1. Brennan C, Weintraub H, Tennant S, Meyers C. Speech, Language, and Communication Deficits and Intervention in a Single Case of Pediatric Autoimmune Encephalitis. American journal of speech-language pathology. 2021; 30(6): 2350-67.

Purpose The current literature on pediatric autoimmune encephalitis (AE) focuses on medical identification/diagnosis and medical treatments. Data about the identification and treatment of communication disorders in these children are limited. This clinical focus article provides an example of the speech, language, and communication characteristics, intervention, and recovery of a single child with medical diagnoses of pediatric AE and pediatric acute-onset neuropsychiatric syndrome (PANS) and special education eligibility under the autism spectrum disorder category. Method This is an in-depth illustrative/descriptive case study. Medical, educational, and speech-language documentation of one child diagnosed with AE at age 7 years was reviewed. Methods included interviews with family members, teachers, and the school speech-language pathologist and reviews of documentation including evaluations, reports, and Individualized Education Programs. Results This child received special education and therapy services through his public school and a university speech-language clinic. He concurrently received medical treatment for AE and PANS. Comprehensive augmentative and alternative communication (AAC) intervention included the use of core words, modeling, parallel talk, self-talk, expansive recasts, shared book reading, family counseling, and collaboration with the parents and the school speech-language pathologist. The child made progress on all goals despite irregular attendance to therapy due to medical complications. Discussion Because experimental research including this population is currently limited, this descriptive case study provides valuable information to clinicians, educators, pediatricians, medical diagnosticians, and anyone providing services to a child with a complex neuropsychological disorder like AE. Future research is needed with more children who have AE, especially experimental investigations of the intervention methods utilized here. Additional research of more children with AE can provide information about the scope and severity of speech, language, and communication needs and the trajectory of recovery given AAC intervention.

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2. Fish LA, Nyström P, Gliga T, Gui A, Begum Ali J, Mason L, Garg S, Green J, Johnson MH, Charman T, Harrison R, Meaburn E, Falck-Ytter T, Jones EJH. Development of the pupillary light reflex from 9 to 24 months: association with common autism spectrum disorder (ASD) genetic liability and 3-year ASD diagnosis. Journal of child psychology and psychiatry, and allied disciplines. 2021; 62(11): 1308-19.

BACKGROUND: Although autism spectrum disorder (ASD) is heritable, the mechanisms through which genes contribute to symptom emergence remain unclear. Investigating candidate intermediate phenotypes such as the pupillary light reflex (PLR) prospectively from early in development could bridge genotype and behavioural phenotype. METHODS: Using eye tracking, we longitudinally measured the PLR at 9, 14 and 24 months in a sample of infants (N = 264) enriched for a family history of ASD; 27 infants received an ASD diagnosis at 3 years. We examined the 9- to 24-month developmental trajectories of PLR constriction latency (onset; ms) and amplitude (%) and explored their relation to categorical 3-year ASD outcome, polygenic liability for ASD and dimensional 3-year social affect (SA) and repetitive/restrictive behaviour (RRB) traits. Polygenic scores for ASD (PGS(ASD) ) were calculated for 190 infants. RESULTS: While infants showed a decrease in latency between 9 and 14 months, higher PGS(ASD) was associated with a smaller decrease in latency in the first year (β = -.16, 95% CI = -0.31, -0.002); infants with later ASD showed a significantly steeper decrease in latency (a putative ‘catch-up’) between 14 and 24 months relative to those with other outcomes (typical: β = .54, 95% CI = 0.08, 0.99; other: β = .53, 95% CI = 0.02, 1.04). Latency development did not associate with later dimensional variation in ASD-related traits. In contrast, change in amplitude was not related to categorical ASD or genetics, but decreasing 9- to 14-month amplitude was associated with higher SA (β = .08, 95% CI = 0.01, 0.14) and RRB (β = .05, 95% CI = 0.004, 0.11) traits. CONCLUSIONS: These findings corroborate PLR development as possible intermediate phenotypes being linked to both genetic liability and phenotypic outcomes. Future work should incorporate alternative measures (e.g. functionally informed structural and genetic measures) to test whether distinct neural mechanisms underpin PLR alterations.

