Pubmed du 03/10/25
1. Erdogan M, Olinger E, Ferrao Santos S. Atypical Rett syndrome with chorea: a case report. Acta Neurol Belg. 2025.
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2. Gao L, Zhang T, Zhou R, Zhang T, Guo X. Sex heterogeneity of inter-individual functional hierarchical organization similarity in autism spectrum disorder based on the joint embedding analysis. Neuroimage. 2025: 121495.
Autism spectrum disorder (ASD) has been reported to exhibit altered functional connectivity in the brain. While extant research has predominantly examined male samples, sex differences of functional organization in ASD remains poorly characterized. This study aimed to explore the sex heterogeneity of the inter-individual functional hierarchical organization similarity in ASD. Resting-state functional magnetic resonance imaging data from the Autism Brain Imaging Data Exchange database, including 284 males/65 females with ASD and 340 male/119 female neurotypical controls (NCs) were used in this study. A joint embedding method was used to embed the functional connectomes of individuals into a common connectivity space and the inter-individual functional hierarchical organization similarity was further calculated within each group. Two-way analysis of variance (ANOVA) was used to explore sex heterogeneity in the functional hierarchical organization similarity in ASD. Significant diagnosis-by-sex interaction effects on the functional hierarchical organization similarity were observed in the default mode network, frontal-parietal network, subcortical network, dorsal attention network, and undefined network. The predictive analysis of symptom severity showed that the functional hierarchical organization similarity of brain regions with significant diagnosis-by-sex interaction effects can predict the social interaction impairments in males with ASD, whereas this relationship was not detected in females with ASD. These findings emphasize the sex heterogeneity of functional hierarchical organization in ASD and underscore the necessity of considering sex differences in future studies of ASD.
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3. Halldner L, Eberhard S, Lichtenstein P, Gustafsson P, Gillberg C, Johnson M, Billstedt E, Täljemark J, Råstam M, Lundström S. Thorough clinical child psychiatric diagnostic evaluation and validation of the Autism- Tics, ADHD and other comorbidities inventory (A-TAC) in a population-based sample of 9-year-olds. BMC Psychiatry. 2025; 25(1): 918.
BACKGROUND: The Autism- Tics, ADHD and other Comorbidities inventory (A-TAC) has been validated in epidemiological data. However, validation against clinical diagnostic assessments in a population-based sample has been lacking, limiting the implications for clinical practice, clinical research and public health decisions. METHODS: Study participants were recruited from the longitudinal Child and Adolescent Twin Study in Sweden (CATSS) inviting parents to all twins in Sweden. We investigated the psychometric properties of the A-TAC in 263 children, where one or both twins screened positive for neuropsychiatric problems, as well as control pairs, where both twins were screen negative. Study participants underwent thorough clinical examination within one year of the A-TAC interview. The psychometric properties of the A-TAC were then investigated. We also mapped the extent of comorbidity of neurodevelopmental disorders. RESULTS: Using the A-TAC as screening for neurodevelopmental disorders we could discriminate two groups of children with clearly different occurrences of clinical diagnoses. The predictive screening properties of the A-TAC were good for most of the neurodevelopmental disorders (AUC ranging from 0.806 to 0.958), with exception for developmental coordination disorder (AUC = 0.616). More than 40% of children fulfilling diagnostic criteria for a neurodevelopmental disorder, also fulfilled diagnostic criteria for at least one other neurodevelopmental disorder. CONCLUSION: This study confirms the utility of the A-TAC interview as a screening tool for neuropsychiatric disorders in a non-clinical sample. It also supports the necessity to maintain a broad diagnostic approach in clinical child psychiatric investigations for meaningful understanding of the child’s problems. Although, A-TAC can be informative on neurodevelopmental problems in both clinical and population-based samples, it cannot replace a clinical neurodevelopmental investigation or be used to delimit individual access to specialized care.
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4. Han X, Zhu J, Zhao W, Han Y. Serum Metabolic and Gut Microbiome Differences in Age-Associated Fragile X Syndrome (FXS) Pediatric Patients May Benefit Clinical Therapy Development. Int J Gen Med. 2025; 18: 5869-82.
BACKGROUND: Fragile X syndrome (FXS) is a rare, genetically based neurodevelopmental disorder characterized by intellectual disability. While previous research has largely focused on its genetic mechanisms, the role of metabolism and the gut microbiome in FXS remains underexplored. This study aimed to investigate age-related metabolic differences in the gut flora and serum metabolites of children with FXS and their associations with clinical behavioral outcomes. METHODS: A total of 32 children with FXS under 18 years were enrolled and divided into two age groups: younger (3-8 years) and older (8-18 years). Intestinal microbiota composition was analyzed using 16S rDNA gene sequencing, and serum metabolite profiles were assessed via ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Spearman correlation analysis was used to assess associations among gut flora, serum metabolites, and scores from the Social Responsiveness Scale (SRS) and Child Behavior Checklist (CBCL). RESULTS: Significant differences in gut bacterial genera and 1,352 serum metabolites were observed between the age groups. The older group exhibited higher levels of phospholipids, steroids, and peptides, and enrichment in the steroid hormone biosynthesis pathway. Several metabolites were significantly correlated with SRS and CBCL scores, indicating potential links between metabolic changes and behavioral symptoms. CONCLUSION: Age-associated metabolic and gut microbiota alterations in FXS may contribute to variations in clinical presentation. These findings suggest a metabolic basis for FXS and provide a foundation for future research into microbiome-targeted interventions in FXS management.
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5. Hendry A, Nosyk M, Hulks V, Hudson J, Constable L, Charman T, Mathers S, Rhodes S, Scerif G. Protocol for a feasibility randomized control trial of the Supporting Toddlers with a connection to autism or ADHD to develop Strong Attention, Regulation, and Thinking skills (START) programme. Pilot Feasibility Stud. 2025; 11(1): 122.
