1. Baba R, Matsuda S, Arakawa Y, Yamada R, Suzuki N, Ando T, Oki H, Igaki S, Daini M, Hattori Y, Matsumoto S, Ito M, Nakatani A, Kimura H. LSD1 enzyme inhibitor TAK-418 unlocks aberrant epigenetic machinery and improves autism symptoms in neurodevelopmental disorder models. Science advances. 2021 ; 7(11).

Persistent epigenetic dysregulation may underlie the pathophysiology of neurodevelopmental disorders, such as autism spectrum disorder (ASD). Here, we show that the inhibition of lysine-specific demethylase 1 (LSD1) enzyme activity normalizes aberrant epigenetic control of gene expression in neurodevelopmental disorders. Maternal exposure to valproate or poly I:C caused sustained dysregulation of gene expression in the brain and ASD-like social and cognitive deficits after birth in rodents. Unexpectedly, a specific inhibitor of LSD1 enzyme activity, 5-((1R,2R)-2-((cyclopropylmethyl)amino)cyclopropyl)-N-(tetrahydro-2H-pyran-4-yl)thiophene-3-carboxamide hydrochloride (TAK-418), almost completely normalized the dysregulated gene expression in the brain and ameliorated some ASD-like behaviors in these models. The genes modulated by TAK-418 were almost completely different across the models and their ages. These results suggest that LSD1 enzyme activity may stabilize the aberrant epigenetic machinery in neurodevelopmental disorders, and the inhibition of LSD1 enzyme activity may be the master key to recover gene expression homeostasis. TAK-418 may benefit patients with neurodevelopmental disorders.

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2. Bardhan M, Polavarapu K, Bevinahalli NN, Veeramani PK, Anjanappa RM, Arunachal G, Shingavi L, Vengalil S, Nashi S, Chawla T, Nagabhushan D, Mohan D, Horvath R, Nishino I, Atchayaram N. Megaconial congenital muscular dystrophy secondary to novel CHKB mutations resemble atypical Rett syndrome. Journal of human genetics. 2021.

Megaconial congenital muscular dystrophy (CMD)(OMIM #602541), related to CHKB mutation, is a rare autosomal recessive disorder. To date, only 35 confirmed patients are recorded. We present a detailed description of the clinical, histopathological, imaging, and genetic findings of five children from four Indian families. The children had moderate-to-severe autistic behavior, hand stereotypies, and global developmental delay mimicking atypical Rett syndrome. In addition, generalized hypotonia was a common initial finding. The progression of muscle weakness was variable, with two patients having a milder phenotype and three having a severe form. Interestingly, the majority did not attain sphincter control. Only patient 1 had classical ichthyotic skin changes. Muscle biopsy in two patients showed a myopathic pattern with characteristic peripherally placed enlarged mitochondria on modified Gomori trichrome stain and electron microscopy. Genetic analysis in these patients identified three novel null mutations in CHKB [c.1027dupA (p.Ser343LysfsTer86) ;c.224 + 1G > T (5′ splice site) ; c.1123C > T (p.Gln375Ter)] and one reported missense mutation, c.581G > A (p.Arg194Gln), all in the homozygous state. Megaconial CMD, although rare, forms an important group with a complex phenotypic presentation and accounted for 5.5% of our genetically confirmed CMD patients. Atypical Rett syndrome-like presentation may be a clue towards CHKB-related disorder.

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3. Bernardin CJ, Lewis T, Bell D, Kanne S. Associations between social camouflaging and internalizing symptoms in autistic and non-autistic adolescents. Autism. 2021 : 1362361321997284.

Autistic individuals have more mental health difficulties than non-autistic individuals. It is important to understand why this might be. Research has shown that camouflaging, or strategies used to hide autistic traits, might contribute to mental health difficulties in autistic adults. We examined whether this was also the case for autistic adolescents. This study included 140 adolescents ages 13-18 years (62 non-autistic, 58 female). All participants answered questions about camouflaging, autistic traits, and mental health difficulties. We found that autistic and non-autistic adolescents who reported higher levels of camouflaging also reported higher levels of depression, anxiety, and stress. We also found that camouflaging might be particularly stressful for females. These findings improve our understanding of camouflaging during adolescence and point to potential ways to support autistic adolescents, such as help with social skills, self-acceptance, and self-esteem. The findings also support the importance of increasing autism acceptance in the general population.

