1. Alashban Y. Enhanced detection of autism spectrum disorder through neuroimaging data using stack classifier ensembled with modified VGG-19. Acta Radiol;2025 (Apr 15):2841851251333974.

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disease marked by a variety of repetitive behaviors and social communication difficulties.PurposeTo develop a generalizable machine learning (ML) classifier that can accurately and effectively predict ASD in children.Material and MethodsThis paper makes use of neuroimaging data from the Autism Brain Imaging Data Exchange (ABIDE I and II) datasets through a combination of structural and functional magnetic resonance imaging data. Several ML models, such as Support Vector Machines (SVM), CatBoost, random forest (RF), and stack classifiers, were tested to demonstrate which model performs the best in ASD classification when used alongside a deep convolutional neural network.ResultsResults showed that stack classifier performed the best among the models, with the highest accuracy of 81.68%, sensitivity of 85.08%, and specificity of 79.13% for ABIDE I, and 81.34%, 83.61%, and 82.21% for ABIDE II, showing its superior ability to identify complex patterns in neuroimaging data. SVM performed poorly across all metrics, showing its limitations in dealing with high-dimensional neuroimaging data.ConclusionThe results show that the application of ML models, especially ensemble approaches like stack classifier, holds significant promise in improving the accuracy with which ASD is detected using neuroimaging and thus shows their potential for use in clinical applications and early intervention strategies.

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2. Arsenault J, Kong T, Saghian R, Weng OY, Pathak SS, Yang C, Chao OY, Rakhaminov G, Forman-Kay JD, Ditlev JA, Yang YM, Wang LY. Essential lipids enrich membrane-associated condensates to rescue synaptic morpho-functional deficits in a mouse model of autism. Cell Rep;2025 (Apr 14);44(5):115573.

Synaptic proteins form intracellular condensates with their scaffolds, but it is unknown whether and how essential lipids transform dynamic cytosolic condensates into stable, functional macromolecular assemblies at the membrane. We show that docosahexaenoic acid (DHA), independent of canonical fatty acid receptor 4 signaling, facilitates the re-localization of cytosolic « full-droplet » condensates composed of the key synaptic elements PSD95 and Kv1.2 to the plasma membrane as « half-droplets. » To exploit the therapeutic potential of DHA in vivo, we briefly place juvenile wild-type and Fmr1 KO mice, modeling human fragile X syndrome (FXS), under DHA-enriched or -depleted diets. DHA reverses the inhibitory overtone by promoting the re-localization of presynaptic PSD95-Kv1.2 condensates to interneuron terminal membranes and corrects morpho-functional synaptic defects and stereotypic behaviors. These findings reveal an unexpected role of essential lipids in translocating dynamic condensates into stable synaptic condensates, providing long-lasting benefits for rectifying excitation-inhibition imbalance in FXS and potentially other neurodevelopmental disorders.

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3. Aziz-Zadeh L, Ringold SM, Jayashankar A, Kilroy E, Butera C, Jacobs JP, Tanartkit S, Mahurkar-Joshi S, Bhatt RR, Dapretto M, Labus JS, Mayer EA. Relationships between brain activity, tryptophan-related gut metabolites, and autism symptomatology. Nat Commun;2025 (Apr 14);16(1):3465.

While it has been suggested that alterations in the composition of gut microbial metabolites may play a causative role in the pathophysiology of autism spectrum disorder (ASD), it is not known how gut microbial metabolites are associated with ASD-specific brain alterations. In this cross-sectional, case-control observational study, (i) fecal metabolomics, (ii) task-based functional magnetic resonance imaging (fMRI), and (iii) behavioral assessments were obtained from 43 ASD and 41 neurotypical (NT) children, aged 8-17. The fMRI tasks used socio-emotional and sensory paradigms that commonly reveal strong evoked brain differences in ASD participants. Our results show that fecal levels of specific tryptophan-related metabolites, including kynurenate, were significantly lower in ASD compared to NT, and were associated with: 1) alterations in insular and cingulate cortical activity previously implicated in ASD; and 2) ASD severity and symptoms (e.g., ADOS scores, disgust propensity, and sensory sensitivities). Moreover, activity in the mid-insula and mid-cingulate significantly mediated relationships between the microbial tryptophan metabolites (indolelactate and tryptophan betaine) and ASD severity and disgust sensitivity. Thus, we identify associations between gut microbial tryptophan metabolites, ASD symptoms, and brain activity in humans, particularly in brain regions associated with interoceptive processing.

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4. Balasubramanian R, Saha D, Arun A, Vinod PK. Hypometabolism in Autism Spectrum Disorder: Insights from Brain and Blood Transcriptomics. Mol Neurobiol;2025 (Apr 15)

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication, repetitive behaviors, and restricted interests. Recent research has emphasized the importance of metabolic dysfunctions in the pathophysiology of ASD. This study investigates metabolic alterations associated with ASD by analyzing transcriptomic data obtained from the prefrontal cortex (bulk tissue and single-nucleus) and data from peripheral blood mononuclear cells (PBMC). We assessed the metabolic activity of each patient based on gene expression profiles, revealing significant downregulation of vital metabolic pathways, including glycolysis, the tricarboxylic acid (TCA) cycle, and oxidative phosphorylation, indicative of hypometabolism. Our analysis also highlighted dysregulation in lipid, vitamin, amino acid, and heme metabolism, which may contribute to the neurodevelopmental delays associated with ASD. Cell-specific metabolic activities in the ASD brain showed altered pathways in astrocytes, oligodendrocytes, excitatory neurons, and interneurons. Furthermore, we identified critical metabolic pathways and genes from PBMC gene expression data that distinguish ASD patients from typically developing individuals. Our findings demonstrate a consistent pattern of metabolic dysfunction across brain and blood samples. This research provides a comprehensive understanding of metabolic alterations in ASD, paving the way for exploring potential therapeutic strategies targeting metabolic dysregulation.

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5. Benedicto-Rodríguez G, Bosch F, Juan CG, Bonomini MP, Fernández-Caballero A, Fernandez-Jover E, Ferrández-Vicente JM. Understanding Robot Gesture Perception in Children with Autism Spectrum Disorder during Human-Robot Interaction. Int J Neural Syst;2025 (Apr 16):2550026.

Social robots are increasingly being used in therapeutic contexts, especially as a complement in the therapy of children with Autism Spectrum Disorder (ASD). Because of this, the aim of this study is to understand how children with ASD perceive and interpret the gestures made by the robot Pepper versus human instructor, which can also be influenced by verbal communication. This study analyzes the impact of both conditions (verbal and nonverbal communication) and types of gestures (conversational and emotional) on gesture recognition through the study of the accuracy rate and examines the physiological responses of children with the Empatica E4 device. The results reveal that verbal communication is more accessible to children with ASD and neurotypicals (NT), with emotional gestures being more interpretable than conversational gestures. The Pepper robot was found to generate lower responses of emotional arousal compared to the human instructor in both ASD and neurotypical children. This study highlights the potential of robots like Pepper to support the communication skills of children with ASD, especially in structured and predictable nonverbal gestures. However, the findings also point to challenges, such as the need for more reliable robotic communication methods, and highlight the importance of changing interventions tailored to individual needs.

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6. Boerner KE, Pawliuk C, Heran A, Donaghy B, Moore D, Leong K, Devan H, Oberlander TF. Systematic review of autistic representation in the treatment literature for pediatric chronic pain. J Pain;2025 (Apr 12):105390.

Chronic pain disproportionately affects autistic children and young people, yet they are underrepresented in pain research. Research on psychological, physical, and pharmacological therapies for other conditions suggests modifications are required to ensure treatment accessibility and efficacy for autistic individuals. However, no such evidence base has been synthesized in pediatric pain. The aim of this review was to (1) review existing « gold-standard » treatment literature for pediatric chronic pain to determine the representation of autistic participants, and (2) review literature on treatment of chronic pain specifically in autistic children and young people to describe the current evidence landscape and identify next directions for research. 16.7% (12/72) of randomized controlled trials included in Cochrane reviews of interventions for pediatric chronic pain explicitly excluded youth with a developmental delay/disability, of which only 8.3% specifically named autism. However, 52.8% of Cochrane-included trials had criteria or protocols which may have disproportionately impacted autistic participants, such as excluding intellectual disability, psychiatric conditions, medical conditions, and/or requiring participants to communicate verbally. Twenty-nine studies of treating chronic pain in autistic children and young people were identified, of which the majority were case reports (k = 27, 93%) with large variation in pain condition, intervention applied, and outcomes measured. Given the high prevalence of chronic pain in autistic children and young people, there is an ethical imperative to ensure their representation in intervention trials, co-develop interventions that address the specific needs of autistic individuals who live with pediatric chronic pain, and to increase accessibility in chronic pain research more broadly. REGISTRATION: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=491423 registered March 19 2024 Open Science Framework: https://osf.io/8na64/ registered December 18, 2023 PERSPECTIVE: Autistic children and young people (CYP) are not represented in reviews of chronic pain treatments, and the literature on treating chronic pain specifically in this population is so variable no clear conclusions can be drawn. Efforts to increase accessibility of chronic pain interventions and research for autistic CYP is needed.

