1. Güneş H, Tanıdır C, Doktur H, Yılmaz S, Yıldız D, Özbek F, Bozbey S, Özşirin G. Prenatal, Perinatal, Postnatal risk factors, and excess screen time in autism spectrum disorder. Pediatr Int;2022 (Oct 9):e15383.

BACKGROUND: The aim of this study is to investigate prenatal, perinatal, and postnatal factors, screen time in a group of patients with ASD and age and sex-matched clinical controls to evaluate risk factors specific to ASD. METHODS: The study included 211 ASD patients (177 boys, 34 girls; mean age 44.3±13.0 months) and 241 (190 boys, 51 girls; mean age 44.6±14.1 months) age and sex group matched clinical controls. Non-ASD diagnoses were expressive language disorder (n=135, 56.0 %), intellectual disability (n=15, 6.2%), attention deficit-hyperactivity disorder (n=6, 2.4%), oppositional disorder (n=6, 2.4%), and other behavioral or emotional problems (no diagnosis) (n=79, 32.8%). A sociodemographic data form was used to collect data regarding pre-, peri-, and postnatal factors and total daily screen exposure. RESULTS: According to our findings, maternal severe psychological stress and depression during pregnancy, and maternal postpartum depression were more frequent in the ASD group (p=0.005, p=0.035, and p=0.001 respectively). There was a statistically significant difference between groups with regards to maternal any medication use during pregnancy (p=0.004). The mean duration of daily screen exposure was higher in the ASD group (9.90±5.10 hours) compared to non-ASD children (4.46±3.40 hours) (p<0.001). A ROC curve showed that 8.5 hours and above total daily screen exposure (AUC = 0.808 [95%CI, 0.769-0.848], p<000; 55% sensitivity, 90.5% specificity) is likely to be associated with increased risk for ASD. CONCLUSION: Our study suggests that prenatal maternal psychological stress, prenatal and postpartum depression, and excess exposure to screen might be related to an increased risk for ASD.

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2. Haskins AJ, Mentch J, Botch TL, Garcia BD, Burrows AL, Robertson CE. Reduced social attention in autism is magnified by perceptual load in naturalistic environments. Autism Res;2022 (Oct 7)

Individuals with autism spectrum conditions (ASC) describe differences in both social cognition and sensory processing, but little is known about the causal relationship between these disparate functional domains. In the present study, we sought to understand how a core characteristic of autism-reduced social attention-is impacted by the complex multisensory signals present in real-world environments. We tested the hypothesis that reductions in social attention associated with autism would be magnified by increasing perceptual load (e.g., motion, multisensory cues). Adult participants (N = 40; 19 ASC) explored a diverse set of 360° real-world scenes in a naturalistic, active viewing paradigm (immersive virtual reality + eyetracking). Across three conditions, we systematically varied perceptual load while holding the social and semantic information present in each scene constant. We demonstrate that reduced social attention is not a static signature of the autistic phenotype. Rather, group differences in social attention emerged with increasing perceptual load in naturalistic environments, and the susceptibility of social attention to perceptual load predicted continuous measures of autistic traits across groups. Crucially, this pattern was specific to the social domain: we did not observe differential impacts of perceptual load on attention directed toward nonsocial semantic (i.e., object, place) information or low-level fixation behavior (i.e., overall fixation frequency or duration). This study provides a direct link between social and sensory processing in autism. Moreover, reduced social attention may be an inaccurate characterization of autism. Instead, our results suggest that social attention in autism is better explained by « social vulnerability, » particularly to the perceptual load of real-world environments. LAY SUMMARY: Real-world sensory contexts place incredible demands on selective attention. Autistic individuals report a particular challenge navigating contexts with high perceptual load, but little is known about its impact on classic, social signatures of autism. Here, we used eyetracking in immersive virtual reality to test the impact of perceptual load on social attention in naturalistic contexts. Overall, we found that group differences in social attention emerge with increasing real-world perceptual load, revealing a novel link between social and sensory processing in autism.

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3. Kulasinghe K, Whittingham K, Mitchell AE, Boyd RN. Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis. Dev Med Child Neurol;2022 (Oct 8)

AIM: To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship. METHOD: Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences. RESULTS: Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence). INTERPRETATION: Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.

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4. Meimei L, Zenghui M. A systematic review of telehealth screening, assessment, and diagnosis of autism spectrum disorder. Child Adolesc Psychiatry Ment Health;2022 (Oct 8);16(1):79.

