1. Correction to « I think they do not know how to lie: » The perceptions of legal support staff about person with intellectual disabilities/autism in Turkish legal system. J Appl Res Intellect Disabil;2024 (Sep);37(5):e13271.

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2. Al-Agailat L, Guertin S, Littlejohn E. Lipid apheresis in the management of severe hypertriglyceridaemia in an adolescent girl with global developmental delay. BMJ Case Rep;2024 (Aug 14);17(8)

Hypertriglyceridaemia-induced acute pancreatitis (HTG-AP) remains one of the common metabolic causes of acute pancreatitis in the paediatric population and the third most common cause after alcohol and gallstones in the adult population. We report a case of an early adolescent girl with global developmental delay and moderate cognitive impairment of unknown aetiology who presented with recurrent acute pancreatitis and uncompensated hypovolaemic shock. She was found to have serum triglyceride level of 7877 mg/dL (reference range<150 mg/dL) and hyperglycaemia with ketosis (no prior history of diabetes mellitus) that was successfully treated with lipid apheresis. This sometimes is an early modality for treatment in adults; however, it remains a last resort in children, used only for severe cases. A brief literature review on severe HTG-AP and its management is also provided.

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3. Andrews HE, Hedley D, Bury SM. The Relationship Between Autistic Traits and Quality of Life: Investigation of Indirect Effects Through Self-Determination. Autism Adulthood;2024 (Jun);6(2):177-191.

BACKGROUND: Self-determination, described broadly as experiencing causal agency, is positively associated with quality of life (QoL) and increases through satisfaction of three basic psychological needs: autonomy (feeling able to make choices free from pressure), competence (perceived self-efficacy), and relatedness (social connection). Both unsupportive environments and challenges with social interaction can interfere with satisfaction of psychological needs. Social challenges are a key trait for autism diagnosis, and unsupportive environments are also known to adversely affect QoL for autistic people. Autistic people report, on average, lower self-determination than non-autistic people. Therefore, it is hypothesized that higher levels of autistic traits may reduce opportunities to develop self-determination, affecting QoL. METHODS: We tested a parallel indirect effects model where we hypothesized that the relationships between autistic traits and four domains of QoL (psychological, social, physical, and environmental) would be indirectly influenced through self-determination (represented through satisfaction of the basic psychological needs for autonomy, competence, and relatedness). This study drew participants from the general population (N = 262; M (AGE) = 37.6, standard deviation = 11.92; 1.9% reported an autism diagnosis and 2.7% identified as autistic without a diagnosis). Participants completed an online survey. RESULTS: Higher levels of autistic traits were associated with lower levels of self-determination and lower levels of QoL, and there was a significant indirect effect between autistic traits and QoL via self-determination. More specifically, we found a significant indirect effect between autistic traits and all QoL domains via competence; between autistic traits and the environmental, social, and psychological QoL domains via relatedness; and between autistic traits and the physical and environmental QoL domains through autonomy. CONCLUSIONS: Our results suggest that supporting satisfaction of the needs for autonomy, competence, and relatedness may represent an important element in designing effective programs to support the development of self-determination in people with higher levels of autistic traits (potentially including autistic individuals) and also to support these people to improve their QoL. Why is this an important issue? In this study, we looked at how autistic traits might affect self-determination and quality of life. Quality of life is the way that you feel about your own life circumstances. In this study, we looked at four aspects of quality of life—psychological (e.g., mental health), social (how you interact with other people), physical (e.g., disability or sickness), and environmental (e.g., where you live). Self-determination is the ability to choose based on your own wants, needs, and interests, without feeling pressured. To be self-determined, you need to meet your needs for autonomy (experiencing free choice), competence (feeling able to do things effectively), and relatedness (feeling connected with others). Meeting these needs is affected by the world around you (e.g., where you live, if you have a job, whether you are disabled) and by the actions and beliefs of the people around you. People with higher autistic traits report, on average, lower quality of life and self-determination than people with lower autistic traits. Because other researchers have found that self-determination influences quality of life, lower levels of self-determination might partly explain lower quality of life. Programs that promote self-determination may reduce the gap in quality of life between autistic and non-autistic people. What was the purpose of this study? We thought that self-determination might partly explain why people with higher autistic traits report lower quality of life than people with lower autistic traits, so we wanted to test this idea. What did the researchers do? We asked people to answer questions about autistic traits, self-determination, and quality of life in an online survey. We statistically analyzed their answers to find out whether autistic traits influenced the levels of self-determination (feelings of autonomy, competence, and relatedness) or quality of life (psychological, social, physical and environmental quality of life). What were the results of this study? Autistic traits did not directly influence psychological, physical, or environmental quality of life but did directly influence social quality of life. In our study, people with higher autistic traits reported less satisfaction of their psychological needs than people with lower autistic traits. People with lower satisfaction of psychological needs also reported lower quality of life. Autistic traits influenced self-determination, which in turn influenced quality of life. What do these findings add to what was already known? To the best of our knowledge, this was the first study to explore relationships between autistic traits, self-determination, and quality of life. Our results showed that people with higher levels of autistic traits may report lower quality of life partly because autistic traits might make it difficult to become self-determined. What are the potential weaknesses in the study? We investigated self-determination and quality of life among one group of people from the general population. We did not compare autistic and non-autistic people. While some studies have shown that people with high levels of autistic traits may be similar to autistic people in some ways, this is not necessarily the case all the time. We cannot assume that results will be the same in other groups, that autistic traits cause lower self-determination, or that lower self-determination causes lower quality of life. We also did not consider all the things that might have influenced self-determination or quality of life (e.g., where people lived, how much money they had, or what their health was like). How will these findings help autistic adults now or in the future? People with higher autistic traits (including autistic adults) may find it harder to be self-determined both because of their autistic traits (e.g., difficulty in social interaction, sensory sensitivities) and also because school, work, and community systems may not be designed to support acceptance of differences. The results from this study suggest that higher autistic traits might make it difficult to meet the psychological needs for autonomy, competence, and relatedness. Research that compares autistic and non-autistic people is needed to determine both personal and environmental factors which may support the development of self-determination in autistic people and empower them to achieve higher quality of life. eng

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4. Bögl K, Bayer M, Walter H, Dziobek I. Influences of heart rate feedback and autistic traits on affective mindreading. Sci Rep;2024 (Aug 13);14(1):18783.

Although mindreading is an important prerequisite for successful social interactions, the underlying mechanisms are still matter of debate. It is unclear, for example, if inferring others’ and own mental states are distinct processes or are based on a common mechanism. Using an affect-induction experimental set-up with an acoustic heart rate feedback that addresses affective mindreading in self and others, we investigated if non-autistic study participants relied on similar information for self- and other-directed mindreading. We assumed that due to altered mindreading capacities in autism, mainly individuals with low autistic traits would focus on additional sensory cues, such as heart rate, to infer their own and their gambling partner’s affective states. Our analyses showed that the interpretation of a heart rate signal differed in self- and other-directed mindreading trials. This effect was modulated by autistic traits suggesting that individuals with higher autistic traits might not have interpreted the heart rate feedback for gambling partner ratings and differentiated less between self- and other-directed mindreading trials. We discuss these results in the context of a common mechanism underlying self- and other-directed mindreading and hypothesize that the weighting of internal and external sensory information might contribute to how we make sense of our and others’ mental states.

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5. Burke M, Li C, Cheung WC, Terol AK, Johnston A, Schueller SM. Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study. JMIR Form Res;2024 (Aug 14);8:e56043.

BACKGROUND: It is difficult for families to navigate and access services for their children with autism. Barriers to service access are compounded among families from low-resourced backgrounds. OBJECTIVE: The purpose of our study was to explore the development of an app to facilitate access to services among families of children with autism from low-resourced backgrounds. Our specific aims were to explore feedback from an advisory board about the app and to explore feedback from navigators about the app. METHODS: Via a multistage codevelopment process, we elicited feedback from 5 key parties: the research team, a community organization, the app development team, the advisory board, and family navigators. Collectively, 36 individuals provided feedback about the development of the app via individual interviews, focus groups, observations, and surveys. The key features of the app included a dashboard showing the service needs of the family and related resources, a messaging feature between the family, the navigator, and the supervisor, and a fidelity checklist and evaluation feature. RESULTS: The advisory board provided feedback about the app to increase its user-friendliness, include the ability to develop an action plan, improve the identification of needed services, and add information about service providers. Navigators suggested that the app should connect navigators to one another, have a clearer purpose for the notes section, and reflect an easier log-in process. Navigators also wanted training to role-play using the app. After participating in a role play using the app, navigators reported significantly more satisfaction with the app and greater usefulness (P<.001). CONCLUSIONS: Our work sheds light on the importance of eliciting feedback from end users, especially users who are often overlooked by the research community and app developers. Further, it is important to elicit feedback in multiple ways to improve the app.