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7. Bonemazzi I, Ancora C, Ferasin V, Lunghi M, Toldo I. Towards the phenotyping of autism spectrum disorder in children with tuberous sclerosis complex. Dev Med Child Neurol;2025 (Apr 14)

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8. Canaguier J, Mallaret G, Paraschivescu C, Barbosa S, Le Merrer J, Becker J, Glaichenhaus N, Davidovic L. Perinatal exposure to the autism-linked metabolite p-Cresol has limited impact on early development in mice but lasting effects on adult social behavior. Sci Rep;2025 (Apr 15);15(1):12934.

Environmental exposures during pregnancy are increasingly recognized as significant risk factors for the offspring health. Perinatal exposure to environmental toxins, including p-Cresol, may disrupt essential physiological processes during critical developmental windows. The perinatal period is particularly critical for neurodevelopment, making the brain particularly vulnerable to external toxins that can impair neural circuitry and increase the risk of behavioral and neuropsychiatric disorders later in life. p-Cresol, a microbial metabolite produced by the human microbiota and through the bacterial decomposition of organic matter, is also released in exhaust fumes and widely used in chemical manufacturing. Elevated levels of p-Cresol have been consistently observed in patients with autism spectrum disorders (ASD), yet, its developmental toxicity and its impact on ASD-related behaviors remain to be determined. In this study, we exposed pregnant mice (C57BL/6J) to p-Cresol via drinking water from mid-gestation, through lactation, and until weaning, mimicking potential patterns of human exposure during pregnancy and early infancy. Our findings indicated that while perinatal p-Cresol exposure did not affect gestational outcomes, postnatal growth, developmental milestones, or sensorimotor reflexes, it resulted in marked social deficits and stereotyped behaviors in adult males and females offspring-which are core behavioral phenotypes associated with ASD. These results suggest that p-Cresol exposure selectively induces ASD-like behaviors, without broadly impairing early development. Our findings emphasize the need for future epidemiological studies to quantify p-Cresol exposure during pregnancy and early childhood, and to evaluate its potential association with social behavior impairments in children. This research provides a foundation for understanding how environmental factors, such as p-Cresol, may contribute to social impairments and neurodevelopmental disorders in the broader population.

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9. Chang R, Wei M, Li C, Jiang Y, Zhang J. Association between epigenome-wide DNA methylation changes and early neurodevelopment in preschool children: Evidence from a former impoverished county in Central China. Gene;2025 (Apr 15);945:149275.

BACKGROUND: Existing epigenome-wide association studies (EWAS) investigating the association between DNA methylation (DNAm) and child neurodevelopment have been predominantly conducted within Western populations, and yielded inconsistent results, leading to a significant gap within non-Western setting, particularly in resource-limited rural areas of Central China. OBJECTIVES: To investigate the association between altered epigenome-wide DNAm and neurodevelopment in preschool children from resource-limited rural areas of Central China. METHODS: This case-control study involved 64 preschoolers. We assessed children’s neurodevelopment using the Gesell Developmental Diagnostic Scale. The neurodevelopmental potential was expressed as a global developmental quotient (DQ) score. We conducted an EWAS with an Illumina Infinium MethylationEPIC v1.0 BeadChip array, using blood samples from 32 suspected developmental delay children (DQ scores < 85) and 32 controls (DQ scores ≥ 85). Differentially methylated probes (DMPs) and differentially methylated regions (DMRs) between the suspected developmental delay and control groups were analyzed. Multivariate linear regression models were used to evaluate the association between global DQ scores and DNAm. Functional enrichment analyses were conducted using Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG). The BECon tool was utilized to estimate the concordance of CpGs between blood and the human brain. RESULTS: A total of 66 DMRs (P(FDR) < 0.05) were identified between the two groups, but no DMPs were found. After FDR correction, 844 methylated CpG sites exhibited significant associations with the global DQ scores in children. Genes annotated by methylated CpGs were mainly enriched in the "oxytocin signaling pathway", "mTOR signaling pathway", and "thyroid hormone signaling pathway". They were also involved in the "regulation of cell development", "cell-cell junction", and "ATPase activity". Among the top 20 CpGs, nine global DQ scores related-CpGs had blood-brain DNA methylation correlations, and six CpGs among them had an absolute Spearman correlation coefficient bigger than 0.2. CONCLUSIONS: Preschoolers from a former impoverished county exhibited epigenome-wide DNAm changes strongly linked to early neurodevelopment. This study enhances our understanding of the epigenetic landscape associated with early neurodevelopment, and suggests the potential for developmenting epigenetic biomarkers that could facilitate the early identification of children at a higher risk of compromised neurodevelopment, as well as holding implication to inform novel interventions, especially in underprivileged regions.

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10. Chen IC, Hsu HC, Chen CL, Chang MH, Wei CS, Chuang CH. Interbrain synchrony attenuation during a peer cooperative task in young children with autistic traits -an EEG hyperscanning study. Neuroimage;2025 (Apr 15);312:121217.

Young children with autism spectrum disorder (ASD) traits frequently encounter difficulties in peer interaction. Assessing peer interaction performance is crucial but challenging within the clinical diagnostic paradigm of ASD. Hyperscanning, which simultaneously monitors brain activity in multiple individuals, has become a popular tool for assessing social interaction’s neural features. The present study aims to investigate the brain-to-brain connectivity between child-dyads engaged in a game-like collaborative peer interaction task via the hyperscanning electroencephalogram (EEG) approach. The final sample comprised 66 young children: 18 child dyads with typical development (TD), TD-TD, and 15 with ASD traits matched to TD, TD-ASD. The study indicated a depressed level of connectivity in the dyad group with ASD as the responder, with a notable decrease observed in the beta oscillation over the right parietal to left temporal coupling between subjects. A pattern that differed from that observed in the TD-TD group was identified with regard to full-band connectivity over the right-to-right temporal region. It was observed that the TD-TD group exhibited enhanced connectivity following the completion of the task, which was not the case for the TD-ASD group. Significant correlations were observed between scores on the ASD symptom rating scale and the selected significant interbrain connectivity index. The application of a hyperscanning EEG paradigm demonstrated that the participating children with autistic traits exhibited an attenuated and apparently distinct alteration pattern of interbrain connectivity in comparison to a control group. These findings highlight the value of physiologically based measures in informing etiological and interventional studies in neuropsychiatry.

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11. Church BA, Rodgers JD, Jackson BN, Wisniewski MG, Moppert S, Lopata C, Thomeer ML, Mercado E, 3rd. Perceptual discrimination learning in children with and without autism: The effect of feedback, modality, and progressive-learning. Psychon Bull Rev;2025 (Apr 14)

Research suggests autistic children learn and generalize visual family-resemblance categories atypically (e.g., Church, et al., 2010, 2015), particularly when learning incidentally from exposure. This may reflect differences in perceptual learning (Mercado et al., 2020). However, it is unknown whether perceptual discrimination learning is also atypical and if differences extend to other modalities. To address this, autistic children with normal language abilities and IQ and typically developing (TD) matched comparison children completed auditory and visual discrimination tasks, after either incidental exposure to or direct training with stimuli presented in either progressive (easy-to-hard) or random orders of difficulty. In the visual task, both autistic and TD children only performed well after progressive training, suggesting limited perceptual learning from incidental visual exposure. In the auditory task, autistic children showed a progressive learning advantage after both exposure and training, but TD children only showed this advantage after training. They also had significantly better auditory discrimination than TD children after progressive training. These findings suggest typical visual discrimination learning after progressive training and enhanced auditory discrimination learning after progressive training and exposure. This enhanced auditory perceptual learning may help explain why these autistic children are socially impaired while retaining the capacity to learn language.

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12. Deng JR, Tong M, Zhang XT, Lin ZP, Wang Z, Long J, Chen ZM. An Event-Related Potential Study on Facial Recognition in Children with and without Autism Spectrum Disorders. Neuropsychiatr Dis Treat;2025;21:903-916.

