1. Ahsan A, Arafat-Islam M, Fatima M, Mahboob RN, Kamrul-Hasan AB. Knowledge of Autism Spectrum Disorder Among 2nd to 4th Phase MBBS Students of Bangladesh. Mymensingh medical journal : MMJ. 2021; 30(4): 980-5.

Autism spectrum disorder (ASD), being one of the fastest-growing disabilities in children, is an omnipresent, immutable neurodevelopmental disorder characterized by impaired socialization, impaired verbal and non-verbal communication, restricted interests, and repetitive behaviour patterns. A descriptive cross-sectional study was conducted from 30 October to 30 November 2019 among the MBBS students of 21 medical colleges in Bangladesh to assess their knowledge of autism. The ‘Knowledge about Childhood Autism among Health Workers (KCAHW)’ questionnaire containing 19 item questions divided into four domains was used. The total median score in the KCAHW questionnaire is 13 out of 19. The final total of respondents numbered 483. There were 215 (44.51%) male and 268 (55.49%) female students. Among 21 medical colleges, 10 are situated in the Dhaka district and 11 outside Dhaka; 14 medical colleges were public, and seven were private. The study shows that students’ knowledge of autism spectrum disorder (ASD) is not up to the mark. While assessing the knowledge in each domain, Domain 4 (knowledge regarding nature, comorbidities, and onset) shows that only 32.6% of students of 4th phase and 21.5% of other phases have scored more than the median value, revealing that medical students were not familiar with nature, comorbidities, and the onset of ASD. It can be reliably diagnosed before two years of age, but the practical scenario is a different picturesque. Thus, medical students should have bona fide knowledge to diagnose this progressively prevailing disorder at the earliest possible time. We hope this study’s aftermath will significantly impact the integrity and diversity of autism spectrum disorder.

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2. Alhossein A. Teachers’ Knowledge and Use of Evidenced-Based Practices for Students With Autism Spectrum Disorder in Saudi Arabia. Frontiers in psychology. 2021; 12: 741409.

The evidenced-based practices (EBPs) movement in the field of special education began ~20 years ago. This study contributes to that literature. It investigates the teachers’ knowledge and use of EBPs to teach students with autism spectrum disorder (ASD) in Saudi Arabia. The Teachers’ Knowledge and Use of EBPs Survey was administered to 240 special education teachers. The participants generally reported a medium level of knowledge and use of EBPs for students with ASD. Female teachers’ use of EBPs was greater than that of males, and teachers who attended more than five professional development programs reported greater use of EBPs than those that attended fewer programs. Knowledge and use of EBPs were related. Gender and professional development programs were predictors of teachers’ use of EBPs for students with ASD. Teachers’ knowledge of EBPs for students with ASD is a vital indicator of teachers’ use of those practices, professional development programs can improve such knowledge and use, and teachers’ use of EBPs for students with ASD could be improved by offering high-quality professional development programs.

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3. Chagolla GA, Penrod B. Decreasing Number of Food Portions Consumed by an Adolescent Female with Autism. Behavior analysis in practice. 2021; 15(1): 1-6.

The current study evaluated the effectiveness of a treatment package including a behavior contract, brief portion selection training, and a food diary, to manage portion control in an adolescent female with autism. The behavior contract specified a reinforcement contingency for meeting a weekly goal that described how many servings the participant may consume but should not exceed during meals consisting of target foods. Results of the study demonstrated that the treatment package was successful in managing the number of portions the participant consumed across treatment and generalization sessions. • The flexible nature of the intervention may lead to greater treatment adherence • The intervention was rated with high social acceptability. • The intervention is generalizable to other naturalistic contexts. • The intervention may promote independence through teaching self-management skills.

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4. Joseph TP, Zhou F, Sai LY, Chen H, Lin SL, Schachner M. Duloxetine ameliorates valproic acid-induced hyperactivity, anxiety-like behavior, and social interaction deficits in zebrafish. Autism research : official journal of the International Society for Autism Research. 2022; 15(1): 27-41.