BACKGROUND: Autism and ADHD are heritable, co-occurrent, and associated with difficulties with executive functioning (cognitive and self-regulation skills which enable us to set and work toward goals). Executive function difficulties, and their negative impacts across cognitive, health and social domains, extend to individuals with first-degree relatives who are autistic or have ADHD, even if they do not meet thresholds for a clinical diagnosis themselves. Supporting executive function development in children with elevated autism traits, or a first-degree relative with autism or ADHD, addresses community priorities for early support to help achieve the best mental health, education and life outcomes. METHODS: This study will evaluate the feasibility and acceptability of a randomized controlled trial (RCT) of a parent-toddler programme entitled « Supporting Toddlers with a connection to autism or ADHD to develop strong Attention, Regulation and Thinking skills » (START). START is a neurodiversity-affirming programme, co-refined through extensive Patient and Public Involvement. Sixty parent-child dyads, in Oxford or Southampton (UK), will be randomized using Sealed Envelope by a researcher not involved in recruitment, delivery or outcome data collection to receive START or usual practice, on a 1:1 ratio. Children (20 months old) will be assessed using questionnaires completed by the parent (not blind to allocation) post-intervention (within 2 weeks of the end of the active intervention wave, when children are aged 27-31 months), and using parent questionnaires and a battery of executive function measures administered by researchers blind to allocation at baseline and follow-up (36 months old). START will be delivered in small groups to 30 parent-child dyads, in community settings. DISCUSSION: We will assess the feasibility of recruiting eligible participants to the study, the reliability of measures of implementation fidelity and degree of implementation fidelity achieved, the appropriateness of proposed outcome and mechanism measures, the acceptability of an RCT of the programme, parental adherence to the programme, logistics of programme delivery, and the acceptability of START, using mixed-method measures of engagement and satisfaction. Results will inform the design and implementation of a definitive RCT of START, and yield broader insights into the delivery and evaluation of complex early-years interventions in community settings. TRIAL REGISTRATION: ISRCTN registry ISRCTN99820028 https://doi.org/10.1186/ISRCTN99820028 .
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6. Huang JL, Sharifi O, Yasui DH, LaSalle JM. MeCP2 at the crossroads of hypoxia, oxidative stress, and gene regulation in Rett syndrome. Epigenomics. 2025: 1-11.
Rett syndrome (RTT) is a severe neurodevelopmental disorder primarily affecting females, caused by mutations in the X-linked gene MECP2. This gene encodes methyl CpG binding protein 2 (MeCP2), a multifunctional epigenetic regulator critical for neuronal gene regulation. In addition to well-characterized neurological symptoms, such as seizures and motor abnormalities, RTT patients frequently present with irregular breathing patterns that induce intermittent hypoxia, suggesting that MeCP2 contributes to respiratory regulation as well as the brain’s cellular and molecular response to hypoxia. Mechanistically, MeCP2 appears to influence hypoxia-induced expression of the neuroprotective peptide brain-derived neurotrophic factor (BDNF), as impaired BDNF regulation in MeCP2-deficient neurons contributes to hypoxia vulnerability. RTT patients also display increased oxidative stress, marked by elevated lipid peroxidation, DNA damage, and reduced antioxidant production. Dysfunctional mitochondria in MeCP2-deficient astrocytes and neurons further propagate oxidative damage and non-cell-autonomous effects of MeCP2 loss. Moreover, recent transcriptomic studies revealed widespread transcriptional dysregulation in RTT, including pathways associated with mitochondrial function and oxidative stress. We review and discuss an expanded role for MeCP2 as a critical integrator of hypoxia sensing, oxidative stress regulation, and transcriptional adaptation in the developing brain, offering new insights into treatments targeting the complex pathophysiology of RTT. The protein methyl CpG binding protein 2 (MeCP2) is involved in multiple processes that affect how our genes are turned on and off. Although MeCP2 is present in most cells throughout the body, it is particularly important for proper development of neurons in the brain. Defects in MeCP2 are responsible for most cases of Rett Syndrome, while excess amounts lead to MeCP2 Duplication Syndrome; both are disorders of abnormal brain development. One common symptom of these disorders is disturbances in breathing patterns, such as breath holding or temporary pauses in breathing. These symptoms are associated with lower oxygen levels in the blood, leading to an increase in free radicals produced by the mitochondria. Excess amounts of free radicals can change or damage molecules within the body, and many of these damage indicators are found at higher levels within patients in which MeCP2 is not functioning normally. This ultimately results in damage to cells and DNA. MeCP2 also plays a role in helping the brain respond to low oxygen levels. One of the potential ways it achieves this is by promoting the production of factors that help protect neurons from cell death. Furthermore, studies on genes that display altered expression patterns in Rett syndrome reveal that many of these genes are involved in processes related to mitochondria, which generate energy but also free radicals, and oxygen response. Overall, this review discusses the role of MeCP2 in responding to low oxygen levels through its control over switching genes on or off. eng.
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7. Ito H, Tsuji T, Sobue K. Clinical and demographic characteristics of patients with autism spectrum disorder receiving general anesthesia with or without physical restraint: a single-center retrospective study. J Anesth. 2025.
PURPOSE: Perioperative management of patients with autism spectrum disorder (ASD) often requires premedication and physical restraint. This study examined the characteristics of patients with ASD who required special interventions for general anesthesia, particularly physical restraint during induction. METHOD: This retrospective study included patients diagnosed with ASD (autism, pervasive developmental disorder, Rett syndrome, Asperger’s syndrome, or childhood disintegrative disorder) based on established criteria. All patients underwent general anesthesia at a hospital for patients with disabilities between April 2019 and March 2022. Data collected included clinical and demographic characteristics, perioperative management (premedication and anesthetic methods), surgical indications, physical restraint use, and induction time. A comparative analysis was conducted to identify differences in patient characteristics and induction times between physical restraint and no-restraint groups. Induction times were compared using Kaplan-Meier survival curves and log-rank tests. RESULTS: A total of 136 procedures were performed on 102 patients. Median age was 23.3 years (interquartile range: 12.8-35.2), 79% of participants were male, and approximately 40% exhibited self-injurious or aggressive behaviors. Dental procedures were the most common indication for anesthesia. Midazolam and pentobarbital were the most frequently administered premedications. Patients requiring physical restraint were generally larger and more likely to exhibit self-injurious or aggressive behaviors than those who did not. However, induction times were not prolonged in the physical restraint group compared with the no-restraint group. CONCLUSION: The characteristics identified in this study, such as large body size, self-injurious behavior, and aggressive behavior, may inform future research aimed at refining physical restraint use for patients with ASD.
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8. Khalifa ABH, Boukhris H, Ayari G, Ksiksi Y, Baccouche C. Oral Health Challenges and Hygiene Practices in Children with Autism Spectrum Disorder: A Cross-sectional Study from Tunisia. J Contemp Dent Pract. 2025; 26(6): 581-6.