PURPOSE: Facial recognition is very primary and important in individuals’ development and the event-related potential based on face recognition such as N170 is considered as the most potential objective marker of autism, the hot and difficult point of current research. We will explore the electrophysiological basis of facial recognition with autism and without autism. Given the link between facial recognition and social impairments, the core symptom of autism, it is also necessary to study the correlation between the P1 and N170 components and the severity of social functioning in autism. PATIENTS AND METHODS: In this study, autism and age-matched typically developing children were asked to examine photographs of faces, objects and butterflies and event-related potentials were recorded. The parents or caregivers of the participants were asked to fill out the Vineland Adaptive Behavior Scale. Finally, thirteen children with autism (6.60±2.12years) and ten typically developing (6.65±1.64years) children were included in the experiment. RESULTS: Children with autism showed slower P1 and N170 latencies than typically developing children. The N170 amplitude for faces was larger than that for objects. Considering age as a covariant, the results primarily remained unchanged and the effect size of age was significant for the P1 and N170 latencies. As for the correlation between ERPs and the severity of social impairment, there were some significant correlations between the P1 and N170 latencies and social functioning. CONCLUSION: This result not only suggests the electrophysiological basis of facial recognition but also indicates that the P1 and N170 components could assist in the diagnosis and assessment of autism. Moreover, the results suggest that age should be considered in analyses of the P1 and N170 latencies. Due to a limited number of participants, conducting a multi-center and large-sample study in the future is necessary.

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13. ED GW, M JS, Mitchell J, T BT, Sung C, Sherwood K, Dababnah S, Magaña S, Lovelace T, Kattari SK, Olsen D, Elkins J, Humm L, Steacy C, Riddle E, Liggett C. The development and utilization of a diversity advisory board in an intervention to support social skill development for autistic transition-aged youth. Autism;2025 (Apr 15):13623613251330847.

Recent discourse has identified significant issues surrounding the lack of diversity in autism-related research. However, recent efforts have called for the regular use of diversity advisory boards (DAB) in autism-related research to improve the inclusivity of underrepresented and marginalized groups included in the growing autism scholarship. This article outlines the development and implementation of a DAB to support the design and evaluation of an innovative intervention, WorkChat: A Virtual Workday. Specifically, WorkChat focuses on improving knowledge and practicing conversational skills with virtual customers, coworkers, and supervisors to support workplace interactions for autistic transition-age youth. Here, we share guidelines for developing, utilizing, and maintaining a DAB, as well as recommended practices and future implications for implementing DABs in autism services research while using the WorkChat DAB as a case study. The goal is to support the further use of DABs as a means of significantly improving the inclusion of underrepresented and marginalized identities including racial, gender, and sexual minorities, and individuals with disabilities in autism services research.Lay AbstractAutism research often does not include enough people with different identities such as different races, genders, and sexualities. Sometimes, support for autistic individuals does not help everyone equally. They often work better for white, straight autistic males. This article will talk about how we are trying to make autism research more diverse. We will share how we are using a group of diverse advisors to help with research. We will also talk about how to use these advisor groups in the future for autism research.

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14. Feldman D, Prigge M, Alexander A, Zielinski B, Lainhart J, King J. Flexible nonlinear modeling reveals age-related differences in resting-state functional brain connectivity in autistic males from childhood to mid-adulthood. Mol Autism;2025 (Apr 15);16(1):24.

BACKGROUND: Divergent age-related functional brain connectivity in autism spectrum disorder (ASD) has been observed using resting-state fMRI, although the specific findings are inconsistent across studies. Common statistical regression approaches that fit identical models across functional brain networks may contribute to these inconsistencies. Relationships among functional networks have been reported to follow unique nonlinear developmental trajectories, suggesting the need for flexible modeling. Here we apply generalized additive models (GAMs) to flexibly adapt to distinct network trajectories and simultaneously describe divergent age-related changes from childhood into mid-adulthood in ASD. METHODS: 1107 males, aged 5-40, from the ABIDE I & II cross-sectional datasets were analyzed. Functional connectivity was extracted using a network-based template. Connectivity values were harmonized using COMBAT-GAM. Connectivity-age relationships were assessed with thin-plate spline GAMs. Post-hoc analyses defined the age-ranges of divergent aging in ASD. RESULTS: Typically developing (TD) and ASD groups shared 15 brain connections that significantly changed with age (FDR-corrected p < 0.05). Network connectivity exhibited diverse nonlinear age-related trajectories across the functional connectome. Comparing ASD and TD groups, default mode to central executive between-network connectivity followed similar nonlinear paths with no group differences. Contrarily, the ASD group had chronic hypoconnectivity throughout default mode-ventral attentional (salience) and default mode-somatomotor aging trajectories. Within-network somatomotor connectivity was similar between groups in childhood but diverged in adolescence with the ASD group showing decreased within-network connectivity. Network connectivity between the somatomotor network and various other functional networks had fully disrupted age-related pathways in ASD compared to TD, displaying significantly different model curvatures and fits. LIMITATIONS: The present analysis includes only male participants and has a restricted age range, limiting analysis of early development and later life aging, years 40 and beyond. Additionally, our analysis is limited to large-scale network cortical functional parcellation. To parse more specificity of brain region connectivity, a fine-grained functional parcellation including subcortical areas may be warranted. CONCLUSION: Flexible non-linear modeling minimizes statistical assumptions and allows diagnosis-related brain connections to follow independent data-driven age-related pathways. Using GAMs, we describe complex age-related pathways throughout the human connectome and observe distinct periods of divergence in autism.

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15. Garcia-Simon MI, Del Mar Navarro-Jimenez E, Martinez-Ortigosa A, Ropero-Padilla C, Roman P, Rodriguez-Arrastia M. Experiences of Females With Late Diagnosis of Autism: Descriptive Qualitative Study. Nurs Res;2025 (Apr 15)

Background: Females with autism often receive late diagnoses-especially those with average or above-average intellectual abilities-highlighting the need to explore the unique experiences of this population for better health care support.Objective: To explore the experiences and perceptions of females who received a late diagnosis on the autism spectrum in terms of coping and managing their diagnosis.Methods: A descriptive qualitative study was conducted from December 2022 to March 2023 using semistructured interviews with 14 late-diagnosed autistic female subjects. Purposive and snowball sampling were employed, and thematic analysis of the interview data was performed using ATLAS.ti v.9 software. Findings were reported following standards for reporting qualitative research guidelines.Results: Two main themes emerged: (a) getting a diagnosis: fitting into the norm, and (b) navigating the distinct significance for autistic females. The findings indicated that masking strategies contribute to delayed diagnoses, and social and health care stigma surrounding autism in females was evident. Areas for improving access to resources and support programs were identified.Discussion: The results show that masking and camouflaging are predominant strategies among autistic females, contributing to delayed diagnoses and exposing them to additional risks. Enhancing resources and training for health care professionals is necessary to address the specific needs of this population.

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16. Griffith MM, Stanek JR, Lemanek KL, Walden J, Nahata L, Creary SE. Prevalence and Impact of Autism Spectrum Disorder and Selected Neurodevelopmental Diagnoses in Hospitalized Youth With Sickle Cell Disease. Pediatr Blood Cancer;2025 (Apr 14):e31725.

BACKGROUND: Sickle cell disease (SCD) is a chronic illness accounting for 134,000 hospital admissions annually. Youth with SCD and youth with autism spectrum disorder (ASD) experience health disparities, yet the hospitalization outcomes of these youth have not been assessed. This study aimed to (i) determine the prevalence of ASD and selected neurodevelopmental disabilities (NDD) among hospitalized youth with SCD and (ii) compare hospitalization outcomes in youth with selected NDD and SCD to youth with SCD. PROCEDURE: ICD-10 diagnosis codes were used to identify admitted youth (2-18 year olds) with SCD, ASD, and selected NDD (i.e., developmental delay) in the Pediatric Health Information System (October 2015 to April 2024). Demographic (age, race) and clinical variables (length of stay, intensive care unit [ICU] admission, 30-day readmissions, hydroxyurea use, genotype) were assessed. RESULTS: Among 16,369 unique inpatients diagnosed with SCD (54.7% hemoglobin SS, median age = 11.9 years, and 86.4% non-Hispanic Black), 2.6% were diagnosed with a selected NDD; 1.7% were diagnosed with ASD. Hydroxyurea use during hospitalization did not differ between groups (3.3% vs. 3.5%; p = 0.19). Individuals with selected NDD had significantly higher annualized rates of hospitalization (0.88 vs. 0.65; p < .0001), ICU admission (0.12 vs. 0.05; p < .0001), and 30-day readmissions (20.2% vs. 17.4%; p = 0.0004) compared to youth without these neurodevelopmental diagnoses. The median length of stay in both groups was 3 days. CONCLUSIONS: Youth with selected NDD and SCD are at an increased risk of frequent and complicated hospitalizations. Additional research should investigate how inpatient and outpatient care delivery can be tailored and optimized to reduce the frequency and severity of hospitalizations.

