1. Akin-Bulbul I, Ozdemir S. Imitation Performance in Children with Autism and the Role of Visual Attention in Imitation. J Autism Dev Disord;2022 (Sep 9)

In this study, we examined imitation performance, visual attention, and the relationship between imitation and visual attention of children with autism, developmental delay (DD), and typically developing (TD) children. The study findings revealed that children with autism and DD imitated less than TD children in all imitation tasks. Results also showed that children with autism spent less time looking at the model’s face and movement area and more time looking at the external area. Lastly, the relationship between imitation and visual attention separated the study groups. The findings of the study provided new evidence that visual attention to movement area in children with autism was positively related to imitation performance in non-meaningful gestures.

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2. Baker JK, Fenning RM, Erath SA, Fabian S. Parasympathetic withdrawal indexes risk for emotion dysregulation in children with autism spectrum disorder. Autism Res;2022 (Sep 10)

Children with autism spectrum disorder (ASD) experience significant difficulties with emotion regulation. Theory and empirical evidence suggest substantial biological contributions to regulatory challenges, which may be related to core ASD symptoms. Respiratory sinus arrythmia (RSA) is a measure of parasympathetic nervous system activity that serves as a putative biomarker for emotion regulation. Higher baseline RSA and more RSA reactivity (parasympathetic withdrawal; RSA-R) in response to challenge appear adaptive in non-clinical populations, but existing evidence for children with ASD remains inconclusive. The current study examined correlates of observed emotion dysregulation in 61 children with ASD between the ages of 6 and 10 years, including ASD symptom levels as well as both baseline RSA and concurrent RSA reactivity. Consistent with previous research, ASD symptom level was significantly correlated with observed dysregulation whereas additional factors such as child IQ were not. Baseline RSA was unrelated to observed dysregulation, but higher RSA reactivity predicted concurrent dysregulation above and beyond the contribution of child ASD symptoms. Findings contribute to an emerging understanding of dysregulation in these children, raise questions about the utility of traditional baseline RSA measures for this population, and clarify the functional significance of RSA reactivity as a risk factor for emotion dysregulation in children with ASD. LAY SUMMARY: Children with autism spectrum disorder (ASD) are at high risk for emotion dysregulation. This study identifies core ASD symptom level as important to understanding regulatory challenges, and suggests that certain biological arousal processes (e.g., the « freeing » of regulatory control to meet a challenge) may operate in a different way for this population as compared to what is generally observed for most children with neurotypical development.

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3. Brynge M, Sjöqvist H, Gardner RM, Lee BK, Dalman C, Karlsson H. Maternal infection during pregnancy and likelihood of autism and intellectual disability in children in Sweden: a negative control and sibling comparison cohort study. Lancet Psychiatry;2022 (Sep 5)

BACKGROUND: Maternal infections during pregnancy are associated with intellectual disability and autism in exposed children. Whether these associations are causal, and therefore should be targets of preventive strategies, remains unknown. We aimed to investigate these associations, to determine whether there is a causal role of maternal infection during pregnancy for children’s risk of autism and intellectual disability, by accounting for unmeasured familial factors. METHODS: We used a register-based cohort study design, and included children living in Stockholm County, Sweden, who were born in 1987-2010. We excluded children not born in Sweden, adopted children, and children with unknown biological mothers or fathers. Maternal infections during pregnancy, defined by ICD-8, ICD-9, and ICD-10 codes, were identified in the National Patient Register and Medical Birth Register. Children were followed up from birth to an outcome or a censoring event (death, migration from Stockholm, age 18 years, or Dec 31, 2016, whichever occurred first). The primary outcomes were diagnosis of autism or diagnosis of intellectual disability. We did a survival analysis to examine the association between inpatient and outpatient specialised care for any infection during pregnancy and likelihood of autism or intellectual disability in the child. To address potential residual confounding, we also estimated the relationship between maternal infection in the year preceding pregnancy as a negative control exposure and conducted a matched sibling analysis of sibling pairs who were discordant for autism or intellectual disability. FINDINGS: 647 947 children living in Stockholm County were identified and, after excluding 97 980 children, we included 549 967 in the study (267 995 [48•7%] were female and 281 972 [51•3%] were male; mean age at censoring 13•5 years [SD 5•0; range <1 to 18]; 142 597 [25•9%] had a mother who was not born in Sweden). 445 (1•3%) of 34 013 children exposed to maternal infection during pregnancy were diagnosed with intellectual disability and 1123 (3•3%) with autism. 5087 (1•0%) of 515 954 unexposed children were diagnosed with intellectual disability and 13 035 (2•5%) with autism. Maternal infection during pregnancy was associated with autism (hazard ratio [HR] 1•16, 95% CI 1•09-1•23) and intellectual disability (1•37, 1•23-1•51) in exposed children compared with unexposed children. Maternal infection in the year before pregnancy (negative control exposure) was also associated with autism (HR 1•25, 95% CI 1•14-1•36), but was not associated with intellectual disability (1•09, 0•94-1•27). In sibling comparisons, the associations with maternal infection during pregnancy were attenuated for autism (HR 0•94, 95% CI 0•82-1•08; n=21 864), but not to the same extent for intellectual disability (1•15, 0•95-1•40; n=9275). INTERPRETATION: Although infections in pregnant women are associated with both autism and intellectual disability in their children, the association with autism does not appear to reflect a causal relationship, but is more likely to be explained by factors shared between family members such as genetic variation or aspects of the shared environment. Thus, infection prevention is not expected to reduce autism incidence. For intellectual disability, unmeasured familial factors might not fully explain the observed associations, and a causal role of maternal infections cannot be excluded. Causal effects of specific but rare infections or infections not requiring health care contact cannot be excluded in either autism or intellectual disability. FUNDING: Swedish Research Council, Stanley Medical Research Institute, and Autism Speaks. TRANSLATION: For the Swedish translation of the abstract see Supplementary Materials section.