AIM: This study aimed to assess oral hygiene practices, dental conditions, and access to dental care among children with autism spectrum disorder (ASD) in Tunisia. MATERIALS AND METHODS: This descriptive cross-sectional study included 48 children diagnosed with ASD. Data were obtained through a structured questionnaire completed by caregivers and a clinical oral examination. The questionnaire comprised 25 items divided into three domains: (1) Knowledge (awareness of oral hygiene importance, fluoride use, recognition of dental caries, and regular dental checkups); (2) Attitude (motivation for oral care, caregiver perception of dental visits, and beliefs about prevention); (3) Practices (tooth brushing frequency, technique, use of toothpaste, dental attendance, and dietary habits). The clinical examination assessed oral hygiene status, presence of untreated caries, gingival condition, and parafunctional oral habits. Descriptive statistics were used to analyze the data. RESULTS: Of the 48 children included in the study, 23% (n = 11) were classified at the severe end of the autism spectrum, while the remaining 77% (n = 37) presented with mild to moderate forms of ASD. Poor oral hygiene was observed in 46.6% (n = 14) of the children, untreated dental caries were present in 36.6% (n = 11), and 60% (n = 18) had never visited a dentist. Additionally, 33.3% (n = 10) of the children did not brush their teeth regularly. The presence of gingival inflammation and parafunctional habits was also noted but varied across severity levels of ASD. CONCLUSION: The study reveals considerable challenges regarding oral hygiene behaviors, dental health status, and access to dental care among children with ASD in Tunisia. These findings underscore the necessity for targeted oral health education programs and enhanced caregiver involvement to improve oral health outcomes in this population. CLINICAL SIGNIFICANCE: A better understanding of the specific oral health needs of children with ASD is essential for tailoring dental care protocols. Focused caregiver training and adapted dental approaches are recommended to promote improved oral hygiene practices and overall oral health in children with ASD. How to cite this article: Ben Hadj Khalfa A, Boukhris H, Ayari G, et al. Oral Health Challenges and Hygiene Practices in Children with Autism Spectrum Disorder: A Cross-sectional Study from Tunisia. J Contemp Dent Pract 2025;26(6):581-586.
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9. Larsen AB, Buhl RB, Müller K, Dinesen B. The Use of the Social Robot LOVOT for Children with Autism Spectrum Disorder: A Feasibility Study. Stud Health Technol Inform. 2025; 332: 77-81.
BACKGROUND: One in 100 children is diagnosed with autism spectrum disorder (ASD). Social robots have proven to be a promising technology for children with ASD. The emergence of the social robot LOVOT adds new dimensions to the interaction between robots and children with ASD. AIM: To explore how staff experience using the social robot as a pedagogical tool for children with ASD. METHOD: This study was conducted at an institution in Denmark that specializes in special education programs for children with ASD. The interactions between children with ASD and the social robot were tested in individual sessions twice per week for a total of four weeks. Four children with ASD between 9-14 years were included (n=4). A triangulation of data collection techniques was used: Participant observation (n = 15 hours), children’s questionnaire (n = 4), and semi-structured interviews with staff (n = 3). FINDINGS: Findings can be summarized as follows: Acceptance of the social robot, positive changes in mood and behavior of children with ASD, a secure relationship, technical and practical issues to overcome, and ethical considerations. CONCLUSION: The professional staff saw a potential for using the robot with AI functionalities as a pedagogical tool for children with ASD.
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10. Larson C, Taverna E, Mohan A, Girolamo T, Fein D, Eigsti IM. The role of language in social-emotional, educational, and vocational outcomes in autism and in individuals who have lost the diagnosis. medRxiv. 2025.
BACKGROUND: There is striking heterogeneity in long-term outcomes associated with an autism diagnosis, and the role of language in outcomes has not been sufficiently characterized. This study characterized the roles of structural language ability and early language milestones in long-term social-emotional, educational, and vocational outcomes in individuals with autism and individuals who have lost the autism diagnosis (LAD) relative to neurotypical (NT) peers, over and above the potential confounding role of social skills. METHODS: Participants were individuals with autism ( n = 39) or LAD ( n = 32) and NT peers ( n = 38) age 12-39 years. Participants completed standardized and survey-based measures of social-emotional functioning and educational and vocational attainment. Language measures were an experimental structural language task (grammaticality judgement) and caregiver-report of early language milestones. Linear and generalized linear models tested how groups differed in the association between language and outcomes. RESULTS: Language was associated with certain outcomes for all groups, though there were group differences in the nature of these associations. In autism relative to LAD and NT peers, structural language was differentially associated with anxiety/depression, and language milestones were differentially associated with social relationships, quality of life, educational attainment, and full-time employment status. CONCLUSIONS: Findings suggest unique pathways of influence between language and outcomes in individuals with autism versus LAD and NT peers. This evidence suggests that current language and early language development must be considered in social-emotional functioning and in educational and vocational supports from childhood through adulthood for individuals diagnosed with autism in childhood.
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11. Mumena WA, Hamad EO, Kutbi HA. Psychometric evaluation of the Screening Tool for Feeding Problems (STEP) in Saudi children with developmental disabilities aged 4-18 years. Asia Pac J Clin Nutr. 2025; 34(5): 821-8.
BACKGROUND AND OBJECTIVES: Children with developmental disabilities commonly experience feeding problems; however, tools to assess the nature and extent of these difficulties are not available in Arabic. This study aims to validate the Arabic version of the Screening Tool for Feeding Problems (STEP) and evaluate its factorial structure in children with developmental disabilities. METHODS AND STUDY DESIGN: This cross-sectional study involved 167 children with developmental disabilities, recruited from nine disability centers and schools in Madinah, Saudi Arabia. Data were collected from caregivers using a paper version of the Arabic version of STEP, which was sent home with the child along with a consent form for signature. The English-to-Arabic translation of the tool was conducted by a bilingual professional using the forward-backward translation method. RESULTS: Confirmatory factor analysis was performed to evaluate the factorial structure of the Arabic version of STEP using two models. Model 1 included all 23 items; Model 2 excluded six items with low factor loadings, resulting in a 17-item version. Model 2 demonstrated improved goodness of fit indices, supporting a modified five-factor structure. Reliability analysis showed acceptable internal reliability for the total scale in both models, with Cronbach’s alpha of 0.80 and McDonald’s omega of 0.79 for Model 1, and alpha of 0.83 and omega of 0.82 for Model 2. Internal consistency for individual factors ranged from 0.31 to 0.70. CONCLUSIONS: The Arabic version of STEP demonstrates satisfactory psychometric properties and appears to be a valid and reliable tool for screening feeding difficulties in children with developmental disabilities in the Saudi Arabian context.
