1. Abu-Nowar H, Sait A, Al-Hadhrami T, Al-Sarem M, Noman Qasem S. SENSES-ASD: a social-emotional nurturing and skill enhancement system for autism spectrum disorder. PeerJ Comput Sci;2024;10:e1792.

This article introduces the Social-Emotional Nurturing and Skill Enhancement System (SENSES-ASD) as an innovative method for assisting individuals with autism spectrum disorder (ASD). Leveraging deep learning technologies, specifically convolutional neural networks (CNN), our approach promotes facial emotion recognition, enhancing social interactions and communication. The methodology involves the use of the Xception CNN model trained on the FER-2013 dataset. The designed system accepts a variety of media inputs, successfully classifying and predicting seven primary emotional states. Results show that our system achieved a peak accuracy rate of 71% on the training dataset and 66% on the validation dataset. The novelty of our work lies in the intricate combination of deep learning methods specifically tailored for high-functioning autistic adults and the development of a user interface that caters to their unique cognitive and sensory sensitivities. This offers a novel perspective on utilising technological advances for ASD intervention, especially in the domain of emotion recognition.

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2. Barnes GL, Ozsivadjian A, Baird G, Absoud M, Hollocks MJ. Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation. J Autism Dev Disord;2024 (Mar 4)

Internalising symptoms are elevated in autism compared to the general population. Few studies have investigated emotional dysregulation (ED) as a potential mediator between specific transdiagnostic processes and anxiety and depression symptoms in autistic youth. In a sample of 94 autistic young people aged 5-18 years referred to a specialist clinic for an autism evaluation, we tested the effects of ED as a mediator between cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia with anxiety and depression symptoms, using structural equation modelling. Effect sizes were compared to a non-autistic comparison group (n = 84). CI and alexithymia did not significantly predict depression symptoms in autistic young people, directly nor via ED. Relationships between CI/alexithymia and depression were fully mediated by ED in the non-autistic sample. There was a direct effect of CI on anxiety in the non-autistic group but not in those with a diagnosis. IU predicted depression symptoms in the autism group; and ED mediated this relationship only in those who did not receive a diagnosis. IU directly predicted anxiety in both groups and this relationship did not occur via ED. The finding of a direct pathway from IU to anxiety and depression in autistic youth is consistent with the literature. The finding that CI did not predict anxiety or depression in those with autism is novel, as was the finding that ED mediated relationships between alexithymia and anxiety/depression symptoms in both samples. The findings may have important implications for the delivery of psychological interventions for autistic youth.

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3. Cavanaugh G, Bai J, Tartar JL, Lin J, Nunn T, Sangwan N, Patel D, Stanis S, Patel RK, Rrukiqi D, Murphy H. Enteric Dysbiosis in Children With Autism Spectrum Disorder and Associated Response to Stress. Cureus;2024 (Jan);16(1):e53305.

Background Microbiome studies in humans, though limited, have facilitated the evaluation of the potential connection between the microbiome and brain function. Children with autism spectrum disorder (ASD) have several behavioral challenges and avoidant/restrictive food intake disorder, which may contribute to gut microbiome dysbiosis. Aim The aim of this study is to examine the extent to which the gut microbiome of children with ASD differs in comparison to children with neurotypical development (CWND) and to assess whether a probiotic intervention has the potential to influence the gut microbiome in mediating positive behavior change and stress regulation. Methods This pilot study collected data from three children with ASD and four CWND before and after a four-week probiotic intervention. Data collection included microbiome diversity screening from stool samples as well as the following biophysiological measures: salivary alpha-amylase (sAA) levels, response to simulated stressor and calming stimulus (behavior), including pulse rate, galvanic skin response, and pupil diameter (PD). In addition, telomere length was assessed. All measures, except for telomere length, were repeated after the four-week intervention on the ASD and CWND groups for pre-/post-comparison. Data analysis consisted of multivariate analyses, including ANOVA. Results While greater heterogeneity in the ASD group was evident in all measures, the gut microbiome of participants who received probiotic intervention differed from pretreatment results within and across the groups investigated. Further, the biophysiological parameter sAA displayed a significant increase between baseline and exposure to stress in both groups, whereas PD increased in both groups from baseline, F(11, 26615) = 123.43, p = 0.00. Conclusion Though gut microbiome diversity is diminished in children with ASD compared to CWND, the gap is narrowed following a brief probiotic intervention. The results suggest that probiotic interventions have the potential to rescue microbiome diversity and abundance, potentially supporting stress regulation in pediatric populations.

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4. Cheng R, Zhao Z, Hou WW, Zhou G, Liao HT, Zhang X, Li J. [Machine learning algorithms for identifying autism spectrum disorder through eye-tracking in different intention videos]. Zhongguo Dang Dai Er Ke Za Zhi;2024 (Feb 15);26(2):151-157.

OBJECTIVES: To investigate the differences in visual perception between children with autism spectrum disorder (ASD) and typically developing (TD) children when watching different intention videos, and to explore the feasibility of machine learning algorithms in objectively distinguishing between ASD children and TD children. METHODS: A total of 58 children with ASD and 50 TD children were enrolled and were asked to watch the videos containing joint intention and non-joint intention, and the gaze duration and frequency in different areas of interest were used as original indicators to construct classifier-based models. The models were evaluated in terms of the indicators such as accuracy, sensitivity, and specificity. RESULTS: When using eight common classifiers, including support vector machine, linear discriminant analysis, decision tree, random forest, and K-nearest neighbors (with K values of 1, 3, 5, and 7), based on the original feature indicators, the highest classification accuracy achieved was 81.90%. A feature reconstruction approach with a decision tree classifier was used to further improve the accuracy of classification, and then the model showed the accuracy of 91.43%, the specificity of 89.80%, and the sensitivity of 92.86%, with an area under the receiver operating characteristic curve of 0.909 (P<0.001). CONCLUSIONS: The machine learning model based on eye-tracking data can accurately distinguish ASD children from TD children, which provides a scientific basis for developing rapid and objective ASD screening tools.

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5. Davies J, Romualdez AM, Malyan D, Heasman B, Livesey A, Walker A, Pellicano E, Remington A. Autistic Adults’ Priorities for Future Autism Employment Research: Perspectives from the United Kingdom. Autism Adulthood;2024 (Mar 1);6(1):72-85.

BACKGROUND: A growing body of research has sought to understand autistic people’s research priorities. Several of these studies have identified employment as a key research priority. Yet, there have been a few attempts to identify specific, actionable priorities within this area. METHODS: Using an online survey, we asked 197 autistic people in the United Kingdom about their priorities for future autism-employment research. RESULTS: Participants spoke of their challenges in gaining and sustaining meaningful employment and called for researchers to conduct research that results in direct improvements to employment experiences. Regarding their research priorities, participants indicated a need for research covering all aspects of the employment lifecycle from accessing employment to transitioning out of employment. Importantly, participants also discussed how such research should be conducted: with autistic people as co-researchers and ensuring a diverse range of autistic people are listened to. CONCLUSION: While much existing autism-employment research appears to align with the priorities outlined in this study, seemingly minimal attention has been paid to later stages of the work lifecycle (e.g., progressing into more senior job roles or transitioning out of work). By identifying disparities between autistic people’s priorities and the research being conducted, we can support autistic people to drive the research agenda and ensure autism-employment research positively impacts the community it aims to serve. WHY WAS THIS STUDY DONE? It is important for autism research to identify and study topics that are important to autistic people. Employment has been highlighted as an important topic by autistic people in many studies. However, we don’t know what specific topics employment research should look at. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to know which employment-related topics autistic people think are important to research and understand why. WHAT DID THE RESEARCHERS DO? We created an online survey to ask autistic people about what employment research should look at. The survey asked participants about themselves (e.g., their age) and their employment experience (e.g., if they were employed or not). We also asked questions about what employment topics should be researched, why these topics are important, and what changes employment research should lead to. In total, 197 autistic people responded. We read through all the responses and grouped similar responses together. WHAT WERE THE RESULTS OF THE STUDY? Lots of our participants found it hard to find and keep a job. They wanted research to make autistic peoples’ experiences of employment better. For example, by making hiring processes better, and by making workplaces more inclusive. They also said that research should look at all parts of employment from getting a job, to leaving a job and retiring. Participants also talked about how research should be done. They said more autistic people should be included as researchers, and we should include different autistic people from different backgrounds. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Our findings show that lots of autism-employment research is on topics that autistic people think are important. However, not much research has looked at later stages of employment, such as getting a promotion or retiring. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? Most of our participants were White, female, employed and had a degree, but in the wider autistic population that isn’t the case. People from other backgrounds may have different experiences of employment, and therefore want different research. We also don’t know which topic is the most important because we didn’t ask participants to rank the topics they spoke about. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? This study highlights key topics that autism-employment researchers should look at. By showing where the gaps in research are, we can make sure that all the employment topics autistic people think are important are researched. eng

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6. Gajre MP, Shah M, Pradhan SV, Aseri H. Examining the Impact of Group-Based Social Skills Intervention in Autistic Children Aged Eight to 15 Years. Cureus;2024 (Feb);16(2):e53376.

