1. Bowden N, Gibb S, Audas R, Clendon S, Dacombe J, Kokaua J, Milne BJ, Mujoo H, Murray SW, Smiler K, Stace H, van der Meer L, Taylor BJ. Association Between High-Need Education-Based Funding and School Suspension Rates for Autistic Students in New Zealand. JAMA Pediatr;2022 (May 16)

IMPORTANCE: Autistic students often experience poor educational outcomes that have implications for later life, including unemployment, interactions with the criminal justice system, increased risk for substance abuse, and low socioeconomic status. Improving educational outcomes is critical for ensuring that autistic young people can reach their potential. OBJECTIVE: To quantify differences in suspension rates between autistic and nonautistic students and to assess whether high-need education-based funding for autistic students is associated with reduced rates of school suspension. DESIGN, SETTING, AND PARTICIPANTS: This national cohort study used linked health and education data from New Zealand’s Integrated Data Infrastructure. Data were obtained for students aged 5 to 16 years from January 1 to December 31, 2018, and analyzed July 7, 2021, to January 1, 2022. A novel case identification method was used to identify autistic students. EXPOSURES: High-need education-based funding (Ongoing Resourcing Scheme [ORS]) obtained before 2019. MAIN OUTCOMES AND MEASURES: Rates of suspension from school. Crude and adjusted analyses of the association between suspension rates and autism among the full population with adjustment made for sociodemographic characteristics (sex, age, ethnicity, deprivation, and urban or rural profile of residence) were conducted using complete-case, 2-level random intercept logistic multivariable regressions. To assess the association between ORS funding and suspension, analysis was restricted to autistic students. RESULTS: Of the 736 911 students in the study population, 9741 (1.3%) were identified as autistic (median [SD] age, 10 [3.2] years; 7710 [79.1%] boys), and 727 170 (98.7%) as nonautistic (median [SD] age, 10 [3.4] years; 369 777 [50.9%] boys). School suspension was experienced by 504 autistic students (5.2%) and 13 845 nonautistic students (1.9%). After adjustment for demographic characteristics, autistic students had significantly higher odds of suspension than their nonautistic peers (adjusted odds ratio, 2.81; 95% CI, 2.55-3.11). Of the 9741 autistic students, 2895 (29.7%) received high-need education-based (ORS) funding. Suspensions were experienced by 57 autistic students (2.0%) with high-need funding and 447 autistic students (6.5%) without high-need funding. After adjustment for demographic characteristics, co-occurring conditions, and level of disability support need, autistic students with high-need funding had significantly lower odds of suspension than autistic students without high-need funding (adjusted odds ratio, 0.29; 95% CI, 0.21-0.40). CONCLUSIONS AND RELEVANCE: In this cohort study, the findings of disparities in suspension rates between autistic and nonautistic students underscore the challenges faced in providing inclusive education for all young people, regardless of disability status. This study found that high-need funding was associated with reduced suspension rates among autistic students, suggesting that if appropriate supports are afforded to autistic students, a more inclusive education can be provided.

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2. Buchanan CB, Stallworth JL, Joy AE, Dixon RE, Scott AE, Beisang AA, Benke TA, Glaze DG, Haas RH, Heydemann PT, Jones MD, Lane JB, Lieberman DN, Marsh ED, Neul JL, Peters SU, Ryther RC, Skinner SA, Standridge SM, Kaufmann WE, Percy AK. Anxiety-like behavior and anxiolytic treatment in the Rett syndrome natural history study. J Neurodev Disord;2022 (May 14);14(1):31.

