1. Bujnowska AM, Rodríguez C, García T, Areces D, Marsh NV. Coping with stress in parents of children with developmental disabilities. International journal of clinical and health psychology : IJCHP. 2021; 21(3): 100254.

ABSTRACT BACKGROUND/OBJECTIVE: Previous findings indicated that parents of children with developmental disabilities face greater care giving demands and report higher levels of stress. This study explores the styles and strategies of coping with stress among parents of children with developmental disabilities compared to parents of children with typical development. METHOD: 167 parents of children with developmental disabilities and 103 parents of typical development children participated as a voluntary. The CISS and the COPE Inventory were used to assess the coping styles and strategies in rearing a child. RESULTS: The results from Multivariate Analysis indicated significant differences between parents of children with and without developmental disabilities in one of three coping styles and one of eight coping strategies. Parents of children with developmental disabilities less often used the avoidance-oriented style and emotional support strategy. The task-oriented style and strategies were the dominant approach in both groups of parents. In stressful situations connected with rearing a child, parents of children with developmental disabilities do not use as dominant strategies connected with seeking emotional support and religion, which occur in the parents of typical development children. CONCLUSIONS: The results suggest areas where coping may be different than in families of children without DD.

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2. Cao J, Chai-Zhang TC, Huang Y, Eshel MN, Kong J. Potential scalp stimulation targets for mental disorders: evidence from neuroimaging studies. Journal of translational medicine. 2021; 19(1): 343.

Mental disorders widely contribute to the modern global disease burden, creating a significant need for improvement of treatments. Scalp stimulation methods (such as scalp acupuncture and transcranial electrical stimulation) have shown promising results in relieving psychiatric symptoms. However, neuroimaging findings haven’t been well-integrated into scalp stimulation treatments. Identifying surface brain regions associated with mental disorders would expand target selection and the potential for these interventions as treatments for mental disorders. In this study, we performed large-scale meta-analyses separately on eight common mental disorders: attention deficit hyperactivity disorder, anxiety disorder, autism spectrum disorder, bipolar disorder, compulsive disorder, major depression, post-traumatic stress disorder and schizophrenia; utilizing modern neuroimaging literature to summarize disorder-associated surface brain regions, and proposed neuroimaging-based target protocols. We found that the medial frontal gyrus, the supplementary motor area, and the dorsal lateral prefrontal cortex are commonly involved in the pathophysiology of mental disorders. The target protocols we proposed may provide new brain targets for scalp stimulation in the treatment of mental disorders, and facilitate its clinical application.

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3. Cooper K, Mandy W, Butler C, Russell A. The lived experience of gender dysphoria in autistic adults: An interpretative phenomenological analysis. Autism : the international journal of research and practice. 2022; 26(4): 963-74.

Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about their gender and sex assigned at birth not matching which is called gender dysphoria. Research has focused on finding out why autistic people are more likely to have gender dysphoria, and less on what the experience of gender dysphoria is like for autistic people. We interviewed 21 autistic adults about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. We carefully read the transcripts of the interviews, focusing on how participants understood their experiences. We found a range of themes from the interviews. Participants were distressed because their bodies did not match their gender identities. Participants told us they had to work hard to understand themselves and who they were, and to manage having multiple different needs such as mental health needs. It was upsetting for participants to experience discrimination because of being autistic and/or transgender. Some participants said it was more difficult to get transgender healthcare as an autistic person. Some participants thought being autistic had helped them understand their gender identity more than non-autistic people. Other participants found it was challenging to be both autistic and transgender. For example, most participants wanted to change their bodies to match their gender identity, but some participants were nervous about making changes to themselves and their routine due to being autistic. We conclude that autism can in some ways be helpful and other ways contribute to challenges for transgender autistic people.

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4. Kunugi H. [Intestinal Flora and Mental Disorders: A Focus on Mood Disorders and Autism Spectrum Disorder]. Brain and nerve = Shinkei kenkyu no shinpo. 2021; 73(8): 871-7.

