1. Adak P, Sinha S, Banerjee N. An Association Study of Gamma-Aminobutyric Acid Type A Receptor Variants and Susceptibility to Autism Spectrum Disorders. J Autism Dev Disord ;2021 (Jan 13)

In this pilot study, we aim to identify the role of few genetic variants of GABA-receptor type A subunits GABRB3 (rs4906902, rs7171660), GABRG3 (rs208129, rs140679), GABRA5 (rs 140681) in the aetiology of autism spectrum disorders in a population of West Bengal. 192 ASD probands, their parents and 184 ethnically-matched healthy controls were recruited for the study. The rs4906902G and the rs140679T conferred significant risk towards ASD. rs7171660 and rs140679 had transmission bias in the family. Neither alleles of rs 208129 and rs 140681 showed significant over-representation in either groups. All these variants were associated with at least one deficit in ASD-associated phenotypes like ‘relating to people’, ‘Imitation’, ’emotional response’, ‘body use’, ‘taste, smell, touch response’ and ‘activity levels’.

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2. Bacchin R, Salgarello M, Trentin M, Zanette G, Tamburin S. Brain 18F-FDG and 18F-Flumetamol PET Imaging of Fragile X-Associated Tremor Ataxia Syndrome. Clin Nucl Med ;2021 (Jan 13)

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a rare movement disorder caused by a 55-to-200 CGG-trinucleotide expansion premutation in the FMR1 gene. Core diagnostic criteria are tremor, ataxia, and T2-weighted hyperintensity of the middle cerebellar peduncles on MRI, but FXTAS encompass a broad spectrum of neurological symptoms. FXTAS pathophysiology is largely unknown, and some animal models and neuropathology findings suggest possible overlap with Alzheimer disease. We report the combined PET imaging of a genetically confirmed FXTAS patient, presenting reduced temporal-frontal 18F-FDG uptake, and pathological cortical deposition of amyloid to 18F-flumetamol PET scan. This report may offer clues to FXTAS pathophysiology.

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3. Bonsall A, Thullen M, Stevenson BL, Sohl K. Parental Feeding Concerns for Children With Autism Spectrum Disorder : A Family-Centered Analysis. OTJR (Thorofare N J) ;2021 (Jan 12):1539449220985906.

This study identifies and describes feeding concerns of parents of children with autism spectrum disorder (ASD) and examines the extent to which parents relate those concerns as having been addressed by therapists. Survey data were collected from 113 parents of children with ASD. Of the parents surveyed, 68% described a past or present concern with feeding ; 60% of those parents with concerns said a therapist had not addressed those concerns. Feeding concerns were more likely addressed when therapists shared parent’s concerns. Specific types of concerns, such as those around food selectivity and food refusal, were more likely addressed than difficulties around mealtime. A gap is identified between parental report of feeding difficulties and parental report of professional services addressing feeding needs. This analysis presents an opportunity for occupational therapists in the area of feeding, particularly around identifying and addressing parental concerns.

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4. Chae J, Cho GJ, Oh MJ, Park K, Han SW, Choi SJ, Oh SY, Roh CR. In utero exposure to ritodrine during pregnancy and risk of autism in their offspring until 8 years of age. Sci Rep ;2021 (Jan 13) ;11(1):1146.