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17. Horton RH, McIntosh A, Ostinelli EG, Harriss E, Fazel M. Neuropsychiatric Outcomes in Children and Adolescents With Perinatally Acquired HIV: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr;2025 (Apr 15);98(5):411-428.

OBJECTIVE: The objective of this study is to define the neuropsychiatric challenges including developmental delay, cognitive impairment, and psychiatric illness faced by children with perinatally acquired HIV. DATA SOURCES: Nine databases were searched on May 30, 2023: MEDLINE, Embase, and PsycINFO (all through Ovid SP); CINAHL and Child Development and Adolescent Studies (through EBSCO); the Web of Science Core Collection; Scopus; ProQuest Dissertations and Theses Global; and WHO Global Index Medicus. No limits were applied. Search strategies incorporated keywords and thesaurus headings to describe children and adolescents aged 0-25 years with perinatally acquired HIV and terms to describe the spectrum of neuropsychiatric impairment. STUDY SELECTION: Entries were reviewed by 2 independent reviewers. Studies were included if they involved a population of children with perinatally acquired HIV and investigated a neurologic or psychiatric outcome. MAIN OUTCOME MEASURES: Hypothesis that children with pHIV would have more neuropsychiatric challenges than children without pHIV was formulated before the study. Main outcome measures include incidence and severity of cognitive impairment, developmental delay, and psychiatric illness in children with pHIV. RESULTS: Forty-five studies on cognitive impairment were included of which 8 studies were included for meta-analysis and demonstrated a standardized mean difference of -0.508 where children without HIV had higher cognitive scores (95% CI: -0.7903 to -0.2272). In total, 15 studies on developmental delay were included, of which 9 were included for meta-analysis and demonstrated, for motor delay, a standardized mean difference (SMD) of -0.794 where children without HIV achieved higher motor function scores (95% CI: -0.9986 to -0.590) and for cognitive delay an SMD of -0.697 where children without HIV achieved higher cognitive function scores (95% CI: -0.976 to -0.417). In total, 39 studies on psychiatric illness were included with an odds ratio for anxiety and depression of 1.105, suggesting that children with HIV had slightly higher odds of developing anxiety or depression, however, this result was not significant (95% CI: 0.778 to 1.571). CONCLUSIONS: Children with perinatally acquired HIV may have a greater cognitive impairment, motor and cognitive delay, and would likely benefit from tailored approaches to improve their outcomes.

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18. Isenstein EL, Freedman EG, Rico GA, Brown Z, Tadin D, Foxe JJ. Adults on the autism spectrum differ from neurotypical peers when self-generating but not passively-experiencing somatosensation: a high-density electrophysiological (EEG) mapping and virtual reality study. Neuroimage;2025 (May 1);311:121215.

Little is known about how different features of tactile inputs affect somatosensory perception in autism. In this study we combined high-density electroencephalography (EEG) and virtual reality (VR) to assess how the volition and pattern consistency of somatosensory stimulation influenced the electrophysiological responses in neurotypical (n = 30) and autistic (n = 30) adults. Specifically, we compared N1 and P300 amplitudes when vibrotactile stimulation were actively triggered by self-motion (Active) versus passively triggered by target-motion (Passive). We also measured the mismatch negativity (MMN) to assess how deviations in the pattern of stimulus duration affected the electrophysiological responses. We observed comparable responses regardless of pattern deviation in the MMN time window between groups, but different patterns of amplitude in this time frame based on whether the stimulation was Active or Passive. In the autism group we observed smaller N1 amplitudes in response to Passive, but not Active, vibrations as compared to the control group. Conversely, there were overall larger magnitude P300 amplitudes in the autism group, but comparable levels of Passive-to-Active attenuation between groups. Overall, the autism cohort demonstrated variation from the neurotypical cohort with respect to the volition of the stimuli, but there were comparable results between groups in response to pattern deviation. These findings suggest that there are subtle differences in how adults with and without autism handle self-generated and externally-generated somatosensory sensations.

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19. Jasni SH, Graham F, Bell E, Tan VTY. Systematic Review of Group-Based Emotion Regulation Interventions for Autistic Children’s Socio-Emotional Competence. OTJR (Thorofare N J);2025 (Apr 15):15394492251330507.

Autistic children often face challenges in socio-emotional competence (SEC). Group-Based Emotion Regulation Interventions (GBERs), involving parents and teachers, show potential for improving SEC while enhancing accessibility and cost-effectiveness. This systematic review evaluates the effectiveness of GBERs for autistic children. A systematic search of seven databases (2012-2022) identified studies on GBERs targeting SEC in autistic children aged 7-18 years. Studies were assessed for risk of bias. Seventeen studies were included. Cognitive-behavioral therapy (CBT)-based approaches were most prevalent, with some interventions incorporating play-based, mindfulness, or yoga-based approaches. Effective interventions featured components such as parent and teacher psychoeducation and skill reinforcement through homework. GBERs show promise in improving SEC among autistic children, although caution is warranted as some studies lack comparator groups. Occupational therapists may play a pivotal role in expanding GBERs’ access and supporting SEC development. How Group Programs Help Autistic Children Improve Social and Emotional Skills With Support From Parents and TeachersAutistic children often have difficulty understanding and managing emotions, which can make it harder for them to interact with others in daily life. This review looks at research on group-based programs that help improve social and emotional skills in autistic children. These programs often include parents and teachers in the process, which helps children practice these skills at home and in school. The research we reviewed focused on children aged 7–18 years, and we looked at studies from the past decade. We analyzed how effective these programs are and explored whether occupational therapists could adapt them to support autistic children. Cognitive-behavioral therapy (CBT)-based approaches were the most prevalent; play-based, yoga-based, and mindfulness approaches were also incorporated. Effective interventions included parent and teacher psychoeducation, along with skill reinforcement through structured homework activities. Overall, this review shows that group programs are helpful for improving social and emotional skills in autistic children. Occupational therapists could potentially play an important role in making these programs more widely available. eng

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20. Jiang TT, Li XQ, Zhao TT, Li HY, Tang Q. [Advances in research on gender differences in autism spectrum disorders]. Zhongguo Dang Dai Er Ke Za Zhi;2025 (Apr 15);27(4):480-486.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social impairments, repetitive behaviors, and restricted interests. Studies have shown that it is more prevalent in males than females. Although this issue has attracted academic attention since the 20th century, the specific mechanisms underlying the gender differences in ASD remain unclear. This paper reviews the impact of gender differences in ASD, focusing on the female protective effect, DNA methylation, hormone levels, and clinical manifestations. It also discusses corresponding treatment options, particularly suggesting improvements in the diagnostic process, which is often overlooked, in order to provide valuable references for the clinical diagnosis and treatment of ASD.

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21. Lee S, Moon H, Kim E. NMDAR dysfunction in autism spectrum disorders: Lessons learned from 10 years of study. Curr Opin Neurobiol;2025 (Apr 15);92:103023.

Over the past decade or so, mouse models of autism spectrum disorders (ASD) have been extensively studied in the search for key mechanisms underlying the disorder. Numerous intriguing mechanisms have been proposed, spanning various levels of the neural system, including molecular, synaptic, neuronal, circuit, and systems-level processes. However, no single mechanism has emerged as universally applicable, highlighting the heterogeneous nature of the genetic and neurobiological underpinnings of ASD. Among these, the NMDA receptor (NMDAR) dysfunction hypothesis has garnered significant attention. Many mouse models exhibit NMDAR dysfunction, with NMDAR hypofunction appearing more prevalent than hyperfunction. Nevertheless, not all mouse models display this dysfunction, suggesting that NMDAR abnormalities may not be ubiquitous across models, or that we have yet to fully explore the spectrum of NMDAR-related dysfunction in ASD. These findings underscore the need to consider multiple factors when studying ASD mouse models, including different mutations within the same gene, gene deletion dosage, genetic background, sex, age, brain regions, cell types, and neural circuits.

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22. Li R, Anzai M, Shibata A, Ito-Ishida A. Synaptic disturbance in neurodevelopmental disorders: Perspectives from fragile X and Rett syndromes. Brain Dev;2025 (Apr 13);47(3):104358.

