1. Atherton G, Piovesan A, Cross L. Autism, pets, and the importance of seeing human. Autism research : official journal of the International Society for Autism Research. 2023.

People often see the human in the nonhuman, a process called anthropomorphism. Anthropomorphism is particularly prolific regarding the humanization of pets. Some research suggests that people with autism may not anthropomorphize to the same degree as neurotypicals. In this study, we explored whether there were differences in how autistic and neurotypical pet owners anthropomorphized their pets. We also examined differences in levels of connectedness to nature and experiences of loneliness and how this corresponded to autistic traits in the entire sample. We found anthropomorphism was as common among autistic pet owners as in neurotypicals. However, autistic pet owners reported greater loneliness and were more likely to substitute pets for people. We also found that neurotypical pet owners rated pets more highly on physical, non-anthropomorphic traits (i.e., muscular, active). In contrast, autistic pet owners were likelier to rate pets equally between physical and anthropomorphic traits. Moreover, we found that anthropomorphism and connection to nature were positively correlated with autistic traits. These findings challenge accounts stating that individuals with autism may not anthropomorphize to the same degree as neurotypicals. Implications for animal-based interventions supporting adults on the spectrum are discussed.

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2. Clarke KA, Siegel M, Williams DL. The Relationship Between Augmentative and Alternative Communication Use by Pediatric Psychiatric Inpatients With Autism Spectrum Disorder and Interfering Behaviors. American journal of speech-language pathology. 2023: 1-17.

PURPOSE: Previous research conducted by Williams et al. (2018) using data from the Autism Inpatient Collection (AIC) found a weak and inconsistent association between verbal ability and the severity of interfering behaviors; however, adapting/coping scores were significantly associated with self-injury, stereotypy, and irritability (including aggression and tantrums). The previous study did not account for access to or use of alternative forms of communication in their sample population. This study uses retrospective data to investigate the association between verbal ability and augmentative and alternative communication (AAC) use and the presence of interfering behaviors in individuals with autism who have complex behavioral profiles. METHOD: The sample included 260 autistic inpatients, ages 4-20 years, from six psychiatric facilities, enrolled during the second phase of the AIC when detailed information about AAC use was collected. Measures included AAC use, method, and function; comprehension and production of language; receptive vocabulary; nonverbal IQ; severity of interfering behaviors; and the presence and severity of repetitive behaviors. RESULTS: Lower language/communication abilities were related to increased repetitive behaviors and stereotypies. More specifically, these interfering behaviors appeared to be related to communication in those individuals who were candidates for AAC but who were not reported to have access to it. Although the use of AAC did not predict a decrease in interfering behaviors, receptive vocabulary scores-as measured by the Peabody Picture Vocabulary Test-Fourth Edition-were positively correlated with the presence of interfering behaviors in participants with the most complex communication needs. CONCLUSIONS: The communication needs of some individuals with autism may be unmet, prompting the use of interfering behaviors as a form of communication. Further investigation of the functions of interfering behaviors and the related functions of communication skills may provide greater support for an increased focus on the provision of AAC to prevent and ameliorate interfering behaviors in individuals with autism.

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3. Corbett BA, McGonigle T, Muscatello RA, Liu J, Vandekar S. The developmental trajectory of diurnal cortisol in autistic and neurotypical youth. Development and psychopathology. 2023: 1-12.

Increasing age and puberty affect the hypothalamic pituitary adrenal (HPA) axis maturation, which is likely associated with an increase in environmental demands (e.g., social) and vulnerability for the onset of psychiatric conditions (e.g., depression). There is limited research as to whether such patterns are consonant in youth with autism spectrum disorder (ASD), a condition marked by social challenges, dysregulation of the HPA axis, and higher rates of depression setting the stage for enhanced vulnerability during this developmental period.The current study interrogated diurnal cortisol by examining (1) cortisol expression longitudinally over the pubertal transition between autistic and neurotypical youth, (2) the trajectory of diurnal cortisol and the unique contributions of age vs. puberty, and (3) potential sex differences. As hypothesized, results indicate autistic compared to typically developing youth demonstrate a shallower diurnal slope and elevated evening cortisol. These differences were in the context of higher cortisol and flatter rhythms based on age and pubertal development. Also, sex-based differences emerged such that females in both groups had higher cortisol, flatter slopes, and higher evening cortisol than males. The results show that despite the trait-like stability of diurnal cortisol, HPA maturation is impacted by age, puberty, sex, as well as an ASD diagnosis.

