1. Alaerts K, Daniels N, Moerkerke M, Evenepoel M, Tang T, Van der Donck S, Chubar V, Claes S, Steyaert J, Boets B, Prinsen J. At the Head and Heart of Oxytocin’s Stress-Regulatory Neural and Cardiac Effects: A Chronic Administration RCT in Children with Autism. Psychotherapy and psychosomatics. 2023: 1.

INTRODUCTION: Intranasal administration of oxytocin presents a promising new approach to reduce disability associated with an autism spectrum disorder diagnosis. Previous investigations have emphasized the amygdala as the neural foundation for oxytocin’s acute effects. However, to fully understand oxytocin’s therapeutic potential, it is crucial to gain insight into the neuroplastic changes in amygdala circuitry induced from chronic oxytocin administrations, particularly in pediatric populations. OBJECTIVE: We aimed to examine the impact of a 4-week course of intranasal oxytocin on amygdala functional connectivity in children with autism, compared to placebo. Additionally, we investigated whether oxytocin improves cardiac autonomic arousal, as indexed by high-frequency heart rate variability. METHODS: Fifty-seven children with autism aged 8-12 years (45 boys, 12 girls) participated in a double-blind, randomized pharmaco-neuroimaging trial involving twice-daily administrations of intranasal oxytocin or placebo. Resting-state fMRI scans and simultaneous, in-scanner heart rate recordings were obtained before, immediately after, and 4 weeks after the nasal spray administration period. RESULTS: Significant reductions in intrinsic amygdala-orbitofrontal connectivity were observed, particularly at the 4-week follow-up session. These reductions were correlated with improved social symptoms and lower cardiac autonomic arousal. Further, oxytocin’s neural and cardiac autonomic effects were modulated by epigenetic modifications of the oxytocin receptor gene. The effects were more pronounced in children with reduced epigenetic methylation, signifying heightened expression of the oxytocin receptor. CONCLUSION: These findings underscore that a 4-week oxytocin administration course decreases amygdala connectivity and improves cardiac autonomic balance. Epigenetic modulators may explain inter-individual variation in responses to oxytocin.

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2. Caven I, Nguyen C, Wiegelmann J, Laframboise E, Penner M. Understanding how behaviour therapists use autism spectrum disorder diagnostic information for intervention planning. Frontiers in psychiatry. 2023; 14: 1242748.

Understanding how behaviour therapists incorporate diagnostic assessments into their intervention planning can help to streamline assessment procedures and facilitate communication. The objectives are to identify what information from the diagnostic assessment is received by behaviour therapists and which assessment elements are most important and relevant for treatment planning. Behaviour therapists, identified through Ontario registries, were surveyed about their use of diagnostic information in treatment planning. Seventy-one behaviour therapists completed the survey (response rate = 35.5%). The diagnostic information most frequently received by respondents included brief (69%) and detailed (49.2%) physician/psychologist report, speech/language assessment report (52.1%) and individualised education plan (50.7%). Most respondents indicated that information from the physician/psychologist report is often out-dated (74.6% Agree/Strongly Agree). There was variable agreement that the information in the diagnostic package influences the type and quantity of treatment. These findings demonstrate that while diagnostic assessments received by behaviour therapists are important to their planning, other independently obtained sources of information, such as client interviews, are relatively more important to this process. The diagnostic assessment is one tool to inform treatment planning; however, up-to-date information about the child’s needs is likely to be more informative.

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3. Del Bianco T, Lockwood Estrin G, Tillmann J, Oakley BF, Crawley D, San José Cáceres A, Hayward H, Potter M, Mackay W, Smit P, du Plessis C, Brink L, Springer P, Odendaal H, Charman T, Banaschewski T, Baron-Cohen S, Bölte S, Johnson M, Murphy D, Buitelaar J, Loth E, Jones EJ. Mapping the link between socio-economic factors, autistic traits and mental health across different settings. Autism : the international journal of research and practice. 2023: 13623613231200297.

Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings – in Europe and South Africa – to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific ‘factors’. We found that four similar ‘factors’ could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just ‘Family System’ was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people.