Beta-2 adrenergic receptor (B2AR) agonists, used as asthma treatments and tocolytics during pregnancy, have recently been reported to be associated with autism in their offspring. However, the particular link between autism and ritodrine, a common type of B2AR agonist used solely as tocolytics, has never been substantiated with any nationwide database. Thus, we aimed to examine the association between in utero exposure of ritodrine and the risk of autism in their offspring using a national database. This population-based cohort study was conducted by merging the Korea National Health Insurance claims database and National Health Screening Program for Infants and Children database. These databases included all women who had delivered singleton between January 2007 and December 2008 in Korea. Out of the total 770,016 mothers, 30,959 (4.02%) were exposed to ritodrine during pregnancy, and 5583 (0.73%) of their children were identified as having autism, defined until 8 years of age. According to our analysis, the overall cumulative incidence of autism up to 8 years was 1.37% in ritodrine exposure group and 0.70% in ritodrine non-exposure group (p < 0.05, log-rank test). By Cox proportional hazard analysis, use of ritodrine in preterm birth was associated with significantly higher hazard of autism [adjusted hazard ratio : 1.23, 95% CI 1.04-1.47], after adjusting for confounding variables including maternal age, parity, cesarean section, preterm labor, steroid use, birth weight, gender, and preeclampsia. Thus, in utero exposure to ritodrine was associated with an increased risk of autism in their offspring.

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5. Curry AE, Metzger KB, Carey ME, Sartin EB, Huang P, Yerys BE. Comparison of Motor Vehicle Crashes, Traffic Violations, and License Suspensions Between Autistic and Non-autistic Adolescent and Young Adult Drivers. J Am Acad Child Adolesc Psychiatry ;2021 (Jan 13)

OBJECTIVE : One-third of autistic individuals obtain a driver’s license by age 21 ; however, prior studies suggest they may be at heightened risk for motor vehicle crashes. We compared objective rates of crashes, traffic violations, and license suspensions for newly licensed autistic and non-autistic adolescents. METHOD : This retrospective cohort study included New Jersey residents born 1987-2000 who were patients of the Children’s Hospital of Philadelphia healthcare network. Electronic health records were linked with statewide driver licensing and crash databases. Autism status was classified via ICD diagnostic codes ; those with intellectual disability were excluded. We compared rates among 486 autistic and 70,990 non-autistic licensed drivers over their first 48 months of driving. Further, we examined the proportion of crashes attributed to specific driver actions and crash types. RESULTS : Compared with non-autistic drivers, autistic drivers were estimated to have lower average monthly rates of crash involvement (adjRR : 0.89 [0.75-1.05]), moving violations (0.56 [0.48-0.67]), and suspensions (0.32 [0.18-0.58]). Among drivers involved in a crash, autistic drivers were half as likely to crash due to unsafe speed, but substantially more likely to crash due to their failure to yield to a vehicle/pedestrian and while making left- or U-turns. CONCLUSION : Newly licensed autistic adolescent drivers have similar to lower estimated rates of adverse driving outcomes ; the extent to which these can be attributed to different driving patterns is a critical point for future investigation. There were several notable differences in the characteristics of these crashes, which directly inform interventions to improve driving safety of autistic adolescent drivers.

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6. Ferman S. Morpholexical Processes in Children with Autism Spectrum Disorder : Evidence from Artificial Word Learning. Folia Phoniatr Logop ;2021 (Jan 13):1-15.

OBJECTIVES : This study aims to investigate the ability of high-functioning children with autism spectrum disorder and normal language (ALN) to learn artificial words, and to investigate their ability to use their knowledge of morphophonological patterns for this learning. METHODS : Children with ALN and typically developing (TD) children, matched for cognitive and language measures, learned 8 artificial Hebrew words during two daily practice sessions by means of identification and naming tasks. Half the words were constructed from existing morphophonological patterns, and the other half were constructed from pseudo-morphophonological patterns. The two types of words allowed the investigation of the participants’ ability to use their knowledge of morphophonological patterns (morpholexical processes) for word learning. Both accuracy and speed were measured. RESULTS : The ALN group improved incrementally at a rate (slope) similar to that of the TD group in identifying and naming the artificial words, in both accuracy and speed. However, the ALN group were slower than their TD peers in learning to identify the artificial words. Both groups demonstrated higher accuracy and faster speed in both tasks in learning the artificial words with existing morphophonological patterns than those with pseudo-patterns. However, this gap was smaller in the ALN group in the accuracy of naming and marginal in speed of identification. CONCLUSIONS : Children with ALN possess a lexical learning mechanism that is qualitatively not atypical but may be less efficient than that of their TD peers, including exploiting knowledge of morphophonological patterns – where such patterns exist – for word learning.

