1. Erratum: Bibliometric analysis of research themes and trends in childhood autism spectrum disorders from 2012 to 2021. Frontiers in public health. 2022; 10: 1058389.

[This corrects the article DOI: 10.3389/fpubh.2022.925475.].

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2. Almatrafi M, Al-Sabban Z, Balkhy S, Abumansour IS. Case Report: X-Linked Creatine Transporter Deficiency in Two Saudi Brothers with Autism. Journal of autism and developmental disorders. 2022.

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3. Ashaat EA, Sabry S, Zaki ME, Mohamed R, Abdelsattar HA, Bawady SA, Ashaat NA, Elnaggar W, Ganem MMF, El-Hariri HM, El-Bassyouni HT, Saleh DA. Sialic acid and anti-ganglioside M1 antibodies are invaluable biomarkers correlated with the severity of autism spectrum disorder. Brain & development. 2022.

BACKGROUND: Autism spectrum disorders (ASD) are devastating neurodevelopmental disorders that showed global increased prevalence. They are characterized by impairment of social communication and stereotyped patterns. OBJECTIVE: This study aimed at measuring the levels of total sialic acid (SA) and anti-ganglioside M1 (anti- GM1) IgG antibodies as essential biomarkers in a cohort of children with ASD to identify their diagnostic yield as well as their correlation with the severity of autistic behaviors. METHODS: The demographic characteristics, anthropometric measurements, and clinical data were recorded. The levels of total plasma SA and serum anti-GM1 IgG antibodies levels were measured in 100 children with ASD and 100 healthy controls. The severity of ASD-related symptoms was assessed by using the Childhood Autism Rating Scale (CARS). RESULTS: Children with ASD had significantly higher levels of both SA and anti-GM1 antibodies than healthy controls (p < 0.001). SA showed a statistically significant moderate diagnostic performance while anti-GM1 antibody showed a statistically significant high diagnostic in differentiating severe from mild to moderate autism. Moreover, both SA and anti-GM1 antibodies levels were significantly correlated to the severity of ASD symptoms (p < 0.001). CONCLUSION: The significantly increased levels of SA and anti-GM1 antibodies in children with ASD and their correlation with autism-related symptoms suggest their possible etiopathogenic role in autism as one of the pediatric autoimmune neuropsychiatric disorders. However, further large-scale studies are still needed to explore their possible bidirectional relationship as biomarkers for autism.

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4. Boxhoorn S, Schütz M, Mühlherr AM, Mössinger H, Luckhardt C, Freitag CM. The effect of perceptual expectation on processing gain, attention and the perceptual decision bias in children and adolescents with Autism Spectrum Disorder (ASD). Scientific reports. 2022; 12(1): 21688.

Perceptual expectations influence perception, attention and the perceptual decision bias during visuospatial orienting, which is impaired in individuals with Autism Spectrum Disorder (ASD). In this study, we investigated whether during visuospatial orienting, perceptual expectations in ASD differentially influence perception, attention and the perceptual decision bias relative to neurotypical controls (NT). Twenty-three children and adolescents with ASD and 23 NT completed a visuospatial orienting task, which compared the effect of a valid relative to an invalid perceptual expectation on target detection (cue validity effect). Group differences were calculated regarding the cue validity effect on neural correlates of processing gain (N1a amplitude) and attention (N1pc amplitude), the perceptual decision bias and mean reaction time (RT). In ASD relative to NT, findings showed a reduced processing gain for validly relative to invalidly cued targets and increased attentional response following invalidly relative to validly cued targets. Increased attention correlated with faster performance across groups. Increased processing correlated with a higher perceptual decision bias and faster mean RT in NT, but not in ASD. Results suggest that during visuospatial orienting, perceptual expectations in ASD may drive changes in sensory processing and stimulus-driven attention, which may differentially guide behavioural responses.

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5. Burnham Riosa P, Ensor R, Jichici B, Davy B. How my life is unique: Sibling perspectives of autism. Autism : the international journal of research and practice. 2022: 13623613221142385.

The impact of autism on the family is an important area of study. Much of the existing literature has focused on the parent perspective, with less emphasis on the experiences of other family members, especially non-autistic siblings. This study aimed to explore the lived experiences of a sample of nine 8- to 17-year-old non-autistic siblings of children and youth on the autism spectrum. We interviewed non-autistic siblings and analysed the written transcripts. Our results revealed the following themes: (1) Role disparities, different expectations; (2) Connection and disconnection; and (3) Our family is (extra)ordinary. Our study findings highlight siblings’ unique and collective perspectives regarding their brother or sister on the spectrum within the broader family unit. We discuss the implications of these results on siblings of autistic children and youth.

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6. Castillo J, Thibadeau JK, Brei T, Castillo H. From autism to zoom®: Spina bifida advocacy, care, education, and research in a changing word. Journal of pediatric rehabilitation medicine. 2022.