Syndromic autism spectrum disorders (ASDs) are characterized by impaired social communication and repetitive/stereotyped behaviors. Currently available therapeutic agents against ASD have limited efficacy. Thus, searching for novel and effective drugs ameliorating core symptoms, in particular social deficits, is of utmost importance. Duloxetine (DLX), an antidepressant that has been identified as an agonist mimetic for the cell adhesion molecule L1, exhibits beneficial functions in vitro and in vivo. Therefore, in this study, we focused on the rapid and persistent neuroprotective function of DLX following valproic acid (VPA)-triggered hyperactivity, anxiety-like behavior and social deficits in zebrafish. Embryonic exposure to VPA reduced survival in a dose- and time-dependent manner, delayed hatching, and also resulted in a significant number of malformed larvae. After initial dose-response experiments in zebrafish larvae, 10 μM VPA exposure between 0.33 and 4.5 days post fertilization (dpf) was identified as an effective concentration that led to an early and persistent ASD-like phenotype in zebrafish. ASD-like elevated acetylcholine esterase (AChE) activity and reduced Akt-mTOR signaling was observed in zebrafish whole brain. Acute administration of DLX (4.5-6 dpf) reduced the VPA-induced ASD-like phenotype in zebrafish larvae. Additionally, such early-life acute DLX treatment had long-term effects in ameliorating social impairments, hyperactivity, and anxiety-like behaviors through adulthood. This was accompanied by reduced AChE activity and by normalized Akt-mTOR signaling. Overall, DLX treatment showed a long-term therapeutic effect on autistic-like behaviors, and alteration of AChE activity and Akt-mTOR signaling were identified as crucial in the VPA-induced ASD zebrafish model.

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5. Kamekura N, Hojo T, Nitta Y, Hase Y, Fujisawa T. Anesthetic Management of a Rett Syndrome Patient at High Risk for Respiratory Complications. Anesthesia progress. 2021; 68(3): 163-7.

Rett syndrome (RTT) is a rare genetic disorder that can present challenges in airway management during general anesthesia. This is a case report involving a 23-year-old woman with RTT who received an intubated general anesthetic 3 times for dental treatment. The patient also had severe scoliosis, was bedridden, and had dysphagia. These contributing factors likely led to the development of postoperative respiratory complications including pneumonia after the first case. As a result, several changes were incorporated into the 2 subsequent anesthetic plans in efforts to reduce the risk of such complications. Despite these measures, the patient was suspected of having bronchitis postoperatively after the second anesthetic, although the third occurred uneventfully. Anesthetic management alterations included use of desflurane for anesthetic maintenance and postoperatively delaying oral intake and instituting active postural changes.

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6. Liu M, Li B, Hu D. Autism Spectrum Disorder Studies Using fMRI Data and Machine Learning: A Review. Frontiers in neuroscience. 2021; 15: 697870.

Machine learning methods have been frequently applied in the field of cognitive neuroscience in the last decade. A great deal of attention has been attracted to introduce machine learning methods to study the autism spectrum disorder (ASD) in order to find out its neurophysiological underpinnings. In this paper, we presented a comprehensive review about the previous studies since 2011, which applied machine learning methods to analyze the functional magnetic resonance imaging (fMRI) data of autistic individuals and the typical controls (TCs). The all-round process was covered, including feature construction from raw fMRI data, feature selection methods, machine learning methods, factors for high classification accuracy, and critical conclusions. Applying different machine learning methods and fMRI data acquired from different sites, classification accuracies were obtained ranging from 48.3% up to 97%, and informative brain regions and networks were located. Through thorough analysis, high classification accuracies were found to usually occur in the studies which involved task-based fMRI data, single dataset for some selection principle, effective feature selection methods, or advanced machine learning methods. Advanced deep learning together with the multi-site Autism Brain Imaging Data Exchange (ABIDE) dataset became research trends especially in the recent 4 years. In the future, advanced feature selection and machine learning methods combined with multi-site dataset or easily operated task-based fMRI data may appear to have the potentiality to serve as a promising diagnostic tool for ASD.

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7. Lotan M, Ippolito E, Favetta M, Romano A. Skype Supervised, Individualized, Home-Based Rehabilitation Programs for Individuals With Rett Syndrome and Their Families – Parental Satisfaction and Point of View. Frontiers in psychology. 2021; 12: 720927.