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4. Green J. Debate: Neurodiversity, autism and healthcare. Child and adolescent mental health. 2023.

We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years-with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child’s life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.

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5. Hawkins R. Commentary: Reviewing neurodiversity, autism, and healthcare by Jonathan Green (2023) from an autistic perspective. Child and adolescent mental health. 2023.

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6. Irwin J, Harwood V, Kleinman D, Baron A, Avery T, Turcios J, Landi N. Neural and Behavioral Differences in Speech Perception for Children With Autism Spectrum Disorders Within an Audiovisual Context. Journal of speech, language, and hearing research : JSLHR. 2023; 66(7): 2390-403.

PURPOSE: Reduced use of visible articulatory information on a speaker’s face has been implicated as a possible contributor to language deficits in autism spectrum disorders (ASD). We employ an audiovisual (AV) phonemic restoration paradigm to measure behavioral performance (button press) and event-related potentials (ERPs) of visual speech perception in children with ASD and their neurotypical peers to assess potential neural substrates that contribute to group differences. METHOD: Two sets of speech stimuli, /ba/-« /a/ » (« /a/ » was created from the /ba/ token by a reducing the initial consonant) and /ba/-/pa/, were presented within an auditory oddball paradigm to children aged 6-13 years with ASD (n = 17) and typical development (TD; n = 33) within two conditions. The AV condition contained a fully visible speaking face; the pixelated (PX) condition included a face, but the mouth and jaw were PX, removing all articulatory information. When articulatory features were present for the /ba/-« /a/ » contrast, it was expected that the influence of the visual articulators would facilitate a phonemic restoration effect in which « /a/ » would be perceived as /ba/. ERPs were recorded during the experiment while children were required to press a button for the deviant sound for both sets of speech contrasts within both conditions. RESULTS: Button press data revealed that TD children were more accurate in discriminating between /ba/-« /a/ » and /ba/-/pa/ contrasts in the PX condition relative to the ASD group. ERPs in response to the /ba/-/pa/ contrast within both AV and PX conditions differed between children with ASD and TD children (earlier P300 responses for children with ASD). CONCLUSION: Children with ASD differ in the underlying neural mechanisms responsible for speech processing compared with TD peers within an AV context.

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7. Khan A, Kamal M, Alhothi A, Gad H, Adan MA, Ponirakis G, Petropoulos IN, Malik RA. Corneal confocal microscopy demonstrates sensory nerve loss in children with autism spectrum disorder. PloS one. 2023; 18(7): e0288399.

Autism spectrum disorder (ASD) is a developmental disorder characterized by difficulty in communication and interaction with others. Postmortem studies have shown cerebral neuronal loss and neuroimaging studies show neuronal loss in the amygdala, cerebellum and inter-hemispheric regions of the brain. Recent studies have shown altered tactile discrimination and allodynia on the face, mouth, hands and feet and intraepidermal nerve fiber loss in the legs of subjects with ASD. Fifteen children with ASD (age: 12.00 ± 3.55 years) and twenty age-matched healthy controls (age: 12.83 ± 1.91 years) underwent corneal confocal microscopy (CCM) and quantification of corneal nerve fiber morphology. Corneal nerve fibre density (fibers/mm2) (28.61 ± 5.74 vs. 40.42 ± 8.95, p = 0.000), corneal nerve fibre length (mm/mm2) (16.61 ± 3.26 vs. 21.44 ± 4.44, p = 0.001), corneal nerve branch density (branches/mm2) (43.68 ± 22.71 vs. 62.39 ± 21.58, p = 0.018) and corneal nerve fibre tortuosity (0.037 ± 0.023 vs. 0.074 ± 0.017, p = 0.000) were significantly lower and inferior whorl length (mm/mm2) (21.06 ± 6.12 vs. 23.43 ± 3.95, p = 0.255) was comparable in children with ASD compared to controls. CCM identifies central corneal nerve fiber loss in children with ASD. These findings, urge the need for larger longitudinal studies to determine the utility of CCM as an imaging biomarker for neuronal loss in different subtypes of ASD and in relation to disease progression.