The intestinal flora plays a key role in the stress response and barrier function of the gut, both of which are closely associated with the pathophysiology of mental health conditions, such as mood disorders and autistic spectrum disorder through the phenomenon of brain-gut interaction. Despite increasing accumulation of empirical data regarding the contribution of the gut microbiota to these disorders, studies have reported inconsistent results. Notably, short chain fatty acid-producing bacteria and those implicated in the pathophysiology of metabolic diseases appear to be associated with the psychiatric conditions. Clinical trials have shown some evidence to suggest the beneficial effects of probiotics in depressive and neurodevelopmental disorders. Limited studies have discussed this subject; however, the role of the intestinal flora in the pathophysiology and treatment of mental disorders appears to be a promising field of research.

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5. Matthews NL, Skepnek E, Mammen MA, James JS, Malligo A, Lyon A, Mitchell M, Kiefer SL, Smith CJ. Feasibility and acceptability of a telehealth model for autism diagnostic evaluations in children, adolescents, and adults. Autism research : official journal of the International Society for Autism Research. 2021; 14(12): 2564-79.

This study examined the feasibility and acceptability of a telehealth diagnostic model deployed at an autism center in the southwestern United States to safely provide autism spectrum disorder (ASD) diagnostic evaluations to children, adolescents, and adults during the COVID-19 pandemic. Participants included all clients for whom a telehealth diagnostic evaluation was scheduled at the diagnostic clinic (n = 121) over a 6-month period. Of 121 scheduled clients, 102 (84%) completed the telehealth evaluation. A diagnostic determination was made for 91% of clients (93 out of 102) using only telehealth procedures. Nine participants (two females; ages 3 to 11 years) required an in-person evaluation. Responses from psychologist and parent acceptability surveys indicated the model was acceptable for most clients. Psychologist ratings suggested that telehealth modalities used in the current study may be less acceptable for evaluating school-aged children with subtle presentations compared to children in the early developmental period, adolescents, and adults. Parents of females reported higher acceptability than parents of males. Findings contribute to the small but growing literature on feasibility and acceptability of telehealth evaluations for ASD and have implications for improving access to care during and after the COVID-19 pandemic. LAY SUMMARY: This study described telehealth methods for evaluating children, adolescents, and adults for autism spectrum disorder. Telehealth methods were generally acceptable to psychologists conducting the evaluations and parents of diagnostic clients. Psychologists reported the methods to be less acceptable for school-aged children and parents of males found the methods less acceptable than parents of females. The telehealth methods described may help to increase access to diagnostic professionals and reduce wait times for evaluations during and after the COVID-19 pandemic.

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6. Meharwade P, Nookala H, Kajjari S, Malavalli P, Hugar SM, Uppin C. Bridging the communication gap in autistic children, one picture at a time. Journal of oral biology and craniofacial research. 2021; 11(4): 507-10.

One of the main domains of paediatric dentistry is providing oral health care, especially to the children with special needs, like those affected with autism spectrum disorder (ASD). Such children exhibit poor oral hygiene primarily due to their limited communication ability, lack of joint attention, oversensitivity to sensory stimuli and motor coordination deficits. In such cases, multiple studies suggest and emphasize on the importance of early use of interventional services. Children affected with ASD tend to be visual learners, and therefore, are better suited for visual interventional methods. Amongst which, picture exchange communication system (PECS), originally developed by Bondy-Frost, is gaining rapid momentum. It is suggested to help individuals to initiate requests and communicate their needs via picture cards; hence aid in acquiring functional communication and speech, improve socio-communicative impairments, and decrease the behavioural problems. This scoping review aims to raise awareness on PECS amongst the dental fraternity, by emphasizing its usage pertaining to dentistry. PECS though rated hard, has proved to be beneficial in improving oral hygiene practices among autistic children.

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7. Mirsky LB, Rogo EJ, Gurenlian JR. Oral Care Experiences of Young Adults with Autism Spectrum Disorder. Journal of dental hygiene : JDH. 2021; 95(4): 41-50.