Neurodevelopmental disorders (NDDs) are often referred to as « synaptopathies » because many of their behavioral symptoms arise from impaired synaptic development and function. However, the mechanisms that connect synaptic dysfunction to neurological symptoms remain unclear, mainly due to the wide variety of genetic and environmental factors involved in these disorders. Fragile X syndrome and Rett syndrome, two extensively studied monogenic NDDs, provide a unique opportunity to explore these mechanisms at molecular, cellular, and synaptic levels. This review summarizes the current understanding of how synaptic alterations contribute to the neurological symptoms observed in fragile X and Rett syndromes. A comparison of findings from mouse models indicates that an imbalance in local and distal connectivity may serve as a common feature of both disorders.

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23. Liu Z, Wang L, Yu L, Zhao Y, Zhu M, Wang Y, Cao A. Identification of immune cells and circulating inflammatory factors associated with neurodevelopmental disorders by bidirectional Mendelian randomization and mediation analysis. Sci Rep;2025 (Apr 14);15(1):12840.

The roles of various immune cells and circulating inflammatory factors in neurodevelopmental disorders (NDDs) remain controversial. Therefore we employed a two-sample and bidirectional Mendelian randomization and mediation method to explore the causal relationships between immune cells, circulating inflammatory factors, and NDDs. All data were originated from Genome-Wide Association Study (GWAS) datasets. We found a significant positive causal relationship between 13 immune cells and autism spectrum disorder (ASD), including six CD8+ T cells, one CD3+ T cell, two CD20+ B cells, one CD38+  B cell, and two plasmacytoid DC. 9 inflammatory factors showed significant causal relationships with ASD: interleukins-7 (IL-7), interleukins-2 (IL-2), Interleukin-2 receptor subunit beta levels( IL-2β) and interleukins-18 receptor 1 levels (IL-18-R1) were negatively associated. In contrast, five inflammatory factors were positively associated, such as tumor necrosis factor-α (TNF-α). 14 immune cells exhibited significant causal relationships with attention deficit hyperactivity disorder (ADHD). CD3 on naive CD8br and CD4 on activated Treg were positively associated, while four CD27-expressing B cells were positively associated with ASD. Four CD40-expressing monocytes were negatively associated with ADHD. 7 inflammatory factors had significant causal relationships with ADHD: Fibroblast Growth Factor 23 levels (FGF-23), CD40L receptor levels, Glial Cell Line-Derived Neurotrophic Factor levels (GDNF), TNF-α were more important among these. Mediation analysis identified 12 mediating relationships, with three showing strong evidence: Natural killer cell receptor 2B4 levels (19.9%), FGF-23 (11%), and Eotaxin levels (- 5.95%). Strong causal relationships existed between immune cells, circulating inflammatory factors, and NDDs. Inflammatory factors mediated the pathways between immune cells and NDDs.

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24. Long J, Niu M, Liao X, Han K, Chen J, Su W, Wang X, Liu J, Zhang Y, Zhang H. Feasibility, safety, and efficacy of high-dose intermittent theta burst stimulation in children with autism spectrum disorder: study protocol for a pilot randomized sham-controlled trial. Front Psychiatry;2025;16:1549982.

BACKGROUND: Autism spectrum disorders (ASD) are common neurodevelopmental disorders, mainly caused by disrupted excitation/inhibition balance and synaptic plasticity. Intermittent theta burst stimulation (iTBS) is a variant of excitatory repetitive transcranial magnetic stimulation, inducing long-term potentiation-like plasticity. In recent years, there has been a growing interest in high-dose iTBS as a therapeutic tool for psychiatric disorders. We aim to preliminarily investigate the feasibility, safety, and efficacy of high-dose iTBS in children with autism spectrum disorder (ASD). METHODS: A randomized controlled pilot trial with a 4-week intervention will be conducted. Forty children with ASD will be randomized into either the intervention or control group. The intervention group will receive 5400-pulse iTBS per day, while the control group will receive sham iTBS. Feasibility will be evaluated through recruitment, intervention adherence, and assessment completion. Safety will be assessed by comparing the rates of drop-outs attributed to adverse events and the rates of serious adverse events The efficacy outcomes include the Autism Behavior Checklist, Social Responsiveness Scale, 2nd Edition, Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist and Repetitive Behavior Scale-Revised. Resting-state electroencephalogram and functional near-infrared spectroscopy will be employed to quantify alterations in functional brain connectivity and cerebral haemodynamics. Salivary levels of oxytocin, growth hormone, insulin-like growth factor 1, and insulin-like growth factor binding protein 3 are measured to reflect the biochemical response to iTBS. These indicators will be assessed at baseline and at the end of the intervention. DISCUSSION: This trial will evaluate the feasibility, safety, and efficacy of high-dose iTBS treatment in children with ASD. The proposed study will provide pilot data to inform the feasibility and design of larger sample-size trials. CLINICAL TRIAL REGISTRATION: http://www.chictr.org.cn, identifier ChiCTR2400089757.

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25. Looi MK. Trump watch: RFK Jr claims ignorance, NIH investigates autism origins, and more. Bmj;2025 (Apr 14);389:r757.

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26. Mulraney M, Rincones O, Bryant C, Saredakis D, Ghezzi E, Lampit A. A mixed methods systematic review of assistance dogs for people with autism. Neurosci Biobehav Rev;2025 (Apr 15);173:106160.

OBJECTIVES: To critically examine and synthesise the available evidence regarding the impact of assistance dogs on individuals with autism. STUDY DESIGN: Mixed methods systematic review with meta-analysis of quantitative data and meta-aggregation of qualitative data. Studies were eligible for inclusion if they included participants with autism and data describing the impact, effectiveness, or participant experience with an assistance dog or a companion dog. DATA SOURCES: CENTRAL, Embase, MEDLINE, and PsycINFO. DATA SYNTHESIS: Fourteen studies (one randomised controlled trial, three cohort, seven cross-sectional, and three single-arm studies) were included in the meta-analysis and 13 studies (eight cross-sectional, three longitudinal, and two case studies) were included in the meta-aggregation. There was some quantitative evidence that assistance dogs may be associated with benefit, but the pooled effect sizes are similar to those associated with companion dogs. The qualitative data suggested that parents perceived a broad range of benefits of assistance dogs but may be unprepared for the challenges associated with owning an assistance dog. CONCLUSION: There is a lack of compelling evidence to suggest that assistance dogs confer unique benefits for individuals with autism. The evidence base is limited and of poor quality thus the potential benefits identified need to be interpreted with caution. Interpreting the quantitative and qualitative studies together, the findings indicate many potential benefits of assistance dogs for people with autism could be achieved by a companion dog.

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27. Ntontos G, Nikoloudakis N, Zaglavara T, Lolakos K, Pitsis A. Totally Endoscopic Superior Venosus ASD Repair With a Modified Two-Patch Technique. Innovations (Phila);2025 (Apr 15):15569845251320630.

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28. Priyanka C, Christopher R, Nagappa M, Kommu JVS, Krishnadevaraje MB, Gunasekaran DM, Nair BVS, Kenchaiah R, Nanjaiah ND, Philip M, Shivanna SK, Appadorai PK, Padmanabha H. Targeted metabolomics in children with autism spectrum disorder with and without developmental regression. Metab Brain Dis;2025 (Apr 15);40(4):184.

Early diagnosis and intervention in children with autism spectrum disorder (ASD) is crucial. At present, diagnosis of ASD is primarily based on subjective tools. Identifying metabolic biomarkers will aid in early diagnosis of ASD complementing the assessment tools. The study aimed to conduct targeted metabolomic analysis and determine the plasma metabolites that can discriminate children with ASD from typically developing children (TD), and to determine the utility of machine learning in classifying ASD children based on the metabotypes. This was a multi-centric, analytical, case-control study conducted between April 2021-April 2023. Fasting plasma samples were obtained from seventy ASD and fifty-eight TD children, aged 2 to 12 years. Samples were quantitively analysed for 52 targeted metabolites (13 amino acids, 37 acylcarnitines, adenosine and 2-deoxyadenosine levels) using tandem mass spectrometry. An in-depth statistical analysis was performed. A total of 26 metabolites (11 amino acids, 14 acyl carnitines and adenosine) were found to be significantly (p < 0.005) different between ASD and TD children. Adenosine and amino acid levels were significantly decreased in ASD children. Among acyl carnitines, short- and long-chain acyl carnitine levels were significantly decreased, while medium-chain acyl carnitine levels were significantly increased in ASD children. Octenoylcarnitine-C8:1 (Cut-off value- 0.025 mmol/L, AUC- 0.683) and adenosine (Cut-off value- 0.025 mmol/L, AUC- 0.673) were found to predict children with ASD at a sensitivity of 55.7% and 57.1%, specificity of 79.3% and 72.4% respectively. Based on the metabolites, machine learning models like Support Vector Machine (SVM) and Random Forest (RF) were able to discriminate ASD from TD children with the classification accuracy score being highest in RF (79.487%, AUC- 0.800). Significant abnormalities in plasma metabolites were observed leading to disturbances in the Krebs cycle, urea cycle and fatty acid oxidation, suggesting mitochondrial dysfunction that may possibly contribute in the pathobiology of ASD. Octenoylcarnitine-C8:1 and Adenosine may serve as potential metabolic biomarkers for ASD.