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12. Ninochka D’Souza M, Gowda NKC, Hariharan N, Qadri SW, Palakodeti D, Muddashetty RS. Altering rRNA 2’O-methylation pattern during neuronal differentiation is regulated by FMRP. RNA Biol. 2025; 22(1): 1-22.
The Fragile X Messenger Ribonucleoprotein (FMRP) is a selective RNA-binding protein that localizes to the cytoplasm and the nucleus. The loss of FMRP results in Fragile X Syndrome (FXS), an autism spectrum disorder. FMRP interacts with ribosomes and regulates the translation of mRNAs essential for neuronal development and synaptic plasticity. However, the biochemical nature of this translation regulation is unknown. Here, we report that a potential feature of FMRP-mediated translation regulation during neuronal differentiation is the modulation of 2′-O-methylation of ribosomal RNA. 2’O-methylation, facilitated by C/D box snoRNAs in the nucleus, is a major epitranscriptome mark on rRNA, essential for ribosome assembly and function. We found that FMRP influences a distinct rRNA 2’O-Methylation pattern across neuronal differentiation. We show that in H9 ESCs, FMRP interacts with a selected set of C/D box snoRNA in the nucleus, resulting in the generation of ribosomes with a distinct pattern of rRNA 2’O-Methylation. This epitranscriptome pattern on rRNA undergoes a significant change during the differentiation of ESCs to neuronal precursors and cortical neurons. ESCs exhibit substantial levels of hypomethylated residues on rRNA, which progressively decrease in neuronal precursors and post-mitotic cortical neurons. This reduction correlates with changes in global protein synthesis across different stages of differentiation. Importantly, this stepwise change in the 2’O-methylation pattern during neuronal differentiation is altered in the absence of FMRP, which could impact neuronal development and contribute to dysregulated protein synthesis observed in Fragile X Syndrome.
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13. Qin G, Ni H, Ren W, Wang Z, Yan W, Li K, Lin X, Zhang W, Zhang X, Li J, Hou Y, Wu M, Zhang H, Chen L, Xiao X. Gestational diabetes mellitus induces 5-HT system dysfunction and exacerbates an ASD-like phenotype in male offspring by inhibiting the Ahi1/B9D1/Shh axis. Brain Behav Immun. 2025: 106127.
Gestational diabetes mellitus (GDM) is a significant risk factor for autism spectrum disorder (ASD) in offspring. Despite the growing interest in the hypothesis of 5-hydroxytryptamine (5-HT) system dysfunction, the underlying mechanisms remain unclear and require further investigation. In this study, a GDM model was established in mice by feeding them a high fat diet (HFD) and administering an intraperitoneal injection of streptozocin (STZ). Our findings indicated that GDM exposure induced ASD-like behaviors and disrupted 5-HT system function by decreasing the level of Abelson helper integration site 1 (Ahi1) in the dorsal raphe nucleus (DRN) of male offspring. Furthermore, GDM evoked neuroinflammation, accompanied by a notable increase in the concentrations of proinflammatory factors (TNF-α, IL-1βand IL-6). Additionally, Ahi1 knockdown in normal mice mediated by an injection of AAV-Ahi1 in the brain recapitulated ASD-like behaviors and 5-HT system dysfunction, but these effects were blocked by the overexpression of B9 domain-containing protein 1 (B9D1) or meptazinol-mediated pharmacological activation of Ahi1, which ameliorated ASD-like behaviors, neuroinflammation and reversed 5-HT system dysfunction in male offspring of mothers with GDM (GDM-Os). Furthermore, lipopolysaccharide (LPS) induced neuroinflammation inhibited Ahi1 induced 5-HT system dysfunctions in vitro. Based on these findings, the inhibitory effects of meptazinol on GDM-induced ASD-like behaviors could be attributed to the involvement of 5-HT system dysfunction mediated by the Ahi1/B9D1/Shh axis. These findings provide novel insights into the mechanism by which neuroinflammation associated with GDM causes ASD pathogenesis and may pave the way for the development of a new therapeutic strategies for ASD.
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14. Quintero J, Rodríguez-Quiroga A, Medina J, Galvez-Fernandez M, Nuevo J, Ruiz C, Sánchez E, Alonso V, Pérez Domínguez A. A survey of knowledge and perceptions of ADHD and autism spectrum disorder in the workplace at a large corporation. Sci Rep. 2025; 15(1): 34424.
Neurodevelopmental conditions, such as attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), affect millions globally and are often misunderstood in professional environments. Embracing neurodiversity is essential for inclusivity and leveraging the unique strengths of these individuals. This study evaluated employees’ knowledge and perceptions of neurodiversity, focusing on ADHD and autism in large corporations, to identify knowledge gaps and propose strategies to create more inclusive workplaces. Cross-sectional survey of 880 employees from AstraZeneca and Alexion in Spain was conducted in July 2024. It assessed knowledge of ADHD and autism, perceptions of working with neurodivergent individuals, and preferences for educational interventions. Data were collected via self-administered questionnaire and analyzed descriptively and analyzed using descriptive statistics to summarize frequencies, proportions, and central tendency measures. Awareness of ADHD (98.9%) and autism (98.1%) was high, but misconceptions persisted, with ~ 20% misidentifying intellectual disability as a symptom of autism, and restricted interests as a sign of ADHD. Comfort with potentially working with neurodivergent colleagues was rated 7.4/10, yet 60.6% felt that workplaces were inadequately adapted. Preferred educational approaches included school talks (87.5%) and social media (67.6%). Despite positive attitudes, knowledge gaps regarding neurodevelopmental disorders persist. Targeted interventions are essential to emphasize the strengths of neurodivergent individuals and foster adaptable, supportive workplaces that promote inclusivity and innovation.
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15. Rothe J, Thiel T, Roessner V, Ring M. The impact of the COVID-19 pandemic on the well-being of autistic and non-autistic adults in Eastern Germany. BMC Psychiatry. 2025; 25(1): 915.
