1. Adams SN, Seedat J, Neille J. Life under lockdown for children with autism spectrum disorder: Insights from families in South Africa. Child: care, health and development. 2022.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) remain vulnerable during the Covid-19 outbreak due to significant changes to their daily routines, social interactions and diets. In addition, these challenges may be exacerbated for children living in low- and middle-income countries (LMIC) such as South Africa where there are already barriers such as poverty, access to resources and availability of support. Understanding the impact of the Covid-19 outbreak on children with ASD is imperative in order to create awareness as well as provide equitable services and support to both children with ASD and their families. PURPOSE: The study aimed to explore family-reported changes for children with ASD and their reactions and responses to the Covid-19 restrictions in South Africa. METHOD: A qualitative research design was employed. Twelve families consisting of different family compositions with a total of 21 family members (mothers, fathers and grandmothers) participated in the current study using semistructured interviews. Data were transcribed and analysed using a framework method for thematic analysis. RESULTS: Findings indicated that children with ASD present with unique challenges related to Covid-19. Negative themes such as children’s obstructive reactions due to the immediate changes to their routines, increases in emotional dysregulation as well as loss of previously acquired skills as a result of lack of access to services during lockdown were reported. However, families also reported on positive changes such as improved social interactions as children became more accustomed to their new lockdown routines. IMPLICATIONS: The Covid-19 response has had a negative impact on children with disabilities, specifically around access to services and support for both children with ASD and their families. While the future of the virus and impending lockdown measures is unknown, clinicians, providers and educators need to ensure that provisions are made for children’s current adjustments as well as further adjustments to their current routines both during and after the pandemic.

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2. Badura-Stronka M, Śmigiel R, Rutkowska K, Szymańska K, Hirschfeld AS, Monkiewicz M, Kosińska J, Wolańska E, Rydzanicz M, Latos-Bieleńska A, Płoski R. FINCA syndrome-Defining neurobehavioral phenotype in survivors into late childhood. Molecular genetics & genomic medicine. 2022; 10(4): e1899.

We report for the first time a novel missense variant in NHLRC2. We extend the NHLRC2 gene associated neuropsychological and neuroimaging phenotype, and propose that the NHLRC2 gene should be considered in patients with symptoms of atypical Rett syndrome. We also summarise currently available literature on neuropsychological symptoms in children with FINCA who survived into late childhood.

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3. Becerra MA. Closing the Diagnostic Gap: Early Autism Spectrum Disorder Screening for Every Child. Health & social work. 2022; 47(2): 87-91.

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4. Carter M, Casey S, O’Keeffe GW, Gibson L, Gallagher L, Murray DM. Maternal Immune Activation and Interleukin 17A in the Pathogenesis of Autistic Spectrum Disorder and Why It Matters in the COVID-19 Era. Frontiers in psychiatry. 2022; 13: 823096.

Autism spectrum disorder (ASD) is the commonest neurodevelopmental disability. It is a highly complex disorder with an increasing prevalence and an unclear etiology. Consensus indicates that ASD arises as a genetically modulated, and environmentally influenced condition. Although pathogenic rare genetic variants are detected in around 20% of cases of ASD, no single factor is responsible for the vast majority of ASD cases or that explains their characteristic clinical heterogeneity. However, a growing body of evidence suggests that ASD susceptibility involves an interplay between genetic factors and environmental exposures. One such environmental exposure which has received significant attention in this regard is maternal immune activation (MIA) resulting from bacterial or viral infection during pregnancy. Reproducible rodent models of ASD are well-established whereby induction of MIA in pregnant dams, leads to offspring displaying neuroanatomical, functional, and behavioral changes analogous to those seen in ASD. Blockade of specific inflammatory cytokines such as interleukin-17A during gestation remediates many of these observed behavioral effects, suggesting a causative or contributory role. Here, we review the growing body of animal and human-based evidence indicating that interleukin-17A may mediate the observed effects of MIA on neurodevelopmental outcomes in the offspring. This is particularly important given the current corona virus disease-2019 (COVID-19) pandemic as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is a potent stimulator of the maternal immune response, however the long-term effects of maternal SARS-CoV-2 infection on neurodevelopmental outcomes is unclear. This underscores the importance of monitoring neurodevelopmental outcomes in children exposed to SARS-CoV-2-induced MIA during gestation.

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5. Crippa A, Colombo P, De Cosmi V, Mazzocchi A, Scaglioni S, Spolidoro GCI, Bettocchi S, D’Oria V, Viganò N, Mani E, Molteni M, Agostoni C. Understanding feeding problems in autistic children: Exploring the interplay between internalizing symptoms and sensory features. Autism : the international journal of research and practice. 2022: 13623613221080227.