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29. Rezaee M, Effatpanah M, Nasehi MM, Ghamkhar L, Barati N. Assessing the Impact of Neurofeedback on Cognitive Function in Individuals with Autism Spectrum Disorder: A Systematic Review. Iran J Child Neurol;2025;19(2):27-37.

OBJECTIVES: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by qualitative deficits in behavior and social interaction patterns. Recently, cognitive impairments commonly associated with ASD have been well-documented. Neurofeedback (NFB) has been proposed as a potential treatment for individuals with autism, but its effectiveness in improving cognitive issues remains uncertain despite multiple trials. This review aims to summarize the estate of documents regarding the cognitive efficacy of NFB for participants with ASD. MATERIALS & METHODS: Conducting a systematic review adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study scrutinized NFB studies specific to ASD treatment. Its inclusion criteria focused on studies involving individuals with ASD without comorbidities, employing JBI checklists to assess study quality. Utilizing PubMed, Embase, Web of Science, PsycINFO, and Scopus, supplemented by manual paper reviews, we initially identified 474 papers. After deduplication and full-text review, 12 studies were selected for analysis. RESULTS: Findings revealed that 83% of the chosen studies highlighted a positive impact of NFB on cognition in individuals with ASD. The findings suggest NFB as a promising alternative treatment, demonstrating efficacy in addressing attention, memory, executive function, and speech difficulties. Additionally, six studies indicated sustained long-term effectiveness of NFB in improving cognitive functioning among ASD patients. CONCLUSION: This review supports the potential of NFB as a viable intervention for cognitive challenges in ASD. Furthermore, the results hint at broader applications of NFB beyond ASD, suggesting efficacy in addressing conditions like Attention Deficit/Hyperactivity Disorder (ADHD), sleep apnea, depression, and epilepsy.

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30. Riccioni A, Pontillo M, Gialloreti LE, Cicala M, Vasta M, Gatto M, Arturi L, Siracusano M, Di Luzio M, Vicari S, Mazzone L. Investigating the attenuated psychosis syndrome in youth with autism spectrum disorder: results from an observational study. Front Psychiatry;2025;16:1536361.

INTRODUCTION: Despite evidence suggesting increased rates of psychosis in individuals with autism spectrum disorder (ASD), the detection of prodromal psychotic symptoms, including attenuated psychosis syndrome (APS), remains underexplored in this population. METHODS: The primary aim of the present study was to characterize the clinical phenotype of young individuals with ASD who also present with APS (ASD/APS; n = 48) in comparison with individuals with APS only (n = 93) and those with ASD only (n = 30) (age range 9-23 years). Assessments included standardized measures of autistic symptoms (Autism Diagnostic Observation Schedule-Second Edition; ADOS-2), pre-psychotic symptoms (Structured Interview for Psychosis-Risk Syndromes; SIPS), and cognitive and adaptive functioning. RESULTS: Overall, the ASD/APS group demonstrated significantly poorer general adaptive skills compared with the APS group (p = 0.006) and the ASD group (p = 0.005). Compared with the APS group, the ASD/APS group exhibited lower scores across all SIPS domains, with the exception of SIPS-P1 (unusual thought content/delusional ideas; p = 0.062; t = -1.882; F = 5.44) and SIPS-P3 (grandiosity; p = 0.156; t = -1.435; F = 22.6). In contrast, the ASD/APS group displayed significantly higher scores in the repetitive and restricted behavior domain compared with the ASD group (p < 0.001). Notably, there were no significant differences in the age of APS onset across groups (p = 0.601; t = 0.525; F = 0.253). DISCUSSION: These findings provide a more nuanced characterization of APS features in individuals with ASD and emphasize the importance of screening for APS in this population, particularly those considered at increased risk. Early detection and intervention could facilitate timely therapeutic support, potentially improving long-term outcomes for these individuals.

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31. Rum Y, Dolev A, Reichmann O, Zachor DA, Avni E, Ilan M, Meiri G, Koller J. The older sibling effect: comparing social functioning outcomes for autistic children with typically developing siblings, no siblings, and autistic siblings. Front Psychol;2025;16:1568110.

BACKGROUND: Previous research showed that having older, typically developing (TD) siblings is associated with better social functioning in autistic children. Modeling by older siblings and the fact that siblings provide a social companion to practice social skills were suggested as explanations. OBJECTIVES: To investigate whether having older autistic siblings is associated with a similar or an opposite pattern. METHODS: The Azrieli National Centre for Autism and Neurodevelopment Research in Israel database was used to retrieve data of autistic children who completed the Autism Diagnostic Observation Scale [ADOS-2] for secondary analyses. A cohort of 1,100 children was scanned to identify autistic children with no siblings (No-Sib; n = 146), older TD siblings (Older-TD-Sib; n = 300), and older autistic siblings (Older-Autistic-Sib; n = 40). Each Older-Autistic-Sib child was matched to (1) Older-TD-Sib, and (2) No-Sib, by sex, age, and cognitive scores, resulting in 29 triads of matched participants (N = 87). The three groups were compared on the ADOS-2 Social Affect sub-domain [a lower score (0-10) indicates less severe social-communication symptoms (better social functioning)]. RESULTS: Group comparisons revealed that autistic children with older TD siblings showed better social functioning than those with no siblings (p = 0.002, adjusted p = 0.007, d = 0.62). Autistic children with older autistic siblings showed a similar but weaker trend compared to those with no siblings (p = 0.082, adjusted p = 0.247, d = 0.40), and no difference was found between children with older TD versus autistic siblings (p = 0.647, d = -0.13; BF₀₁ = 4.55). CONCLUSION: Autistic children with autistic siblings demonstrated an « intermediate pattern, » implying a possible positive effect of having an older autistic sibling on social functioning, similar to that of having an older TD sibling, albeit smaller. This could be explained by complex relationships between sibling modeling and companionship or the impact of parenting measures, such as experience. These speculative explanations should be directly examined in future research.

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32. Scheithauer M, Vargas Londono F, Naugle B, Walker A, Hodnett JM, Lomas Mevers J, Muething C, Call N. Brief Report: Evaluating the Impact of Behavioural Concerns in Individuals With Intellectual or Developmental Disabilities. J Intellect Disabil Res;2025 (Apr 14)

BACKGROUND: Behavioural concerns, such as aggression and self-injury, are common among youth with intellectual and developmental disabilities. Additional research is needed to further explore the specific ways in which these types of behaviour impact individuals and their families. METHODS: Caregivers seeking treatment for their child’s behavioural concerns completed an interview regarding the negative impact of their child’s behaviour related to (a) physical harm to self or others, (b) property damage, (c) structural modifications, (d) situational avoidance and (e) reactive measures. We reviewed outcomes of these interviews to report on the prevalence of various negative impacts in this clinical sample. RESULTS: Most caregivers reported at least some physical harm (72.99%), property damage (63.99%) and preventative measures such as avoiding removing preferred items or activities (72.35%). Some caregivers endorsed severe negative impacts, such as the need for emergency services (10.61%) or residential placements (5.14%). CONCLUSIONS: Caregivers in this clinical sample consistently endorsed negative impacts resulting from behavioural concerns. This information is crucial in advocating for additional services for this high-need population, and the interview used to gather this information may be a helpful tool to guide future research and clinical work.