BACKGROUND: Autistic individuals often experience significant difficulties adapting to even slight changes in their routines. The COVID-19 pandemic created an uncertain situation marked by frequent changes in daily life, though some pressures of everyday life were reduced during this time. The few existing studies on mental health in autistic individuals during the COVID-19 pandemic have identified a link between pandemic-related distress and increases in symptoms of anxiety and depression. The present study aimed to compare the impact of pandemic-related restrictions on daily life and psychopathological symptoms between groups of autistic and non-autistic adults and to determine whether these variables are interrelated. Furthermore, the study examined potential predictors of psychopathological symptoms during the pandemic. METHODS: A sample of 86 East German autistic adults aged 18-67 years (21 female, M(age) = 33.49 years, SD(age) = 13.32) and 87 non-autistic adults aged 18-70 years (21 female, M(age) = 34.37 years, SD(age) = 14.18) completed self-report questionnaires addressing autism-like traits, the impact of pandemic-related restrictions on daily life, psychopathological symptoms, sensory sensitivity and Intolerance of Uncertainty (IoU). The 7-day incidence rate, pandemic duration, and the scope of social restrictions at the time of the survey were considered individually for each participant. RESULTS: Regarding pandemic-related restrictions, the reduction in social contacts and restrictions on freedom of travel were most relevant for both groups while non-autistic adults reported that they were affected more severely compared to autistic adults. Retrospective self-ratings of changes in overall physical and mental health did not differ between the two groups. Consistent with pre-pandemic evidence, autistic adults reported higher sensory sensitivity and greater IoU compared to non-autistic adults. However, sensory exposure due to face coverings affected both groups similarly. Sensory sensitivities and IoU were the most relevant predictors of psychopathological symptoms in both groups, although changes in overall physical health also emerged as a predictor for autistic adults. CONCLUSIONS: The relation between pandemic-related restrictions and the predictors of psychopathological symptoms differed somewhat between groups. Although it is known that autistic individuals show higher levels of sensory sensitivity and IoU in general, autistic adults appeared to be less affected by certain pandemic-related restrictions than anticipated.
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16. Smith C, Baker DH. Neural correlates of the deployment of spatial attention, and their modulation by repetitive movements. PLoS One. 2025; 20(10): e0332583.
The deployment of spatial attention generates distinct neural signatures that can be detected at the scalp. Here, we use multivariate pattern analysis of EEG data to decode the deployment of spatial attention, and ask if this is modulated by repetitive movements. ‘Stimming’ movements (also known as repetitive stereotypies), are widely reported in autism, but also present in some neurotypical individuals. Stimming has historically been viewed as a problematic behaviour, but many individuals claim that stimming benefits attention. We first validated our paradigm (a Posner-style cueing design), demonstrating above-chance classification of cue direction from around 300 ms post-cue onset. We then investigated whether stimming modulates decoding accuracy and task performance. Our results, consisting of data primarily from neurotypical participants, do not suggest that stimming has a negative impact on an individual’s ability to attend, unless the individual does not typically engage in stimming behaviours. This suggests interventions aiming to reduce stimming behaviours are not necessarily warranted and highlights the need for further research into the potential benefits of stimming specifically within the autistic population. Future research might also consider the potential overlap between autistic stimming and the fidgeting behaviours which are characteristic of ADHD, to help understand the significant overlaps between the characteristics of the two conditions.
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17. Swarup P, Vij PC, Vij A, Kumar P, Wani RA, Upadhyay V, Ambawata P, Dhankar A, Kumar K, Kumar A. To study the effect of children diagnosed with autism spectrum disorder on lives of parents and problems, challenges faced by them. J Family Med Prim Care. 2025; 14(8): 3220-4.
BACKGROUND: Autism spectrum disorder (ASD) poses significant challenges not only to affected children but also to their families, particularly parents. The impact of ASD on parents’ psychological, emotional, and social well-being can lead to increased stress and reduced quality of life. METHOD: This hospital-based observational cross-sectional study was conducted over six months (January to June 2024) at the Department of Pediatrics, School of Medical Sciences and Research, Greater Noida. Ethical clearance was obtained, and informed consent was acquired from parents of children diagnosed with ASD visiting the Pediatrics Outpatient Department. RESULT: Among the participants, a majority were female (56.0%), with most parents aged 31-40 years (65.5%). Many parents reported inadequate support, with 31.5% feeling they received « a little » support. Satisfaction rates varied: 45.5% were satisfied with sleep, and 46.0% with daily living activities. Notably, 32.5% of respondents experienced negative feelings « very often. » CONCLUSION: Parents of children with ASD face diverse challenges, including inadequate support and emotional distress. The findings underscore the need for targeted interventions and support programs to enhance their quality of life.
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18. Szubert M, Stojko R, Sieroszewski P. Statement of the Polish Society of Gynecologists and Obstetricians on paracetamol use during pregnancy and autism risk. Ginekol Pol. 2025.
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19. Takach KE, Dunham-Carr K, Parra G, Joffe-Nelson L, Jones L, Mankaryous R, Rogers S, Serianni C, Shao M, Zhang B, Hanson E, Puts NA, Cornelissen L, Levin AR. The « Sensory Paradox »: Exploring the Positive Association Between Hyper- and Hypo-Responsivity to Sensory Stimuli in Autism and Beyond. medRxiv. 2025.
BACKGROUND: Differences in sensory processing are a core feature of autism spectrum disorder. Hyper- and hyporesponsivity to sensory stimuli have historically been conceptualized as separate constructs but may co-occur within individuals. Sensory processing may impact both lower and higher-level cognitive processes; thus, it is crucial to understand the relationships between hyper- and hyporesponsivity within and across modalities, as well as the relationship between sensory processing and other aspects of development in both autistic and typically developing (TD) children. METHODS: In 3-4-year-old children ( n =41 autism; n =37 TD), we assessed relationships between sensory hyper- and hyporesponsivity both within and across visual, auditory, touch, and oral sensory modalities as measured by caregiver report. Secondary analyses evaluated relationships between sensory responsivity, social communication, and cognitive abilities. FINDINGS: We found a positive correlation between sensory hyper- and hyporesponsivity (ρ = .788, p < .001). These associations persisted within groups and within and across modalities. There are positive associations between sensory responsivity and social interaction, communication, and nonverbal developmental quotient, with associations between sensory responsivity and social communication driven by associations within the autism group. INTERPRETATION: The positive correlations between hyper- and hyporesponsivity both within and across sensory modalities, which we term the "Sensory Paradox," may provide key clues to understanding sensory processing in autism and other neurodevelopmental disorders by pointing towards neural circuit-level mechanisms that may underlie neurodevelopmental conditions. FUNDING: This study was funded by NIH/NINDS 1R01NS134948-01 (ARL), NIMH T32MH112510 (KDC), the Simons Foundation Autism Research Initiative (Award number 648277, ARL), and the Eagles Autism Foundation (ARL). RESEARCH IN CONTEXT: Evidence before this study: Up to 95% of autistic individuals are impacted by sensory processing differences. Across the full range of the autism spectrum, including individuals with profound ASD and self-advocates who speak publicly on issues of neurodiversity, improving sensory processing challenges is repeatedly noted as a common goal that would improve quality of life. Classical medical evaluation of sensory processing typically focuses on whether the structural pathways for transmission of sensory information are intact. The modulation of sensory information as it traverses these pathways, however, is a field ripe for further understanding. Initial reports have identified both hyper- and hyporesponsivity to sensory stimuli in autism, with some overlap between the two patterns of behavior.Added value of this study: This study demonstrates the seemingly paradoxical finding that hyper- and hyporesponsivity are strongly positively correlated in both autistic and typically developing toddlers. This positive correlation persists within groups and within individual sensory modalities (sight, sound, touch, and oral), as well as across modalities.Implications of all of the available evidence: The current findings, taken together with prior literature, support the Sensory Paradox - a framework for understanding sensory processing and the resulting sensory experience of autistic individuals which may also have key implications for a wider variety of neurological, psychiatric, and developmental conditions. Rather than considering hyper- and hyporesponsivity as static and opposing constructs, future work on the neurobiology, diagnosis, and management of sensory processing will benefit from considering the variable and context-dependent nature of sensory processing within individuals.
