1. Adin E, Pancar Z. Effect of Swimming Exercise on Respiratory Muscle Strength and Respiratory Functions in Children with Autism. The Eurasian journal of medicine. 2023; 55(2): 135-9.

OBJECTIVE: The aim of this study is to examine the effects of swimming exercise on respiratory muscle strength and respiratory functions in children with autism. Autism is a mental disorder that affects many areas such as sensory, cognitive, motor, and psycho-motor development in individuals. MATERIALS AND METHODS: For this purpose, 15 individuals with autism, 8 of which were in the experimental group and 7 in the control group, participated in the study. The experimental group was subjected to swimming exercise for 1 hour, 3 days a week, for 6 weeks. The control group was not included in this exercise. Respiratory muscle strength and pulmonary function tests were applied to both groups before and after the 6-week period. The obtained data were analyzed using Statistical Package for Social Sciences Program Version 22.0. Values were presented as minimum, maximum, mean, standard deviation, and standard error. The Shapiro-Wilk test was used to test for normality. Paired-sample t-test was used for pre-test and post-test, and independent-sample t-test was used for intergroup analysis. RESULTS: At the end of 6 weeks, according to the statistical analysis data, there was a significant difference in some of the respiratory function parameters of the experimental group (P < .05), and an improvement was observed in the respiratory muscle strength values, but no significant difference was found (P > .05). No significant difference was found in the respiratory functions of the control group as a result of respiratory muscle strength measurements (P > .05). CONCLUSION: As a result, we can say that swimming exercise is effective in improving respiratory muscle strength and respiratory functions in children with autism.

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2. Cohenour TL, Gulsrud A, Kasari C. Heterogeneity of autism symptoms in community-referred infants and toddlers at elevated or low familial likelihood of autism. Autism research : official journal of the International Society for Autism Research. 2023.

Evidence suggests autistic individuals at elevated familial likelihood of autism spectrum disorder (by virtue of having an autistic sibling) have stronger cognitive abilities on average than autistic individuals with no family history of the condition, who have a low familial likelihood of autism. Investigating phenotypic differences between community-referred infants and toddlers with autism symptoms at elevated or low familial likelihood of autism may provide important insight into heterogeneity in the emerging autism phenotype. This study compared behavioral, cognitive, and language abilities of community-referred infants and toddlers with confirmed autism symptoms at elevated (EL) or low familial likelihood of autism (LL). Participants were 121 children aged 12 to 36 months who participated in two larger randomized trials of parent-mediated interventions for children with autism symptoms. Behavioral phenotypes were compared across three groups: children with at least one autistic sibling (EL-Sibs, n = 30), those with at least one older, non-autistic sibling and no family history of autism (LL-Sibs, n = 40), and first-born children with no family history of autism (LL-FB, n = 51). EL-Sibs had less severe autism symptoms and stronger cognitive abilities than children in LL groups. While the rate of receptive language delay was similar across groups, the rate of expressive language delay was markedly lower among EL-Sibs. After controlling for age and nonverbal cognitive ability, EL-Sibs were significantly less likely to present with expressive language delay than LL-Sibs. Familial likelihood of autism may play an important role in shaping the emerging autism phenotype in infancy and toddlerhood.

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3. Davoudi S, Rahdar M, Hosseinmardi N, Behzadi G, Janahmadi M. Chronic inhibition of astrocytic aquaporin-4 induces autistic-like behavior in control rat offspring similar to maternal exposure to valproic acid. Physiology & behavior. 2023: 114286.