Whereas legislation mandates for folic acid fortification have been implemented throughout many nations, divergent neural tube defects (NTDs) prevalence rates still remain among the world’s populations. In North America, the prevalence estimate is 39 infants per 100,000 live births. Open spina bifida (SB), also known as myelomeningocele, remains the most complex congenital abnormality of the central nervous system compatible with long term survival; this recognized complexity gives rise to emerging comorbidities and interventions. For example, increasing autism spectrum disorder rates have been reported among individuals with SB utilizing a 31,220 subject population-based birth cohort. Along with new clinical observations, telecommunication platforms such as Zoom ® have evolved as clinical and investigational tools. Historically, society meetings, research conferences, and journals have provided opportunities for professional development and dissemination of up-to-date materials. The Journal of Pediatric Rehabilitation Medicine (JPRM) has arisen as an open-access global platform for the dissemination of SB-related inquiry. The journal has also highlighted the research presented at the Spina Bifida Association’s previous Spina Bifida World Congresses. At the last congress, which was held in 2017, twenty-three countries were represented; this number is expected to grow by the next convocation in 2023. This congress will provide an opportunity for health care professionals from around the globe to present a broad array of research topics and build collaborations. Concurrently, the JPRM will continue as an open-access platform for SB advocacy, care, education, and investigation, across our fast changing world for the international SB community well into the future.

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7. Chen X, Peng M, Cai Y, Zhou C, Liu L. Human iPSC-derived neural stem cells with ALDH5A1 mutation as a model of succinic semialdehyde dehydrogenase deficiency. BMC neuroscience. 2022; 23(1): 77.

BACKGROUND: Succinic semialdehyde dehydrogenase deficiency (SSADH-D) is an autosomal recessive gamma-aminobutyric acid (GABA) metabolism disorder that can arise due to ALDH5A1 mutations, resulting in severe, progressive, untreatable neurodegeneration. SSADH-D is primarily studied using simplified models, such as HEK293 cells overexpressing genes of interest, but such overexpression can result in protein aggregation or pathway saturation that may not be representative of actual underlying disease phenotypes. METHODS: We used a CRISPR/Cas9 approach to generate human iPSC cell lines bearing ALDH5A1 mutations. Through screening, two different mutant cell lines, NM_001080.3: c.727_735del (p.L243_S245del) and NM_001080.3: c.730_738del (p.A244_Q246del), were obtained. We induced iPSCs to neural stem cells and analyzed the characteristics of ALDH5A1 mutations in stem cells. RESULTS: The human iPSC and NSC cell lines presented typical stem cell-like morphology. We found changes in ALDH5A1 expression and GABA accumulation in the different cell lines. In addition, by analyzing the cDNA between the wild-type and the mutant cell lines, we found that the mutant cell lines had a splicing variant. CONCLUSIONS: iPSCs represent a promising in vitro model for SSADH-D that can be used to study early central nervous system developmental alterations and pathogenic mechanisms.

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8. Dai YG, Thomas RP, Brennan L, Luu ML, Hughes-Lika J, Reilly M, Moreno P, Obe B, Ahmed KB, Berry LN, Goin-Kochel RP, Helt MS, Barton ML, Dumont-Mathieu T, Robins DL, Fein DA. An initial trial of OPT-In-Early: An online training program for caregivers of autistic children. Autism : the international journal of research and practice. 2022: 13623613221142408.

Early intervention can help children learn language and improve social communication. However, many barriers, including the expense of services and an insufficient number of providers, prohibit families from accessing services when their children are young. We developed a comprehensive online program for caregivers of autistic children. The program, Online Parent Training in Early Behavioral Intervention (OPT-In-Early), uses text and video demonstrations to teach caregivers effective methods for improving their children’s language, social, and adaptive skills (e.g. using utensils, toilet training), and reducing their children’s disruptive behavior. Sixty-three parents from three states participated in the study. Half of the parents received access to the OPT-In-Early program. After 4 months, parents who had access to the OPT-In-Early program learned more effective intervention strategies, and started using these strategies during interactions with their children, than parents who did not receive access to the program. Parent participation in OPT-In-Early did not significantly influence children’s social communication compared to children whose parents did not have access to OPT-In-Early. A longer duration of parents using learned intervention skills with their children may be needed for children’s social communication skills to improve.

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9. Dellapiazza F, Michelon C, Rattaz C, Picot MC, Baghdadli A. Sex-related differences in clinical characteristics of children with ASD without ID: Results from the ELENA cohort. Frontiers in psychiatry. 2022; 13: 998195.

OBJECTIVE: The literature on sex related-clinical differences for children with autism spectrum disorder (ASD) is highly contradictory, whereas this topic has major clinical implications. We aimed to investigate sex-related clinical differences in children with ASD without intellectual disability (ID). MATERIALS AND METHODS: We compared 319 boys and 65 girls with ASD without ID, aged from 2 to 12 years, recruited from a multiregional cohort on their clinical profiles based on the scores for the Vineland-II, the SRS-2, the ADOS calibrated severity score, sensory processing, aberrant behaviors, and comorbidity rates. RESULTS: Our results confirm a high sex ratio of 4.9 males/females. Many similarities were found in the clinical profiles. However, we found that girls had higher SRS-2 total scores. In addition, there was a negative correlation between the SRS-2 total score and the intellectual quotient level (IQ) for girls only. CONCLUSION: We confirm the higher rates of boys with ASD without ID. A comparison between the girls and boys showed them to have similar clinical profiles, except for the SRS- 2 total scores, which were higher among girls, suggesting more severe social impairment perceived by parents. Our findings that the cognitive level is related to ASD severity in girls should be taken into account during the diagnostic procedure in the clinical interpretation of gold-standard measures of ASD, and additional clinical observations are necessary. CLINICAL TRIAL REGISTRATION: [ClinicalTrials.gov], identifier [NCT02625116s].

