1. Adiguzel E, Bozkurt NM, Unal G. Independent and combined effects of astaxanthin and omega-3 on behavioral deficits and molecular changes in a prenatal valproic acid model of autism in rats. Nutr Neurosci;2023 (Aug 3):1-17.

Objectives: Autism is a devastating neurodevelopmental disorder and recent studies showed that omega-3 or astaxanthin might reduce autistic symptoms due to their anti-inflammatory properties. Therefore, we investigated the effects of omega-3 and astaxanthin on the VPA-induced autism model of rats.Material and Methods: Female Wistar albino pups (n = 40) were grouped as control, autistic, astaxanthin (2 mg/kg), omega-3 (200 mg/kg), and astaxanthin (2 mg/kg)+omega-3 (200 mg/kg). All groups except the control were prenatally exposed to VPA. Astaxanthin and omega-3 were orally administered from the postnatal day 41 to 68 and behavioral tests were performed between day 69 and 73. The rats were decapitated 24 h after the behavioral tests and hippocampal and prefrontal cytokines and 5-HT levels were analyzed by ELISA.Results: VPA rats have increased grooming behavior while decreased sociability (SI), social preference index (SPI), discrimination index (DI), and prepulse inhibition (PPI) compared to control. Additionally, IL-1β, IL-6, TNF-α, and IFN-γ levels increased while IL-10 and 5-HT levels decreased in both brain regions. Astaxanthin treatment raised SI, SPI, DI, PPI, and prefrontal IL-10 levels. It also raised 5-HT levels and decreased IL-6 levels in both brain regions. Omega-3 and astaxanthin + omega-3 increased the SI, SPI, DI, and PPI and decreased grooming behavior. Moreover, they increased IL-10 and 5-HT levels whereas decreased IL-1β, IL-6, TNF-α, IFN-γ levels in both brain regions.Conclusions: Our results showed that VPA administration mimicked the behavioral and molecular changes of autism in rats. Single and combined administration of astaxanthin and omega-3 improved the autistic-like behavioral and molecular changes in the VPA model of rats.

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2. Ahadi H, Abbasi H, Fekar Gharamaleki F. Linguistic and metalinguistic characteristics of Persian-speaking children with autistic spectrum disorders: A systematic review. J Public Health Res;2023 (Jul);12(3):22799036231189068.

Studies of ASD children have mainly focused on pragmatics, but research showed they have problems in other language dimensions. The present systematic review aims to analyze the literature related to linguistic and metalinguistic studies to determine linguistic characteristics and their correlation with reading and writing. After reviewing 43 articles founded, the studies were divided into four main categories: descriptive, comparative, linguistic, and finally nonlinguistic interventional studies. 42% of studies are descriptive, 14% were comparative, and 5% were about the effect of linguistic and metalinguistic training on reading and writing. Studies on the effect of other training on linguistic and metalinguistic skills were about 39% of the studies. They have deficiencies in different linguistic and metalinguistic skills, especially grammar. There were no studies investigating the relationship between linguistic and metalinguistic abilities. The relationship between language and reading skills has been neglected and only one study has examined the correlation between phonological awareness and reading skills. Thus, there is a serious gap in metalinguistic studies. However, it is necessary to study these relationships due to the change in the reading education system from a phonological to a lexical path in schools. The effect of nonlinguistic interventions has been studied more than linguistic ones.

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3. Byiers BJ, Merbler AM, Raiter A, Burkitt CC, Symons FJ. Caregiver Perspectives on Pain Sensitivity and Pain Experience in Rett Syndrome. Can J Pain;2023;7(1):2229400.

BACKGROUND: Although delayed or decreased responses to pain are commonly reported among caregivers of individuals with Rett syndrome (RTT), previous studies in relatively small samples have documented that caregivers are concerned about pain, particularly due to gastrointestinal and musculoskeletal conditions. AIMS: The purpose of the current study was to investigate in detail caregivers’ perceptions of pain sensitivity, as well as the types, severity, and effect of pain experienced by individuals with RTT in a larger sample than previous studies. METHODS: A total of 51 caregivers (mostly mothers) participated in the study, which involved standardized questionnaires and interviews. The individuals with RTT ranged in age from 2 to 52 years of age, and most (n = 46; 90%) met criteria for classic RTT. RESULTS: Across the sample, 84% of caregivers reported that they believed that their child was less sensitive to pain compared to her typically developing peers. Despite this perception, 63% of caregivers reported that their child had experienced at least one form of pain in the previous 7 days, and 57% reported their child experienced at least one form of chronic pain. On average, caregivers reported that their child’s pain was of moderate severity and interfered with at least one activity of daily living. CONCLUSIONS: The results suggest that pain is a substantial concern among caregivers of individuals with RTT and indicate that additional research is needed to understand the apparent paradox of frequently reported pain experiences despite widespread perceptions of decreased pain sensitivity.