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8. Magidigidi L, Roman NV, Sonn IK. Human capabilities of South African parents who have children with developmental disabilities. African journal of disability. 2023; 12: 1155.

BACKGROUND: Parenting a child with a developmental disability (DD) has a substantial influence on the lives of the parents or caregivers, as well as on how the family operates. This is frequently because of the adjustments in some daily practices that are crucial for parents’ or caregivers’ human capabilities to provide for childcare. There is not enough research done on human capabilities of parents or children with DD in South Africa. OBJECTIVES: This study investigated the available support in improving the human capabilities of parents or caregivers with children with DD and the bodily health and bodily integrity human capabilities of parents or caregivers with children with DD. METHOD: Qualitative interviews were conducted with 11 parents or caregivers of children aged between 1 and 8 years old with DD. This study used snowball sampling. Thematic data analysis was chosen to analyse the data collected. RESULTS: The results of the study indicate that participants have difficulties bringing up their children because of the emotional strain that goes along with parenting a child with DD. In addition, participants were not able to afford decent and satisfactory shelter and had limited access to good quality food because they could not afford it. CONCLUSION: A lack of social support and care burden influences parents’ or caregivers’ ability to raise their child with developmental disability. CONTRIBUTION: The study contains helpful information about families of children with DD in under-resourced locations. The information may be of significance to policymakers who are accountable for designing and executing policies that are targeted at assisting parents or caregivers of children with DD.

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9. Nicolardi V, Fanizza I, Accogli G, Macchitella L, Scoditti S, Trabacca A. Pain assessment in autism: updating the ethical and methodological challenges through a state-of-the-art review. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 2023.

Sensory features of autism include hypo- or hyper-reactivity to pain; however, previous studies on pain in autism lead to conflicting results. Here, we present the state of the art and the methodological challenges concerning pain perception in autism, focusing on studies that used standardized protocol as Quantitative Sensory Testing (QST) to measure perception. Despite there are still scant evidences found with the use of QST, they have challenged the presumed hyposensitivity to pain in autisms, which emerged from parents’ reports. Both, peripheral and central mechanisms, have been found involved in typical features of perception in autism. Nonetheless, evidences with controlled protocols are still scarce, and even scarcer are studies focused on children. Overall, complex ethical challenges have to be overcome in order to collect subjective and objective measures from autistic children. With heterogeneous neurodevelopmental features, or intellectual disability, novel or modified protocols are needed.

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10. Radhoe TA, Agelink van Rentergem JA, Torenvliet C, Groenman AP, van der Putten WJ, Geurts HM. Finding Similarities in Differences Between Autistic Adults: Two Replicated Subgroups. Journal of autism and developmental disorders. 2023.

Autism is heterogeneous, which complicates providing tailored support and future prospects. We aim to identify subgroups in autistic adults with average to high intelligence, to clarify if certain subgroups might need support. We included 14 questionnaire variables related to aging and/or autism (e.g., demographic, psychological, and lifestyle). Community detection analysis was used for subgroup identification in an original sample of 114 autistic adults with an adulthood diagnosis (autism) and 58 non-autistic adults as comparison group (COMP), and a replication sample (N(Autism) = 261; N(COMP) = 287), both aged 30-89 years. Next, we identified subgroups and assessed external validity (for cognitive and psychological difficulties, and quality of life [QoL]) in the autism samples. To test specificity, we repeated the analysis after adding 123 adults with ADHD, aged 30-80 years. As expected, the autism and COMP groups formed distinct subgroups. Among autistic adults, we identified three subgroups of which two were replicated. One of these subgroups seemed most vulnerable on the cluster variables; this subgroup also reported the most cognitive and psychological difficulties, and lowest QoL. Adding the ADHD group did not alter results. Within autistic adults, one subgroup could especially benefit from support and specialized care, although this must be tested in future studies.

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11. Teneqexhi P, Khalid A, Nisbett KE, Job GA, Messer WS, Jr., Ragozzino ME. The Partial M(1) Muscarinic Cholinergic Receptor Agonist, CDD-0102A, Differentially Modulates Glutamate Efflux in Striatal Subregions during Stereotyped Motor Behavior in the BTBR Mouse Model of Autism. ACS chemical neuroscience. 2023.