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7. Hiremath CS, Sagar KJV, Yamini BK, Girimaji AS, Kumar R, Sravanti SL, Padmanabha H, Vykunta Raju KN, Kishore MT, Jacob P, Saini J, Bharath RD, Seshadri SP, Kumar M. Emerging behavioral and neuroimaging biomarkers for early and accurate characterization of autism spectrum disorders : a systematic review. Transl Psychiatry ;2021 (Jan 13) ;11(1):42.

The possibility of early treatment and a better outcome is the direct product of early identification and characterization of any pathological condition. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social communication, restricted, and repetitive patterns of behavior. In recent times, various tools and methods have been developed for the early identification and characterization of ASD features as early as 6 months of age. Thorough and exhaustive research has been done to identify biomarkers in ASD using noninvasive neuroimaging and various molecular methods. By employing advanced assessment tools such as MRI and behavioral assessment methods for accurate characterization of the ASD features and may facilitate pre-emptive interventional and targeted therapy programs. However, the application of advanced quantitative MRI methods is still confined to investigational/laboratory settings, and the clinical implication of these imaging methods in personalized medicine is still in infancy. Longitudinal research studies in neurodevelopmental disorders are the need of the hour for accurate characterization of brain-behavioral changes that could be monitored over a period of time. These findings would be more reliable and consistent with translating into the clinics. This review article aims to focus on the recent advancement of early biomarkers for the characterization of ASD features at a younger age using behavioral and quantitative MRI methods.

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8. Jan TY, Wong LC, Yang MT, Huang CJ, Hsu CJ, Peng SS, Tseng WI, Lee WT. Correlation of dystonia severity and iron accumulation in Rett syndrome. Sci Rep ;2021 (Jan 12) ;11(1):838.

Individuals with Rett syndrome (RTT) commonly demonstrate Parkinsonian features and dystonia at teen age ; however, the pathological reason remains unclear. Abnormal iron accumulation in deep gray matter were reported in some Parkinsonian-related disorders. In this study, we investigated the iron accumulation in deep gray matter of RTT and its correlation with dystonia severity. We recruited 18 RTT-diagnosed participants with MECP2 mutations, from age 4 to 28, and 28 age-gender matched controls and investigated the iron accumulation by susceptibility weighted image (SWI) in substantia nigra (SN), globus pallidus (GP), putamen, caudate nucleus, and thalamus. Pearson’s correlation was applied for the relation between iron accumulation and dystonia severity. In RTT, the severity of dystonia scales showed significant increase in subjects older than 10 years, and the contrast ratios of SWI also showed significant differences in putamen, caudate nucleus and the average values of SN, putamen, and GP between RTT and controls. The age demonstrated moderate to high negative correlations with contrast ratios. The dystonia scales were correlated with the average contrast ratio of SN, putamen and GP, indicating iron accumulation in dopaminergic system and related grey matter. As the first SWI study for RTT individuals, we found increased iron deposition in dopaminergic system and related grey matter, which may partly explain the gradually increased dystonia.

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9. Kowallik AE, Pohl M, Schweinberger SR. Facial Imitation Improves Emotion Recognition in Adults with Different Levels of Sub-Clinical Autistic Traits. J Intell ;2021 (Jan 13) ;9(1)

We used computer-based automatic expression analysis to investigate the impact of imitation on facial emotion recognition with a baseline-intervention-retest design. The participants : 55 young adults with varying degrees of autistic traits, completed an emotion recognition task with images of faces displaying one of six basic emotional expressions. This task was then repeated with instructions to imitate the expressions. During the experiment, a camera captured the participants’ faces for an automatic evaluation of their imitation performance. The instruction to imitate enhanced imitation performance as well as emotion recognition. Of relevance, emotion recognition improvements in the imitation block were larger in people with higher levels of autistic traits, whereas imitation enhancements were independent of autistic traits. The finding that an imitation instruction improves emotion recognition, and that imitation is a positive within-participant predictor of recognition accuracy in the imitation block supports the idea of a link between motor expression and perception in the processing of emotions, which might be mediated by the mirror neuron system. However, because there was no evidence that people with higher autistic traits differ in their imitative behavior per se, their disproportional emotion recognition benefits could have arisen from indirect effects of imitation instructions.