BACKGROUND: Rett syndrome (RTT) is a neurodevelopmental disorder most often related to a pathogenic variant in the X-linked MECP2 gene. Internalizing behaviors appear to be common, but standard methods of diagnosing anxiety are not readily applied in this population which typically has cognitive impairment and limited expressive language. This study aims to describe the frequency of anxiety-like behavior and anxiolytic treatments along with associated clinical features in individuals with RTT. METHODS: Parental reports and medication logs provided data from 1380 females with RTT participating in two iterations of the multicenter U.S. RTT Natural History Study (RNHS) from 2006 to 2019. RESULTS: Most participants with RTT (77.5%) had at least occasional anxious or nervous behavior. Anxiety was reported to be the most troublesome concern for 2.6%, and within the top 3 concerns for 10.0%, of participants in the second iteration. Parents directly reported treatment for anxious or nervous behavior in 16.6% of participants in the second iteration with most reporting good control of the behavior (71.6%). In the medication logs of both RNHS iterations, the indication of anxiety was listed for a similar number of participants (15% and 14.5%, respectively). Increased use of anxiolytics and selective serotonin reuptake inhibitors (SSRIs) was related to more frequent anxiety-like behaviors (P < 0.001), older age (P < 0.001), and mild MECP2 variants (P = 0.002). CONCLUSION: Anxiety-like behavior is frequent at all ages and is a significant parental concern in RTT. Older individuals and those with mild MECP2 variants are more likely to be treated with medications. Better diagnosis and treatment of anxiety in RTT should be a goal of both future studies and clinical care. TRIAL REGISTRATION: NCT00299312 and NCT02738281.

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3. Finke EH. The Kind of Friend I Think I Am: Perceptions of Autistic and Non-autistic Young Adults. J Autism Dev Disord;2022 (May 16)

Autistic people have different preferences for friendship than non-autistic people. The aims of the current project were to determine how autistic people prefer to behave in their friendships and how this compares to the friendship practices reported by non-autistic participants. Autistic (n = 102) and non-autistic (n = 107) young adults between the ages of 18 and 24 years completed an online survey comprised of selected questions from the Friendship Questionnaire. Binary logistic regression and multivariate general linear modeling were used to analyze and compare the responses across the groups. Results identified differences in the preferred friendship practices between the participant groups, which may further confirm the Double Empathy Theory and provide a context for understanding the friendship normative practices of autistic people.

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4. Golos A, Ben-Zur H, Chapani SI. Participation in preschool activities of children with autistic spectrum disorder and comparison to typically developing children. Res Dev Disabil;2022 (May 12);127:104252.

BACKGROUND: Participation is essential to children’s development and is a major focus of intervention. This study aimed to describe the participation patterns of children with ASD, in comparison to typically developing (TD) children. METHODS: 70 preschoolers participated: 33 children with ASD, attending non-inclusive-education settings; and 37 TD children, attending mainstream educational settings. Two occupational therapists assessed their participation through structured observations in self-care activities, play, learning, and social participation areas; demographic and environmental questionnaires were also completed. RESULTS: In the ASD group, frequency of participation was found to be significantly higher in ADL and learning than in other areas; level of performance was found to be significantly lower in social participation than in other areas. The TD group scored significantly higher than did the ASD group in most areas and scales. Initial findings tentatively showed that a structured educational environment for children with ASD may increase participation frequency. CONCLUSIONS: The findings are consistent with recognized disabilities in play and social participation among children with ASD, and their limitations in participation, compared to their TD peers in most areas. Further studies are needed to evaluate additional psychometric properties of the different scales, and the impact of educational environments on participation.

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5. Kunihiro N, Tsukamoto M, Taura S, Hitosugi T, Miki Y, Yokoyama T. Sevoflurane concentration for cannulation in developmental disabilities. BMC Anesthesiol;2022 (May 16);22(1):148.