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33. Shaw KA, Williams S, Patrick ME, Valencia-Prado M, Durkin MS, Howerton EM, Ladd-Acosta CM, Pas ET, Bakian AV, Bartholomew P, Nieves-Muñoz N, Sidwell K, Alford A, Bilder DA, DiRienzo M, Fitzgerald RT, Furnier SM, Hudson AE, Pokoski OM, Shea L, Tinker SC, Warren Z, Zahorodny W, Agosto-Rosa H, Anbar J, Chavez KY, Esler A, Forkner A, Grzybowski A, Agib AH, Hallas L, Lopez M, Magaña S, Nguyen RHN, Parker J, Pierce K, Protho T, Torres H, Vanegas SB, Vehorn A, Zhang M, Andrews J, Greer F, Hall-Lande J, McArthur D, Mitamura M, Montes AJ, Pettygrove S, Shenouda J, Skowyra C, Washington A, Maenner MJ. Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years – Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR Surveill Summ;2025 (Apr 17);74(2):1-22.

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2022. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2022, a total of 16 sites (located in Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas [two sites: Austin and Laredo], Utah, and Wisconsin) conducted surveillance for ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2022. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in a comprehensive developmental evaluation, 2) autism special education eligibility, or 3) an ASD International Classification of Diseases, Ninth Revision (ICD-9) code in the 299 range or International Classification of Diseases, Tenth Revision (ICD-10) code of F84.0, F84.3, F84.5, F84.8, or F84.9. Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had an evaluator’s suspicion of ASD documented in a comprehensive developmental evaluation. RESULTS: Among children aged 8 years in 2022, ASD prevalence was 32.2 per 1,000 children (one in 31) across the 16 sites, ranging from 9.7 in Texas (Laredo) to 53.1 in California. The overall observed prevalence estimate was similar to estimates calculated using Bayesian hierarchical and random effects models. ASD was 3.4 times as prevalent among boys (49.2) than girls (14.3). Overall, ASD prevalence was lower among non-Hispanic White (White) children (27.7) than among Asian or Pacific Islander (A/PI) (38.2), American Indian or Alaska Native (AI/AN) (37.5), non-Hispanic Black or African American (Black) (36.6), Hispanic or Latino (Hispanic) (33.0), and multiracial children (31.9). No association was observed between ASD prevalence and neighborhood median household income (MHI) at 11 sites; higher ASD prevalence was associated with lower neighborhood MHI at five sites.Record abstraction was completed for 15 of the 16 sites for 8,613 children aged 8 years who met the ASD case definition. Of these 8,613 children, 68.4% had a documented diagnostic statement of ASD, 67.3% had a documented autism special education eligibility, and 68.9% had a documented ASD ICD-9 or ICD-10 code. All three elements of the ASD case definition were present for 34.6% of children aged 8 years with ASD.Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability. Intellectual disability was present among 52.8% of Black, 50.0% of AI/AN, 43.9% of A/PI, 38.8% of Hispanic, 32.7% of White, and 31.2% of multiracial children with ASD. The median age of earliest known ASD diagnosis was 47 months and ranged from 36 months in California to 69.5 months in Texas (Laredo).Cumulative incidence of ASD diagnosis or eligibility by age 48 months was higher among children born in 2018 (aged 4 years in 2022) than children born in 2014 (aged 8 years in 2022) at 13 of the 15 sites that were able to abstract records. Overall cumulative incidence of ASD diagnosis or eligibility by age 48 months was 1.7 times as high among those born in 2018 compared with those born in 2014 and ranged from 1.4 times as high in Arizona and Georgia to 3.1 times as high in Puerto Rico. Among children aged 4 years, for every 10 children meeting the case definition of ASD, one child met the definition of suspected ASD.Children with ASD who were born in 2018 had more evaluations and identification during ages 0-4 years than children with ASD who were born in 2014 during the 0-4 years age window, with an interruption in the pattern in early 2020 coinciding with onset of the COVID-19 pandemic.Overall, 66.5% of children aged 8 years with ASD had a documented autism test. Use of autism tests varied widely across sites: 24.7% (New Jersey) to 93.5% (Puerto Rico) of children aged 8 years with ASD had a documented autism test in their records. The most common tests documented for children aged 8 years were the Autism Diagnostic Observation Schedule, Autism Spectrum Rating Scales, Childhood Autism Rating Scale, Gilliam Autism Rating Scale, and Social Responsiveness Scale. INTERPRETATION: Prevalence of ASD among children aged 8 years was higher in 2022 than previous years. ASD prevalence was higher among A/PI, Black, and Hispanic children aged 8 years than White children aged 8 years, continuing a pattern first observed in 2020. A/PI, Black, and Hispanic children aged 8 years with ASD were also more likely than White or multiracial children with ASD to have a co-occurring intellectual disability. Identification by age 48 months was higher among children born in 2018 compared with children born in 2014, suggesting increased early identification consistent with historical patterns. PUBLIC HEALTH ACTION: Increased identification of autism, particularly among very young children and previously underidentified groups, underscores the increased demand and ongoing need for enhanced planning to provide equitable diagnostic, treatment, and support services for all children with ASD. The substantial variability in ASD identification across sites suggests opportunities to identify and implement successful strategies and practices in communities to ensure all children with ASD reach their potential.

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34. Shi Z, Allenmark F, Theisinger LA, Pistorius RL, Glasauer S, Müller HJ, Falter-Wagner CM. Predictive Processing in Autism Spectrum Disorder: The Atypical Iterative Prior Updating Account. Biol Psychiatry Glob Open Sci;2025 (May);5(3):100468.

BACKGROUND: The nature of predictive-processing differences between individuals with autism spectrum disorder (ASD) and typically developing (TD) individuals remains contested. Some studies have reported impaired predictive processing in ASD, while others have suggested intact but atypical learning dynamics. METHODS: We investigated duration reproduction tasks under high- and low-volatility settings to examine the updating dynamics of prior beliefs and sensory estimate updating in individuals with ASD (n = 32) and TD counterparts (n = 32). Using a two-state Bayesian model, we analyzed how the participants updated their prior beliefs and perceptual estimates and how these updates affected their behavior over time. RESULTS: Individuals with ASD integrated prior knowledge similarly to TD control participants for perceptual estimates. However, they relied more heavily on sensory input for iteratively updating their prior beliefs, perceiving events as less interconnected. This heightened reliance on sensory inputs led to the initial underweighting of priors in perceptual estimates, resulting in a weaker central tendency early in sessions. Over time, ASD participants adapted, reaching integration weights comparable to those of TD control participants by the end of the session. These findings suggest that predictive processing in ASD is characterized by distinct updating dynamics, not an inability to form or use prior effectively. CONCLUSIONS: Our study highlights a unique interplay between sensory inputs and prior beliefs in ASD, where greater reliance on sensory inputs during prior updating influences adaptation speed and intertrial dynamics. This process clarifies inconsistencies in the literature and underscores the role of interactive updating in predictive processing differences between individuals with ASD and TD individuals. This study explores how individuals with autism spectrum disorder (ASD) process sensory information and update their beliefs during predictive tasks. Using a duration reproduction task, researchers found that while people with ASD can use prior knowledge like typically developing (TD) individuals, they rely more on sensory input for belief updates. This results in slower adaptation and a weaker initial central tendency. These findings highlight unique updating dynamics in ASD, resolving inconsistencies in past research and emphasizing differences in how sensory inputs and prior beliefs interact in predictive processing. eng

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35. Shil A, Arava N, Levi N, Levine L, Golan H, Meiri G, Michaelovski A, Tsadaka Y, Aran A, Menashe I. An integrative scoring approach for prioritization of rare autism spectrum disorder candidate variants from whole exome sequencing data. Sci Rep;2025 (Apr 15);15(1):13024.

Discerning clinically relevant autism spectrum disorder (ASD) candidate variants from whole-exome sequencing (WES) data is complex, time-consuming, and labor-intensive. To this end, we developed AutScore, an integrative prioritization algorithm of ASD candidate variants from WES data and assessed its performance to detect clinically relevant variants. We studied WES data from 581 ASD probands, and their parents registered in the Azrieli National Center database for Autism and Neurodevelopment Research. We focused on rare allele frequency (< 1%) and high-quality proband-specific variants affecting genes associated with ASD or other neurodevelopmental disorders (NDDs). We developed AutScore and AutScore.r and assigned each variant based on their pathogenicity, clinical relevance, gene-disease association, and inheritance patterns. Finally, we compared the performance of both AutScore versions with the rating of clinical experts and the NDD variant prioritization algorithm, AutoCaSc. Overall, 1161 rare variants distributed in 687 genes in 441 ASD probands were evaluated by AutScore with scores ranging from - 4 to 25, with a mean ± SD of 5.89 ± 4.18. AutScore.r cut-off of ≥ 0.335 performs better than AutoCaSc and AutScore in detecting clinically relevant ASD variants, with a detection accuracy rate of 85% and an overall diagnostic yield of 10.3%. Five variants with AutScore.r of ≥ 0.335 were distributed in five novel ASD candidate genes. AutScore.r is an effective automated ranking system for ASD candidate variants that could be implemented in ASD clinical genetics pipelines.