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4. Clin E, Kissine M. Listener- Versus Speaker-Oriented Disfluencies in Autistic Adults: Insights From Wearable Eye-Tracking and Skin Conductance Within a Live Face-to-Face Paradigm. J Speech Lang Hear Res;2023 (Aug 3);66(8):2562-2580.

PURPOSE: Our study addresses three main questions: (a) Do autistics and neurotypicals produce different patterns of disfluencies, depending on the experimenter’s direct versus averted gaze? (b) Are these patterns correlated to gender, skin conductance responses, fixations on the experimenter’s face, alexithymia, or social anxiety scores? Lastly, (c) can eye-tracking and electrodermal activity data be used in distinguishing listener- versus speaker-oriented disfluencies? METHOD: Within a live face-to-face paradigm combining a wearable eye-tracker with electrodermal activity sensors, 80 adults (40 autistics, 40 neurotypicals) defined words in front of an experimenter who was either staring at their eyes (direct gaze condition) or looking elsewhere (averted gaze condition). RESULTS: Autistics produce less listener-oriented (uh, um) and more speaker-oriented (prolongations, breath) disfluencies than neurotypicals. In both groups, men produce less um than women. Both autistics’ and neurotypicals’ speech are influenced by whether their interlocutor systematically looks at them in the eyes or not, but their reactions go in opposite directions. Disfluencies seem to primarily be linguistic phenomena as experienced stress, social attention, alexithymia, and social anxiety scores do not influence any of the reported results. Finally, eye-tracking and electrodermal activity data suggest that laughter could be a listener-oriented disfluency. CONCLUSIONS: This article studies disfluencies in a fine-grained way in autistic and neurotypical adults while controlling for social attention, experienced stress, and experimental condition (direct vs. averted gaze). It adds to current literature by (a) enlightening our knowledge of speech in autism, (b) opening new perspectives on disfluency patterns as important signals in social interaction, (c) addressing theoretical issues on the dichotomy between listener- and speaker-oriented disfluencies, and (d) considering understudied phenomena as potential disfluencies (e.g., laughter, breath). SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23549550.

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5. Foster NC, Bennett SJ, Pullar K, Causer J, Becchio C, Clowes DP, Hayes SJ. Observational learning of atypical biological kinematics in autism. Autism Res;2023 (Aug 3)

Observing and voluntarily imitating the biological kinematics displayed by a model underpins the acquisition of new motor skills via sensorimotor processes linking perception with action. Differences in voluntary imitation in autism could be related to sensorimotor processing activity during action-observation of biological motion, as well as how sensorimotor integration processing occurs across imitation attempts. Using an observational practice protocol, which minimized the active contribution of the peripheral sensorimotor system, we examined the contribution of sensorimotor processing during action-observation. The data showed that autistic participants imitated both the temporal duration and atypical kinematic profile of the observed movement with a similar level of accuracy as neurotypical participants. These findings suggest the lower-level perception-action processes responsible for encoding biological kinematics during the action-observation phase of imitation are operational in autism. As there was no task-specific engagement of the peripheral sensorimotor system during observational practice, imitation difficulties in autism are most likely underpinned by sensorimotor integration issues related to the processing of efferent and (re)afferent sensorimotor information during trial-to-trial motor execution.

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6. Genovesi E, Ullmer P, Bhatti L, Meyer P, Memon P, Panchani D, Rafla M, Welford M, Hoekstra RA. Perspectives on children’s autistic traits in UK-based British and Egyptian/Sudanese communities. Res Dev Disabil;2023 (Aug 1);140:104576.

BACKGROUND: While most autism research is conducted in White Western samples, culture may affect perceptions and reporting of autistic traits. We explored how UK-based British and Egyptian/Sudanese communities perceive autism features. METHODS AND PROCEDURES: Nineteen participants self-identifying as British and 20 as Egyptian/Sudanese participated in focus group discussions on child development norms, and individual interviews on items of the Autism-spectrum Quotient: Children’s version (AQ-Child; Auyeung et al., 2007), measuring autistic traits. Data were analysed using template analysis. OUTCOMES AND RESULTS: Three themes were developed: 1) Value judgements of behaviours; 2) Considerations on differences between children; 3) Problematic interpretations of AQ-Child items. These processes may affect how parents and community members report on children’s autistic traits. Cross-cultural comparisons suggested subtle differences in interpretations and judgements, and British participants referred to age expectations and comparisons with other children more than Egyptian/Sudanese participants. However, within-group variability, sometimes attributed to socioeconomic status and generation, appeared larger than cross-cultural differences. CONCLUSIONS AND IMPLICATIONS: Our findings further the insights on influence of culture and within-community factors on reporting children’s behaviour relevant to autism. These can inform the adaptation of screening tools in multi-cultural settings, to promote better autism recognition in communities where it may be underdiagnosed.