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4. Buro AW, Gray HL, Kirby RS, Marshall J, Strange M, Hasan S, Holloway J. Pilot Study of a Virtual Nutrition Intervention for Adolescents and Young Adults With Autism Spectrum Disorder. J Nutr Educ Behav;2022 (Sep);54(9):853-862.

OBJECTIVE: Examine the impact of a virtual nutrition education program, Bringing Adolescent Learners with Autism Nutrition and Culinary Education (BALANCE), on dietary intake and psychosocial determinants of healthy eating in adolescents and young adults (AYA) with autism spectrum disorder (ASD). METHODS: A sample of AYA with ASD aged 12-21 years (n = 27; 6 groups of 2-7 adolescents) participated in BALANCE, a Social Cognitive Theory-based intervention, for eight 30-45-minute lessons. Outcomes were compared using a pre-post design and included dietary intake (assessed using a food frequency questionnaire) and psychosocial determinants of healthy eating (assessed by a validated survey). Wilcoxon signed-rank tests compared preintervention and postintervention medians with an alpha level of 0.05. RESULTS: Mean added sugar intake (P = 0.026) decreased, and behavioral strategies (P = 0.010), self-efficacy (P < 0.001), and outcome expectations (P = 0.009) improved. There was no difference in fruit or vegetable intake or other psychosocial determinants. CONCLUSIONS AND IMPLICATIONS: The BALANCE intervention may improve psychosocial determinants and dietary behaviors in AYA with ASD. Future virtual programs may incorporate more assistance and support to be accessible for AYA with ASD of varying severity levels.

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5. Eni M, Gorodetski A, Dinstein I, Zigel Y. The Impact of Speaker Diarization on DNN-based Autism Severity Estimation. Annu Int Conf IEEE Eng Med Biol Soc;2022 (Jul);2022:3414-3417.

This paper presents a speech-based system for autism severity estimation combined with automatic speaker diarization. Speaker diarization was performed by two different methods. The first used acoustic features, which included Mel-Frequency Cepstral Coefficients (MFCC) and pitch, and the second used x-vectors – embeddings extracted from Deep Neural Networks (DNN). The speaker diarization was trained using a Fully Connected Deep Neural Network (FCDNN) in both methods. We then trained a Convolutional Neural Network (CNN) to estimate the severity of autism based on 48 acoustic and prosodic features of speech. One hundred thirty-two young children were recorded in the Autism Diagnostic Observation Schedule (ADOS) examination room, using a distant microphone. Between the two diarization methods, the MFCC and Pitch achieved a better Diarization Error Rate (DER) of 26.91%. Using this diarization method, the severity estimation system achieved a correlation of 0.606 (Pearson) between the predicted and the actual autism severity scores (i.e., ADOS scores). Clinical Relevance- The presented system identifies children’s speech segments and estimates their autism severity sc30:310ore.

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6. Fujimoto T, Fukuzawa E, Tatehara S, Satomura K, Ohya J. Automatic Diagnosis of Early-Stage Oral Cancer and Precancerous Lesions from ALA-PDD Images Using GAN and CNN. Annu Int Conf IEEE Eng Med Biol Soc;2022 (Jul);2022:2161-2164.