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6. Camussi D, Naef V, Brogi L, Della Vecchia S, Marchese M, Nicoletti F, Santorelli FM, Licitra R. Delving into the Complexity of Valproate-Induced Autism Spectrum Disorder: The Use of Zebrafish Models. Cells;2024 (Aug 14);13(16)

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental condition with several identified risk factors, both genetic and non-genetic. Among these, prenatal exposure to valproic acid (VPA) has been extensively associated with the development of the disorder. The zebrafish, a cost- and time-effective model, is useful for studying ASD features. Using validated VPA-induced ASD zebrafish models, we aimed to provide new insights into VPA exposure effects during embryonic development and to identify new potential biomarkers associated with ASD-like features. Dose-response analyses were performed in vivo to study larval phenotypes and mechanisms underlying neuroinflammation, mitochondrial dysfunction, oxidative stress, microglial cell status, and motor behaviour. Wild-type and transgenic Tg(mpeg1:EGFP) zebrafish were water-exposed to VPA doses (5 to 500 µM) from 6 to 120 h post-fertilisation (hpf). Embryos and larvae were monitored daily to assess survival and hatching rates, and numerous analyses and tests were conducted from 24 to 120 hpf. VPA doses higher than 50 µM worsened survival and hatching rates, while doses of 25 µM or more altered morphology, microglial status, and larval behaviours. VPA 50 µM also affected mRNA expression of inflammatory cytokines and neurogenesis-related genes, mitochondrial respiration, and reactive oxygen species accumulation. The study confirmed that VPA alters brain homeostasis, synaptic interconnections, and neurogenesis-related signalling pathways, contributing to ASD aetiopathogenesis. Further studies are essential to identify novel ASD biomarkers for developing new drug targets and tailored therapeutic interventions for ASD.

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7. Capelli E, Riva V, D’Alfonso S, Panichi V, Riboldi EM, Borgatti R, Molteni M, Provenzi L. Exploring the impact of parents’ face-mask wearing on dyadic interactions in infants at higher likelihood for autism compared with general population. J Exp Child Psychol;2024 (Aug 12);247:106037.

Since the COVID-19 pandemic, both the public and researchers have raised questions regarding the potential impact of protective face-mask wearing on infants’ development. Nevertheless, limited research has tested infants’ response to protective face-mask wearing adults in real-life interactions and in neurodiverse populations. In addition, scarce attention was given to changes in interactive behavior of adults wearing a protective face-mask. The aims of the current study were (1) to examine differences in 12-month-old infants’ behavioral response to an interactive parent wearing a protective face-mask during face-to-face interaction, (2) to investigate potential differences in infants at higher likelihood for autism (HL-ASD) as compared with general population (GP) counterparts, and (3) to explore significant differences in parents’ behaviors while wearing or not wearing a protective face-mask. A total of 50 mother-infant dyads, consisting of 20 HL-ASD infants (siblings of individuals with autism) and 30 GP infants, participated in a 6-min face-to-face interaction. The interaction was videotaped through teleconferencing and comprised three 2-min episodes: (a) no mask, (b) mask, and (c) post-mask. Infants’ emotionality and gaze direction, as well as mothers’ vocal production and touching behaviors, were coded micro-analytically. Globally, GP infants exhibited more positive emotionality compared with their HL-ASD counterparts. Infants’ negative emotionality and gaze avoidance did not differ statistically across episodes. Both groups of infants displayed a significant increase in looking time toward the caregiver during the mask episode. No statistically significant differences emerged in mothers’ behaviors. These findings suggest that the use of protective face-masks might not negatively affect core dimensions of caregiver-infant interactions in GP and HL-ASD 12-month-old infants.

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8. Carbone PS, Stipelman CH, Villalobos ME, Ellzey A, Stuart A, Stoddard GJ, Campbell K. A Comparison of Parent-Reported Severe Autism With Mild/Moderate Autism Among US Children. J Dev Behav Pediatr;2024 (Aug 13)

OBJECTIVE: An expert commission has proposed the term « profound » autism for children on the spectrum who are minimally verbal or nonverbal and have intellectual disability (ID), behavioral challenges, and co-occurring conditions. It is unknown whether parents’ rating of « severe » autism aligns with the definition of « profound » autism. Using the National Survey of Children’s Health, we sought to (1) estimate the prevalence of parent-reported severe autism, (2) identify child characteristics that are associated with severe autism, (3) compare health care utilization, and (4) compare caregiver stress and resilience between families of children with severe versus mild/moderate autism. METHODS: Parent responses on the 2018 to 2019 NSCH were used to compare school-age children with parent-reported severe autism and those with mild/moderate autism. Descriptive statistics, χ2 tests, and logistic regression were used for statistical analysis. RESULTS: Among parents of 1,368 US children with autism, 10.1% characterized their child’s autism as severe, a prevalence of 1 in 333. Parents of children with severe autism were more likely to report ID (45% vs 12.1%, p < 0.001), language delay (88% vs 58.7%, p < 0.001), and difficulties in dressing and bathing (67% vs 19.2%, p < 0.001). Children with severe autism had more behavioral problems and co-occurring conditions but were no more likely to see specialists or receive autism-specific behavioral therapy. Their caregivers reported more stress and less resilience. CONCLUSION: The characteristics of "profound" autism and parent-reported "severe" autism significantly overlap, allowing the use of the NSCH for studies of this vulnerable population. Children with profound/severe autism could benefit from more behavioral therapy, specialty care, and family support.

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9. Carpita B, Amatori G, Cremone IM, Bonelli C, Nardi B, Massimetti G, Pini S, Dell’Osso L. Major Depressive Disorder with Catatonia: A Phenotype Related to Autistic Traits and High Suicidality. J Clin Med;2024 (Aug 14);13(16)

Background: Major Depressive Disorder (MDD) represents a significant global health concern, often complicated by comorbidities such as catatonia and autism spectrum disorder (ASD). Recognizing the interplay among these conditions and their impact on suicidal tendencies is crucial for effective clinical management. Methods: A total sample of 147 subjects with MDD was divided into Significant Catatonia (SC) and Non-Significant Catatonia (NSC) groups based on Catatonia Spectrum (CS) scores. Participants were evaluated through the Structured Clinical Interview for DSM-5, Research Version (SCID-5-RV), the Adult Autism Subtreshold Spectrum (AdAS Spectrum), and the Mood Spectrum-Self Report questionnaires. Statistical analyses included Mann-Whitney U test, Chi-square test, logistic regression analyses, and a decision tree model. Results: The SC group exhibited higher CS, AdAS Spectrum, and MOODS-SR total and domain scores compared to the NSC group. Individuals with significant autistic traits were over-represented in the SC group, as well as participants with higher suicidality, suicidal ideation, and a history of suicide attempts. The total AdAS Spectrum and MOOD-SR score, the AdAS domain « Hyper-hypo reactivity to sensory input », and the « Cognitive depressive » MOOD-SR domain were predictive of belonging to the SC group. Suicidality levels appeared to be higher in clinically significant ASD, intermediate in subjects with autistic traits (AT), and low in the absence of AT. Conclusions: the study suggests the existence of a specific phenotype of MDD associated with catatonia, characterized by elevated autistic traits and suicide risk.

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10. Choi YY, Lee KS, Park SG, Kim YS, Lee J, Sung HK, Kim MH. COVID-19 and Neurodevelopmental Delays in Early Childhood: A Longitudinal Analysis of Developmental Outcomes in Korean Children. J Korean Med Sci;2024 (Aug 12);39(31):e243.

This study employed a longitudinal analysis to evaluate the association between the coronavirus disease 2019 pandemic and neurodevelopment by analyzing over 1.8 million children from the Korean Developmental Screening Test for Infants and Children included in South Korea’s National Health Screening Program. We compared the developmental outcomes in five age groups-9-17 months, 18-29 months, 30-41 months, 42-53 months, and 54-65 months-between the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Significant increases in potential developmental delays were observed during the pandemic in communication, cognitive, social interaction, self-care, and fine motor skills across most age groups. All five age groups experienced notable disruptions in communication and fine motor skills. Children from socioeconomically disadvantaged backgrounds faced higher risks across all domains. These findings highlight the need for targeted interventions and continuous monitoring to support the developmental needs of children affected by pandemic-related disruptions.

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11. Clegg A, Wood J, Hobson H, Sedgewick F. The Experiences of Autistic People When Facemask Wearing and Interacting with Masked Individuals. Autism Adulthood;2024 (Jun);6(2):162-176.