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7. Huang C, Voglewede MM, Ozsen EN, Wang H, Zhang H. SHANK3 Mutations Associated with Autism and Schizophrenia Lead to Shared and Distinct Changes in Dendritic Spine Dynamics in the Developing Mouse Brain. Neuroscience;2023 (Jul 31);528:1-11.

Autism Spectrum Disorders (ASD) and schizophrenia are distinct neurodevelopmental disorders that share certain symptoms and genetic components. Both disorders show abnormalities in dendritic spines, which are the main sites of excitatory synaptic inputs. Recent studies have identified the synaptic scaffolding protein Shank3 as a leading candidate gene for both disorders. Mutations in the SHANK3 gene have been linked to both ASD and schizophrenia; however, how patient-derived mutations affect the structural plasticity of dendritic spines during brain development is unknown. Here we use live two photon in vivo imaging to examine dendritic spine structural plasticity in mice with SHANK3 mutations associated with ASD and schizophrenia. We identified shared and distinct phenotypes in dendritic spine morphogenesis and plasticity in the ASD-associated InsG3680 mutant mice and the schizophrenia-associated R1117X mutant mice. No significant changes in dendritic arborization were observed in either mutant, raising the possibility that synaptic dysregulation may be a key contributor to the behavioral defects previously reported in these mice. These findings shed light on how patient-linked mutations in SHANK3 affect dendritic spine dynamics in the developing brain, which provides insight into the synaptic basis for the distinct phenotypes observed in ASD and schizophrenia.

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8. Kaiser S, Mathiassen B, Handegård BH, Arnesen Y, Halvorsen MB. Examining the psychometric properties of the Norwegian version of the Social Aptitudes Scale in two clinical samples. BMC Psychol;2023 (Aug 3);11(1):221.

BACKGROUND: Few studies have examined the psychometric properties of the Social Aptitudes Scale (SAS). The study aims of the current paper were to examine the internal consistency and the validity of the Norwegian SAS. METHODS: Parents of children from a clinical neuropediatric sample (N = 257) and from a clinical sample from child and adolescent’s mental health services (N = 804) filled in the SAS. RESULTS: Internal consistency for the SAS were good in both samples and correlations between the SAS and different scales were in the expected directions. The results from the Confirmatory Factor Analyses indicated poor model fit. CONCLUSIONS: Future validity studies should investigate whether SAS is suitable as a screening instrument for detecting autism spectrum disorder.

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9. Le Roy Olivos C, Núñez Farías A, López Espejo M, Coelho Medeiros E, Gálvez Fuenzalida A, Fuentes López E, Riquelme Pérez A. Impact of the COVID-19 pandemic on the eating behaviors of children and adolescents with autism spectrum disorder. Arch Argent Pediatr;2023 (Aug 10):e202202982.

Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2-18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children’s median age was 6.3 years (p25-p75: 4.7-8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.

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10. Li B, Blijd-Hoogewys EMA, Stockmann L, Rieffe C. The early development of emotion recognition in autistic children: Decoding basic emotions from facial expressions and from emotion-provoking situations. Dev Psychopathol;2023 (Aug 3):1-12.

Autism is associated with challenges in emotion recognition. Yet, little is known about how emotion recognition develops over time in autistic children. This four-wave longitudinal study followed the development of three emotion-recognition abilities regarding four basic emotions in children with and without autism aged 2.5 to 6 years over three years. Behavioral tasks were used to examine whether children could differentiate facial expressions (emotion differentiation), identify facial expressions with verbal labels (emotion identification), and attribute emotions to emotion-provoking situations (emotion attribution). We confirmed previous findings that autistic children experienced more difficulties in emotion recognition than non-autistic children and the group differences were present already from the preschool age. However, the group differences were observed only when children processed emotional information from facial expressions. When emotional information could be deduced from situational cues, most group differences disappeared. Furthermore, this study provided novel longitudinal evidence that emotion recognition improved with age in autistic children: compared to non-autistic children, autistic children showed similar learning curves in emotion discrimination and emotion attribution, and they showed greater improvements in emotion identification. We suggest that inclusion and respect in an environment free of stereotyping are likely to foster the development of emotion recognition among autistic children.

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11. Liang J, Xin C, Xin M, Wang G, Wu X. An insertion mutation of the MECP2 gene in severe neonatal encephalopathy and ocular and oropharyngeal dyskinesia: a case report. BMC Med Genomics;2023 (Aug 3);16(1):181.

BACKGROUND: Pathogenic variation of the MECP2 gene presents mostly as Rett syndrome in females and is extremely rare in males. Most male patients with MECP2 gene mutation show MECP2 duplication syndrome. CASE PRESENTATION: Here we report a rare case in a 10-month-old boy with a hemizygous insertion mutation in MECP2 as NM_001110792, c.799_c.800insAGGAAGC, which results in a frameshift mutation (p.R267fs*6). The patient presented with severe encephalopathy in the neonatal period, accompanied by severe development backwardness, hypotonia, and ocular and oropharyngeal dyskinesia. This is the first report of this mutation, which highlights the phenotype variability associated with MECP2 variants. CONCLUSIONS: This case helps to expand the clinical spectrum associated with MECP2 variants. Close attention should be paid to the growth and development of patients carrying a MECP2 variant or Xq28 duplication. Early interventions may help improve symptoms to some certain extent.

