1. Correction to: Exploring the Experiences of Autistic Transgender and Non Binary Adults in Seeking Gender Identity Health Care, by Bruce et al. Autism Adulthood 2023;5(2):191-203; doi: 10.1089/aut.2023.0003. Autism in adulthood : challenges and management. 2023; 5(3): 343.

[This corrects the article DOI: 10.1089/aut.2023.0003.].

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2. Correction to: Centering the Inner Experience of Autism: Development of the Self-Assessment of Autistic Traits, by Ratto et al. Autism Adulthood 2023;5(1):93-105; doi: 10.1089/aut.2021.0099. Autism in adulthood : challenges and management. 2023; 5(3): 344.

[This corrects the article DOI: 10.1089/aut.2021.0099.].

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3. Acero-Garcés DO, Saldarriaga W, Cabal-Herrera AM, Rojas CA, Hagerman RJ. Fragile X Syndrome in children. Colombia medica (Cali, Colombia). 2023; 54(2): e4005089.

Fragile X syndrome is caused by the expansion of CGG triplets in the FMR1 gene, which generates epigenetic changes that silence its expression. The absence of the protein coded by this gene, FMRP, causes cellular dysfunction, leading to impaired brain development and functional abnormalities. The physical and neurologic manifestations of the disease appear early in life and may suggest the diagnosis. However, it must be confirmed by molecular tests. It affects multiple areas of daily living and greatly burdens the affected individuals and their families. Fragile X syndrome is the most common monogenic cause of intellectual disability and autism spectrum disorder; the diagnosis should be suspected in every patient with neurodevelopmental delay. Early interventions could improve the functional prognosis of patients with Fragile X syndrome, significantly impacting their quality of life and daily functioning. Therefore, healthcare for children with Fragile X syndrome should include a multidisciplinary approach.

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4. Aderinto N, Olatunji D, Idowu O. Autism in Africa: prevalence, diagnosis, treatment and the impact of social and cultural factors on families and caregivers: a review. Annals of medicine and surgery (2012). 2023; 85(9): 4410-6.

This paper presents a narrative review of current knowledge on autism in Africa, including prevalence, diagnosis, treatment and the impact of social and cultural factors on families and caregivers. The prevalence of autism in Africa is estimated to be similar to that in other regions. However, diagnosis and treatment access remain limited due to various challenges, such as a shortage of specialised healthcare professionals and resources, a lack of awareness and understanding of autism spectrum disorder (ASD) among healthcare providers, and cultural stigma surrounding mental health and developmental disorders. Alternative therapies are commonly used with other therapies, but their effectiveness is often unproven. The impact of ASD on families and caregivers in Africa is significant, with many facing challenges in accessing support services and coping with stigma. Efforts are being made to increase awareness and reduce the stigma around ASD in African communities, but more research is needed on effective interventions and culturally appropriate treatments. Policy recommendations include increasing resources and training for healthcare professionals, improving access to evidence-based interventions and promoting community awareness and support. With improved understanding and investment, the quality of life of individuals with ASD in Africa can be significantly improved.

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5. Alberca CD, Papale LA, Madrid A, Alisch RS. Hippocampal and peripheral blood DNA methylation signatures correlate at the gene and pathway level in a mouse model of autism. Human molecular genetics. 2023.

Autism spectrum disorders (ASD) are polygenic multifactorial disorders influenced by environmental factors. ASD-related differential DNA methylation has been found in human peripheral tissues, such as placenta, paternal sperm, buccal epithelium, and blood. However, these data lack direct comparison of DNA methylation levels with brain tissue from the same individual to determine the extent that peripheral tissues are surrogates for behavior-related disorders. Here, whole genome methylation profiling at all the possible sites throughout the mouse genome (>25 million) from both brain and blood tissues revealed novel insights into the systemic contributions of DNA methylation to ASD. Sixty-six differentially methylated regions (DMRs) share the same genomic coordinates in these two tissues, many of which are linked to risk genes for neurodevelopmental disorders and intellectual disabilities (e.g. Prkch, Ptn, Hcfc1, Mid1, and Nfia). Gene ontological pathways revealed a significant number of common terms between brain and blood (n = 65 terms), and nearly half (30/65) were associated with brain/neuronal development. Furthermore, seven DMR-associated genes among these terms contain methyl-sensitive transcription factor sequence motifs within the DMRs of both tissues; four of them (Cux2, Kcnip2, Fgf13, and Mrtfa) contain the same methyl-sensitive transcription factor binding sequence motifs (HES1/2/5, TBX2 and TFAP2C), suggesting DNA methylation influences the binding of common transcription factors required for gene expression. Together, these findings suggest that peripheral blood is a good surrogate tissue for brain and support that DNA methylation contributes to altered gene regulation in the pathogenesis of ASD.

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6. Ballantine J, Rocheleau J, Macarios J, Ross G, Artemeva N. « Change Isn’t Exactly Easy »: Autistic University Students’ Lived Learning Experiences During the COVID-19 Pandemic. Autism in adulthood : challenges and management. 2023; 5(3): 325-34.

BACKGROUND: The COVID-19 (coronavirus disease 2019) pandemic-related isolation measures caused significant unexpected changes in learning experiences for all university students, including autistic students. So far, there has been a lack of information on autistic university students’ lived learning experiences caused by the changes in the teaching delivery formats from face-to-face to online during this time. Our study addressed this gap by investigating eight autistic students’ reported learning experiences during the rapid changes caused by the pandemic and discussing student-advocated learning supports. METHODS: The participants in this qualitative study were eight formally or self-diagnosed, English-speaking, autistic undergraduate and graduate university students from a mid-sized Canadian university. Participants took part in semi-structured interviews that focused on their learning experiences and preferences before and during the pandemic, including what supports they found helpful. To analyze and interpret the data, autistic and nonautistic researchers used reflexive thematic analysis and a consultative participatory approach. RESULTS: Our findings suggest that individual (i.e., organizational skills; mental health), interactional (i.e., prior experiences interacting with instructors and teaching assistants), and environmental (i.e., sensory environments, class sizes, virtual learning environments) factors, which were interrelated, determined the nature and quality of these autistic students’ learning experiences and their academic preferences during the pandemic. We also found that each autistic student reported unique learning experiences and needed individualized supports for their learning. CONCLUSIONS: Several interrelated factors (individual, interactional, and environmental) affected the nature and quality of autistic university students’ experiences during the pandemic. Each student had unique experiences and needed individualized supports. WHAT WAS THE PURPOSE OF THIS STUDY? During the COVID-19 pandemic, all university students experienced rapid unexpected changes in teaching and learning formats when they had to switch from face-to-face learning to online platforms. There is almost no published information on autistic students’ learning experiences during the pandemic. The purpose of this study was to understand eight autistic university students’ reported lived learning experiences during the COVID-19 pandemic and to discover potential academic supports that the students identified. WHAT DID THE RESEARCHERS DO? We interviewed eight Canadian autistic university students (five undergraduates and three graduates) about their lived academic experiences before and during the pandemic, focusing on their experiences with changes from face-to-face to online learning. We also asked them about effective academic supports that universities could provide. Autistic and nonautistic researchers worked together to analyze the participants’ responses. WHAT WERE THE FINDINGS OF THE STUDY? The study found that individual, interactional, and environmental factors combined to affect these university autistic students’ lived learning experiences and their preferences for either online or in-person learning. Specifically, first, we found that each student’s ability to study independently in an organized way and their personal mental health concerns such as anxiety management were key in deciding their learning preferences. Second, each student’s prior success in socially interacting with instructors and teaching assistants was important in their preferences for online or in-person learning. Third, each student’s sensory experiences on campus and at home including factors such as having to attend large noisy classes or the availability of quiet home-based learning environments were important. We also found that each autistic student experienced learning uniquely and required individualized supports. In this study, the three graduate students reported wanting to return to in-person learning as soon as possible, whereas most undergraduate students preferred online learning. WHAT ARE THE POTENTIAL WEAKNESSES IN THE STUDY? We were not able to recruit as many or as diverse a group of students as we would have liked. Additionally, although autistic co-researchers took part in the coding, analysis, and writing of this study, they did not contribute to the earlier design or data collection. In the future, we plan to fully involve autistic co-researchers from the start to ensure we produce research that addresses the expressed needs of autistic people. HOW DO THESE FINDINGS HELP AUTISTIC ADULTS? This study provided evidence of eight autistic university students’ lived learning experiences and preferences during the pandemic and described supports that the students indicated were important in helping them learn effectively at university. HOW DO THESE FINDINGS ADVANCE THE LITERATURE? This small-scale study provided early evidence about these autistic university students’ preferences for online or in-person learning and the reasons for these preferences. These findings can be used to expand this study to include a greater number and diversity of students to investigate how other factors such as race, economic status, presence of co-occurring conditions (e.g., learning disabilities), and others may also influence autistic university students’ learning preferences. eng.