This study adds to a growing body of research documenting feeding problems in autistic children. Our results indicate that children aged 1.5-5 years with feeding problems may present with elevated internalizing difficulties and alterations in sensory processing when compared to same-age children without feeding problems. Our study also proposes that sensory processing may be an important, mediating factor in the relationship between autism features and feeding problems. The present work suggests, therefore, that implementers should thoroughly consider the sensory profile of autistic children prior to intervening on feeding behaviors. In particular, based on these preliminary findings, feeding interventions could benefit from environments designed to support children who can find them noisy and overwhelming.

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6. Crompton CJ, Hallett S, Axbey H, McAuliffe C, Cebula K. ‘Someone like-minded in a big place’: Autistic young adults’ attitudes towards autistic peer support in mainstream education. Autism : the international journal of research and practice. 2022: 13623613221081189.

Autistic young people may struggle in mainstream schools and feel disconnected from their peers and their school. We know that autistic adults can benefit from spending time with other autistic people, but we don’t know if this is the case for younger autistic people. We conducted interviews with 13 autistic young adults in the United Kingdom who recently left mainstream schooling. We asked them if they would have been interested in being involved in autistic peer support when they were at school, and if so, what that peer support should look like. Results indicated that autistic young people were enthusiastic about the idea of peer support. They thought it was important that peer support was flexible to suit their needs at different times, as well as inclusive, positive, and embracing neurodiversity. They also discussed the potential benefits and difficulties of having a peer support system within a school setting. This adds to the growing body of research on the potential benefits of autistic-autistic interactions on autistic people’s well-being and sense of belonging. Findings can be used to help design pilot peer support projects in schools that can be tested to see how effective they are.

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7. Czajeczny D, Jaroszkiewicz A, Daroszewski P, Kopczyński P, Warchoł-Biedermann K, Pigłowska A, Samborski W, Wójciak RW, Mojs E. Application of Eye-tracking in research on the theory of mind in ASD. European review for medical and pharmacological sciences. 2022; 26(4): 1364-73.

Autism spectrum disorder (ASD) is a broad diagnostic category describing a group of neurodevelopmental disorders which includes the autistic disorder. Failure to develop normal social relationships is a hallmark of autism. An inability to understand and cope with the social environment can occur regardless of IQ. One of the hypotheses of the appearance of ASD symptoms is associated with the theory of mind (TOM). ASD patients do not have the ability to attribute the full range of mental states (goal states and epistemic states) to themselves and to others. Eye-tracking allows for observation of early signs of TOM in ASD individuals, even before they are 1 year old, without the need of developed motor and language skills. This provides a window for looking at the very basics of mindreading – detecting intentionality and eyes in our environment. Studies show that ASD children fail to recognize biological motion, while being highly sensitive to physical contingency within the random movement. Their perception of faces seems disorganized and undirected, while object recognition is intact. Evidence suggests that this orientation of attention following gaze cues is diminished in ASD patients. Available data also show deficits in emotion recognition, that cannot be accounted for by impairments in face processing or visual modality alone. Such observations provide an insight into disturbances of information processing and offer an explanation for poor social functioning of ASD patients. When combined with other methods, Eye-tracking has the potential to reveal differences in processing information on a neural circuitry level. Thus, it may help in understanding the complexity of TOM mechanisms, and their role in social functioning.

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8. Gabarron E, Dechsling A, Skafle I, Nordahl-Hansen A. Discussions of Asperger Syndrome on Social Media: Content and Sentiment Analysis on Twitter. JMIR formative research. 2022; 6(3): e32752.

BACKGROUND: On May 8, 2021, Elon Musk, a well-recognized entrepreneur and business magnate, revealed on a popular television show that he has Asperger syndrome. Research has shown that people’s perceptions of a condition are modified when influential individuals in society publicly disclose their diagnoses. It was anticipated that Musk’s disclosure would contribute to discussions on the internet about the syndrome, and also to a potential change in the perception of this condition. OBJECTIVE: The objective of this study was to compare the types of information contained in popular tweets about Asperger syndrome as well as their engagement and sentiment before and after Musk’s disclosure. METHODS: We extracted tweets that were published 1 week before and after Musk’s disclosure that had received >30 likes and included the terms « Aspergers » or « Aspie. » The content of each post was classified by 2 independent coders as to whether the information provided was valid, contained misinformation, or was neutral. Furthermore, we analyzed the engagement on these posts and the expressed sentiment by using the AFINN sentiment analysis tool. RESULTS: We extracted a total of 227 popular tweets (34 posted the week before Musk’s announcement and 193 posted the week after). We classified 210 (92.5%) of the tweets as neutral, 13 (5.7%) tweets as informative, and 4 (1.8%) as containing misinformation. Both informative and misinformative tweets were posted after Musk’s disclosure. Popular tweets posted before Musk’s disclosure were significantly more engaging (received more comments, retweets, and likes) than the tweets posted the week after. We did not find a significant difference in the sentiment expressed in the tweets posted before and after the announcement. CONCLUSIONS: The use of social media platforms by health authorities, autism associations, and other stakeholders has the potential to increase the awareness and acceptance of knowledge about autism and Asperger syndrome. When prominent figures disclose their diagnoses, the number of posts about their particular condition tends to increase and thus promote a potential opportunity for greater outreach to the general public about that condition.