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20. Vitale C, Jaudon F, Luján R, Bartolucci M, Celora L, Reisoli E, Ruggeri R, Petretto A, Thalhammer A, Cingolani LA. Dysregulated cortical excitability and tau phosphorylation in a β3 integrin mouse model of autism. Brain. 2025; 148(10): 3635-51.
Autism spectrum disorder is a complex neurodevelopmental disease characterized by altered cortical network excitability. Recent genetic studies have identified deep layer V cortical pyramidal neurons in the frontal cortex as central to autism pathophysiology, yet the cortical circuits, plasticity mechanisms and molecular signalling pathways involved remain poorly understood. Layer V pyramidal neurons consist of two main types with distinct functional roles: intratelencephalic neurons, which respond to low-frequency stimulation and project within the cortex and striatum, and pyramidal tract neurons, which are tuned to theta-frequency inputs and convey information to subcortical structures. Determining which of these two neuron types is more critical to autism pathophysiology and whether disruptions in their synaptic connectivity or intrinsic excitability contribute to autism-related dysfunctions would significantly advance our understanding of the disorder. Integrins, a family of cell adhesion molecules, are vital for neuronal function. The gene encoding β3 integrin (ITGB3) is genetically linked to autism spectrum disorder, with rare mutations identified in affected individuals, while Itgb3 knockout mice exhibit autism-like behaviours, including impaired social memory and increased grooming. However, it remains unclear why loss of β3 integrin is associated with autism spectrum disorder, how it disrupts cortical circuits, and which plasticity mechanisms and molecular pathways are involved. Here, we demonstrate that β3 integrin selectively regulates the excitability of pyramidal tract neurons in the medial prefrontal cortex. Using electrophysiology, proteomics and molecular approaches, we show that β3 integrin regulates the gain, adaptation and precision of action potential discharge by controlling the surface expression of Ca2+-activated SK2 channels. Genetic ablation of Itgb3 impaired intrinsic excitability and SK2 channel function in pyramidal tract neurons, with no effects in intratelencephalic neurons. Furthermore, we identified Tau, a protein traditionally linked to neurodegenerative diseases, as part of the SK2 channel interactome. Proteomic analyses revealed altered protein kinase A-dependent phosphorylation of Tau in Itgb3 knockout mice, while protein kinase A inhibition restored SK2 channel currents, thereby connecting phosphorylation changes to excitability deficits. Our findings expand the current mechanistic framework linking signalling pathway dysfunctions to cortical excitability deficits, highlighting the dysregulation of pyramidal tract neuron excitability as a core feature of autism pathophysiology and demonstrating the involvement of β3 integrin, SK2 channels, Tau and PKA in this process. Because pyramidal tract neurons serve as final integrators of cortical computations before relaying information outside the cortex, their impaired excitability may disrupt communication with subcortical targets, contributing to the complex pathophysiology of autism spectrum disorder.
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21. Wang Q, Jia S, Ding F, Wang X, Si Y, Wang X, Sun J. Effect of fundamental movement skills practice on executive function and social interaction ability in children with moderate autism: a randomized controlled trial. BMC Complement Med Ther. 2025; 25(1): 354.
OBJECTIVE: To investigate the effects of practicing fundamental movement skills (FMS) on executive function and social interaction abilities in children with moderate autism. METHODS: A randomized controlled experimental design was employed. Twenty-five children with moderate autism were randomly assigned to either an experimental group or a control group. The experimental group received the FMS intervention, while the control group continued with their regular daily routine without intervention. The intervention was conducted over 18 weeks, with sessions held four times per week, each lasting 45 min at a moderate intensity. Executive function and social interaction abilities were assessed in both groups before and after the intervention. RESULTS: Social interaction abilities, as measured by the SRS-2 scores and its sub-dimensions, showed significant improvement (P < 0.05). In terms of executive function, significant improvements were observed in the Behavior Rating Inventory of Executive Function (BRIEF) scale scores, specifically in inhibition, shifting (cognitive flexibility), emotional control, and working memory (P < 0.05). However, there were no significant improvements in initiation, planning, organization, or monitoring functions (P > 0.05). CONCLUSION: The FMS intervention led to improvements in both social interaction abilities and executive function in children with autism spectrum disorder. However, the improvement in executive function was selective, with certain sub-dimensions showing significant gains while others did not. This study underscores the value of cross-modal interventions that bridge motor skill development and socioemotional learning, providing a foundation for future hybrid paradigms integrating FMS and dance movement therapy (DMT)principles. TRIAL REGISTRATION: The study protocol, based on a true experimental design, was registered with ClinicalTrials.gov (registration number ChiCTR2400087989) on August 8, 2024.
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22. Xu J, Graziosi G, Rodrigues FF, Tian R, Birnbaum R, Neil N. Economic impacts of caring for autistic children in Ontario, Canada: report from a pilot study. Front Public Health. 2025; 13: 1659801.
INTRODUCTION: Although research on the economic costs of autism is growing, relatively few studies have examined these costs incurred by families of autistic children in Canada. METHODS: This study designed and piloted a survey to capture the broader economic impact of caring for autistic children, including direct and indirect costs. It also sought to gather preliminary data to inform a future full-scale survey and enhance understanding of autism’s economic impact in the Canadian context. The pilot survey was developed through a systematic and iterative process involving a literature review, workshops, and focus group discussions. It was then distributed to families with autistic children in Ontario, Canada’s most populous province. RESULTS AND DISCUSSION: A mixed-method analysis of survey responses revealed that financial challenges for these families often begin during the diagnostic process and continue with high out-of-pocket medical and therapy costs. Caregivers also face challenges accessing funding and appropriate support services, contributing to indirect costs such as increased living expenses, childcare, education, and training. Caregivers of autistic children in Ontario experience substantial and multifaceted challenges that are compounded by inadequate public support. Understanding the nature and extent of caregiver expenditures can inform more targeted and efficient policy responses in financial, informational, and practical autism-related support.
