Pubmed du 04/05/23

Pubmed du jour

1. Almendingen A, Pilkington P. Parenting Self-Efficacy and Psychological Distress in Parents of Children with an Autism Spectrum Disorder. Journal of autism and developmental disorders. 2023.

Research suggests that challenges associated with raising a child with an Autism Spectrum Disorder (ASD) can increase parents’ risk for diminished parenting self-efficacy (PSE) and psychological wellbeing. The present study aimed to explore interrelationships between noteworthy predictors of PSE and parental psychological distress, including parental mastery beliefs and the co-parenting relationship amongst 122 Australian parents of children with autism. Results indicated that greater mastery beliefs and more favourable co-parenting relationships predicted greater PSE, and higher PSE predicted less psychological distress. PSE significantly mediated relationships between mastery beliefs and psychological distress, and between the co-parenting relationship and psychological distress. Findings have implications that can aid professionals to more effectively support parents raising children on the autism spectrum.

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2. Artis J, Arunachalam S. Semantic and Syntactic Properties of Words and the Receptive-Expressive Gap in Autistic and Non-Autistic Children. Journal of speech, language, and hearing research : JSLHR. 2023: 1-21.

PURPOSE: The goal of this work was to examine the semantic and syntactic properties of the vocabularies of autistic and non-autistic infants and toddlers to see if children in these two groups know different kinds of words. We focused on both receptive and expressive vocabularies. For expressive vocabulary, we looked only at the « active » lexicon: Of those words that are already in children’s receptive vocabulary, we asked which ones they also produce. METHOD: We used an existing data set of 346 parent report vocabulary checklists (MacArthur-Bates Communicative Development Inventory: Words and Gestures) from 41 autistic and 27 non-autistic children at multiple timepoints between the ages of 6 and 43 months. We coded the words on the checklists for various semantic and syntactic properties and evaluated which properties predicted whether children understood and produced those words. RESULTS: Overall, we replicated a common finding that autistic children have smaller receptive vocabularies than non-autistic children, but we found that of the words they understand, autistic children produce a similar proportion of those words as non-autistic children. While we found that some syntactic properties are more or less likely to be represented in children’s early vocabularies (e.g., nouns are more likely to be understood and produced than words that are not nouns), these patterns did not differ across autistic and non-autistic children. CONCLUSIONS: The semantic and syntactic compositions of autistic and non-autistic children’s vocabularies are similar. Thus, while receptive vocabularies are relatively smaller for autistic children, they do not appear to have specific difficulty with words that have particular syntactic or semantic properties, or with adding words to the expressive vocabulary that they already understand.

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3. Aslan Genç H, Doenyas C, Aksu Y, Musaoğlu MN, Uzunay S, Mutluer T. Long-term Behavioral Consequences of the COVID-19 Pandemic for Autistic Individuals and Their Mothers. Journal of autism and developmental disorders. 2023.

Long-term effects of the COVID-19 pandemic on autistic individuals and their families are recently emerging. This study investigated these effects in 40 mother-child dyads by measuring the behavioral problems of autistic individuals (via Aberrant Behavior Checklist) and their mothers’ anxiety levels (via Beck Anxiety Inventory) during the pre-pandemic period, one month after, and one year after its onset. One year into the pandemic, aberrant behaviors of autistic individuals worsened only for those whose mothers had high anxiety levels. The continued negative impact of the COVID-19 pandemic on the behavior of autistic individuals is related to their mother’s anxiety level, highlighting the need to support maternal mental health in families with individuals with autism.

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4. Beck KB, Terhorst LA, Greco CM, Kulzer JL, Skidmore ER, McCue MP. Item Understanding of Common Quality of Life Measures for use with Autistic Adults. Journal of autism and developmental disorders. 2023.

Quality of life (QOL) and life satisfaction are important research priorities for autistic adults. As such, we saw a need to evaluate individual items of commonly used subjective QOL scales to understand how they are interpreted and perceived by autistic adults. This study used cognitive interviews and repeated sampling to evaluate the accessibility, test-retest reliability and internal consistency of several common QOL measures in a sample of young autistic adults (n = 20; aged 19-32). Cognitive interviews suggested that the Satisfaction with Life Scale was well understood and demonstrated excellent internal consistency and test-retest reliability. While the WHOQoL-BREF and WHOQoL Disability Modules had adequate reliability, cognitive interviews suggested that additional instructions and examples would further enhance their accessibility for use with autistic adults.

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5. Berends D, Bent CA, Vivanti G, Dissanayake C, Hudry K. Developmental Skills Moderate the Association Between Core Autism Features and Adaptive Behaviour in Early Childhood. Journal of autism and developmental disorders. 2023.

PURPOSE: While research indicates that both the core features of autism and associated developmental skills influence adaptive behaviour outcomes, results to date suggest greater influence of the latter than the former, and little attention has been given to how the interaction of both together might impact functional disability. Seeking to expand understanding of associations between young children’s core social autism features, developmental skills, and functional ability/disability, we specifically tested whether early developmental skills might have a moderating effect on the association between early social features and subsequent functional disability. METHODS: Data from 162 preschool children were available for this study. These included time-1 measures of social autism features (ADOS-Social Affect score) and developmental skills (MSEL-Developmental Quotient; DQ), and a measure of functional ability/disability (VABS-Adaptive Behaviour Composite; ABC) available at follow-up 1-year later (time-2). RESULTS: Time-1 ADOS-SA and MSEL-DQ scores were concurrently associated with one another, and both prospectively associated with time-2 VABS-ABC scores. Examination of partial correlations (i.e., controlling for MSEL-DQ) demonstrated that the association of time-1 ADOS-SA and time-2 VABS-ABC was accounted for by shared variance with DQ. Formal moderation analysis returned a non-significant overall interaction term, but showed a lower-bound region of significance whereby the association of time-1 ADOS-SA with time-2 VABS-ABC was significant for children with baseline DQ ≤ 48.33. CONCLUSION: Our results add to a body of empirical evidence consistent with an understanding of the needs of and resources available to autistic people through a ‘cognitive compensation’ lens.