Purpose: Individuals with autism need oral health care providers who understand their sensitivities and are responsive to their oral health care needs. The purpose of this study was to understand the oral health care experiences and needs of young adults with autism spectrum disorder (ASD).Methods: A qualitative descriptive research design was used and young adults with ASD were recruited through purposive and snowball sampling. Semi-structured interviews with open-ended questions were conducted and audio-recorded. Pseudonyms were used to protect confidentiality. Interviews were transcribed and data were analyzed simultaneously at the time of data collection. Open coding and axial coding were used to create common categories. Validity was established using investigator triangulation and member checks.Results: Fifteen individuals (ten males and five females) met the inclusion criteria and participated in the study. Participants revealed a range of feelings related to their oral care experiences from positive to neutral to negative. Participants identified likes and dislikes in regard to dental hygiene and dental treatment as well as daily self-care practices. Individuals reported that improvements in communication were needed; some indicated not wanting to disclose their ASD diagnosis with their oral care providers. Multiple auditory, visual, and tactile sensory challenges were experienced while waiting in the reception area and during the provision of oral health care treatment. Participants made recommendations to improve oral health care experiences.Conclusions: Results from this study offered insight into the oral care experiences of young adults with ASD and the challenges they encounter. Additional research is needed to further explore this phenomenon from the perspective of non-verbal individuals with ASD and from the standpoint of oral health care professionals who are working with young adults with developmental disabilities.

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8. Shawahna R, Jaber M, Yahya N, Jawadeh F, Rawajbeh S. Are medical students in Palestine adequately trained to care for individuals with autism spectrum disorders? A multicenter cross-sectional study of their familiarity, knowledge, confidence, and willingness to learn. BMC medical education. 2021; 21(1): 424.

BACKGROUND: Medical students are the future workforce of physicians in primary, secondary, tertiary, and highly specialized care centers. The present study was undertaken to assess familiarity, knowledge, confidence, of medical students with regard to autism spectrum disorders (ASDs). METHODS: This multicenter study was conducted in a cross-sectional design among medical students in the 3 main universities in Palestine. In addition to the sociodemographic and academic details, the questionnaire measured familiarity (8-items), knowledge (12-items), confidence and willingness to learn (5-items) with regard to ASDs. RESULTS: The questionnaire was completed by309 medical students (response rate = 77.3 %). The median familiarity, knowledge, and confidence scores were 50 % (42.5 %, 57.5 %), 50 % (41.7 %, 66.7 %), and 60.0 % (54.0 %, 68.0 %), respectively. There was a positive moderate correlation between familiarity and knowledge scores (Spearman’s rho = 0.29, p-value < 0.001) and familiarity and confidence scores (Spearman's rho = 0.34, p-value < 0.001). Medical students who have received a course on autism were 3.08-fold (95 % C.I. of 1.78-5.31) more likely to score ≥ 50 % on the familiarity items compared to those who did not receive a course. The medical students who were in their clinical academic stage, who received a course on ASDs, and those who interacted with individuals with ASDs were 2.36-fold (95 % C.I. of 1.34-4.18), 2.66-fold (95 % C.I. of 1.52-4.65), and 2.59-fold (95 % C.I. of 1.44-4.63) more likely to score ≥ 50 % on the knowledge items. Medical students who reported high satisfaction with their social life were 2.84-fold (95 % C.I. of 1.15-7.00) more likely to score ≥ 50 % on the confidence items. CONCLUSIONS: The present study identified considerable awareness and knowledge gaps among medical students with regard to ASDs. Medical students in this study reported low confidence in their ability to provide healthcare services to individuals with ASDs. Appropriately designed educational interventions might improve familiarity, knowledge, and confidence of medical students. More studies are still needed to investigate if such interventions can improve healthcare services for individuals with ASDs.

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9. Trambacz-Oleszak S, Nosulia T. [Genetic factors in Autism Spectrum Disorders (ASD)]. Postepy biochemii. 2021; 67(1): 28-33.

