1. Aishworiya R, Ma VK, Feldman HM. Commentary: Taking stock and moving forward – the need to consider the influence of loss to follow-up in autism screening research. J Child Psychol Psychiatry;2024 (Mar 14)

This commentary highlights the limitations of many existing population-based studies examining the utility of the Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) in screening for autism. We expound on three major factors: (a) the limited number of screen-negative children who undergo diagnostic evaluations, (b) the substantial number of children who screen positive and were subsequently lost to follow-up (i.e. without further diagnostic evaluations), and (c) the sizeable number of children who did not complete the full two-stage screening process as intended. Each of these factors can lead to erroneous estimates of the psychometric properties, specifically, the sensitivity, specificity, and negative predictive value. Hence, we emphasize the need for future studies to increase the number of children who screen negative and receive a diagnostic evaluation and ensure that these children are selected at random without a higher likelihood for the presence of autism. It is also imperative that concrete steps are taken to minimize the number of screen-positive children who are lost to follow-up both within and after the screening process. Both of these will play a major role in ensuring more robust results from empirical research that can guide the clinical implementation of the M-CHAT-R/F.

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2. Brown S, Rabenstein K, Doherty M. Autism and anaesthesia: a simple framework for everyday practice. BJA Educ;2024 (Apr);24(4):129-137.

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3. Dark J. Eight principles of neuro-inclusion; an autistic perspective on innovating inclusive research methods. Front Psychol;2024;15:1326536.

In this article I explain the value of autistic perspectives in research and argue that support for autistic scholars, community leaders and professionals are required as an inclusive research consideration. I propose consolidation, innovation, and evaluation of inclusive research principles, with consideration given to epistemic agency, autistic participation, and actionable research outcomes. I then present « Eight Principles of Neuro-Inclusion, » a reflexive tool that I have designed as a way of encouraging new developments of inclusive research practices. Through flexible application of this approach, it is hoped that innovative new inclusive methods will materialize, in pursuit of epistemic justice, and in support of actionable research outcomes that benefit our autism community.

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4. Davis JM, Harrington MB, Howie FR, Mohammed KS, Gunderson JA. Reducing Time to Diagnosis of Autism Spectrum Disorder Using an Integrated Community Specialty Care Model: A Retrospective Study. J Pediatr;2024 (Mar 14):114009.

OBJECTIVE: To evaluate a fast-track triage model in an integrated community specialty clinic to reduce the age of diagnosis for patients with autism spectrum disorder (ASD). STUDY DESIGN: A retrospective chart review was performed for patients seen in an integrated community specialty (ICS) pediatric practice using a fast-track screening and triage model. The percentage of ASD diagnoses, age at diagnosis, and time from referral to diagnosis were evaluated. The fast-track triage model was compared with national and statewide estimates of median age of first evaluation and diagnosis. RESULTS: From January 1, 2020, through December 31, 2021, 189 children with a mean (SD) age of 32.2 (12.4) months were screened in the ICS. Of these, 82 (43.4%) children were referred through the fast-track triage for further evaluation in the developmental and behavioral pediatrics (DBP) department, where 62 (75.6%) were given a primary diagnosis of ASD. Average wait time from referral to diagnosis using the fast-track triage model was 6 months. Mean (SD) age at diagnosis was 37.7 (13.5) months. The median age of diagnosis by the fast-track triage model was 33 months compared with the national and state median ages of diagnosis at 49 and 59 months respectively. CONCLUSION: With the known workforce shortage in fellowship-trained developmental behavioral pediatricians, the fast-track triage model is feasible and maintains quality of care while resulting in more timely diagnosis, and reducing burden on DBP by screening out cases who did not require further multidisciplinary DBP evaluation as they were appropriately managed by other areas.

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5. Duville MM, Alonso-Valerdi LM, Ibarra-Zarate DI. Improved emotion differentiation under reduced acoustic variability of speech in autism. BMC Med;2024 (Mar 14);22(1):121.

