Pubmed du 09/11/25
1. Aguirre Mtanous NG, Koenig J, Nikahd M, Effertz SE, Silinonte S, Hyer JM, Hand BN, Bishop L. Mental health outcomes associated with applied behavior analysis in a US national sample of privately insured autistic youth. Autism. 2025: 13623613251390604.
Applied behavior analysis is a widely used intervention for autistic youth, though its mental health impacts remain under-researched. This study aims to investigate the association between applied behavior analysis therapy and post-traumatic stress disorder, suicidality, mental health hospitalization rates, and length of mental health hospitalizations using a national database of privately insured youth under 18. We matched 17,120 autistic youth who received applied behavior analysis with a control group of autistic youth with no record of applied behavior analysis and clustered them into four applied behavior analysis dose groups using two-stage bisecting k-medians clustering. Then, we used negative binomial regression and logistic regression to compare outcomes for the applied behavior analysis and non-applied behavior analysis groups. Overall, applied behavior analysis receipt was associated with 30% higher odds of experiencing a mental health hospitalization (odds ratio = 1.30, p < 0.001) and a 32% higher incidence rate of these hospitalizations (incidence rate ratio = 1.32, p < 0.001). Our analysis found no relationship between applied behavior analysis dosing and the other tracked mental health outcomes. These results indicate the need for more quantitative analysis with more comprehensive records of applied behavior analysis receipt to fully investigate claims of ABA resulting in adverse adult mental health outcomes.Lay abstractAutistic youth often receive applied behavior analysis (ABA) therapy, but some autistic adults who had ABA as youth say it harmed their mental health as adults. We looked at the relationship between ABA and post-traumatic stress disorder (PTSD), suicidality, mental health hospitalization rates, and length of mental health hospitalizations among autistic youth. We used private health insurance claims data to look at how ABA receipt was related to those mental health outcomes. We divided autistic youth into groups based on how much ABA they received, so we could see if different amounts of ABA had different associations with mental health. There were 17,120 autistic youth in the group that did not receive ABA, and 17,120 autistic youth in the group that did receive ABA. In this sample, ABA therapy was associated with a greater use of acute mental health services; autistic youth in the ABA group had an overall risk that was 30% higher for mental health hospitalizations; and a 32% greater frequency of mental health hospitalizations. These results suggest that there may be a relationship between mental health hospitalizations and getting ABA. However, more work is needed to fully understand the impact of ABA therapy on mental health outcomes.
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2. Richter C, Gilbert R, Smith BM, Jarvis E, Hollingue C, Showell N, Morris S, Choueiri R. Teaching Pediatric Residents to Evaluate and Screen for Autism in Primary Care Clinics with the Rapid Interactive Screening Test for Autism in Toddlers (RITA-T). Acad Pediatr. 2025: 103175.
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3. Sheikh J, Allotey J, Sobhy S, Plana MN, Martinez-Barros H, Naidu H, Junaid F, Sofat R, Mol BW, Kenny LC, Gladstone M, Teede H, Zamora J, Thangaratinam S. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. Bmj. 2025; 391: e088141.
OBJECTIVE: To assess the quality, biases, and validity of evidence on maternal paracetamol (acetaminophen) use during pregnancy and the risk of autism spectrum disorder (referred to as autism) and attention deficit/hyperactivity disorder (ADHD) in offspring. DESIGN: Umbrella review of systematic reviews. DATA SOURCES: Medline, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews, along with grey literature, Epistemonikos, and the reference lists of included studies (inception to 30 September 2025). INCLUSION CRITERIA: Systematic reviews of randomised trials and cohort, case-control, or cross sectional studies that reported maternal paracetamol use during pregnancy and the diagnosis of autism or ADHD in offspring. Details of the primary studies included in the reviews are reported, including adjustments for key confounders (maternal characteristics, indication for paracetamol use, and familial factors) and unmeasured confounders and ascertainment of outcomes. RESULTS: Nine reviews (40 studies) reporting on autism (six studies) and ADHD (17 studies) in offspring were included. Four reviews undertook meta-analysis. The overlap of primary studies included in the reviews was very high (corrected covered area 23%). The reviews reported a possible to strong association between maternal paracetamol intake and autism or ADHD or both in offspring. Seven of the nine reviews advised caution when interpreting the findings owing to the potential risk of bias and confounding in the included studies. Confidence in the findings of the reviews was low (two reviews) to critically low (seven reviews) based on the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) criteria. Only one review included studies (n=2) reporting autism and ADHD in offspring that appropriately adjusted for familial factors and unmeasured confounding through sibling controlled analyses. In both studies, the increased risk of autism in offspring (one study, hazard ratio 1.05, 95% confidence interval 1.02 to 1.08) and ADHD (two studies, 1.07, 1.05 to 1.10 and 2.02, 1.17 to 3.25 ) observed in the whole cohort analyses did not persist in sibling controlled analyses for autism (0.98, 0.93 to 1.04) and ADHD (0.98, 0.94 to 1.02 and 1.06, 0.51 to 2.05). CONCLUSION: Existing evidence does not clearly link maternal paracetamol use during pregnancy with autism or ADHD in offspring. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251154052.