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7. Cai RY, Hall G, Pellicano E. Predicting the financial wellbeing of autistic adults: Part I. Autism : the international journal of research and practice. 2023: 13623613231196085.

Researchers have found the way people feel about their financial situation is related to their quality of life. We know that many autistic people find it hard to find a job. And for those autistic people who have a job, they are often underpaid. Not having a job or being underpaid often means having low income. Having low income is likely to influence how autistic people feel about their financial situation. However, no research has looked at these issues for autistic people. This is the first study that helps us learn more about what autistic adults think about their financial situation. We looked at autistic people’s thoughts on this issue compared to people from the general Australian population. We also looked at what things might impact how autistic people feel about their financial situation-which might be how much money they earn, what they do with that money, and their mental health. Many autistic adults felt they were struggling with financial wellbeing and this was connected both to the level of their income and how they said they managed their money. Those who were able to save and not borrow for everyday expenses reported feeling a greater sense of financial wellbeing. Concrete changes might help to improve autistic people’s financial wellbeing. We need to investigate how we can help autistic people find and keep well-paying jobs. And we need to work out the best ways of equipping autistic people with the skills they need in financial matters.

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8. Cai RY, Love A, Robinson A, Gibbs V. The Inter-Relationship of Emotion Regulation, Self-Compassion, and Mental Health in Autistic Adults. Autism in adulthood : challenges and management. 2023; 5(3): 335-42.

BACKGROUND: Emotion regulation is one of the key factors that influence mental health outcomes in autistic and nonautistic populations. Recent research has also identified self-compassion as a negative correlate of depression and positive correlate of psychological well-being in autistic adults. Empirical evidence from the general population supports the notion that being kind and compassionate toward oneself during stressful and difficult moments can help with one’s ability to regulate negative emotions, which then has flow-on effects on mental health outcomes. However, the inter-relationship between self-compassion, emotion regulation, and mental health has not been examined in autistic samples. Therefore, the aim of this study was to determine if emotion regulation mediates the relationship between self-compassion and anxiety or depression in a sample of autistic adults. METHODS: Participants were 153 adults (mean(age) = 35.70, standard deviation(age) = 12.62) who had either self-reported a clinical diagnosis of autism spectrum disorder or self-identified as autistic. They completed an online survey capturing self-compassion, emotion regulation, anxiety, and depression. We hypothesized that emotion regulation would mediate the relationship between self-compassion and anxiety or depression, and self-compassion would not mediate the relationship between emotion regulation and anxiety or depression. RESULTS: As predicted, only emotion regulation mediated the relationship between self-compassion and mental health outcomes. Self-compassion did not mediate the relationship between emotion regulation and mental health outcomes. CONCLUSION: This study provides preliminary evidence for the role that self-compassion plays in improving emotion regulation and mental health in autistic adults. If this mechanism of emotion regulation mediating the relationship between self-compassion and mental health is consistently found in future studies, then it would be helpful for future research to examine the clinical benefits of including a self-compassion component in emotion regulation interventions to improve mental health outcomes of autistic adults. WHY IS THIS AN IMPORTANT ISSUE? Many autistic individuals are diagnosed with mental illnesses such as anxiety or depression. Having a mental illness leads to negative consequences such as feelings of loneliness and sleep problems. Research findings show that improving autistic people’s ability to regulate emotions can reduce symptoms of mental illnesses. Being compassionate toward ourselves during stressful and difficult moments can help us better regulate our negative emotions such as anger, sadness, and fear. Better emotion regulation then improves mental health. Research in the general population supports this proposal. But no research has studied the relationship between self-compassion, emotion regulation, and mental health in autistic adults. WHAT WAS THE PURPOSE OF THIS STUDY? This study aims to look at the relationship between self-compassion, emotion regulation, and mental health in a sample of autistic adults. WHAT DID THE RESEARCHERS DO? We designed an online survey and asked autistic adults to complete this survey. Several autism and autistic organizations around the world helped us spread the word about this study (we are grateful for their support!). The survey contained questions capturing people’s self-compassion levels, emotion regulation difficulties, and symptoms of anxiety and depression. One hundred and fifty-three autistic adults completed the survey. These participants either self-reported a diagnosis of autism or self-identified as autistic. WHAT WERE THE RESULTS OF THE STUDY? We found that autistic adults with higher levels of self-compassion had better emotion regulation and fewer symptoms of anxiety and depression. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Researchers and clinicians have designed various treatments to improve autistic people’s emotion regulation. And we know that some of these treatments also improve mental health. We need to identify the components that should be included in the treatments to make them most effective. If future research continues to find this relationship between self-compassion, emotion regulation, and mental health, then adding a self-compassion component to emotion regulation treatments may be helpful. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? This study has several weaknesses: Online survey design—we could not conduct diagnostic assessments to confirm the participant’s autism diagnosis. But we have used a questionnaire called the Autism Spectrum Quotient; all participants who self-identified as autistic met the cutoff for autism.Data collection—we collected data from participants at one point, which meant we could not identify the direction of the relationships between variables.Gender of autistic people—a larger proportion of our participants were women, which does not match the typical autism gender ratio of 1:4 (female:male). HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? We hope this study will start the conversation on the relevance of increasing self-compassion for improving emotion regulation and mental health in autistic adults. Therefore, this study may inform the design of future interventions for improving autistic adults’ emotion regulation and mental health. eng.

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9. Chamarthi VR, Arangannal P. Prognostic Factors for Successful Dental Treatment in Autistic Children and Adolescents. International journal of clinical pediatric dentistry. 2023; 16(Suppl 1): S45-s50.

AIM: The aim of this study was to recognize and assess the prognostic factors which could predict the level of cooperation of children with autism for dental appointments. METHODS: A total of 395 parents of children with autism participated in this study. Prognostic factors of cooperation were evaluated using questionnaires. Data were collected using parent surveys by a dentist. STATISTICAL ANALYSIS: Statistical analyses used in the present study include the formation one way and two-way frequency tables, binomial tests, Pearson’s Chi-squared tests, Fisher’s exact test, and collation of multiple proportions tests. RESULTS: Autistic children meeting their own needs, cooperation for nail-clipping and haircuts, smiling frequently, using toothbrushes and toothpaste and being assisted by parents for toothbrushing, and children who brushed their teeth once a day were more cooperative with the dentist. Children who had thumb-sucking and nail-biting habits were cooperative with the dentist. Children who bit their hands appeared to be more cooperative with the dentist when compared to other self-inflicting habits. CONCLUSION: This study identified « prognostic factors » such as their cooperative ability during nail clipping, hair cutting, and ability to read, write, and meet their own needs that are answered by a parent and that may show a child’s cooperative potential. HOW TO CITE THIS ARTICLE: Chamarthi VR, Arangannal P. Prognostic Factors for Successful Dental Treatment in Autistic Children and Adolescents. Int J Clin Pediatr Dent 2023;16(S-1):S45-S50.