BACKGROUND: The World Health Organization recommended that individuals use a facemask to prevent the ongoing spread of COVID-19. Many governments implemented this recommendation into law. However, the increased usage of facemasks may have had particular impacts on the autistic population, due to differences in emotion processing, sensory issues, and anxiety about regularly changing rules. This research aimed to investigate the lived experiences of autistic people when wearing facemasks and their experiences interacting with others wearing facemasks. METHODS: First, the research team conducted a content analysis of social media posts (n = 124) created by autistic individuals. Based on this, we developed a novel questionnaire and distributed it so that autistic adults could share their facemask experiences (n = 49). RESULTS: Seven main themes were identified from the social media analyses: general attitudes toward masks, sensory issues, « wear-a-mask » message, rules and expectations, sunflower lanyards, social problems and benefits, and mask exemption. Secondary questionnaire responses highlighted that the experience of facemasks was mixed. Many individuals experienced sensory issues. Yet, for some individuals, there were benefits: they did not have to monitor their facial expressions to camouflage their autistic responses. Participants reported differing opinions on the topic of mask exemption, and the sunflower lanyard as a symbol of mask exemption. Data did not suggest anxiety around rule changes but did suggest feelings of anger at others who were perceived not to be following the rules. CONCLUSIONS: These findings highlight the mixed experiences of autistic people with facemasks and suggest lessons for future events in which there are rapid changes to public health messaging. Why is this an important issue? During the COVID-19 pandemic, people across the world were suddenly asked to wear facemasks to stop the spread of infection. Rules around mask wearing then changed frequently, as scientists and governments learning more about the virus and how it spread. For autistic people, who have sensory sensitivities and can find unpredictable changes difficult and distressing, this may have made wearing a facemask more difficult than it was for non-autistic people. What was the purpose of this study, and what did the researchers do? This study set out to try to understand autistic people’s experiences of wearing facemasks and interacting with other people who were wearing facemasks. To do this, the researchers took a two-stage approach. First, they looked at what autistic people were saying about facemask wearing online (in social media posts), and used this to develop a specific questionnaire. That questionnaire was then filled out by 49 autistic adults (age 18–63 years) online. What were the results of the study? The stage 1 social media posts revealed seven themes: general attitudes toward masks, sensory issues, “wear-a-mask” message, rules and expectations, sunflower lanyards, social problems and benefits, and mask exemption. The stage 2 questionnaire showed that autistic people had varied experiences of facemask wearing, with sensory issues being a common challenge. Some autistic people said that there were benefits of facemask wearing, such as being able to think less about controlling their facial expressions in social interactions. The sunflower lanyard, and the masking exemption it indicated, was a particularly divisive topic among participants. What do these findings add to what was already known? Before this research, nothing was formally known about the experiences of autistic adults when wearing facemasks, or their attitudes toward this during the pandemic. The few studies that do exist on facemask wearing focus on teaching children to tolerate masks better, rather than asking autistic people for their opinions. We now know that experiences varied, as would be expected in such a varied group, but that some common themes were present—especially around the sensory aspects of facemask wearing. What are the potential weaknesses of the study? As the research was conducted entirely online, there is potentially a bias toward autistic adults who are capable and interested in sharing their thoughts and experiences in writing. This means that our findings may not apply for autistic adults with learning difficulties, for example. The sample was also mostly made up of cis-women, which means that the experiences of other genders of autistic people may not be fully represented. The study also does not have a non-autistic control group, so some of these experiences may be common to autistic and non-autistic people. How will these findings help autistic adults now or in the future? Understanding how autistic adults experienced facemask wearing during the initial waves of the COVID-19 pandemic can inform how future mask mandates are implemented and communicated if there is a need for this in response to further waves or novel illnesses. eng

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12. Emerson LM, Monk R, van der Meer L, Sutherland D, McLay L. Autistic Co-Led Community Priorities for Future Autism Research in Aotearoa New Zealand. Autism Adulthood;2024 (Jun);6(2):141-151.

BACKGROUND: Previous studies of community priorities for autism research have been limited by low representation of autistic people and thus a bias toward the views of families and professionals. We aimed to determine the first community-led priorities for autism research in Aotearoa New Zealand (NZ). METHODS: Autistic people were essential partners in the project, from inception and design through to methods and outputs. We gathered the views of the autistic and autism communities (including family, practitioners, and researchers) through focus groups (n = 55) and an online survey (n = 450). Almost 40% of the survey respondents indicated that they were autistic. RESULTS: The findings across the focus groups and survey highlighted the importance of research that centralizes the experiences and needs of autistic people, particularly of autistic New Zealanders, including culturally specific research for Māori and Pacific peoples. All five priority topics for autistic adults were also priorities for at least one other group: (1) Health, mental health, and well-being of autistic people (all groups); (2) Services across the life span (autistic adults, health care/disability, and education practitioners); (3) Needs of autistic people in Aotearoa NZ (autistic adults, whānau); (4) Perspectives from autistic people with a diverse range of support needs (autistic adults; education practitioners); (5) Quality of life of autistic people in Aotearoa NZ (autistic adults; health care/disability practitioners). CONCLUSIONS: We discuss the advantages of autistic involvement in research, and how these community priorities can inform future research and policy in NZ. Why is this an important issue? There are no previous autism research priorities for Aotearoa New Zealand that have been determined by the autistic and autism communities. The population characteristics and social and cultural context of Aotearoa New Zealand (NZ) are unique. What was the purpose of this study? We wanted to find out what the autistic and autism communities think future autism research should focus on. What did the researchers do? Autistic people were essential partners in this project and contributed to the design, methods, and outputs. We carried out focus groups and an online survey of autistic people and members of the broader autism community (family, practitioners, and researchers) in NZ. In the focus groups, we asked 55 people what they thought future autism research in NZ should focus on. Three researchers (one autistic and two non-autistic) analyzed the focus group data. They read the written transcripts of the focus groups. Then, they met multiple times to talk about what they thought the ideas were and agree on the final ideas (themes). In the online survey, we asked 450 people to rate how important different autism research topics were to them. To analyze the survey data, two researchers looked at how important each autism research topic was for different community groups, including autistic adults, family, practitioners, and researchers. What were the results of the study? The results showed that the community thought future autism research should focus on the experiences of autistic people, particularly of autistic New Zealanders. Community members also thought that it was important that there is autism research that is specific to NZ, including culturally specific research for Māori and Pacific peoples. The five topics rated as most important by autistic adults were also priorities for at least one other group of people from the autism community (e.g., practitioners). Health, mental health, and well-being of autistic people was a priority topic for all groups. What do these findings add to what was already known? These findings tell us what autistic adults think is important for future autism research in NZ to focus on. The findings also show us the similarities and differences between what autistic adults think is important for future autism research, and what other people in the broader autism community think is important. What are the potential weaknesses in the study? The focus groups and online survey may not have been accessible to everyone who would like to take part. So we may have missed the opinion of some people. How will these findings help autistic adults now or in the future? We have determined what is important to autistic people and the broader autism community for future autism research. We can use this information to inform future autism research in NZ. Funding bodies can use this information to inform their decisions about funding for autism research. We hope that the way we included autistic adults in this project will also inspire other autism research in NZ, which will make autism research more appropriate, relevant, and ethical. eng

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13. Evans JA, Krumrei-Mancuso EJ, Rouse SV. What You Are Hiding Could Be Hurting You: Autistic Masking in Relation to Mental Health, Interpersonal Trauma, Authenticity, and Self-Esteem. Autism Adulthood;2024 (Jun);6(2):229-240.

BACKGROUND: Autistic masking refers to some autistic individuals’ tendency to hide, suppress, or camouflage their autistic traits, autistic identity, or autism diagnosis. Autistic masking also may include unconscious or conscious attempts to mimic the behavioral, cognitive, or sensory styles of nonautistic neurotypical people and to suppress natural forms of autistic behavior, cognition, and reactions to sensory experiences. Since autistic people are a stigmatized minority in many neurotypical dominated societies, passing as nonautistic through autistic masking may be an attempt to avoid autism stigma and a reaction to previous interpersonal trauma. Increased autistic masking behaviors are associated with reports of increased depression, anxiety, burnout, and exhaustion in autistic people, and thus, exploring the roots and impact of autistic masking is an important mental health topic. METHODS: This study investigated the relationships between autistic masking and depression, anxiety, gender identity, sexual orientation, interpersonal trauma, self-esteem, authenticity, and autistic community involvement. Participants were autistic adults (n = 342) recruited through autistic social media groups. RESULTS: This study found that higher self-reported autistic masking behaviors were associated with higher reports of past interpersonal trauma, greater anxiety and depression symptoms, lower self-esteem, lower authenticity, and lower participation within the autistic community. Autistic masking was not associated with gender identity or sexual orientation. CONCLUSIONS: The results of this study highlight the relationship between autistic masking and past interpersonal trauma, finding that autistic masking behavior is associated with mental health, self-esteem, and authenticity risks for autistic adults. We call into question the teaching of autistic masking strategies in therapies and education programs for autistic people based on the negative associations with autistic masking presented in this study and other research in this field. Why is this an important issue? Autistic masking refers to autistic people suppressing their natural autistic traits, responses, and behaviors, in an attempt, consciously or unconsciously, to hide or reduce the visibility of their autistic traits, autistic identity, or autism diagnosis. High levels of autistic masking are associated with negative mental health, authenticity challenges, and burnout for autistic people. Interpersonal pressuring, past traumatic social experiences, and autism stigma potentially fuel autistic masking. What is the purpose of this study? This study aimed to investigate relationship between autistic masking and depression, anxiety, interpersonal trauma, self-esteem, authenticity, autistic community involvement, gender identity, and sexual orientation. What did the researchers do? We recruited 342 autistic adult participants through autistic social media groups on Facebook to complete a 30-minute anonymous survey online comprising validated scales to measure autistic masking, depression, anxiety, interpersonal trauma, self-esteem, and authenticity. Additional questions were asked about demographic factors, such as gender identity and sexual orientation, and we asked open-ended questions about past social trauma and intersectional issues. What were the results of the study? We found that higher self-reported autistic masking behaviors were associated with higher reports of past interpersonal trauma, specifically being shamed and teased about autistic traits, and broader experiences of emotional and physical abuse. Masking was also associated with greater anxiety and more depression symptoms, lower self-esteem, lower authentic living, greater accepting of external influence, higher self-alienation, and lower participation within the autistic community. Autistic masking was not found to be associated with gender identity or sexual orientation. Participants who reported involvement in previous applied behavior analysis therapy reported higher past interpersonal trauma than participants involved in some other forms of therapy such as cognitive behavior therapy. What do the findings add to what was already known? This study supports previous research associating autistic masking with depression and anxiety symptoms, and lower reported authenticity, such as autistic people feeling they were not being true to themselves, or revealing their genuine selves to others. This study is the first to quantitatively investigate relationships between autistic masking and past interpersonal traumas, self-esteem, authenticity, and autistic community involvement. What are potential weaknesses in the study? Our sample is not representative of the U.S. population when it comes to race, educational level, gender, and sexual orientation. It was very White, highly educated, had few cisgender men, and sixty three percent were members of sexual minority groups. The majority of participants reported late diagnosis of autism. This sample potentially contained an overrepresentation of people with high levels of autistic masking or who more recently realized they were autistic masking in comparison with the general autistic population. We did not analyze differences between early-diagnosed and late-diagnosed cohorts. How will these findings help autistic adults now or in the future? This research calls into question the teaching of autistic masking strategies in parenting, education, and therapy programs for autistic people based on the negative associations of autistic masking. Our findings should be utilized as a strong call to action to push back against practices that encourage autistic masking and autistic trait shaming. Instead we advocate for promoting forms of parenting, education, and therapy that respect autistic people’s traits, communication styles, sensory needs, and autistic identity. eng

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14. Fantozzi P, Billeci L, Muratori P, Maestro S, Muratori F, Chakrabarti B, Calderoni S. Autistic traits and perspective taking in youths with anorexia nervosa: an exploratory clinical and eye tracking study. J Eat Disord;2024 (Aug 14);12(1):116.