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9. Galli J, Loi E, Visconti LM, Mattei P, Eusebi A, Calza S, Fazzi E. Sleep Disturbances in Children Affected by Autism Spectrum Disorder. Frontiers in psychiatry. 2022; 13: 736696.

BACKGROUND: Sleep disturbances are common in children affected by Autism Spectrum Disorder (ASD). The aim of our study was to describe sleep characteristics and disturbances in children with ASD, to evaluate possible related factors, and to assess parental stress. METHODS: Hundred children with a diagnosis of ASD (mean age: 66.7 months, SD: 27.4, range: 24.7-152.1 months, n = 79 males) were included in the study. We collected data on sociodemographic, clinical, genetic and instrumental variables as well as comorbid conditions. Parents filled out the Questionnaire on sleep behavior in the first years of life, the BEARS questionnaire, and the Parenting Stress Index Short Form. From the analysis on sleep characteristics, we excluded 25 children treated with melatonin. RESULTS: Fifty-seven (57%) out of 100 children met the criteria for insomnia. Sleep disorders were associated with developmental or cognitive delay, emotional and behavioral problems (such as anxiety problems and aggressive behaviors) and absence of strategies for inducing sleep after nocturnal awakenings. From parents’ reports, sleep disorders had diurnal repercussions on their offspring; however, we found no statistical correlation between disturbances and family stress. Also, no significant correlation was found between sleep disturbances and epilepsy. Finally, a statistical correlation was found between the regular intake of melatonin and the resolution of insomnia. CONCLUSIONS: Multifactorial variables may be associated to insomnia that could have an impact on the children’ behavior. Clinicians need to be aware of the value of screening for sleep disturbance in children with ASD to integrate sleep interventions in the treatment plan.

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10. Grigoropoulos I. The influence of family’s cohesion and adaptability in family satisfaction of parents with a child with autism spectrum disorder. Psychiatrike = Psychiatriki. 2022; 33(1): 72-5.

The current study examined whether there was significant relationship among family functioning (cohesion and adaptability) and overall family satisfaction in parents with a child with autism spectrum disorder. It was predicted that poor family adaptive functioning, poor family cohesion along with other family-related variables (child diagnosis, parents’ marital status, and other siblings in the family) would predict lower levels of family satisfaction. 73 mothers and 27 fathers of a child with ASD participated in this study. Google forms were used in this electronic web research. Data were collected using the Family Adaptability and Cohesion Evaluation Scale (FACES-III) and the Family satisfaction scale (FSS). This study’s results demonstrate that family adaptability along with a child’s autism spectrum disorder diagnosis may be significant predictors of family satisfaction. Findings report the significance of identifying discrepancies in family functioning as they provide an insight into how family members not only view but also how they interact with each other which in turn can inform clinical interventions and the therapeutic work.

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11. Hand BN, Gilmore D, Harris L, Darragh A, Hanks C, Coury D, Moffatt-Bruce S, Garvin J. « They looked at me as a person, not just a diagnosis »: A qualitative study of patient and parent satisfaction with a specialized primary care clinic for autistic adults. Autism in adulthood : challenges and management. 2021; 3(4): 347-55.

BACKGROUND: Autistic adults have complex physical and mental healthcare needs that necessitate specialized approaches to healthcare. One promising approach is to embed providers with specialized training or specialty clinics for autistic adults within general primary care facilities. We previously found that autistic adults who received their healthcare through one specialty clinic designed with and for autistic adults had better continuity of care and more preventive service utilization than national samples of autistic adults. OBJECTIVE: To characterize factors that increased or decreased satisfaction with healthcare received through a specialty clinic for autistic adults. METHODS: We conducted 30-60-minute semi-structured interviews with autistic adults (N=9) and parents of autistic adults (N=12). We conducted an inductive thematic analysis, using a phenomenological approach. RESULTS: Factors that increased participants’ satisfaction included: (1) receiving personalized care from the provider; (2) spending quality time with the provider; and (3) having strong, positive patient-provider relationships. Factors that decreased participants’ satisfaction included: (1) lack of access to services due to scarcity of trained providers; (2) difficulty at times communicating with the provider; and (3) system-level barriers such as policies, practices, or procedures. CONCLUSION: Our findings highlight the importance of providers using personalized approaches to care that meet patients’ sensory and communication needs and spending quality time with patients to establish strong, positive patient-provider relationships. Our findings also underscore the critical scarcity of healthcare providers who are trained to deliver care for the growing population of autistic adults.