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6. Bradshaw J, Eberth JM, Zgodic A, Federico A, Flory K, McLain AC. County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States. Journal of autism and developmental disorders. 2023.

Prevalence estimates of autism spectrum disorder (ASD) point to geographic and socioeconomic disparities in identification and diagnosis. Estimating national prevalence rates can limit understanding of local disparities, especially in rural areas where disproportionately higher rates of poverty and decreased healthcare access exist. Using a small area estimation approach from the 2016-2018 National Survey of Children’s Health (N = 70,913), we identified geographic differences in ASD prevalence, ranging from 4.38% in the Mid-Atlantic to 2.71% in the West South-Central region. Cluster analyses revealed « hot spots » in parts of the Southeast, East coast, and Northeast. This geographic clustering of prevalence estimates suggests that local or state-level differences in policies, service accessibility, and sociodemographics may play an important role in identification and diagnosis of ASD.County-Level Prevalence Estimates of Autism Spectrum Disorder in Children in the United States.

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7. Chen A, Zhao R, Huang G, Li A, Cheung H. Successful lexical tone production of Mandarin Chinese autistic children with intellectual impairment. International journal of language & communication disorders. 2023.

BACKGROUND: Atypical speech prosody has been commonly found among autistic children. Yet it remains unknown whether prosody impairment originates from poor pitch ability in general or whether it is the result of the difficulty in understanding and using prosody for communicative purposes. AIMS: To investigate whether native Mandarin Chinese-speaking autistic children with intellectual impairment were able to accurately produce native lexical tones, which are pitch patterns that distinguish word meaning lexically and serve little social purpose. METHODS & PROCEDURES: Using a picture-naming task, thirteen 8-13-year-old Mandarin Chinese-speaking autistic children with intellectual impairment were tested on their production of Chinese lexical tones. Chronical age-matched typically developing (TD) children were included as the control group. Perceptual assessment and phonetic analyses were conducted with the produced lexical tones. OUTCOMES & RESULTS: The majority of the lexical tones produced by the autistic children were perceived as accurate by adult judges. Phonetic analysis of the pitch contours found no significant difference between the two groups, and the autistic children and TD children used the phonetic features in comparable ways when differentiating the lexical tones. However, the lexical tone accuracy rate was lower among the autistic children than among the TDs, and the larger individual difference was observed among the autistic children than the TD children. CONCLUSIONS & IMPLICATIONS: These results indicate that autistic children are able to produce the global contours of the lexical tones, and pitch deficits do not seem to qualify as a core feature of autism. WHAT THIS PAPER ADDS: What is already known on the subject Atypical prosody has been considered a maker of the speech of autistic children, and meta-analysis found a significant difference in mean pitch and pitch range between TD children and autistic children. Yet it remains unknown whether the pitch deficits are the result of impaired perceptual-motoric ability or if they reflect failure in learning sentential prosody, which requires an understanding of the interlocutors’ mind. In addition, research on pitch ability of autistic children with intellectual disabilities has been scarce, and whether these children are able to produce pitch variation is largely unknown. What this paper adds to existing knowledge We tested native Mandarin Chinese autistic children with intellectual impairment on their production of native lexical tones. The lexical tones in Chinese are pitch variations realized on individual syllables that distinguish lexical meaning, but they do not serve social pragmatic purposes. We found that although these autistic children had only developed limited spoken language, the majority of their lexical tones were perceived as accurate. They were able to use the phonetic features in comparable ways with the TD children when distinguishing the lexical tones. What are the potential or actual clinical implications of this work? It seems unlikely that pitch processing at the lexical level is fundamentally impaired in autistic children, and pitch deficits do not seem to qualify for a core feature of their speech. Practitioners should be cautious when using pitch production as a clinical marker for autistic children.

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8. Dong S, Tuo Y, Qi Z, Zhang Y, Liu X, Huang P, Chen X. Case report: Novel compound heterozygous variants in the PANK2 gene in a Chinese patient diagnosed with ASD and ADHD. Frontiers in neurology. 2023; 14: 1118076.

The PANK2 gene, which encodes mitochondrial pantothenate kinase 2 protein, is the disease-causing gene for pantothenate kinase-associated neurodegeneration (PKAN). We report a case of atypical PKAN with autism-like symptoms presenting with speech difficulties, psychiatric symptoms, and mild developmental retardation. Magnetic resonance imaging (MRI) of the brain showed the typical « eye-of-the-tiger » sign. Whole-exon sequencing revealed PANK2 p.Ile501Asn/p.Thr498Ser compound heterozygous variants. Our study highlights the phenotypic heterogeneity of PKAN, which can be confused with autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) and requires careful clinical identification.