BACKGROUND: Socio-emotional impairments are among the diagnostic criteria for autism spectrum disorder (ASD), but the actual knowledge has substantiated both altered and intact emotional prosodies recognition. Here, a Bayesian framework of perception is considered suggesting that the oversampling of sensory evidence would impair perception within highly variable environments. However, reliable hierarchical structures for spectral and temporal cues would foster emotion discrimination by autistics. METHODS: Event-related spectral perturbations (ERSP) extracted from electroencephalographic (EEG) data indexed the perception of anger, disgust, fear, happiness, neutral, and sadness prosodies while listening to speech uttered by (a) human or (b) synthesized voices characterized by reduced volatility and variability of acoustic environments. The assessment of mechanisms for perception was extended to the visual domain by analyzing the behavioral accuracy within a non-social task in which dynamics of precision weighting between bottom-up evidence and top-down inferences were emphasized. Eighty children (mean 9.7 years old; standard deviation 1.8) volunteered including 40 autistics. The symptomatology was assessed at the time of the study via the Autism Diagnostic Observation Schedule, Second Edition, and parents’ responses on the Autism Spectrum Rating Scales. A mixed within-between analysis of variance was conducted to assess the effects of group (autism versus typical development), voice, emotions, and interaction between factors. A Bayesian analysis was implemented to quantify the evidence in favor of the null hypothesis in case of non-significance. Post hoc comparisons were corrected for multiple testing. RESULTS: Autistic children presented impaired emotion differentiation while listening to speech uttered by human voices, which was improved when the acoustic volatility and variability of voices were reduced. Divergent neural patterns were observed from neurotypicals to autistics, emphasizing different mechanisms for perception. Accordingly, behavioral measurements on the visual task were consistent with the over-precision ascribed to the environmental variability (sensory processing) that weakened performance. Unlike autistic children, neurotypicals could differentiate emotions induced by all voices. CONCLUSIONS: This study outlines behavioral and neurophysiological mechanisms that underpin responses to sensory variability. Neurobiological insights into the processing of emotional prosodies emphasized the potential of acoustically modified emotional prosodies to improve emotion differentiation by autistics. TRIAL REGISTRATION: BioMed Central ISRCTN Registry, ISRCTN18117434. Registered on September 20, 2020.

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6. Girault JB, Veatch OJ, Won H. Etiologic heterogeneity, pleiotropy, and polygenicity in behaviorally defined intellectual and developmental disabilities. J Neurodev Disord;2024 (Mar 13);16(1):8.

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7. Huang Q, Ellis CL, Leo SM, Velthuis H, Pereira AC, Dimitrov M, Ponteduro FM, Wong NML, Daly E, Murphy DGM, Mahroo OA, McAlonan GM. Retinal GABAergic alterations in adults with autism spectrum disorder. J Neurosci;2024 (Mar 14)

Alterations in γ-aminobutyric acid (GABA) have been implicated in sensory differences in individuals with autism spectrum disorder (ASD). Visual signals are initially processed in the retina and in this study we explored the hypotheses that the GABA-dependent retinal response to light is altered in individuals with ASD. Light-adapted electroretinograms (ERGs) were recorded from 61 adults (38 males and 23 females; n = 22 ASD) in response to three stimulus protocols: i) the standard white flash; ii) the standard 30-Hz flickering protocol; iii) the photopic negative response (PhNR) protocol. Participants were administered an oral dose of placebo, 15 or 30 mg of arbaclofen (STX209, GABA(B) agonist) in a randomized, double-blind, cross-over order before the test. At baseline (placebo), the a-wave amplitudes in response to single white flashes were more prominent in ASD, relative to typically developed (TD) participants. Arbaclofen was associated with decrease in the a-wave amplitude in ASD, but an increase in TD, eliminating the group difference observed at baseline. The extent of this arbaclofen-elicited shift significantly correlated with the arbaclofen-elicited shift in cortical responses to auditory stimuli as measured by electroencephalogram in our prior study, and with broader autistic traits measured with the Autism Quotient across the whole cohort. Hence, GABA-dependent differences in retinal light processing in ASD appear to be an accessible component of a wider autistic difference in central processing of sensory information, which may be upstream of more complex autistic phenotypes.Significance Statement Our current study provides the first direct in vivo experimental confirmation that autistic alterations in central GABA function extend to the retina. We show that arbaclofen was associated with reduced flash elicited a-wave amplitude in the electroretinogram (ERG) of autistic individuals but increased amplitude in non-autistic people. The retinal arbaclofen response correlated with previously reported arbaclofen effects on cortical visual and auditory responses in the same individuals. The extent of this differential GABAergic function correlated with the extent of autistic traits captured using the Autism Quotient. Thus, sensory processing differences in autism appear to be upstream of more complex autistic traits and the ERG from the retina is a potentially useful proxy for cross-domain brain GABA function and target engagement.