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10. Chari T, Hernandez A, Portera-Cailliau C. A novel head-fixed assay for social touch in mice uncovers aversive responses in two autism models. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2023.

Social touch, an important aspect of social interaction and communication, is essential to kinship across animal species. How animals experience and respond to social touch has not been thoroughly investigated, in part due to the lack of appropriate assays. Previous studies that examined social touch in freely moving rodents lacked the necessary temporal and spatial control over individual touch interactions. We designed a novel head-fixed assay for social touch in mice, in which the experimenter has complete control to elicit highly stereotyped bouts of social touch between two animals. The user determines the number, duration, context, and type of social touch interactions, while monitoring an array of complex behavioral responses with high resolution cameras. We focused on social touch to the face because of its high translational relevance to humans. We validated this assay in two different models of autism spectrum disorder (ASD), the Fmr1 knockout (KO) model of Fragile X Syndrome and maternal immune activation mice. We observed higher rates of avoidance running, hyperarousal, and aversive facial expressions (AFEs) to social touch than to object touch, in both ASD models compared to controls. Fmr1 KO mice showed more AFEs to mice of the same sex but whether they were stranger or familiar mice mattered less. Because this new social touch assay for head-fixed mice can be used to record neural activity during repeated bouts of social touch it could be used to uncover underlying circuit differences.Significance StatementSocial touch is important for communication in animals and humans. However, it has not been extensively studied and current assays to measure animals’ responses to social touch have limitations. We present a novel head-fixed assay to quantify how mice respond to social facial touch with another mouse. We validated this assay in autism mouse models since autistic individuals exhibit differences in social interaction and touch sensitivity. We find that mouse models of autism exhibit more avoidance, hyperarousal, and aversive facial expressions to social touch compared to controls. Thus, this novel assay can be used to investigate behavioral responses to social touch and the underlying brain mechanisms in rodent models of neurodevelopmental conditions, and to evaluate therapeutic responses in preclinical studies.

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11. Chen WX, Liu X, Huang Z, Guo C, Feng F, Zhang Y, Gao Y, Zheng K, Huang J, Yu J, Wei W, Liang S. Autistic clinical profiles, age at first concern, and diagnosis among children with autism spectrum disorder. Frontiers in psychiatry. 2023; 14: 1211684.

BACKGROUND: To explore the relationship between autistic clinical profiles and age at first concern and diagnosis among children with autism spectrum disorder. The clinical profiles included the severity of autism, cognition, adaptability, language development, and regression. METHODS: The multivariate linear regression model was used to examine the association of diagnostic age and first-concern age with autistic clinical profiles and with further stratification analysis. RESULTS: A total of 801 autistic children were included. Language delay and regression were associated with earlier diagnostic age (language delay: crudeβ: -0.80, 95%CI%: -0.92–0.68; regression: crudeβ: -0.21, 95%CI%: -0.43–0.00) and the age of first concern of autistic children (language delay: crudeβ: -0.55, 95%CI%: -0.65–0.45; regression: crudeβ: -0.17, 95%CI%: -0.34–0.00). After stratification by sex, language delay tended to be more associated with the earlier diagnostic age among boys (crudeβ: -0.85, 95%CI%: -0.98–0.72) than among girls (crudeβ: -0.46, 95%CI%: -0.77–0.16). After stratification by maternal education level or family income level, language delay was most associated with the earlier diagnostic age in autistic children from families with higher socioeconomic levels. CONCLUSION: Language delay, rather than other symptoms, promoted an earlier diagnostic age. Among male autistic children or children from families with higher socioeconomic levels, language delay was most significantly associated with an earlier age of diagnosis. Cognitive delay, or adaptive delay, was associated with a later age at diagnosis and presented only in autistic children from families with lower socioeconomic levels. There may be sex or socioeconomic inequality in the diagnostic age for autistic children. More publicity and public education about the diversity of autistic symptoms are urgently needed in the future, especially for low-socioeconomic families.

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12. Demopoulos C, Skiba SA, Kopald BE, Bangera N, Paulson K, Lewine JD. Associations between rapid auditory processing of speech sounds and specific verbal communication skills in autism. Frontiers in psychology. 2023; 14: 1223250.

INTRODUCTION: The ability to rapidly process speech sounds is integral not only for processing other’s speech, but also for auditory processing of one’s own speech, which allows for maintenance of speech accuracy. Deficits in rapid auditory processing have been demonstrated in autistic individuals, particularly those with language impairment. We examined rapid auditory processing for speech sounds in relation to performance on a battery of verbal communication measures to determine which aspects of verbal communication were associated with cortical auditory processing in a sample of individuals with autism. METHODS: Participants were 57 children and adolescents (40 male and 17 female) ages 5-18 who were diagnosed with an Autism Spectrum Disorder (ASD). Rapid auditory processing of speech sounds was measured via a magnetoencephalographic (MEG) index of the quality of the auditory evoked response to the second of two differing speech sounds (« Ga » / « Da ») presented in rapid succession. Verbal communication abilities were assessed on standardized clinical measures of overall expressive and receptive language, vocabulary, articulation, and phonological processing. Associations between cortical measures of left- and right-hemisphere rapid auditory processing and verbal communication measures were examined. RESULTS: Rapid auditory processing of speech sounds was significantly associated with speech articulation bilaterally (r = 0.463, p = 0.001 for left hemisphere and r = 0.328, p = 0.020 for right hemisphere). In addition, rapid auditory processing in the left hemisphere was significantly associated with overall expressive language abilities (r = 0.354, p = 0.013); expressive (r = 0.384, p = 0.005) vocabulary; and phonological memory (r = 0.325, p = 0.024). Phonological memory was found to mediate the relationship between rapid cortical processing and receptive language. DISCUSSION: These results demonstrate that impaired rapid auditory processing for speech sounds is associated with dysfunction in verbal communication in ASD. The data also indicate that intact rapid auditory processing may be necessary for even basic communication skills that support speech production, such as phonological memory and articulatory control.

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13. Emborg C. Enduring the silence: High silence tolerance and other tools for promoting topic initiations of a man with autism. Clinical linguistics & phonetics. 2023: 1-23.

Persistent deficits in the ability to initiate social interaction is a core criterion for a diagnosis of autism, and quantitative research shows that children with autism initiate fewer bids for interaction than neurotypical children. This conversation-analytic examination of two interactions between a man with autism, Harry, and two familiar carers will provide insights into the scope of his competences in topic initiation. Analyses of the participants’ online management of turn-taking and sequence organisation demonstrate that Harry’s topic initiations can be facilitated by a high silence tolerance of the interlocutor in initiation-relevant sequential environments. Specifically, Harry initiates more topics, when his conversational partner endures the long silences after possible sequence closure. The analyses underline that Harry does not lack neither competences nor motivation to successfully execute initiations. Instead, it is proposed that Harry’s deficits in initiation should be reconceptualised as a difficulty of initiating interaction on neurotypical terms, where the standard maximum silence between turns is approximately one second. Hereby, the study emphasises that communicative competences of individuals with autism are interactionally managed, emerging in interaction with conversational partners.