Individuals with Rett syndrome (RTT) experience impaired gross motor skills limiting their capacity. Therefore, they need support to participate in physical activities, and it is crucial to work with primary caregivers when developing appropriate strategies, thereby leading to an active lifestyle. There is limited evidence supporting the effectiveness of remotely supported physical activity interventions. This project aimed to evaluate the effects of a skype-based, telehealth-delivered physical activity program carried out by participants’ parents at home. This article will focus on parental points of view. A mixed-methods design evaluating parental satisfaction was conducted. Forty participants with a confirmed genetic diagnosis of RTT and their families were recruited. The intervention included a 12-week individualized daily physical activity program carried out by participants’ parents and bi-weekly supervised by expert therapists. Parents’ impressions and feelings related to the program implementation were collected throughout semi-structured interviews, and an ad hoc developed questionnaire and discussed. The current project results suggest that a remote physical rehabilitation program, supported fortnightly by video calls, represents an effective way of conducting a remote physical therapy intervention for this population and that it can be easily carried out at home by primary caregivers, promoting positive functional changes, without bringing feelings of frustration due to the required workload. The strategies that families have learned during the program to support the motor activities of their daughters represent an easily performed set of tools that they can maintain and use in everyday life even after the cessation of the program.

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8. Mohd Nordin A, Ismail J, Kamal Nor N. Motor Development in Children With Autism Spectrum Disorder. Frontiers in pediatrics. 2021; 9: 598276.

Objective: This study was conducted to determine the gross and fine motor profiles of children with autism spectrum disorder compared to typically developing children. Additionally, we also assessed if the motor delay was more pronounced with increasing age. Method: This was a retrospective study involving children aged 12-60 months of age comparing motor development in children with autism spectrum disorder with typically developing children. Their developmental profile was assessed using Schedule of Growing Skills II. Descriptive statistics was used to analyse the developmental profile between the groups. Results: ASD children had significant gross motor (6.7%) and fine motor delay (38.5%) compared to typically developing children, who did not show any delay. The motor delay in ASD children was more prominent in older children. Conclusion: It is important to assess motor development in ASD children as there is significant motor delay in these children compared to typically developing children, and the delay becomes more prominent with age. Early detection of motor delay could allow provision of early intervention services to optimize developmental outcomes.

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9. Salcedo-Arellano MJ, Sanchez D, Wang JY, McLennan YA, Clark CJ, Juarez P, Schneider A, Tassone F, Hagerman RJ, Martínez-Cerdeño V. Case Report: Coexistence of Alzheimer-Type Neuropathology in Fragile X-Associated Tremor Ataxia Syndrome. Frontiers in neuroscience. 2021; 15: 720253.

This case documents the co-occurrence of the fragile X-associated tremor ataxia syndrome (FXTAS) and Alzheimer-type neuropathology in a 71-year-old premutation carrier with 85 CGG repeats in the fragile X mental retardation 1 (FMR1) gene, in addition to an apolipoprotein E (APOE) ε4 allele. FXTAS and Alzheimer’s Disease (AD) are late-onset neurodegenerative diseases that share overlapping cognitive deficits including processing speed, working memory and executive function. The prevalence of coexistent FXTAS-AD pathology remains unknown. The clinical picture in this case was marked with rapid cognitive decline between age 67 and 71 years in addition to remarkable MRI changes. Over the 16 months between the two clinical evaluations, the brain atrophied 4.12% while the lateral ventricles increased 26.4% and white matter hyperintensities (WMH) volume increased 15.6%. Other regions atrophied substantially faster than the whole brain included the thalamus (-6.28%), globus pallidus (-10.95%), hippocampus (-6.95%), and amygdala (-7.58%). A detailed postmortem assessment included an MRI with confluent WMH and evidence of cerebral microbleeds (CMB). The histopathological study demonstrated FXTAS inclusions in neurons and astrocytes, a widespread presence of phosphorylated tau protein and, amyloid β plaques in cortical areas and the hippocampus. CMBs were noticed in the precentral gyrus, middle temporal gyrus, visual cortex, and brainstem. There were high amounts of iron deposits in the globus pallidus and the putamen consistent with MRI findings. We hypothesize that coexistent FXTAS-AD neuropathology contributed to the steep decline in cognitive abilities.

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10. Sourander A, Upadhyaya S, Surcel HM, Hinkka-Yli-Salomäki S, Cheslack-Postava K, Silwal S, Sucksdorff M, McKeague IW, Brown AS. Maternal Vitamin D Levels During Pregnancy and Offspring Autism Spectrum Disorder. Biological psychiatry. 2021; 90(11): 790-7.