A screening system for early-stage oral cancer and precancerous lesions should be established because it is difficult to detect them even for specialists and they are often detected too late. In this paper, we propose a method for automatically classifying fluorescence images acquired by ALA-PDD (Photodynamic Diagnosis using 5-Aminolevulinic Acid) into three classes: Normal, Low-Risk, High-Risk. We augment a small image dataset by training GAN (Generative adversarial networks) with Differentiable Augmentation, and then train CNN (Convolutional Neural Network) for the classification by the augmented dataset. Experimental results show good classification results, which suggest that the combination of ALA-PDD and CNN classification is a promising method for oral cancer screening. Clinical Relevance- The method proposed in this paper has a potential to be used as a screening method for early-stage oral cancer and precancerous lesions, that is non-invasive, accurate, easy to use, and does not require specialization.

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7. Inokuchi R, Ichikawa T, Ichikawa H, Yamamoto M, Takemura H. Gait Perception of Life-Size Point-Light Walker is Associated with Autistic Traits: Evidence from Event-Related Evoked Potentials. Annu Int Conf IEEE Eng Med Biol Soc;2022 (Jul);2022:4068-4071.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a combination of atypicalities in social cognition. Previous studies showed that people with autistic traits have atypicality in motion perception on a point-light display by measuring visual event-related potentials (ERPs). Although some studies have focused on the association between motion perception and autistic traits, visual ERPs to biological motion as large as actual person have not been investigated. Measuring brain activity in a real-life environment help us to understand the difficulties showed in daily life by people with autistic traits. In this study, we investigated the association between gait perception and autistic traits by measuring ERPs during video observation of approaching and receding life-sized point-light walkers (PLW s). ERPs were measured using an 8-channel EEG system in 22 adults. The multiple regression analyses were conducted to assess association between the Subthreshold Autism Trait Questionnaire (SATQ) score and the ERP amplitude or latency. As the results, we found that the higher SATQ score could be explained by the longer latency of N1 on the occipitotemporal area. These findings suggested that people with autistic traits have difficulty in perceiving the approach of others in daily life.

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8. Jha RR, Bhardwaj A, Garg D, Bhavsar A, Nigam A. MHATC: Autism Spectrum Disorder Identification Utilizing Multi-Head Attention Encoder Along with Temporal Consolidation Modules. Annu Int Conf IEEE Eng Med Biol Soc;2022 (Jul);2022:337-341.

Resting-state fMRI is commonly used for diagnosing Autism Spectrum Disorder (ASD) by using network-based functional connectivity. It has been shown that ASD is associated with brain regions and their inter-connections. However, discriminating based on connectivity patterns among imaging data of the control population and that of ASD patients’ brains is a non-trivial task. In order to tackle said classification task, we propose a novel deep learning architecture (MHATC) consisting of multi-head attention and temporal consolidation modules for classifying an individual as a patient of ASD. The devised architecture results from an in-depth analysis of the limitations of current deep neural network solutions for similar applications. Our approach is not only robust but computationally efficient, which can allow its adoption in a variety of other research and clinical settings.

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9. Park-Cardoso J, Silva A. Insistence on sameness for food space appropriation: An exploratory study on Brazilians with autism (self-)diagnosis in adulthood. Autism;2022 (Sep 9):13623613221121417.

Insistence on sameness is common in autistic individuals and continues into adulthood. Research shows it may be a way to cope with environments because of their sensory sensitivity, intolerance to uncertainty, and anxiety. Understanding the reasons for insistence on sameness from the perspective of autistic adults is important. To study the meanings of insistence on sameness for autistic adults, we interviewed 16 Brazilian autistic adults. All 10 formally diagnosed participants were diagnosed in adulthood. Six participants identified as being on the autism spectrum without formal diagnosis. During the interviews by email, we first asked about participants’ experiences with autism diagnosis, either formal diagnosis or self-diagnosis. Then, we asked about their experiences in places for eating out and grocery shopping. We found they tended to always go to the same places and use protective accessories to eat or shop comfortably. But their such behaviors were considered weird habits, first by other people and later by themselves. While trying to control their weird habits because of social pressure, they often suffered anxiety and meltdowns. When they finally learned of their autism in adulthood, they began to better understand who they are and why they experience the environment differently from others. This new understanding taught them that their so-called weird habits are actually part of their authentically autistic ways to cope with the weirder world. This study suggests that autistic adults’ insistence on sameness is an authentically autistic way to exercise their right to comfortably co-exist and live as human beings and as themselves.