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12. Liu J, Chang H, Abrams DA, Kang JB, Lang C, Rosenberg-Lee M, Menon V. Atypical cognitive training-induced learning and brain plasticity and their relation to insistence on sameness in children with autism. Elife;2023 (Aug 3);12

Children with autism spectrum disorders (ASD) often display atypical learning styles, however little is known regarding learning-related brain plasticity and its relation to clinical phenotypic features. Here, we investigate cognitive learning and neural plasticity using functional brain imaging and a novel numerical problem-solving training protocol. Children with ASD showed comparable learning relative to typically developing children but were less likely to shift from rule-based to memory-based strategy. While learning gains in typically developing children were associated with greater plasticity of neural representations in the medial temporal lobe and intraparietal sulcus, learning in children with ASD was associated with more stable neural representations. Crucially, the relation between learning and plasticity of neural representations was moderated by insistence on sameness, a core phenotypic feature of ASD. Our study uncovers atypical cognitive and neural mechanisms underlying learning in children with ASD, and informs pedagogical strategies for nurturing cognitive abilities in childhood autism.

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13. Lorang E, Hanania A, Venker CE. Parent Certainty and Consistency When Completing Vocabulary Checklists in Young Autistic Children. J Speech Lang Hear Res;2023 (Aug 3);66(8):2750-2765.

PURPOSE: Using a novel parent report measure, this study investigated whether asking parents to rate their certainty when reporting on child vocabulary skills provided additional insight into parent report and emerging language abilities in young autistic children. Specifically, we investigated whether parent certainty varied based on whether the child was reported to understand, understand and say, or neither understand nor say the word and whether standardized measures of expressive and receptive language abilities and/or autistic traits predicted parent certainty. Lastly, we investigated whether certainty was associated with inconsistency in parent report of child word knowledge. METHOD: Twenty-one parents and their autistic children ages 2-5 years participated. One parent per child completed the MacArthur-Bates Communicative Development Inventories (MCDI) Words and Gestures form and a custom vocabulary checklist including 24 object nouns from the MCDI. Within the custom form, parents indicated whether their child understood, understood and said, or neither understood nor said 24 target nouns and reported how certain they were about their responses using a 5-point scale. Expressive language, receptive language, and autistic traits were measured via direct assessment using standardized measures. RESULTS: Parent certainty varied widely and was higher for words the parents reported the children understood and said compared to that for words children either understood or neither understood nor said. Certainty ratings were higher when a child had higher standardized receptive and expressive language scores. Lastly, parent certainty was associated with reporting consistency, clarifying previous findings of inconsistencies in parent report of child vocabulary. CONCLUSION: Findings from this study indicate that measuring parent certainty provides critical information when assessing early vocabulary skills in autistic children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23671497.

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14. Lubala TK, Kayembe-Kitenge T, Mubungu G, Lumaka A, Kanteng G, Savage S, Luboya O, Hagerman R, Devriendt K, Lukusa-Tshilobo P. Usefulness of automated image analysis for recognition of the fragile X syndrome gestalt in Congolese subjects. Eur J Med Genet;2023 (Jul 31);66(9):104819.

BACKGROUND: Computer-aided software such as the facial image diagnostic aid (FIDA) and Face2Gene has been developed to perform pattern recognition of facial features with promising clinical results. The aim of this pilot study was to test Face2Gene’s recognition performance on Bantu Congolese subjects with Fragile X syndrome (FXS) as compared to Congolese subjects with intellectual disability but without FXS (non-FXS). METHOD: Frontal facial photograph from 156 participants (14 patients with FXS and 142 controls) predominantly young-adults to adults, median age 18.9 age range 4-39yo, were uploaded. Automated face analysis was conducted by using the technology used in proprietary software tools called Face2Gene CLINIC and Face2Gene RESEARCH (version 17.6.2). To estimate the statistical power of the Face2Gene technology in distinguishing affected individuals from controls, a cross validation scheme was used. RESULTS: The similarity seen in the upper facial region (of males and females) is greater than the similarity seen in other parts of the face. Binary comparison of subjects with FXS versus non-FXS and subjects with FXS versus subjects with Down syndrome reveal an area under the curve values of 0.955 (p = 0.002) and 0.986 (p = 0.003). CONCLUSION: The Face2Gene algorithm is separating well between FXS and Non-FXS subjects.

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15. Mohammadi K, Samavi A, Mehdiabadi FZ, Samavi SA. Psychometric validation of concerning behavior scale in Iranian children and young people with autism spectrum disorder. Front Psychiatry;2023;14:1153112.