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3. Henneberry E, Lamy M, Dominick KC, Erickson CA. Decades of Progress in the Psychopharmacology of Autism Spectrum Disorder. Journal of autism and developmental disorders. 2021; 51(12): 4370-94.

Recent decades have been marked by a wave drug treatment research in autism spectrum disorder (ASD). This work has resulted in improved ability to treat commonly occurring behavioral challenges associated with ASD including most prominently irritability marked by aggression, self-injurious behavior, and severe tantrums. While treatment of interfering behavior has progressed in our field, there remain several areas of unmet medical need including most prominently a lack of any approved drug therapies for the core, defining symptoms of autism. We outline the progress to date in the field of autism drug treatment while taking a future look forward into how decades of work can inform better future steps in this field.

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4. Jelili S, Halayem S, Taamallah A, Ennaifer S, Rajhi O, Moussa M, Ghazzei M, Nabli A, Ouanes S, Abbes Z, Hajri M, Fakhfakh R, Bouden A. Impaired Recognition of Static and Dynamic Facial Emotions in Children With Autism Spectrum Disorder Using Stimuli of Varying Intensities, Different Genders, and Age Ranges Faces. Frontiers in psychiatry. 2021; 12: 693310.

A multitude of research on facial emotion recognition (FER) in Autism Spectrum Disorders (ASD) have been published since several years. However, these studies have mainly used static high intensity stimuli, including adult and/or children facial emotions. This current study investigated FER in children with ASD using an innovative task, composed of a combination of static (114 pictures) and dynamic (36 videos) subtests, including children, adolescent, and adult male and female faces, with high, medium, and low intensity of basic facial emotions, and neutral expression. The ASD group consisted of 45 Tunisian verbal children, and the control group consisted of 117 tunisian typically developing children. Both groups were aged 7-12 years. After adjusting for sex, age, mental age, and school grade, the ASD group scored lower than controls on all tests except for the recognition of happiness and fear in the static subtest, and the recognition of happiness, fear, and sadness in the dynamic subtest (p ≥ 0.05). In the ASD group, the total score of both the static and the dynamic subtest were positively correlated with the school grade (p < 0.001), but not with age, or mental age. Children with ASD performed better in recognizing facial emotions in children than in adults and adolescents on videos and photos (p < 0.001). Impairments in FER would have negative impact on the child's social development. Thus, the creation of new intervention instruments aiming to improve emotion recognition strategies at an early stage to individuals with ASD seems fundamental.

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5. Leo A, De Caro C, Mainardi P, Tallarico M, Nesci V, Marascio N, Striano P, Russo E, Constanti A, De Sarro G, Citraro R. Increased efficacy of combining prebiotic and postbiotic in mouse models relevant to autism and depression. Neuropharmacology. 2021; 198: 108782.

The Microbiota-Gut-Brain axis (MGBA) is a bidirectional communication pathway between gut bacteria and the central nervous system (CNS) (including the intestine) that exerts a profound influence on neural development, neuroinflammation, activation of stress response and neurotransmission, in addition to modulating complex behaviours, such as sociability and anxiety. Several MGBA modulating approaches are possible, such as probiotic administration. A reasonable pharmacological approach would also be the contemporarily administration of both prebiotics and postbiotics. To test this hypothesis, we probed the effects of α-lactalbumin (ALAC; a prebiotic in the dose range of 125-500 mg/kg) and sodium butyrate (NaB; a postbiotic in the dose range of 30-300 mg/kg) alone and in combination. We used two animal behavioural models of idiopathic autism, (BTBR mice) and anxiety/depression (chronic unexpected mild stress – CUMS mice) respectively, using several standard behavioural paradigms such as Three-chamber social interaction test, Marble burying assay, depression-, anxiety- and memory-tests. In BTBR autistic mice, we found that both ALAC and NaB improve animal sociability, and memory in the passive avoidance (PA); drug combination was more effective in almost all tests also reducing immobility time in the forced swimming test (FST), which was not affected by single drug administration. Similarly, in the CUMS mice, single drug administration was effective in improving: 1) depressive-like behaviour in the FST and sucrose preference test; 2) memory and learning in the PA, novel object recognition and Morris water maze tests. Drug combination was again more effective than single drug administration in most cases; however, in the CUMS model, neither single drug or combination was effective in the elevated plus maze test for anxiety. Our results suggest that in both models, ALAC and NaB combination is more effective in improving some pathological aspects of animal behaviour than single administration and that the prebiotic/postbiotic approach should be considered a reasonable approach for the manipulation of the MGBA to improve efficacy.