Autism spectrum disorder (ASD) is common early neurodevelopmental disorder characterized by a varied trajectory and symptoms which affects diagnosis and therapy. For this reason, great diagnostic and therapeutic possibilities are seen in genetic studies. The aim of this review is to discuss the genetic architecture of ASD and possible therapeutic strategies.The patterns of ASD inheritance are discussed, genetic variations (including CNV polymorphisms) and the percentage of the ASD patients divided into specific classes of genetic mutations are indicated. The paper shows the most important three basic models of inheritance: polygenic, oligogenic and main gene. Molecular and cellular mechanisms linked to neurobiological models of ASD are also presented. Genetic research confirms the diversity of genetic factors involved in the ASD formation. Model systems based on the genes of the neurodevelopmental syndrome show the ability to reverse some deficits in adult patients.

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10. Vivanti G, Tao S, Lyall K, Robins DL, Shea LL. The prevalence and incidence of early-onset dementia among adults with autism spectrum disorder. Autism research : official journal of the International Society for Autism Research. 2021; 14(10): 2189-99.

The prevalence and incidence of early-onset dementia among adults with autism spectrum disorder (ASD) is currently unknown. In this case-control study, the prevalence and incidence of early-onset dementia in individuals with ASD was examined during 2008-2012 using Medicaid Analytic eXtract files. Participants were 30-64 year-old adults who were Medicaid beneficiaries and had either a diagnosis of ASD only (n = 12,648), a diagnosis of ASD with co-occurring intellectual disability (ID) (n = 26,168), a diagnosis of ID without ASD (n = 406,570), or no ASD nor ID diagnoses (n = 798,828). The 5-year prevalence of dementia was 4.04% among adults with ASD only, and 5.22% for those with ASD and co-occurring ID. This prevalence was higher compared to the prevalence of dementia in individuals with no ASD and no ID (0.97%), but lower compared to individuals with ID only (7.10%). Risk factors associated with the increased prevalence in the general population were similarly associated with the increased risk of dementia in individuals with ASD. Even after adjusting for these risk factors, compared to the general population, dementia was found to occur more frequently in individuals with ASD only (adjusted hazard ratio, 1.96; 95% CI, 1.69-2.28), as well as individuals with ASD and co-occurring ID (adjusted hazard ratio, 2.89; 95% CI, 2.62-3.17). In conclusion, adults with ASD under the age of 65 were approximately 2.6 times more likely to be diagnosed with dementia compared to the general population in our study. LAY SUMMARY: It is unclear whether adults diagnosed with autism spectrum disorder (ASD) are at higher risk of being diagnosed with early-onset dementia compared to those who are not on the autism spectrum. In this study we examined for the first time the nationwide prevalence and incidence of Alzheimer’s Disease and other types of dementia in ASD in a sample of adults with ASD aged 30-64 years who were enrolled in Medicaid, the largest insurer of behavioral health services in the US. Medicaid claims data, which include information on the diagnoses that beneficiaries receive, suggested that the adults with ASD were approximately 2.6 times more likely to be diagnosed with early-onset Alzheimer’s disease and related dementias compared to the general population.

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11. Waldron DA, Coyle C, Kramer J. Aging on the Autism Spectrum: Self-care Practices and Reported Impact on Well-Being. Journal of autism and developmental disorders. 2021.

The population aging on the Autism Spectrum (AS) faces disproportionate physical and mental health comorbidities. This research describes self-care practices, including physical activity (PA), nutrition, and spirituality, and the impact of these practices on the health and well-being of older adults on the AS. Researchers conducted semi-structured interviews (N = 30) with older adults (age 50+ years) on the AS on the following topics: health, employment, relationships, and services/supports. Data were analyzed using Dedoose software and a constant comparative method. Participants described self-reported health benefits of their PA. Participants who engaged with organizations reported receiving instrumental support and fulfillment. Several themes emerged regarding socialization and routines in self-care in older adults on the AS, which may inform interventions.