INTRODUCTION: Assessment of Concerning Behavior (ACB) was introduced by Tarver et al. (2021) to evaluate mental health and problematic/risky behaviors in children and young people with autism spectrum disorder (ASD). METHODS: This study examined the psychometric validation of the Assessment of Concerning Behavior (ACB) in an Iranian sample of parents of children and young people with ASD. Confirmatory factor analysis was conducted to examine the structure of ACB in a sample of 303 parents. RESULTS: The data supported the two factor structure, all factor loadings were significant and scale structure was confirmed similar to the original scale. The results supported the two-factor structure for ACB that included internalizing and externalizing problems scales. The two factors of ACB are positively correlated with Aberrant Behavior Checklist scores which showed that the validity of two factors is satisfactory. The reliability of the two subscales was reasonable as well. CONCLUSION: The study suggests that the ACB could be an operational tool to assess the mental health and problematic/risky behaviors in Iranian children and young people with ASD.

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16. Nicoli G, Pavon G, Grayson A, Emerson A, Mitra S. Touch may reduce cognitive load during assisted typing by individuals with developmental disabilities. Front Integr Neurosci;2023;17:1181025.

Many techniques have attempted to provide physical support to ease the execution of a typing task by individuals with developmental disabilities (DD). These techniques have been controversial due to concerns that the support provider’s touch can influence the typed content. The most common interpretation of assisted typing as an ideomotor phenomenon has been qualified recently by studies showing that users with DD make identifiable contributions to the process. This paper suggests a neurophysiological pathway by which touch could lower the cognitive load of seated typing by people with DD. The required sensorimotor processes (stabilizing posture and planning and executing manual reaching movements) and cognitive operations (generating and transcribing linguistic material) place concurrent demands on cognitive resources, particularly executive function (EF). A range of developmental disabilities are characterized by deficits in sensorimotor and EF capacity. As light touch has been shown to facilitate postural coordination, it is proposed that a facilitator’s touch could assist the seated typist with sensorimotor and EF deficits by reducing their sensorimotor workload and thereby freeing up shared cognitive resources for the linguistic elements of the task. This is the first theoretical framework for understanding how a facilitator’s touch may assist individuals with DD to contribute linguistic content during touch-assisted typing.

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17. Pak NS, Chow JC, Dillehay KM, Kaiser AP. Long-Term Effects of Early Communication Interventions: A Systematic Review and Meta-Analysis. J Speech Lang Hear Res;2023 (Aug 3);66(8):2884-2899.

PURPOSE: Early language and communication interventions for children with language impairments have been shown to be effective in assessments administered immediately after treatment. The purpose of the current systematic review and meta-analysis was to assess the overall durability of those effects over time and whether durability was related to outcome type, etiology of child language impairments, implementer of intervention, magnitude of posttest effects, time between intervention and follow-up, and study risk of bias. METHOD: We conducted a systematic search of online databases and reference lists to identify experimental and quasi-experimental group design studies. All studies tested the effects of early communication interventions at least 3 months post-intervention. Participants were children 0-5 years old with language impairments. Coders identified study features and rated methodological quality indicators for all studies. Effect sizes at long-term timepoints and associations with potential moderators were estimated using multilevel meta-analysis with robust variance estimation. RESULTS: Twenty studies with 129 long-term outcome effect sizes met inclusion criteria. Studies included children with developmental language disorders or language impairment associated with autism. The overall average effect size was small and significant (g = .22, p = .002). Effect size estimates were larger for prelinguistic outcomes (g = .36, p < .001) than for linguistic outcomes (g = .14, p = .101). Significant factors were the posttest effect sizes, the risk of bias for randomized trials, and etiology of language impairment for linguistic outcomes. Time post-intervention did not significantly predict long-term effect sizes. CONCLUSIONS: Outcomes of early language and communication interventions appear to persist for at least several months post-intervention. More research is needed with collection and evaluation of long-term outcomes, a focus on measurement, and consistency of primary study reporting. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23589648.

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18. Piazza C, Dondena C, Riboldi EM, Riva V, Cantiani C. Baseline EEG in the first year of life: Preliminary insights into the development of autism spectrum disorder and language impairments. iScience;2023 (Jul 21);26(7):106987.

Early identification of neurodevelopmental disorders is important to ensure a prompt and effective intervention, thus improving the later outcome. Autism spectrum disorder (ASD) and language learning impairment (LLI) are among the most common neurodevelopmental disorders, and they share overlapping symptoms. This study aims to characterize baseline electroencephalography (EEG) spectral power in 6- and 12-month-old infants at higher likelihood of developing ASD and LLI, compared to typically developing infants, and to preliminarily verify if spectral power components associated with the risk status are also linked with the later ASD or LLI diagnosis. We found risk status for ASD to be associated with reduced power in the low-frequency bands and risk status for LLI with increased power in the high-frequency bands. Interestingly, later diagnosis shared similar associations, thus supporting the potential role of EEG spectral power as a biomarker useful for understanding pathophysiology and classifying diagnostic outcomes.