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10. Ferreira JP, Matos R, Campos MJ, Monteiro D, Antunes R, Jacinto M. Effects of Physical Exercise Program in Adults with Intellectual and Developmental Disabilities-A Study Protocol. Journal of clinical medicine. 2022; 11(24).

We developed a physical exercise (PE) program for people with Intellectual and Developmental Disabilities (IDD), aiming to determine the effects on physical fitness, health, cognitive ability, and quality of life (QoL). Using experimental methodology, this intervention study recruited 21 adults (18 to 65 years old), institutionalized and with no other associated pathology, who will be allocated to one of the different groups: (i) gym/indoor intervention group (using weight machines), (ii) outdoor intervention group (using low-cost materials), or (iii) control group (without specific intervention, who continue with their normal daily activities). Both intervention groups will engage in 45 min of training per session, twice a week, for 24 weeks. Assessments will be conducted at baseline (initial assessment), 3 months (mid-term assessment), and 6 months (final assessment). Variables assessed include anthropometrics, body composition, functional capacity, muscle strength, general health, cognitive ability, and QoL. The results of this study will assist in the development of more effective strategies, recommendations, and interventions to ensure better and greater adherence to PE by institutionalized individuals with IDD, namely, recommendations for assessment, prescription, and implementation of PE for this population. Additionally, we intend to make available two PE programs, if they are adapted and promote positive effects.

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11. Forbes G, Kent R, Charman T, Baird G, Pickles A, Simonoff E. How do autistic people fare in adult life and can we predict it from childhood?. Autism research : official journal of the International Society for Autism Research. 2022.

This study describes social, mental health, and quality of life outcomes in early adulthood, and examines childhood predictors in the Special Needs and Autism Project (SNAP), a longitudinal population-based cohort. Young autistic adults face variable but often substantial challenges across many areas of life. Prediction of outcomes is important to set expectations and could lead to the development of targeted early intervention. Autistic children were enrolled at age 12 and parents reported outcomes 11 years later when their children were age 23 (n = 121). Thirty six percent of autistic adults were in competitive employment or education and 54% had frequent contact with friends. Only 5% of autistic adults were living independently, and 37% required overnight care. Moderate or severe anxiety and depression symptoms were found for 11% and 12% of young adults, respectively. Subjective quality of life was similar to UK averages except for social relationships. Using childhood IQ, autism traits and adaptive functioning meaningful predictions can be made of living situation, employment and education and physical health. Prediction was poor for friendships, mental health outcomes and other aspects of quality of life. Our results suggest that although young autistic adults face challenges across normative, social outcomes, they may be faring better in regard to mental health or quality of life. Childhood IQ, autism traits and adaptive functioning are most useful for predicting outcomes. After accounting for these factors, childhood measurements of behavioral and emotional problems and language offered little improvement in prediction of adult outcomes.

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12. Fu C, Ngo J, Zhang S, Lu L, Miron A, Schafer S, Gage FH, Jin F, Schumacher FR, Wynshaw-Boris A. Novel correlative analysis identifies multiple genomic variations impacting ASD with macrocephaly. Human molecular genetics. 2022.

Autism spectrum disorders (ASD) display both phenotypic and genetic heterogeneity, impeding the understanding of ASD and development of effective means of diagnosis and potential treatments. Genes affected by genomic variations for ASD converge in dozens of gene ontologies (GOs), but the relationship between the variations at the GO level have not been well elucidated. In the current study, multiple types of genomic variations were mapped to GOs and correlations among GOs were measured in ASD and control samples. Several ASD-unique GO correlations were found, suggesting the importance of co-occurrence of genomic variations in genes from different functional categories in ASD etiology. Combined with experimental data, several variations related to WNT signaling, neuron development, synapse morphology/function and organ morphogenesis were found to be important for ASD with macrocephaly, and novel co-occurrence patterns of them in ASD patients were found. Further, we applied this gene ontology correlation analysis method to find genomic variations that contribute to ASD etiology in combination with changes in gene expression and transcription factor binding, providing novel insights into ASD with macrocephaly and a new methodology for the analysis of genomic variation.

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13. Gawrys BL, Trang DT. Music Therapy for Autistic People. American family physician. 2022; 106(6): 622a-b.

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14. Groenendijk ER, Van Heijst B, Geurts HM. Short report: A co-designed psychoeducation for older autistic adults-a multiple case study. Autism : the international journal of research and practice. 2022: 13623613221138691.