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4. Dubey I, Groom M, Tahir A, Hamilton A. Social anxiety is more likely to influence reputation management decisions than autistic traits. Autism research : official journal of the International Society for Autism Research. 2023.

People manage their social reputation by selectively sharing achievements, thereby shaping the way others think about them. Autistic traits and social anxiety may have opposing impacts on reputation management. This study aimed to identify the influence of autistic traits and social anxiety on reputation management behavior, independently and in co-occurrence with one another. Seventy-seven adults with varying levels of autistic and social anxiety traits completed a novel self-disclosure task that required them to complete a computerized game and decide whether to disclose their scores to another participant. This design provided a safe social environment for sharing performance outcomes and allowed us to manipulate performance outcomes for participants and set a perceived ‘norm’ of high self-disclosure. Results showed that participants were more likely to disclose their high than low scores to the other player. Social anxiety reliably predicted the likelihood of disclosing their scores while high autistic traits predicted the likelihood of disclosure only in combination with high social anxiety. Additionally, establishing the norm of high disclosure facilitated self-disclosure in all the participants. This study shows that social anxiety may influence reputation management via selective self-disclosure more when co-occurring with high autistic traits. People with varying levels of autistic traits may not behave differently to maintain a social reputation.

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5. Greenberg RL, Guzick AG, Schneider SC, Weinzimmer SA, Kook M, Perozo Garcia AB, Storch EA. Depressive Symptoms in Autistic Youth with Anxiety Disorders. Journal of developmental and behavioral pediatrics : JDBP. 2023.

OBJECTIVE: Anxiety and depression often coexist in youth and share overlapping symptomatology; however, little is known about the comorbidity of anxiety and depression in autistic youth. This study explores (1) the frequency of depressive symptoms among autistic children with clinically significant anxiety, (2) clinical variables that may be associated with elevated depressive symptoms, and (3) whether pretreatment depressive symptoms predict cognitive behavioral therapy (CBT) outcomes for anxiety. METHOD: Children aged 7 to 13 years (N = 87) and their parents participated in a randomized controlled trial comparing 2 versions of a parent-led, telehealth-delivered CBT program. Parents and children completed a variety of clinical assessments and self-report questionnaires before and after treatment. RESULTS: Fifty-seven percent of the child sample reported experiencing elevated depressive symptoms while roughly 20% of parents reported elevated depressive symptoms in their child. A strong association between anxiety and depression was found. Heightened feelings of loneliness, per child report, and functional impairment, per parent report, were found to be uniquely associated with elevated depressive symptoms. Finally, depressive symptoms were not a significant predictor of CBT outcomes for anxiety. CONCLUSION: Findings suggest high degrees of comorbidity between anxiety and depression among autistic children and that feelings of loneliness, anxiety, and functional impairment may be early indicators of mood-related concerns. Further research is needed to determine the full extent of the association between anxiety and depression and additional options for treating depression in autistic children.

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6. Li Q, Li Y, Zheng J, Yan X, Huang J, Xu Y, Zeng X, Shen T, Xing X, Chen Q, Yang W. Prevalence and trends of developmental disabilities among US children and adolescents aged 3 to 17 years, 2018-2021. Scientific reports. 2023; 13(1): 17254.

Developmental disabilities prevalence seem to be high in countries around the world. It’s worth understanding the most recent prevalence and trends of developmental disabilities. The objective of this study is to examine the prevalence and trends of developmental disabilities of US children and adolescents. A total of 26,422 individuals aged 3-17 years were included. Annual data were examined from the National Health Interview Survey (2018-2021). Weighted prevalence for each of the selected developmental disabilities were calculated. The prevalence of any developmental disabilities in individuals was 16.65% (95% CI 16.03-17.26%), prevalence of attention deficit/hyperactivity disorder (ADHD), learning disability (LD), autism spectrum disorder (ASD), intellectual disability (ID), and other developmental delay were 9.57% (95% CI 9.09-10.06%), 7.45% (95% CI 7.00-7.89%), 2.94% (95% CI 2.67-3.21%), 1.72% (95% CI 1.51-1.93%), and 5.24% (95% CI 4.89-5.59%), respectively. Significant increases were observed for other developmental delay (4.02-6.05%) and co-occurring LD & ID (1.03-1.82%). Findings form this study highlight a high prevalence of any developmental disabilities, although no significant increase was observed. The prevalence of other developmental delay and co-occurring LD & ID were significantly increased. Further investigation is warranted to assess potentially modifiable risk factors and causes of developmental disabilities.