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4. Chen Y, Wang J, Guo Y, Zhu Z, Bai X, Li X. Reliability and validity of a novel caregiver-assessed skills system based on the ALSO conception in children with autism spectrum disorders. Translational pediatrics. 2021 ; 10(2) : 366-77.

BACKGROUND : In responding to the potential challenges in the transition from childhood to adulthood for individuals with autism spectrum disorders (ASD) in China, a novel conception of « ALSO » was proposed to bridge the transitional needs and early intervention. To facilitate the application of ALSO in early intervention, ALSOLIFE skills assessment system (ALSOLIFE Assessment) was developed to enable caregivers to evaluate their children’s skills guided by the ALSO conception. Given that the critical shortage of qualified professionals in China, many caregivers of children with ASD must function as home therapists. To address the practical needs of Chinese families of children with ASD, ALSOLIFE Assessment is designed as a free, online, technology-assisted, self-operated and behavioral intervention approaches supported system. The assessment report then further served as the basis for caregivers to deliver the tailored educational intervention to their children. Although ALSOLIFE Assessment provides caregivers a home-based intervention program, it is still unclear whether its evaluation is reliable and accurate. Therefore, we conduct this study to investigate the reliability and validity of the ALSOLIFE Assessment. METHODS : A total of 1,050 children with ASD (1 to 10 years old) were recruited from 31 provinces of mainland China. Their caregivers participated simultaneously as ALSOLIFE Assessment evaluators. The testing results of Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP) and Psychoeducational Profile-3 (PEP-3) were also collected for a portion of the child participants (VB-MAPP, N=34 ; PEP-3, N=31) to check criterion-related validity. RESULTS : The reliability and validity of the ALSOLIFE Assessment satisfied psychometric requirements after the reduction from 511 to 464 items. Exploratory factor analysis (EFA) of ALSOLIFE Assessment scoring data yielded six factors, and confirmatory factor analysis (CFA) verified the best fitting construct model is a bifactorial model with one general factor and six group factors. Compared to the VB-MAPP and PEP-3, the ALSOLIFE Assessment exhibited good criterion-related validity across three levels : total scores, 6 skill domains, and 22 skill subdomains. The reliability tests indicated its strong internal consistency, test-retest reliability, and inter-rater reliability. CONCLUSIONS : The reliability and validity of the revised ALSOLIFE Assessment (464-items) satisfied psychometric requirements. It is essential to develop validated and comprehensive evaluation tools, embedded on the needs of Chinese families of children with ASD.

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5. Davidovitch M, Shmueli D, Rotem RS, Bloch AM. Diagnosis despite clinical ambiguity : physicians’ perspectives on the rise in Autism Spectrum disorder incidence. BMC Psychiatry. 2021 ; 21(1) : 150.

BACKGROUND : To provide insight on physicians’ perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders. METHOD : A questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians’ opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed. RESULTS : 115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP : 8.6%, p < 0.01 ; mental illnesses : 25.8%, p = 0.03 ; ADHD : 68.4%, p = 0.03). CONCLUSION : The clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.

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6. Feng K, Zhao Y, Yu Q, Deng J, Wu J, Liu L. Can probiotic supplements improve the symptoms of autism spectrum disorder in children ? : A protocol for systematic review and meta analysis. Medicine. 2021 ; 100(10) : e18621.