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36. Smith JD, Vaughn LM, Page E, Mitchell T, Anixt JS. The Value of ECHO Autism to Primary Care Providers: Building Community and Capacity. J Dev Behav Pediatr;2025 (Mar-Apr 01);46(2):e162-e168.

OBJECTIVES: The Extension for Community Healthcare Outcomes (ECHO) model has been shown to increase primary care providers’ (PCPs) knowledge and self-efficacy in caring for patients with autism spectrum disorder (ASD). Benefits of ECHO Autism participation may not be fully captured in studies measuring only quantitative outcomes. Qualitative methodology was used to explore the perceptions, meaning, and impact of ECHO Autism from the perspective of participating PCPs. METHODS: We used group level assessment, a large-group participatory, qualitative research method modified to a virtual format to explore the perceptions, meaning, and impact of the ECHO Autism program from the perspective of 6 participating PCPs, 1 family member, and 5 hub team members. Individual, semi-structured interviews were conducted with 4 ECHO Autism participants to further explore the identified themes. RESULTS: Participants identified 6 primary themes corroborated by interview participants: (1) direct benefits to PCPs, (2) appreciation of the « all teach, all learn » approach, (3) sense of community, (4) value of the multidisciplinary conceptualization of care for children with ASD, (5) demystification of care for children with ASD, and (6) benefits to the PCPs’ patients and their families. Feedback about ways to enhance the ECHO Autism program was categorized into 5 areas for improvement. CONCLUSION: ECHO Autism builds a community for providers who may otherwise feel isolated and hesitant to manage complex needs of children with ASD. ECHO Autism is an innovative approach to build capacity for PCPs to provide high-quality evidence-based care to these children within their own communities.

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37. Srikar M, Meera SS, Raju R, Swaminathan D, Green J, Wan MW. Caregiver-infant interactions in infants at elevated familial likelihood for autism in India. Infant Behav Dev;2025 (Apr 15);79:102060.

Prospective studies of infants at elevated likelihood for autism (EL-A) have identified differences in caregiver-infant interactions (CII) when compared to infants at typical likelihood (TL). These differences begin to emerge prior to the infant’s first birthday and may impact social opportunities essential for facilitating social-communicative development. To our knowledge, all studies to date have focused on Western samples (Australian, European, and US). However, parenting science has long recognised cultural variability in CII. This study investigated whether global features of CII differed between EL-A and TL infants in India. Caregiver-infant free-play videos involving 33 EL-A and 15 TL infants aged 9-15 months were rated using the Manchester Assessment of Caregiver-Child Interaction-Infant (MACI). EL-A infants received lower sensitive responsiveness and psychological stimulation compared to TL infants in age-controlled analyses. No significant group differences were found in caregiver directiveness or in infant or dyadic MACI scales. Furthermore, caregiver sensitive responsiveness and psychological stimulation (incorporating social and cognitive stimulation) were positively associated with concurrent parent-reported infant play and leisure, lending support for ecological validity. This first study in a South Asian context demonstrates a partial replication of previous CII studies. Early pre-emptive interventions targeting caregiver-infant interaction are recommended for Indian families to enhance infant exposure to responsive and stimulating social interactions. The strength of findings is understood in the context of utilising caregiver self-recorded CII, the sample size and broad age range.

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38. Sun S, Wang F, Xu F, Deng Y, Ma J, Chen K, Guo S, Liang XS, Zhang T. Atypical hierarchical brain connectivity in autism: Insights from stepwise causal analysis using Liang information flow. Neuroimage;2025 (Apr 15);310:121107.

Autism spectrum disorder (ASD) is associated with atypical brain connectivity, yet its hierarchical organization remains underexplored. In this study, we applied the Liang information flow method to analyze stepwise causal functional connectivity in ASD, offering a novel approach to understanding how different brain networks interact. Using resting-state fMRI data from ASD individuals and healthy controls, we observed significant alterations in both positive and negative causal connections across the ventral attention network, limbic network, frontal-parietal network, and default mode network. These disruptions were detected at multiple hierarchical levels, indicating changes in communication patterns across brain regions. By leveraging features of hierarchical causal connectivity, we achieved high classification accuracy between ASD and healthy individuals. Additionally, changes in network node degrees were found to correlate with ASD clinical symptoms, particularly social and communication behaviors. Our findings provide new insights into disrupted hierarchical brain connectivity in ASD and demonstrate the potential of this approach for distinguishing ASD from typical development.

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39. Tan H, Xu M, Ren T, Deng L, Zhang L, Wang S, Cao M, Yuan TF, Li F. Evaluating the feasibility, safety and efficacy of accelerated continuous theta-burst stimulation targeting the left primary motor cortex to improve social communication impairment in children with autism. Gen Psychiatr;2025;38(2):e102012.

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40. Wang J, Kawata NYS, Cao X, Zhang J, Fujisawa TX, Zhang X, Fan L, Xia W, Wu L, Tomoda A. White-Matter fiber tract and resting-state functional connectivity abnormalities in young children with autism spectrum disorder. Neuroimage;2025 (Apr 15);310:121109.

Autism spectrum disorder (ASD) is a complex developmental disorder characterized by difficulties in social interaction and communication and repetitive behaviors. Although abnormal brain development has been shown to exist in children with ASD, the link between structural brain abnormalities and resting-state functional connectivity (rsFC) disruptions in children with ASD remains understudied. To address this limitation, we utilized the population-based bundle-to-region connectome, providing a detailed understanding of the connectivity between cortical regions and white matter (WM) tracts. By precisely indexing WM-Gray Matter (GM) interactions, we investigated the rsFC of the cortex-associated ROIs to explore the association between structural and rsFC abnormalities and clinical symptoms in young children with ASD. This MRI study identified significant differences in WM structure and rsFC between children with ASD (n = 34) and typically developing children (TD, n = 43). Our results showed that decreased fractional anisotropy (FA) and increased mean diffusivity (MD) and radial diffusivity (RD) in ASD WM tracts compared to TD, particularly in left hemisphere tracts (anterior thalamic radiation [ATR], cingulum, inferior fronto-occipital fasciculus [IFOF], inferior longitudinal fasciculus [ILF], superior longitudinal fasciculus [SLF], and uncinate fasciculus [UF]). Abnormal rsFC was observed in GM areas connected by ATR, cingulum, IFOF, ILF, and SLF. Furthermore, abnormalities in the structural and functional connectivity index (SFCI) within the SLF and cingulum were identified. An association has been observed between these abnormalities and clinical symptoms. Specifically, SLF structural and functional connectivity appear to be associated with repetitive and restrictive behavior (RRB), while cingulum connectivity is associated with communication abilities. In conclusion, young children with ASD exhibit abnormal WM tract structures and associated rsFC abnormalities. These differences highlight significant disruptions in rsFC mapped from WM tracts to cortical areas in ASD, correlating with the severity of ASD symptoms, and suggest the importance of multi-modal imaging in capturing these variations.

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41. Xiao S, Li J. Publisher Correction: Impact of imitation abilities on social communication in autistic children: evidence from an Early Start Denver Model intervention study. Mol Autism;2025 (Apr 15);16(1):25.

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42. Zhou X, Deng YY, Qian L, Zhong SS, Zou FY, Shen LS, Luo XW, Yin BY, He YF, Guo RM. Alterations in brain iron and myelination in children with ASD: A susceptibility source separation imaging study. Neuroimage;2025 (Apr 15);310:121128.

Autism spectrum disorder (ASD) may have both brain iron and myelin changes, but traditional methods fail to differentiate them. This study utilized an advanced susceptibility source separation technique, APART-QSM (iterAtive magnetic suscePtibility sources sepARaTion), to investigate brain iron and myelination alterations in children with ASD and link neuroimaging findings to clinical symptom severity. Sixty-five school-aged children with ASD and Sixty age- and sex-matched typically developing children were included. By providing enhanced and broader detection capabilities compared to conventional QSM, APART-QSM uncovered reduced iron content across multiple deep gray matters and decreased myelin content in the globus pallidum in ASD. The iron and myelin contents in the globus pallidum and iron content in the substantia nigra were significantly negatively correlated with ASD symptom severity. Coexisting abnormal brain iron and myelin contents in ASD, particularly in the globus pallidus, offer innovative and promising insights into ASD pathology and potential biomarkers.

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