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9. Girolamo T, Ghali S, Eigsti IM. A Community-Based Approach to Longitudinal Language Research With Racially and Ethnically Minoritized Autistic Young Adults: Lessons Learned and New Directions. American journal of speech-language pathology. 2023; 32(3): 977-88.

PURPOSE: Language and autism research each typically excludes racially and ethnically minoritized (REM) autistic individuals. In addition, in the case of autistic individuals with language impairment, investigators often approach caregivers to discuss research participation, rather than autistic individuals themselves. This gap limits the ecological validity of language research in autism. To address this gap, this clinical focus article describes strategies for engaging REM autistic young adults with language impairment using lessons learned from 5 years of longitudinal research with this population. This approach involved an ongoing community partnership, as well as participatory partnerships with REM autistic individuals and community stakeholders, consistent with a « slow science » approach. CONCLUSIONS: The approach yielded excellent retention of participants over 5 years and led to co-development of research projects aimed at priorities described by REM autistic individuals and their families, including understanding self-determination, social determinants of health, and language variability in autistic REM individuals with language impairment. Findings support the utility of community-based methods with autistic REM young adults with language impairment, with key takeaways for diversifying research while replicating, extending, and building theory.

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10. Hall SS, Britton TC. Differential Effects of a Behavioral Treatment Probe on Social Gaze Behavior in Fragile X Syndrome and Non-Syndromic Autism Spectrum Disorder. Journal of autism and developmental disorders. 2023.

The purpose of this study was to examine potential differences in social learning between individuals with fragile X syndrome (FXS), the leading known inherited cause of intellectual disability, and individuals with non-syndromic autism spectrum disorder (ASD). Thirty school-aged males with FXS and 26 age and symptom-matched males with non-syndromic ASD, were administered a behavioral treatment probe designed to improve levels of social gaze during interactions with others. The treatment probe was administered by a trained behavior therapist over two days in our laboratory and included reinforcement of social gaze in two alternating training conditions – looking while listening and looking while speaking. Prior to each session, children in each group were taught progressive muscle relaxation and breathing techniques to counteract potential increased hyperarousal. Measures included the rate of learning in each group during treatment, in addition to levels of social gaze and heart rate obtained during administration of a standardized social conversation task administered prior to and following the treatment probe. Results showed that learning rates obtained during administration of the treatment probe were significantly less steep and less variable for males with FXS compared to males with non-syndromic ASD. Significant improvements in social gaze were also observed for males with FXS during the social conversation task. There was no effect of the treatment probe on heart rate in either group. These data reveal important differences in social learning between the two groups and have implications for early interventions in the two conditions.

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11. Harkins C, Mazurek MO. The Impact of Co-occurring ADHD on Social Competence Intervention Outcomes in Youth with Autism Spectrum Disorder. Journal of autism and developmental disorders. 2023.

PURPOSE: The co-occurrence of autism spectrum disorder (ASD) and attention- deficit/hyperactivity disorder (ADHD) is significant and associated with a host of negative outcomes. Studies investigating social functioning in the presence of the ASD/ADHD co-occurrence have produced mixed findings. The present study further evaluated the impact of co-occurring ADHD on social functioning among youth with ASD and compared treatment response to a social competence intervention between youth with ASD and ASD + ADHD. METHODS: Two-way repeated measures analyses of variance (ANOVAs) were computed with diagnostic group and time as the independent variables and measures of social functioning as dependent variables. Group and Time effects and Group by Time interactions were examined. RESULTS: Youth with co-occurring ADHD displayed more impairments related to social awareness, but not in other social areas. Participants in both the ASD and ASD + ADHD groups demonstrated significant improvement following a social competence intervention. CONCLUSION: Co-occurring ADHD did not negatively affect treatment response. Youth with ASD + ADHD may benefit highly structured interventions with a scaffolded teaching design.

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12. Horan MR, Latendresse SJ, Limbers CA. Mental Health in Mothers of Autistic Children with a Medical Home: The Potentially Mechanistic Roles of Coping and Social Support. Journal of autism and developmental disorders. 2023.

Mothers of autistic children often report poor mental health outcomes. One established risk factor for these outcomes is the child having a medical home. This study examined possible mediating variables (coping, social support) in this relationship in 988 mothers of autistic children from the 2017/2018 National Survey of Children’s Health (NSCH). The results of the multiple mediation model suggest the relationship between having a medical home and maternal mental health is largely explained by indirect associations with coping and social support. These findings suggest that clinical interventions for coping and social support provided by the medical home for mothers of autistic children may improve maternal mental health outcomes over and above implementation of a medical home.

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13. Iao LS, Shen CW, Wu CC. A Longitudinal Study of Joint Attention, Motor Imitation and Language Development in Young Children with Autism Spectrum Disorder in Taiwan. Journal of autism and developmental disorders. 2023.

This longitudinal study examined early predictors of language development in 74 young children with Autism Spectrum Disorder (ASD) in Taiwan. Participants were assessed twice (initial age between 17 and 35 months) on responding to joint attention (RJA), initiating joint attention (IJA), motor imitation with objects (object imitation; OI) and without objects (manual imitation; MI), and receptive and expressive language. The two assessments were 18 months apart. Results showed that both RJA and MI concurrently and longitudinally predicted receptive and expressive language across the two assessments. These findings were not entirely consistent with the limited and mixed findings of Western longitudinal studies. However, they have implications for early interventions aiming to facilitate language development in children with ASD internationally.