INTRODUCTION : Autism spectrum disorder (ASD) is a neurodevelopmental disorder with increasing incidence. The externalizing and internalizing problems among children with ASD often persistent and highly impair functioning of both the child and the family. Children with ASD often develop gut-related comorbidities and dysbiosis can have negative effects on not only the gastrointestinal (GI) tract, but also psychological symptoms. Dietary exclusions and probiotic supplements also have been investigated in the management of ASD symptoms. Especially, there is some anecdotal evidence that probiotics supplements are able to alleviate GI symptoms as well as improve behaviors in children with ASD. METHOD AND ANALYSIS : This review will report on overall studies that include randomized control trials, randomized cross-over studies and cluster-randomized trials designs that consider curative effect in children with ASD by probiotic supplements. We will search 6 databases : MEDLINE, Embase, Scopus, PubMed, The Cochrane Library, and Web of Science and we will perform a manual search the journal Autism and information of ongoing or unpublished studies. The Mixed Methods Appraisal Tool (MMAT) will be used to assess quality of articles and the Jadad scale will be used to assess for bias. Assessment of publication bias will be performed using funnel plots generated by Comprehensive Meta-Analysis (CMA) 3.0 software. Clarifying the evidence in this area will be important for future research directions when reformulating and promoting the therapeutic regime in the field. ETHICS AND DISSEMINATION : There are no human participants, data, or tissue being directly studied for the purposes of the review ; therefore, ethics approval and consent to participate are not applicable. The results of this study will be presented at conferences and published in peer-reviewed journals. REGISTRATION AND STATUS : PROSPERO 2019 CRD42019132754.

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7. Hansen JB, Bilenberg N, Timmermann CAG, Jensen RC, Frederiksen H, Andersson AM, Kyhl HB, Jensen TK. Prenatal exposure to bisphenol A and autistic- and ADHD-related symptoms in children aged 2 and5 years from the Odense Child Cohort. Environmental health : a global access science source. 2021 ; 20(1) : 24.

BACKGROUND : Bisphenol A (BPA) is a non-persistent chemical with endocrine disrupting abilities used in a variety of consumer products. Fetal exposure to BPA is of concern due to the elevated sensitivity, which particularly relates to the developing brain. Several epidemiological studies have investigated the association between prenatal BPA exposure and neurodevelopment, but the results have been inconclusive. OBJECTIVE : To assess the association between in utero exposure to BPA and Attention Deficit/Hyperactivity Disorder (ADHD-) symptoms and symptoms of Autism Spectrum Disorder (ASD) in 2 and 5-year old Danish children. METHOD : In the prospective Odense Child Cohort, BPA was measured in urine samples collected in gestational week 28 and adjusted for osmolality. ADHD and ASD symptoms were assessed with the use of the ADHD scale and ASD scale, respectively, derived from the Child Behaviour Checklist preschool version (CBCL/1½-5) at ages 2 and 5 years. Negative binomial and multiple logistic regression analyses were performed to investigate the association between maternal BPA exposure (continuous ln-transformed or divided into tertiles) and the relative differences in ADHD and ASD problem scores and the odds (OR) of an ADHD and autism score above the 75th percentile adjusting for maternal educational level, maternal age, pre-pregnancy BMI, parity and child age at evaluation in 658 mother-child pairs at 2 years of age for ASD-score, and 427 mother-child pairs at 5 years of age for ADHD and ASD-score. RESULTS : BPA was detected in 85.3% of maternal urine samples even though the exposure level was low (median 1.2 ng/mL). No associations between maternal BPA exposure and ASD at age 2 years or ADHD at age 5 years were found. Trends of elevated Odds Ratios (ORs) were seen among 5 year old children within the 3rd tertile of BPA exposure with an ASD-score above the 75th percentile (OR = 1.80, 95% CI 0.97,3.32), being stronger for girls (OR = 3.17, 95% CI 1.85,9.28). A dose-response relationship was observed between BPA exposure and ASD-score at 5 years of age (p-trend 0.06) in both boys and girls, but only significant in girls (p-trend 0.03). CONCLUSION : Our findings suggest that prenatal BPA exposure even in low concentrations may increase the risk of ASD symptoms which may predict later social abilities. It is therefore important to follow-up these children at older ages, measure their own BPA exposure, and determine if the observed associations persist.

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8. Hedger N, Chakrabarti B. Autistic differences in the temporal dynamics of social attention. Autism. 2021 : 1362361321998573.

One behaviour often observed in individuals with autism is that they tend to look less towards social stimuli relative to neurotypical individuals. For instance, many eye-tracking studies have shown that individuals with autism will look less towards people and more towards objects in scenes. However, we currently know very little about how these behaviours change over time. Tracking these moment-to-moment changes in looking behaviour in individuals with autism can more clearly illustrate how they respond to social stimuli. In this study, adults with and without autism were presented with displays of social and non-social stimuli, while looking behaviours were measured by eye-tracking. We found large differences in how the two groups looked towards social stimuli over time. Neurotypical individuals initially showed a high probability of looking towards social stimuli, then a decline in probability, and a subsequent increase in probability after prolonged viewing. By contrast, individuals with autism showed an initial increase in probability, followed by a continuous decline in probability that did not recover. This pattern of results may indicate that individuals with autism exhibit reduced responsivity to the reward value of social stimuli. Moreover, our data suggest that exploring the temporal nature of gaze behaviours can lead to more precise explanatory theories of attention in autism.