BACKGROUND: Despite their apparent dissimilarity, Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD) share many features, especially in terms of social and emotional difficulties. In recent years, empathic abilities in AN have been frequently assessed using self-report measures. Otherwise, the director task (DT) has been used to investigate the ability to take the visual perspective of another individual in a communicative context, using eye-tracking technology. The aim of the current study was to test the presence of autism-relevant features in AN, through: (i) comparing self-reported autistic traits and empathic abilities in a group of young inpatients with AN and age/gender matched healthy controls (HC); (ii) comparing performance on the director paradigm. METHODS: The participants were females in the age-range between 11 and 18 years: 24 with AN and 23 HC. Autistic traits, empathic abilities, and severity of the eating disorder were respectively measured using: the Autism Quotient (AQ), the Interpersonal Reactivity Index (IRI), and the Eating Disorder Inventory-3 (EDI-3). Both groups performed a computerized task in which a director instructed them to move objects placed on a set of shelves using a mouse, while their eye gaze was tracked. A total of 36 shelf configurations, divided into three categories (with dimensional distractor – with spatial distractor – control), were created. RESULTS: Subjects with AN showed higher autistic traits than HC. Eye-tracking data revealed that subjects with AN took longer to decide which object to select and where to move it, both in distractor-trials and in control-trials. In the AN group, we found a significant negative correlation between the total score of the AQ and the number of fixations to the irrelevant object in the dimensional control condition -in which the subjects were asked to focus on dimensional aspects of the object (large-small)-. CONCLUSIONS: Autistic traits were over-represented in a group of young inpatients with AN. Through the use of eye-tracking technology, this exploratory study documented some differences between AN inpatients and HC in their online processes during the perspective taking tasks, which could be considered a target of tailored intervention. A larger sample of patients is needed to confirm these preliminary findings.

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15. Fatani AN, Alasiri NM, Gasem OA. Autism Spectrum Disorder and Suicide: A Case Report. Cureus;2024 (Jul);16(7):e64451.

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) significantly impact mental health, increasing the risk of severe behaviors, including suicidality. This case report examines a 13-year-old boy with ASD and ADHD who presented to the emergency department with homicidal and suicidal ideations. Despite being prescribed risperidone and carbamazepine, his noncompliance with medication and therapy, combined with significant social stressors like physical abuse by his stepfather and his mother’s mental health issues, exacerbated his condition. His aggressive actions toward siblings and self-harm attempts highlight the severe behavioral manifestations of these conditions. The case underscores the necessity for comprehensive and consistent intervention strategies, robust support systems, and regular follow-ups to manage ASD and ADHD effectively and mitigate the risk of severe outcomes.

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16. Friedman S, Noble R, Archer S, Gibson J, Hughes C. « It Helps Make the Fuzzy Go Away »: Autistic Adults’ Perspectives on Nature’s Relationship with Well-being Through the Life Course. Autism Adulthood;2024 (Jun);6(2):192-204.

BACKGROUND: While previous work highlights the links between nature and various positive well-being-related outcomes, the experiences of autistic people in nature have received limited empirical research. Our study aimed at gathering autistic adults’ perspectives on the relationship between nature and well-being in both childhood and adulthood. METHODS: We used an online survey to capture the views of 127 autistic adults across the United Kingdom. Using reflexive thematic analysis, we analyzed responses to three questions focused on nature experiences in childhood and adulthood and how the participants felt that nature was (or was not) related to well-being. Guided by self-determination theory, we used both inductive and deductive analysis. RESULTS: We developed three main themes to reflect the nature experiences of autistic adults: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn’t judge, but other people do. Compared with many other contexts, nature provides a non-judgmental space through which (in both childhood and adulthood) many, but not all, autistic individuals can meet individual needs and experience autonomy, relatedness, and competence. CONCLUSION: This analysis of how autistic adults in the United Kingdom utilize nature to support well-being has implications for how nature can be used in social prescribing as well as in ensuring that existing outdoor spaces, organizations, and activities are supportive of autistic people. Why is this an important issue? Autistic adults often experience poorer mental health and overall well-being than neurotypical adults. Since some autistic adults are very interested in nature and often report that they feel better after spending time in nature, natural spaces and activities taking place outside could be one way of improving well-being for autistic adults. What was the purpose of this study? There is very little research on how autistic adults experience nature, although some autistic people have written about their experiences. The purpose of this study was to develop an understanding of how autistic people experience nature and how nature might benefit their well-being. What did the researchers do? We created a survey that asked 26 questions about how autistic adults experience nature. This survey included questions about how often they visited nature, if they had a focused interest in nature, whether and how nature was related to their well-being, and childhood experiences of nature. Focusing on three of the questions, we used reflexive thematic analysis (a way of identifying patterns in data) to develop three themes. What were the results of the study? The three themes we developed were: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn’t judge, but other people do. These themes illustrate the different ways that autistic adults experienced nature. For some, nature was a way of relating to others and relating more deeply with themselves. Nature was also a way of escaping from people who were unkind, from situations that were uncomfortable, and from other stresses in life. Many autistic participants reported that nature was helpful to their well-being, because they experienced less judgment from natural spaces and creatures—though other people were sometimes judgmental, which made nature experiences worse. What do these findings add to what was already known? These findings confirm previous research showing that many autistic people have focused interests in nature. The findings not only add to the numerous existing anecdotal accounts about how autistic people feel in nature but also demonstrate a diverse range of perspectives. Not all autistic participants in this study felt that nature was beneficial to their well-being. What are the potential weaknesses of the study? Unfortunately, surveys are only accessible to people who have Wi-Fi/internet access, can use a computer or phone, and have the time to complete the survey. The survey might also have drawn in participants who were specifically interested in this topic, which might influence the findings. How will these findings help autistic adults now or in the future? These findings will help autistic adults, practitioners, and carers to identify a potential source of support for well-being. As autistic adults in this study used nature to meet different needs related to their well-being, natural space and nature-based activities may help improve well-being in autistic adults who enjoy nature. eng

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17. Gaier ED, Jaimes C, Gise RA, Armstrong-Javors AE, Kadzielski SM. Case 25-2024: A 12-Year-Old Boy with Autism and Decreased Vision. N Engl J Med;2024 (Aug 15);391(7):641-650.

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18. Hou Y, Song Z, Deng J, Song X. The impact of exercise intervention on social interaction in children with autism: a network meta-analysis. Front Public Health;2024;12:1399642.

BACKGROUND: Extensive research has documented the positive impacts of physical activity on children and adolescents with Autism Spectrum Disorders (ASD). However, the specific benefits of various sports on the social functioning of children with ASD remain ambiguous. This study aims to employ a network meta-analysis to investigate the effects of different sports on the social functioning of children and adolescents with ASD and to establish a ranking of their effectiveness. METHODS: This study conducted a comprehensive online search across Web of Science, PubMed, Cochrane, and Embase databases for randomized controlled trials and quasi-experimental studies focusing on social functioning outcomes. Data were synthesized using a Bayesian framework. RESULTS: Sixteen relevant studies encompassing 560 participants were included. According to Cohen’s classification, mini-basketball (SMD = 0.84, 95% CI: 0.46, 1.20), SPARK (SMD = 0.88, 95% CI: 0.06, 1.70), and Karate (SMD = 1.10, 95% CI: 0.27, 2.00) demonstrated high effect sizes, with Karate identified as the most effective intervention. Conversely, Combined Exercise and Nei Yang Gong interventions exhibited the least significant effects, falling below small effect sizes. CONCLUSION: Physical activity interventions have been shown to enhance social functioning in children and adolescents with ASD to varying extents, with Karate emerging as the most efficacious.

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19. Kacimi FE, Didou L, Ed Day S, Azzaoui FZ, Ramchoun M, Berrougui H, Khalki H, Boulbaroud S. Gut microbiota, vitamin A deficiency and autism spectrum disorder: an interconnected trio – a systematic review. Nutr Neurosci;2024 (Aug 13):1-11.

Accumulating evidence proves that children with autism have gastrointestinal problems. However, a significant difference in gut microbiota (GM) exists between autistic and non-autistic children. These changes in the GM may stem from several factors. Recently, researchers focused on nutritional factors, especially vitamin deficiency. Thus, our systematic review investigates the connections among autism, GM alterations, and vitamin A deficiency (VAD), by analyzing studies sourced from PubMed and Embase databases spanning from 2010 to 2022. Adhering to PRISMA guidelines, we meticulously selected 19 pertinent studies that established links between autism and GM changes or between autism and VAD. Our findings uniformly point to significant alterations in the GM of individuals with autism, indicating these changes as promising biomarkers for the disorder. Despite the consistent association of GM alterations with autism, our analysis revealed no notable differences in GM composition between individuals with autism and those experiencing VAD. This suggests that VAD, especially when encountered early in life, might play a role in the onset of autism. Furthermore, our review underscores a distinct correlation between reduced levels of retinoic acid in children with autism, a disparity that could relate to the severity of autism symptoms. The implications of our findings are twofold: they not only reinforce the significance of GM alterations as potential diagnostic markers but also spotlight the critical need for further research into nutritional interventions. Specifically, vitamin A supplementation emerges as a promising avenue for alleviating autism symptoms, warranting deeper investigation into its therapeutic potential.