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7. Logan K, Iacono T, Trembath D. Aided Enhanced milieu teaching to develop symbolic and social communication skills in children with autism spectrum disorder. Augmentative and alternative communication (Baltimore, Md : 1985). 2023: 1-15.

Children who lack functional spoken language are candidates for augmentative and alternative communication (AAC). Aided AAC and naturalistic interventions offer the potential to extend the communication functions demonstrated by children with autism spectrum disorder (ASD) who are nonspeaking. Related intervention research, however, has been limited, in that interventions have generally targeted a limited range of communication functions taught in highly structured, decontextualized environments. The aim of this study was to investigate the efficacy of an intervention that combined aided AAC with a naturalistic intervention – enhanced milieu teaching (AEMT) – to increase symbolic communication in children with autism spectrum disorder. Three children with autism spectrum disorder participated in a multiple probe design, in which a range of communication functions were targeted using the AEMT. Results showed increases in the use of symbolic communication from baseline to intervention phases, which were found to be statistically significant for two of the three children (phi 0.7-0.81; p < .001). Intervention outcomes were generalized to a communication partner not involved in the intervention and maintained over time for all children. The study provides preliminary evidence that communication functions beyond object requests could be taught using a systematic, multi-element approach implemented across activities.

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8. Owen TM, Rodriguez NM. Toward establishing a qualifying autoclitic repertoire in children with autism spectrum disorder. Journal of applied behavior analysis. 2023.

Autoclitics are secondary verbal operants that are controlled by a feature of the conditions that occasion or evoke a primary verbal operant such as a tact or mand. Qualifying autoclitics extend, negate, or assert a speaker’s primary verbal response and modify the intensity or direction of the listener’s behavior. Howard and Rice (1988) established autoclitics that indicated weak stimulus control (e.g., « like a [primary tact] ») with four neurotypical preschool children. However, generalization to newly acquired tacts was limited. In Experiment 1, we addressed similar behavior as in Howard and Rice but with autistic children while using simultaneous teaching procedures, and we observed generalization across sets and with newly acquired tacts. In Experiment 2, we evaluated the effects of multiple-exemplar training on generalization of autoclitics across sets of naturalistic stimuli. Across participants, gradual increases in the frequency of autoclitics occurred with untaught stimuli after teaching with one or more sets.

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9. Roy R, Leadbitter K, Shields G, Taylor C, Aldred C, Juneja M, Gulati S, Vajaratkar V, Davies L, Emsley R, Patel V, Divan G, Green J. A randomised controlled trial of clinical and cost-effectiveness of the PASS Plus intervention for young children with autism spectrum disorder in New Delhi, India: study protocol for the COMPASS trial. Trials. 2023; 24(1): 667.

BACKGROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disability affecting at least 5 million children in South Asia. Majority of these children are without access to evidence-based care. The UK Pre-school Autism Communication Therapy (PACT) is the only intervention to have shown sustained impact on autism symptoms. It was systematically adapted for non-specialist community delivery in South Asia, as the ‘Parent-mediated Autism Social Communication Intervention for non-Specialists (PASS)’ and extended ‘PASS Plus’ interventions. RCTs of both showed feasibility, acceptability and positive effect on parent and child dyadic outcomes. METHODS: The Communication-centred Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS) trial is now a scale-up two-centre, two-arm single (rater) blinded random allocation parallel group study of the PASS Plus intervention in addition to treatment as usual (TAU) compared to TAU alone, plus health economic evaluation embedded in the India health system. Two hundred forty children (approximately 120 intervention/120 TAU) with ASD aged 2-9 years will be recruited from two tertiary care government hospitals in New Delhi, India. Accredited Social Health Activists will be one of the intervention delivery agents. Families will undertake up to 12 communication sessions over 8 months and will be offered the Plus modules which address coexisting problems. The trial’s primary endpoint is at 9 months from randomisation, with follow-up at 15 months. The primary outcome is autism symptom severity; secondary outcomes include parent-child communication, child adaptation, quality of life and parental wellbeing. Primary analysis will follow intention-to-treat principles using linear mixed model regressions with group allocation and repeated measures as random effects. The cost-effectiveness analysis will use a societal perspective over the 15-month period of intervention and follow-up. DISCUSSION: If clinically and cost-effective, this programme will fill an important gap of scalable interventions delivered by non-specialist health workers within the current care pathways for autistic children and their families in low-resource contexts. The programme has been implemented through the COVID-19 pandemic when restrictions were in place; intervention delivery and evaluation processes have been adapted to address these conditions. TRIAL REGISTRATION: ISRCTN; ISRCTN21454676 ; Registered 22 June 2018.

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10. Van der Donck S, Hendriks M, Vos S, Op de Beeck H, Boets B. Neural sensitivity to facial identity and facial expression discrimination in adults with autism. Autism research : official journal of the International Society for Autism Research. 2023.

The fluent processing of faces can be challenging for autistic individuals. Here, we assessed the neural sensitivity to rapid changes in subtle facial cues in 23 autistic men and 23 age and IQ matched non-autistic (NA) controls using frequency-tagging electroencephalography (EEG). In oddball paradigms examining the automatic and implicit discrimination of facial identity and facial expression, base rate images were presented at 6 Hz, periodically interleaved every fifth image with an oddball image (i.e. 1.2 Hz oddball frequency). These distinctive frequency tags for base rate and oddball stimuli allowed direct and objective quantification of the neural discrimination responses. We found no large differences in the neural sensitivity of participants in both groups, not for facial identity discrimination, nor for facial expression discrimination. Both groups also showed a clear face-inversion effect, with reduced brain responses for inverted versus upright faces. Furthermore, sad faces generally elicited significantly lower neural amplitudes than angry, fearful and happy faces. The only minor group difference is the larger involvement of high-level right-hemisphere visual areas in NA men for facial expression processing. These findings are discussed from a developmental perspective, as they strikingly contrast with robust face processing deficits observed in autistic children using identical EEG paradigms.

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11. Wong TJ, Yu T. Association Between Socioeconomic Status and Prevalence of Hypersensitivity Diseases and Autism: A Nationwide Study of Children. Maternal and child health journal. 2023.

OBJECTIVE: Prior research suggests that children with a low socioeconomic status (SES) background are at an increased risk for special healthcare needs. Conversely, for hypersensitivity-related diseases, many studies reported a lower risk among children with lower SES according to the hygiene hypothesis. We aimed to evaluate the association between SES and several hypersensitivity diseases and autism in a representative American sample. METHODS: We used data from the 2016, 2017 and 2018 US National Survey of Children’s Health. A total of 102,341 children aged 0-17 years were included. The dependent variables were doctor-diagnosed allergies, arthritis, asthma, diabetes, and autism. The main SES indicators were family poverty levels, highest education of the reported adults and difficulty in family income. Our analysis used logistic regression that accounted for the survey sampling design. RESULTS: The sample had a mean age of 9.4 ± 5.3 years. The weighted prevalence for allergies was 24.4%, 0.3% for arthritis, 11.9% for asthma, 0.5% for diabetes and 2.6% for autism. Children with adults reporting higher educational levels had greater odds of allergies (adjusted odds ratio and 95% CI: 1.48, 1.23-1.78) than those with lower educational levels. But for all other diseases, most findings suggested that a higher odds of disease was associated with lower SES instead of higher SES. CONCLUSIONS: A low SES background remains an important risk factor for hypersensitivity diseases in children. Most of our results suggested that children with low SES were associated with a higher risk of hypersensitivity diseases and autism.

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