1. Bartakovicova K, Kemenyova P, Belica I, Janik Szapuova Z, Stebelova K, Waczulikova I, Ostatnikova D, Babinska K. Sleep Problems and 6-Sulfatoxymelatonin as Possible Predictors of Symptom Severity, Adaptive and Maladaptive Behavior in Children with Autism Spectrum Disorder. Int J Environ Res Public Health;2022 (Jun 21);19(13)

In children with autism spectrum disorder (ASD), sleep disturbances are a frequent comorbidity with an adverse effect on their behavior and functioning. It was suggested that melatonin deficit is at least partly responsible for the sleep problems. The study aimed to investigate, in a sample of 56 children with ASD aged 2.8-13.3 years, if the sleep problems and melatonin secretion can serve as predictors of adaptive functioning and severity of the ASD core symptoms. We demonstrated that, after adjustment for age, the Sleep score assessed by the Children’s Sleep Habits Questionnaire predicts the Adaptive behavior composite score only in children younger than 6 years, and the preferred predictive model is for the domain Socialization. The age-adjusted Sleep score predicted Externalizing and Internalizing maladaptive behavior, with a near-zero contribution of age to the relationship between the Internalizing maladaptive behavior and Sleep score. After adjustment for age, the reduced night-time melatonin secretion predicted a higher severity of ASD symptoms in the domain Social affect and the Calibrated Severity Score, but not the sleep problems. Our results emphasize the importance of assessing sleep problems as a modifiable predictor of behavior in children with ASD and support the hypothesis about the role of melatonin in pathophysiology of ASD.

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2. Bentz M, Pedersen SH, Moslet U. Case series of family-based treatment for restrictive-type eating disorders and comorbid autism: What can we learn? A brief report. Eur Eat Disord Rev;2022 (Jul 8)

OBJECTIVE: Autism is more prevalent among persons with Restrictive type eating disorders (R-ED) compared to the general population and is associated with poorer outcomes across treatment modalities. Knowledge is sparse with regard to whether poorer outcomes are also associated with Family-based treatment (FBT), which is recommended as the first choice of treatment for young persons (YPs) with R-ED. This case series compares outcome between groups with and without autism in a large consecutive series of YPs with R-ED treated with FBT. METHOD: In an earlier described consecutive series of 157 YPs with R-ED treated with FBT, we compared the outcomes of the subgroup with (N = 16) and without (N = 141) comorbid autism. Primary ICD-10 diagnoses were typical (50.0) or atypical anorexia nervosa (AN) (F50.1), the latter implying a condition as typical AN but with a failure to meet one of the diagnostic criteria. Autism diagnoses were clinically assigned. The outcomes were receiving intensified care, weight normalisation and overall successful treatment. RESULTS: 10.2% (N = 16) of the sample had autism. 2.5% (N = 4) had autism diagnosed prior to the Eating Disorder (ED), and an additional 7.7% (N = 12) were diagnosed with autism during ED treatment. Significantly more YPs with autism (50%, N = 8) compared with YPs without autism (16%, N = 23) received intensified care (day programme or inpatient treatment) during their treatment. No significant difference between groups regarding neither weight normalisation nor successful ending of the treatment were found. CONCLUSION: This small sample of YPs with autism suggests that comparable proportions of YPs with and without autism may restore normal weight and end the treatment successfully within 12 months. However, more YPs with comorbid autism needed more intensive treatment, indicating that outpatient treatment delivery may not be sufficient to bring about desired change in this patient group. Findings need confirmation in a larger sample with a systematic screening for autism.

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3. Gentil-Gutiérrez A, Santamaría-Peláez M, Mínguez-Mínguez LA, Fernández-Solana J, González-Bernal JJ, González-Santos J, Obregón-Cuesta AI. Executive Functions in Children and Adolescents with Autism Spectrum Disorder in Family and School Environment. Int J Environ Res Public Health;2022 (Jun 26);19(13)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by the presence of difficulties in communication and social interaction, often associated with deficits in executive functions (EF). The EF correct development is related to a more effective functioning in all its daily activities, while being associated with more efficient social relations. The objective of this research is to analyze the level of development of EF in children and adolescents with ASD in school and at home. This is a descriptive, cross-sectional, and multicenter study with 102 participants selected by non-probabilistic sampling, 32 parents of children with ASD, and 70 professionals in the field of education of students with ASD. The study confirms that although children and adolescents with ASD have problems in executive functioning, the perception of informants, parents, and education professionals is similar but not the same in the different contexts: school and home.