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19. Raman N, Ringold SM, Jayashankar A, Butera CD, Kilroy E, Harrison L, Cermak SA, Aziz-Zadeh L. Relationships between Affect Recognition, Empathy, Alexithymia, and Co-Occurring Conditions in Autism. Brain Sci;2023 (Aug 3);13(8)

Prior studies show differences in empathy and affect-recognition ability between those with autism spectrum disorder (ASD) and typically developing (TD) individuals. Autistic individuals also exhibit increased behavioral, gastrointestinal, and sleep issues. In the current study, we explored the differences in empathy and affect recognition between the ASD and TD groups; and we investigated their associations with conditions co-occurring in ASD. A total of 54 TD and 56 ASD children (8-17 years) were included. As compared to the TD group, the ASD group showed lower scores for affect recognition and perspective taking (PT) and higher scores for personal distress (PD). Interestingly, results from hierarchical linear regressions suggested that disparities in the PD and PT between the groups were primarily attributable to attenuated levels of alexithymia, rather than being mediated by the presence of an autism diagnosis. Differences in affect-recognition ability, however, were mediated by both an autism diagnosis and alexithymia. We also found significant correlations between empathy and affect recognition and measures of related conditions common in ASD. Alexithymia, hence, contributes to difficulties in empathy while both alexithymia and autism are associated with affect-recognition ability in ASD. Additionally, the association between affect recognition and empathic ability with co-occurring conditions in ASD needs to be considered during assessments and interventions.

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20. Shaw SCK, Fossi A, Carravallah LA, Rabenstein K, Ross W, Doherty M. The experiences of autistic doctors: a cross-sectional study. Front Psychiatry;2023;14:1160994.

INTRODUCTION: Medicine may select for autistic characteristics. As awareness and diagnosis of autism are growing, more medical students and doctors may be discovering they are autistic. No studies have explored the experiences of autistic doctors. This study aimed to fill that gap. METHODS: This is a cross-sectional study. A participatory approach was used to identify the need for the project and to modify a pre-existing survey for use exploring the experiences of autistic doctors. RESULTS: We received 225 responses. 64% had a formal diagnosis of autism. The mean age of receiving a formal diagnosis was 36 (range 3-61). Most were currently working as doctors (82%). The most common specialties were general practice / family medicine (31%), psychiatry (18%), and anesthesia (11%). Almost half of those working had completed specialty training (46%) and 40% were current trainees. 29% had not disclosed being autistic to anyone at work. 46% had requested adjustments in the workplace but of these, only half had them implemented.Three quarters had considered suicide (77%), one quarter had attempted suicide (24%) and half had engaged in self-harm (49%). 80% reported having worked with another doctor they suspected was autistic, but only 22% reported having worked with another doctor they knew was autistic. Having never worked with a potentially autistic colleague was associated with having considered suicide.Most preferred to be called « autistic doctors » (64%). Most considered autism to be a difference (83%). Considering autism to be a disorder was associated with preference for the term « doctors with autism, » and with having attempted suicide. CONCLUSION: Autistic doctors reported many challenges in the workplace. This may have contributed to a culture of nondisclosure. Mental health was poor with high rates of suicidal ideation, self-harm, and prior suicide attempts. Despite inhospitable environments, most were persevering and working successfully. Viewing autism as a disorder was associated with prior suicide attempts and a preference for person-first language. A neurodiversity-affirmative approach to autism may lead to a more positive self-identity and improved mental health. Furthermore, providing adequate supports and improving awareness of autistic medical professionals may promote inclusion in the medical workforce.

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21. Sutherland D, Flynn S, Kurzeja O, Griffin J, Hastings R. Family-systems interventions for families of people with an intellectual disability or who are autistic: a systematic review. J Intellect Disabil Res;2023 (Aug 2)

BACKGROUND: Family-systems interventions have been proposed as one way of supporting families of people with an intellectual disability (ID) or who are autistic. This systematic review aimed to summarise what family-systems interventions have been studied with this population, what evidence there is for their effectiveness and families’ experiences of the interventions. METHODS: The review was preregistered on PROSPERO (CRD42022297516). We searched five electronic databases, identified 6908 records and screened 72 full texts. Study quality was evaluated using the Mixed Methods Appraisal Tool, and a narrative synthesis was used. RESULTS: We identified 13 eligible articles with 292 participating families. Most studies reported positive effects of the interventions on wellbeing and family relationships, and families reported positive experiences. However, research quality was poor and there are no any sufficiently powered randomised controlled trials demonstrating family-systems interventions’ effectiveness for this population. CONCLUSIONS: There is a need for higher-quality research to establish whether family-systems interventions are beneficial for families of people who have an ID or who are autistic.