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6. Lindly O, Eaves MC, Xu Y, Tarazi CL, Rao SR, Kuhlthau KA. Therapy use for U.S. school-aged children with developmental disabilities: State variation and determinants. Disability and health journal. 2022; 15(1): 101198.

BACKGROUND: Therapy services can support developmental needs, improve social emotional outcomes, and reduce persistent health inequities for children with developmental disabilities (DD). Receipt of therapy services may be especially timely when children with DD are school-aged, once diagnosis has often occurred. Yet limited knowledge exists on geographic variability and determinants of therapy use among school-aged U.S. children with DD. OBJECTIVES: We aimed to (1) determine if therapy use varies significantly by state and (2) examine associations of health determinants with therapy use among U.S. school-aged children with DD. METHODS: This was a secondary analysis of 2016 and 2017 National Survey of Children’s Health data. The sample included 9984 children with DD ages 6-17 years. We obtained odds ratios and predicted margins with 95% confidence intervals from multilevel logistic regression models to examine therapy use variation and determinants. RESULTS: Overall, 34.6% of children used therapy services. Therapy use varied significantly across states (σ(2) = 0.11, SE = 0.04). Younger age, public insurance, functional limitations, individualized education program, frustration accessing services, and care coordination need were associated with higher adjusted odds of therapy access. In states with Medicaid Home and Community-Based Services waivers, higher estimated annual waiver cost was associated with lower adjusted odds of therapy use. CONCLUSIONS: Results highlight geographic disparities in therapy use and multilevel targets to increase therapy use for school-aged children with DD.

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7. Martinsone B, Tzivian L. Differences in Stress and Coping During the COVID-19 Pandemic in Families With and Without Children With Developmental Disorders or Chronic Conditions. Frontiers in public health. 2021; 9: 704577.

Objectives: To compare COVID-19-induced stress and coping in families with and without children diagnosed with developmental disorders or chronic conditions. Methods: In this mixed-method design study, an online survey collected information on parental stress levels before and during COVID-19, sources of stress, and coping strategies using open-ended questions. Qualitative answers were categorized thematically. Multiple linear regression models were built for the association between changes in stress levels (during-before COVID-19) and sources of stress for parents of children of both groups. Results: Answers of 1,827 parents were analyzed; of these, 186 (9.75%) had children with diagnosed problems. Changes in stress levels during vs. before COVID-19 were associated with the age of the parent, changes in working conditions, a total number of stressors, and distance learning of children. Stronger associations were found for parents of children with diagnoses. For example, for distance learning, the standardized beta (β) was 0.68 (95% confidence interval 0.37; 1.00) for parents of children without problems and β = 0.73 (0.43; 1.03) for those with problematic children. Conclusions: Parents of children with developmental disorders need specific attention in a pandemic.

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8. Matano M, Monden Y, Kurane K, Kawasaki M, Kamo T. Potential of internet-delivered PCIT for ASD in the COVID-19 era: A pilot study. Pediatrics international : official journal of the Japan Pediatric Society. 2022; 64(1): e14699.

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9. Park S, Haak KV, Cho HB, Valk SL, Bethlehem RAI, Milham MP, Bernhardt BC, Di Martino A, Hong SJ. Atypical Integration of Sensory-to-Transmodal Functional Systems Mediates Symptom Severity in Autism. Frontiers in psychiatry. 2021; 12: 699813.