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12. Hartmann H, Lengersdorff L, Hitz HH, Stepnicka P, Silani G. Emotional Ego- and Altercentric Biases in High-Functioning Autism Spectrum Disorder: Behavioral and Neurophysiological Evidence. Frontiers in psychiatry. 2022; 13: 813969.

Self-other distinction is a crucial aspect of social cognition, as it allows us to differentiate our own mental and emotional states from those of others. Research suggests that this ability might be impaired in individuals on the autism spectrum, but convincing evidence of self-other distinction difficulties in the emotional domain is lacking. Here we aimed at evaluating emotional self-other distinction abilities in autistic and non-autistic adults, in two behavioral pilot studies and one fMRI study. By using a newly developed virtual ball-tossing game that induced simultaneous positive and negative emotional states in each participant and another person, we were able to measure emotional egocentric and altercentric biases (namely the tendency to ascribe self-/other-related emotions to others/ourselves, respectively). Despite no behavioral differences, individuals on the autism spectrum showed decreased activation (1) in the right temporoparietal junction (rTPJ) during active overcoming of the emotional egocentric bias vs. passive game viewing, and (2) in the right supramarginal gyrus (rSMG) during ego- vs. altercentric biases, compared to neurotypical participants. These results suggest a different recruitment of these two regions in autistic individuals when dealing with conflicting emotional states of oneself and another person. Furthermore, they highlight the importance of considering different control conditions when interpreting the involvement of rTPJ and rSMG during self-other distinction processes.

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13. Hong E, Issarraras A, Matson JL, Montrenes JJ, Weir PA. Examination of multiple birth as a predictor of autism symptom severity and developmental functioning in an early intervention sample. Developmental neurorehabilitation. 2022: 1-8.

Multiple birth is one of several perinatal factors associated with increased risk for autism spectrum disorder (ASD); however, complexity in its relationship to ASD symptoms and developmental functioning remains. The present study investigated perinatal risk factors for ASD, primarily focusing on birth status, within a large early intervention sample. In particular, the relationship between ASD, perinatal factors, and the effect of birth status on developmental functioning and ASD symptom severity were examined in youth with and without ASD classification who were born singly or were the product of a multiple birth. Overall, the presence of other perinatal risk factors, including prematurity, low birth weight, and advanced parental age, was primarily related to birth status and not to ASD classification, while severity of ASD symptoms and developmental impairments were primarily related to ASD classification and not to birth status. Study findings and implications for early screening of children with developmental delays are discussed.

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14. Li F, Tang Y, Li F, Fang S, Liu X, Tao M, Wu D, Jiang L. Psychological distress in parents of children with autism spectrum disorder: A cross-sectional study based on 683 mother-father dyads. Journal of pediatric nursing. 2022.

PURPOSE: This study aimed to assess psychological distress and its gender difference in parents of children with ASD. Predictive factors for parental psychological distress and interaction effects between parents were also explored. DESIGN AND METHODS: A cross-sectional study was conducted for parents of children with ASD and 683 mother-father dyads were included in the analyses. RESULTS: Mothers of children with severe autistic symptoms reported significantly higher levels of stress, anxiety, and depression than fathers. The prevalence of moderate-to-severe anxiety and depression for mothers was 13.8% and 13.1%, respectively. The corresponding prevalence for fathers was 9.9% and 8.0%, respectively. A college education or above protected against maternal stress and an only child predicted paternal stress. Child social impairment predicted maternal but not paternal psychological distress. Stress was a significant predictor of anxiety and depression for both parents. Paternal stress and anxiety moderated the relationship between child’s social impairment and maternal stress, and paternal anxiety moderated the relationship between child’s social impairment and maternal depression. CONCLUSIONS: The gender difference in the parental psychological distress depends on the severity of children’s autistic symptoms. Child social impairment exerts significant effects on mothers’ psychological distress and parental stress contributes to anxiety and depression for both parents. The psychological distress of fathers moderates the relationship between child social impairment and maternal psychological distress. IMPLICATIONS: Health-care professionals should pay special attention to parents who are susceptible to psychological distress. Social skill interventions for children and stress reduction programs for parents are recommended to promote parental psychological well-being.

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15. Li W. Excitation and Inhibition Imbalance in Rett Syndrome. Frontiers in neuroscience. 2022; 16: 825063.