Introduction Autism spectrum disorder (ASD) is a neurological and developmental disorder, which poses challenges to social communication and behavior, particularly affecting social functioning. Individuals with ASD face significant social challenges, including difficulty understanding social cues and body language, limited ability to engage in reciprocal social interactions, and challenges with establishing empathy. A preference for routines and repetitive behaviors limits their ability to adapt to new or unexpected social situations. These problems tend to escalate during adolescence. These often cause distress to the individual as well as the caregivers. Group-based social skills interventions (GSSIs) are a widely used and effective modality for addressing core social impairments in children with autism. This study aims to assess the impact of GSSI on the broad age group of eight to 15 years, involving parents to enhance the transferability of children’s social skills. Methods This was a single-arm interventional study where 30 verbal autistic children, aged eight to 15 years, with intelligence quotient (IQ) > 70 were enrolled after utilizing the Binet Kamat Test of Intelligence (BKT) to assess IQ and the Indian Scale for Assessment of Autism (ISAA) to grade severity of autism. The children received GSSI from interdisciplinary therapists for 12 sessions, on a weekly basis, lasting 90 minutes each for a period of three months. After each therapy session, parents received summaries of each session and were delegated reinforcing homework assignments to enable generalization and maintenance of the skills taught. Outcome measures were taken at three points in time by utilizing the Social Communication Questionnaire (SCQ) and the parent-rated Social Responsiveness Scale 2 (p-SRS-2): T1: pre-therapy at the time of enrolment; T2: immediately post-therapy at the end of three months of training; and T3: long-term follow-up, three months after the end of training. Results Mean SCQ scores were as follows: T1 = 21.87, T2 = 18.57, and T3 = 18.57 (p = 0.000). This progressive decline at T1, T2, and T3 indicated a decreasing trend in the severity of difficulties in the social communication domain. Mean p-SRS-2 scores were as follows: T1 = 73.00, T2 = 64.57, and T3 = 64.30 (p < 0.0001). This declining trend at T1, T2, and T3 suggested a statistically significant decrease in the severity of difficulties faced in various social aspects tested by the p-SRS-2, i.e., social awareness, social cognition, social communication, and social motivation, along with a reduction in restricted interests and repetitive behaviors (RRBs). Very strong correlation coefficients were obtained for SCQ scores (T1-T2 = 0.921, T1-T3 = 0.921, and T2-T3 = 1.000), as well as for p-SRS-2 scores (T1-T2 = 0.743, T1-T3 = 0.746, and T2-T3 = 0.989), which reinforced the statistical significance of the data. Conclusion GSSI is an effective parent-assisted intervention for adolescents with ASD, with effects lasting up to three months post-intervention.

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7. Garzotto F, Gianotti M, Patti A, Pentimalli F, Vona F. Empowering Persons with Autism through Cross-Reality and Conversational Agents. IEEE Trans Vis Comput Graph;2024 (Mar 4);Pp

Autism Spectrum Disorder is a neurodevelopmental condition that can affect autonomy and independence. Our research explores the integration of Cross-Reality and Conversational Agents for Autistic persons to improve ability and confidence in everyday life situations. We combine two technologies of the Virtual-Real continuum. User experiences unfold from the simulation of tasks in VR to the execution of similar tasks supported by AR in the real world. A speech-based Conversational Agent is integrated with both VR and AR. It provides contextualized help, promotes generalization, and stimulates users to apply what they learned in the virtual space. The paper presents the approach and describes an empirical study involving 17 young Autistic persons.

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8. Gilmore D, Radford D, Haas MK, Shields M, Bishop L, Hand B. Building Community and Identity Online: A Content Analysis of Highly Viewed #Autism TikTok Videos. Autism Adulthood;2024 (Mar 1);6(1):95-105.

BACKGROUND: TikTok is a popular social media site for connecting with others online where many users also access and share health-related information. Previous studies have characterized information shared about specific disabilities on TikTok, but descriptions of autism-related content are lacking. Understanding the information shared about autism on TikTok is important to understanding health communication in this space, the lived experiences of autistic people, and the role that social media platforms play in building community through connection, understanding, and inclusion. METHODS: We used an open-source data scraper to identify and download videos with at least 1 million views and that used the hashtag #autism from TikTok. Using a joint inductive and deductive approach, we performed a content analysis of videos. We identified six content topics that described video content (e.g., positive social interactions and features of autism), and three categories that described video purpose (e.g., educational, experiential, and observational). We used descriptive statistics to describe characteristics of who was in the TikTok videos. RESULTS: We analyzed n = 678 videos. The most common content topic of TikTok videos was features of autism (39.7%), followed by marginalization (25.4%). Most videos were categorized as experiential (61.4%) or observational (31.4%) rather than educational (7.2%). Approximately 65.5% of videos featured an autistic adult and 22.6% featured an autistic child. Among videos featuring an autistic person (n = 594), most autistic people were perceived to be White (87.0%) with similar numbers of feminine (52.9%) and masculine (44.8%) presenting autistic people. CONCLUSIONS: Highly viewed #autism TikTok videos primarily share autistic people’s individual experiences rather than providing general education about autism. However, autistic Black, Indigenous, and people of color may have difficulty finding others that represent them along both disability and racial dimensions. Future research should investigate autistic people’s motivations for using TikTok, and how #autism content shapes social discourse about autism. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to describe information about autism that is highly viewed on TikTok to better understand what people see, hear, and learn about autism online. Autism content on TikTok can help autistic people find others with similar experiences and build community and can shape the way nonautistic people view and interact with autistic people. WHAT DID THE RESEARCHERS DO? We downloaded videos from TikTok that used the hashtag #autism and had at least 1 million views. We watched the videos and assigned each video a content topic and a category. Content topics described the content of the video and categories described the purpose of the video. WHAT WERE THE RESULTS OF THE STUDY? We included 678 videos grouped into six content topics: (1) features of autism, which included videos about restrictive and repetitive behaviors, social and communication differences, associated core experiences, and talents; (2) marginalization, which included videos about lack of access, stigma and misconceptions, and inspiration porn; (3) supports, which included accommodations, services and interventions, and caregiving; (4) positive social interactions; (5) daily life; and (6) miscellaneous/other.The most common content topic was features of autism (39.7%), followed by marginalization (25.4%). The least common content topic was positive social interactions (5.2%). The most common category of videos was experiential (61.4%), followed by observational (31.4%) and educational (7.2%). More than half of the videos included an autistic adult, and about a quarter included an autistic child. Among the videos that included an autistic person, most autistic people were perceived to be White, and there were similar numbers of masculine and feminine-presenting autistic people. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? We know that many autistic people like to communicate online and use social media. These findings show that most of the content about autism on TikTok involves autistic people sharing their life experiences instead of providing “facts” or education about autism. Because autistic people from diverse backgrounds were less often present in videos, these individuals may have difficulty connecting with each other on TikTok. WHAT ARE POTENTIAL WEAKNESSES IN THIS STUDY? We did not download TikTok videos while logged into a user account, so the videos we included may be different than the videos shown to an individual user who searches #autism. The way that we categorized videos may have been different from how others would have done so. We did not include less-viewed videos in the study, which could have had different content topics. Our perceptions of the gender, race, and ethnicity of people in videos may not reflect how they would self-identify. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? These findings may be helpful for autistic adults who are looking for online community building with other autistic people. Because many autistic people shared their lived experiences, these findings may promote understanding and acceptance of autistic people by nonautistic people. eng

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9. Gore K, Hayward SM, Flower RL, Gilbert M, Barbaro J. « Maybe No One Knows We Need Help »: Understanding the Experiences of Autistic Working Mothers in Australia. Autism Adulthood;2024 (Mar 1);6(1):47-59.