The BTBR T(+) Itpr3(tf)/J (BTBR) mouse displays elevated repetitive motor behaviors. Treatment with the partial M(1) muscarinic receptor agonist, CDD-0102A, attenuates stereotyped motor behaviors in BTBR mice. The present experiment investigated whether CDD-0102A modifies changes in striatal glutamate concentrations during stereotyped motor behavior in BTBR and B6 mice. Using glutamate biosensors, change in striatal glutamate efflux was measured during bouts of digging and grooming behavior with a 1 s time resolution. Mice displayed both decreases and increases in glutamate efflux during such behaviors. Magnitude of changes in glutamate efflux (decreases and increases) from dorsomedial and dorsolateral striatum were significantly greater in BTBR mice compared to those of B6 mice. In BTBR mice, CDD-0102A (1.2 mg/kg) administered 30 min prior to testing significantly reduced the magnitude change in glutamate decreases and increases from the dorsolateral striatum and decreased grooming behavior. Conversely, CDD-0102A treatment in B6 mice potentiated glutamate decreases and increases in the dorsolateral striatum and elevated grooming behavior. The findings suggest that activation of M(1) muscarinic receptors modifies glutamate transmission in the dorsolateral striatum and self-grooming behavior.

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12. Torenvliet C, Groenman AP, Lever AG, Ridderinkhof KR, Geurts HM. Prepotent response inhibition in autism: Not an inhibitory deficit?. Cortex; a journal devoted to the study of the nervous system and behavior. 2023; 166: 275-85.

Research outcomes on prepotent response inhibition in neurodevelopmental conditions during adulthood seem inconsistent, especially in autism. To gain further insight in these inconsistencies, the current study investigates inhibitory performance, as well as task strategies such as adaptive behavior during inhibitory tasks in autistic adults. As Attention-Deficit/Hyperactivity Disorder (ADHD) is often co-occurring in autism and associated with differences in both inhibition and adaptation, the role of ADHD symptoms is explored. Additionally, prior research is extended to middle- and late-adulthood, and the role of cognitive aging is assessed. Hundred-and-five autistic adults and 139 non-autistic adults (age: 20-80 yrs) were compared on a Go-NoGo task. No significant group differences in inhibitory difficulties (commission errors) or adaptation (post error slowing) were observed, and both did not relate significantly to ADHD symptoms. However, when controlling for reaction time autistic individuals made significantly more inhibitory errors than non-autistic individuals, yet the effect size was modest (Cohen’s d = .27). Exploratory analyses showed that adaption significantly related to inhibition in non-autistic individuals only, possibly hinting at altered adaptive behavior during inhibitory tasks in autistic adults. ADHD symptoms related to response variability in the autism group only. Furthermore, task strategy changed with older age in both groups, with slower and more cautious responses at older age. Taken together, although minor differences may exist, autistic and non-autistic people show largely similar patterns of inhibitory behavior throughout adulthood. Differences in task timing and strategy seem relevant for future longitudinal studies on cognitive aging across neurodevelopmental conditions.

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13. Turpin V, Schaffhauser M, Thabault M, Aubert A, Joffre C, Balado E, Longueville JE, Francheteau M, Burucoa C, Pichon M, Layé S, Jaber M. Mice prenatally exposed to valproic acid do not show autism-related disorders when fed with polyunsaturated fatty acid-enriched diets. Scientific reports. 2023; 13(1): 11235.

Dietary supplementations with n-3 polyunsaturated fatty acid (PUFA) have been explored in autism spectrum disorder (ASD) but their efficiency and potential in ameliorating cardinal symptoms of the disease remain elusive. Here, we compared a n-3 long-chain (LC) PUFA dietary supplementation (n-3 supp) obtained from fatty fish with a n-3 PUFA precursor diet (n-3 bal) obtained from plant oils in the valproic acid (VPA, 450 mg/kg at E12.5) ASD mouse model starting from embryonic life, throughout lactation and until adulthood. Maternal and offspring behaviors were investigated as well as several VPA-induced ASD biological features: cerebellar Purkinje cell (PC) number, inflammatory markers, gut microbiota, and peripheral and brain PUFA composition. Developmental milestones were delayed in the n-3 supp group compared to the n-3 bal group in both sexes. Whatever the diet, VPA-exposed offspring did not show ASD characteristic alterations in social behavior, stereotypies, PC number, or gut microbiota dysbiosis while global activity, gait, peripheral and brain PUFA levels as well as cerebellar TNF-alpha levels were differentially altered by diet and treatment according to sex. The current study provides evidence of beneficial effects of n-3 PUFA based diets, including one without LCPUFAs, on preventing several behavioral and cellular symptoms related to ASD.