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23. Yang W, He S, Zuoqiu S. Real-world evidence from a multi-center pediatric network: greenness exposure and autism spectrum disorder in urban China. Front Public Health. 2025; 13: 1666873.
INTRODUCTION: Childhood autism spectrum disorder (ASD) is a global public health concern and its prevalence is increasing rapidly in developing countries such as China. The mechanism behind ASD development remains unclear. Greenness exposure is reportedly associated with various health outcomes, however, the connection between greenness exposure and ASD is relatively unexplored. METHODS: We designed a two-stage screening process and conducted city-wide screening for early childhood ASD to investigate the association between greenness exposure and ASD prevalence in a megacity in southwest China. RESULTS: We screened 13,458 children from 0-52 months through 20 local primary care hospitals and the estimated ASD prevalence was 0.55%. We matched greenness exposure, air pollution exposure, and weather condition with ASD diagnosis outcomes based on the study subject’s geographic information. Gender (male) and age (older) were significantly associated with higher odds of being diagnosed with ASD. DISCUSSION: Although the association between ASD diagnosis and greenness was not statistically significant, real-world data may help improve ASD screening methods and guide future studies. Our findings highlight the potential role of real-world environmental and health data in informing sustainable urban and pediatric health policies.
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24. Yaylaci M, Dogan O, Kirşan FZ, Oztop DB. An Investigation of the Levels of Serine Protease and Associated Molecules in Children with Autism Spectrum Disorder. J Mol Neurosci. 2025; 75(4): 134.
This study aimed to elucidate the potential role of serine proteases and their associated regulatory molecules in the etiopathogenesis of autism spectrum disorder (ASD) and to assess their relationship with symptom severity and specific behavioral domains in children diagnosed with ASD. A cross-sectional design was employed, including 44 children aged 2 to 6 years with a confirmed diagnosis of ASD and 43 age- and sex-matched typically developing children as controls. Behavioral assessments were conducted using the Childhood Autism Rating Scale (CARS), the Autism Behavior Checklist (ABC), and the Repetitive Behavior Scale-Revised, Turkish Version (RBS-R-TV). Serum concentrations of motopsin, agrin, C-terminal agrin fragment (CAF), tissue plasminogen activator (tPA), neuroserpin, and plasminogen activator inhibitor-1 (PAI-1) were determined using enzyme-linked immunosorbent assay (ELISA). Serum levels of all analyzed molecules were significantly reduced in the ASD group compared to controls (p < 0.05 for all). Although no significant associations were observed between total ASD severity scores and biomarker concentrations, notable correlations emerged between specific behavioral subdomains and select biomarkers. Motopsin levels exhibited a moderate positive correlation with the "imitation" subdomain of CARS and the "sensory" subdomain of ABC. Conversely, agrin levels demonstrated moderate inverse correlations with "listening response," "taste-smell-touch response and use," and "activity level" subdomains of CARS. PAI-1 levels showed a significant negative correlation with the "self-injurious behavior" subdomain of RBS-R-TV. The findings suggest that serine proteases and their modulators implicated in synaptic remodeling and neuroplasticity may contribute to the underlying neurobiological mechanisms of ASD. The observed domain-specific associations support the hypothesis that ASD comprises heterogeneous neurodevelopmental trajectories, and that peripheral biochemical markers reflecting these pathways may aid in the identification of ASD subtypes and guide personalized therapeutic strategies.
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25. Yoon CD, Alexander AL, Travers BG, Lainhart JE, Iii DCD. Widespread alterations in white matter microstructure in autism: A multilevel meta-analysis. Res Sq. 2025.
Background Disrupted brain connectivity is central to understanding the neurobiological basis of autism spectrum disorder (ASD). Diffusion tensor imaging (DTI) has been extensively used to study brain microstructure in ASD, which often reveals reduced fractional anisotropy (FA) and increased mean diffusivity (MD), indicating altered microstructural integrity. Methods We conducted a multivariate random-effects meta-analysis with a multilevel structure to evaluate the extent to which FA and MD measures of white matter microstructure are altered in individuals with ASD compared to typically developing (TD) individuals, as well as how participant characteristics and laterality moderate the magnitude of the estimated differences. Our analysis included 680 effect sizes from 59 studies ( N (ASD) = 1,750, N (TD) = 1,484; M (age) = 2-50 years) across 11 white matter tracts. Results We found a significant moderate summary effect size for FA in eight tracts (corpus callosum, corticospinal tract, thalamic radiation, arcuate fasciculus, inferior fronto-occipital fasciculus [IFOF], inferior longitudinal fasciculus [ILF], superior longitudinal fasciculus [SLF], and uncinate fasciculus; Hedges’ g = -0.40 to -0.59), suggesting that individuals with ASD have lower FA values in these tracts compared to TD controls. Additionally, we found a significant moderate-to-large summary effect size for MD in six tracts (corpus callosum, corona radiata, arcuate fasciculus, IFOF, ILF, and SLF; Hedges’ g = 0.32 to 1.09), suggesting that individuals with ASD have higher MD values in these tracts compared to TD controls. Furthermore, moderators demonstrated tract- and metric-specific effects. Limitations: Participants were primarily male, and the age range excludes later adulthood when white matter deterioration becomes more evident. Therefore, our findings are limited in generalizing to females and may not be applicable across the entire lifespan. Conclusions Collectively, our findings highlight the complex and multidimensional nature of white matter alterations observed in ASD.
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26. Yorke I, Boatman CA, Roy Choudhury A, Oakley B, Conde P, Sankesara H, Ranjan Y, Rashid Z, Dineley J, Downs J, Chatham CH, Cummins N, Folarin A, Loth E, Buitelaar J, Murphy D, Dobson R, Simonoff E. A Dual In-Person and Remote Assessment Approach to Developing Digital End Points Relevant to Autism and Co-Occurring Conditions: Protocol for a Multisite Observational Study. JMIR Res Protoc. 2025; 14: e71145.
