflammatory cytokines, which has been associated with ASD-like syndromes. The inflammatory and behavioural responses to lipopolysaccharide (LPS) were also altered in the St3gal5-/- mice compared to wild-type, which is indicative of the importance of GM3 gangliosides in regulating immune responses. Together, the St3gal5-/- mice display ASD-like behavioural features, altered response to systemic inflammation, signs of hypomyelination and neuroinflammation, which suggests that deficiency in a- and b-series gangliosides could contribute to the development of an ASD-like pathology in humans.

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16. Trelles MP, Levy T, Lerman B, Siper P, Lozano R, Halpern D, Walker H, Zweifach J, Frank Y, Foss-Feig J, Kolevzon A, Buxbaum J. Individuals with FOXP1 syndrome present with a complex neurobehavioral profile with high rates of ADHD, anxiety, repetitive behaviors, and sensory symptoms. Molecular autism. 2021; 12(1): 61.

BACKGROUND: FOXP1 syndrome is an autosomal dominant neurodevelopmental disorder characterized by intellectual disability, developmental delay, speech and language delays, and externalizing behaviors. We previously evaluated nine children and adolescents with FOXP1 syndrome to better characterize its phenotype. We identified specific areas of interest to be further explored, namely autism spectrum disorder (ASD) and internalizing and externalizing behaviors. METHODS: Here, we assess a prospective cohort of additional 17 individuals to expand our initial analyses and focus on these areas of interest. An interdisciplinary group of clinicians evaluated neurodevelopmental, behavioral, and medical features in participants. We report results from this cohort both alone, and in combination with the previous cohort, where possible. RESULTS: Previous observations of intellectual disability, motor delays, and language deficits were confirmed. In addition, 24% of the cohort met criteria for ASD. Seventy-five percent of individuals met DSM-5 criteria for attention-deficit/hyperactivity disorder and 38% for an anxiety disorder. Repetitive behaviors were almost universally present (95%) even without a diagnosis of ASD. Sensory symptoms, in particular sensory seeking, were common. LIMITATIONS: As FOXP1 syndrome is a rare disorder, sample size is limited. CONCLUSIONS: These findings have important implications for the treatment and care of individuals with FOXP1 syndrome. Notably, standardized testing for ASD showed high sensitivity, but low specificity, when compared to expert consensus diagnosis. Furthermore, many individuals in our cohort who received diagnoses of attention-deficit/hyperactivity disorder or anxiety disorder were not being treated for these symptoms; therefore, our findings suggest that there may be immediate areas for improvements in treatment for some individuals.

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17. Wickstrom J, Dell’Armo K, Salzman E, Hooker JL, Delehanty A, Bishop S, Tassé MJ, Wetherby AM, Piergies AMH, Damiano D, Rauch A, Thurm A. Systematic Review: Recommendations for Rehabilitation in ASD and ID From Clinical Practice Guidelines. Archives of rehabilitation research and clinical translation. 2021; 3(3): 100140.

OBJECTIVE: To identify and summarize clinical practice guidelines for autism spectrum disorder (ASD) and intellectual disability (ID) for the Package of Interventions for Rehabilitation for the World Health Organization (WHO). DATA SOURCES: Academic databases, Google Scholar, guideline databases, and professional society websites were searched using the general criteria « ASD/ID » AND « rehabilitation » AND « guideline, » restricted to English-only guidelines. STUDY SELECTION: Work group members independently screened titles and abstracts (1952 ASD; 1027 ID) and excluded articles if not (1) a guideline; (2) about rehabilitation; (3) published since 2008; or (4) about ASD/ID. Full-text screening (29 ASD; 5 ID) involved 3 additional exclusion criteria: (1) contained conflict of interest; (2) lacked information on strength of recommendation; or (3) failed the Appraisal of Guidelines for Research and Evaluation II instrument. Six guidelines (4 ASD: 2 on youth, 1 on adults, 1 on all ages; 2 ID: 1 on challenging behaviors, 1 on mental health) resulted. DATA EXTRACTION: Work group members extracted 524 recommendations (386 ASD; 138 ID) from the guidelines including the level of evidence, diagnostic and age group, recommendation type (assessment, intervention, service), target, and valence. DATA SYNTHESIS: Of the 270 intervention recommendations (212 ASD; 58 ID), only 36 for ASD and 47 for ID were empirically based. Most comprised biomedical (23%), pharmacologic (29%), and psychosocial (21%) interventions for ASD and behavioral (14%), pharmacologic (29%), and psychological (14%) interventions for ID. Intervention recommendations primarily targeted coexisting conditions (56% ASD; 93% ID), whereas core symptoms received much less attention (26% ASD). CONCLUSIONS: Clinical practice guidelines reviewed for ASD and ID primarily contained recommendations based on expert opinion, with the plurality of recommendations relating to pharmacologic treatment. Vital next steps include identifying relevant interventions for inclusion in the WHO Package and continuing to conduct rigorous intervention research, particularly on core symptoms of these conditions, to extend recommendations for high-quality guidelines.

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