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8. John A, Evans S, Dow E. Parenthood and Glee: An online study to examine differences between viewers and non-viewers of televisions shows featuring a character with a developmental disability. J Intellect Disabil;2024 (Mar 14):17446295241239103.

We present findings from our study, which examined whether ability to identify Down syndrome and autism was linked to participants’ willingness to maintain social contact with individuals with the respective conditions. Additionally, we explored whether viewers and non-viewers of Parenthood and Glee, television shows featuring a character with autism and Down syndrome respectively, differed in their awareness, beliefs regarding causes and interventions, and desire to maintain social proximity with individuals with these conditions. Participants completed an online survey, which included vignettes based on Max, the character with autism from Parenthood and Becky, the character with Down syndrome from Glee as well as the adapted Intellectual Disabilities Literacy Scale. Based on 300 responses, key differences were noted in the hypothesized direction on the assessed variables (symptom recognition, causal beliefs, and treatment beliefs) between Parenthood and Glee viewers and non-viewers. Findings are discussed in the context of practical implications and methodological limitations.

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9. Kimhi Y, Mirsky Y, Bauminger-Zviely N. The Role of Theory of Mind, Executive Functions, and Central Coherence in Reading Comprehension for Children with ASD and Typical Development. J Autism Dev Disord;2024 (Mar 14)

Many children with autism spectrum disorders (ASD) have challenges in reading comprehension, especially when implicit information in narrative texts is involved. Three interrelated factors influencing reading comprehension have been proposed to explain these challenges: Theory of Mind – ToM; executive functions – EF; and central coherence – CC. This study investigated the differential contribution of these cognitive abilities to reading comprehension among cognitively able children with ASD compared to matched peers with typical development (TD). 28 third-grade children with ASD and 28 third-grade children with TD participated in the study. Four measures were administered: ToM, CC, EF (working memory, planning, inhibitory control, cognitive flexibility), and reading comprehension. One-way ANOVAs were computed to examine group differences in cognitive characteristics (ToM, CC, EF) and reading comprehension. Regressions were performed to examine the contribution of cognitive characteristics (ToM, CC, EF) to reading comprehension abilities (explicit, implicit, and general score) in ASD and TD. The TD group outperformed the ASD group in ToM and various EF measures but not in CC or reading comprehension. Positive main effects were found for ToM, and EF measures (planning – 3rd level, inhibition, and cognitive flexibility), demonstrating their contribution to reading comprehension abilities in both groups. Interactions revealed positive main effects for EF planning and CC for the ASD group only, showing the contribution of EF planning and CC for better reading comprehension. Our findings suggest different processing mechanisms regarding reading comprehension in each group.

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10. Lu X, Song Y, Wang J, Cai Y, Peng S, Lin J, Lai B, Sun J, Liu T, Chen G, Xing L. Developmental dopaminergic signaling modulates neural circuit formation and contributes to autism spectrum disorder (ASD)-related phenotypes. Am J Pathol;2024 (Mar 14)

Autism spectrum disorder (ASD) is a prevalent neurodevelopmental disorder with a complex etiology. Recent evidence suggests that dopamine plays a crucial role in neural development. However, it remains unclear whether and how disrupted dopaminergic signaling during development contributes to ASD. In this study, human brain RNA-seq transcriptome analysis revealed a significant correlation between changes in dopaminergic signaling pathways and neural developmental signaling in ASD patients. In the zebrafish model, disrupted developmental dopaminergic signaling led to neural circuit abnormalities and behavior reminiscent of autism. Dopaminergic signaling may impact neuronal specification by potentially modulating integrins. These findings shed light on the mechanisms underlying the link between disrupted developmental dopamine signaling and ASD, and they point to the possibility of targeting dopaminergic signaling in early development for ASD treatment.