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4. Stewart GR. Distinguishing midlife and old age: A recommendation for autism researchers. Autism. 2025: 13623613251396316.
Research on ageing in autism has sharply increased following a number of influential publications that highlighted the lack of knowledge in this area. However, much of the research on autism ageing has inadvertently treated all people aged over 50 as a homogeneous ‘older adult’ group, overlooking important distinctions between midlife (40-64 years) and old age (65+ years). Midlife is marked by complex role management, career pressures, health changes and identity development, while old age often involves retirement, shifts in priorities, physical and cognitive changes, and planning for less independent living. Recognising midlife and old age as distinct life phases is essential to accurately characterise the lived experiences and needs of autistic adults across the latter part of the lifespan. This letter makes conceptual and methodological suggestions that autism researchers should align with established ageing frameworks by labelling samples accurately, using appropriate keywords and, where possible, stratifying analyses by age subgroup. Doing so will enhance research accuracy, improve indexing and increase clinical relevance. This shift is vital for advancing autism ageing research and ensuring findings reflect the diverse experiences of autistic adults throughout later life.Lay AbstractResearch on autism and ageing has increased a lot in recent years. However, many studies group everyone over the age of 50 as part of the same ‘older adult’ group. This overlooks the fact that people in midlife (ages 40-64) and those in old age (65 and older) often face very different experiences, challenges and opportunities. Recognising that midlife and old age are separate stages of life is important for understanding what autistic adults go through as they age. This letter encourages autism researchers to be more specific when describing age groups in their studies. By doing this, research on autism and ageing will be more accurate, easier to find and more useful for researchers, healthcare professionals and autistic people alike.
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5. Wang L, Li W, Yao Y, Jiang X, Ma D, Liu Y, Deng Y, Sun L, Li H, Zhao Y, Peng G, Wei G, Luo X, Peng S, Yang J, Zhong Z, Zhou J, Wang X, Dai T, Cai X, Guo P, Lv Z. Maternal exposure to indoor and outdoor air pollution during pregnancy increases offspring risk of autism spectrum disorder. Environ Res. 2025; 288(Pt 2): 123274.
BACKGROUND: The impact of indoor and outdoor air pollution during pregnancy on offspring ASD risk remains under-investigated. This multi-center study aimed to assess the impact of both indoor and ambient air pollution on offspring ASD risk. METHODS: We recruited 1501 participants from child healthcare department across 8 representative regions of China. High-resolution air pollution datasets and a well-validated indoor air pollution index were utilized to estimate prenatal outdoor and indoor air pollution exposure. Multilevel logistic regression models were performed to evaluate the above relationships after controlling for confounding factors including socio-economic and demographic variables, maternal health and behavioral factors. An adverse outcome pathway framework was constructed to explore underlying biological mechanisms. RESULTS: The results showed that indoor air pollution index exhibited a significant positive correlation with the risk of ASD (OR: 1.69, 95 % CI: [1.25, 2.27]). As for outdoor air pollutants, across the three models, the occurrence of ASD was positively correlated with O(3) (OR: 1.54, 95 % CI: [1.16, 2.03]) and CO (OR: 1.72, 95 % CI: [1.40, 2.12]). For NO(2), the results from Model 3 indicated a significant association with the occurrence of ASD (OR: 1.28, 95 % CI: [1.08, 1.52]). CONCLUSIONS: This study provides robust evidence of the detrimental effects of prenatal exposure to both indoor and outdoor air pollution on offspring ASD risk, with significant exposure-response relationships. These findings underscore the urgency of implementing air pollution control measures, and targeted public health interventions to mitigate ASD risk.