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14. Hu C, He T, Zou B, Li H, Zhao J, Hu C, Cui J, Huang Z, Shu S, Hao Y. Fecal microbiota transplantation in a child with severe ASD comorbidities of gastrointestinal dysfunctions-a case report. Frontiers in psychiatry. 2023; 14: 1219104.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by social communication impairments and restricted, repetitive behaviors. In addition to behavioral interventions and psychotherapies, and pharmacological interventions, in-depth studies of intestinal microbiota in ASD has obvious abnormalities which may effectively influenced in ASD. Several attempts have been made to indicate that microbiota can reduce the occurrence of ASD effectively. Fecal microbiota transplantation (FMT) is a type of biological therapy that involves the transplant of intestinal microbiota from healthy donors into the patient’s gastrointestinal tract to improve the gut microenvironment. In this case report, we describe a case of child ASD treated by FMT. The patient have poor response to long-term behavioral interventions. After five rounds of FMT, clinical core symptoms of ASD and gastrointestinal(GI) symptoms were significantly altered. Moreover, the multiple levels of functional development of child were also significantly ameliorated. We found that FMT changed the composition of the intestinal microbiota as well as the metabolites, intestinal inflammatory manifestations, and these changes were consistent with the patient’s symptoms. This report suggests further FMT studies in ASD could be worth pursuing, and more studies are needed to validate the effectiveness of FMT in ASD and its mechanisms.

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15. Liu NH, Liu HQ, Zheng JY, Zhu ML, Wu LH, Pan HF, He XX. Fresh Washed Microbiota Transplantation Alters Gut Microbiota Metabolites to Ameliorate Sleeping Disorder Symptom of Autistic Children. Journal of microbiology (Seoul, Korea). 2023.

Accumulating studies have raised concerns about gut dysbiosis associating autism spectrum disorder (ASD) and its related symptoms. However, the effect of gut microbiota modification on the Chinese ASD population and its underlying mechanism were still elusive. Herein, we enrolled 24 ASD children to perform the first course of fresh washed microbiota transplantation (WMT), 18 patients decided to participate the second course, 13 of which stayed to participate the third course, and there were 8 patients at the fourth course. Then we evaluated the effects of fresh WMT on these patients and their related symptoms. Our results found that the sleeping disorder symptom was positively interrelated to ASD, fresh WMT significantly alleviated ASD and its sleeping disorder and constipation symptoms. In addition, WMT stably and continuously downregulated Bacteroides/Flavonifractor/Parasutterella while upregulated Prevotella_9 to decrease toxic metabolic production and improve detoxification by regulating glycolysis/myo-inositol/D-glucuronide/D-glucarate degradation, L-1,2-propanediol degradation, fatty acid β-oxidation. Thus, our results suggested that fresh WMT moderated gut microbiome to improve the behavioral and sleeping disorder symptoms of ASD via decrease toxic metabolic production and improve detoxification. Which thus provides a promising gut ecological strategy for ASD children and its related symptoms treatments.

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16. Lizon M, Taels L, Vanheule S. Specific interests as a social boundary and bridge: A qualitative interview study with autistic individuals. Autism : the international journal of research and practice. 2023: 13623613231193532.

Growing evidence shows that specific interests can help autistic individuals cope with difficulties in social communication and interaction. However, it is unclear which specific characteristics of these interests make them suitable for this coping role. Therefore, this study explored how specific interests can help autistic individuals navigate social communication and interaction. We conducted semi-structured interviews with nine autistic individuals to inquire about their perspectives on the meanings and functions of their specific interest in their (social) life. We found that specific interests served two important social functions. First, the interests provided a way to disconnect from the challenging outside world, through a shift in the attentional focus of participants. Second, the interests served as a « social compass, » providing structure and meaning to social situations and helping the participants feel more connected to others. Based on these findings, we propose a conceptual model suggesting that specific interests create the experience of a « protective boundary » between oneself and others, which helps autistic individuals feel safe during social interactions. Namely, engaging in specific interests not only creates a space where autistic individuals can retreat when they feel overwhelmed, but also provides a framework with delineations in time and space, as well as explicit rules for social interactions, which make them more predictable and regulated. The study suggests that incorporating specific interests into therapy can help improve social communication and interaction for autistic individuals while still prioritizing their personal well-being.

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17. Mandy W. The old and the new way of understanding autistic lives: Reflections on the life of Donald Triplett, the first person diagnosed as autistic. Autism : the international journal of research and practice. 2023; 27(7): 1853-5.

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18. Mason D, Milner V, Clark L, Kelly E, Pyefinch R, Happé F. Autistic People and Moving Home: A Systematic Review. Autism in adulthood : challenges and management. 2023; 5(3): 236-47.

BACKGROUND: While many studies have examined where and with whom autistic people live, very few have looked at autistic people’s experience of moving home. Choosing where to live, and being able to move residence, could be important for autonomy, and we therefore undertook a systematic review to identify studies about autistic adults’ experience of moving home. METHODS: We entered search terms relevant to autism and moving home into six databases and Google Scholar. After screening the titles and abstracts, we identified a final set of articles and screened the full text. We then checked the reference lists for potentially relevant articles; then, we conducted a search for articles that cited our final set of articles. Three raters assessed each included article for methodological quality. RESULTS: The search strategy identified a total of 311 articles (initial search, ancestry searching, articles from other sources). After deduplication, we screened a total of 165 articles for eligibility. A final set of seven articles was identified. Our narrative synthesis of the articles suggests that both autistic people and the relatives of autistic people think living independently is a source of positive personal development. However, autistic people reported that poor employment prospects impacted on their financial independence and hence independent living. Parents highlighted concerns about their offspring’s personal care, safety, and the difficulty of navigating the housing system for those autistic people with co-occurring intellectual disability. CONCLUSIONS: Taken together, our review suggests that autistic people and those who care for them have a positive view of independent living and are aware of the barriers to achieving this. Our review highlights a gap in the understanding of autistic adults’ experience of moving home. We briefly describe our ongoing research project [the « Moving (as an) Autistic Person » project] exploring autistic people’s experiences of moving house. WHY IS THIS TOPIC IMPORTANT? Many research studies find that autistic people do not live independently—many autistic people live with their parents or in sheltered accommodation. As our knowledge about autistic people, and the diversity of their life experiences, increases, it is important to investigate a range of real-life transitions. So far, the transition to independent living has not been reviewed (specifically, the process of moving from one living place to another). WHAT IS THE PURPOSE OF THIS ARTICLE? We reviewed published studies to try and find all the available studies that may have looked at the process of moving home for autistic people. WHAT DID THE AUTHORS DO? We designed a search method to find all the articles that were relevant to this question. We searched six academic databases and used Google Scholar. WHAT DID YOU FIND ABOUT THIS TOPIC? We found that there were no studies which looked at the specific question of what autistic people experience when they move home. However, we did find some studies which looked at the benefits of living independently (with reports from autistic people and from the parents of autistic people). We also found one study which looked at the choices autistic people have in where, and with whom, they live. WHAT DO THE AUTHORS RECOMMEND? Based on the included studies, it does seem that autistic people may benefit from living independently. However, we do note that the issue of independent living cannot be examined without consideration of other factors, such as employment. Also, it is not universally the case that all autistic adults prefer, or will benefit from, living independently. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? We aim to use the findings of this review, alongside our ongoing mixed-methods study of autistic people’s experiences, to design a tailored co-produced resource to help autistic people plan for moving home. eng.

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19. Morrel J, Singapuri K, Landa RJ, Reetzke R. Neural correlates and predictors of speech and language development in infants at elevated likelihood for autism: a systematic review. Frontiers in human neuroscience. 2023; 17: 1211676.