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11. McMaughan DJ, Lewis C, McGehee A, Noreen D, Parker E, Criss MM. Meaningful Social Inclusion and Mental Well-Being Among Autistic Adolescents and Emerging Adults: Protocol for a Community-Based Mixed Methods Study. JMIR Res Protoc;2024 (Mar 14);13:e52658.

BACKGROUND: In the United States, autistic people face high rates of co-occurring mental illnesses and premature death due to self-harm, which are indicators of threats to mental well-being. Social inclusion may enhance mental well-being and resilience among autistic people. According to Simplican and colleague’s (2015) model of social inclusion for people with intellectual and developmental disabilities, social inclusion is an interaction between community participation and interpersonal relationships. There is limited research on social inclusion that includes the integration of interpersonal relationships and community participation among autistic people or the impact of social inclusion on the well-being of autistic people. Additionally, little evidence exists regarding how autistic people prefer to be included in the community or form interpersonal relationships. OBJECTIVE: The long-term objective of this project is to improve social inclusion factors to support the mental well-being of autistic people. This protocol describes a community-based, mixed methods pilot study to develop a definition of meaningful social inclusion for autistic people and to understand the relationship between meaningful social inclusion and mental well-being among autistic adolescents and emerging adults. METHODS: The project uses a community-based, sequential mixed methods design with a formative phase (Phase 1) that informs a survey phase (Phase 2) and concludes with a process evaluation of the community engagement process (Phase 3). During Phase 1, we will recruit 10 community partners (autistic adults and stakeholders) and conduct sharing sessions to cocreate a definition of meaningful social inclusion and a survey of meaningful social inclusion and well-being. During Phase 2, we will recruit 200 participants (100 autistic adolescents and emerging adults and 100 caregivers) to complete the survey. We will examine whether meaningful social inclusion predicts well-being given sociodemographic factors using ordered logistic regression, with well-being categorized as low, medium, and high. During Phase 3, the community partners from Phase 1 will complete a survey on their experiences with the project. RESULTS: Ethics approval was obtained for this project in March 2023. We have recruited community partners and started the Phase 1 focus groups as of September 2023. Phase 2 and Phase 3 have not yet started. We expect to complete this study by March 2025. CONCLUSIONS: Using a community-based, mixed methods approach, we intended to develop a definition of meaningful social inclusion for autistic people and understand the role meaningful social inclusion plays in the well-being of autistic people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52658.

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12. Mohamad T, Lepage JF. Computing a cure for fragile-X syndrome. Brain Commun;2024;6(2):fcae066.

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13. Oh J, Kim K, Kannan K, Parsons PJ, Mlodnicka A, Schmidt RJ, Schweitzer JB, Hertz-Picciotto I, Bennett DH. Early childhood exposure to environmental phenols and parabens, phthalates, organophosphate pesticides, and trace elements in association with attention deficit hyperactivity disorder (ADHD) symptoms in the CHARGE study. Environ Health;2024 (Mar 14);23(1):27.