BACKGROUND: Research priorities for autistic people include developing effective interventions for the numerous challenges affecting their daily living, for example, mental health problems, sleep difficulties, and social well-being. However, clinical research progress is limited by a lack of validated objective measures that represent target outcomes for improvement. Digital technologies, including wearable devices and smartphone apps, provide opportunities to develop novel measures that may reflect everyday experience and complement key clinical assessments. However, little is known about the acceptability and feasibility of implementing digital data collection in this population. OBJECTIVE: The primary objective of this study is to evaluate the usability, acceptability, adherence, and feasibility of a dual in-person and remote (ie, at-home) protocol. Secondarily, we aim to explore the properties of certain resulting data with a view to developing novel digital end points for key target outcomes, including social communication, sleep, and mental health. METHODS: Eligible autistic and nonautistic in the AIMS Longitudinal European Autism Project were invited to participate in a digitally augmented in-person Autism Diagnostic Observation Schedule-2 (ADOS-2) and a 28-day remote measurement (RM) protocol involving wearing a Fitbit device, downloading a passive smartphone data collection app, and using 2 active reporting apps. RESULTS: The first AIMS Longitudinal European Autism Project study participants were enrolled in September 2021 (in-person component) and March 2022 (RM component). To date, 190 participants have taken part in the digitally augmented ADOS-2 component, and 86 participants have been enrolled for the RM protocol. Recruitment is now complete with some RM data collection ongoing until August 2025. Data analysis has commenced, including qualitative framework analysis of feedback interview data coproduced with autism community members, exploration of acceptability and feasibility metrics, pipeline development for ADOS-2 speech analysis, and RM sleep measures. CONCLUSIONS: This study lays important groundwork in understanding the acceptability and feasibility of in-person and remotely implemented digital measurement procedures to capture meaningful outcomes in domains important to improving everyday life for autistic people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/71145.
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27. Zhang Y, Yahia A, Sandin S, Åden U, Tammimies K. Prematurity and genetic liability for autism spectrum disorder. Genome Med. 2025; 17(1): 108.
BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by diverse presentations and a strong genetic component. Environmental factors, such as prematurity, have also been linked to increased liability for ASD, though the interaction between genetic predisposition and prematurity remains unclear. This study aims to investigate the impact of genetic liability and preterm birth on ASD conditions. METHODS: We analyzed phenotype and genetic data from two large ASD cohorts, the Simons Foundation Powering Autism Research for Knowledge (SPARK) and Simons Simplex Collection (SSC), encompassing 78,559 individuals for phenotype analysis, 12,519 individuals with genome sequencing data, and 8104 individuals with exome sequencing data. Statistical significance of differences in clinical measures was evaluated between individuals with different ASD and preterm status. We assessed the rare variants burden using generalized estimating equations (GEE) models and polygenic load using the ASD-associated polygenic risk score (PRS). Furthermore, we developed a machine learning model to predict ASD in preterm children using phenotype and genetic features available at birth. RESULTS: Individuals with both preterm birth and ASD exhibit more severe phenotypic outcomes despite similar levels of genetic liability for ASD across the term and preterm groups. Notably, preterm-ASD individuals showed an elevated rate of de novo variants identified in exome sequencing (GEE model, p = 0.005) in comparison to non-ASD-preterm group. Additionally, a GEE model showed that a higher ASD PRS, preterm birth, and male sex were positively associated with a higher predicted probability for ASD in SPARK, reaching a probability close to 90%. Lastly, we developed a machine learning model using phenotype and genetic features available at birth with limited predictive power (AUROC = 0.65). CONCLUSIONS: Preterm birth may exacerbate multimorbidity present in ASD, which was not due to ASD-associated genetic variants. However, increased ASD-associated rare variants may elevate the likelihood of a preterm child being diagnosed with ASD. Additionally, a polygenic load of ASD-associated variants had an additive role with preterm birth in the predicted probability for ASD, especially for boys. Future integration of genetic and phenotypic data in larger preterm or population-based cohorts will be crucial for advancing early ASD identification in preterm subgroup.
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28. Zou M, Gong X, Feng L, Li S, Lu C, Liu Z, Sun C, Wu L. Regional Disparities in the Use and Demand for Digital Health Services for Autism Spectrum Disorder in China: Cross-Sectional Survey of Stakeholder Perspectives. J Med Internet Res. 2025; 27: e77157.
BACKGROUND: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, the prevalence of which is increasing in China and worldwide. Digital health technologies offer promising solutions for improving screening, diagnosis, and rehabilitation of children with ASD, particularly in resource-limited settings. However, digital health technologies for ASD have not been adopted in China. Understanding utilization patterns, influencing factors, and user needs is essential to inform equitable, effective digital health strategies. OBJECTIVE: This study aimed to assess the current use, influencing factors, and perceived needs of digital health services among parents of children with ASD and rehabilitation therapists in 2 distinct provinces in China. METHODS: A cross-sectional survey was carried out between November 2023 and February 2024 in Heilongjiang and Fujian provinces. Purposive sampling recruited a total of 780 parents and 745 rehabilitation therapists to complete a structured questionnaire. Data were analyzed using descriptive statistics, stepwise multivariable logistic regression, and multiple response analysis. RESULTS: The use of digital health services was low among parents (46/780, 5.9%) and rehabilitation therapists (161/745, 21.6%), although the demand was substantially higher (621/780, 79.6% and 671/745, 90.0%, respectively). Among parents, higher use was positively associated with younger age (20-29 years), employment, lower income (≤CNY 3000/month [US $421.247/month]), and delayed ASD diagnosis (7-12 years old). Among rehabilitation therapists, male, special education background, and autism-specific training experience predicted higher use (all P<.05). Demand was significantly greater in Fujian than in Heilongjiang and was positively associated with higher education levels in parents and rehabilitation therapists (P<.05). Parents and rehabilitation therapists valued a greater understanding of ASD behaviors and development and easier access to resources as primary benefits. Common barriers to the use of digital health services included high cost, need for additional equipment, and usability challenges. The smartphone-WeChat mini-program was the preferred device and platform, respectively. Parents prioritized access to rehabilitation courses, remote guidance, and policy information, while rehabilitation therapists favored personalized plans and professional skills training. CONCLUSIONS: Despite a strong demand, digital health services are underused in ASD care across China, with adoption of digital health services influenced by regional disparities and sociodemographic factors. This study, as the first comparative analysis of parents and rehabilitation therapists in 2 Chinese provinces, provides stakeholder-specific insights to guide targeted, locally relevant interventions. Bridging the digital divide through inclusive policies, training, and cross-sector collaboration will be essential for equitable integration into ASD care pathways.