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22. Tan BL, Nair R, Duggal MS, Aishworiya R, Tong HJ. Development of oral health resources and a mobile app for caregivers and autistic children through consensus building. Autism;2023 (Aug 3):13623613231188768.

Caregivers of autistic children often lack knowledge regarding oral homecare and when and where to see the dentist. To address this need, we developed a series of information on oral health. An autistic child assisted in developing two social stories to showcase a dental visit. A mobile app was developed to deliver the above mentioned. Other features include creation of customised social stories and visual schedule and an inbox to allow dentists to send messages to parents. The developed information and social stories were reviewed by experts and parents. The app also underwent anonymous and independent testing by parents. Overall the information and app were well received by the experts and parents.

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23. Vicedo M. Autism’s heterogeneity in historical perspective: from challenge to opportunity. Front Psychol;2023;14:1188053.

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24. Wegmann B, Tatemoto P, Miemczyk S, Ludvigsson J, Guerrero-Bosagna C. Identification of potentially relevant metals for the etiology of autism by using a Bayesian multivariate approach for partially censored values. Sci Rep;2023 (Aug 3);13(1):12622.

Heavy metals are known to be able to cross the placental and blood brain barriers to affect critical neurodevelopmental processes in the fetus. We measured metal levels (Al, Cd, Hg, Li, Pb and Zn) in the cord blood of newborns and in the serum of the same children at 5 years of age, and compared between individuals with or without (controls) autism spectrum disorder (ASD) diagnosis. The samples were from a biobank associated with the All Babies in Southeast Sweden (ABIS) registry. We proposed a Bayesian multivariate log-normal model for partially censored values to identify potentially relevant metals for the etiology of ASD. Our results in cord blood suggest prenatal Al levels could be indicative of later ASD incidence, which could also be related to an increased possibility of a high, potentially toxic, exposure to Al and Li during pregnancy. In addition, a larger possibility of a high, potentially beneficial, exposure to Zn could occur during pregnancy in controls. Finally, we found decisive evidence for an average increase of Hg in 5-year-old ASD children compared to only weak evidence for controls. This is concordant with previous research showing an impaired ability for eliminating Hg in the ASD group.

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25. Wignall L, Moseley R, McCormack M. Autistic Traits of People Who Engage in Pup Play: Occurrence, Characteristics and Social Connections. J Sex Res;2023 (Aug 3):1-11.

Pup play is a kink or BDSM activity and subculture that provides opportunities for social and sexual play and exploration. While growing scholarly attention has focused on the diverse dynamics of pup play cultures, and reasons for participation within them, no research has considered how pup play may be attractive for neurodivergent people. This study sample consisted of 413 pup play practitioners from an international internet survey to examine the occurrence of autistic traits and explore characteristics and social connections of people with autistic traits who engage in pup play. Autistic traits were assessed using the Autism-Spectrum Quotient-Short Form (AQ-S), with 1 in 2 participants reporting a score that is indicative of an autism diagnosis, substantially higher than the prevalence of autism in the general population (1 in 44). Using linear and multinomial regression analyses, we found that people with high autistic traits preferred non-flexible roles in pup play, had lower identity resilience, and more restricted sociosexuality. People with high autistic traits were also less likely to belong to pup play social communities or to closer-knit family/pack units despite wishing to and were also less likely to have a strong identification with pup play communities than people with low AQ-S scores. While these findings need to be treated as preliminary based on methodological and sample limitations, this research demonstrates the importance of considering intersections between autistic traits and sexual subcultures and provides evidence that sexuality research would be enhanced by a more inclusive approach to considering neurodivergence more broadly.

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26. Wu Q, Boonma P, Badu S, Yalcinkaya N, So SY, Garey KW, Williams K, Arnold LE, Shulman RJ, Kellermayer R, Savidge TC. Donor-recipient specificity and age-dependency in fecal microbiota therapy and probiotic resolution of gastrointestinal symptoms. NPJ Biofilms Microbiomes;2023 (Aug 3);9(1):54.

Fecal microbiota transplantation (FMT) has proven to be an effective treatment for recurrent Clostridioides difficile infection (rCDI) in both adult and pediatric patients. However, as microbiome development is a critical factor in children, it remains unclear whether adult fecal donors can provide age-appropriate functional restoration in pediatric patients. To address this issue, we conducted an integrated systems approach and found that concordant donor strain engraftment, along with metabolite restoration, are associated with FMT outcomes in both adult and pediatric rCDI patients. Although functional restoration after FMT is not strain-specific, specialized metabolic functions are retained in pediatric patients when adult fecal donors are used. Furthermore, we demonstrated broad utility of high-resolution variant-calling by linking probiotic-strain engraftment with improved gastrointestinal symptoms in adults with irritable bowel syndrome and in children with autism spectrum disorder. Our findings emphasize the importance of strain-level identification when assessing the efficacy of probiotics and microbiota-based therapeutics.