BACKGROUND: A growing body of literature investigated childhood exposure to environmental chemicals in association with attention-deficit/hyperactivity disorder (ADHD) symptoms, but limited studies considered urinary mixtures of multiple chemical classes. This study examined associations of concurrent exposure to non-persistent chemicals with ADHD symptoms in children diagnosed with autism spectrum disorder (ASD), developmental delay (DD), and typical development (TD). METHODS: A total of 549 children aged 2-5 years from the Childhood Autism Risks from Genetics and Environment (CHARGE) case-control study were administered the Aberrant Behavior Checklist (ABC). This study focused on the ADHD/noncompliance subscale and its two subdomains (hyperactivity/impulsivity, inattention). Sixty-two chemicals from four classes (phenols/parabens, phthalates, organophosphate pesticides, trace elements) were quantified in child urine samples, and 43 chemicals detected in > 70% samples were used to investigate their associations with ADHD symptoms. Negative binomial regression was used for single-chemical analysis, and weighted quantile sum regression with repeated holdout validation was applied for mixture analysis for each chemical class and all chemicals. The mixture analyses were further stratified by diagnostic group. RESULTS: A phthalate metabolite mixture was associated with higher ADHD/noncompliance scores (median count ratio [CR] = 1.10; 2.5th, 97.5th percentile: 1.00, 1.21), especially hyperactivity/impulsivity (median CR = 1.09; 2.5th, 97.5th percentile: 1.00, 1.25). The possible contributors to these mixture effects were di-2-ethylhexyl phthalate (DEHP) metabolites and mono-2-heptyl phthalate (MHPP). These associations were likely driven by children with ASD as these were observed among children with ASD, but not among TD or those with DD. Additionally, among children with ASD, a mixture of all chemicals was associated with ADHD/noncompliance and hyperactivity/impulsivity, and possible contributors were 3,4-dihydroxy benzoic acid, DEHP metabolites, MHPP, mono-n-butyl phthalate, and cadmium. CONCLUSIONS: Early childhood exposure to a phthalate mixture was associated with ADHD symptoms, particularly among children with ASD. While the diverse diagnostic profiles limited generalizability, our findings suggest a potential link between phthalate exposure and the comorbidity of ASD and ADHD.

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14. Simmons GL, Corbett BA, Lerner MD, Wofford K, White SW. Social competence in autism: A structural equation modeling approach. Autism Res;2024 (Mar 14)

Autistic individuals present with difficulties in social competence (e.g., navigating social interactions and fostering relationships). Clinical interventions widely target social cognition and social behavior, but there is inconsistent understanding of the underlying components of social competence. The present study used structural equation modeling to examine social cognition and social behavior and explore the relationship between these latent constructs. Autistic youth (ages 10-17; n = 219) and their caregivers participated in this study. Constructs of social cognition and social behavior were captured using caregiver-report and self-report rating scales, as well as observational measures and direct clinical assessments (e.g., NEPSY-II). Measurement models of social cognition and social behavior demonstrated adequate to good fit. Correlational models demonstrated adequate to poor fit, indicating latent constructs of social cognition and social behavior are not closely related in autistic youth. Exploratory examination of a subsample of male youth (n = 157) evidenced improved model fit of social behavior, specifically. Findings tease apart social cognition and social behavior as cohesive and separable constructs; results do not support a structural relationship between social cognition and social behavior. Noted treatment implications include consideration of how targeting social cognition and social behavior together or separately may support autistic youth’s progress toward reaching their identified therapeutic goals and supporting their self-directed social development.

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15. Turcan C, Delamain H, Loke A, Pender R, Mandy W, Saunders R. Measurement invariance of the parent-reported Strengths and Difficulties Questionnaire in autistic adolescents. Autism;2024 (Mar 13):13623613241236805.

Autistic people are more likely than non-autistic people to experience mental health difficulties. The Strengths and Difficulties Questionnaire is often used to screen for these difficulties and to otherwise make important decisions about mental health treatment and research in populations of autistic people. However, this study suggests that parent-reported Strengths and Difficulties Questionnaire scores may not be useful for comparing autistic and non-autistic adolescents at 11, 14 and 17 years old, as well as screening for mental health conditions in autistic adolescents. In addition, several items may be more likely to be endorsed by parents of autistic 17-year-olds than by parents of non-autistic 17-year-olds (and vice versa), which might suggest caution is needed when comparing groups on specific items.

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16. Yoffe J, Valicenti-McDermott M, Seijo R. Letter to the Editor: Suicide Risk Screening Practices in Youth with Developmental Disabilities. J Child Adolesc Psychopharmacol;2024 (Mar);34(2):108-109.

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