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9. Huang S, Sun T, Zhu Y, Song S, Zhang J, Huang L, Chen Q, Peng G, Zhao D, Yu H, Jing J. Impact of the COVID-19 Pandemic on Children with ASD and Their Families : An Online Survey in China. Psychology research and behavior management. 2021 ; 14 : 289-97.

BACKGROUND : The COVID-19 pandemic and lockdown will have short-term and long-term psychosocial and mental health implications for children. Children with autism may have some specific needs for support because of their difficulties in social communication, stereotyped behavior patterns, and other specificities brought about by autism. PURPOSE : The purpose of this study was to investigate the impact of the COVID-19 pandemic on ASD children and their families. PATIENTS AND METHODS : A total of 406 parents of ASD children completed an online survey investigating basic information ; sleep, outdoor activities, and rehabilitation training ; ASD children’s frequency of abnormal behaviors ; and stress and emotional status of parents. RESULTS : 50.3% of the parents thought their children had sleep problems, and 47.3% of the parents thought their children’s outdoor activity time was reduced. About 40% of parents think that their children have improved cognitive ability, language expression, and understanding. 36.2% of the families reported that their children’s emotional and social performance became worse. 60.8% of parents reported that their children’s training intensity decreased. The most common abnormal behaviors observed in children with ASD were being easily distracted, losing temper, and crying. 81.3% of parents did not have anxiety, but 98% of parents reported that family training was under pressure. CONCLUSION : The main impact of the COVID-19 pandemic on children with ASD is that they do not have access to professional rehabilitation training. These families need more medical support, especially in family training, to help parents improve the social and emotional control skills of ASD children.

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10. Leader G, Flynn C, O’Rourke N, Coyne R, Caher A, Mannion A. Comorbid Psychopathology, Challenging Behavior, Sensory Issues, Adaptive Behavior and Quality of Life in Children and Adolescents with Autism Spectrum Disorder. Dev Neurorehabil. 2021 : 1-11.

Aim : Comorbid psychopathology refers to having a diagnosis of two or more co-occurring psychological disorders. The current study investigated the differences between children and adolescents with no-mild, moderate and severe comorbid psychopathology in children and adolescents with ASD.Method : Parents of 133 children completed the Autism Spectrum Disorder-Comorbid for Children, Behavior Problems Inventory-Short Form, Pediatric Quality of Life Inventory, Vineland Adaptive Behavior Scales, Social Communication Questionnaire, Short Sensory Profile, and Behavioral/Educational Interventions and Complementary/Alternative Medicine (CAM) Interventions of the Autism Treatment Network Registry Parent Baseline Assessment.Results : A significant difference was found between severity of comorbid psychopathology and all types of challenging behavior and all sensory issues except movement. A small effect size was also found between comorbid psychopathology and quality of life.Conclusion : The findings from this study show significant difficulties associated with those with comorbid psychopathology in ASD in challenging behavior, sensory issues and quality of life.

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11. Mamashli F, Kozhemiako N, Khan S, Nunes AS, McGuiggan NM, Losh A, Joseph RM, Ahveninen J, Doesburg SM, Hämäläinen MS, Kenet T. Children with autism spectrum disorder show altered functional connectivity and abnormal maturation trajectories in response to inverted faces. Autism Res. 2021.