Autism spectrum disorder (ASD) is an increasingly prevalent and heterogeneous neurodevelopmental condition, characterized by social communicative differences, and a combination of repetitive behaviors, focused interests, and sensory sensitivities. Early speech and language delays are characteristic of young autistic children and are one of the first concerns reported by parents; often before their child’s second birthday. Elucidating the neural mechanisms underlying these delays has the potential to improve early detection and intervention efforts. To fill this gap, this systematic review aimed to synthesize evidence on early neurobiological correlates and predictors of speech and language development across different neuroimaging modalities in infants with and without a family history of autism [at an elevated (EL infants) and low likelihood (LL infants) for developing autism, respectively]. A comprehensive, systematic review identified 24 peer-reviewed articles published between 2012 and 2023, utilizing structural magnetic resonance imaging (MRI; n = 2), functional MRI (fMRI; n = 4), functional near-infrared spectroscopy (fNIRS; n = 4), and electroencephalography (EEG; n = 14). Three main themes in results emerged: compared to LL infants, EL infants exhibited (1) atypical language-related neural lateralization; (2) alterations in structural and functional connectivity; and (3) mixed profiles of neural sensitivity to speech and non-speech stimuli, with some differences detected as early as 6 weeks of age. These findings suggest that neuroimaging techniques may be sensitive to early indicators of speech and language delays well before overt behavioral delays emerge. Future research should aim to harmonize experimental paradigms both within and across neuroimaging modalities and additionally address the feasibility, acceptability, and scalability of implementing such methodologies in non-academic, community-based settings.

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20. Offutt A, Breitschwerdt EB. Case report: Substantial improvement of autism spectrum disorder in a child with learning disabilities in conjunction with treatment for poly-microbial vector borne infections. Frontiers in psychiatry. 2023; 14: 1205545.

Poly-microbial vector-borne infections may have contributed to neuropsychiatric symptoms in a boy diagnosed with autism spectrum disorder. Targeted antimicrobial treatment resulted in substantial improvement in cognitive (such as learning disabilities, focus, concentration) and neurobehavioral (such as oppositional, defiant, anti-social, disordered mood, immaturity, tics) symptoms.

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21. Realpe AX, Mills N, Beasant L, Douglas S, Kenny L, Rai D. Lockdown Experiences and Views on Future Research Participation of Autistic Adults in the UK During the First 6 Months of the COVID-19 Pandemic. Autism in adulthood : challenges and management. 2023; 5(3): 301-10.

BACKGROUND: The COVID-19 pandemic resulted in large-scale public health restrictions and lockdowns across many countries. There is an increasing literature on the varied impact of such lockdowns in autistic adults. However, there is very little research on how the pandemic and related public health measures may impact the willingness of autistic people in engaging and taking part in research. The aim of this qualitative study was to explore autistic adults’ experiences of the COVID-19 lockdown and how the pandemic may affect future research participation. METHODS: We conducted in-depth interviews with 31 autistic adults between March and July 2020. Transcripts were analyzed thematically within a critical realism framework. RESULTS: Participants identified positive aspects of lockdown such as enjoying the lack of social pressures and using their well-developed skills for dealing with uncertainty. Autistic people also shared challenges of adjusting to lockdown, for example, rapid change in daily routines. While hopeful about the freedom gained from easing restrictions, participants were concerned about the inconsistent communication and application of rules during the transition out of lockdown. This may have exacerbated already rising mental health issues among autistic people. The participants viewed research participation and engagement with increased relevance during the pandemic and welcomed efforts to conduct research using online methods of communication. CONCLUSION: The COVID-19 lockdown had a varied effect in the lives and routines of autistic people. However, health care providers and researchers need to be mindful of rising mental health issues in the aftermath of the pandemic, especially for people who were already vulnerable. The response to the pandemic may have offered opportunities for innovation in research processes enabling more autistic people to engage with research and making studies more inclusive. WHY IS THIS AN IMPORTANT ISSUE? We did not know how the pandemic and the strict restrictions that followed would affect autistic people’s well-being and mental health.Also, there was a worry that the pandemic would affect the number of volunteers taking part in research that matters the most to autistic people. Thus, it was important to understand any implications for the way we conduct research with the autistic community after the pandemic. WHAT WAS THE PURPOSE OF THIS STUDY? We explored the experiences of autistic people living through the first 6 months of the COVID-19 lockdown in the United Kingdom. We were particularly interested in autistic people’s views on how the pandemic may affect them taking part in research. WHAT DID THE RESEARCHERS DO? We co-produced this interview study to answer our research questions. We carried out in-depth interviews with 31 autistic people. We looked for patterns or themes in what the participants said. WHAT WERE THE RESULTS OF THE STUDY? Autistic people we interviewed reported being able to enjoy a quieter pace of life. They felt less anxious early in the lockdown. But they also faced great challenges adjusting to changes in their daily routines. Inconsistent public health communication caused worry during the transition out of lockdown. Unnecessary stress might have led to worsening of mental health issues in some people. Our participants held positive views on taking part in and engage with research, despite the pandemic. We identified opportunities that could make research more inclusive for autistic people, for example, online methods for taking consent and taking part in research remotely. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Our study adds to the evidence of the varied responses of autistic people to the pandemic and the public health measures that it led to. One important strength of our work is our focus on the impact of the pandemic on research and implications of future research. We learnt that autistic people welcome and value the use of online technology to reach study participants. Wider use of remote technology can make research more inclusive and participatory. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? Many of our participants were already had experience participating in research. Also most had relatively high education levels. We did not include autistic people with intellectual disabilities. We did not collect information on ethnicity. Our sample is likely to have little ethnic diversity. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? We describe the experiences of autistic people in the face of unprecedented circumstances. We found the need for clear public health communication to avoid unnecessary stress. The pandemic has provided the opportunity for a wider use of remote methods of research, even in areas where this was not done in the past (e.g., clinical trials). Our study found that such approaches would make research more inclusive. eng.

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22. Riquelme I, Hatem SM, Sabater-Gárriz Á, Montoya P. A multidimensional investigation of the relationship between skin-mediated somatosensory signals, emotion regulation and behavior problems in autistic children. Frontiers in neuroscience. 2023; 17: 1227173.

INTRODUCTION: Autistic children may have abnormal sensory perception, emotion dysregulation and behavior problems. The aim of this cross-sectional study was to explore the relationship between skin-mediated somatosensory signals and emotion/behavior difficulties in autistic children and adolescents, in comparison typically developing peers (TDP). METHODS: Thirty-eight autistic children and adolescents and 34 TDP completed a multidimensional assessment consisting of the measurement of somatosensory thresholds of touch, pain and temperature, a task on emotion knowledge and parent-reported questionnaires on sensory reactivity, emotion regulation and behavior. RESULTS: Autistic children had higher pain sensitivity, less sensory reactive behaviors and more behavior problems than their TDP. In contrast to TDP, several somatosensory thresholds of autistic children correlated with emotion regulation and behavior problems. DISCUSSION: Sensory dysfunction may affect the development of emotional processing and behavior in autistic children and adolescents. This knowledge can lay the foundation for future studies on co-occurring alterations in corresponding neural networks and for the implementation of early interventions, including sensory rehabilitation therapy, for promoting regulated behaviors in autistic children and adolescents.

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23. Saade S, Bockstal-Fieulaine B, Gillespie-Lynch K, Besche-Richard C, Boujut É, Johnson Harrison A, Cappe É. Evaluation of an Autism Training in a Much-Needed Context: The Case of France. Autism in adulthood : challenges and management. 2023; 5(3): 289-300.