After receiving an autism diagnosis by a clinician, psychoeducation (i.e. information regarding autism) is often offered. However, older autistic adults (55+ years) may need specific information about the challenges they face in daily life as they are in a specific life phase. A psychoeducation program for this specific age group does not exist yet. We first developed such a program together with autistic adults and clinicians working with autistic people, after which we tested the program with nine autistic adults (56-73 years) and someone close to them (so-called proxy). Before testing the program, we determined together with autistic older adults what they thought should be the outcome of this intervention in order to state whether it was, indeed, a useful intervention. Earlier studies found that autistic people often think differently about their own autistic characteristics than their proxy. A reduction of this difference could increase mutual understanding. Therefore, the main hypothesis was that the program would decrease this difference with respect to autistic characteristics and cognitive challenges (e.g. memory problems). Another hypothesis was that the program would have a positive impact on a series of other factors, such as self-esteem. The results showed that the program did neither decrease the difference in insight nor the other tested factors. Nonetheless, we believe it is important to keep on working on a psychoeducation program for older autistic adults, because participants informed us the program had still helped them in certain ways and they gave helpful feedback for improvements of the program.

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15. Guo X, Tang P, Hou C, Li R. Mendelian randomization investigation highlights different roles of selenium status in mental disorders. Progress in neuro-psychopharmacology & biological psychiatry. 2023; 122: 110694.

Observational studies have suggested a relationship between selenium status and mental disorders (MDs). However, it remains unclear whether selenium status was causally associated with MDs. Thus, we performed a two-sample Mendelian randomization analysis using genome-wide association studies (GWAS) summary statistics to investigate the causal effects of selenium levels on seven MDs, including schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), bipolar disorder (BD), anorexia nervosa (AN), attention-deficit/hyperactivity disorder (ADHD), and panic disorder (PD). Strong genetic instruments of blood selenium (n = 9) and blood-toenail selenium (n = 12) were applied to the above seven MDs GWAS datasets from Psychiatric Genomics Consortium, which were further replicated in the FinnGen Biobank. The inverse-variance weighted method was employed to calculate the causal effects. The results showed that genetically predicted blood selenium levels were associated with a decreased risk of schizophrenia (odds ratio [OR] = 0.90, 95% CI: 0.87-0.95) and AN (OR = 0.87, 95% CI: 0.77-0.97). However, both blood and blood-toenail selenium levels were linked to an increased risk of MDD (blood: OR = 1.08, 95% CI: 1.05-1.12; blood-toenail: OR = 1.08, 95% CI: 1.04-1.13) and ASD (blood: OR = 1.11, 95% CI: 1.05-1.17; blood-toenail: OR = 1.13, 95% CI: 1.05-1.21), respectively. No obvious associations were found between selenium levels and BD as well as ADHD. Our findings highlighted a protective role of selenium in SZ and AN, while a risk effect in MDD and ASD. Further studies are required to verify the underlying mechanism mediating the unequal effects of Se on different MDs, which will pave a new path for the intervention of MDs.

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16. Higuchi Y, Tachigori SI, Arakawa H. Faded neural projection from the posterior bed nucleus of the stria terminalis to the lateral habenula contributes to social signaling deficit in male BTBR mice as a mouse model of autism. Psychoneuroendocrinology. 2022; 149: 106004.

BTBR T(+) Itpr3(tf)/J (BTBR) mice display several behavioral characteristics, including social deficits resembling the core symptoms of human autism. Atypical social behaviors include sequential processes of assembled cognitive-behavior components, such as recognition, investigatory assessment, and signaling response. This study aimed to elucidate the neural circuits responsible for the regulation of the social signaling response, as shown by scent marking behavior in male mice. We first assessed the recognition and investigatory patterns of male BTBR mice compared to those of C57BL/6 J (B6) mice. Next, we examined their scent-marking behavior as innate social signaling responses adjusted to a confronted feature of social stimuli and situations, along with the expression of c-Fos as a marker of neuronal activity in selected brain areas involved in the regulation of social behavior. The function of the targeted brain area was confirmed by chemogenetic manipulation. We also examined the social peptides, oxytocin and vasopressin neurons of the major brain regions that are associated with the regulation of social behavior. Our data indicate that male BTBR mice are less responsive to the presentation of social stimuli and the expression of social signaling responses, which is paralleled by blunted c-Fos responsivity and vasopressin neurons morphological changes in selected brain areas, including the posterior bed nucleus of the stria terminalis (pBnST) and lateral habenula (LHb) in BTBR mice. Further investigation of LHb function revealed that chemogenetic inhibition and activation of LHb activity can induce a change in scent marking responses in both B6 and BTBR mice. Our elucidation of the downstream LHb circuits controlling scent marking behavior indicates intact function in BTBR mice. The altered morphological characteristics of oxytocin neurons in the paraventricular nucleus of the hypothalamus and vasopressin-positive neurons and axonal projections in the pBnST and LHb appear to underlie the dysfunction of scent marking responses in BTBR mice. (300/300 words).

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17. Itoi C, Ujiie Y, Matsushima K, Takahashi K, Ide M. Validation of the Japanese version of the Interoception Sensory Questionnaire for individuals with autism spectrum disorder. Scientific reports. 2022; 12(1): 21722.