BACKGROUND: Although there are no known studies investigating autistic working mothers, research has demonstrated that managing employment and motherhood in non-autistic populations has specific challenges, as does employment in autistic populations. This autistic-led study aimed at investigating the experience of autistic working mothers to identify benefits, challenges, and support needs. METHODS: We utilized a subjectivist epistemological perspective to learn about the experiences of autistic working mothers. We recruited 10 autistic working mothers (aged 34-50 years) via social media advertisements, who participated in a 45- to 60-minute semi-structured interview where we asked questions developed in consultation with a community reference group. We transcribed interviews and then analyzed them using inductive reflexive thematic analysis. RESULTS: We identified three key themes. The first theme, « Wellbeing: Work gives me purpose, » discusses how employment supports mental well-being. The second theme, « Challenges: It’s hard being an autistic working mother, » includes the challenges of balancing work and caregiving, guilt related to being a working mother, and issues with part-time work. The third theme, « The invisible disability: Everyone thinks I look okay, » discusses the lack of understanding of participants’ challenges, with assumptions they are coping, and the lack of supports that led to some participants no longer seeking assistance. CONCLUSIONS: The responses of the autistic women who took part support a view that autistic working mothers may experience some similar challenges to non-autistic working mothers, including stress in juggling caring and work roles. They identified additional challenges related to their gender and their autistic identity, including a lack of understanding of the female (or « internalized ») presentation of autism. These findings will help autistic working mothers by promoting a better understanding of their experiences and challenges when they speak with health professionals, government, and employers seeking support and accommodations. WHY IS THIS AN IMPORTANT ISSUE? We did not find any existing research about the experiences of autistic women who are working mothers. However, we felt this was an important topic to investigate because previous research involving women who are not autistic has reported that being a working mother can be challenging. In addition, previous autism research has found that autistic people can find aspects of work difficult. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to find out about the experiences of autistic working mothers and their support needs. WHAT DID THE RESEARCHERS DO? We recruited 10 autistic working mothers (aged 34–50 years), through social media advertisements. We interviewed each participant separately and the interviews took between 45 and 60 minutes. We asked each participant the same set of questions to understand their perspectives on the benefits and challenges of being a mother, an employee, and a working mother, and to find out where they needed support. We then analyzed the interview transcripts to find common themes. WHAT WERE THE RESULTS OF THE STUDY? We identified three key themes about the experience of autistic working mothers. The first theme called “Wellbeing: Work gives me purpose” discusses how employment supports mental well-being and financial independence. The second theme, “Challenges: It’s hard being an autistic working mother,” includes the challenges in balancing work and caregiving, guilt related to being a working mother, and issues with part-time work. The third theme called “The invisible disability: Everyone thinks I look okay” discusses a lack of understanding of participants’ challenges, with assumptions they are coping, and the lack of supports for autistic working mothers that led to some participants no longer seeking assistance. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? We found that autistic working mothers may experience some challenges, which are similar to those identified in previous studies involving working mothers who are not autistic such as stress related to juggling being a mother and an employee. In addition to this, they may experience other challenges related to their gender and their autism, such as a lack of understanding of how autistic women mask and camouflage and assumptions by professionals that autistic working mothers are coping because they previously managed employment and parenting without any support. WHAT ARE THE POTENTIAL WEAKNESSES IN THE STUDY? One limitation of our study is that the participant group lacks diversity. For example, it does not include autistic people from a range of cultural backgrounds such as First Nations Australians, or from a range of educational and socio-economic backgrounds. Although the study was open to participants who identify their gender as non-binary, no non-binary autistic people registered for the study. This meant our results only included the views of autistic working mothers who identify as women and have completed further education after high school. In addition, 90% of participants were diagnosed with autism as adults. Although late diagnosis is common, especially in women, it may also mean that some of the results were specific to this group. Future research could address these issues by having a larger participant group, which specifically includes those from diverse cultural, educational, and socioeconomic backgrounds, gender diverse participants, and both early- and late-diagnosed autistic women and non-binary people. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? These findings will help autistic working mothers by promoting a better understanding of their experiences and challenges when they speak with health professionals, government, and employers seeking support and accommodations. eng

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10. Hong S, Lee Y, Park W. Evaluating the delivery of physical activity for people with developmental disabilities using an online knowledge translation approach: part 1 – web accessibility. Disabil Rehabil Assist Technol;2024 (Mar 4):1-9.

Background: Knowledge-to-action gap exists in delivering physical activity (PA) to people with developmental disabilities via online platforms. Although web-based platforms have great potential in facilitating the delivery of PA for this target group, the lack of knowledge regarding web accessibility poses a challenge in accessing PA-related information online.Objective: This study evaluates the delivery of PA in terms of web accessibility. It also aims to identify barriers and facilitators in delivering PA knowledge to people with developmental disabilities online to improve web accessibility for the target user group.Methods: The study employs a concurrent nested design incorporating both quantitative (web usability questionnaire) and qualitative data (in-depth interviews). Fifteen pairs of individuals consisting of a person with developmental disabilities and a primary caregiver participated in the study, and three web-based platforms were selected for web accessibility tests and in-depth interviews.Results: The nested analysis provides a quantitative comparison of web accessibility and identifies barriers and facilitators of delivering PA for the target user group from the web accessibility perspective. Conclusion: The study findings could inform the development of accessible online platforms that distribute health-related knowledge to populations with developmental disabilities. Additionally, they could help enhance the design of other platforms intended for these populations. Online platforms have significant potential to improve the delivery of physical activity information to individuals with developmental disabilities.Barriers to accessing online platforms due to poor web usability impede the process of online knowledge translation to end-users.Web usability can be enhanced by implementing appropriate interventions, such as restructuring navigation and redesigning the user interface.Improving web usability will enhance the accessibility of physical activity knowledge for individuals with developmental disabilities, which consequently will positively impact their health. eng

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11. Huo Y, Chen J, Zhang A, Zhou C, Cao W. Roles of complement system in psychiatric disorders. Zhong Nan Da Xue Xue Bao Yi Xue Ban;2023 (Oct 28);48(10):1539-1545.

The complement system is an important part of the innate immune system, including more than 50 secretory proteins and membrane-bound proteins, and it contributes to the clearance of apoptotic cells and invading pathogens to limit inflammatory immune responses and maintaining brain homeostasis. Complement activity is strictly regulated to protect cells from random attacks or to prevent the deposition of complement proteins in physiological cases. However, overactivation or abnormal regulation of the complement cascade in the brain can lead to neuronal damage and brain dysfunction. Recent studies have pointed out that changes in complement molecules exist in patients with psychiatric diseases and play an important role in the occurrence and development of diseases by regulating the function of neurons and glial cells. Therefore, summarizing the latest research progress of complement system in psychiatric diseases such as schizophrenia, autism spectrum disorder, major depression, bipolar disorder and anxiety disorder can provide new ideas for preventing and controlling psychiatric diseases caused by abnormal activation of complement system.

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12. Keenan EG, Gurba AN, Mahaffey B, Kappenberg CF, Lerner MD. Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights. Autism Adulthood;2024 (Mar 1);6(1):1-8.

Autistic people may experience high emotion and sensory sensitivities and a slow return to baseline emotional state. Dialectical behavior therapy (DBT) was developed to address reactivity, impulsivity, and mood dysregulation in individuals with mood and personality disorders. DBT may be therapeutically beneficial to autistic individuals struggling with these or similar emotional and sensory challenges. This article is a synthesis of the first author’s experiences of DBT as an autistic person and professional insights from all authors. We provide an overview of the development of DBT, its foundational components, and adaptations. Using this basis, the first author describes the benefits DBT has had, the modifications that have helped him, and how those modifications may enhance DBT for autistic people. Modifications include visuals, graphics, and a gaming format that target the client’s personal interests. The essence of these alterations is to transform life skills and DBT skills into something meaningful and functional. Receptivity of the therapist to the modifications and neurodivergent problem solving may be foundational to therapeutic success. Client-initiated contributions in collaborative therapy may improve autistic participants’ understanding, validation, and adherence with DBT. The authors suggest expanding work on DBT modifications for autism in the areas of daily self-monitoring, assessing for preferred visual and gaming formats, and utilizing personal interests. WHY IS THIS TOPIC IMPORTANT? Many autistic people struggle with their emotions. There are few therapies that assist autistic people with these challenges. Dialectical behavior therapy (DBT) is a therapy that teaches skills for coping with emotions and forming healthy bonds with others. DBT may provide benefits to autistic people. WHAT IS THE PURPOSE OF THIS ARTICLE? This article uses personal insights with DBT from the first author. The article combines the professional expertise of all authors. We talk about the strengths DBT may have for autistic people. We recommend changes to make DBT a more helpful therapy. WHAT PERSONAL OR PROFESSIONAL PERSPECTIVES DO THE AUTHORS BRING TO THIS TOPIC? The first author is an autistic researcher in psychology. He has other mental health disabilities. He has been in DBT. The second author is an autistic person working in autism research and advocacy. The remaining authors are non-autistic. They do research and therapy with autistic people. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? DBT is used to help people manage their emotions and engage with others successfully. Many autistic people struggle with these skills. There is not a lot of research on how DBT can benefit autistic people. Early work has shown that it might be effective for autistic people. WHAT DO THE AUTHORS RECOMMEND? We outline several changes to DBT that might make it more helpful to autistic people. One change included is using images to help autistic people keep track of therapy skills. Another suggested change is making therapy into a game. More research is needed to test if these changes work in larger groups of autistic people. HOW WILL THESE RECOMMENDATIONS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? We hope therapists use these changes to DBT to better support autistic people. We hope that this encourages more research into how DBT can better help autistic people. Autistic people may also benefit from DBT skills in their own lives. eng

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13. Li X, Qi S, Li W, Liu X, Xue Z, Yu T, Xun G. Cohen syndrome combined with psychiatric symptoms: a case report. BMC Psychiatry;2024 (Mar 4);24(1):180.

BACKGROUND: Cohen syndrome (CS) is a rare autosomal recessive inherited condition characterized by pathological changes affecting multiple systems. The extensive clinical variability associated with CS poses a significant diagnostic challenge. Additionally, there is limited documentation on the co-occurrence of CS with psychiatric symptoms. CASE REPORT: We report a case of a 30-year-old patient exhibiting characteristic physical features and psychiatric symptoms. Whole exome sequencing identified two heterozygous variants, a nonsense variation c.4336 C > T and a missense mutation c.4729G > A. Integrating clinical manifestations with genetic test results, we established the diagnosis of CS combined with psychiatric symptoms. CONCLUSIONS: This case introduces a novel missense variant as a candidate in the expanding array of VPS13B pathogenic variants. Its clinical significance remains unknown, and further investigation may broaden the spectrum of pathogenic variants associated with the VPS13B gene. Early diagnosis of CS is crucial for the prognosis of young children and holds significant importance for their families.