Social communication and interaction deficits, memory impairment, and anxiety-like behavior are characterized in many people identified with autism spectrum disorder (ASD). A thorough understanding of the specific aspects that contribute to the deficiencies associated with ASD can aid research into the etiology of the disorder while also providing targets for more effective intervention. As part of the ASD pathophysiology, alterations in synaptogenesis and abnormal network connections were seen in high-order brain areas, which control social behavior and communication. The early emergence of microglia during nervous system development may contribute to synaptic dysfunction and the pathobiology of ASD. Since aquaporin-4 (AQP4) appears to be required for the basic procedures of synapse activation, certain behavioral and cognitive impairments as well as disturbance in water homeostasis might likely arise from AQP4 deficiency. Here, through the measurement of the water content of the hippocampus and behavioral experiments we aim to explore the contribution of astrocytic AQP4 to the autism-like behavior induced by prenatal valproic acid (VPA) exposure and whether inhibition of AQP4 per se can induce autistic-like behavior in control rats. Microinjection of TGN-020 (10µM, i.c.v), a specific AQP4 inhibitor, for 7 successive days before behavioral tasks from postnatal day 28 to 35 revealed that inhibition of AQP4 in the control offspring caused lower social interaction and locomotor activity, higher anxiety, and decreased ability to recognize novel objects, very similar to the behavioral changes observed in offspring prenatally exposed to VPA. However, VPA-exposed offspring treated with TGN-020, showed no further remarkable behavioral impairments than those detected in the autistic-like rats. Furthermore, both control offspring treated with TGN-020 and offspring exposed to VPA had a considerable accumulation of water in their hippocampi. But AQP4 inhibition did not affect the water status of the autistic-like rats. The findings of this study revealed that control offspring exhibited similar hippocampal water retention and behavioral impairments that were observed in maternal VPA-exposed offspring following inhibition of astrocytic AQP4, whereas, in autistic-like rats, it did not produce any significant change in water content and behaviors. Findings suggest that AQP4 deficiency could be associated with autistic disorder and may be a potential pharmaceutical target for treating autism in the future.

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4. Esquilín Nieves AA, Danzak RL. Examining Perspectives of Latina Mothers and Speech-Language Pathologists Through Dyadic Interviews: Implications for Latine Children on the Autism Spectrum. Language, speech, and hearing services in schools. 2023; 54(3): 746-64.

PURPOSE: This qualitative pilot study explored cultural perspectives and needs of two bilingual (Spanish/English) Latina mothers with children on the autism spectrum in conversations with their children’s speech-language pathologists (SLPs), one identifying as Mexican American and the other identifying as White American. METHOD: Dyadic interviews were used to promote dialogue and learning opportunities for the participants. Two dyads (mothers and SLPs) participated, completing background questionnaires, dyadic interviews, and post-interview written reflections. RESULTS: Three main themes emerged from the qualitative analysis of the dyadic interviews: comunicación (communication), language, and challenge. Post-interview written reflections evidenced increased advocacy skills for the mothers and heightened awareness regarding communication style for the SLPs. CONCLUSION: The lived experiences revealed by all participants offer several implications: (a) the value of extended conversations between caregivers and service providers, (b) caregiver sacrifices, (c) the importance of cultural sensitivity for SLPs, and (d) positive outcomes from online learning for children on the autism spectrum.

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5. Griffin JW, Azu MA, Cramer-Benjamin S, Franke CJ, Herman N, Iqbal R, Keifer CM, Rosenthal LH, McPartland JC. Investigating the Face Inversion Effect in Autism Across Behavioral and Neural Measures of Face Processing: A Systematic Review and Bayesian Meta-Analysis. JAMA psychiatry. 2023.

IMPORTANCE: Face processing is foundational to human social cognition, is central to the hallmark features of autism spectrum disorder (ASD), and shapes neural systems and social behavior. Highly efficient and specialized, the face processing system is sensitive to inversion, demonstrated by reduced accuracy in recognition and altered neural response to inverted faces. Understanding at which mechanistic level the autistic face processing system may be particularly different, as measured by the face inversion effect, will improve overall understanding of brain functioning in autism. OBJECTIVE: To synthesize data from the extant literature to determine differences of the face processing system in ASD, as measured by the face inversion effect, across multiple mechanistic levels. DATA SOURCES: Systematic searches were conducted in the MEDLINE, Embase, Web of Science, and PubMed databases from inception to August 11, 2022. STUDY SELECTION: Original research that reported performance-based measures of face recognition to upright and inverted faces in ASD and neurotypical samples were included for quantitative synthesis. All studies were screened by at least 2 reviewers. DATA EXTRACTION AND SYNTHESIS: This systematic review and meta-analysis was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Multiple effect sizes were extracted from studies to maximize information gain and statistical precision and used a random-effects, multilevel modeling framework to account for statistical dependencies within study samples. MAIN OUTCOMES AND MEASURES: Effect sizes were calculated as a standardized mean change score between ASD and neurotypical samples (ie, Hedges g). The primary outcome measure was performance difference between upright and inverted faces during face recognition tasks. Measurement modality, psychological construct, recognition demand, sample age, sample sex distribution, and study quality assessment scores were assessed as moderators. RESULTS: Of 1768 screened articles, 122 effect sizes from 38 empirical articles representing data from 1764 individual participants (899 ASD individuals and 865 neurotypical individuals) were included in the meta-analysis. Overall, face recognition performance differences between upright and inverted faces were reduced in autistic individuals compared with neurotypical individuals (g = -0.41; SE = 0.11; 95% credible interval [CrI], -0.63 to -0.18). However, there was considerable heterogeneity among effect sizes, which were explored with moderator analysis. The attenuated face inversion effect in autistic individuals was more prominent in emotion compared with identity recognition (b = 0.46; SE = 0.26; 95% CrI, -0.08 to 0.95) and in behavioral compared with electrophysiological measures (b = 0.23; SE = 0.24; 95% CrI, -0.25 to 0.70). CONCLUSIONS AND RELEVANCE: This study found that on average, face recognition in autism is less impacted by inversion. These findings suggest less specialization or expertise of the face processing system in autism, particularly in recognizing emotion from faces as measured in behavioral paradigms.