The Interoception Sensory Questionnaire (ISQ) is a self-report instrument used to assess the characteristics of interoceptive processing in individuals with autism spectrum disorder (ASD). Previous studies have shown that scores of the ISQ are more appropriate than other subjective measures for evaluating difficulties in interoceptive processing in individuals with ASD. Yet, no prior research has demonstrated the validation of the ISQ in Japanese samples. This study attempted to validate the Japanese version of the ISQ (ISQ-J) by examining its psychometric properties. We confirmed the score distribution, internal consistency, and factor structure in Japanese samples. We also examined the relationships with other interoceptive questionnaires. In addition, we compared the scores of the ISQ-J between adolescents and adults with ASD participants and control participants. Results of confirmatory factor analyses showed that the reliability of the ISQ-J in adults with ASD reached an acceptable level of a one-factor structure with excellent internal consistency (α = 0.963). The result of the ISQ-J showed a significant positive correlation with the measure of awareness of interoceptive sensitivity for localized bodily states; on the other hand, a significant negative correlation was found with those integrated bodily states. In addition, the ISQ-J scores were significantly higher in the ASD group than in the control group. The current findings depend on self-report data (including a diagnosis of ASD) to measure validity constructs. Additionally, since the ISQ-J was surveyed in adults with ASD, it is unclear whether similar the results would be obtained if the ISQ-J were conducted with children. These results indicate the validity and reliability of the ISQ-J and provide a tool for assessing confusion of interoceptive information in Japanese adults with ASD.

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18. Ke F, Moon J, Sokolikj Z. Designing and deploying a virtual social sandbox for autistic children. Disability and rehabilitation Assistive technology. 2022: 1-32.

PURPOSE: This exploratory study was intended to investigate the design and feasibility of using a web virtual reality based social learning space for autistic children at home. MATERIALS AND METHODS: The researchers of the current study developed and implemented an open-source, web virtual reality based learning program for children with autism. Endorsing mixed-method convergent parallel design, we collected both qualitative and quantitative data from four autistic children, including repeated measures of social skills performance, self- and parent-reported social and communication competence, observation notes, and individual interviews. RESULTS: The study found preliminary evidence for a positive impact of deploying a virtual reality-based social sandbox on the practice and development of complex social skills for autistic children. All participants showed significant reduced social communication impairments from the pre- to the post-intervention phases. Nevertheless, participants’ social skills performance in the virtual world was mediated by two social task design features-external goal structure and individualization. CONCLUSIONS: Play- and design-oriented social tasks in the three-dimensional virtual world framed meaningful social experiences or the naturalistic intervention for social skills development.IMPLICATIONS FOR REHABILITATIONPositive impacts of using a virtual reality-based social sandbox on complex social skills development for autistic children.Social task design features mediate social skills performance of autistic children.Purposeful environment arrangement creates a naturalistic intervention for autism.

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19. Kim SY, Cheon JE, Gillespie-Lynch K, Grandits J, Kim YH. Explicit stigma and implicit biases toward autism in South Korea versus the United States. Autism : the international journal of research and practice. 2022: 13623613221140695.

How people report their feelings about autism may be different from how they actually think about autism because some people may not want to reveal their true feelings. People who value the group’s goal tend to present themselves as more socially acceptable than people who value one person’s interests. We studied how people in South Korea and the United States report their feelings about autism and think about autism. Koreans tend to value the group’s goals. Americans tend to prefer one person’s goals. Koreans reported that they wanted more space from autistic people than Americans did. Koreans were more likely to think about autism with negative words (and think more negatively about autism). How Koreans and Americans report their feelings about autism was not related to their thoughts about autism. People who knew about autism and liked meeting with autistic people wanted to get closer to autistic people in South Korea and the US, Koreans who had met autistic people and thought that people who newly came to Korea from abroad should be more like Koreans did not want to get very close to autistic people. This could be because very few foreign people live in South Korea compared to the United States. Teaching Koreans that all cultures have values and should be appreciated will help them like autistic people more.

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20. Lacoste S. [Changes in child and adolescent psychiatric care with respect to autism spectrum disorders]. Soins Psychiatrie. 2022; 43(342): 22-6.

The evaluation unit for pervasive developmental disorders and autism – diagnostic center of Seine-et-Marne « United » has been open for eleven years within the child and adolescent psychiatry department. At the beginning, it welcomed patients as a first intention, or not, at a time when the diagnosis verbalized to the families was not self-evident. It has gradually taken on the role of an evaluation center for complex situations, pushed in this by the political authorities who are trying to structure (to change) the life course of people with autism. The Canadian « SACCADE » model opens up avenues of reflection on the understanding of autism, thus reexamining the place of the caregiver in child psychiatry.

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21. Markfeld JE, Feldman JI, Bordman SL, Daly C, Santapuram P, Humphreys KL, Keçeli-Kaysılı B, Woynaroski TG. Associations Between Caregiver Stress and Language Outcomes in Infants With Autistic and Non-Autistic Siblings: An Exploratory Study. Journal of speech, language, and hearing research : JSLHR. 2022: 1-16.