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14. Mamimoué É, Gauld C. The importance of social relationships in depression in autistic adolescents: a narrative-review. Front Psychol;2024;15:1335882.

OBJECTIVE: The impact of social relationships on autistic adolescents has been recently studied. However, the link between social relationships and depression in autistic adolescents seem underrepresented in the scientific literature. Especially no specific assessment tool has been developed to evaluate depression in autistic adolescents. The aim of this narrative review is to raise the impact of social relationships on depression in autistic adolescents. We aim to propose lines of thought on the creation of a sensitive tool for identifying depression in this population. METHODS: We conducted two types of searches for articles and reviews on PubMed, Embase, and Cochrane. First, regarding social relationships, we searched the following terms: [(« adolesc* » OR « youth ») AND (« ASD » OR « autis* ») AND (« social communication » OR « peer relationship ») AND (« depress* »)]. Secondly, regarding assessment tool, we searched the following terms: [(« tool » OR « assess* ») AND (« depress* ») AND (« ASD » OR « Autis*) »]. RESULTS: Social impact, verbal skills, and good social motivation are risk factors of depression in autistic adolescents. Social impairment during childhood is related to peer victimization and is a risk factor for depression. There is no specific tool to measure depression in autistic adolescents. CONCLUSION: No specific tool based on social relationships was developed to evaluate depression in autistic adolescents. Depression in autistic adolescents needs to be assessed considering the social and pragmatic specificities of autism. Social communication and difficulties in peer relationships may be evaluated in specific assessment tools based on social relationships for depression in autistic adolescents.

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15. Moolla M, Linjawi H, Taylor D, Mathew A. Device-related thrombosis after transcatheter closure of atrial septal defect using the Gore Cardioform ASD occluder. J Invasive Cardiol;2024 (Mar 4)

A previously healthy 60-year-old female was diagnosed with a secundum atrial septal defect measuring 23 x 12 mm on transesophageal echocardiogram.

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16. Moseley RL, Gregory NJ, Smith P, Allison C, Cassidy S, Baron-Cohen S. Potential Mechanisms Underlying Suicidality in Autistic People with Attention Deficit/Hyperactivity Disorder: Testing Hypotheses from the Interpersonal Theory of Suicide. Autism Adulthood;2024 (Mar 1);6(1):9-24.

BACKGROUND: Autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) appear to be at heightened risk of suicide. To understand why, we explored two explanatory mechanisms from the interpersonal theory of suicide: first, that co-occurring ADHD might be associated with greater risk through greater thwarted belongingness and perceived burdensomeness and, secondly, that hyperactive/impulsive features might incur additional risk through their association with painful and provocative events, which are suggested to create « capability » for suicide. METHODS: Autistic adults (n = 314) completed an online survey including measures of thwarted belongingness, perceived burdensomeness, painful and provocative events, acquired capability for suicide, and ADHD features. Creating an overall index of likely ADHD, we examined associations between likely ADHD, suicide ideation, and lifetime suicide attempts through the parallel mediators of thwarted belongingness, perceived burdensomeness, anxiety, and depression. In several models, we then examined hyperactive, impulsive, and inattentive features as predictors of exposure to painful and provocative events and subsequent capability for suicide, and examined whether these two variables, sequentially or individually, mediated an association with lifetime suicide attempts. RESULTS: Likely ADHD was associated with past-year suicide ideation through greater depression and perceived burdensomeness, which also mediated its association with more suicide attempts. Hyperactive and impulsive features were associated with exposure to painful and provocative events and through this acquired suicide capability. Both features were associated with more numerous suicide attempts through these two mediators sequentially, and through exposure to painful and provocative events alone. CONCLUSIONS: These data suggest that suicidality in autistic people with ADHD may be partially related to perceived burdensomeness and to acquired suicide capability after exposure to painful and provocative events. However, as we observed a pathway to suicidality associated with painful and provocative events alone, it is likely that there are also other explanatory mechanisms for the influence of traumatic events on suicide risk. WHY IS THIS AN IMPORTANT ISSUE? Suicide is a leading cause of premature death in autistic people, but we still know little about why autistic people are at greater risk and how we can help. Recent findings suggest that autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) are at even higher risk, but we do not yet understand why. WHAT WAS THE PURPOSE OF THIS STUDY? This research examined two potential explanations for higher risk of suicide in autistic people with co-occurring ADHD. First, we expected that because these individuals are often very isolated and struggle with independence and employment, they might be more vulnerable to two risk factors for suicide: “thwarted belongingness,” the feeling of being alienated from other people, and “perceived burdensomeness,” the feeling that one is a burden to others. We also expected that hyperactive/impulsive features associated with ADHD might make people more likely to experience painful and dangerous events. Exposure to events like this is suggested to make people less frightened of dying by suicide and more able to attempt to end their lives. This is called “acquiring capability” for suicide. WHAT DID THE RESEARCHERS DO? We asked 314 autistic adults to complete an online survey including measures of thwarted belongingness, perceived burdensomeness, exposure to painful and dangerous events, and acquired capability for suicide. They also completed a scale measuring ADHD features, and symptoms of depression and anxiety. We then looked at which of these factors, if any, explained suicide risk in autistic people with co-occurring ADHD. WHAT WERE THE RESULTS OF THE STUDY? Our data suggest that autistic people with co-occurring ADHD might be at greater risk of suicide ideation and attempts because they are more likely to experience depression and to feel like a burden to others. We also found that people with high degrees of hyperactive/impulsive features were more likely to experience painful and dangerous events, and, therefore, had greater capability for suicide—because of this, they were more likely to have attempted suicide more times in the past. Exposure to these kinds of traumatic events also increased the risk of suicide all by itself. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Very little is known about why autistic people with co-occurring ADHD might be at even higher risk of suicide than people with either ADHD or autism alone. No studies have examined explanations for suicide in this subgroup. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? Because this study looked at a snapshot of participants’ current states, we cannot be sure of the direction of relationships between variables. For example, it might be that experiences of surviving suicide attempts actually make people feel more depressed and more like a burden afterward, rather than these feelings being the risk factors that contributed to suicide attempts. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? These findings indicate feelings and experiences that are relevant to suicide risk in autistic people with co-occurring ADHD, which might thus be important to target in interventions. eng

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17. Nick J, Seaborg K, Kastner K, Bazalakova M, Antony K. Are Symptoms of Obstructive Sleep Apnea During Pregnancy Associated With Autism Spectrum Disorder in Children: A Case-Control Study. Wmj;2024 (Feb);123(1):18-23.

BACKGROUND: Obstructive sleep apnea complicates 10% to 32% or greater of pregnancies, however, reports on long-term effects on the children of pregnancies affected by obstructive sleep apnea are limited. OBJECTIVE: We sought to test the hypothesis that the children of pregnant people with symptoms of obstructive sleep apnea during pregnancy have an increased incidence of autism spectrum disorder. METHODS: This was a case-control study comparing the pregnancies of people whose children were later diagnosed with autism spectrum disorder without a known associated genetic condition to those whose children were diagnosed with autism spectrum disorder with a known associated genetic condition. RESULTS: Of the 51 total parents who were eligible and consented to participate, 4 had a child with autism associated with a known genetic condition, and 47 had a child with autism with no known genetic condition. The prevalence of any snoring (50.0% and 36.2%, respectively) and daytime tiredness (75.0% and 89.4%, respectively) were similar between both groups. CONCLUSIONS: In this study, the prevalence of any snoring and falling asleep while driving during pregnancy was higher in the sampled population than typically reported in pregnant people. While the sample size for this study was small, our preliminary results suggest that parents of children with autism have a high prevalence of sleep-related concerns during their pregnancies, which indicates the need for further investigation - especially for obstructive sleep apnea. Future studies exploring the neurodevelopmental outcomes of children of a cohort of pregnant people with known presence or absence of obstructive sleep apnea during pregnancy is warranted.

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18. O’Connor M, Jones SC, Gordon C, Joosten A. Exploring Environmental Barriers and Facilitators to Inclusion on a University Campus for Autistic Students. Autism Adulthood;2024 (Mar 1);6(1):36-46.