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14. Krishnappa Babu PR, Aikat V, Di Martino JM, Chang Z, Perochon S, Espinosa S, Aiello R, K LHC, Compton S, Davis N, Eichner B, Flowers J, Franz L, Dawson G, Sapiro G. Blink rate and facial orientation reveal distinctive patterns of attentional engagement in autistic toddlers: a digital phenotyping approach. Scientific reports. 2023; 13(1): 7158.

Differences in social attention are well-documented in autistic individuals, representing one of the earliest signs of autism. Spontaneous blink rate has been used to index attentional engagement, with lower blink rates reflecting increased engagement. We evaluated novel methods using computer vision analysis (CVA) for automatically quantifying patterns of attentional engagement in young autistic children, based on facial orientation and blink rate, which were captured via mobile devices. Participants were 474 children (17-36 months old), 43 of whom were diagnosed with autism. Movies containing social or nonsocial content were presented via an iPad app, and simultaneously, the device’s camera recorded the children’s behavior while they watched the movies. CVA was used to extract the duration of time the child oriented towards the screen and their blink rate as indices of attentional engagement. Overall, autistic children spent less time facing the screen and had a higher mean blink rate compared to neurotypical children. Neurotypical children faced the screen more often and blinked at a lower rate during the social movies compared to the nonsocial movies. In contrast, autistic children faced the screen less often during social movies than during nonsocial movies and showed no differential blink rate to social versus nonsocial movies.

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15. Leung MHB, Ngan STJ, Cheng PWC, Chan FCG, Chang WC, Cheung HK, Ho C, Lee CKK, Tang YCV, Wong SMC, Chan KLP. Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study. Frontiers in psychiatry. 2023; 14: 1088209.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample. METHODS: This cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children’s Sleep Habits Questionnaire (CSHQ). RESULTS: Children with autism had significantly more sleep problems than non-autistic children [t ((226.73)) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t ((165)) = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t ((165)) = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ. CONCLUSION: In summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.

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16. Li Y, Gao S, Meng Y. Integrated analysis of endoplasmic reticulum stress regulators’ expression identifies distinct subtypes of autism spectrum disorder. Frontiers in psychiatry. 2023; 14: 1136154.

Endoplasmic reticulum (ER) stress has been demonstrated to play important roles in a variety of human diseases. However, their relevance to autism spectrum disorder (ASD) remains largely unknown. Herein, we aimed to investigate the expression patterns and potential roles of the ER stress regulators in ASD. The ASD expression profiles GSE111176 and GSE77103 were compiled from the Gene Expression Omnibus (GEO) database. ER stress score determined by the single sample gene set enrichment analysis (ssGSEA) was significantly higher in ASD patients. Differential analysis revealed that there were 37 ER stress regulators dysregulated in ASD. Based on their expression profile, the random forest and artificial neuron network techniques were applied to build a classifier that can effectively distinguish ASD from control samples among independent datasets. Weighted gene co-expression network analysis (WGCNA) screened out the turquoise module with 774 genes was closely related to the ER stress score. Through the overlapping results of the turquoise module and differential expression ER stress genes, hub regulators were gathered. The TF/miRNA-hub gene interaction networks were created. Furthermore, the consensus clustering algorithm was performed to cluster the ASD patients, and there were two ASD subclusters. Each subcluster has unique expression profiles, biological functions, and immunological characteristics. In ASD subcluster 1, the FAS pathway was more enriched, while subcluster 2 had a higher level of plasma cell infiltration as well as the BCR signaling pathway and interleukin receptor reaction reactivity. Finally, the Connectivity map (CMap) database was used to find prospective compounds that target various ASD subclusters. A total of 136 compounds were significantly enriched. In addition to some specific drugs which can effectively reverse the differential gene expression of each subcluster, we found that the PKC inhibitor BRD-K09991945 that targets Glycogen synthase kinase 3β (GSK3B) might have a therapeutic effect on both ASD subtypes that worth of the experimental validation. Our finding proved that ER stress plays a crucial role in the diversity and complexity of ASD, which may inform both mechanistic and therapeutic assessments of the disorder.

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17. Lim A, Brewer N, Aistrope D, Young RL. Response format changes the reading the mind in the eyes test performance of autistic and non-autistic adults. Autism : the international journal of research and practice. 2023: 13623613231167226.

Recognizing and understanding the perspectives of others-also called theory of mind-is important for effective communication. Studies have found that some autistic individuals have greater difficulty with theory of mind compared to non-autistic individuals. One purported theory of mind measure is the Reading the Mind in the Eyes Test (RMET). This test presents participants with photographs of pairs of eyes and asks them to identify the emotion displayed by each pair of eyes from four choices. Some researchers have argued that the multiple-choice format of the RMET may not be an accurate measure of theory of mind, as participants could simply be guessing or using a process of elimination to select the correct answer. Participants may also be disadvantaged if they are not familiar with the specific emotion words used in the multiple-choice answers. We examined whether a free-report (open-ended) format RMET would be a more valid measure of theory of mind than the multiple-choice RMET. Autistic and non-autistic adults performed better on the multiple-choice RMET than the free-report RMET. However, both versions successfully differentiated autistic and non-autistic adults, irrespective of their level of verbal ability. Performance on both versions was also correlated with another well-validated adult measure of theory of mind. Thus, the RMET’s multiple-choice format does not, of itself, appear to underpin its ability to differentiate autistic and non-autistic adults.