PURPOSE: Caregivers of autistic children present with high stress levels, which have been associated with poorer child outcomes in several domains, including language development. However, prior to this study, it was unknown whether elevated caregiver stress was associated with language development in infant siblings of autistic children (Sibs-autism), who are at increased likelihood of receiving a future diagnosis of autism and/or language impairment compared to infant siblings of non-autistic children. This study explored the degree to which, as well as the mechanisms by which, caregiver stress was linked with later language outcomes of Sibs-autism and infant siblings of non-autistic children (Sibs-NA). METHOD: Participants were 50 infants (28 Sibs-autism; 22 Sibs-NA) aged 12-18 months at the first time point in this study (Time 1). Infants were seen again 9 months later, at 21-27 months of age (Time 2). Caregiver stress was measured via a validated self-report measure at Time 1. Caregiver language input, the putative mechanism by which caregiver stress may influence later language outcomes, was collected via two daylong recordings from digital recording (Language ENvironment Analysis) devices worn by the child at this same time point. Child language outcomes were measured via standardized and caregiver report measures at Time 2. RESULTS: Several models testing hypothesized indirect effects of caregiver stress on later child language outcomes through caregiver language input were statistically significant. Specifically, significant indirect effects suggest that (a) caregivers with increased stress tend to speak less to their infants, and (b) this reduced language input tends to covary with reduced child language outcomes later in life for Sibs-autism and Sibs-NA. CONCLUSIONS: This study provides new insights into links between caregiver stress, caregiver language input, and language outcomes in Sibs-autism and Sibs-NA. Further work is necessary to understand how to best support caregivers and optimize the language learning environments for infants. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21714368.

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22. McNally Keehn R, Enneking B, Ryan T, James C, Tang Q, Blewitt A, Tomlin A, Corona L, Wagner L. Tele-assessment of young children referred for autism spectrum disorder evaluation during COVID-19: Associations among clinical characteristics and diagnostic outcome. Autism : the international journal of research and practice. 2022: 13623613221138642.

The diagnosis of autism spectrum disorder (ASD) has traditionally been made through in-person evaluation. While the COVID-19 pandemic disrupted access to ASD services, there has been remarkable growth in research focused on novel ASD diagnostic practices, including the use of telemedicine. We implemented a standard ASD tele-assessment evaluation procedure, including use of a novel remote clinician-coached, caregiver-delivered ASD assessment tool (TELE-ASD-PEDS; TAP), with the goal of continuing to provide diagnostic services to young children and their families during the pandemic. We examined the relationship between child characteristics and diagnostic outcome for 335 children, ages 14-78 months, who received ASD tele-assessment conducted by psychologists and pediatricians in an outpatient clinic of a Midwestern academic medical center. We found that clinicians could make a determination about ASD diagnosis for most children (85%) evaluated using tele-assessment. Child clinical characteristics, including TAP scores and clinician ratings of ASD symptoms, were related to diagnostic outcome (i.e. diagnosis of ASD, no ASD, and Unsure about ASD). When all clinical characteristics were examined together, the presence of specific repetitive behaviors predicted ASD diagnosis. We also found that the TAP is effective for making an ASD diagnosis when used as part of comprehensive tele-assessment evaluation in children ⩾ 36 months of age with delayed language. Our study adds to an increasing body of research supporting use of tele-assessment for diagnosis of ASD. Although further research is needed, telemedicine may help families from different backgrounds and geographic locations to access high-quality diagnostic services.

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23. Ozsivadjian A, Milner V, Pickard H, Hollock MJ, Gaigg SB, Colvert E, Happé F, Magiati I. Autistic and non-autistic young people’s and caregivers’ perspectives on COVID-19-related schooling changes and their impact on emotional well-being: An opportunity for change?. Autism : the international journal of research and practice. 2022: 13623613221140759.

Autistic young people experience poorer mental health and well-being compared to their non-autistic peers. Navigating the complex social, academic, procedural and sensory aspects of school may be particularly challenging for autistic young people and contribute to poorer mental well-being. The COVID-19 pandemic caused unprecedented school changes and provided a unique opportunity to gather caregiver’s and young people’s perspectives on the impact of school and pandemic-related school changes on the well-being of both autistic and non-autistic young people. We asked for the views of caregivers and young people aged 11-18 years gathered across three timepoints between May and December 2020. Their responses revealed both benefits and challenges associated with school changes. Insights into possible lessons from the pandemic and recommendations for more flexible, individualised and strengths-based educational practices are discussed.

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24. Perkovich E, Sun L, Mire S, Laakman A, Sakhuja U, Yoshida H. What children with and without ASD see: Similar visual experiences with different pathways through parental attention strategies. Autism & developmental language impairments. 2022; 7: 23969415221137293.