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6. Hong Y, Chen S, Zhou F, Chan A, Tang T. Phonetic entrainment in L2 human-robot interaction: an investigation of children with and without autism spectrum disorder. Frontiers in psychology. 2023; 14: 1128976.

Phonetic entrainment is a phenomenon in which people adjust their phonetic features to approach those of their conversation partner. Individuals with Autism Spectrum Disorder (ASD) have been reported to show some deficits in entrainment during their interactions with human interlocutors, though deficits in terms of significant differences from typically developing (TD) controls were not always registered. One reason related to the inconsistencies of whether deficits are detected or not in autistic individuals is that the conversation partner’s speech could hardly be controlled, and both the participants and the partners might be adjusting their phonetic features. The variabilities in the speech of conversation partners and various social traits exhibited might make the phonetic entrainment (if any) of the participants less detectable. In this study, we attempted to reduce the variability of the interlocutors by employing a social robot and having it do a goal-directed conversation task with children with and without ASD. Fourteen autistic children and 12 TD children participated the current study in their second language English. Results showed that autistic children showed comparable vowel formants and mean fundamental frequency (f0) entrainment as their TD peers, but they did not entrain their f0 range as the TD group did. These findings suggest that autistic children were capable of exhibiting phonetic entrainment behaviors similar to TD children in vowel formants and f0, particularly in a less complex situation where the speech features and social traits of the interlocutor were controlled. Furthermore, the utilization of a social robot may have increased the interest of these children in phonetic entrainment. On the other hand, entrainment of f0 range was more challenging for these autistic children even in a more controlled situation. This study demonstrates the viability and potential of using human-robot interactions as a novel method to evaluate abilities and deficits in phonetic entrainment in autistic children.

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7. Malachowski LG, Huntley MA, Needham AW. Case report: An evaluation of early motor skills in an infant later diagnosed with autism. Frontiers in psychiatry. 2023; 14: 1205532.

Researchers and clinicians are increasingly interested in understanding the etiology of autism spectrum disorder (ASD) and identifying behaviors that can provide opportunities for earlier detection and therefore earlier onset of intervention activities. One promising avenue of research lies in the early development of motor skills. The present study compares the motor and object exploration behaviors of an infant later diagnosed with ASD (T.I.) with the same skills in a control infant (C.I.). There were notable difference in fine motor skills by just 3 months of age, one of the earliest fine motor differences reported in the literature. In line with previous findings, T.I. and C.I. demonstrated different patterns of visual attention as early as 2.5 months of age. At later visits to the lab, T.I. engaged in unique problem-solving behaviors not demonstrated by the experimenter (i.e., emulation). Overall, findings suggest that infants later diagnosed with ASD may show differences in fine motor skills and visual attention to objects from the first months of life.

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8. Oakley B, Boatman C, Doswell S, Dittner A, Clarke A, Ozsivadjian A, Kent R, Judd A, Baldoza S, Hearn A, Murphy D, Simonoff E. Molehill Mountain feasibility study: Protocol for a non-randomised pilot trial of a novel app-based anxiety intervention for autistic people. PloS one. 2023; 18(7): e0286792.