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4. Gentil-Gutiérrez A, Santamaría-Peláez M, Mínguez-Mínguez LA, González-Santos J, Fernández-Solana J, González-Bernal JJ. Executive Functions in Children and Adolescents with Autism Spectrum Disorder, Grade 1 and 2, vs. Neurotypical Development: A School View. Int J Environ Res Public Health;2022 (Jun 29);19(13)

BACKGROUND: Autism spectrum disorders are neurodevelopmental disorders characterized by deficits in social and communication functioning. Previous studies suggest that people with autism spectrum disorders have deficits in executive functions, having found a relationship with cognitive flexibility, planning, working memory, inhibition or self-control, but it is especially with respect to cognitive flexibility where the greatest dysfunctions have been found. The objective of this research was to compare the executive functioning of a group of children and adolescents diagnosed with autism spectrum disorders with another with neurotypical development in an educational context. METHODS: This was a cross-sectional, descriptive and multicenter confirmatory study in which 121 people who participated acted as informants, with 70 of them being education professionals who work with people with autism spectrum disorders grade 1 and 2 and 51 of them being teachers who work with people of neurotypical development; these individuals were selected through non-probabilistic sampling. RESULTS: People diagnosed with autism spectrum disorders obtained significantly higher scores on the Behavior Rating Inventory of Executive Function-2 scale for the nine clinical scales and the four indexes that compose it compared to the group of people with neurotypical development; in addition, the average scores obtained are clinically significant, with them being elevated for the group with autism spectrum disorders. This study confirms that children and adolescents with autism spectrum disorders experience greater difficulties with respect to their executive functions than children with neurotypical development.

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5. Park JEJ. A Parent-Focused Creative Approach as a Treatment for a High-Functioning Child with Autism Spectrum Disorder (ASD) in Korea: A Case Study. Int J Environ Res Public Health;2022 (Jun 26);19(13)

This study was conducted on a 6-year-old girl with autism spectrum disorder (ASD) in Korea. The case was initiated in February 2015, and intensive treatment was provided for one year. Then, the case was monitored over the course of 6 years until December 2021. The intervention plan was an art therapy-based treatment plan (Individual Therapeutic Education Plan: ITEP) with two integral foci: (1) creative arts-based parent counseling and education and (2) didactic art therapy with the child. This was a new type of integral approach that was not a standard of care practice in Korea, acknowledging the importance of including parents in therapy and the notion of creative arts therapy. There was no scientific evidence supporting this qualitive approach; however, the intervention was a notable success, sustaining a positive outcome-the intervention (1) reduced the anxiety levels of both the mother and the child in the short term; (2) enhanced the child-parent relationship as well as the home environment of the child while the art therapy-based counseling and education increased the mother’s competence; and (3) enhanced the communicative and adaptive functioning of the child and the mother, with art becoming the supportive breakthrough for their emotional obstacles. The findings suggest that a parent-focused creative approach impacts parental changes and child development: the evidence indicates that parent-driven interventions are a viable option for parents and children with ASD to build a better home environment that supports the child’s development.

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6. Raghavan R, Anand NS, Wang G, Hong X, Pearson C, Zuckerman B, Xie H, Wang X. Association between cord blood metabolites in tryptophan pathway and childhood risk of autism spectrum disorder and attention-deficit hyperactivity disorder. Transl Psychiatry;2022 (Jul 9);12(1):270.

Alterations in tryptophan and serotonin have been implicated in various mental disorders; but studies are limited on child neurodevelopmental disabilities such as autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD). This prospective cohort study examined the associations between levels of tryptophan and select metabolites (5-methoxytryptophol (5-MTX), 5-hydroxytryptophan (5-HTP), serotonin, N-acetyltrytophan) in cord plasma (collected at birth) and physician-diagnosed ASD, ADHD and other developmental disabilities (DD) in childhood. The study sample (n = 996) derived from the Boston Birth Cohort, which included 326 neurotypical children, 87 ASD, 269 ADHD, and 314 other DD children (mutually exclusive). These participants were enrolled at birth and followed-up prospectively (from October 1, 1998 to June 30, 2018) at the Boston Medical Center. Higher levels of cord 5-MTX was associated with a lower risk of ASD (aOR: 0.56, 95% CI: 0.41, 0.77) and ADHD (aOR: 0.79, 95% CI: 0.65, 0.96) per Z-score increase, after adjusting for potential confounders. Similarly, children with cord 5-MTX ≥ 25th percentile (vs. <25th percentile) had a reduction in ASD (aOR: 0.27, 95% CI: 0.14, 0.49) and ADHD risks (aOR: 0.45, 95% CI: 0.29, 0.70). In contrast, higher levels of cord tryptophan, 5-HTP and N-acetyltryptophan were associated with higher risk of ADHD, with aOR: 1.25, 95% CI: 1.03, 1.51; aOR: 1.32, 95% CI: 1.08, 1.61; and aOR: 1.27, 95% CI: 1.05, 1.53, respectively, but not with ASD and other DD. Cord serotonin was not associated with ASD, ADHD, and other DD. Most findings remained statistically significant in the sensitivity and subgroup analyses.