A notable characteristic of autism spectrum disorder (ASD) is co-occurring deficits in low-level sensory processing and high-order social interaction. While there is evidence indicating detrimental cascading effects of sensory anomalies on the high-order cognitive functions in ASD, the exact pathological mechanism underlying their atypical functional interaction across the cortical hierarchy has not been systematically investigated. To address this gap, here we assessed the functional organisation of sensory and motor areas in ASD, and their relationship with subcortical and high-order trandmodal systems. In a resting-state fMRI data of 107 ASD and 113 neurotypical individuals, we applied advanced connectopic mapping to probe functional organization of primary sensory/motor areas, together with targeted seed-based intrinsic functional connectivity (iFC) analyses. In ASD, the connectopic mapping revealed topological anomalies (i.e., excessively more segregated iFC) in the motor and visual areas, the former of which patterns showed association with the symptom severity of restricted and repetitive behaviors. Moreover, the seed-based analysis found diverging patterns of ASD-related connectopathies: decreased iFCs within the sensory/motor areas but increased iFCs between sensory and subcortical structures. While decreased iFCs were also found within the higher-order functional systems, the overall proportion of this anomaly tends to increase along the level of cortical hierarchy, suggesting more dysconnectivity in the higher-order functional networks. Finally, we demonstrated that the association between low-level sensory/motor iFCs and clinical symptoms in ASD was mediated by the high-order transmodal systems, suggesting pathogenic functional interactions along the cortical hierarchy. Findings were largely replicated in the independent dataset. These results highlight that atypical integration of sensory-to-high-order systems contributes to the complex ASD symptomatology.

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10. Schreuder S, van de Loo-Neus GHH, Broers DLM. [Mental disorders in the dental practice. Autism spectrum disorder]. Nederlands tijdschrift voor tandheelkunde. 2021; 128(9): 451-5.

Autism spectrum disorder is a developmental disorder with a prevalence of about 1% of the population. This disorder, characterised by limitations in the domain of social communication, interaction, flexibility and processing stimuli, often requires additional attention in the dental practice. The disorder can have an effect on both general health and oral health as a result of unusual eating habits, problems with oral hygiene, the use of psychotropic medications or a vitamin D deficiency. The treatment of patients with an autism spectrum disorder generally also requires more time and patience due to the non-typical communication and interaction. Analysing the sensitivities and fears of a specific patient with autism spectrum disorder, if necessary in consultation with parents of carers, is also recommended.

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11. Soltani Kouhbanani S, Khosrorad R, Zarenezhad S, Arabi SM. Comparing the Effect of Risperidone, Virtual Reality and Risperidone on Social Skills, and Behavioral Problems in Children with Autism: A Follow-up Randomized Clinical Trial. Archives of Iranian medicine. 2021; 24(7): 534-41.

BACKGROUND: Improving behavioral and social problems in children with autism requires extensive training programs even with parents at home. The main goal of this study is to design a virtual reality (VR) intervention based on the TEACCH method in combination with risperidone to evaluate its effectiveness on social and behavioral problems. METHODS: Forty-three children with autism (6-12 years old) randomly were divided into three groups: risperidone (n = 15), risperidone + VR (n = 15), and control (n = 13). The interventions lasted for 3 months (90 sessions) and post-test assessments were done immediately after intervention. Follow up tests were done 3 months after that. RESULTS: Risperidone + VR group showed significant differences in social skills (MD = 36.59; 95% CI: 30.74 to 38.42, P < 0.001, ŋ2 = 1.51 in post-test; MD = 19.63; 95% CI: 17.27 to 21.63, P < 0.001, ŋ2 = 0.86 in follow up); and behavioral symptoms (MD = -36.12 ; 95% CI: -39.72 to -36.91, P < 0.001, ŋ2 = 1.99 in post-test; MD = -28.82 ; 95% CI: -29.43 to -25.32, P < 0.001, ŋ2 = 1.58 in follow up) compared to the control group. However, the risperidone group showed significant differences in social skills (MD = 2.03; 95% CI: 0.82 to 3.67, P < 0.001, ŋ2 = 0.12) and behavioral symptoms (MD = -36.66; 95% CI: -38.96 to -34.27, P < 0.001, ŋ2 = 1.96) only in post-test. Thus, the experimental groups did not have any significant difference in post-test. CONCLUSION: Combined interventions such as VR can enhance the effectiveness of risperidone response and boost children's preparedness to practice and learn social interaction.

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