BACKGROUND: Attending university allows individuals to build independence, develop social networks, and attain valuable qualifications, contributing to enhanced outcomes in adulthood. However, autistic people have poorer participation rates and outcomes in university than those with all other disabilities or without disabilities. Most research conducted with autistic young adults in the university environment focuses on their social and communicative challenges and supports rather than on how the physical environment impacts an autistic student’s university experience. Therefore, there is a need for research into how the sensory aspects of the university environment can affect the well-being and outcomes of autistic students. METHODS: This qualitative study explored the experiences of seven autistic university students in the physical spaces of an Australian university. Using a semi-structured interview guide, and photo-elicitation, we collected data in one-on-one interviews with seven autistic undergraduate students. RESULTS: We found that sensory aspects of physical spaces on university campuses are both enabling and challenging for autistic students. These aspects not only impact how students navigate and utilize aspects of the campus, but they also influence how students engage and participate at university. Autistic students need the space and resources to manage sensory overload on campus, and universities that seek to support autistic students need to consider the physical and sensory needs of this cohort. CONCLUSIONS: Inclusive university education requires attention to the physical aspects of campuses that support the mental and physical well-being of autistic students. WHY WAS THIS STUDY DONE? Autistic people are less likely to enroll in and complete further education than those with all other disabilities or without disabilities. Most research conducted with autistic young adults in the university environment focuses on their social and communication challenges, rather than the enabling and disabling aspects of the physical university environment. WHAT WAS THE PURPOSE OF THIS STUDY? This study aimed to capture and understand autistic students’ experiences in navigating and participating in the physical spaces in an Australian university. WHAT DID THE RESEARCHERS DO? We interviewed seven undergraduate university students about the places and spaces on the university campus that they found challenging and enabling. Participants took photographs of these spaces before the interview and brought the photographs with them for discussion. WHAT WERE THE RESULTS OF THE STUDY? We found that the participants readily identified places on the campus that were both enabling and challenging. Physical aspects that were challenging included noisy spaces, crowded areas, and spaces with bright artificial lights. These spaces impacted on their ability to participate and succeed in their studies. They also impacted on their ability to interact with other students, their enjoyment of university, and their physical and emotional well-being. Comfortable spaces that allowed them to recharge were those that were quiet, less busy, had lower levels of sensory input, and allowed them to unmask. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Previous research on the university experience of autistic students has focused primarily on social and educational supports. Research on sensory-friendly education settings has typically focused on primary and secondary education. This study provides evidence of the importance of physical and sensory environments in the educational experience of autistic students in a postsecondary environment. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? The main weakness of the study is the small number of participants (n = 7) and that they were all drawn from one university. While this limits the generalizability of the findings, this was an exploratory study and an important first step in developing our understanding of barriers and facilitators to inclusion on a university campus. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? While this is a small-scale exploratory study, and there is a need for more research in this area, there are some simple takeaways that could be implemented by universities at minimal cost to support the inclusion of autistic students. For example, sensory input could be reduced by lowering the volume of piped music or reducing the number or brightness of lights. Simple supports for students experiencing sensory overload could include quiet times in cafeterias and access to sensory retreat rooms. At a minimum, our findings could serve as a starting point for discussions between university administrators and autistic students about necessary environmental adjustments to create more inclusive campuses. eng

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19. O’Loghlen JJ, Lang CP. High Autistic Traits or Low Social Competence? Correlates of Social Camouflaging in Non-Autistic Adults. Autism Adulthood;2024 (Mar 1);6(1):60-71.

BACKGROUND: Autistic traits have been linked with the use of social camouflaging behavior by non-autistic people. In addition, low social competence (i.e., poor social skills) has also been posited as a possible explanation for the use of social camouflaging by non-autistic people. In this study, we investigated the comparative influence of autistic traits and social competence on three components of social camouflaging (compensation, masking, and assimilation) in a sample of non-autistic adults. METHODS: Using a cross-sectional design, we recruited 284 undergraduate students (28.5% male; 69.7% female; 1.8% not specified) who reported that they had never been diagnosed with autism. Participants completed standardized measures assessing social camouflaging, autistic traits, social competence, and psychological distress via an online questionnaire. RESULTS: We found that women reported greater use of social camouflaging, and greater social camouflaging use was associated with worse psychological distress. We also found that both social competence and autistic traits were associated with the use of social camouflaging, with higher autistic traits influencing camouflaging use to a greater degree than low social competence. Compared with the use of compensation- and assimilation-based social camouflaging, masking was the least well explained by the current predictors. CONCLUSIONS: We conclude that social competence and autistic traits are important factors influencing the use of social camouflaging by non-autistic adults. However, there are other (unknown) factors that contribute to the use of each aspect of camouflaging by non-autistic individuals, and a deeper understanding of the individual motivations for social camouflaging use is still needed. In turn, this may allow for the development of psychosocial interventions to offset the need for social camouflaging and mitigate the negative psychological consequences often associated with its use. WHY IS THIS AN IMPORTANT ISSUE? Autistic traits have been linked with the use of social camouflaging behavior by non-autistic people. Poor social skills have also been suggested as a possible explanation for social camouflaging use by non-autistic people. By exploring social camouflaging with non-autistic people, we may be able to offer different, and possibly complimentary, understandings about the developing construct of social camouflaging and its link with psychological well-being. WHAT WAS THE PURPOSE OF THIS STUDY? We explored the links between aspects of autism and social skills, and the use of different social camouflaging behaviors, among non-autistic people with varying levels of autistic traits and social skills. WHAT DID THE RESEARCHERS DO? We conducted an online survey with 284 undergraduate students who stated that they had never been diagnosed with autism. Our participants provided personal information (e.g., age, gender) and answered questionnaires that investigated different types of autistic traits (rigid personality, pragmatic language deficits, and aloof personality) and aspects of social competence (initiating relationships, asserting displeasure, self-disclosure, providing emotional and managing interpersonal conflict) in relation to three different types of social camouflaging behavior (compensation, masking, and assimilation) and their psychological well-being. WHAT WERE THE RESULTS OF THE STUDY? We found that both low self-assessed social skills and high autistic traits were associated with the use of social camouflaging behaviors by non-autistic adults. Women reported more social camouflaging than men. We also found that higher autistic traits influenced social camouflaging use more than low social skills, although the strength of influence varied with the type of social camouflaging behavior. All types of social camouflaging were related to worse psychological well-being. WHAT DO THESE FINDINGS ADD TO WHAT IS ALREADY KNOWN? This study is among the first to investigate social camouflaging, autistic traits, and social skills in a nuanced way with non-autistic people. Our findings offer new explanations for how specific camouflaging behaviors may be influenced by different aspects of social behavior in non-autistic people. WHAT ARE POTENTIAL WEAKNESSES IN THIS STUDY? Our participants were university students, so most participants were young, female, and Caucasian. Therefore, research within diverse samples of non-autistic people is still needed. Also, we only looked at a broad measure of psychological distress, so more in-depth investigation of social camouflaging and specific psychological experiences, such as social anxiety, is still needed. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? Social camouflaging seems to be costly in terms of the effort required to camouflage and its flow-on effects for psychological well-being. Understanding what factors might contribute to camouflaging for both autistic and non-autistic adults might lead to better ideas about less effortful ways to manage difficult social situations or techniques to reduce possible costs of camouflaging. eng

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20. Ou J, Dong H, Dai S, Hou Y, Wang Y, Lu X, Xun G, Xia K, Zhao J, Shen Y. Development and validation of a risk score model for predicting autism based on pre- and perinatal factors. Front Psychiatry;2024;15:1291356.

BACKGROUND: The use of pre- and perinatal risk factors as predictive factors may lower the age limit for reliable autism prediction. The objective of this study was to develop a clinical model based on these risk factors to predict autism. METHODS: A stepwise logistic regression analysis was conducted to explore the relationships between 28 candidate risk factors and autism risk among 615 Han Chinese children with autism and 615 unrelated typically developing children. The significant factors were subsequently used to create a clinical risk score model. A chi-square automatic interaction detector (CHAID) decision tree was used to validate the selected predictors included in the model. The predictive performance of the model was evaluated by an independent cohort. RESULTS: Five factors (pregnancy influenza-like illness, pregnancy stressors, maternal allergic/autoimmune disease, cesarean section, and hypoxia) were found to be significantly associated with autism risk. A receiver operating characteristic (ROC) curve indicated that the risk score model had good discrimination ability for autism, with an area under the curve (AUC) of 0.711 (95% CI=0.679-0.744); in the external validation cohort, the model showed slightly worse but overall similar predictive performance. Further subgroup analysis indicated that a higher risk score was associated with more behavioral problems. The risk score also exhibited robustness in a subgroup analysis of patients with mild autism. CONCLUSION: This risk score model could lower the age limit for autism prediction with good discrimination performance, and it has unique advantages in clinical application.

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21. Pearson A, Hodgetts S. « Comforting, Reassuring, and…Hot »: A Qualitative Exploration of Engaging in Bondage, Discipline, Domination, Submission, Sadism and (Sado)masochism and Kink from the Perspective of Autistic Adults. Autism Adulthood;2024 (Mar 1);6(1):25-35.