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18. Liu A, Lu Y, Gong C, Sun J, Wang B, Jiang Z. Bibliometric Analysis of Research Themes and Trends of the Co-Occurrence of Autism and ADHD. Neuropsychiatric disease and treatment. 2023; 19: 985-1002.

BACKGROUND: In recent years, there has been a growing body of research suggesting that ASD and ADHD are two disorders that often co-exist. Despite the rapid development of research, little is known about their etiology, diagnostic markers, and interventions, which has led us to review and summarise the development of the field in the hope that this will provide an opportunity to look for future directions. METHODS: A bibliometric approach was used to analyse papers in the field of ASD co-morbidities in ADHD on Web of Science from 1991-2022, using CiteSpace and VOSview to map the country/institution, journal, author, co-citation, and keyword networks in the field and to visualise the results. RESULTS: A total of 3284 papers were included, showing an increasing trend in terms of posting trends. Research on co-morbidities of ASD has proven to be mainly focused on universities. The USA (1662) published the most relevant literature in this area, followed by the UK (651) and Sweden (388). Lichtenstein P is the most published author (84), and research into the pathogenesis of ASD co-occurring ADHD and related clinical diagnostics is currently at the forefront of the field. CONCLUSION: This analysis identifies the most influential institutions and countries, cited journals, and authors in the field of ASD co-morbid ADHD research. The future direction of ASD co-occurring ADHD should be based on improving case identification, discovering the etiological and diagnostic markers of ASD and ADHD, and finding more effective clinical interventions.

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19. Martinez C, Chen ZS. Identification of atypical sleep microarchitecture biomarkers in children with autism spectrum disorder. Frontiers in psychiatry. 2023; 14: 1115374.

IMPORTANCE: Sleep disorders are one of the most frequent comorbidities in children with autism spectrum disorder (ASD). However, the link between neurodevelopmental effects in ASD children with their underlying sleep microarchitecture is not well understood. An improved understanding of etiology of sleep difficulties and identification of sleep-associated biomarkers for children with ASD can improve the accuracy of clinical diagnosis. OBJECTIVES: To investigate whether machine learning models can identify biomarkers for children with ASD based on sleep EEG recordings. DESIGN SETTING AND PARTICIPANTS: Sleep polysomnogram data were obtained from the Nationwide Children’ Health (NCH) Sleep DataBank. Children (ages: 8-16 yrs) with 149 autism and 197 age-matched controls without neurodevelopmental diagnosis were selected for analysis. An additional independent age-matched control group (n = 79) selected from the Childhood Adenotonsillectomy Trial (CHAT) was also used to validate the models. Furthermore, an independent smaller NCH cohort of younger infants and toddlers (age: 0.5-3 yr.; 38 autism and 75 controls) was used for additional validation. MAIN OUTCOMES AND MEASURES: We computed periodic and non-periodic characteristics from sleep EEG recordings: sleep stages, spectral power, sleep spindle characteristics, and aperiodic signals. Machine learning models including the Logistic Regression (LR) classifier, Support Vector Machine (SVM), and Random Forest (RF) model were trained using these features. We determined the autism class based on the prediction score of the classifier. The area under the receiver operating characteristics curve (AUC), accuracy, sensitivity, and specificity were used to evaluate the model performance. RESULTS: In the NCH study, RF outperformed two other models with a 10-fold cross-validated median AUC of 0.95 (interquartile range [IQR], [0.93, 0.98]). The LR and SVM models performed comparably across multiple metrics, with median AUC 0.80 [0.78, 0.85] and 0.83 [0.79, 0.87], respectively. In the CHAT study, three tested models have comparable AUC results: LR: 0.83 [0.76, 0.92], SVM: 0.87 [0.75, 1.00], and RF: 0.85 [0.75, 1.00]. Sleep spindle density, amplitude, spindle-slow oscillation (SSO) coupling, aperiodic signal’s spectral slope and intercept, as well as the percentage of REM sleep were found to be key discriminative features in the predictive models. CONCLUSION AND RELEVANCE: Our results suggest that integration of EEG feature engineering and machine learning can identify sleep-based biomarkers for ASD children and produce good generalization in independent validation datasets. Microstructural EEG alterations may help reveal underlying pathophysiological mechanisms of autism that alter sleep quality and behaviors. Machine learning analysis may reveal new insight into the etiology and treatment of sleep difficulties in autism.

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20. Moorthy SD, Carlstedt AB, Fischl C. Mothers’ participation in family gatherings and social events with their children with autism spectrum disorder: A scoping review. Australian occupational therapy journal. 2023.

INTRODUCTION: Participating in family gatherings can provide enjoyment and quality time together as a family. However, being the primary carers, mothers of children with autism spectrum disorder may experience this phenomenon differently. The purpose of this study is to explore how available literature describes mothers’ experiences of participation in family gatherings and social events with their children with autism spectrum disorder. METHODS: A scoping review was used to explore available literature and identify studies describing mothers’ experiences of family gatherings and social events with their children. A thematic synthesis was performed to analyse and synthesise the findings. RESULTS: A total of 8 articles were included for review. The analysis of the included studies resulted in one central theme-Negative experiences despite strategies-and four analytical themes: Feeling fear, stress, and anxiety; Avoiding family gatherings; Enjoying less and becoming less confident; and Using strategies. CONCLUSION: These findings indicate that mothers of children with autism spectrum disorder experience difficulties during gatherings even when using strategies, hence limiting their participation.