BACKGROUND: Autistic people in France have called for community education to reduce autism stigma. As such, training is needed to help university students appreciate autistic peers and autistic people they may work with in their future careers. METHODS: We adapted an autistic-affirming training from a training developed in other cultural contexts and evaluated it with 107 university students in France using a pretest-post-test design. RESULTS: Questionnaire responses suggested that our brief online training helped improve attitudes toward inclusion, autism knowledge, and stigma among future educators and psychologists in France. Participants’ open-ended definitions of autism revealed increased alignment with the neurodiversity movement after training. CONCLUSIONS: Findings suggest that wider-scale autistic-led adaptations of autism trainings like the one described in this report could begin to ameliorate autism stigma in France. WHY IS THIS AN IMPORTANT ISSUE? Autistic people in France have been treated very badly in the past. They have been left out of school and hurt by professionals. They still face stigma. This means they are often misunderstood, made fun of, and excluded. Some are forced to take medications they do not want. Autistic people in France have been trying to help other people in France understand autism. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to see whether autism training could help university students in France to better understand autistic people. We wanted to see whether our training could help students appreciate autistic people more (or lower stigma). We also wanted to see whether the training could help students understand that it is important to include autistic people in classes with other students at school. WHAT DID THE RESEARCHERS DO? Researchers in France, Lebanon, and the United States modified an autism training that had been used in other countries. The training was autistic affirming, which means it taught people to listen to autistic people and to see their strengths. We translated it into French. We included training topics that French collaborators thought were important. We asked university students in France who were studying education and psychology to do our training online. We also asked them to fill out surveys about autism. WHAT WERE THE RESULTS OF THE STUDY? After doing our training, students knew more about autism than they did before training. Some learned that autism is part of a person for their whole life. They seemed to appreciate autistic people more after training. They also agreed that it is important to include autistic people in school with other students more than they had before. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? This study shows that autistic-affirming training can also help people in France appreciate autistic people. Much autism training only focuses on stigma and knowledge. Our training may also have helped future educators and clinicians understand how important it is to include autistic people in school with other students. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? The students in our study were mostly women. They were all training for jobs where they can help people. We do not know whether our training would help other French people. We also cannot be sure that our training really helped the students who did it. Students may have been dishonest about how they felt about autism. In future studies, people should see whether training changes what people do, not just what they say. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? By teaching students in France about autism, we hope to begin to help make life better for autistic people in France. We hope studies like this will help people to understand autistic people better. We also hope more people conduct trainings like that used in this study around the world to improve understanding and treatment of autistic people. eng.

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24. Seker A, Qirko-Gurakuqi A, Tabaku M, Javate KRP, Rathwell I. Maternal atopic conditions and autism spectrum disorder: a systematic review. European child & adolescent psychiatry. 2023.

Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk factor. It is hypothesized that maternal atopic disease during pregnancy can lead to increased levels of inflammatory cytokines in fetal circulation via placental transfer or increased production. These cytokines can then pass through the immature blood-brain barrier, causing aberrant neurodevelopment via mechanisms including premature microglial activation. The objective of this study is to systematically review observational studies that investigate whether a maternal history of atopic disease (asthma, allergy, or eczema/atopic dermatitis) is associated with a diagnosis of ASD in offspring. A search was conducted in Ovid MEDLINE, PsycINFO, and Embase databases for relevant articles up to November 2021; this was later updated in January 2022. Observational studies published in peer-reviewed journals were included. Data were synthesized and qualitatively analyzed according to the specific atopic condition. Quality assessment was done using the Newcastle-Ottawa Scale. Nine articles were identified, with all including asthma as an exposure, alongside four each for allergy and eczema. Findings were inconsistent regarding the association between a maternal diagnosis of either asthma, allergy, or eczema, and ASD in offspring, with variations in methodology contributing to the inconclusiveness. More consistent associations were demonstrated regarding maternal asthma that was treated or diagnosed during pregnancy. Evidence suggests that symptomatic maternal asthma during pregnancy could be associated with ASD in offspring, underscoring the importance of effective management of atopic conditions during pregnancy. Further research is needed, particularly longitudinal studies that use gold-standard assessment tools and correlate clinical outcomes with laboratory and treatment data.PROSPERO Registration Number and Date: CRD42018116656, 26.11.2018.

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25. Souza AJ, Sharmin D, Cook JM, Guimarães FS, Gomes FV. An alpha 5-GABAa receptor positive allosteric modulator attenuates social and cognitive deficits without changing dopamine system hyperactivity in an animal model for autism. bioRxiv : the preprint server for biology. 2023.

Autism Spectrum Disorders (ASD) are characterized by core behavioral symptoms in the domains of sociability, language/communication, and repetitive or stereotyped behaviors. Deficits in the prefrontal and hippocampal excitatory/inhibitory balance due to a functional loss of GABAergic interneurons are proposed to underlie these symptoms. Increasing the postsynaptic effects of GABA with compounds that selectively modulate GABAergic receptors could be a potential target for treating ASD symptoms. In addition, deficits in GABAergic interneurons have been linked to dopamine (DA) system dysregulation, and, despite conflicting evidence, abnormalities in the DA system activity may underly some ASD symptoms. Here, we investigated whether the positive allosteric modulator of α5-containing GABA (A) receptors (α5-GABA (A) Rs) SH-053-2’F-R-CH3 (10 mg/kg) attenuates behavioral abnormalities in a rat model for autism based on in utero VPA exposure. We also evaluated if animals exposed to VPA in utero present changes in the ventral tegmental area (VTA) DA system activity using in vivo electrophysiology and if SH-053-2’F-R-CH3 could attenuate these changes. In utero VPA exposure caused male and female rats to present increased repetitive behavior (self-grooming) in early adolescence and deficits in social interaction in adulthood. Male, but not female VPA rats, also presented deficits in recognition memory as adults. SH-053-2’F-R-CH3 attenuated the impairments in sociability and cognitive function in male VPA-exposed rats without attenuating the decreased social interaction in females. Male and female adult VPA-exposed rats also showed an increased VTA DA neuron population activity, which was not changed by SH-053-2’F-R-CH3. Despite sex differences, our findings indicate α5-GABA (A) Rs positive allosteric modulators may effectively attenuate some core ASD symptoms.

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26. Stacey R, Cage E. « Simultaneously Vague and Oddly Specific »: Understanding Autistic People’s Experiences of Decision Making and Research Questionnaires. Autism in adulthood : challenges and management. 2023; 5(3): 263-74.