BACKGROUND: There is a lack of research on autistic intimacy; however, a small body of research suggests that bondage, discipline, domination, submission, sadism and (sado)masochism (BDSM)/kink may be appealing to autistic people. We aimed at exploring how engagement in BDSM/kink related to autistic identity, using a phenomenological approach. METHODS: We recruited six autistic adults through purposive sampling on social media. All participants took part in a one-to-one spoken interview about their engagement in BDSM/kink and how it related to their sense of identity. RESULTS: We used interpretative phenomenological analysis to analyze the data and found three key themes. Theme 1, « Practicing safe ‘sex' » highlighted how the clear communication and explicit focus on consent present in BDSM/kink facilitated a feeling of safety. Theme 2, « So many ways to touch and be touched » was focused on the sensory draw of BDSM/kink, and how it provided exciting ways to explore sensory joy (and sometimes revulsion). Theme 3, « Subverting (neuro)normativity » showed how autistic people can find pleasure in intimate practices that transgress normative expectations. CONCLUSION: Our findings highlighted the importance of exploring the perceptions of autistic adults in relation to their own intimate practices. Autistic intimacy is an emerging area of research, with very little focus on lived experience. Although engagement in BDSM/kink may appear niche, our findings suggest that there are aspects which are inherently appealing to autistic people. These findings can be used to destigmatize both autistic intimacy and engagement in alternative intimate practices more broadly. WHY IS THIS AN IMPORTANT ISSUE? Autistic intimacy is an under-explored area, with very little focus on the lived experiences of autistic adults and their preferences. Bondage, discipline, domination, submission, sadism and (sado)masochism (BDSM) and kink are alternative intimate practices. There are aspects of BDSM/kink that may appeal to autistic people (e.g., sensory experiences such being restrained during intimacy). However, to date, there is very little research to explore this. WHAT WAS THE PURPOSE OF THIS STUDY? This study aimed at exploring the experiences and motivations of autistic people who engage in BDSM/kink from their own perspectives. WHAT DID THE RESEARCHERS DO? We conducted online video interviews with six autistic adults. We purposefully recruited a small number of people, choosing to use a method called “interpretative phenomenological analysis” that emphasizes deep explorations of the experiences of a small number of people. This method is particularly suitable for areas where very little research exists. WHAT WERE THE RESULTS OF THE STUDY? We found three key themes: Theme 1, “Practicing safe ‘sex’” highlighted how the clear communication and explicit focus on consent present in BDSM/kink facilitated a feeling of safety for our participants, who found uncertainty during intimacy stressful. The sense of safety fostered within these interactions also provided the participants with a space to be their authentic selves, and “switch off” from the outside world. Theme 2, “So many ways to touch and be touched” was focused on the sensory lure of BDSM/kink, and how it provided exciting ways to explore sensory joy (and sometimes revulsion) for autistic people. Theme 3, “Subverting (neuro)normativity” showed how autistic people can find pleasure in intimate practices that other people might find unusual. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? To our knowledge, this is the first study to explore autistic engagement in BDSM/kink from a first-person perspective. Our findings show that some alternative ways of being intimate might attract autistic people, because they provide stability, pathways for sensory exploration, or because they are fun in ways that other people sometimes find unexpected. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? We only interviewed a small number of people, and most of them shared similar interests within BDSM/kink. In future, it would be good to find out about the interests of a larger number of autistic people. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? There is very little research exploring autistic intimacy from a validating perspective. Our findings will help to destigmatize autistic intimacy and normalize conversations about things that people might think of as “taboo.”. eng

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22. Perkovich E, Laakman A, Mire S, Yoshida H. Conducting head-mounted eye-tracking research with young children with autism and children with increased likelihood of later autism diagnosis. J Neurodev Disord;2024 (Mar 4);16(1):7.

BACKGROUND: Over the past years, researchers have been using head-mounted eye-tracking systems to study young children’s gaze behaviors in everyday activities through which children learn about the world. This method has great potential to further our understanding of how millisecond-level gaze behaviors create multisensory experiences and fluctuate around social environments. While this line of work can yield insight into early perceptual experiences and potential learning mechanisms, the majority of the work is exclusively conducted with typically-developing children. Sensory sensitivities, social-communication difficulties, and challenging behaviors (e.g., disruption, elopement) are common among children with developmental disorders, and they may represent potential methodological challenges for collecting high-quality data. RESULTS: In this paper, we describe our research practices of using head-mounted eye trackers with 41 autistic children and 17 children with increased likelihood of later autism diagnosis without auditory or visual impairments, including those who are minimally or nonspeaking and/or have intellectual disabilities. The success rate in gathering data among children with autism was 92.68%. 3 of 41 children failed to complete the play-session, resulting in an 86.36% success rate among 1-4-year-olds and a 100.00% success rate among 5-8-year-olds. 1 of 17 children with increased likelihood of later autism diagnosis failed to complete the play-session, resulting in a success rate of 94.11%. There were numerous « challenging » behaviors relevant to the method. The most common challenging behaviors included taking the eye-tracking device off, elopement, and becoming distressed. Overall, among children with autism, 88.8% of 1-4-year-olds and 29.4% of 5-8-year-olds exhibited at least one challenging behavior. CONCLUSIONS: Research capitalizing on this methodology has the potential to reveal early, socially-mediated gaze behaviors that are relevant for autism screening, diagnosis, and intervention purposes. We hope that our efforts in documenting our study methodology will help researchers and clinicians effectively study early naturally-occuring gaze behaviors of children during non-experimental contexts across the spectrum and other developmental disabilities using head-mounted eye-tracking. Ultimately, such applications may increase the generalizability of results, better reflect the diversity of individual characteristics, and offer new ways in which this method can contribute to the field.

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23. Peterson T, Dodson J, Hisey A, Sherwin R, Strale F. Examining the Effects of Discrete Trials, Mass Trials, and Naturalistic Environment Training on Autistic Individuals Using Repeated Measures. Cureus;2024 (Feb);16(2):e53371.

INTRODUCTION: Behavioral interventions based on applied behavior analysis (ABA) form current evidence-based practices in treating autism spectrum disorder (ASD). Research is scarce relative to the broad effects of intensive repetitive, discrete trial training, and mass trials combined with a naturalistic environment as measured by overall general target behaviors. The primary objective of this study was to evaluate the effectiveness of a mixed behavioral model consisting of discrete trial training and mass trial interventions in the naturalistic environment, using a repeated measures design with a retrospective snapshot cohort of 93 individuals with autism. METHODS: A repeated measures analysis tracked 89 autistic children with four adult autistic individuals over seven time points during a three-month snapshot period from March 19, 2023, to June 11, 2023. This study determined the effectiveness of applied behavior analysis (ABA) interventions combining discrete trial training, mass trials, and naturalistic environment training on mastered broad target behaviors in autistic individuals using a mixed (between and within) ANOVA statistical design. RESULTS: Mixed (between and within) ANOVA indicated overall statistical significance, F (6,674)=45.447, p<0.001, partial eta squared=0.365 across time. These results indicated a large effect size. Multiple comparisons showed statistical significance (p<0.001) on all 21 multiple comparisons between timepoints. There was also a significant interaction effect with time × age category, F (24,474)=2.961, p<0.001, partial eta squared=0.130. These results also indicated a large effect size. CONCLUSIONS: Autistic individuals who received applied behavior analysis combining discrete trial training, mass trials, and naturalistic environment training intervention demonstrated statistically significant improvement in target behaviors over the three-month snapshot period, the most prominent being in the 13-16 years age category.

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24. Peterson T, Dodson J, Strale F, Jr. Impact of Applied Behavior Analysis on Autistic Children Target Behaviors: A Replication Using Repeated Measures. Cureus;2024 (Feb);16(2):e53372.

INTRODUCTION: Applied behavior analysis (ABA) is a primary evidence-based practice in treating autism spectrum disorder (ASD). Ongoing research is needed to report the results of ABA relative to attaining target behaviors. This study aims to replicate the results of previous research to determine the effectiveness of ABA of target behaviors in autistic children with a new timepoint sample of data. Materials & methods: A repeated measures analysis tracked 98 autistic children, which included four adult participants, over three timepoints during a one-month snapshot period from 6/7/23 to 7/7/23. This study used a retrospective chart review to gather data on target behaviors to determine the effectiveness of ABA treatments across age categories. A mixed (between x within) analysis of variance (ANOVA) and subsequent post hoc and interaction contrasts were used to determine statistical significance. RESULTS: Mixed (between x within) ANOVA indicated statistical significance (sphericity assumed), F(2,160) = 32.893, and p < 0.05, across time. Using bootstrapped paired t-tests, multiple comparisons indicated p < 0.001 on all three multiple comparisons, with Bonferroni corrected α = 0.017. There was also a non-significant interaction effect (sphericity assumed) with (time) x (age category), F(8,160) = 0.333, p = 0.952, likely due to sizeable within-group variation resulting in a lowered statistical power. Conclusions: This replication found that autistic children receiving the ABA intervention demonstrated statistically significant improvement in target behaviors over the one-month snapshot period.

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25. Sartin EB, Webb MS, Labows CG, Myers RK, Yerys BE, McDonald CC, Curry AE. Caregivers’ Perspectives on Use of and Need for Driving Resources for Their Autistic Adolescent. Autism Adulthood;2024 (Mar 1);6(1):86-94.