The processing of information conveyed by faces is a critical component of social communication. While the neurophysiology of processing upright faces has been studied extensively in autism spectrum disorder (ASD), less is known about the neurophysiological abnormalities associated with processing inverted faces in ASD. We used magnetoencephalography (MEG) to study both long-range and local functional connectivity, with the latter assessed using local cross-frequency coupling, in response to inverted faces stimuli, in 7-18 years old individuals with ASD and age and IQ matched typically developing (TD) individuals. We found abnormally reduced coupling between the phase of the alpha rhythm and the amplitude of the gamma rhythm in the fusiform face area (FFA) in response to inverted faces, as well as reduced long-range functional connectivity between the FFA and the inferior frontal gyrus (IFG) in response to inverted faces in the ASD group. These group differences were absent in response to upright faces. The magnitude of functional connectivity between the FFA and the IFG was significantly correlated with the severity of ASD, and FFA-IFG long-range functional connectivity increased with age in TD group, but not in the ASD group. Our findings suggest that both local and long-range functional connectivity are abnormally reduced in children with ASD when processing inverted faces, and that the pattern of abnormalities associated with the processing of inverted faces differs from the pattern of upright faces in ASD, likely due to the presumed greater reliance on top-down regulations necessary for efficient processing of inverted faces. LAY SUMMARY : We found alterations in the neurophysiological responses to inverted faces in children with ASD, that were not reflected in the evoked responses, and were not observed in the responses to upright faces. These alterations included reduced local functional connectivity in the fusiform face area (FFA), and decreased long-range alpha-band modulated functional connectivity between the FFA and the left IFG. The magnitude of long-range functional connectivity between the FFA and the inferior frontal gyrus was correlated with the severity of ASD.

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12. Moore HL, Rogan L, Taylor LJ, Charman T, Le Couteur A, Green J, Grahame V. Which Factors Influence Teacher Report of Adaptive Functioning in Autistic Children ?. J Autism Dev Disord. 2021.

A wealth of parent-report research shows adaptive functioning difficulties in autistic children, with parent-report influenced by a number of child factors. Adaptive functioning in autistic children is known to vary across settings ; however, no research has yet explored factors influencing education professional-report. This study investigated the rate and profile of impairment, and child factors influencing education professional-reported adaptive skills in 248 autistic children. Twelve children were < 3 years (min age for available normative data on the adaptive function measure), so were removed from the analyses. Results replicated parent-literature ; adaptive skills were negatively associated with age and informant-reported autism severity, and positively associated with nonverbal ability and expressive language. Adaptive functioning is important for real-world outcomes, e.g. educational attainment, independence, and support needs. Improving our understanding of adaptive functioning in the education context may support opportunities for shared learning and enhance personalised support .

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13. Ozsahin I, Mustapha MT, Albarwary S, Sanlidag B, Ozsahin DU, Butler TA. An investigation to choose the proper therapy technique in the management of autism spectrum disorder. Journal of comparative effectiveness research. 2021 ; 10(5) : 423-37.

Aim : Autism spectrum disorder is a class of neurological disorders that affect the development of brain functions. This study aims to evaluate, compare and rank the therapy techniques used in the management of autism spectrum disorder using multicriteria decision-making approaches. Materials & methods : Fuzzy PROMETHEE and fuzzy TOPSIS approaches were used. Fuzzy PROMETHEE utilizes a pair-wise comparison of alternatives under the fuzzy environment while fuzzy TOPSIS utilizes geometric distance from the positive ideal solution under the fuzzy environment for the evaluation of the effectiveness of the alternatives.The techniques selected for evaluation are applied behavioral analysis, cognitive behavioral therapy, speech therapy and pharmacological therapy such as Risperidone and Aripiprazole. Criteria used in this study include efficacy, cost and side effects, and their weights are assigned based on specific patient conditions. Results : The results indicate that applied behavioral analysis, cognitive behavioral therapy and speech therapy are the most preferred techniques, followed by Aripiprazole and Risperidone. Conclusion : More criteria could be considered and the weights could be assigned according to the patient profile.

Lay abstract Autism spectrum disorder is a neurodevelopmental disorder (affecting the development of the brain) that usually presents during childhood. Because autism spectrum disorder has no cure, selecting the best therapy to manage the disorder is important for therapists, parents, health institutions and researchers with an interest in these types of disorders. This study focuses on comparing specific therapy techniques by using multicriteria decision-making methods. The result obtained by a decision-maker is not always the same, as different decision-makers may come up with different solutions depending on things like the cost and how well a therapy works on different aspects of the disorder. The outcome of the study indicates that applied behavioral analysis, cognitive behavioral therapy and speech therapy are preferred treatment alternatives, followed by treatment with Risperidone and Aripiprazole. Further analyses are needed to obtain more accurate patient-specific results that will incorporate specific patient demographics and data, as well as looking at the combination of two or three techniques.

eng

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14. Pham A, Kasenic A, Hayden L, Inwards-Breland DJ, Sumerwell C, Twible H, Ahrens KR, Orlich F. A Case Series on Disordered Eating Among Transgender Youth With Autism Spectrum Disorder. J Adolesc Health. 2021.