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21. Muller K. Exploring the Clinical Feasibility of Alternative Word-Understanding Measures for Autistic Children With Minimal Spoken Language. American journal of speech-language pathology. 2023; 32(3): 1322-35.

PURPOSE: The primary aim of this study was to explore the clinical feasibility of using alternate word-understanding assessment modalities for autistic children who have minimal verbal skills. Specifically, assessment duration, occurrence of disruptive behavior, and no-response trials were examined across three word-understanding assessment conditions: a low-tech condition, a touchscreen condition, and a condition that used real-object stimuli. A secondary aim was to examine the relationship between disruptive behavior and assessment outcomes. METHOD: Twenty-seven autistic children between the ages of 3 and 12 years who had minimal verbal skills completed 12 test items on the three assessment conditions. Repeated-measures analyses of variance with post hoc Bonferroni procedures were used to describe and compare assessment duration, occurrence of disruptive behavior, and no-response trials across conditions. A Spearman rank-order correlation coefficient was used to examine the relationship between disruptive behavior and assessment outcomes. RESULTS: The real-object assessment condition took significantly longer than the low-tech and touchscreen conditions. Participants engaged in disruptive behavior most frequently during the low-tech condition; however, differences among conditions were not significant. There were significantly more no-response trials in the low-tech condition than in the touchscreen condition. There was a significant, weak negative correlation between disruptive behavior and experimental assessment outcomes. CONCLUSION: Results show there is promise in using real objects and touchscreen devices to assess word understanding in autistic children who have minimal verbal skills.

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22. Patti MA, Croen LA, Chen A, Fallin MD, Khoury J, Lyall K, Newschaffer C, Hertz-Picciotto I, Schmidt RJ, Yolton K, Braun JM. Prepregnancy BMI, gestational weight gain, and susceptibility to autism-related traits: the EARLI and HOME studies. Obesity (Silver Spring, Md). 2023; 31(5): 1415-24.

OBJECTIVE: Excessive gestational weight gain (GWG) has been associated with autism spectrum disorder (ASD). This study sought to examine whether familial susceptibility for autism, intensity of ASD-related behaviors, or prepregnancy BMI influences the association of GWG with ASD-related behaviors. METHODS: Using data from the Early Autism Risk Longitudinal Investigation (EARLI) study (n = 136), a familial enriched cohort of mothers who had a previous child with ASD, and the Health Outcomes and Measures of the Environment (HOME) study (n = 253), a general population cohort, gestational age and prepregnancy BMI category-specific GWG z scores were calculated. Caregivers completed the Social Responsiveness Scale (SRS) to assess the presence and severity of ASD-related traits in children aged 3 to 8 years. Using quantile regression, the association between GWG z scores and ASD-related behaviors in children was estimated. RESULTS: In HOME, among mothers who had overweight or obesity prepregnancy BMI values, GWG z scores and SRS scores were positively associated in children with more ASD-related traits (higher SRS scores), but not in children with fewer ASD-related traits. Similar patterns were observed in EARLI among mothers with prepregnancy obesity. CONCLUSIONS: GWG may be associated with autism-related behaviors among children who have a greater predisposition to these behaviors and who have mothers with prepregnancy overweight or obesity.

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23. Rhodes SM, Eaton CB, Oldridge J, Rodgers J, Chan S, Skouta E, McKechanie AG, Mackie L, Stewart TM. Lived experiences of depression in autistic children and adolescents: A qualitative study on child and parent perspectives. Research in developmental disabilities. 2023; 138: 104516.

BACKGROUND: Depression is highly prevalent in autistic children and adolescents. Despite this, little is known about the nature of the autistic child’s subjective experience of depression and the impact of depression on their lives. METHODS: We therefore conducted a qualitative study using thematic analysis with 7 autistic children and adolescents and their parents to identify common themes and individual differences. All children had previously experienced at least one depressive episode. RESULTS: Six main themes were identified: (1) Autism related experiences; (2) Difficulties with peer relationships; (3) Co-occurring relationships between anxiety and depression; (4) Impactful pessimism and anhedonia; (5) Impactful difficulties with focus and concentration and (6) Feelings of irritability, including aggressive behaviours. Parent’s accounts of their children’s experience of depression mirrored the child’s perspective. Novel findings included reports of depression related restriction of diet variety and masking of mental health difficulties. Children and parents linked being autistic and developing depression, referring to the difficulties of being autistic in a complex, neurotypical world. CONCLUSIONS: These results highlight key challenges that autistic children and their families experience, calling for increased awareness of the impact of depression on autistic young people.

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24. Rollins PR, Rangel-Uribe C, Rojas R, Brantley S. Examining Cultural and Linguistic Sensitivity of Pathways Early Autism Intervention with Hispanic Families. Journal of autism and developmental disorders. 2023.

PURPOSE: This research aimed to evaluate evidence of Pathways parent-mediated early autism intervention as a culturally and linguistically sensitive intervention (CLSI) for Hispanic families with autistic children. METHODS: We used Bernal et al.’s ecologically valid (EV) framework to evaluate current practice and Hispanic parents’ perceptions of Pathways 1 ½ years after completing the intervention. Both quantitative and qualitative methods were used. Nineteen parents were contacted, of which 11 completed a semi-structured interview about their experience with Pathways. RESULTS: On average, the group that completed the interview was less educated, had more monolingual Spanish speakers, and rated their general experience with the intervention slightly more positively than those who did not agree to complete the interview. A review of Pathways’s current practices through the lens of the EV framework suggested that Pathways was a CLSI for Hispanic participants in the domains of context, methods, language, and persons. Parental interviews echoed these strengths. However, Pathways did less well balancing evidence-based intervention strategies for autistic children with the heritage value of respeto. CONCLUSION: Pathways demonstrated strengths regarding cultural and linguistic sensitivity for Hispanic families with young autistic children. Future work with our community stakeholder group will integrate heritage and majority culture perspectives to strengthen Pathways as a CLSI.