BACKGROUND: Findings from previous studies on maternal 25-hydroxyvitamin D [25(OH)D] levels during pregnancy and autism spectrum disorder (ASD) in offspring are inconsistent. METHODS: The association between maternal 25(OH)D levels during pregnancy and offspring ASD was examined using data from a nationwide population-based register with a nested case-control study design. The ASD cases (n = 1558) were born between 1987 and 2004 and received a diagnosis of ASD by 2015; cases were matched with an equal number of controls. Maternal 25(OH)D levels during pregnancy were measured using quantitative immunoassay from maternal sera collected during the first and early second trimesters and archived in the national biobank of the Finnish Maternity Cohort. Conditional logistic regression examined the association between maternal 25(OH)D levels and offspring ASD. RESULTS: In the adjusted model, there was a significant association between increasing log-transformed maternal 25(OH)D levels and decreasing risk of offspring ASD (adjusted odds ratio [aOR] 0.75, 95% confidence interval [CI] 0.62-0.92, p = .005). Analyses by quintiles of maternal 25(OH)D levels revealed increased odds for ASD in the 2 lowest quintiles, <20 (aOR 1.36, 95% CI 1.03-1.79, p = .02) and 20-39 (aOR 1.31, 95% CI 1.01-1.70, p = .04), compared with the highest quintile. The increased risk of ASD was observed in association with deficient (<30 nmol/L) (aOR 1.44, 95% CI 1.15-1.81, p = .001) and insufficient (30-49.9 nmol/L) maternal 25(OH)D levels (aOR 1.26, 95% CI 1.04-1.52, p = .01) compared with sufficient levels. CONCLUSIONS: This finding has implications for understanding the role of maternal vitamin D during fetal brain development and increased risk of ASD.

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11. Stewart TM, Martin K, Fazi M, Oldridge J, Piper A, Rhodes SM. A systematic review of the rates of depression in autistic children and adolescents without intellectual disability. Psychology and psychotherapy. 2022; 95(1): 313-44.

OBJECTIVES: Increasing evidence suggests that major depressive disorder (MDD) is highly prevalent in autism spectrum disorder (ASD). The current study is a systematic review of rates of depression in autistic children and adolescents, without intellectual disability. DESIGN: Adhering to PRISMA guidelines, a total of 14,557 studies were identified through five databases (MEDLINE, EMBASE, Cinahl, ERIC, PsycINFO, and Web of Science). METHODS: Articles were screened for inclusion and exclusion criteria and 10% double coded at each stage. Nineteen studies met criteria and were retained in the review. RESULT: The reported rates of depression in autistic children and adolescents varied from 0% to 83.3%. We discuss these findings in relation to method of report (self/informant, interview/questionnaire), recruitment status (clinical/community recruited), and age (pre-pubertal/adolescent). CONCLUSION: Rates of depression vary considerably across studies and do not show a particular pattern in relation to methodology, or age. Our research joins a crucial call to action from the research community for future research to improve the identification of depression in autism, which in turn will aid our understanding of the potentially different characterization and manifestation of depression in autism, to ultimately improve assessment and treatment of depression in autistic children and adolescents. PRACTITIONER POINTS: Rates of depression in autistic children and adolescents vary and do not show a particular pattern in relation to methodology or age. Our research joins the call to action from the research community for future research to improve the identification of depression in autistic children and adolescents, which in turn will aid understanding of depression in autism, and ultimately improve assessment and treatment of depression in autistic children and young people. The development of new measures of depression, specifically designed with, and for, children and adolescents with autism, is warranted.

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12. Thoen A, Steyaert J, Alaerts K, Evers K, Van Damme T. A Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum. Review journal of autism and developmental disorders. 2021: 1-24.

BACKGROUND: The goal of this systematic review was to provide an overview of self-report measures of stress in populations on the autism spectrum. In addition, information regarding psychometric properties was discussed as well. METHODS: Four databases were systematically searched following the PRISMA guidelines and using strict eligibility criteria. Risk of bias assessment was performed using the COSMIN checklist. RESULTS: Eight questionnaires were previously used in populations on the autism spectrum, reported over 31 studies. DISCUSSION: Future research should focus more on examining psychometric properties of these self-report measures in this population as current evidence is scarce. In addition, it is important to consider which concept of stress one aims to measure as not all questionnaires cover the same aspects of stress. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40489-021-00293-4.

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