OBJECTIVE: The goal of this study was to compare the end-tidal sevoflurane concentration and time for intravenous cannulation at induction of anesthesia using sevoflurane with or without nitrous oxide in healthy children and in those with developmental disabilities. METHODS: Normal and developmentally disabled children were anesthetized by inhalation of sevoflurane with nitrous oxide or with nitrous oxide-free oxygen, and intravenous cannulae were introduced. Nitrous oxide was stopped after loss of consciousness. The following parameters were recorded for each patient: age, gender, height, weight, BMI, duration of intravenous cannulation, end-tidal concentration of sevoflurane at the completion of intravenous cannulation, and use of nitrous oxide. For each parameter except gender, p-value were calculated by one-way analysis of variance (ANOVA). For gender, p-value were calculated using the Fisher method. Two-way ANOVA was performed to evaluate the effect of patient health status and nitrous oxide use on the end-tidal concentrations of sevoflurane and the time required for intravenous cannulation. RESULTS: The end-tidal sevoflurane concentrations at the completion of the intravenous cannulation had received a significant main effect of the factor « the use of nitrous oxide » (F(1,166) = 25.8, p < 0.001, η(2) = 0.13) and a small effect of the factor "the patient health status" (F(1,166) = 0.259, p = 0.611, η(2) = 0.001). However, the time required for intravenous cannulation was not significantly affected by either of the two factors, "the use of nitrous oxide" (F(1,166) = 0.454, p = 0.501, η(2) = 0.003) and "the patient health status" (F(1,166) = 0.308, p = 0.579, η(2) = 0.002). CONCLUSIONS: Between the healthy children and the children with developmental disabilities, no significant differences in the time required for the intravenous cannulation from the beginning of anesthetic induction. However, the end-tidal sevoflurane concentrations at the completion of the intravenous cannulation was significantly different. Sevoflurane in alveoli might be diluted by nitrous oxide.

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6. Martin V, Flanagan TD, Vogus TJ, Chênevert D. Sustainable employment depends on quality relationships between supervisors and their employees on the autism spectrum. Disabil Rehabil;2022 (May 16):1-12.

PURPOSE: Employment outcomes for individuals on the autism spectrum may be contingent upon employers’ knowledge of autism and provision of appropriate workplace supports. We aimed to understand the organizational factors that influenced the organizational socialization of autistic employees. MATERIALS AND METHODS: We wrote nine case histories based on interviews from managers, autistic employees, and job coaches. Intra-case analysis, then cross-case analysis, provided an understanding of organizational factors that lead to sustained employment of autistic employees. RESULTS: The quality of the relationship between managers and autistic employees was consistently seen as the key facilitator of organizational socialization and positive employment outcomes of autistic employees. These relationships, however, relied on the skilled facilitation of the job coach during each stage of the employment cycle (hiring, on-boarding, training, performance management), as they had an important role in building a mutual understanding between supervisors and employees. As such, our study draws upon and contributes to leader-member exchange theory. CONCLUSIONS: Consistent with prior research, our study shows the importance of high-quality relationships between supervisors and supervisees for positive employment outcomes of autistic employees in organization but adds skilled communication facilitation as a novel antecedent to leader-member exchange, as a potentially key factor for autistic employees. Implications for rehabilitationThe relationship between the a manager and their employee is an important factor in effective organizational socialization and workplace outcomes for autistic employees.Job coaches can play a crucial role in building mutual understanding and high-quality relationships between managers and employees.Job coaches can support the inclusion of autistic employees by illustrating the multi-faceted socioemotional performance benefits over the longer term.

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7. Oike R, Inoue Y, Mitsui J, Ota Y. A case of idiopathic normal pressure hydrocephalus with fragile X-associated tremor/ataxia syndrome. Clin Neurol Neurosurg;2022 (May 4);218:107278.

Clinical management of patients with fragile X-associated tremor/ataxia syndrome (FXTAS) is a challenge, and there has been not an established treatment for FXTAS, which is now treated symptomatically. Diagnosis of coexistent idiopathic normal pressure hydrocephalus (iNPH) with FXTAS is also hard because clinical and imaging features can overlap between the FXTAS patients coexistent with and without iNPH. We present a 79-year-old male genetically diagnosed with FXTAS who was successfully treated by a shunt surgery and consequently diagnosed with iNPH, and suggest the management of coexistent iNPH with FXTAS when it is clinically suspicious.

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