BACKGROUND AND AIMS: Although young children’s gaze behaviors in experimental task contexts have been shown to be potential biobehavioral markers relevant to autism spectrum disorder (ASD), we know little about their everyday gaze behaviors. The present study aims (1) to document early gaze behaviors that occur within a live, social interactive context among children with and without ASD and their parents, and (2) to examine how children’s and parents’ gaze behaviors are related for ASD and typically developing (TD) groups. A head-mounted eye-tracking system was used to record the frequency and duration of a set of gaze behaviors (such as sustained attention [SA] and joint attention [JA]) that are relevant to early cognitive and language development. METHODS: Twenty-six parent-child dyads (ASD group = 13, TD group = 13) participated. Children were between the ages of 3 and 8 years old. We placed head-mounted eye trackers on parents and children to record their parent- and child-centered views, and we also recorded their interactive parent-child object play scene from both a wall- and ceiling-mounted camera. We then annotated the frequency and duration of gaze behaviors (saccades, fixation, SA, and JA) for different regions of interest (object, face, and hands), and attention shifting. Independent group t-tests and ANOVAs were used to observe group comparisons, and linear regression was used to test the predictiveness of parent gaze behaviors for JA. RESULTS: The present study found no differences in visual experiences between children with and without ASD. Interestingly, however, significant group differences were found for parent gaze behaviors. Compared to parents of ASD children, parents of TD children focused on objects and shifted their attention between objects and their children’s faces more. In contrast, parents of ASD children were more likely to shift their attention between their own hands and their children. JA experiences were also predicted differently, depending on the group: among parents of TD children, attention to objects predicted JA, but among parents of ASD children, attention to their children predicted JA. CONCLUSION: Although no differences were found between gaze behaviors of autistic and TD children in this study, there were significant group differences in parents’ looking behaviors. This suggests potentially differential pathways for the scaffolding effect of parental gaze for ASD children compared with TD children. IMPLICATIONS: The present study revealed the impact of everyday life, social interactive context on early visual experiences, and point to potentially different pathways by which parental looking behaviors guide the looking behaviors of children with and without ASD. Identifying parental social input relevant to early attention development (e.g., JA) among autistic children has implications for mechanisms that could support socially mediated attention behaviors that have been documented to facilitate early cognitive and language development and implications for the development of parent-mediated interventions for young children with or at risk for ASD.Note: This paper uses a combination of person-first and identity-first language, an intentional decision aligning with comments put forth by Vivanti (Vivanti, 2020), recognizing the complexities of known and unknown preferences of those in the larger autism community.

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25. Pillai J, Dunn K, Efron D. Parent-reported factors associated with the emergency department presentation of children and adolescents with autism spectrum disorder and/or intellectual disability with behaviours of concern: a qualitative study. Archives of disease in childhood. 2022.

OBJECTIVE: We aimed to examine the parent-reported factors contributing to the emergency department (ED) presentation of children and adolescents with autism spectrum disorder (autism) and/or intellectual disability (ID) with behaviours of concern (BOC). DESIGN: Qualitative study using semistructured interviews. Data were analysed phenomenologically using inductive thematic analysis. SETTING: The ED of the Royal Children’s Hospital, Melbourne, Australia, a tertiary paediatric hospital. PARTICIPANTS: 14 parents and/or carers of children and adolescents with autism and/or ID who presented to ED for management of BOC. RESULTS: Three themes emerged from the data: (1) Parents and carers had difficulties navigating the healthcare system and accessing appropriate community supports prior to their child’s ED presentation; (2) Families presented to ED due to an inability to manage risk and/or contain their child’s behaviour, compounded by carer burn-out; (3) Presentation to ED was considered a last resort option for many families. The ED was generally unable to assist families in the ongoing management of their child’s BOC, leading to a potential need to re-present in future. CONCLUSIONS: This study highlights the need for families of children with autism and ID and associated BOC to have improved access to appropriately skilled community health professionals, allowing their BOC to be addressed as they emerge rather than at crisis point. The findings additionally highlight the need for changes to the delivery of acute care in the management of BOC, to minimise patient distress and maximise safe and satisfactory patient outcomes.

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26. Roberts MY, Stern YS, Grauzer J, Nietfeld J, Thompson S, Jones M, Kaat AJ, Kaiser AP. Teaching Caregivers to Support Social Communication: Results From a Randomized Clinical Trial of Autistic Toddlers. American journal of speech-language pathology. 2022: 1-13.

BACKGROUND: Studies of early caregiver-mediated interventions targeting social communication of young autistic children have yielded variable child outcomes. This study examined the effects of combining two caregiver-mediated interventions on caregiver strategy use and child social communication and language outcomes. METHOD: This was a multisite parallel randomized controlled trial. Participants included 120 caregivers and their autistic children between 24 and 36 months of age. Dyads were randomly assigned to receive a hybrid intervention that combined Enhanced Milieu Teaching (EMT) and Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER) or to a behavior management control condition, each delivered over 6 months. Caregivers in the JASP-EMT group received twice-weekly, in-home, and hour-long sessions. Outcomes were measured at baseline, the end of intervention (T1), and 6 months later (T2) and included a naturalistic language sample procedure, standardized measures, and caregiver report measures. This trial was registered at clinicaltrials.gov (NCT02595697). RESULTS: Child outcomes did not differ between conditions at T1 or T2 for child primary (social communication) or secondary (language, play, and autism symptoms) outcomes. Relative to control group caregivers, intervention group caregivers demonstrated significantly higher use of JASP-EMT strategies at T1 and T2, with the exception of two strategies (Responsiveness and Matched Responsiveness), which were used significantly more by control group caregivers. Neither autism severity nor baseline caregiver responsiveness moderated outcomes. Post hoc analyses revealed significant correlations between specific strategies and all child outcomes. CONCLUSIONS: Twice-weekly caregiver-mediated intervention that taught caregivers of autistic children to use social communication support strategies did not yield significant child outcomes. Future studies should examine possible sources for the lack of main effects including unexpected differences in linguistic features of caregiver input, changes in control group caregiver behavior, and insufficient intervention dosage. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21714278.