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20. Kalani L, Kim BH, de Chavez AR, Roemer A, Mikhailov A, Merritt JK, Good KV, Chow RL, Delaney KR, Hendzel MJ, Zhou Z, Neul JL, Vincent JB, Ausió J. Testing the PEST hypothesis using relevant Rett mutations in MeCP2 E1 and E2 isoforms. Hum Mol Genet;2024 (Aug 14)

Mutations in methyl-CpG binding protein 2 (MeCP2), such as the T158M, P152R, R294X, and R306C mutations, are responsible for most Rett syndrome (RTT) cases. These mutations often result in altered protein expression that appears to correlate with changes in the nuclear size; however, the molecular details of these observations are poorly understood. Using a C2C12 cellular system expressing human MeCP2-E1 isoform as well as mouse models expressing these mutations, we show that T158M and P152R result in a decrease in MeCP2 protein, whereas R306C has a milder variation, and R294X resulted in an overall 2.5 to 3 fold increase. We also explored the potential involvement of the MeCP2 PEST domains in the proteasome-mediated regulation of MeCP2. Finally, we used the R294X mutant to gain further insight into the controversial competition between MeCP2 and histone H1 in the chromatin context. Interestingly, in R294X, MeCP2 E1 and E2 isoforms were differently affected, where the E1 isoform contributes to much of the overall protein increase observed, while E2 decreases by half. The modes of MeCP2 regulation, thus, appear to be differently regulated in the two isoforms.

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21. Kangarani-Farahani M, Thompson-Hodgetts S, Zwicker JG. Effectiveness of Cognitive Orientation to daily Occupational Performance for autistic children with developmental coordination disorder. Dev Med Child Neurol;2024 (Aug 14)

AIM: To determine if the Cognitive Orientation to daily Occupational Performance (CO-OP) intervention is effective in improving motor skills of autistic children with developmental coordination disorder (DCD), and whether motor gains are maintained 3 months after therapy. METHOD: In this quasi-experimental study, we recruited 27 autistic children (8-12 years) with DCD without intellectual disability. The treatment group received CO-OP intervention once weekly for 10 weeks, focusing on three child-chosen motor goals. The waitlist group received CO-OP 3 months later. Outcome measures included the Canadian Occupational Performance Measure (child ratings of motor performance and satisfaction), Performance Quality Rating Scale (therapist-observed movement quality), and the Bruninks-Oseretsky Test of Motor Proficiency, Second Edition (motor ability). RESULTS: Non-parametric analyses showed significant improvements (p < 0.013) in all outcomes. Follow-up analysis revealed significant improvements in performance (p < 0.001, W = 0.69), satisfaction (p < 0.001, W = 0.72), and movement quality (p < 0.001, W = 0.62). Despite slight declines at follow-up, overall improvements from pretest remained evident. INTERPRETATION: The CO-OP intervention effectively improved motor skills of autistic children.

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22. Kaufmann WE, Percy AK, Neul JL, Downs J, Leonard H, Nues P, Sharma GD, Bartolotta TE, Townend GS, Curfs LMG, Mariotti O, Buda C, O’Leary HM, Oberman LM, Vogel-Farley V, Barnes KV, Missling CU. Burden of illness in Rett syndrome: initial evaluation of a disorder-specific caregiver survey. Orphanet J Rare Dis;2024 (Aug 13);19(1):296.

BACKGROUND: Rett syndrome (RTT) is a severe X-linked neurodevelopmental disorder associated with multiple neurologic impairments. Previous studies have shown challenges to the quality of life of individuals with RTT and their caregivers. However, instruments applied to quantify disease burden have not adequately captured the impact of these impairments on affected individuals and their families. Consequently, an international collaboration of stakeholders aimed at evaluating Burden of Illness (BOI) in RTT was organized. METHODS: Based on literature reviews and qualitative interviews with parents of children and adults with RTT, a caregiver questionnaire was constructed to evaluate 22 problems (inclusive of core characteristics, functional impairments, and comorbidities) often experienced with RTT, rated mainly with a 5-level Likert scale. The questionnaire was administered anonymously online to an international sample of 756 caregivers (predominantly parents) of girls and women with RTT. Descriptive statistics were used to identify problems of high frequency and impact on affected individuals and caregivers. Chi-square tests characterized the relationship between problem severity and impact responses, while nonparametric ANOVAs of raw and z-score adjusted scores identified agreement between severity and impact on individual and caregiver. Secondary inferential tests were used to determine the roles of age, clinical type, and country of residence on BOI in RTT. RESULTS: There was variability in reported frequency of problems, with the most prevalent, severe and impactful being those related to the core features of RTT (i.e., communication and fine and gross motor impairments). Chi-square analyses demonstrated interdependence between severity and impact responses, while ANOVAs showed that many problems had disproportionately greater impact than severity, either on affected individuals (e.g., hand stereotypies) or their caregivers (e.g., sleep difficulties, seizures, pain, and behavioral abnormalities). With certain exceptions (e.g., breath-holding, seizures), age, clinical type, or country of residence did not influence these BOI profiles. CONCLUSIONS: Our data demonstrate that core features and related impairments are particularly impactful in RTT. However, problems with mild severity can also have disproportionate impact on affected individuals and, particularly, on their caregivers. Future analyses will examine the role of factors such as treatment outcomes, healthcare services, and healthcare provider’s perspectives, in these BOI profiles.

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23. Keller J, Herle M, Mandy W, Leno VC. The overlap of disordered eating, autism and ADHD: future research priorities as identified by adults with lived experience. Lancet Psychiatry;2024 (Aug 14)

The focus of mental health research in emerging fields should be driven by the priorities of people with relevant lived experience. Autism and ADHD are childhood-onset neurodevelopmental conditions that are associated with a range of health inequalities, including increased risk for eating disorders. The evidence base for how best to support neurodivergent individuals who experience disordered eating is still in its infancy, but research suggests that existing clinical approaches are not currently fit for purpose. In this Personal View, through community consultation with autistic people and people with ADHD who have experienced disordered eating, we present a comprehensive ranked list of research topics that people with lived experience prioritise. These priorities could be clustered into two areas: improving outcomes and identifying causal mechanisms. Within the theme of improving disordered eating outcomes, priorities are the improvement of treatment, the need for neurodiversity training in clinical services, and the identification and minimisation of unintended adverse effects of psychological intervention. Within the theme of identifying causal mechanisms, priorities are the identification of risk factors and a better understanding of the effect of autistic or ADHD neurocognitive profiles as potential contributors to eating disorder vulnerability. The final top ten research priorities are contextualised in terms of how they compare to the existing literature on the overlap between autism or ADHD and eating disorders, and concrete suggestions are made for how to implement these research priorities as testable hypotheses. Research informed by these priorities will build necessary understanding of the reasons behind the increased risk for eating disorders in neurodivergent people, and how to best support people who are affected by disordered eating to live positive and fulfilling lives.

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24. Kongo E, Gaҫe E, Gravina GM, Gribizi I, Rizaj X, Emir B. Cross-bite and oral habits among Albanian autistic children according to the stages of occlusal development. Sci Rep;2024 (Aug 14);14(1):18890.

This study had two aims. First, we aimed to investigate the prevalence of ACB, PCB, and oral habits among a group of Albanian children with ASD compared with a group of children without ASD. Second, we aimed to identify the associations of ASD with ACB, PCB, and oral habits. The sample inlcuded 125 children with ASD (91 males, 34 females) from 2 special schools for children with disabilities and 2 daily residential centers in Tirana. The control group included 125 children without ASD. The relationships between categorical variables were evaluated via the chi-square test. To identify the potential risk factors for ASD, we performed binary logistic regression. No statistically significant differences were found for CB or oral habits between the primary and adolescent dentition stages. A comparison of children with ASD with CB and oral habits revealed a significant difference in the prevalence of PCB. Binary logistic regression revealed that ACB, PCB and oral habits were not associated with ASD. CB was more prevalent among children with ASD in the primary and mixed dentition stages. Oral habits were more prevalent in the mixed and adolescent dentition stages. However, ASD is not a risk factor for CB or other oral habits.

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25. Lassen J, Oranje B, Vestergaard M, Foldager M, Kjær TW, Aggernæs B, Arnfred S. Reduced P300 amplitude in children and adolescents with autism is associated with slowed processing speed, executive difficulties, and social-communication problems. Autism;2024 (Aug 14):13623613241271950.

Selective attention to auditory input is reflected in the brain by an electric amplitude called the P3b amplitude, which is measured using electroencephalography. Previous research has shown that children and adolescents with autism have an attenuated P3b amplitude when they have to attend specific sounds while ignoring other sounds. However, it is unknown whether a reduced P3b amplitude in autistic children and adolescents is associated with their autism features, daily functioning and/or cognitive functions. This study aimed to examine these questions. Therefore, we assessed selective attention to auditory input in 57 children with autism aged 7-14 years and 57 neurotypically developing controls while measuring their brain activity with electroencephalography. Participants further underwent cognitive assessment, and parents reported on autistic traits and daily functioning. As expected, children with autism had lower P3b amplitude compared to their neurotypical peers. Importantly, an attenuated P3b amplitude was associated with more parent-reported social-communication problems and difficulties with daily functioning. Children with autism further had reduced processing speed of visual input, which also was coupled to a lower P3b amplitude. In conclusion, we found attenuated P3b amplitude in children with autism performing an auditory selective attention task, which was related to difficulties with processing visual input and allocating attentional resources critical for social and daily functioning. The results suggest that autistic children are more vulnerable to being disturbed when the environment is filled with conflicting sensory input.