A loss of the excitation/inhibition (E/I) balance in the neural circuit has emerged as a common neuropathological feature in many neurodevelopmental disorders. Rett syndrome (RTT), a prevalent neurodevelopmental disorder that affects 1:10,000-15,000 women globally, is caused by loss-of-function mutations in the Methyl-CpG-binding Protein-2 (Mecp2) gene. E/I imbalance is recognized as the leading cellular and synaptic hallmark that is fundamental to diverse RTT neurological symptoms, including stereotypic hand movements, impaired motor coordination, breathing irregularities, seizures, and learning/memory dysfunctions. E/I balance in RTT is not homogeneously altered but demonstrates brain region and cell type specificity instead. In this review, I elaborate on the current understanding of the loss of E/I balance in a range of brain areas at molecular and cellular levels. I further describe how the underlying cellular mechanisms contribute to the disturbance of the proper E/I ratio. Last, I discuss current pharmacologic innervations for RTT and their role in modifying the E/I balance.

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16. Li Y, Zhao Y, Lu Y, Lu X, Hu Y, Li Q, Shuai M, Li R. Autism spectrum disorder-like behavior induced in rat offspring by perinatal exposure to di-(2-ethylhexyl) phthalate. Environmental science and pollution research international. 2022.

Autism spectrum disorders (ASD), also known as childhood autism, is a common neurological developmental disorder. Although it is generally believed that genetic factors are a primary cause for ASD development, more and more studies show that an increasing number of ASD diagnoses are related to environmental exposure. Epidemiological studies indicated that perinatal exposure to endocrine disruptors might cause neurodevelopmental disorders in children. Di-(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in many products. To explore the neurodevelopmental effect induced by perinatal exposure to DEHP on rat offspring, and the potential mechanisms, female Wistar rats were exposed to 1, 10, and 100 mg/kg/day DEHP during pregnancy and lactation, while valproic acid (VPA) was used as a positive control. The behavior tests showed that rat pups exposed to VPA and 100 mg/kg/day DEHP were not good as those from the control group in both their socialability and social novelty. Expression of mTOR pathway-related components increased while the number of autophagosomes decreased in the brain tissue of the rat offspring exposed to 100 mg/kg/day DEHP. In addition, perinatal exposure to DEHP at all dosages decreased the level of autophagy proteins LC3II and Beclin1 in the brain tissue of rat pups. Our results indicated that perinatal DEHP exposure would induce ASD-like behavioral changes in rat offspring, which might be mediated by activation of the mTOR signaling pathway, and inhibition of autophagy in the brain.

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17. Lilja MM, Sandblom E, Lichtenstein P, Serlachius E, Hellner C, Bhagia J, Halldner L. The effect of autistic traits on response to and side-effects of pharmacological ADHD treatment in children with ADHD: results from a prospective clinical cohort. Journal of neurodevelopmental disorders. 2022; 14(1): 17.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common childhood behavioral condition that globally affects an average of around 5% of children and is associated with several adverse life outcomes. Comorbidity with autism spectrum disorder (ASD) is highly prevalent. Pharmacological treatment for ADHD symptoms has been shown to be effective. However, the prevailing perception is that children with ADHD and concomitant ASD symptoms report poorer efficacy and more side effects. This has been supported by studies on this population, but prospective studies directly comparing children with ADHD and different levels of ASD symptoms are lacking. We aimed to assess if children with ADHD and concomitant ASD symptoms differ regarding effects and side-effects of pharmacological ADHD treatment compared to children with ADHD without ASD traits. This is to our knowledge the second study to directly compare the effect of ADHD medication between ADHD patients with different levels of ASD symptoms. METHODS: In a non-randomized, observational, prospective cohort study, 323 patients aged 6 to 17 years who were diagnosed with ADHD and starting pharmacological treatment were divided into two groups: one with high level of ASD symptoms (ASD group, N=71) and one with low level of ASD symptoms (non-ASD group, N = 252). Treatment outcome was measured as ADHD symptoms, and evaluated using the Swanson, Nolan and Pelham Teacher and Parent ADHD rating scale-version IV (SNAP-IV). Side-effects were evaluated using the Pediatric Side Effects Checklist (P-SEC), at 3 months follow-up. RESULTS: From baseline to 3 months, there was no significant difference in neither treatment effect nor number of clinically significant adverse events experienced between the ASD group and the non-ASD group. CONCLUSIONS: Our results did not implicate that ADHD patients with concomitant ASD symptoms have decreased treatment effect of ADHD medication than patients with ADHD without concomitant ASD symptoms. Neither did the results support that ADHD patients with ASD symptoms experienced significantly more side-effects than ADHD patients without ASD symptoms. Although, we did not analyze different medications separately, this is in line with the only previous study directly comparing methylphenidate treatment in children with or without ASD. TRIAL REGISTRATION: NCT02136147 , May 12, 2014.