Up to 50% of autistic people experience co-occurring anxiety, which significantly impacts their quality of life. Consequently, developing new interventions (and/ or adapting existing ones) that improve anxiety has been indicated as a priority for clinical research and practice by the autistic community. Despite this, there are very few effective, evidence-based therapies available to autistic people that target anxiety; and those that are available (e.g., autism adapted Cognitive Behavioural Therapy; CBT) can be challenging to access. Thus, the current study will provide an early-stage proof of concept for the feasibility and acceptability of a novel app-based therapeutic approach that has been developed with, and adapted for, autistic people to support them in managing anxiety using UK National Institute for Health and Care Excellence (NICE) recommended adapted CBT approaches. This paper describes the design and methodology of an ethically approved (22/LO/0291) ongoing non-randomised pilot trial that aims to enrol approximately 100 participants aged ≥16-years with an existing autism diagnosis and mild-to-severe self-reported anxiety symptoms (trial registration NCT05302167). Participants will be invited to engage with a self-guided app-based intervention-‘Molehill Mountain’. Primary (Generalised Anxiety Disorder Assessment, Hospital Anxiety and Depression Scale) and secondary outcomes (medication/ service use and Goal Attainment Scaling) will be assessed at baseline (Week 2 +/- 2), endpoint (Week 15 +/- 2) and three follow-ups (Weeks 24, 32 and 41 +/- 4). Participants will also be invited to complete an app acceptability survey/ interview at the study endpoint. Analyses will address: 1) app acceptability/ useability and feasibility (via survey/ interview and app usage data); and 2) target population, performance of outcome measures and ideal timing/ duration of intervention (via primary/ secondary outcome measures and survey/ interview)-with both objectives further informed by a dedicated stakeholder advisory group. The evidence from this study will inform the future optimisation and implementation of Molehill Mountain in a randomised-controlled trial, to provide a novel tool that can be accessed easily by autistic adults and may improve mental health outcomes.

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9. Watanabe D, Watanabe T. Distinct frontoparietal brain dynamics underlying the co-occurrence of autism and ADHD. eNeuro. 2023.

Previous diagnostic systems precluded the co-existence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in one person; but, after many clinical reports, such diagnostic criteria were updated to allow their co-occurrence. Despite such a clinical change, the neurobiological bases underpinning the comorbidity remain poorly understood, and whether the ASD+ADHD condition is a simple overlap of the two disorders is unknown. Here, to answer this question, we compared the brain dynamics of high-functioning ASD+ADHD children with age-/sex-/IQ-matched pure ASD, pure ADHD, and typically developing children. Regarding autistic traits, the socio-communicational symptom of the ASD+ADHD children was explained by the same over-stable brain dynamics as seen in pure ASD. In contrast, their ADHD-like traits were grounded on a unique neural mechanism that was unseen in pure ADHD: the core symptoms of pure ADHD were associated with the overly flexible whole-brain dynamics that were triggered by the unstable activity of the dorsal-attention network and the left parietal cortex; by contrast, the ADHD-like cognitive instability of the ASD+ADHD condition was correlated with the atypically frequent neural transition along a specific brain state pathway, which was induced by the atypically unstable activity of the frontoparietal control network and the left prefrontal cortex. These observations need to be validated in future studies using more direct and comprehensive behavioural indices, but the current findings suggest that the ASD+ADHD comorbidity is not a mere overlap of the two disorders. Particularly, its ADHD-like traits could represent a unique condition that would need a specific diagnosis and bespoke treatments.Significance statementChildren with autism spectrum disorder (ASD) have cognitive rigidity and tend to persist in specific thoughts, whereas those with ADHD exhibit overly flexible cognition and have trouble with concentration. Despite such contrast, clinically, the two neurodevelopmental disorders are often reported to co-exist in one person. How can such a co-occurrence happen? By investigating the global and local brain dynamics, this study found that the comorbidity of ASD and ADHD is not a simple overlap of the two conditions. Instead, the cognitive instability seen in ASD+ADHD children was underpinned by unique brain dynamics that were not observed in pure ADHD. These findings indicate that the comorbid condition would need a bespoke diagnosis and treatment.

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