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7. Rødgaard EM, Jensen K, Miskowiak KW, Mottron L. Representativeness of autistic samples in studies recruiting through social media. Autism Res;2022 (Jul 9)

Survey-based research with recruitment through online channels is a convenient way to obtain large samples and has recently been increasingly used in autism research. However, sampling from online channels may be associated with a high risk of sampling bias causing findings not to be generalizable to the autism population. Here we examined autism studies that have sampled on social media for markers of sampling bias. Most samples showed one or more indicators of sampling bias, in the form of reversed sex ratio, higher employment rates, higher education level, lower fraction of individuals with intellectual disability, and later age of diagnosis than would be expected when comparing with for example population study results from published research. Findings from many of the included studies are therefore difficult to generalize to the broader autism population. Suggestions for how research strategies may be adapted to address some of the problems are discussed. LAY SUMMARY: Online surveys offer a convenient way to recruit large numbers of participants for autism research. However, the resulting samples may not fully reflect the autism population. Here we investigated the samples of 36 autism studies that recruited participants online and found that the demographic composition tended to deviate from what has been reported about the autism population in previous research. The results may thus not be generalizable to autism in general.

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8. Saban-Bezalel R, Zachor DA, Ben-Itzchak E. Relationship between cognitive ability and predictors for age at the time of autism spectrum disorder diagnosis. Psychiatry Res;2022 (Jun 30);315:114696.

The rising prevalence of autism spectrum disorder (ASD) has increased awareness of the need for early diagnosis and intervention; however, not all children are diagnosed at preschool age. In the literature, findings regarding factors that may play a role in later diagnosis are inconsistent. Presence or absence of intellectual disability is a possible factor. This study aimed to identify factors associated with later diagnosis of ASD among children grouped according to low and high cognitive levels. Data of children who were previously diagnosed with ASD between 2002 and 2016 at a national autism center were analyzed. Better cognitive ability, having more siblings, and previous diagnosis of attention-deficit/hyperactivity disorder were predictors of later diagnosis among the entire cohort. Children exhibiting lower cognitive levels (LC-ASD; DQ/IQ < 70; n = 209) were diagnosed much earlier. Among this group, later ASD diagnosis was predicted by poorer adaptive behavior, more severe restricted and repetitive behaviors, and previous diagnosis of epilepsy. In the higher cognitive level group (HC-ASD; DQ/IQ ≥ 70; n = 321), familial variables and more severe social impairments were predictors of later ASD diagnosis. Clinicians should be aware of variables that may affect ASD diagnostic age among children with varying cognitive abilities.

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9. Sanchez M, Bullen JC, Zajic MC, McIntyre N, Mundy P. Behavioral gender differences in school-age children with autism. Eur Child Adolesc Psychiatry;2022 (Jul 9)

This study examined differences in internalizing and externalizing behaviors between school-aged boys and girls diagnosed with autism spectrum disorder (ASD). Eighty-nine children between the ages of 8 and 16 years participated in this study: 17 girls (M = 11.5 years, SD = 2.3) and 72 boys (M = 11.3 years, SD = 2.2). Participants were matched on the Autism Diagnostic Observation Schedule, Second Edition and Full-Scale IQ (FSIQ > 64). The results indicated that, girls had higher reported instances of Bullying, less Anger Control, and poorer Emotional Self-Control than boys on the Behavior Assessment System for Children, Second Edition. Groups did not differ on subscales of the Social Communication Scale. While evidence of increased externalizing behaviors is less common in girls, there is evidence supporting these differing behaviors that warrant further research.