BACKGROUND: Autism researchers often use questionnaires to gather the views and experiences of autistic people. However, questionnaires may not always be designed in accessible ways. In addition, answering questions within a questionnaire involves decision making, which some autistic people have reported finding difficult. Therefore, this exploratory study aimed to enhance our understanding of autistic people’s experiences of decision making, and to analyze their feedback on questionnaire measures to further understand decision making within the research context. METHODS: One hundred seventeen participants completed an online questionnaire. In the questionnaire, they answered an open question about what affected their ability to make decisions. They then completed four questionnaire measures and after each one provided feedback. We used content analysis to categorize participants’ qualitative answers. RESULTS: Participants discussed how their internal state, other people, the quality and quantity of information, pressure on choosing a response, external distractions, and lack of time all affected their decision making. Feedback on the questionnaires highlighted how questions needed context, often questions themselves were unclear and difficult to understand, that there were issues with Likert scales, and how measures could have questionable validity for autistic people. CONCLUSIONS: Autism researchers need to consider how they can make their research as accessible as possible for autistic people. Our study highlights how decision making is not a straight-forward process, and researchers have a role in ensuring they give their participants clear and contextualized information. Involving autistic people in the design of research is a potential way of improving the quality of research. WHY IS THIS AN IMPORTANT ISSUE? Autism researchers often use questionnaires but might not always use well-designed ones. Its important that autistic people feel they can complete questionnaires and provide accurate information about what is important to them. Also, when answering a questionnaire, someone usually must make decisions, for example, about which option best fits their own experiences. But researchers might not consider that making decisions can be difficult for some autistic people. WHAT WAS THE PURPOSE OF THIS STUDY? We wanted to find out what autistic people thought about questionnaires and what things affected their decision making. WHAT DID THE RESEARCHERS DO? We created an online survey, which 117 autistic people completed. We had an open question asking participants what affected their ability to make decisions. Participants then completed four questionnaire measures that other people had created before, which had statements followed by tick boxes on different scales (e.g., strongly agree to strongly disagree). After each of these measures, we asked participants to give open feedback. We then identified patterns in the participants’ responses. WHAT WERE THE RESULTS OF THE STUDY? Participants’ decision making was affected by things such as their mood and energy level, having to consider how their decision affects others, the quality and quantity of information provided, pressure on choosing a response, external distractions (like noise), and having to decide quickly. Participants’ feedback about the questionnaire measures identified potential improvements. There were some positive comments, but participants often said the measures needed more context to explain them or needed to consider the current context (like how a global pandemic might be affecting their answers). They also said some questions were not clear and difficult to understand, the response options needed improving, or the questions were not relevant for autistic people. WHAT DO THESE FINDINGS ADD TO WHAT WAS KNOWN? Our findings show how decision making can be challenging for some autistic people, and this could influence their responses when doing research. Participants’ responses give important information for autism researchers to consider when using questionnaires. Our findings are further evidence that questionnaires should be adapted or new ones created specifically for autistic people. The findings imply that it is important to involve non-academic autistic people in research. WHAT ARE POTENTIAL WEAKNESSES? Most participants were female, White, and from Western countries, which limits how our findings might apply more widely. We asked generally about decision making rather than specifically about the research context, and more in-depth interviews on this topic would be useful. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? The things we have learned from our study can be used by autism researchers to improve their research design. If they make improvements, this means taking part in research will be more enjoyable and straightforward for autistic people. Autism research can potentially improve autistic people’s lives, but we need to make the experience of taking part in research better. eng.

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27. Stewart GR, Leoni M, Charlton RA, Pickard HR, Happé F. A Qualitative Study of Autistic Adults’ Quality of Life During the COVID-19 Pandemic and Lockdowns. Autism in adulthood : challenges and management. 2023; 5(3): 311-24.

BACKGROUND: Autistic people experience higher rates of most mental health conditions and report more difficulties with change than nonautistic people. As such, the periods of national stay-at-home orders (known in the United Kingdom as a « lockdown ») endured since the beginning of the COVID-19 (coronavirus disease 2019) pandemic in March 2020 may have been particularly challenging for autistic people. AIM: This study explored autistic adults’ experience of quality of life and well-being during the start of the COVID-19 pandemic (specifically March to August 2020) using open-text responses from an online survey. METHODS: In total, 79 autistic adults from the United Kingdom (aged 21-75 years) took part. Participants completed an online survey, including open-text questions on how various factors influencing quality of life, such as social interactions, general health, well-being, and sensory experiences, were impacted by the COVID-19 pandemic and the first set of national lockdowns that occurred between March and August 2020. RESULTS: Thematic analysis created four key themes, each illustrated by several subthemes. These four themes explore (1) health, (2) social changes, (3) support provisions, and (4) adopting new routines. Many participants discussed the impact that the COVID-19 pandemic and the first set of national lockdowns had on their health and expressed concerns regarding the transition out of periods of lockdown, including readjusting to new rules, going back to in-person interactions, and reacclimatizing to high-stimulation sensory environments. However, several participants reported positive experiences of the periods of lockdown, such as reduced commuting, more control over sensory environments, and more time to pursue personal interests and self-care. CONCLUSIONS: These findings highlight the importance of giving autistic individuals the support they need to transition back to « normality » as COVID-19 becomes endemic. WHY IS THIS AN IMPORTANT ISSUE? The COVID-19 pandemic and national stay-at-home order (known in the United Kingdom as a “lockdown”) led to severe disruption and change in people’s lives throughout 2020 and early 2021. However, only a few studies have examined the impact of the lockdowns on autistic people’s well-being. WHAT WAS THE PURPOSE OF THIS STUDY? The abrupt changes caused by the COVID-19 pandemic and lockdowns may have had a more detrimental impact on the lives of autistic people compared with others. This study aimed to explore the impact of the pandemic on the lives of autistic people and to provide context and descriptions of their experiences. WHAT DID THE RESEARCHERS DO? We asked autistic adults a range of open-response questions using an online survey in July/August 2020 to understand how they experienced the COVID-19 pandemic and periods of national lockdown. A total of 79 autistic adults from the United Kingdom took part. The questions asked about participants’ health and general well-being, their social lives, and sensory differences before (retrospectively) and during the U.K. national lockdowns that occurred between March and August 2020. WHAT WERE THE RESULTS OF THE STUDY? Overall, most people felt that the pandemic had a negative impact on their lives. Many felt isolated and lonely due to lockdowns, and many expressed feelings of distress and anxiety at the prospect of returning to normality. However, several participants did report positive aspects of the periods of lockdown, such as having more time for personal interests and practicing self-care, and having to deal with less noise and sensory overload. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? To date, much of the research about the impact of the COVID-19 pandemic and lockdowns on autistic peoples’ lives has been quantitative (e.g., using scores on questionnaires). This study uses qualitative data (responses to open-ended questions). This study provides important contextualization of how the pandemic and lockdowns have impacted the lives of autistic people and highlights the need for additional support in the years after the pandemic. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? This study only includes autistic people, so we cannot be sure whether these experiences are unique to autistic people. Additionally, these findings may not be generalizable to the wider autistic population, including those who were unable to participate (e.g., those with learning difficulties). HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? The COVID-19 pandemic and lockdowns are likely to have a long-lasting impact on well-being, which may disproportionately impact autistic people. As such, autistic people may need additional, tailored, support as COVID-19 becomes endemic (i.e., no longer a pandemic but part of everyday life, somewhat like seasonal flu). Additionally, lessons may be learned from the pandemic about how society could be adapted to become more inclusive. eng.

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28. Stogiannos N, Harvey-Lloyd JM, Brammer A, Cleaver K, McNulty JP, Dos Reis CS, Nugent B, Simcock C, O’Regan T, Bowler D, Parveen S, Marais K, Pavlopoulou G, Papadopoulos C, Gaigg SB, Malamateniou C. Toward Autism-Friendly Magnetic Resonance Imaging: Exploring Autistic Individuals’ Experiences of Magnetic Resonance Imaging Scans in the United Kingdom, a Cross-Sectional Survey. Autism in adulthood : challenges and management. 2023; 5(3): 248-62.

