1. Atherton G, Cross L. Reading the mind in cartoon eyes : Comparing human versus cartoon emotion recognition in those with high and low levels of autistic traits. Psychological reports. 2021 : 33294120988135.

People who have a high degree of autistic traits often underperform on theory of mind tasks such as perspective-taking or facial emotion recognition compared to those with lower levels of autistic traits. However, some research suggests that this may not be the case if the agent they are evaluating is anthropomorphic (i.e. animal or cartoon) rather than typically human. The present studies examined the relation between facial emotion recognition and autistic trait profiles in over 750 adults using either a standard or cartoon version of the Reading the Mind in the Eyes (RME) test. Results showed that those scoring above the clinical cut off for autistic traits on the Autism Quotient performed significantly worse than those with the lowest levels of autistic traits on the standard RME, while scores across these groups did not differ substantially on the cartoon version of the task. These findings add further evidence that theory of mind ability such as facial emotion recognition is not at a global deficit in those with a high degree of autistic traits. Instead, differences in this ability may be specific to evaluating human agents.

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2. Barkocy M, Schilz J, Heimerl S, Chee M, Valdez M, Redmond K. The Effectiveness of Serial Casting and Ankle Foot Orthoses in Treating Toe Walking in Children With Autism Spectrum Disorder. Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association. 2021.

PURPOSE : This proof of concept study examined the effectiveness of serial casting (SC) and ankle foot orthoses (AFOs) in children with autism spectrum disorder (Ch-ASD) who toe walk (TW). Data collected determined effects of SC, followed by AFO intervention on ankle dorsiflexion (A-DF) passive range of motion and kinematics, and parent-reported functional outcomes for children with autism spectrum disorder who TW and have limited A-DF passive range of motion. SUMMARY OF KEY POINTS : The 5 participants increased passive range of motion with SC, except for 1 participant’s left ankle. Two of 4 participants had near typical A-DF kinematic patterns following SC. The 5 participants improved A-DF during walking following 6 months of AFO use. CONCLUSIONS : Serial casting increased A-DF ROM and kinematics during walking. Consistent AFO use for walking training improved function and reduced toe walking. Serial casting followed by AFOs is a potential intervention for children with autism spectrum disorder who TW.

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3. Beiting M, Maas E. Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS) : A Single-Case Experimental Design Study. American journal of speech-language pathology. 2021 : 1-17.

Purpose A subset of children with autism spectrum disorder (ASD) has speech sound disorders, including childhood apraxia of speech (CAS). To date, virtually all speech treatment studies consider ASD an exclusionary criterion, resulting in little scientific evidence for treatment of CAS for children who also have ASD. This study proposes and tests a novel approach, Autism-Centered Therapy for Childhood Apraxia of Speech (ACT4CAS), as a theoretically and clinically informed speech treatment option for this population. Method Using a multiple-baseline design within and across participants, three children with co-occurring ASD and CAS received 11-18 treatment sessions. Treatment targets were individually designed and matched with untreated control words. Probes were administered at the start of each session to assess speech production accuracy perceptually. Changes in production accuracy were examined through visual inspection and quantified with effect sizes. Results Findings were mixed, with one child showing significant gains for half of the treated targets at follow-up and two children showing no clear improvement. Conclusions Preliminary evidence suggests potentially positive treatment effects for ACT4CAS when implemented as intended, although treatment intensity and disorder severity likely influence treatment outcome. Replication and comparison of ACT4CAS to other speech treatments is needed. Supplemental Material https://doi.org/10.23641/asha.14110445.

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4. Jones M, Falkmer M, Milbourn B, Tan T, Bölte S, Girdler S. Identifying the Essential Components of Strength-based Technology Clubs for Adolescents with Autism Spectrum Disorder. Dev Neurorehabil. 2021 : 1-15.

Background : Strength-based technology clubs for adolescents with autism spectrum disorder (ASD) have become increasingly popular ; however, they remain poorly described in the literature. Before the impact and benefit of strength-based technology clubs can be measured, consistency in their design and delivery must be established. This study aimed to identify the essential components of strength-based technology clubs by exploring context, mechanisms, and outcomes of existing strength-based technology clubs.Method : Twenty-three adolescents with ASD (mean age 12.96 years, SD = 1.86, range = 10-18 years), 25 parents (mean age 46.08 years, SD = 8.27, range = 33-69 years), and 20 facilitators (mean age 27.93 years, SD = 6.55, range = 20-46 years) were purposively sampled from three established strength-based technology clubs. Data were obtained via ethnographic methods, including participant observations, interviews, and focus groups. Data analysis was underpinned by a realist evaluation, which provided the context-mechanism-outcome framework.Results : Data analysis revealed that strength-based technology clubs had four context themes (personal factors of adolescents, personal factors of facilitators, personal factors of parents, institution), three mechanism themes (activity design, strengths and abilities, environment), and three outcome themes (skill building, connection with others, emotion).Conclusion : The results highlighted the importance of understanding the personal context of adolescents, providing an individualized approach, leveraging individual interests, and modifying the environment to suit the individual. The findings contributed to defining a strength-based approach within ASD, and have demonstrated that positive outcomes can be achieved by focusing on strengths rather than deficits. Future ASD services can use the results as a framework for applying a strength-based approach. The efficacy of newly designed strength-based programs can then be tested.