Transgender youth with autism spectrum disorder (ASD) may experience complex relationships with eating because of cognitive rigidity, including inflexible thoughts and behaviors around food and/or their body. Yet, there is no research that provides guidance to clinicians providing care for youth with the unique triad of gender dysphoria, ASD, and disordered eating. This case series discusses trends in presentation and management of three cases from a multidisciplinary gender care clinic. All three individuals endorsed rigid thoughts around food and/or body appearance, which affected nutritional intake ; however, their presenting eating disorder behaviors, described etiology for disordered thoughts, diagnosis, and level of engagement in a multidisciplinary treatment model varied. Based on these cases we hypothesize several strategies including early engagement with ASD specialists, proactive screening and discussions around eating with all transgender youth with suspected/confirmed ASD, continued discussions throughout care, as disordered eating behaviors may change after the initiation of gender-affirming medications, dietician visits early in treatment regardless of endorsed thoughts and behaviors, tailored management to the unique needs of each individual and their eating thoughts/behaviors, and consistent multidisciplinary collaboration.

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15. Rahmani Z, Fayyazi Bordbar MR, Dibaj M, Alimardani M, Moghbeli M. Genetic and molecular biology of autism spectrum disorder among Middle East population : a review. Human genomics. 2021 ; 15(1) : 17.

BACKGROUND : Autism spectrum disorder (ASD) is a neurodevelopmental disease, characterized by impaired social communication, executive dysfunction, and abnormal perceptual processing. It is more frequent among males. All of these clinical manifestations are associated with atypical neural development. Various genetic and environmental risk factors are involved in the etiology of autism. Genetic assessment is essential for the early detection and intervention which can improve social communications and reduce abnormal behaviors. Although, there is a noticeable ASD incidence in Middle East countries, there is still a lack of knowledge about the genetic and molecular biology of ASD among this population to introduce efficient diagnostic and prognostic methods. MAIN BODY : In the present review, we have summarized all of the genes which have been associated with ASD progression among Middle East population. We have also categorized the reported genes based on their cell and molecular functions. CONCLUSIONS : This review clarifies the genetic and molecular biology of ASD among Middle East population and paves the way of introducing an efficient population based panel of genetic markers for the early detection and management of ASD in Middle East countries.

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16. Sarma A. Crochetage Sign : An Invaluable Independent ECG Sign in Detecting ASD. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2021 ; 25(2) : 234-5.

Bedside diagnosis of congenital heart disease is sometimes very difficult in patient presenting with respiratory distress in intensive care unit. However, an ECG can provide abundant information regarding its presence and its management. A 25-year-old female presented with sudden onset of respiratory difficulty and shortness of breath, following delivery one day back. Echocardiography could not be done as a poor echo window was obtained and patient could not lie down supine. However, ECG revealed right axis deviation, RBBB, and notching in the apex of the R wave in inferior leads 2,3,aVF (crochetage sign). This is directed to the presence of ASD, which was confirmed with echocardiography after stabilization of patient. We would like to illustrate the importance of simple bedside ECG finding of crochetage sign in the diagnosis of ASD when echocardiography is not possible or available in underdeveloped countries. How to cite this article : Sarma A. Crochetage Sign : An Invaluable Independent ECG Sign in Detecting ASD. Indian J Crit Care Med 2021 ;25(2):234-235.

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17. Schwartz AE, Kramer JM. Inclusive approaches to developing content valid patient-reported outcome measure response scales for youth with intellectual/developmental disabilities. British journal of learning disabilities. 2021 ; 49(1) : 100-10.