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10. Landry O, Mitchell P. An examination of perseverative errors and cognitive flexibility in autism. PLoS One ;2021 ;16(1):e0223160.

Perseveration is a well-replicated finding in autism. The aim of this study was to examine how the context of the task influences performance with respect to this phenomenon. We randomly assigned 137 children aged 6-12 with and without autism to complete a modified card-sorting task under one of two conditions : Children were either told the sorting rules on each trial (Explicit), or were given feedback to formulate the rules themselves (Implicit). While performance was enhanced on the Explicit condition for participants without autism, the participants with autism were disadvantaged by this manipulation. In contrast, there were few differences in performance between groups on the Implicit condition. Exploratory analyses were used to examine this unexpected result ; increased autism symptomology was associated with poorer performance.

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11. Mesleh AG, Abdulla SA, El-Agnaf O. Paving the Way toward Personalized Medicine : Current Advances and Challenges in Multi-OMICS Approach in Autism Spectrum Disorder for Biomarkers Discovery and Patient Stratification. J Pers Med ;2021 (Jan 13) ;11(1)

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder characterized by impairments in two main areas : social/communication skills and repetitive behavioral patterns. The prevalence of ASD has increased in the past two decades, however, it is not known whether the evident rise in ASD prevalence is due to changes in diagnostic criteria or an actual increase in ASD cases. Due to the complexity and heterogeneity of ASD, symptoms vary in severity and may be accompanied by comorbidities such as epilepsy, attention deficit hyperactivity disorder (ADHD), and gastrointestinal (GI) disorders. Identifying biomarkers of ASD is not only crucial to understanding the biological characteristics of the disorder, but also as a detection tool for its early screening. Hence, this review gives an insight into the main areas of ASD biomarker research that show promising findings. Finally, it covers success stories that highlight the importance of precision medicine and the current challenges in ASD biomarker discovery studies.

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12. Mulé CM, Lavelle TA, Sliwinski SK, Wong JB. Shared Decision-Making During Initial Diagnostic and Treatment Planning Visits for Children with Autism Spectrum Disorder. J Dev Behav Pediatr ;2021 (Jan 13)

OBJECTIVE : Although shared decision-making (SDM) can improve patient engagement, adherence, and outcomes, evidence on the use of SDM within the context of autism spectrum disorder (ASD) initial diagnosis and treatment planning remains limited. The goal of this study was to objectively assess the occurrence of SDM in these visits and to compare this assessment with parent and provider perceptions of SDM in the same encounter. METHODS : After audio-recording and transcribing initial clinical visits between parents (n = 22) and developmental behavioral pediatricians (n = 6) discussing the diagnosis of ASD and treatment options, we used the OPTION5 Item scale to assess the occurrence of SDM. Afterward, parents and providers completed the OPTION5 Item, and parents also participated in a semistructured qualitative interview. Analysis consisted of descriptive statistics for OPTION5 Item scores and a modified grounded theory framework for interviews. RESULTS : Low levels of SDM were observed, with 41% of visits having no elements of SDM. On average, visits scored 1.1 of a possible 20 points on the OPTION5 Item scale for SDM. By contrast, parents and providers indicated on the OPTION5 Item scale that providers made a « moderate » to « skilled » effort to engage parents in SDM. Qualitative interviews with parents were consistent with their OPTION5 Item ratings. CONCLUSION : The level of SDM determined by parent and provider reports was higher than the level of SDM determined by objective observation using a standard validated rating method. The findings reinforce the need for further research into barriers and facilitators of SDM methods and outcomes within ASD.