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10. Valenzuela-Zamora AF, Ramírez-Valenzuela DG, Ramos-Jiménez A. Food Selectivity and Its Implications Associated with Gastrointestinal Disorders in Children with Autism Spectrum Disorders. Nutrients;2022 (Jun 27);14(13)

Food selectivity (FS) in children with autism spectrum disorders (ASD) is common, and its impact on a nutritional level is known. However, the etiology of gastrointestinal disorders (GID) related to alterations in the intestinal microbiota in children with ASD remains unclear. This article provides a narrative review of the literature on FS from the last 15 years, and its relationship with GID in children with ASD. Sensory aversion in ASD leads to food elimination, based on consistencies, preferences, and other sensory issues. The restriction of food groups that modulate the gut microbiota, such as fruits and vegetables, as well as the fibers of some cereals, triggers an intestinal dysbiosis with increased abundance in Enterobacteriaceae, Salmonella Escherichia/Shigella, and Clostridium XIVa, which, together with an aberrant immune response and a leaky gut, may trigger GID. It is observed that FS can be the product of previous GID. GID could provide information to generate a hypothesis of the bidirectional relationship between FS and GID. Emphasis is placed on the need for more studies with methodological rigor in selecting children with ASD, the need for homogeneous criteria in the evaluation of GID, and the adequate classification of FS in children with ASD.

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11. Vecchione R, Wang S, Rando J, Chavarro JE, Croen LA, Fallin MD, Hertz-Picciotto I, Newschaffer CJ, Schmidt RJ, Lyall K. Maternal Dietary Patterns during Pregnancy and Child Autism-Related Traits: Results from Two US Cohorts. Nutrients;2022 (Jun 30);14(13)

We examined the relationship between maternal intake of established dietary patterns and child autism-related outcomes in two prospective cohorts in the United States. Participants were drawn from the Early Autism Risk Longitudinal Investigation (EARLI, n = 154) and the Nurses’ Health Study II (NHSII, n = 727). Dietary information was collected via food frequency questionnaires (FFQs) and used to calculate the empirical dietary inflammatory pattern (EDIP), Alternative Healthy Eating Index (AHEI), Western and Prudent dietary patterns, and the alternative Mediterranean Diet (aMED) score. Primary analyses examined associations with continuous autism-related traits as measured by the Social Responsiveness Scale (SRS), and secondary analyses with autism spectrum disorder (ASD) diagnosis. We used crude and multivariable quantile regression fixed at the 50th percentile to examine associations between quartiles of dietary patterns and SRS scores, and logistic regression to examine associations with ASD diagnosis. There was suggestion of a positive association with the Western diet (Q4 vs. Q1, ß = 11.19, 95% CI: 3.30, 19.90) in EARLI, though the association was attenuated with adjustment for total energy intake, and no clear associations were observed with other dietary patterns and ASD diagnosis or SRS scores. Further work is needed to better understand the role of maternal dietary patterns in ASD and related outcomes.

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12. Vetri L, Maniscalco L, Diana P, Guidotti M, Matranga D, Bonnet-Brilhault F, Tripi G. A Preliminary Study on Photic Driving in the Electroencephalogram of Children with Autism across a Wide Cognitive and Behavioral Range. J Clin Med;2022 (Jun 21);11(13)

Intermittent photic stimulation (IPS) is a useful technique in electroencephalography (EEG) to investigate the neurophysiological anomalies of brain activity. Although not an active task, IPS has also been explored in ASD; it is thought to capture local potential oscillators at specific frequencies and perhaps tap into rhythmic activity in a way that general resting-state recordings cannot. Previous studies suggest that individuals with ASD showed photic driving reactivity predominantly at lower frequencies of stimulation. In our study we used IPS to measure rhythmic oscillatory activity in a sample of 81 ASD children. We found a significant correlation linking ASD children with photic driving activation only at low frequencies (δθ band) and increased severity of « restricted behavior ». This suggests that ASD children with higher severity of restricted behaviors could have a hypersynchronous θ power and an impaired resonance synchronization at middle-ranged frequencies (α). Furthermore, we found some evidence of hemispherical oscillatory asymmetry linked particularly to behavioral impairments. This result is in line with the EEG pattern model indicating a « U-shaped profile » of electrophysiological power alterations with excess power in low- and high-frequency bands and a reduction of power in the middle-ranged frequencies. IPS technique in electroencephalography is confirmed to reveal EEG biomarkers in autistic children, with a focus on spectral power, coherence, and hemisphere asymmetries.

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13. Zürcher NR. Novel Insights Into Facial Emotion Encoding in Autism Spectrum Disorder Through Deep Learning. Biol Psychiatry Cogn Neurosci Neuroimaging;2022 (Jul);7(7):631-632.

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