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18. Messinger DS, Perry LK, Mitsven SG, Tao Y, Moffitt J, Fasano RM, Custode SA, Jerry CM. Computational approaches to understanding interaction and development. Advances in child development and behavior. 2022; 62: 191-230.

Audio-visual recording and location tracking produce enormous quantities of digital data with which researchers can document children’s everyday interactions in naturalistic settings and assessment contexts. Machine learning and other computational approaches can produce replicable, automated measurements of these big behavioral data. The economies of scale afforded by repeated automated measurements offer a potent approach to investigating linkages between real-time behavior and developmental change. In our work, automated measurement of audio from child-worn recorders-which quantify the frequency of child and adult speech and index its phonemic complexity-are paired with ultrawide radio tracking of children’s location and interpersonal orientation. Applications of objective measurement indicate the influence of adult behavior in both expert ratings of attachment behavior and ratings of autism severity, suggesting the role of dyadic factors in these « child » assessments. In the preschool classroom, location/orientation measures provide data-driven measures of children’s social contact, fertile ground for vocal interactions. Both the velocity of children’s movement toward one another and their social contact with one another evidence homophily: children with autism spectrum disorder, other developmental disabilities, and typically developing children were more likely to interact with children in the same group even in inclusive preschool classrooms designed to promote interchange between all children. In the vocal domain, the frequency of peer speech and the phonemic complexity of teacher speech predict the frequency and phonemic complexity of children’s own speech over multiple timescales. Moreover, children’s own speech predicts their assessed language abilities across disability groups, suggesting how everyday interactions facilitate development.

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19. Ntre V, Papanikolaou Κ, Amanaki E, Triantafyllou K, Tzavara C, Kolaitis G. Coping Strategies in mothers of children with autism spectrum disorder and their relation to maternal stress and depression. Psychiatrike = Psychiatriki. 2022.

Having a child with autism may have a strong impact on the family, especially on mothers, who are usually the primary caregivers of children with autism. Parents of children with autism report more mental health problems compared to parents of children with typical development or other developmental disabilities. Parental copying strategies may play a significant role when parents have to overcome stressful situations during the child development. The present study aimed to investigate the coping strategies used by mothers of children with autism spectrum disorder (ASD), and their relation to maternal stress and depression. One hundred and forty-three (143) mothers (mean age 42.7 years) of children with ASD (6-17years), who attended the ASD Outpatient Clinic of the Department of Child Psychiatry, at a Children’s Hospital, participated in the current study. Mothers completed a series of questionnaires: a demographic characteristics questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), the Family Crisis Oriented Personal Scales (F-COPES), and the Parenting Stress Index Short-Form (PSI-SF). Mothers with higher educational level scored significantly lower in total F-COPES and its subscale « reframing ». Increased daily hours related to child care and the child’s medication were additional factors significantly associated with lower scores on « reframing ». Reframing subscale was also negatively correlated with « parental distress », whereas « passive appraisal » was positively correlated with depressive symptoms. Lower scores on « mobilizing family to acquire » and « accept help » were associated with family life being more seriously affected. Coping strategies of mothers of children with ASD are associated with a number of factors related to personal characteristics of caregivers, child treatment and family characteristics. Mental health professionals should examine factors that may strengthen coping strategies that handle the challenges of having a child with ASD.

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20. Pandey MK, Grabrucker AM, Mehta SQ, Harvey RJ. Editorial: Autism Spectrum Disorders and Metal Dyshomeostasis. Frontiers in molecular neuroscience. 2022; 15: 861483.

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21. Pattison A, Torres E, Wieters L, Waldschmidt JG. A comparison of caregiver burden between long-term care and developmental disability family caregivers. Journal of research in nursing : JRN. 2021; 26(8): 781-93.

BACKGROUND: As the United States’ population ages and health concerns rise, the family caregiver occupation will continue to be an integral part of the health care system. AIMS: It is important to examine the burden that family caregivers experience so they can seek out additional training and services to maintain their own well-being. The researchers examined caregiver burden from a perspective of developmentally disabled and long-term care. METHODS: The researchers examined difference in Zarit scores, guilt, burden and personal strain for 72 caregivers of people with developmental disability (DD) or people with long-term care (LTC) needs. The researchers also examined differences in these based on whether the individual was caregiving for family or « others ». RESULTS: For DD, there were significant differences in Zarit, role strain and personal strain; caring for others has significantly lower scores on these. Role strain was significantly higher than personal strain, which was significantly higher than guilt for both LTC and DD groups. CONCLUSIONS: Given these findings, it is important to support family caregivers first and foremost with role strain, especially for those caring for family members with DD. This support could be given through personal counselling, caregiver training, non-profit social service resources, and support groups for family caregivers.