INTRODUCTION: Autistic individuals who independently travel-or commute without companionship or supervision-report feeling more connected to social, education, and employment opportunities. Despite the potential for independent transportation to improve quality of life, little is known about what transportation-related resources, specifically driving focused ones, exist for autistic individuals or how they and their families find and use them. The objectives of this study were to characterize: (1) where and how families in the United States find driving-related resources for their autistic adolescents; (2) families’ perceived availability and utility of identified resources; and (3) resources families believe should be developed. METHODS: We conducted semi-structured interviews with 33 caregivers of autistic adolescents aged 16-24 years without an intellectual disability. We used a directed-content approach to develop and implement codes; three trained coders analyzed all transcripts (inter-rater reliability ≥0.8 for all codes). Members of the research team reviewed coded data and created code summaries, which were then developed and discussed by the larger research team to determine final consensus. RESULTS: Caregivers described a few existing resources that were helpful in guiding driving-related decisions. In addition, caregivers voiced that there were limited resources tailored to the unique needs that arise while teaching or learning how to drive, particularly ones that support their own and their adolescent’s mental health. The limited resources and services identified as helpful-specifically support groups/perspectives of other families and specialized driving instructors-are seemingly difficult to find, costly, and/or perceived as having geographic- and time-related barriers. CONCLUSION: There is a critical need and opportunity for stakeholders of the autism community to both expand access to existing and develop novel driving-related resources for families with autistic adolescents, with a particular focus of supporting caregiver and adolescent mental health. WHY IS THIS AN IMPORTANT ISSUE? Many autistic teens and young adults rely on caregivers, siblings, family, and friends to give them rides to the places they need to go. Research has found that resources and services created specifically for autistic people can help them decide whether driving is right for them, and if so, then learn how to drive. However, little is known about if, and if so how, families find or use these resources and services. WHAT WAS THE PURPOSE OF THIS STUDY? This study had three goals: (1) learn what driving resources and services autistic teens and young adults (and their families) use, (2) learn how they find these resources and services, and (3) learn what other things they think would help them make decisions about driving and learn how to drive. WHAT DID THE RESEARCHERS DO? The researchers asked 33 caregivers of autistic teens and young adults without an intellectual disability (ID) (teens and young adults were 16–24 years old) questions about their experiences finding and using driving resources and services. These conversations were recorded and later typed out word for word. WHAT WERE THE RESULTS OF THE STUDY? Caregivers said that they spend a lot of time looking for driving resources and services for their autistic teen or young adult. Many resources and services were not easy to use or helpful. Caregivers said that behind-the-wheel driving instructors with specific training teaching autistic individuals were the most helpful and/or wanted resource. However, caregivers also said that these instructors and their services were hard to find, cost a lot of money, and require families to spend a lot of time training with them to get results. In the future, caregivers said that making it easier to find and get driving resources and services (e.g., making them less expensive) was necessary. Caregivers also had strong interest in their family participating in support groups related to driving. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Previous research has shown that training, resources, and services designed specifically for autistic people help prepare autistic teens and young adults to drive. Before our study, it was unclear if, and if so how, families actually use these resources and services in the real world, or outside of academic research. Families in our study said that it is hard to find or get access to driving resources and services, especially those created specifically for autistic populations. This difficulty is one reason why families think it is stressful and hard for autistic teens and young adults to learn how to drive. WHAT ARE THE POTENTIAL WEAKNESSES IN THE STUDY? We only asked caregivers who lived in the Northeast part of the United States questions, so our findings may not be true for all families. Also, this study only asked questions to caregivers of autistic teens and young adults who did not have an ID. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? Our findings can help autistic teens and young adults by showing what resources and services families use and want to use while they are learning how to drive or making decisions about if driving is right for them. eng

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26. Somerville M, MacPherson SE, Fletcher-Watson S. The Associations Between Camouflaging, Autistic Traits, and Mental Health in Nonautistic Adults. Autism Adulthood;2024 (Mar 1);6(1):106-113.

BACKGROUND: Camouflaging is frequently reported in autistic people and entails the disguising of autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a nonautistic sample, examining the relationship between autistic traits, self-reported camouflaging, gender, and mental health. METHOD: In total 110 nonautistic adults completed standardized self-report questionnaires that measured autistic traits, mental health symptoms, and camouflaging behaviors. Hierarchical multiple linear regression models were used to analyze data and examine the unique contributions of autistic traits and camouflaging to mental health. RESULTS: Self-reported autistic traits were associated with increased symptoms of poor mental health. However, autistic traits were not associated with mental health symptoms when controlling for self-reported camouflaging, and self-reported camouflaging predicted increased mental health symptoms over and above the effects of autistic traits. Women had poorer mental health than men in our sample, and in women there was a stronger relationship between camouflaging and mental health than in men. CONCLUSIONS: Camouflaging may contribute to poor mental health outcomes in the general population, just as it does for autistic people, to the extent that camouflaging more clearly relates to mental health profile than self-reported autism traits. This suggests camouflaging is an important construct for understanding mental health in general, and for exploring the complex relationship between autism and autistic traits. WHY WAS THIS STUDY DONE? Some autistic individuals report trying to hide their autistic traits to blend in with others, referring to this as “camouflaging” or “masking.” Many autistic people who camouflage describe it as being a very difficult and distressing process, which can be harmful to their mental health. In nonautistic people, a higher level of autistic traits is related to poor mental health. Nonautistic people have also reported camouflaging autistic traits, but we know less about whether this might also impact their mental health. WHAT WAS THE PURPOSE OF THIS STUDY? We did this study to find out more about the relationship between mental health and camouflaging of autistic traits in nonautistic people. WHAT DID THE RESEARCHERS DO? We asked 110 nonautistic adults to complete a series of questionnaires. These questionnaires asked them about their autistic traits, their camouflaging behaviors, and their mental health. We then used statistical tests to look at the relationships between autistic traits, camouflaging, gender, and mental health. WHAT WERE THE RESULTS OF THE STUDY? We found that people who camouflaged more had poorer mental health, including symptoms of anxiety, depression, and stress. People with more autistic traits also had poorer mental health. When we looked at both of these relationships at the same time, only camouflaging was related to poor mental health, and not autistic traits. When we also looked at gender, we found that women in our study had poorer mental health than men, and the relationship between camouflaging and mental health was stronger for women. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? These findings help us understand the relationship between autistic traits and mental health by demonstrating that it may be the camouflaging of autistic traits that is related to poorer mental health. These findings also help us better understand camouflaging by showing that the negative consequences of camouflaging for mental health may apply to both autistic and nonautistic people. WHAT ARE THE POTENTIAL WEAKNESSES IN THE STUDY? Our study only looked at the relationship between autistic traits, camouflaging, gender, and mental health. It is possible that there are other factors our study did not investigate, such as ethnicity or sexual identity, which also play an important role. Our study also cannot tell us whether or not camouflaging is the cause of poor mental health, only that there is a relationship between camouflaging and mental health. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? By studying camouflaging in different groups and seeing what is shared and what is unique between autistic and nonautistic people, we can develop a better understanding of camouflaging. Knowledge of the mental health consequences of camouflaging can help mental health services to reduce the negative impact of camouflaging for autistic and nonautistic people. Our findings also show an important similarity between autistic and nonautistic people, showing that both groups of people may camouflage, and this negatively impacts mental health. Acknowledgment of this shared experience may help to reduce the discrimination and stigma that autistic people face. eng

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27. Su WC, Mutersbaugh J, Huang WL, Bhat A, Gandjbakhche A. Developmental Differences in Reaching-and-Placing Movement and Its Potential in Classifying Children with and without Autism Spectrum Disorder: Deep Learning Approach. Res Sq;2024 (Mar 4)

Autism Spectrum Disorder (ASD) is among the most prevalent neurodevelopmental disorders, yet the current diagnostic procedures rely on behavioral analyses and interviews and lack objective screening methods. This study seeks to address this gap by integrating upper limb kinematics and deep learning methods to identify potential biomarkers that could be validated in younger age groups in the future to enhance the identification of ASD. Forty-one school-age children, with and without an ASD diagnosis (Mean age ± SE = 10.3 ± 0.4; 12 Females), participated in the study. A single Inertial Measurement Unit (IMU) was affixed to the child’s wrist as they engaged in a continuous reaching and placing task. Deep learning techniques were employed to classify children with and without ASD. Our findings suggest delays in motor planning and control in school-age children compared to healthy adults. Compared to TD children, children with ASD exhibited poor motor planning and control as seen by greater number of movement units, more movement overshooting, and prolonged time to peak velocity/acceleration. Compensatory movement strategies such as greater velocity and acceleration were also seen in the ASD group. More importantly, using Multilayer Perceptron (MLP) model, we demonstrated an accuracy of ~ 78.1% in classifying children with and without ASD. These findings underscore the potential use of studying upper limb movement kinematics during goal-directed arm movements and deep learning methods as valuable tools for classifying and, consequently, aiding in the diagnosis and early identification of ASD upon further validation in younger children.