There is a significant delay between parents having concerns and receiving a formal assessment and Autism Spectrum Disorder (ASD) diagnosis. Telemedicine could be an effective alternative that shortens the waiting time for parents and primary health providers in ASD screening and diagnosis. We conducted a systematic review examining the uses of telemedicine technology for ASD screening, assessment, or diagnostic purposes and to what extent sample characteristics and psychometric properties were reported. This study searched four databases from 2000 to 2022 and obtained 26 studies that met the inclusion criteria. The 17 applications used in these 26 studies were divided into three categories based on their purpose: screening, diagnostic, and assessment. The results described the data extracted, including study characteristics, applied methods, indicators seen, and psychometric properties. Among the 15 applications with psychometric properties reported, the sensitivity ranged from 0.70 to 1, and the specificity ranged from 0.38 to 1. The present study highlights the strengths and weaknesses of current telemedicine approaches and provides a basis for future research. More rigorous empirical studies with larger sample sizes are needed to understand the feasibility, strengths, and limitations of telehealth technologies for screening, assessing, and diagnosing ASD.

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5. Wong PW, Lam YY, Lau JS, Fok HK. Adapting and pretesting the World Health Organization’s Caregiver Skills Training Program for children with autism and developmental disorders or delays in Hong Kong. Sci Rep;2022 (Oct 8);12(1):16932.

The World Health Organization Caregiver Skills Training Program (WHO-CST) was developed to strengthen caregivers’ skills in supporting children with developmental delays and the caregivers’ well-being. The WHO-CST Hong Kong (HK) was adapted, and pre-pilot tested to support families with children suspected of having developmental delays and autism spectrum disorder and to empower the caregivers to foster their children’s learning, social communication, and adaptive behavior. A sequential mixed-methods research methodology was undertaken to examine the adaptation process and initial implementation experiences. The acceptability, feasibility, and perceived benefits of the WHO-CST were assessed using stakeholders’ and caregivers’ qualitative and caregivers’ quantitative pre- and post-intervention feedback. The data included materials generated from (1) three consultation meetings with stakeholders; (2) detailed reviews of the translated and adapted WHO-CST materials by master trainees (n = 10) trained by the WHO-CST representatives; (3) needs assessment focus group interviews with caregivers (n = 15) of children with autism spectrum disorder; and (4) pre- and post-CST program qualitative focus group interviews and quantitative evaluation. Consultation with stakeholders suggested that the program was acceptable for the local community, but the home visit and fidelity components were initially considered to be challenges towards the feasibility and sustainability of the program. Caregivers in the needs assessment focus groups gave widely diverse views about the program’s uniqueness, length, delivery mode, and the inclusion of videotaping in-home visits. Post-intervention comments by caregivers about the program were mainly positive, while the MTs were critical of the content and length of the training and fidelity process. As one of the first high-income locations to adopt the WHO-CST, the evaluation findings of the WHO-CST-HK indicate that it is feasible and acceptable to implement the program in a metropolitan area where families have busy work schedules and are very conscious of privacy issues. The study results suggest that the WHO-CST program in HK and other high-income countries require scaling up and further evaluation of its implementation in real community settings. This involves systemic and contextual changes to allow task-sharing between professionals and non-specialists at the macro level. Furthermore, technology should be used to support the supervision of non-specialists. In addition, easier access to the WHO-CST materials at the micro level is required to ensure equity, equality, diversity, and inclusion of diversified families of children with developmental delays.

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6. Zhou YY, Fu QH. [Advance in pathogenesis of oligodendrocytes-associated autism spectrum disorder]. Zhonghua Yu Fang Yi Xue Za Zhi;2022 (Sep 6);56(9):1232-1237.

Autism spectrum disorder (ASD) is a serious neurodevelopmental impairment of children. Because of its difficulty of early diagnosis, length of disease course, irreversible injury and slim chance of curability, it brings heavy burdens to patients, their families and the whole society. Recent studies have shown that the pathogenic mechanism of ASD is closely related to the abnormal myelination caused by the imbalance of differentiation, proliferation and apoptosis of oligodendroglial lineage cells. This article will review on the role of oligodendroglial lineage cells in myelination and the mechanisms of ASD caused by improper differentiation, proliferation and apoptosis of oligodendroglial lineage cells, according to advanced researches. Oligodendrocytes play vital roles in neurodevelopment, and the defect in these cells has been recognized as one of the key pathogenic mechanisms leading to ASD. Elucidating the effects and disciplines which oligodendrocytes exert on the occurrence and development of ASD would provide guidance for precise prevention and control of neurodevelopmental disorders such as ASD.

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