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22. Penney AM, Greenson J, Schwartz IS, Estes AM. « On-Time Autism Intervention »: A Diagnostic Practice Framework to Accelerate Access. Frontiers in psychiatry. 2022; 13: 784580.

It is well-documented that autism can be reliably diagnosed by age two and that early signs emerge most often between 18 and 24 months. However, despite the increased awareness and focus on early diagnosis, the average age of diagnosis is over 4 years old; even later for Black children and those who are Medicaid-eligible. In this paper, we will propose a framework for accurate and accelerated autism diagnosis for children before age three. The proposed framework emphasizes a collaborative diagnostic process, which relies heavily on Birth to Three provider knowledge and expertise. Considerations for next steps are presented. This approach could increase access to diagnosis of young children soon after first signs of autism emerge.

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23. Phillips L. Commentary: A comparison of caregiver burden between long-term care and developmental disability family caregivers. Journal of research in nursing : JRN. 2021; 26(8): 794-5.

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24. Procyshyn TL, Lombardo MV, Lai MC, Jassim N, Auyeung B, Crockford SK, Deakin JB, Soubramanian S, Sule A, Terburg D, Baron-Cohen S, Bethlehem RAI. Oxytocin Enhances Basolateral Amygdala Activation and Functional Connectivity While Processing Emotional Faces: Preliminary Findings in Autistic Versus Non-Autistic Women. Social cognitive and affective neuroscience. 2022.

Oxytocin is hypothesized to promote social interactions by enhancing the salience of social stimuli. While previous neuroimaging studies have reported that oxytocin enhances amygdala activation to face stimuli in autistic men, effects in autistic women remain unclear. In this study, the influence of intranasal oxytocin on activation and functional connectivity of the basolateral amygdala – the brain’s « salience detector » – while processing emotional faces vs. shapes was tested in 16 autistic and 21 non-autistic women by fMRI in a placebo-controlled, within-subjects, cross-over design. In the placebo condition, minimal activation differences were observed between autistic and non-autistic women. However, significant drug × group interactions were observed for both basolateral amygdala activation and functional connectivity. Oxytocin increased left basolateral amygdala activation among autistic women (35 voxel cluster, MNI coordinates of peak voxel= -22 -10 -28; mean change=+0.079%, t=3.159, ptukey=0.0166), but not non-autistic women (mean change =+0.003%, t=0.153, ptukey=0.999). Furthermore, oxytocin increased functional connectivity of the right basolateral amygdala with brain regions associated with socio-emotional information processing in autistic women, but not non-autistic women, attenuating group differences in the placebo condition. Taken together, these findings extend evidence of oxytocin’s effects on the amygdala to specifically include autistic women and specify the subregion of the effect.

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25. Sainsbury WJ, Carrasco K, Whitehouse AJO, Waddington H. Parent-reported Early Atypical Development and Age of Diagnosis for Children with Co-occurring Autism and ADHD. Journal of autism and developmental disorders. 2022.

Autism and attention-deficit/hyperactivity disorder (ADHD) often co-occur. This survey of 288 New Zealand parents of children diagnosed with autism (n = 111), ADHD (n = 93), or both conditions (n = 84), examined the relations between age of diagnosis and early atypical development, the age specialist consultation was needed and types of specialists seen. Co-occurring autism and ADHD was associated with an earlier ADHD diagnosis and a later autism diagnosis. Parents of children with both diagnoses reported less atypical development in language and social behaviours compared to parents of children of autism, and this co-occurring group also experienced longer wait times to diagnosis, and saw more types of specialists prior to a diagnosis, than those with autism.

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26. Wang F, Wang L, Xiong Y, Deng J, Lü M, Tang B, Zhang X, Li Y. [Mechanism of valproic acid-induced dendritic spine and synaptic impairment in the prefrontal cortex for causing core autistic symptoms in mice]. Nan fang yi ke da xue xue bao = Journal of Southern Medical University. 2022; 42(1): 101-7.