BACKGROUND : Patient-reported outcome measures (PROMs) are increasingly used in health care to evaluate service quality and client progress. Response scales are a critical component of PROM content validity and must be designed to be relevant and comprehensible by users. METHODS : In collaboration with eight youth co-researchers with intellectual/developmental disabilities ages 14-21, we used an iterative, three-stage approach to develop and select a response scale for the PEDI-PRO. Stages : 1) inclusive development of response scale options ; 2) Collecting data about response scale options during focus groups with youth with intellectual/ developmental disabilities (n = 62) ; and 3) Analysing data to refine response options. RESULTS : Through two cycles of the three-stage process, the inclusive research approach led to the development of a content valid response scale that describes functional performance of everyday activities (« very easy, » « a little easy, » « a little hard »). CONCLUSION : An inclusive research approach can support the development of content valid PROM scales. We identified four broad strategies that supported youth co-researchers to engage in this response scale development process : universal design for learning, use of lived experiences, breaking down tasks, and peer support. Researchers may adopt and/or adapt the accessible inclusive research approaches described in this manuscript for measurement development and other research projects.

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18. Shrestha R, Barbaro J, Dissanayake C. Changes in Knowledge on the Signs of Autism in Young Children (11-30 Months) among Female Community Health Volunteers in Nepal. J Autism Dev Disord. 2021.

Nepalese Female Community Health Volunteers’ (FCHVs) knowledge on social attention and communication development and the early signs of autism was evaluated before, immediately after, and 12-months following training on typical and atypical social-communicative development in infants/toddlers, early signs of autism, and monitoring of key « markers » of autism using Social Attention and Communication Surveillance. FCHVs (N = 60) significantly improved their knowledge about autism and reported increased perceived confidence in monitoring and referring young children at high likelihood of autism following training, which was sustained one year later. FCHVs also reported a positive impact of training on their work. These findings indicate the effectiveness of training in improving FCHVs’ knowledge and perceived confidence to monitor and refer young children at high likelihood of autism.

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19. Wada M, Ikeda H, Kumagaya S. Atypical Effects of Visual Interference on Tactile Temporal Order Judgment in Individuals With Autism Spectrum Disorder. Multisensory research. 2020 ; 34(2) : 129-51.

Visual distractors interfere with tactile temporal order judgment (TOJ) at moderately short stimulus onset asynchronies (SOAs) in typically developing participants. Presentation of a rubber hand in a forward direction to the participant’s hand enhances this effect, while that in an inverted direction weakens the effect. Individuals with autism spectrum disorder (ASD) have atypical multisensory processing ; however, effects of interferences on atypical multisensory processing in ASD remain unclear. In this study, we examined the effects of visual interference on tactile TOJ in individuals with ASD. Two successive tactile stimuli were delivered to the index and ring fingers of a participant’s right hand in an opaque box. A rubber hand was placed on the box in a forward or inverted direction. Concurrently, visual stimuli provided by light-emitting diodes on the fingers of the rubber hand were delivered in a congruent or incongruent order. Participants were required to judge the temporal order of the tactile stimuli regardless of visual distractors. In the absence of a visual stimulus, participants with ASD tended to judge the simultaneous stimuli as the ring finger being stimulated first during tactile TOJ compared with typically developing (TD) controls, and congruent visual stimuli eliminated the bias. When incongruent visual stimuli were delivered, judgment was notably reversed in participants with ASD, regardless of the direction of the rubber hand. The findings demonstrate that there are considerable effects of visual interferences on tactile TOJ in individuals with ASD.

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20. Zeleke WA, Hughes TL, Kanyongo G. Assessing the Effectiveness of Professional Development Training on Autism and Culturally Responsive Practice for Educators and Practitioners in Ethiopia. Frontiers in psychiatry. 2020 ; 11 : 583674.

This study examines the effect of professional development training on educators’ and practitioners’ knowledge of Autism and the use of culturally responsive practices. Using a single group, pre-post design, data was gathered from 34 educators and health professionals (i.e., teachers, counselors, psychologists, therapists, therapeutic care workers, social workers, and nurses) in Ethiopia. A week-long training covering ASDs and culturally responsive evidence-based training was provided to participants. Results showed significant improvement in participants’ knowledge about ASD symptoms, nature, characteristics, as well as intervention selection. Participants’ use of culturally informed approaches, in their area of professional service, showed a high level of participants’ knowledge and low-level use of culturally responsive practices, policies, and procedures. Recommendations for addressing cultural factors impacting the diagnosis and treatment-seeking approaches to ASD in Africa are provided.

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