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25. Saha P. Eigenvector Centrality Characterization on fMRI Data: Gender and Node Differences in Normal and ASD Subjects : Author name. Journal of autism and developmental disorders. 2023.

With the budding interests of structural and functional network characteristics as potential parameters for abnormal brains, an essential and thus simpler representation and evaluations have become necessary. Eigenvector centrality measure of functional magnetic resonance imaging (fMRI) offer region wise network representations through fMRI diagnostic maps. The article investigates the suitability of network node centrality values to discriminate ASD subject groups compared to typically developing controls following a boxplot formalism and a classification and regression tree model. Region wise differences between normal and ASD subjects primarily belong to the frontoparietal, limbic, ventral attention, default mode and visual networks. The reduced number of regions-of-interests (ROI) clearly suggests the benefit of automated supervised machine learning algorithm over the manual classification method.

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26. Sapiets SJ, Hastings RP, Totsika V. Predictors of Access to Early Support in Families of Children with Suspected or Diagnosed Developmental Disabilities in the United Kingdom. Journal of autism and developmental disorders. 2023.

This study examined predictors of access to early support amongst families of 0-6-year-old children with suspected or diagnosed developmental disabilities in the United Kingdom. Using survey data from 673 families, multiple regression models were fitted for three outcomes: intervention access, access to early support sources, and unmet need for early support sources. Developmental disability diagnosis and caregiver educational level were associated with intervention access and early support access. Early support access was also associated with child physical health, adaptive skills, caregiver ethnicity, informal support, and statutory statement of special educational needs. Unmet need for early support was associated with economic deprivation, the number of household caregivers, and informal support. Multiple factors influence access to early support. Key implications include enhancing processes for formal identification of need, addressing socioeconomic disparities (e.g., reducing inequalities, increasing funding for services), and providing more accessible services (e.g., coordinating support across services, flexible service provision).

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27. Schaaf RC, Puts NA, Williams ZJ, Woynaroski T. Forwarding the Science of Sensory Features in Autism and Related Conditions. Journal of autism and developmental disorders. 2023.

This editorial accompanies the JADD Special Issue on Sensory Features in Autism and Related Conditions: Developmental Approaches, Mechanisms and Targeted Interventions. The editorial is a commentary on the state of the science in sensory features in autism and related conditions and provides a synopsis of the information contained in the special issue including provocative thoughts about moving the field forward in this area.

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28. St John T, Estes AM, Hazlett HC, Marrus N, Burrows CA, Donovan K, Torres Gomez S, Grzadzinski RL, Parish-Morris J, Smith R, Styner M, Garic D, Pandey J, Lee CM, Schultz RT, Botteron KN, Zwaigenbaum L, Piven J, Dager SR. Association of Sex With Neurobehavioral Markers of Executive Function in 2-Year-Olds at High and Low Likelihood of Autism. JAMA network open. 2023; 6(5): e2311543.

IMPORTANCE: Children with autism and their siblings exhibit executive function (EF) deficits early in development, but associations between EF and biological sex or early brain alterations in this population are largely unexplored. OBJECTIVE: To investigate the interaction of sex, autism likelihood group, and structural magnetic resonance imaging alterations on EF in 2-year-old children at high familial likelihood (HL) and low familial likelihood (LL) of autism, based on having an older sibling with autism or no family history of autism in first-degree relatives. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed 165 toddlers at HL (n = 110) and LL (n = 55) of autism at 4 university-based research centers. Data were collected from January 1, 2007, to December 31, 2013, and analyzed between August 2021 and June 2022 as part of the Infant Brain Imaging Study. MAIN OUTCOMES AND MEASURES: Direct assessments of EF and acquired structural magnetic resonance imaging were performed to determine frontal lobe, parietal lobe, and total cerebral brain volume. RESULTS: A total of 165 toddlers (mean [SD] age, 24.61 [0.95] months; 90 [54%] male, 137 [83%] White) at HL for autism (n = 110; 17 diagnosed with ASD) and LL for autism (n = 55) were studied. The toddlers at HL for autism scored lower than the toddlers at LL for autism on EF tests regardless of sex (mean [SE] B = -8.77 [4.21]; 95% CI, -17.09 to -0.45; η2p = 0.03). With the exclusion of toddlers with autism, no group (HL vs LL) difference in EF was found in boys (mean [SE] difference, -7.18 [4.26]; 95% CI, 1.24-15.59), but EF was lower in HL girls than LL girls (mean [SE] difference, -9.75 [4.34]; 95% CI, -18.32 to -1.18). Brain-behavior associations were examined, controlling for overall cerebral volume and developmental level. Sex differences in EF-frontal (B [SE] = 16.51 [7.43]; 95% CI, 1.36-31.67; η2p = 0.14) and EF-parietal (B [SE] = 17.68 [6.99]; 95% CI, 3.43-31.94; η2p = 0.17) associations were found in the LL group but not the HL group (EF-frontal: B [SE] = -1.36 [3.87]; 95% CI, -9.07 to 6.35; η2p = 0.00; EF-parietal: B [SE] = -2.81 [4.09]; 95% CI, -10.96 to 5.34; η2p = 0.01). Autism likelihood group differences in EF-frontal (B [SE] = -9.93 [4.88]; 95% CI, -19.73 to -0.12; η2p = 0.08) and EF-parietal (B [SE] = -15.44 [5.18]; 95% CI, -25.86 to -5.02; η2p = 0.16) associations were found in girls not boys (EF-frontal: B [SE] = 6.51 [5.88]; 95% CI, -5.26 to 18.27; η2p = 0.02; EF-parietal: B [SE] = 4.18 [5.48]; 95% CI, -6.78 to 15.15; η2p = 0.01). CONCLUSIONS AND RELEVANCE: This cohort study of toddlers at HL and LL of autism suggests that there is an association between sex and EF and that brain-behavior associations in EF may be altered in children at HL of autism. Furthermore, EF deficits may aggregate in families, particularly in girls.