OBJECTIVE: To investigate the mechanism of valproic acid (VPA) -induced impairment of the dendritic spines and synapses in the prefrontal cortex (PFC) for causing core symptoms of autism spectrum disorder (ASD) in mice. METHODS: Female C57 mice were subjected to injections of saline or VPA on gestational days 10 and 12, and the male offspring mice in the two groups were used as the normal control group and ASD model group (n=10), respectively. Another 20 male mice with fetal exposure to VPA were randomized into two groups for stereotactic injection of DMSO or Wortmannin into the PFC (n=10). Open field test, juvenile play test and 3-chamber test were used to evaluate autistic behaviors of the mice. The density of dendrite spines in the PFC was observed with Golgi staining. Western blotting and immunofluorescence staining were used to detect the expressions of p-PI3K, PI3K, p-AKT, AKT, p-mTOR, mTOR and the synaptic proteins PSD95, p-Syn, and Syn in the PFC of the mice. RESULTS: Compared with the normal control mice, the mice with fetal exposure to VPA exhibited obvious autism-like behaviors with significantly decreased density of total, mushroom and stubby dendritic spines (P < 0.05) and increased filopodia dendritic spines (P < 0.05) in the PFC. The VPA-exposed mice also showed significantly increased expressions of p-PI3K/PI3K, p-AKT/AKT, and p-mTOR/mTOR (P < 0.01) and lowered expressions of PSD95 and p-Syn/Syn in the PFC (P < 0.05 or 0.001). Wortmannin injection into the PFC obviously improved the ASD-like phenotype and dendritic spine development, down-regulated PI3K/Akt/mTOR signaling pathway and up-regulated the synaptic proteins in VPA-exposed mice. CONCLUSION: In male mice with fetal exposure to VPA, excessive activation of PI3K/Akt/mTOR signaling pathway and decreased expressions of the synaptic proteins PSD95 and p-Syn cause dendritic spine damage and synaptic development disturbance in the PFC, which eventually leads to ASD-like phenotype. Publisher: Abstract available from the publisher. chi.

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27. Wang Z, Wang L, Chang S, Wang H. The Mediating Effect of Parenting Stress on the Relationship Between Social Support and Quality of Life in Parents of Children With Autistic Spectrum Disorder: A Meta-Analytic Structural Equation Modeling. Frontiers in psychiatry. 2022; 13: 713620.

OBJECTIVE: The aim of the present study is to investigate whether parenting stress mediate the relationship between social support and quality of life in parents of children with Autistic Spectrum Disorder. In addition, we examined what other variables moderate the relationships in this mediation model. METHODS: Using the two-stage meta-analytic structural equation modeling approach (MASEM), 44 correlation matrices were synthesized from 28 empirical studies (N = 13,270) and fitted to the hypothesized mediation model. RESULTS: There is a significant partial mediation effect of parenting stress on the relationship between social support and quality of life. Subgroup analysis through the first stage analysis suggested that social support measurements, parental role, and child’s age moderated the relationship between social support and parenting stress, and that the focus of quality of life moderated the relationship between social support and quality of life. Subgroup analysis through the second stage analysis indicated that parenting stress had a significantly stronger predictive effect on quality of life in Western culture, while the predictive effect of social support on quality of life was significantly stronger in Eastern culture. CONCLUSION: Having more social support can reduce parents’ stress and then improving their quality of life, which can help them cope more positively and effectively with their autistic children.

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28. Zoccante L, Ciceri ML, Gozzi LA, Gennaro GD, Zerman N. The « Connectivome Theory »: A New Model to Understand Autism Spectrum Disorders. Frontiers in psychiatry. 2021; 12: 794516.

The classical approach to autism spectrum disorders (ASD) is often limited to considering their neuro-functional aspects. However, recent scientific literature has shown that ASDs also affect many body systems and apparatuses such as the immune system, the sensory-motor system, and the gut-brain axis. The connective tissue, a common thread linking all these structures, may have a pathogenetic role in the multisystem involvement of ASD. Depending on its different anatomical sites, the connective tissue performs functions of connection and support; furthermore, it acts as a barrier between the external and internal environments, regulating the interchange between the two and performing immunological surveillance. The connective tissue shares a close relationship with the central nervous system, the musculoskeletal system and the immune system. Alterations in brain connectivity are common to various developmental disorders, including ASD, and for this reason here we put forward the hypothesis that alterations in the physiological activity of microglia could be implicated in the pathogenesis of ASD. Also, muscle hypotonia is likely to clinically correlate with an altered sensoriality and, in fact, discomfort or early muscle fatigue are often reported in ASDs. Furthermore, patients with ASD often suffer from intestinal dysfunctions, malabsorption and leaky gut syndrome, all phenomena that may be linked to reduced intestinal connectivity. In addition, at the cutaneous and subcutaneous levels, ASDs show a greater predisposition to inflammatory events due to the lack of adequate release of anti-inflammatory mediators. Alveolar-capillary dysfunctions have also been observed in ASD, most frequently interstitial inflammations, immune-mediated forms of allergic asthma, and bronchial hyper-reactivity. Therefore, in autism, altered connectivity can result in phenomena of altered sensitivity to environmental stimuli. The following interpretative model, that we define as the « connectivome theory, » considers the alterations in connective elements of common mesodermal origin located in the various organs and apparatuses and entails the evaluation and interpretation of ASDs through also highlighting somatic elements. We believe that this broader approach could be helpful for a more accurate analysis, as it is able to enrich clinical evaluation and define more multidisciplinary and personalized interventions.

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