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12. Williams ZJ, Gotham KO. Improving the measurement of alexithymia in autistic adults: a psychometric investigation of the 20-item Toronto Alexithymia Scale and generation of a general alexithymia factor score using item response theory. Molecular autism. 2021; 12(1): 56.

BACKGROUND: Alexithymia, a personality trait characterized by difficulties interpreting emotional states, is commonly elevated in autistic adults, and a growing body of literature suggests that this trait underlies several cognitive and emotional differences previously attributed to autism. Although questionnaires such as the 20-item Toronto Alexithymia Scale (TAS-20) are frequently used to measure alexithymia in the autistic population, few studies have investigated the psychometric properties of these questionnaires in autistic adults, including whether differential item functioning (I-DIF) exists between autistic and general population adults. METHODS: This study is a revised version of a previous article that was retracted due to copyright concerns (Williams and Gotham in Mol Autism 12:1-40). We conducted an in-depth psychometric analysis of the TAS-20 in a large sample of 743 cognitively able autistic adults recruited from the Simons Foundation SPARK participant pool and 721 general population controls enrolled in a large international psychological study. The factor structure of the TAS-20 was examined using confirmatory factor analysis, and item response theory was used to generate a subset of the items that were strong indicators of a « general alexithymia » factor. Correlations between alexithymia and other clinical outcomes were used to assess the nomological validity of the new alexithymia score in the SPARK sample. RESULTS: The TAS-20 did not exhibit adequate model fit in either the autistic or general population samples. Empirically driven item reduction was undertaken, resulting in an 8-item general alexithymia factor score (GAFS-8, with « TAS » no longer referenced due to copyright) with sound psychometric properties and practically ignorable I-DIF between diagnostic groups. Correlational analyses indicated that GAFS-8 scores, as derived from the TAS-20, meaningfully predict autistic trait levels, repetitive behaviors, and depression symptoms, even after controlling for trait neuroticism. The GAFS-8 also presented no meaningful decrement in nomological validity over the full TAS-20 in autistic participants. LIMITATIONS: Limitations of the current study include a sample of autistic adults that was majority female, later diagnosed, and well educated; clinical and control groups drawn from different studies with variable measures; only 16 of the TAS-20 items being administered to the non-autistic sample; and an inability to test several other important psychometric characteristics of the GAFS-8, including sensitivity to change and I-DIF across multiple administrations. CONCLUSIONS: These results indicate the potential of the GAFS-8 to robustly measure alexithymia in both autistic and non-autistic adults. A free online score calculator has been created to facilitate the use of norm-referenced GAFS-8 latent trait scores in research applications (available at https://asdmeasures.shinyapps.io/alexithymia ).

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13. Yamane T. Longitudinal psychometric evaluation of the developmental disorder parenting stressor index with Japanese parents of children with autism. Autism : the international journal of research and practice. 2021; 25(7): 2034-47.

Parents of children with autism experience high rates of parenting stress. Assessing parenting stress in them has crucial clinical implications because increased parental stress is associated with psychological disorders and personal distress, which can result in worse child-parent relationships. Theorists have proposed that a person’s cognitive appraisal determines whether or not a situation or an encounter is personally stressful. However, prior scales merely measure the outcomes of parental stress as a stress response: little the scales were designed to assess events and cognitive appraisal-related parenting stressors of parents of children with autism. We investigated whether a new index for assessing parenting stressors-the Developmental Disorder Parenting Stressor Index is a valid measure to assess parenting stressors of parents of children with autism using longitudinal online surveys at three times. Participants were 212 Japanese parents of children with autism aged 2-18 years who completed the Developmental Disorder Parenting Stressor Index and measures of autism symptoms and stress response . Overall, the findings indicated that the Developmental Disorder Parenting Stressor Index can be reliably used to measure both experiences and cognitive appraisal of parenting stressors among parents of children with autism. Moreover, the Developmental Disorder Parenting Stressor Index has several advantages and is a valuable measurement tool to be able to evaluate parenting stressors in clinical settings; Developmental Disorder Parenting Stressor Index is shorter, easier to complete, and can evaluate both viewpoints of parenting stressors.

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