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10. Peristeri E, Tsimpli IM. Disentangling Language Disorder and Bilingualism in Children with Developmental Language Disorder and Autism Spectrum Disorder: Evidence from Writing. J Autism Dev Disord;2022 (Sep 10)

Twenty-eight Albanian-Greek bilingual children with Developmental Language Disorder and 28 children with Autism Spectrum Disorder but no language impairment, along with 28 typically-developing, age-, Performance IQ- and socioeconomic status-matched bilingual children were asked to produce two expository texts which were coded for spelling (phonological, grammatical, orthographic) errors, stress and punctuation use. The children’s expressive vocabulary, current language use and home language history were also measured. The results show that the bilingual children with Developmental Language Disorder were particularly vulnerable to spelling errors, while their bilingual peers with Autism Spectrum Disorder were rather challenged by stress and punctuation. The evidence speaks in favor of distinct patterns of writing impairment across the bilingual children with Developmental Language Disorder and Autism Spectrum Disorder.

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11. Shurtz L, Schwartz C, DiStefano C, McPartland JC, Levin AR, Dawson G, Kleinhans NM, Faja S, Webb SJ, Shic F, Naples AJ, Seow H, Bernier RA, Chawarska K, Sugar CA, Dziura J, Senturk D, Santhosh M, Jeste SS. Concomitant medication use in children with autism spectrum disorder: Data from the Autism Biomarkers Consortium for Clinical Trials. Autism;2022 (Sep 9):13623613221121425.

Children with autism spectrum disorder are prescribed a variety of medications that affect the central nervous system (psychotropic medications) to address behavior and mood. In clinical trials, individuals taking concomitant psychotropic medications often are excluded to maintain homogeneity of the sample and prevent contamination of biomarkers or clinical endpoints. However, this choice may significantly diminish the clinical representativeness of the sample. In a recent multisite study designed to identify biomarkers and behavioral endpoints for clinical trials (the Autism Biomarkers Consortium for Clinical Trials), school-age children with autism spectrum disorder were enrolled without excluding for medications, thus providing a unique opportunity to examine characteristics of psychotropic medication use in a research cohort and to guide future decisions on medication-related inclusion criteria. The aims of the current analysis were (1) to quantify the frequency and type of psychotropic medications reported in school-age children enrolled in the ABC-CT and (2) to examine behavioral features of children with autism spectrum disorder based on medication classes. Of the 280 children with autism spectrum disorder in the cohort, 42.5% were taking psychotropic medications, with polypharmacy in half of these children. The most commonly reported psychotropic medications included melatonin, stimulants, selective serotonin reuptake inhibitors, alpha agonists, and antipsychotics. Descriptive analysis showed that children taking antipsychotics displayed a trend toward greater overall impairment. Our findings suggest that exclusion of children taking concomitant psychotropic medications in trials could limit the clinical representativeness of the study population, perhaps even excluding children who may most benefit from new treatment options.

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12. Yang S, Han D, Zhou H, Yang C, Zhang K, Chen S, Yang R, Cao X, Grodberg D, Zhao X, Kang C. Validity and Cutoff Score of the Autism Mental Status Exam for an Autism Spectrum Disorder Diagnosis in Chinese Children. J Autism Dev Disord;2022 (Sep 10)

The Autism Mental Status exam (AMSE) has demonstrated excellent sensitivity and specificity in Western high-risk population with suspected autism spectrum disorder (ASD). This study aimed to evaluate the psychometric properties of the AMSE in a sample of high-risk Chinese children, and to determine the optimal cutoff score of the Chinese version of the AMSE in supporting ASD diagnosis. 66 young children aged from 2 to 11 years with suspected ASD were enrolled in the present study. A diagnosis of ASD or non-ASD was determined by a Best Estimate Diagnosis protocol according to the DSM-5 criteria. Receiver operating characteristic (ROC) curve analysis was conducted to assess the validity of the AMSE and search for the most effective cutoff score. The ROC curve analysis yields the area under the ROC curve of 0.98 which represents excellent diagnostic accuracy. Findings indicate the optimal cutoff score of the Chinese version of the AMSE was estimated as 6, producing the highest sensitivity of 98% and a specificity of 87%. Preliminary findings of the study suggest the AMSE has promising psychometric properties as an assessment tool for identifying ASD symptoms and supporting diagnostic decision-making in high-risk Chinese children population.

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