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26. Mediane DH, Basu S, Cahill EN, Anastasiades PG. Medial prefrontal cortex circuitry and social behaviour in autism. Neuropharmacology;2024 (Aug 14);260:110101.

Autism spectrum disorder (ASD) has proven to be highly enigmatic due to the diversity of its underlying genetic causes and the huge variability in symptom presentation. Uncovering common phenotypes across people with ASD and pre-clinical models allows us to better understand the influence on brain function of the many different genetic and cellular processes thought to contribute to ASD aetiology. One such feature of ASD is the convergent evidence implicating abnormal functioning of the medial prefrontal cortex (mPFC) across studies. The mPFC is a key part of the ‘social brain’ and may contribute to many of the changes in social behaviour observed in people with ASD. Here we review recent evidence for mPFC involvement in both ASD and social behaviours. We also highlight how pre-clinical mouse models can be used to uncover important cellular and circuit-level mechanisms that may underly atypical social behaviours in ASD.

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27. Menezes M, Rutten M, Anderson S, Linde J, Ibrahim K, Sukhodolsky DG. Association of Irritability with Restricted, Repetitive Behaviors and Social Communication Challenges in Autistic Youth. J Autism Dev Disord;2024 (Aug 14)

Although affective irritability is a common and concerning problem for autistic youth, limited research has examined relations among core autism characteristics and irritability. Therefore, this study investigated potential associations among types of restricted/repetitive behaviors (RRBs) and social communication challenges and irritability in autistic children and adolescents. Participants were 107 autistic youth recruited from a university-based autism clinical research program. Two hierarchical multiple regressions were conducted with Affective Reactivity Index as the dependent variable. Covariates were entered at step 1, followed by the independent variables of interest at step 2. For the first model, independent variables of interest were Repetitive Behavior Scale-Revised subscales: stereotyped behavior, self-injurious behavior, compulsive behavior, ritualistic behavior, sameness behavior, and restricted behavior. For the second model, independent variables of interest were Social Responsiveness Scale, Second Edition subscales: social awareness, social cognitive, social communication, and social motivation. Irritability was significantly associated with several categories of RRBs (i.e., insistence on sameness, stereotypic behavior, and restricted interests/activities). Nonetheless, irritability was not associated with categories of social communication and interaction challenges in autistic youth. Results from this study indicated differing associations between core autism characteristics and affective irritability. Findings highlight the importance of differentiating types of restricted, repetitive behaviors and social communication and interaction challenges in conceptualizing mental health concerns in autistic youth.

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28. Nijhof D, Melville C, Rydzewska E, Pavlopoulou G, Meehan L, Gardani M. Experiences of and treatment preferences for insomnia in autistic adults: An Interpretative Phenomenological Analysis. Sleep Med;2024 (Aug 14);122:163-170.

Insomnia and insomnia symptoms are frequent experiences of autistic people resulting in pronounced daytime effects and poor quality of life. This study employed an Interpretive Phenomenological Analysis approach to explore lived experiences of autistic adults with insomnia, perspectives on current available interventions and future treatment preferences. Twelve participants (aged 21-48 years old) were interviewed following screening for insomnia, using the Sleep Condition Indicator (scores ranged from 1 to 12; cut off >16). Each interview was analysed individually developing Personal Experiential Themes for each case, which were then mapped across cases based on identified patterns and connections. Results yielded rich personal accounts and identified two Group Experiential Themes: « The Night is Friendlier » and « It Doesn’t Really Work for Me ». Participants described experiences with sleeplessness throughout their adult lives and often since childhood. They discussed how the night time offers them a more relaxed and safe space to freely behave as they wish. Advice and interventions were viewed by participants via the prism of underlying social issues, such as autism acceptance and trust, and how these structures can affect participants’ experiences with insomnia, help seeking and effectiveness of current interventions. Our results highlight the need for inclusion of autistic people in insomnia research through co-production and co-creation as well as clinical practice and delivery. This is the first study to integrate perspectives and experiences of autistic people towards insomnia and sleep-related advice by health care professionals. Findings are discussed in relation to theoretical and practical implications, as well as directions for future research.

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29. Pfeiffer B, Song W, Davidson A, Salzer M, Feeley C, Shea L. Transportation Use and Barriers for Employed and Unemployed Autistic Adults. Autism Adulthood;2024 (Jun);6(2):241-246.

BACKGROUND: Autistic adults are significantly unemployed or underemployed even compared with other disability groups. Employment is a social determinant that, when satisfied, closely influences health-related quality of life. For autistic adults, environmental barriers to transportation can impact the ability to get to employment resulting in limited employment opportunities. This study provides a closer examination of the association between transportation use and employment status. OBJECTIVE: To examine the use of different types of transportation and barriers to public transit by employed and unemployed autistic adults. METHOD: The data were from a large statewide study conducted between May 2017 and June 2018 using the Pennsylvania Autism Needs Assessment (PANA), in which information about employment and transportation use was obtained from autistic adults who were residents of Pennsylvania. The study sample included 1120 autistic adults (M(age) = 28.03 years, standard deviation = 9.84; 70% men; 82% non-Hispanic White). RESULTS: Participants who were employed were more likely to drive themselves than those who were unemployed (45% vs. 21%, p < 0.001), while they were less likely to take rides from others (62% vs. 75%, p < 0.001) or use service transportation (11% vs. 18%, p = 0.001). For barriers to public transit, the results identified that employed participants reported fewer barriers to public transportation than unemployed participants with a small effect size (1.98 vs. 2.54, d = 0.22). CONCLUSION: Employed autistic adults exercise more transportation independence. Unemployed autistic adults report more barriers to participation and lower ability to independently use public transportation. Future transportation and employment studies are necessary. Why is this an important issue? Employment is important for income, quality of life, and the ability to get the supports or services a person needs. Autistic adults are more likely to be unemployed or underemployed when compared with neurotypical adults and people with other disabilities. There are many environmental barriers to participating in adult activities in the community, but issues with transportation are a primary barrier. In previous research, a high number of autistic adults (72%) reported that they had missed some of their desired activities due to lack of transportation. It is important to understand the relationship between transportation and employment to know how to overcome barriers and improve employment options for autistic adults who want to work. What was the purpose of this research? The purpose of this research was to look at transportation and employment status (i.e., employed or unemployed). Specifically, this study compared types of transportation used and perceived barriers to transportation between autistic adults who were employed and those who were unemployed. What did the researchers do? Information was collected from 1120 autistic adults through a large statewide survey, which included questions about employment and transportation. Information from autistic adults who were employed and those who were not employed was compared. What were the results of the study? Results of this comparison showed that participants who were employed were more likely to drive themselves and less likely to take rides from other people or to use service transportation. Those who were employed also reported fewer barriers to public transportation. Barriers such as crime, planning a trip, treatment by fellow passengers, cost, knowledge on how to use public transportation, and sensory overload were identified by more people who were unemployed than by people who were employed. How will these findings help autistic adults now or in the future? The study identified specific barriers to transportation for autistic adults who are unemployed. This information can help to guide supports and policies to reduce barriers for travel needed for employment. In addition, results of this study can help guide future research to develop or identify the transportation skills needed for travel to work for autistic adults. eng

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30. Pollick SA, Pesch MH, Spellun A, Betances EM, Wiley S, Geer LC, Prout KK, Hu M, Nyp SS. Hearing Loss and Autism Spectrum Disorder. J Dev Behav Pediatr;2024 (Aug 13)

Gretta is a 3.5-year-old girl with a history of congenital cytomegalovirus, congenital bilateral profound sensorineural hearing loss (SNHL), and bilateral vestibular dysfunction, resulting in frequent falls. She underwent cochlear implantation at 12 months of age and was diagnosed with autism spectrum disorder at 2.5 years of age.On presentation for follow-up in the developmental-behavioral pediatrics (DBP) clinic, Gretta’s mother reports that Gretta has refused to wear her cochlear implants for the past 5 months. Before that, she seemed to enjoy having access to sound and like dancing to music, and her receptive and expressive language skills, including speech, were progressing. Initially, the rejection of her devices occurred only at preschool. When frustrated or overwhelmed, she would close her eyes and remove her devices for up to 5 minutes before allowing them to be reapplied. Over time, this progressed to a complete refusal to wear her devices at school and then at home, rendering her without access to sound and spoken language.Gretta’s mood has become sullen, and she is now having tantrums at school. She physically startles when attempts are made to reintroduce her devices. Her ability to participate in classroom learning or interact with her classmates is limited, as she attends a spoken-language-focused preschool program. A board-certified behavioral analyst, hired by the family, recommended that Gretta not be allowed to participate in classroom activities unless she wears her devices. She now becomes visibly anxious even when in the same room as her devices and repetitively states « no implant, no implant. » Her mother is worried about her inability to communicate and has « no idea » what may have changed or sparked her initial refusal to wear the devices.What factors would you consider when determining the cause and function of Gretta’s refusal to wear the cochlear implants? How would you guide her parents, teachers, and clinicians to ensure the best developmental and behavioral outcomes for her?