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27. Xu S, Fan J, Zhang H, Zhang M, Zhao H, Jiang X, Ding H, Zhang Y. Hearing Assistive Technology Facilitates Sentence-in-Noise Recognition in Chinese Children With Autism Spectrum Disorder. J Speech Lang Hear Res;2023 (Aug 3);66(8):2967-2987.

PURPOSE: Hearing assistive technology (HAT) has been shown to be a viable solution to the speech-in-noise perception (SPIN) issue in children with autism spectrum disorder (ASD); however, little is known about its efficacy in tonal language speakers. This study compared sentence-level SPIN performance between Chinese children with ASD and neurotypical (NT) children and evaluated HAT use in improving SPIN performance and easing SPIN difficulty. METHOD: Children with ASD (n = 26) and NT children (n = 19) aged 6-12 years performed two adaptive tests in steady-state noise and three fixed-level tests in quiet and steady-state noise with and without using HAT. Speech recognition thresholds (SRTs) and accuracy rates were assessed using adaptive and fixed-level tests, respectively. Parents or teachers of the ASD group completed a questionnaire regarding children’s listening difficulty under six circumstances before and after a 10-day trial period of HAT use. RESULTS: Although the two groups of children had comparable SRTs, the ASD group showed a significantly lower SPIN accuracy rate than the NT group. Also, a significant impact of noise was found in the ASD group’s accuracy rate but not in that of the NT group. There was a general improvement in the ASD group’s SPIN performance with HAT and a decrease in their listening difficulty ratings across all conditions after the device trial. CONCLUSIONS: The findings indicated inadequate SPIN in the ASD group using a relatively sensitive measure to gauge SPIN performance among children. The markedly increased accuracy rate in noise during HAT-on sessions for the ASD group confirmed the feasibility of HAT for improving SPIN performance in controlled laboratory settings, and the reduced post-use ratings of listening difficulty further confirmed the benefits of HAT use in daily scenarios.

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28. Zane E, Grossman RB. Analysis of Noun Phrase Ambiguity in Narratives Reveals Differences in Referential Establishment But Not Cohesion for Older Autistic Children. J Speech Lang Hear Res;2023 (Aug 3);66(8):2802-2820.

PURPOSE: Stories told by autistic narrators often contain relatively frequent use of ambiguous references. However, it remains unclear whether this ambiguity is driven by ambiguous character establishment (e.g., « Once upon a time, she/the girl… ») and/or ambiguous cohesion (e.g., « Two girls lived in a castle. She/The girl… »). In this study, we directly compared rates of each type of ambiguity within and between narratives told by autistic and non-autistic children, to determine which type of ambiguity is relatively more common in narratives told by autistic children. METHOD: Thirty-three 10- to 17-year-old autistic participants (n = 17) and non-autistic peers (n = 16), who were not statistically different in age, standardized language scores, and IQ scores (p > .8 for all), watched two short animated videos alone and then described the videos’ events to two listeners who were openly unfamiliar with the videos. We transcribed video recordings of narratives and coded all referential noun phrases (NPs) as either clear or ambiguous. We further categorized ambiguous NPs as either ineffective introduction or ineffective cohesion. RESULTS: Autistic children produced significantly higher rates of ambiguous establishment than non-autistic peers, whereas between-group comparisons’ rates of ambiguous cohesion were not statistically significant. CONCLUSIONS: Older children on the autism spectrum show differences in the way they introduce characters, selecting NP types that are only appropriate when their listener is already familiar with the referent. In contrast, once they have introduced characters, they show cohesive skills that are comparable to those of non-autistic peers. Findings support theories arguing that autistic children show differences in their application of social pragmatic principles (listener/context-specific pragmatic rules), whereas their use of linguistic pragmatics (context-independent rules) is similar to that of non-autistic peers.

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29. Zhang M, Ming Y, Du Y, Xin Z. Two-sample Mendelian randomization study does not reveal a significant relationship between cytomegalovirus (CMV) infection and autism spectrum disorder. BMC Psychiatry;2023 (Aug 2);23(1):559.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting ~ 2% of children worldwide and is characterized by repetitive, stereotypical behaviours and impaired expressive communication. Cytomegalovirus (CMV) is considered a risk factor for ASD; however, published studies are usually limited by covering too few events and have different conclusions, indicating that the relationship between CMV infection and ASD remains elusive. METHODS: To investigate the association between CMV infection and ASD, we conducted this 2-sample Mendelian randomization (MR) study using genome-wide association studies (GWAS) summary data from FinnGen and the IEU Open GWAS project. RESULTS: Our results showed no significant relationship between all 3 CMV infections (unspecified cytomegaloviral diseases, anti-CMV IgG levels, and maternal CMV) and ASD. CONCLUSIONS: Our results indicate that CMV infection does not significantly increase ASD risk. These results show that the relationship between CMV infection and ASD remains elusive and needs to be further clarified.

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