BACKGROUND: Autistic individuals might undergo a magnetic resonance imaging (MRI) examination for clinical concerns or research. Increased sensory stimulation, lack of appropriate environmental adjustments, or lack of streamlined communication in the MRI suite may pose challenges to autistic patients and render MRI scans inaccessible. This study aimed at (i) exploring the MRI scan experiences of autistic adults in the United Kingdom; (ii) identifying barriers and enablers toward successful and safe MRI examinations; (iii) assessing autistic individuals’ satisfaction with MRI service; and (iv) informing future recommendations for practice improvement. METHODS: We distributed an online survey to the autistic community on social media, using snowball sampling. Inclusion criteria were: being older than 16, have an autism diagnosis or self-diagnosis, self-reported capacity to consent, and having had an MRI scan in the United Kingdom. We used descriptive statistics for demographics, inferential statistics for group comparisons/correlations, and content analysis for qualitative data. RESULTS: We received 112 responses. A total of 29.6% of the respondents reported not being sent any information before the scan. Most participants (68%) confirmed that radiographers provided detailed information on the day of the examination, but only 17.1% reported that radiographers offered some reasonable environmental adjustments. Only 23.2% of them confirmed they disclosed their autistic identity when booking MRI scanning. We found that quality of communication, physical environment, patient emotions, staff training, and confounding societal factors impacted their MRI experiences. Autistic individuals rated their overall MRI experience as neutral and reported high levels of claustrophobia (44.8%). CONCLUSION: This study highlighted a lack of effective communication and coordination of care, either between health care services or between patients and radiographers, and lack of reasonable adjustments as vital for more accessible and person-centered MRI scanning for autistic individuals. Enablers of successful scans included effective communication, adjusted MRI environment, scans tailored to individuals’ needs/preferences, and well-trained staff. WHY IS THIS AN IMPORTANT ISSUE? Magnetic resonance imaging (MRI) is an examination that shows human anatomy and may explain the causes of symptoms. Autistic people may need MRI scans for various reasons, such as low back pain, headaches, accidents, or epilepsy. They have known sensitivities to sound, light, smell, or touch and increased anxiety, so the narrow, loud, isolating, unfamiliar MRI environment may be overwhelming to them. If MRI scans are, for these reasons, inaccessible, many autistic people will have to live with long-standing conditions, pain, or other symptoms, or have delayed treatment, with impact on their quality of life, and life expectancy. WHAT WAS THE PURPOSE OF THIS STUDY? We tried to understand how autistic people perceive MRI examinations, things that work, and the challenges they face. We also asked for their suggestions to improve practice and accessibility. WHAT DID WE DO? We distributed an online questionnaire to autistic adults through social media. We analyzed the data using appropriate statistical and text analysis methods. WHAT WERE THE RESULTS OF THE STUDY? We received 112 responses. Autistic people rated their overall MRI experience as average. Nearly a third (29.6%) reported they were not sent any information before MRI, and only 17.1% reported that radiographers offered some reasonable environmental adjustments. Most participants (68%) reported that radiographers provided detailed information on the day of the scan. Only 23.2% of them disclosed their autistic identity when booking MRIs. We found that quality of communication, physical environment, patient emotions, staff training, stigma, and timely autism diagnosis impacted their MRI experiences. WHAT DO THESE FINDINGS ADD TO WHAT WAS ALREADY KNOWN? Autistic people MRI scan experiences are at the heart of this project. Our project shows that MRI for common symptoms is often inaccessible by autistic people. We should improve the MRI environment, adjust communication format/content for them, and deliver person-centered care in MRI. Health care professionals should receive relevant training, to understand the challenges autistic people might face and better support them in MRI scanning. WHAT ARE POTENTIAL WEAKNESSES IN THE STUDY? The pandemic has impacted participant recruitment; therefore, the results of this sample may not reflect the full impact on the wider autistic population or adequately represent the autistic community, due to small size and including only people who could consent.These results come from different centers, so there is a lot of variation in the use of MRI equipment. HOW WILL THESE FINDINGS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? We outline the main challenges associated with MRI, so autistic adults and their families/carers understand more of what they could expect in future examinations; hopefully, researchers and scanner manufacturers will try to tackle these challenges to make MRI scans truly accessible for autistic people.We shared this knowledge with stakeholders to develop guidelines and started using it in training. We want to ensure that MRI is person-centered and more accessible for autistic patients. eng.

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29. Tan DW. Early-Career Autism Researchers Are Shifting Their Research Directions: Tragedy or Opportunity?. Autism in adulthood : challenges and management. 2023; 5(3): 218-24.

Early-career researchers (ECRs) are among the most creative, talented, and energetic researchers, and they play an important role in knowledge production and pushing scientific boundaries. Recent debates have implied that many early-career autism researchers are compelled to shift their areas of focus within autism research as a consequence of their work being scrutinized by the autistic and autism communities. In this Perspective, I draw on my own experience as an early-career autism researcher having recently pivoted my research focus to become more aligned with community priorities. I reflect on whether these putative shifts in research direction are, indeed, a tragedy, as has previously been suggested, or, in fact, an opportunity for autism researchers. I argue that pivoting in research is a demonstration of science adapting to the ever-evolving needs in society and changes in our understanding of neurodiversity, neurodivergence, and research methods. While disagreements between the autistic, autism, and research communities may well feel uncomfortable, these tensions also present an opportunity for us-as non-autistic autism researchers-to reflect and to act toward building trust with the community. I recommend three areas for reflections: the purpose of our research, our position of power, and the epistemic limits of our academic expertise. I end by encouraging ECRs to consider taking actions, however small, to lead the charge in improving practices in autism research. WHY IS THIS TOPIC IMPORTANT? The autism and autistic communities are increasingly unhappy with the current state of autism research, which have led to tensions between community members and autism researchers. Recent discussions on this topic have mentioned that early-career autism researchers—those who have gotten their PhDs but are still working toward a more stable career—have been negatively affected by community members publicly criticizing their work. According to several recent reports, these public criticisms have made early-career autism researchers feel worried about continuing their work in the same area and are considering doing another research topic. This is an important issue to discuss because such claims are not consistent with what the research shows, my own experiences as well as those of several other autism researchers. I think this discussion should prompt us—autism researchers—to take a step back and reflect on our research practices. WHAT IS THE PURPOSE OF THIS ARTICLE? In this article, I reflect on my own experience as an early-career autism researcher who has recently changed my research topic from trying to understand how autism occurs to trying to understand how society can be more accepting of autistic people. I use my own experience and experiences of other researchers to argue that changes in research directions as a result of community feedback comprise positive progress for autism research. WHAT PERSONAL OR PROFESSIONAL PERSPECTIVES DO THE AUTHOR BRING TO THIS TOPIC? I am a non-autistic early-career researcher who has been working in autism research for over 10 years as a student and postdoctoral researcher. I have recently changed my research topic due to having doubts about the real-world impact of my early work after reflecting on autistic people’s criticisms on my work. These criticisms played an important role in my development as a researcher. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC? Based on previous studies, we know that the autistic and autism communities are dissatisfied with much of the autism research being done. Many community members felt that some autism research is out-of-touch with their everyday experiences. Though it has been suggested that a participatory research approach—meaning involving autistic people throughout the research process—should help address some of these concerns, such an approach is still uncommon. WHAT DOES THE AUTHOR RECOMMEND? I recommend that autism researchers—non-autistic researchers in particular—take this opportunity to reflect on the purpose of one’s research and how it affects the everyday lives of autistic people, our position of power in influencing the way autistic people are being perceived, and the limitations of our academic understanding of autism and autistic people’s experiences. I also encourage early-career autism researchers to consider taking steps, even small steps, to improve the way autism research respects and aligns with the perspectives and priorities of the autism and autistic communities. HOW WILL THESE RECOMMENDATIONS HELP AUTISTIC ADULTS NOW OR IN THE FUTURE? It is my hope that my experiences, reflections, and recommendations will encourage autism researchers to conduct studies that are more in line with the priorities of the autism and autistic communities and are better informed by lived experiences. eng.

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30. White SW, Siegle GJ, Kana R, Rothman EF. Correction to: Pathways to Psychopathology Among Autistic Adults. Current psychiatry reports. 2023.

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