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31. Pritchard-Rowe E, de Lemos C, Howard K, Gibson J. Diversity in Autistic Play: Autistic Adults’ Experiences. Autism Adulthood;2024 (Jun);6(2):218-228.

BACKGROUND: Play is important for mental health and well-being. Descriptions of autistic play have typically focused on « deficits » and are based on comparisons to neurotypical « norms ». According to the neurodiversity paradigm, it is important that autistic voices are highlighted and that difficulties, differences, and strengths are explored. With this in mind, we designed the present study to focus on the experiences and perspectives of autistic people concerning the topic of autistic play. METHODS: We conducted a consultation with autistic stakeholders, as well as with parents and teachers of autistic individuals to help us design the study and interview questions. We used semi-structured interviews with 22 autistic adults aged 18-57 years (clinically confirmed diagnosis, n = 21; self-diagnosed, n = 1) who live in the United Kingdom. We analyzed the data using interpretative phenomenological analysis to identify themes. RESULTS: We found important commonalities and differences in the ways that socialization in play, imaginary play, and flow (a state involving intense focus on the play) are experienced. Autistic adults discussed the importance of both solitary play and social play, with solitary play having an important recuperative function. They also reported preferences for parallel play and playing with similar autistic people. They also discussed imaginary play experiences, including social role-play and grounded-in-reality play, and the dual nature of flow experiences during play. CONCLUSIONS: The findings of this study contrast with deficit-focused understandings of autistic play and build on neurodiversity-informed studies. We highlight, for example, the importance of considering the different circumstances under which solitary play or social play are preferred, as well as the importance of taking an individual approach to play. We encourage wider understanding and acceptance of these play preferences and experiences to support autistic people’s well-being. Why is this an important issue? Usually, descriptions of autistic play are negative and are based on what non-autistic people think autistic play should be like. We think that it is important to challenge this by exploring autistic play in a more balanced way and focusing on what autistic people say about their play. What was the purpose of this study? We wanted to find out how autistic adults experience play. We were also interested in how they think their play is different from non-autistic play. What did the researchers do? We asked autistic and non-autistic people to help us design our study and interview questions. We interviewed 22 autistic adults and asked them about their play now or when they were younger. We then analyzed the data using a qualitative method called interpretative phenomenological analysis. This meant that we could identify themes covering the group’s views and experiences. What were the results of the study? We found a range of play experiences and different ways in which some autistic adults play. Many autistic adults talked about the importance of both playing by themselves and with others, with solitary play described as being recuperating. Some described preferring play that involves playing nearby other people without necessarily interacting with them directly. Many preferred to play with similar autistic people. Several autistic adults discussed engaging in imaginary play activities such as role-play and preferring play that is based on reality. They also described the benefits and limitations of something called a flow state, which involves intense focus on the play. What do these findings add to what was already known? Our findings highlight how autistic adults like to play and different ways some autistic adults experience play. For example, we highlight the situations where solitary play and social play are preferred, and the importance of understanding that different people like to play in different ways. What are potential weaknesses in the study? We did not involve autistic people beyond consultation. We think that a better understanding of autistic play can come from using approaches with greater autistic involvement, such as co-production. Most of our participants were White, highly educated, and primarily communicate using speech. We do not know if other autistic people would experience play in a similar way. How will these findings help autistic adults now or in the future? Understanding and acceptance of the ways in which autistic people like to play can help support autistic people’s well-being. In practice, this involves limiting the use of supports that aim to make autistic people’s play “normal” and instead encouraging authentic autistic play. eng

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32. Reed ZE, Thomas R, Boyd A, Griffith GJ, Morris TT, Rai D, Manley D, Davey Smith G, Davis OSP. Mapping associations of polygenic scores with autistic and ADHD traits in a single city region. J Child Psychol Psychiatry;2024 (Aug 14)

BACKGROUND: The genetic and environmental aetiology of autistic and Attention Deficit Hyperactivity Disorder (ADHD) traits is known to vary spatially, but does this translate into variation in the association of specific common genetic variants? METHODS: We mapped associations between polygenic scores for autism and ADHD and their respective traits in the Avon Longitudinal Study of Parents and Children (N = 4,255-6,165) across the area surrounding Bristol, UK, and compared them to maps of environments associated with the prevalence of autism and ADHD. RESULTS: Our results suggest genetic associations vary spatially, with consistent patterns for autistic traits across polygenic scores constructed at different p-value thresholds. Patterns for ADHD traits were more variable across thresholds. We found that the spatial distributions often correlated with known environmental influences. CONCLUSIONS: These findings shed light on the factors that contribute to the complex interplay between the environment and genetic influences in autistic and ADHD traits.

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33. Reynolds M, Faron N, Hoekel J, Tychsen L. Refractive surgery to correct visual impairments in 267 children with autism spectrum and related neuro-developmental disorders: improvements in vision and behavior. Med Hypothesis Discov Innov Ophthalmol;2024 (Summer);13(2):88-95.

BACKGROUND: Children with autism spectrum disorder (ASD) may have impaired vision owing to high refractive errors and aversion to spectacles or contact lenses. Visual blurring is caused by near-sighted myopia, far-sighted hyperopia, or astigmatism in one or both eyes. Refractive surgery can restore sharp vision and eliminate the need for spectacles and contact lenses. Restoration of sharp vision may improve ASD behavior. We aimed to determine the refractive outcomes in this cohort using ophthalmic measures and behavioral and school performance alterations after refractive surgery by employing parent-proxy reports. METHODS: This interventional, retrospective case series included data from 267 children with refractive errors and neurodevelopmental disorders (NDDs) diagnosed as ASD alone or NDD with ASD-like behaviors over a 15-year period. One of three refractive surgery methods was employed, with the choice of method uniquely tailored to the child’s eye anatomy. Laser photorefractive keratectomy (PRK) was performed in 131 children, implantation of a phakic intraocular lens (pIOL) in 115 children, and removal of the crystalline lens and implantation of an intraocular lens (refractive lens exchange, RLE) in 21 children. All procedures were performed under brief general anesthesia, with the child returning home on the same day. RESULTS: The median age at surgery was 10.9 years and the median follow-up period was 3.1 years. Pre-operative refractive errors ranged from a mean (standard deviation) +7.5 (0.09) D to -14.3 (4.8) D. Surgery corrected 87% of the children to normal focal length (± 1 D). Visual acuity improved an average of 0.6 logarithm of the minimum angle of resolution, the equivalent of 6 lines on a standard eye chart. Change in visual acuity was significant (all P < 0.01) between baseline and the most recent follow-up examination in each of subgroups. Change in spherical equivalent refractive error at 3, 12, 24, 36, 60, and > 60 months post-operatively were significant (all P < 0.01) between baseline and each follow-up visit in each of subgroups. Social interactions and ASD behaviors improved in 72% (192) of the treated children (P < 0.01). The incidence of sight-threatening complications was low. CONCLUSIONS: Refractive surgery improves both visual function and behavior in most children with ASD and major myopia, hyperopia, or astigmatism. The PRK, pIOL, and RLE procedures appear to be effective and reasonably safe methods for improving refractive error, visual acuity, and behavior in many ametropic children with ASD and ASD-like NDDs.

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34. Shin T, Song JHT, Kosicki M, Kenny C, Beck SG, Kelley L, Antony I, Qian X, Bonacina J, Papandile F, Gonzalez D, Scotellaro J, Bushinsky EM, Andersen RE, Maury E, Pennacchio LA, Doan RN, Walsh CA. Rare variation in non-coding regions with evolutionary signatures contributes to autism spectrum disorder risk. Cell Genom;2024 (Aug 14);4(8):100609.

Little is known about the role of non-coding regions in the etiology of autism spectrum disorder (ASD). We examined three classes of non-coding regions: human accelerated regions (HARs), which show signatures of positive selection in humans; experimentally validated neural VISTA enhancers (VEs); and conserved regions predicted to act as neural enhancers (CNEs). Targeted and whole-genome analysis of >16,600 samples and >4,900 ASD probands revealed that likely recessive, rare, inherited variants in HARs, VEs, and CNEs substantially contribute to ASD risk in probands whose parents share ancestry, which enriches for recessive contributions, but modestly contribute, if at all, in simplex family structures. We identified multiple patient variants in HARs near IL1RAPL1 and in VEs near OTX1 and SIM1 and showed that they change enhancer activity. Our results implicate both human-evolved and evolutionarily conserved non-coding regions in ASD risk and suggest potential mechanisms of how regulatory changes can modulate social behavior.

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35. Srinivasan AP, Nishiguchi EP, Gonzalez C, Jimenez ME, Zuckerman KE, Lion KC. Toward More Equitable Care: A Closer Look at Autism Clinic Intake Practices and Paperwork. J Dev Behav Pediatr;2024 (Aug 13)

OBJECTIVE: To describe intake requirements among autism clinics and to assess how well intake paperwork aligns with national standards for enhancing language and literacy accessibility. METHODS: This was a survey of 126 autism clinics in the Children’s Hospital Association, assessing intake processes and intake paperwork readability conducted between November 2021 and August 2022. Descriptive analyses characterized intake requirements and paperwork components. Free-text responses about intake support strategies were categorized into themes. Logistic regression models examined associations between clinic patient demographics and odds of requiring intake paperwork. Intake packet length, content, and reading grade level were examined. RESULTS: Of the invited clinics, 73% completed the survey. Among the participating clinics, 55% required intake paperwork before scheduling appointments, 34% offered English forms only, and 89% had no plain language forms. Clinic patient demographics were not associated with intake paperwork requirements. Analyzed intake packets (n = 67) averaged 11 pages long, and most were written above the fifth-grade reading level. Most packets solicited medical, developmental, and educational/therapy history. Many also requested psychoeducational evaluations and teacher rating forms. Reported intake support strategies for families with language or literacy needs included making ad hoc exceptions to the usual process, task shifting to outside organizations, providing support at family’s request, and delegating to support staff. CONCLUSION: Many autism clinics nationwide require intake paperwork before diagnostic evaluation. Many clinics offer intake paperwork in English only, and paperwork often does not meet health literacy standards. Reducing paperwork requirements and providing more routine and robust intake support may facilitate equitable access to autism diagnostic evaluations.