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27. Vuijk R, Deen M, Geurts HM, Arntz A. Schema Therapy for personality disorders in autistic adults: Results of a multiple case series study. Clinical psychology & psychotherapy. 2022.

BACKGROUND: To our knowledge, treatment of personality disorder (PD) comorbidity in autistic adults is understudied, and is still in its infancy. We investigated the effectiveness of Schema Therapy (ST) for autistic adults with personality disorder (PD). METHOD: A multiple case series design with 12 adults (aged 19-62 years) was used with baseline, exploration, ST (with cognitive behavioural and experiential techniques), and follow-up conditions. Participants rated dysfunctional core beliefs (primary outcome) weekly during baseline and treatment, and monthly during follow-up. Schema modes, general mental health symptoms, social responsiveness, PD-traits, and common Axis-I mental disorders were assessed. RESULTS: Mixed model analyses indicated significant effects of ST with medium to large effect sizes for dysfunctional core beliefs, functional schema modes, PD-traits, general mental health symptoms, and social responsiveness. Results remained stable during follow-up. CONCLUSION: The results of this study indicate that ST might be effective in decreasing dysfunctional core beliefs, PD traits, general mental health symptoms, and increasing functional schema modes and social responsiveness. Improvements persisted over time. ST seems effective in treating PD in autistic individuals.

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28. Wang J, Xu C, Liu C, Zhou Q, Chao G, Jin Y. Effects of different doses of lithium on the central nervous system in the rat valproic acid model of autism. Chemico-biological interactions. 2022; 370: 110314.

Epidemiological studies have shown that low doses of lithium in the environment can have beneficial effects on mental health. Autism spectrum disorder, a neurodevelopmental disorder in which patients exhibit abnormal behaviors, pharmacological interventions usually relied on a range of psychotropic medications. However, such medications often produce severe side effects or are ineffective in symptoms. Finding alternative ways to improve abnormal behaviors in individuals with autism are warranted, in which case lithium may be a relatively safe and effective medication. Lithium salt therapy is used to treat a variety of neuropsychiatric disorders and has neuroprotective effects. In this study, we investigated the effects of different doses of lithium on neurobehavioural disorders using the rat model of autism established by valproic acid (VPA) injection. Lithium was observed to have an ameliorative effect on the social cognitive, social memory and anxiety levels in the rat model of autism. Immunofluorescence staining showed that subchronic LiCl administration (1.0 mmol/kg) significantly reduced the number of Iba-1 positive cells in the CA1 region of the hippocampus in VPA group and brought it close to the levels of control group. Significantly lower levels of the pro-inflammatory marker IL-6 were observed in the hippocampus and serum after lithium treatment. In addition, the lithium treatment increased the levels of H3K9 acetylation in the hippocampus of VPA-exposed rats. The results showed a defensive effect of environment-related lithium exposure doses on neurobehavioural deficits in the rat valproic acid model of autism, suggesting that it may be a potential drug for the treatment of autism.

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29. Widatalla N, Khandoker A, Yoshida C, Nakanishi K, Fukase M, Suzuki A, Saito M, Kimura Y, Kasahara Y. Correlation between maternal and fetal heart rate increases with fetal mouse age in typical development and is disturbed in autism mouse model treated with valproic acid. Frontiers in psychiatry. 2022; 13: 998695.

INTRODUCTION: Autism spectrum disorder (ASD) is considered a significant behavioral problem that is characterized by impairment in social interaction and communication. It is believed that some cases of ASD originate in the intrauterine maternal environment. Therefore, we hypothesized that there might be qualitative changes in the interaction between the mother and fetus in ASD during the prenatal period, hence, we investigated the similarity patterns between maternal and fetal heart rate (HR). METHODS: In this study, we first demonstrate the presence and formation of similarities between maternal and fetal RR interval (RRI) collected from typical developmental mice at different embryonic days (EDs), ED13.5, ED15.5, ED17.5, and ED18.5. The similarities were quantified by means of cross-correlation (CC) and magnitude-squared coherence (MSC) analyses. Correlation analysis between the CC coefficients and EDs and between MSC coefficients and EDs showed that the same coefficients increase with EDs, suggesting that similarities between maternal and fetal RRI are associated with typical fetal development. Next, because maternal and fetal similarities were indicative of development, a comparison analysis between the autism mouse model (injected with valproic acid (VPA)), and the control group (injected with saline) was performed for ED15.5 and ED18.5. RESULTS: The results of the comparison showed that the CC and MSC coefficients of VPA fetuses were significantly lower than that of the control group. The lower coefficients in VPA-treated mice suggest that they could be one of the features of ASD symptoms. The findings of this study can assist in identifying potential ASD causes during the prenatal period.

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