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13. Peng J, Zhou Y, Wang K. Multiplex gene and phenotype network to characterize shared genetic pathways of epilepsy and autism. Sci Rep ;2021 (Jan 13) ;11(1):952.

It is well established that epilepsy and autism spectrum disorder (ASD) commonly co-occur ; however, the underlying biological mechanisms of the co-occurence from their genetic susceptibility are not well understood. Our aim in this study is to characterize genetic modules of subgroups of epilepsy and autism genes that have similar phenotypic manifestations and biological functions. We first integrate a large number of expert-compiled and well-established epilepsy- and ASD-associated genes in a multiplex network, where one layer is connected through protein-protein interaction (PPI) and the other layer through gene-phenotype associations. We identify two modules in the multiplex network, which are significantly enriched in genes associated with both epilepsy and autism as well as genes highly expressed in brain tissues. We find that the first module, which represents the Gene Ontology category of ion transmembrane transport, is more epilepsy-focused, while the second module, representing synaptic signaling, is more ASD-focused. However, because of their enrichment in common genes and association with both epilepsy and ASD phenotypes, these modules point to genetic etiologies and biological processes shared between specific subtypes of epilepsy and ASD. Finally, we use our analysis to prioritize new candidate genes for epilepsy (i.e. ANK2, CACNA1E, CACNA2D3, GRIA2, DLG4) for further validation. The analytical approaches in our study can be applied to similar studies in the future to investigate the genetic connections between different human diseases.

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14. Rixon L, Hastings RP, Kovshoff H, Bailey T. Sibling Adjustment and Sibling Relationships Associated with Clusters of Needs in Children with Autism : A Novel Methodological Approach. J Autism Dev Disord ;2021 (Jan 13)

We tested a novel methodological approach to examine associations between characteristics of autistic children and outcomes for siblings. Cluster analysis was used to define five groups of children with autism (n = 168) based on autism symptoms, adaptive behavior, pro-social behavior, and behavior problems. Primary and secondary parent carers, and siblings themselves, reported on sibling relationship quality and psychological adjustment. Siblings of autistic children with a mild symptom profile, high levels of adaptive skills, but high internalizing and externalizing problems had the highest level of these problems themselves and more conflict in their relationship. Siblings of autistic children with the most complex support needs (adaptive skills deficits, severe autism symptoms) reported lower warmth relationships but not elevated internalizing and externalizing problems.

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15. Rumball F, Antal K, Happé F, Grey N. Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults. Res Dev Disabil ;2021 (Jan 13) ;110:103836.

BACKGROUND : Mental health problems are common amongst adults with an Autism Spectrum Disorder (ASD). Stressful and traumatic life events can trigger or exacerbate symptoms of anxiety, depression and PTSD. In the general population, transdiagnostic processes such as suppression and perseverative thinking are associated with responses to trauma and mental health symptoms. AIMS : This study explored the relationships between thought suppression, perseverative thinking and symptoms of depression, anxiety and PTSD in ASD adults who reported exposure to a range of DSM-5 and non-DSM-5 traumatic events. METHODS : 59 ASD adults completed a series of online self-report questionnaires measuring trauma, transdiagnostic cognitive processes, and mental health symptoms. RESULTS : Probable PTSD rarely occurred in isolation and was associated with depression and anxiety symptoms in trauma-exposed ASD adults. All cognitive processes and mental health symptoms were positively associated with one another, regardless of whether the trauma met DSM-5 PTSD Criterion A. When accounting for both cognitive processes, only thought suppression significantly predicted PTSD and anxiety symptoms, while only perseverative thinking significantly predicted depression symptoms. CONCLUSIONS AND IMPLICATIONS : These preliminary results suggest that different cognitive processes more strongly affect anxiety/PTSD versus depression symptom severity in trauma-exposed ASD adults, although co-occurring symptoms are common. Implications for assessment, treatment and future research are discussed.