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14. Whitehouse A. Commentary: A spectrum for all? A response to Green et al. (2023), neurodiversity, autism and health care. Child and adolescent mental health. 2023.

The broadening of the clinical definition of autism over time-the so-called, autism spectrum-has run in parallel with the growth of a neurodiversity movement that has reframed the concept of autism entirely. Without a coherent and evidence-based framework through which both of these advances can be situated, the field is at risk of losing definition altogether. In his commentary, Green describes such a framework, which has appeal because of its grounding in basic and clinical evidence, and its ability to guide its users through its real-world application in health care. An endless spectrum creates barriers to autistic children having their human rights met, but a denial of neurodiversity principles has the same effect. Green’s framework holds great promise in coherently framing this sentiment. The real test of the framework is in its implementation, and all communities should walk that path together.

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15. Yeung PP, Johnson KA, Riesenberg R, Orejudos A, Riccobene T, Kalluri HV, Malik PR, Varughese S, Findling RL. Cariprazine in Pediatric Patients with Autism Spectrum Disorder: Results of a Pharmacokinetic, Safety and Tolerability Study. Journal of child and adolescent psychopharmacology. 2023.

Objective: Cariprazine is a dopamine D(3)-preferring D(3)/D(2) and serotonin 5-HT(1A) receptor partial agonist approved to treat adults with schizophrenia and manic/mixed or depressive episodes associated with bipolar I disorder. This study, which is the first to evaluate cariprazine in pediatric patients with autism spectrum disorder (ASD) (including children 5-9 years of age) using an oral solution formulation, evaluated the safety, tolerability, pharmacokinetics (PK), and exploratory efficacy of cariprazine and its two major active metabolites, desmethyl cariprazine (DCAR) and didesmethyl cariprazine (DDCAR). Methods: This clinical pharmacology, open-label, multiple-dose study enrolled 25 pediatric patients from 5 to 17 years of age, who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for ASD. All patients began treatment with cariprazine 0.5 mg once daily (QD) and underwent a titration over 7 days to maintenance doses of 1.5 or 3 mg QD for patients 13-17 years of age at Screening, 0.75 or 1.5 mg QD for patients 10-12 years of age at Screening, and 0.5 or 1.5 mg QD for patients 5-9 years of age at Screening. After 6 weeks total of dosing, there was a 6-week follow-up period. Study assessments included adverse events (AEs), safety parameters, noncompartmental PK parameters, and exploratory efficacy assessments, including the Aberrant Behavior Checklist-Irritability Subscale (ABC-I), Clinical Global Impressions (CGI-S), Caregiver Global Impressions (CgGI-S), Children’s Yale-Brown Obsessive Compulsiveness Scale Modified for ASD (CYBOCS-ASD), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scale (VABS-III). Results: All AEs were mild or moderate in severity. Most frequent treatment-emergent adverse events (TEAEs) were increased weight, increased alanine aminotransferase, increased appetite, dizziness, agitation, and nasal congestion. Increases in weight were not considered clinically meaningful. Two subjects reported extrapyramidal symptom-related TEAEs that resolved without leading to discontinuation. Dose-normalized exposures of all analytes were modestly higher in pediatric patients from 5 to 9 years of age when compared to older patients. Consistent with previous studies, at steady state, the rank of exposure in plasma was DDCAR > cariprazine > DCAR. There was numerical improvement on all exploratory endpoints (ABC-I, CGI-S, CgGI-S, CYBOCS-ASD, SRS, and VABS-III). Conclusions: PK of cariprazine and its metabolites were characterized in pediatric patients with ASD at doses up to 3 mg QD (13-17 years) and 1.5 mg QD (5-12 years). Caripazine treatment was generally well tolerated and results from this study will inform the selection of appropriate pediatric doses for subsequent studies.

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