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28. Ward EK, Buitelaar JK, Hunnius S. Autistic and nonautistic adolescents do not differ in adaptation to gaze direction. Autism Res;2024 (Mar 3)

Predictive processing accounts of autism posit that autistic individuals’ perception is less biased by expectations than nonautistic individuals’, perhaps through stronger precision-weighting of prediction errors. Since precision-weighting is fundamental to all information processing, under this theory, the differences between autistic and nonautistic individuals should be domain-general and observable in both behavior and brain responses. This study used EEG, behavioral responses, and eye-tracking co-registration during gaze-direction adaptation, to investigate whether increased precision-weighting of prediction errors is evident through smaller adaptation after-effects in autistic adolescents compared with nonautistic peers. Multilevel modeling showed that autistic and nonautistic adolescents’ responses were consistent with behavioral adaptation, with Bayesian statistics providing extremely strong evidence for the absence of a group difference. Cluster-based permutation testing of ERP responses did not show the expected adaptation after-effect but did show habituation to repeated stimulus presentation, and no group difference was detected, a result not consistent with the theoretical account. Combined with the few other available studies, the current findings raise challenges for the theory, suggesting no fundamental difference in precision-weighting of prediction errors in autism.

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29. Wenzell ML, Pulver SL, McMahon MXH, Rubio EK, Gillespie S, Berry RC, Betancourt I, Minter B, Schneider O, Yarasani C, Rogers D, Scahill L, Volkert V, Sharp WG. Clinical Correlates and Prevalence of Food Selectivity in Children with Autism Spectrum Disorder. J Pediatr;2024 (Mar 4):114004.

OBJECTIVE: To examine clinical correlates and prevalence of food selectivity (FS) – i.e., self-restricted diet, reluctance to try new foods – in children with autism spectrum disorder (ASD) ascertained from a general outpatient autism clinic. STUDY DESIGN: A multidisciplinary team (pediatric nurse practitioner, psychologist and dietitian) assessed medical and psychosocial histories and dietary habits in 103 children with ASD (mean age= 5.8 + 2.2 years; range 2-10). Parents rated child mealtime behavior on Brief Autism Mealtime Behavior Inventory (BAMBI) and disruptive behavior on Aberrant Behavior Checklist (ABC). Height and weight measurements were collected. Children were classified as FS or no FS based on parent reported intake and mealtime behavior. A 24-hour dietary recall was used to record intake percentages < 80%. Logistic regression and multivariable modeling were used to evaluate clinical correlates with FS. RESULTS: Of 103 children, 45.6% (n=47) were classified as FS; 54.4% (n=56) no FS. After adjusting for potential confounders, the odds of FS increased by 1.91 (95% CI: 1.38, 2.64, p<.001) for every half-SD increase in BAMBI total score and by 1.35 (95% CI: 1.05, 1.74, p=.020) for every half-SD increase in ABC Hyperactivity/Noncompliance. No group differences in anthropometrics or nutritional intake were identified. CONCLUSIONS: FS in children with ASD was strongly associated with greater severity of disruptive mealtime and hyperactivity/noncompliance behaviors. FS was not associated with anthropometrics or nutritional intake.

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30. Williams TI, Loucas T, Sin J, Jeremic M, Meyer S, Boseley S, Fincham-Majumdar S, Aslett G, Renshaw R, Liu F. Using music to assist language learning in autistic children with minimal verbal language: The MAP feasibility RCT. Autism;2024 (Mar 3):13623613241233804.

Research has shown that autistic individuals often have unusually good musical skills and that combining words and music helps autistic individuals to focus on spoken words. This study tests the idea that music will help with early language learning of preschool autistic children. The results show that when caregivers sing words to autistic children, the children pay more attention to the caregiver than when the words are spoken and that they learn word combinations more easily.

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31. Xu H. Comment on « Preterm birth and weight-for-gestational age for risks of autism spectrum disorder and intellectual disability: A nationwide population-based cohort study ». J Formos Med Assoc;2024 (Mar 4)

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32. You W, Li Q, Chen L, He N, Li Y, Long F, Wang Y, Chen Y, McNamara RK, Sweeney JA, DelBello MP, Gong Q, Li F. Common and distinct cortical thickness alterations in youth with autism spectrum disorder and attention-deficit/hyperactivity disorder. BMC Med;2024 (Mar 4);22(1):92.

BACKGROUND: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with overlapping behavioral features and genetic etiology. While brain cortical thickness (CTh) alterations have been reported in ASD and ADHD separately, the degree to which ASD and ADHD are associated with common and distinct patterns of CTh changes is unclear. METHODS: We searched PubMed, Web of Science, Embase, and Science Direct from inception to 8 December 2023 and included studies of cortical thickness comparing youth (age less than 18) with ASD or ADHD with typically developing controls (TDC). We conducted a comparative meta-analysis of vertex-based studies to identify common and distinct CTh alterations in ASD and ADHD. RESULTS: Twelve ASD datasets involving 458 individuals with ASD and 10 ADHD datasets involving 383 individuals with ADHD were included in the analysis. Compared to TDC, ASD showed increased CTh in bilateral superior frontal gyrus, left middle temporal gyrus, and right superior parietal lobule (SPL) and decreased CTh in right temporoparietal junction (TPJ). ADHD showed decreased CTh in bilateral precentral gyri, right postcentral gyrus, and right TPJ relative to TDC. Conjunction analysis showed both disorders shared reduced TPJ CTh located in default mode network (DMN). Comparative analyses indicated ASD had greater CTh in right SPL and TPJ located in dorsal attention network and thinner CTh in right TPJ located in ventral attention network than ADHD. CONCLUSIONS: These results suggest shared thinner TPJ located in DMN is an overlapping neurobiological feature of ASD and ADHD. This alteration together with SPL alterations might be related to altered biological motion processing in ASD, while abnormalities in sensorimotor systems may contribute to behavioral control problems in ADHD. The disorder-specific thinner TPJ located in disparate attention networks provides novel insight into distinct symptoms of attentional deficits associated with the two neurodevelopmental disorders. TRIAL REGISTRATION: PROSPERO CRD42022370620. Registered on November 9, 2022.

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33. Zhong C, Rando J, Patti MA, Braun JM, Chen A, Xu Y, Lanphear BP, Yolton K, Croen LA, Fallin MD, Hertz-Picciotto I, Newschaffer CJ, Lyall K. Gestational thyroid hormones and autism-related traits in the EARLI and HOME studies. Autism Res;2024 (Mar 4)

Thyroid hormones are essential for neurodevelopment. Few studies have considered associations with quantitatively measured autism spectrum disorder (ASD)-related traits, which may help elucidate associations for a broader population. Participants were drawn from two prospective pregnancy cohorts: the Early Autism Risk Longitudinal Investigation (EARLI), enrolling pregnant women who already had a child with ASD, and the Health Outcomes and Measures of the Environment (HOME) Study, following pregnant women from the greater Cincinnati, OH area. Gestational thyroid-stimulating hormone (TSH) and free thyroxine (FT4) were measured in mid-pregnancy 16 (±3) weeks gestation serum samples. ASD-related traits were measured using the Social Responsiveness Scale (SRS) at ages 3-8 years. The association was examined using quantile regression, adjusting for maternal and sociodemographic factors. 278 participants (132 from EARLI, 146 from HOME) were included. TSH distributions were similar across cohorts, while FT4 levels were higher in EARLI compared to HOME. In pooled analyses, particularly for those in the highest SRS quantile (95th percentile), higher FT4 levels were associated with increasing SRS scores (β = 5.21, 95% CI = 0.93, 9.48), and higher TSH levels were associated with decreasing SRS scores (β = -6.94, 95% CI = -11.04, -2.83). The association between TSH and SRS remained significant in HOME for the 95% percentile of SRS scores (β = -6.48, 95% CI = -12.16, -0.80), but not EARLI. Results for FT4 were attenuated when examined in the individual cohorts. Our results add to evidence that gestational thyroid hormones may be associated with ASD-related outcomes by suggesting that relationships may differ across the distribution of ASD-related traits and by familial likelihood of ASD.

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34. Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, Liu X, Yan X, Shen L. Autism spectrum disorder: pathogenesis, biomarker, and intervention therapy. MedComm (2020);2024 (Mar);5(3):e497.

Autism spectrum disorder (ASD) has become a common neurodevelopmental disorder. The heterogeneity of ASD poses great challenges for its research and clinical translation. On the basis of reviewing the heterogeneity of ASD, this review systematically summarized the current status and progress of pathogenesis, diagnostic markers, and interventions for ASD. We provided an overview of the ASD molecular mechanisms identified by multi-omics studies and convergent mechanism in different genetic backgrounds. The comorbidities, mechanisms associated with important physiological and metabolic abnormalities (i.e., inflammation, immunity, oxidative stress, and mitochondrial dysfunction), and gut microbial disorder in ASD were reviewed. The non-targeted omics and targeting studies of diagnostic markers for ASD were also reviewed. Moreover, we summarized the progress and methods of behavioral and educational interventions, intervention methods related to technological devices, and research on medical interventions and potential drug targets. This review highlighted the application of high-throughput omics methods in ASD research and emphasized the importance of seeking homogeneity from heterogeneity and exploring the convergence of disease mechanisms, biomarkers, and intervention approaches, and proposes that taking into account individuality and commonality may be the key to achieve accurate diagnosis and treatment of ASD.

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