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5. Nakagawa A, Hayashi W, Nishio T, Hanawa Y, Aoyagi K, Okajima Y, Iwanami A. Similarity of subjective symptoms between autism spectrum disorder and attention-deficit/hyperactivity disorder in adults : Preliminary findings. Neuropsychopharmacology reports. 2021.

AIM : The purpose of this study was to examine the symptoms of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in the adult clinical population using the Autism-Spectrum Quotient (AQ) and the Adult ADHD Rating Scales self-report screening version (CAARS-S:SV). METHODS : We included 50 adults with ASD and 52 with ADHD diagnosed using the DSM-5 criteria. Clinical symptoms were evaluated using the AQ and CAARS-S:SV. RESULTS : The AQ score was elevated in the ADHD group and the CAARS scores were increased in the ASD group. Specifically, the total AQ score in adults with ADHD was lower than that in the ASD group, but was higher than that in controls. Similarly, the CAARS scores in adults with ASD were lower than in those with ADHD, but were higher than those in controls. No significant correlations were found between AQ, CAARS Inattention/Memory Problems, and CAARS Hyperactivity/Restlessness scores in both the ASD and ADHD groups. CONCLUSION : While adults with ASD and ADHD exhibited similar clinical symptoms, the absence of AQ-CAARS correlations suggests the need for examining factors other than the apparent similarity of clinical symptoms of the two disorders.

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6. Olafson E, Bedford SA, Devenyi GA, Patel R, Tullo S, Park MTM, Parent O, Anagnostou E, Baron-Cohen S, Bullmore ET, Chura LR, Craig MC, Ecker C, Floris DL, Holt RJ, Lenroot R, Lerch JP, Lombardo MV, Murphy DGM, Raznahan A, Ruigrok ANV, Spencer MD, Suckling J, Taylor MJ, Lai MC, Chakravarty MM. Examining the Boundary Sharpness Coefficient as an Index of Cortical Microstructure in Autism Spectrum Disorder. Cereb Cortex. 2021.

Autism spectrum disorder (ASD) is associated with atypical brain development. However, the phenotype of regionally specific increased cortical thickness observed in ASD may be driven by several independent biological processes that influence the gray/white matter boundary, such as synaptic pruning, myelination, or atypical migration. Here, we propose to use the boundary sharpness coefficient (BSC), a proxy for alterations in microstructure at the cortical gray/white matter boundary, to investigate brain differences in individuals with ASD, including factors that may influence ASD-related heterogeneity (age, sex, and intelligence quotient). Using a vertex-based meta-analysis and a large multicenter structural magnetic resonance imaging (MRI) dataset, with a total of 1136 individuals, 415 with ASD (112 female ; 303 male), and 721 controls (283 female ; 438 male), we observed that individuals with ASD had significantly greater BSC in the bilateral superior temporal gyrus and left inferior frontal gyrus indicating an abrupt transition (high contrast) between white matter and cortical intensities. Individuals with ASD under 18 had significantly greater BSC in the bilateral superior temporal gyrus and right postcentral gyrus ; individuals with ASD over 18 had significantly increased BSC in the bilateral precuneus and superior temporal gyrus. Increases were observed in different brain regions in males and females, with larger effect sizes in females. BSC correlated with ADOS-2 Calibrated Severity Score in individuals with ASD in the right medial temporal pole. Importantly, there was a significant spatial overlap between maps of the effect of diagnosis on BSC when compared with cortical thickness. These results invite studies to use BSC as a possible new measure of cortical development in ASD and to further examine the microstructural underpinnings of BSC-related differences and their impact on measures of cortical morphology.

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7. Wieckowski AT, Hamner T, Nanovic S, Porto KS, Coulter KL, Eldeeb SY, Chen CA, Fein DA, Barton ML, Adamson LB, Robins DL. Early and Repeated Screening Detects Autism Spectrum Disorder. The Journal of pediatrics. 2021.

OBJECTIVE : To evaluate timing and accuracy of early and repeated screening for autism spectrum disorder (ASD) during well-child visits. STUDY DESIGN : Using a longitudinal study design, toddlers (n=5784) were initially screened at 12 (n=1504), 15 (n=1228), or 18 (n=3052) months during well-child visits, and rescreened at 18, 24, and 36 months. Of those screened, 368 toddlers attended an ASD evaluation after a positive screen and/or a provider concern for ASD at any visit. RESULTS : Screens initiated at 12 months yielded an ASD diagnosis significantly earlier than at 15 months (P = .003, d = 0.99) and 18 months (P < .001, d = 0.97). Cross-group overall sensitivity of the initial screen was .715 and specificity was .959. Repeat screening improves sensitivity (82.1%), without notably decreasing specificity (all > 93.5%). Screening at 18 months resulted in significantly higher positive predictive value (PPV) than at 12 months (X(2) (1, n=221) = 9.87, P = .002, OR = 2.60) and 15 months (X(2) (1, n=208) = 14.57, P < .001, OR = 3.67). With repeat screening, PPV increased for all screen groups but the increase was not significant. CONCLUSION : Screening as early as 12 months effectively identifies many children at risk for ASD. Children screened at 12 months receive a diagnosis of ASD significantly earlier than peers who are first screened at later ages, facilitating earlier intervention. However, as the sensitivity is lower for a single screen, screening needs to be repeated.

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