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36. Szechy KA, Turk PD, O’Donnell LA. Autism and Employment Challenges: The Double Empathy Problem and Perceptions of an Autistic Employee in the Workplace. Autism Adulthood;2024 (Jun);6(2):205-217.

BACKGROUND: High unemployment rates are found among autistic adults. Difficulties with social functioning in non-autistic workplaces can be significant barriers to employment success. Autistic social functioning challenges in non-autistic spaces have traditionally been attributed to assumed impairments in Theory of Mind (ToM). Alternatively, the Double Empathy Problem (DEP) posits that autistic social challenges arise not from assumed impairments within the autistic person but instead from mutual misunderstandings in the autistic/non-autistic social interaction. The purpose of this study was to compare the ToM impairments explanation of autistic social functioning with the DEP, within the context of autistic employee social functioning in a non-autistic workplace. METHODS: This study compared autistic and non-autistic participants’ ability to accurately interpret the behaviors of an autistic employee at work. A sample of 254 participants (173 non-autistic and 81 autistic) read a vignette about a hypothetical autistic employee having difficulty coping in the workplace. Participants answered open-ended questions regarding their interpretation of the employee’s behavior and emotional state. RESULTS: A significantly greater proportion of autistic participants (50.7%) accurately interpreted the behavior of the employee compared with non-autistic participants (31.2%) (χ (2) = 8.65, p = 0.003). Autistic participants with the highest behavior interpretation scores had significantly higher mean self-reported autism traits scores (M = 26.8) compared with autistic participants who scored lowest on behavior interpretation (M = 19.3, p < 0.001). The opposite relationship was found for non-autistic participants. CONCLUSIONS: Results from this study contribute to evidence supporting the DEP, shifting the paradigm of autistic social functioning away from a deficit model and toward addressing mutual misunderstandings in the autistic/non-autistic social interaction. The pattern of findings between neurotype groups by behavior interpretation abilities on an autism traits measure points to mutual misunderstandings as a clash of neurologically different social cultures. Addressing the DEP in the workplace would contribute to removing barriers to successful employment for autistic adults. Why is this an important issue? Autistic adults have difficulty finding work and staying employed. One reason for this is problems they report having with social interactions in non-autistic workplaces. Traditionally, autistic people are assumed to have trouble with social skills because they lack the ability to read what is going on in the minds of other people, something non-autistic people are assumed to be able to do. However, there is another theory that says the problem is not that there is something wrong with autistic people, but rather that autistic and non-autistic people do not understand each other due to being socially and neurologically different. Therefore, the problem lies not within the autistic person but in the autistic/non-autistic social interaction. What was the purpose of this study? This study examined the two competing ways of explaining autistic social difficulties in workplaces that are primarily non-autistic: (1) autistic people having trouble with reading the minds of other people versus (2) autistic and non-autistic people being socially different and mutually misunderstanding each other. What did the researchers do? With help from autistic people, we wrote a story about an autistic employee having a difficult day in a non-autistic workplace, which results in negative social interactions and an emotional reaction. We had 81 autistic and 173 non-autistic people read the story and tell us what they think is going on with the person in the story and the reason for the person's behavior. What were the results of the study? Autistic people who read the story were more likely to accurately understand the autistic employee in the story (50.7% accurate), compared with non-autistic people (31.2% accurate). Autistic study participants who were the best at understanding the autistic person in the story on average also reported having more characteristics of autism. What do these findings add to what was already known? This study adds to a growing group of studies that demonstrate that autistic people have strong social rapport and communicate well with each other and also demonstrate that non-autistic people have trouble in understanding autistic people. This study applied these previous findings to autistic social challenges in non-autistic workplaces. It contributes evidence that autistic people are not impaired socially, but rather that their social difficulties in non-autistic workplaces are due to problems within the autistic/non-autistic social interaction. What are potential weaknesses in the study? Because it was an online survey, people in the study could not ask questions about the story. The researchers also could not confirm participant autism diagnosis. The sample did not have enough people of different races and possibly not enough participants who routinely use the internet or social media and therefore may have been excluded from the study. How will these findings help autistic adults now or in the future? This work is important because it contributes to changing the way we think about why autistic people struggle to function socially in a world where the majority of people are non-autistic, including in the workplace. Rather than placing sole responsibility on autistic employees for mutual misunderstandings between autistic and non-autistic persons in the workplace, findings of this study point to shifting workplace environment and culture that understands and values autistic social differences. eng

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37. Tuan Y, Chen LC, Chen IC, Tsai SJ, Chen TJ, Chen MH. Effect of Parental Severe Mental Disorders on the Timing of Autism Diagnosis: A Family Linkage Study. J Autism Dev Disord;2024 (Aug 13)

The mean diagnosis age of autism was about 5 years in Taiwan. Whether the delayed diagnosis of autism (≥ 6 years) was associated with parental severe mental disorders remained unknown. The parents of 22,859 autistic individuals and 228,590 age- and sex-matched nonautistic individuals were assessed for the presence of severe mental disorders (schizophrenia, bipolar disorder, major depressive disorder, alcohol use disorder, and substance use disorder). The timing of autism diagnosis was classified into three age categories: < 6 years, 6-11 years, and ≥ 12 years. Logistic regression models were used to examine associations between parental severe mental disorders and these age categories of autism diagnosis. Parental schizophrenia and substance use disorders were associated with the delayed diagnosis of autism, both diagnosis at ≥ 12 years (odds ratio [OR]: 2.14; 1.57) and at 6-11 years (1.87; 1.38). Parental bipolar disorder and major depressive disorder were also associated with the delayed diagnosis of autism, especially diagnosis at 6-11 years (OR 1.98; 1.86). Our findings underscore the need for clinicians to monitor the neurodevelopmental conditions of offspring born to parents with severe mental disorders during the early stages of their life.

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38. Wu YX, Li MJ, Liu Y, Guo M, Lan MN, Zheng HJ. ASPG and DAD1 are potential placental-derived biomarkers for ASD-like symptom severity levels in male/female offspring. Placenta;2024 (Aug 14);155:78-87.

INTRODUCTION: An early evaluating system for autism spectrum disorder (ASD) severity is crucial. Questionnaire survey is challenging for accurately assessing the severity levels for ASD in children. METHODS: Offspring with ASD-like phenotypes were induced by treating pregnant mice with Poly (I:C) at GD12.5 and the placentae corresponding to the offspring were obtained by caesarean. The autism severity composite score (ASCS) for offspring was calculated through behavioral tests. HE staining and immunohistochemistry were used to observe the morphology of placenta. Candidate biomarkers were identified by weighted protein co-expression network analysis (WPCNA) combined with machine learning and further validated by ELISA. Sperman’s was used to analyze the correlation between biomarkers and metabolome. RESULTS: The placental weight and mean vascular area of male offspring with ASD-like phenotypes were significantly decreased compared with typical mice. According to the WPCNA, four modules were identified and significantly correlated with ASCS of offspring. Two biomarkers (ASPG and DAD1) with high correlation with ASCS in offspring were identified. DISCUSSION: VEGF pathway may contribute to sexual dimorphism in placental morphology within mice with ASD-like phenotypes in term. The placental ASPG and DAD1 levels could reflect ASD-like symptom severity levels in male/female mice offspring.

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39. Zanin J, Tomlin D, Rance G. Effectiveness of Noise Cancelling Earbuds in Reducing Hearing and Auditory Attention Deficits in Children with Autism. J Clin Med;2024 (Aug 14);13(16)

Background/Objectives: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition characterised by impairments in social communication, sensory abnormalities, and attentional deficits. Children with ASD often face significant challenges with speech perception and auditory attention, particularly in noisy environments. This study aimed to assess the effectiveness of noise cancelling Bluetooth earbuds (Nuheara IQbuds Boost) in improving speech perception and auditory attention in children with ASD. Methods: Thirteen children aged 6-13 years diagnosed with ASD participated. Pure tone audiometry confirmed normal hearing levels. Speech perception in noise was measured using the Consonant-Nucleus-Consonant-Word test, and auditory/visual attention was evaluated via the Integrated Visual and Auditory Continuous Performance Task. Participants completed these assessments both with and without the IQbuds in situ. A two-week device trial evaluated classroom listening and communication improvements using the Listening Inventory for Education-Revised (teacher version) questionnaire. Results: Speech perception in noise was significantly poorer for the ASD group compared to typically developing peers and did not change with the IQbuds. Auditory attention, however, significantly improved when the children were using the earbuds. Additionally, classroom listening and communication improved significantly after the two-week device trial. Conclusions: While the noise cancelling earbuds did not enhance speech perception in noise for children with ASD, they significantly improved auditory attention and classroom listening behaviours. These findings suggest that Bluetooth earbuds could be a viable alternative to remote microphone systems for enhancing auditory attention in children with ASD, offering benefits in classroom settings and potentially minimising the stigma associated with traditional assistive listening devices.

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