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29. Sunagawa M. How much of my true self can i show? social adaptation in autistic women: a qualitative study. BMC psychology. 2023; 11(1): 144.

BACKGROUND: Social adaptation is often aimed at supporting autistic people, yet its specific goals may not include their actual perspectives. That is, the state of adaptation is judged based on the standards and values of non-autistic people. This qualitative study focused on autistic women’s perceptions of social adaptation and examined their lived experiences in daily life, as adaptive behaviors have often been reported as a « female autism phenotype. » METHODS: Semi-structured interviews were conducted face-to-face with ten autistic women aged 28-50 years (M = 36.7; standard SD = 7.66). The analysis was conducted based on the grounded theory approach. RESULTS: Two core perceptions were identified: maintaining stable relationships and fulfilling social roles based on past experiences of « maladaptation. » The participants sought adaptations within a reasonable range and adjusted their balance with society to maintain stability in their daily lives. CONCLUSION: The findings indicated that autistic women’s perceptions of adaptation were based on the accumulation of past negative experiences. Further harmful efforts should be prevented. Support for autistic people to make their own choices in life is also important. Moreover, autistic women need a place where they can be themselves and be accepted as they are. This study showed the importance of changing the environment rather than modifying autistic people to adapt to a society.

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30. Tinelli MM, Roddy A, Knapp M, Arango C, Mendez MA, Cusack J, Murphy D, Canitano R, Oakley B, Quoidbach V. Economic Evaluation of anti-epileptic Medicines for Autistic Children with Epilepsy. Journal of autism and developmental disorders. 2023.

We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children’s families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure.

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31. Yerkes BD, Vanden Bosch der Nederlanden CM, Beasley JF, Hannon EE, Snyder JS. Acoustic and Semantic Processing of Auditory Scenes in Children with Autism Spectrum Disorders. Journal of autism and developmental disorders. 2023.

PURPOSE: Processing real-world sounds requires acoustic and higher-order semantic information. We tested the theory that individuals with autism spectrum disorder (ASD) show enhanced processing of acoustic features and impaired processing of semantic information. METHODS: We used a change deafness task that required detection of speech and non-speech auditory objects being replaced and a speech-in-noise task using spoken sentences that must be comprehended in the presence of background speech to examine the extent to which 7-15 year old children with ASD (n = 27) rely on acoustic and semantic information, compared to age-matched (n = 27) and IQ-matched (n = 27) groups of typically developing (TD) children. Within a larger group of 7-15 year old TD children (n = 105) we correlated IQ, ASD symptoms, and the use of acoustic and semantic information. RESULTS: Children with ASD performed worse overall at the change deafness task relative to the age-matched TD controls, but they did not differ from IQ-matched controls. All groups utilized acoustic and semantic information similarly and displayed an attentional bias towards changes that involved the human voice. Similarly, for the speech-in-noise task, age-matched-but not IQ-matched-TD controls performed better overall than the ASD group. However, all groups used semantic context to a similar degree. Among TD children, neither IQ nor the presence of ASD symptoms predict the use of acoustic or semantic information. CONCLUSION: Children with and without ASD used acoustic and semantic information similarly during auditory change deafness and speech-in-noise tasks.

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32. Zhang W, Watson LR, Johnson KR. Racial Disparities in Hospitalization Due to Ambulatory Care Sensitive Conditions Among U.S. Children with Autism. Journal of autism and developmental disorders. 2023.

PURPOSE: This study was to investigate the factors associated with preventable hospitalization due to ambulatory care sensitive conditions (ACSCs) in children with autism. METHODS: Using secondary data from the U.S. Nationwide Inpatient Sample (NIS), multivariable regression analyses were conducted to determine the potential effect of race and income level on the likelihood of inpatient stays for ACSCs among autistic children. Pediatric ACSCs included three acute conditions (dehydration, gastroenteritis, and urinary infection) and three chronic conditions (asthma, constipation, and diabetes short-term complications). RESULTS: In this analysis, there were 21,733 hospitalizations among children with autism; about 10% were hospitalized due to pediatric ACSCs. Overall, the odds of ACSCs hospitalization were greater among Hispanic and Black autistic children versus White autistic children. Both Hispanic and Black autistic children from the lowest income level had the highest odds to be hospitalized for chronic ACSCs. CONCLUSION: Inequities of access to health care among racial/ethnic minorities were most notable for autistic children with chronic ACSC conditions.

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