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16. Schalbroeck R, van Velden FHP, de Geus-Oei LF, Yaqub M, van Amelsvoort T, Booij J, Selten JP. Striatal dopamine synthesis capacity in autism spectrum disorder and its relation with social defeat : an [(18)F]-FDOPA PET/CT study. Transl Psychiatry ;2021 (Jan 13) ;11(1):47.

Alterations in dopamine signalling have been implied in autism spectrum disorder (ASD), and these could be associated with the risk of developing a psychotic disorder in ASD adults. Negative social experiences and feelings of social defeat might result in an increase in dopamine functioning. However, few studies examined dopamine functioning in vivo in ASD. Here we examine whether striatal dopamine synthesis capacity is increased in ASD and associated with social defeat. Forty-four unmedicated, non-psychotic adults diagnosed with ASD and 22 matched controls, aged 18-30 years, completed a dynamic 3,4-dihydroxy-6-[(18)F]-fluoro-L-phenylalanine positron emission tomography/computed tomography ([(18)F]-FDOPA PET/CT) scan to measure presynaptic dopamine synthesis capacity in the striatum. We considered unwanted loneliness, ascertained using the UCLA Loneliness Scale, as primary measure of social defeat. We found no statistically significant difference in striatal dopamine synthesis capacity between ASD and controls (F(1,60) = 0.026, p = 0.87). In ASD, striatal dopamine synthesis capacity was not significantly associated with loneliness (β = 0.01, p = 0.96). Secondary analyses showed comparable results when examining the associative, limbic, and sensorimotor sub-regions of the striatum (all p-values > 0.05). Results were similar before and after adjusting for age, sex, smoking-status, and PET/CT-scanner-type. In conclusion, in unmedicated, non-psychotic adults with ASD, striatal dopamine synthesis capacity is not increased and not associated with social defeat.

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17. Shea L, Nonnemacher S. Embedded research approaches to address the needs of the increasing, aging autistic population. Healthc (Amst) ;2021 (Jan 9):100517.

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18. Stichter J, Stormont M, Buranova N, Herzog M, O’Donnell R. Educational and Diagnostic Classification of Autism Spectrum Disorder and Associated Characteristics. J Autism Dev Disord ;2021 (Jan 13)

Research continues to highlight discrepancies between clinical diagnoses of Autism Spectrum Disorder (ASD) and determination of special education eligibility for services within school settings. However, limited research has been conducted on the impact of those discrepancies for the identification of appropriate services within schools. The aim of the current study is to examine students’ characteristics (e.g., language, social emotional) associated with educational eligibility and clinical diagnoses. More specifically, the study examines characteristics differentially associated with ASD diagnoses to inform targeted evidence-based interventions. The study accessed data from a four-year cluster-randomized trial of 283 students with and without reported ASD diagnosis. The results of the study demonstrate that the educational eligibility of Autism did not differentiate between students with and without autism on any of the measured characteristics including language, peer and social competence, academics, and aggressive behaviors. However, the Autism Diagnostic Observation Schedule, second edition (ADOS-2 ; Lord et al. in Autism diagnostic observation schedule. Western Psychological Services, Torrance, CA, 2012) classification was a more sensitive diagnostic measure for characteristics associated with autism. Implications for research, practitioners, and schools are discussed.

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19. Thongkorn S, Kanlayaprasit S, Panjabud P, Saeliw T, Jantheang T, Kasitipradit K, Sarobol S, Jindatip D, Hu VW, Tencomnao T, Kikkawa T, Sato T, Osumi N, Sarachana T. Sex differences in the effects of prenatal bisphenol A exposure on autism-related genes and their relationships with the hippocampus functions. Sci Rep ;2021 (Jan 13) ;11(1):1241.

Our recent study has shown that prenatal exposure to bisphenol A (BPA) altered the expression of genes associated with autism spectrum disorder (ASD). In this study, we further investigated the effects of prenatal BPA exposure on ASD-related genes known to regulate neuronal viability, neuritogenesis, and learning/memory, and assessed these functions in the offspring of exposed pregnant rats. We found that prenatal BPA exposure increased neurite length, the number of primary neurites, and the number of neurite branches, but reduced the size of the hippocampal cell body in both sexes of the offspring. However, in utero exposure to BPA decreased the neuronal viability and the neuronal density in the hippocampus and impaired learning/memory only in the male offspring while the females were not affected. Interestingly, the expression of several ASD-related genes (e.g. Mief2, Eif3h, Cux1, and Atp8a1) in the hippocampus were dysregulated and showed a sex-specific correlation with neuronal viability, neuritogenesis, and/or learning/memory. The findings from this study suggest that prenatal BPA exposure disrupts ASD-related genes involved in neuronal viability, neuritogenesis, and learning/memory in a sex-dependent manner, and these genes may play an important role in the risk and the higher prevalence of ASD in males subjected to prenatal BPA exposure.

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20. Tokatly Latzer I, Leitner Y, Karnieli-Miller O. Core experiences of parents of children with autism during the COVID-19 pandemic lockdown. Autism ;2021 (Jan 12):1362361320984317.

The lockdown and home isolation due to the COVID-19 pandemic led to significant transformation in lifestyles. Being a parent in this situation was not easy for anyone, much less for parents of children with special needs. The shutting down of special education systems meant that parents lost a vital support network and had to be the sole full-time caregivers despite often lacking the skills to cope with this new and daunting situation. We interviewed parents and learned that the main difficulties faced by homebound autistic children stemmed from the change in routine, lack of special education services, limited physical space, and food- and sleep-related issues. Some children experienced worsening in behavioral, social, and developmental domains, yet others seemed to not only overcome the challenges of changing conditions but even benefit from them. The children’s success or failure was directly related to how their parents coped. The key factors that enabled successful coping were the parents’ ability to accommodate to the child’s needs, their own creativeness and resourcefulness, and a generally positive outlook. The results of this analysis revealed that the best way to benefit autistic children caught up in drastic changes in their routine lifestyle is to invest in a strong support system for their parents.

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21. Treise C, Simmons C, Marshall N, Painter M, Perez J. Autism Spectrum Disorder in Early Intervention in Psychosis Services : Implementation and Findings of a 3-step Screening and Diagnostic Protocol. J Psychiatr Pract ;2021 (Jan 21) ;27(1):23-32.

Evidence indicates that autism spectrum disorder (ASD) is underidentified in populations with psychosis, but that clinical presentations of comorbid ASD and psychosis (ASD-P) and specific treatment needs that may relate to this group are not well understood. In fact, recent studies of ASD in first-episode psychosis suggest that there may be a specific clinical presentation of ASD-P. In response, the Cambridgeshire and Peterborough Early Intervention in Psychosis (EIP) service in the UK implemented and evaluated a 3-step ASD screening and diagnostic protocol, using the Autism Spectrum Disorder in Adults Screening Questionnaire (ASDASQ), case note review, and the Autism Diagnostic Observation Schedule (ADOS-2) and the Childhood Autism Spectrum Test (CAST). As a quality improvement project, the evaluation aimed to (1) establish the prevalence of patients with ASD-P, (2) describe characteristics of the clinical presentation of ASD-P and compare them to those of patients suffering from psychosis but no ASD, and (3) determine any differences in treatment between psychosis patients with and without ASD. Notably, at least 9% of the EIP service caseload met the criteria for a diagnosis of ASD-P, with half identified via the implementation of this protocol. The patients with ASD-P had specific clinical presentations and treatment needs that differed from those of patients with psychosis but no ASD. Thus, the findings from this study supported existing evidence concerning the underdetection of ASD in EIP populations. Our findings also added to emerging evidence for a clinical presentation of ASD-P with specific treatment needs. Our protocol has now been established as routine practice, and its implementation has improved the detection and treatment of patients with ASD-P within our EIP service.

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