1. Afsharnejad B, Whitehorne Smith P, Bölte S, Milbourn B, Girdler S. A Systematic Review of Implicit Versus Explicit Social Skills Group Programs in Different Settings for School-Aged Autistic Children and Adolescents. J Autism Dev Disord. 2024.

This systematic review and meta-analysis aimed to identify and evaluate the quality of randomised controlled trials (RCTs), assessing the efficacy of Social Skills Group Programs (SSGPs) for primary and secondary school aged autistic children and adolescents exploring the influence of informant, setting characteristics and teaching strategies as moderating factors for social outcomes. A search of the electronic databases of Medline, ProQuest, CINAHL, Scopus, and Web of Sciences electronic databases was conducted for the period January 1, 2013 until December 31, 2023 for peer-reviewed RCT studies published in English, evaluating the efficacy of SSGPs for school-aged autistic children and adolescents (6-18 years). Included studies were assessed for methodological quality and efficacy using random effect meta-analysis. Informant analysis and moderator analyses were also conducted investigating the influence of informant, setting characteristics and teaching strategy utilised in the SSGPs on the participants social outcomes. Sixty-five studies were included in the systematic review with 49 studies included in the meta-analysis. Although most studies had strong or good methodological quality, a high possibility of publication bias was detected in the meta-analysis. After statistical adjustments for publication bias were made, findings revealed that SSGPs had no effect on the overall outcomes assessed by included studies on school-aged autistic children and adolescents. However, informant analysis revealed small effects reported by self-report, parent-proxy and researchers. Teaching strategies and setting characteristics were not significant moderators for the efficacy of SSGPs on the social outcomes of autistic children and adolescents. This review highlights the need for improvements in measurement frameworks for assessing social skills in autistic children and adolescents.

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2. Bahji A, Forth E, Nasar A, Waqas A, Hawken ER, Ayub M. Navigating agitation in neurodevelopmental disorders: A comparative study of pharmacotherapies via network meta-analysis in children and adults with autism spectrum disorder or intellectual disabilities. J Psychopharmacol. 2024: 2698811241303654.

IMPORTANCE: Individuals with autism spectrum disorder (ASD) and intellectual disability often experience persistent challenges related to aggressive behaviour and agitation, highlighting the critical need for evidence-based pharmacological interventions among other strategies. Despite previous network meta-analyses (NMAs), the rapidly evolving landscape of treatment options necessitates ongoing and updated assessments. OBJECTIVE: To evaluate the efficacy and tolerability of various pharmacotherapies in managing agitation in children and adults with ASD or intellectual disabilities (ID). METHODS: Employing a systematic review and network meta-analysis methodology, we conducted an exhaustive search across multiple databases for double-blind, randomized controlled trials focusing on pharmacotherapies targeting agitation in these neurodevelopmental disorders. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, our assessment of study quality utilized the Cochrane Risk of Bias Tool to ensure methodological rigour and accuracy in data synthesis. Primary outcomes encompassed measures of reduced agitation, as indicated by treatment response on standardized agitation scales, alongside dropout rates, providing a comprehensive overview of treatment efficacy and tolerability. RESULTS: Our analysis included data from 38 eligible trials, involving 2503 participants across both pediatric and adult populations. Key pharmacological interventions, such as arbaclofen, risperidone plus buspirone, omega-3 fatty acids, risperidone plus palmitoylethanolamide, aripiprazole and risperidone, demonstrated significant efficacy in reducing agitation compared to placebo. Importantly, these treatments were generally well-tolerated, with no significant increase in all-cause dropouts compared to placebo, highlighting their suitability for clinical use in managing agitation in individuals with ASD or ID. CONCLUSIONS: This study underscores the efficacy and tolerability of several pharmacotherapies in managing agitation among children and adults with ASD or ID. Our findings provide robust evidence that specific treatments, such as arbaclofen, risperidone plus buspirone and omega-3 fatty acids, are both effective and well-tolerated, offering valuable therapeutic options for clinicians. The study emphasizes the need for ongoing research to ensure that treatment strategies remain aligned with the evolving clinical landscape, ultimately improving patient outcomes in this challenging population.

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3. Chen VC, Lee CT, Wu SI, Gossop M. Neurobehavioral disorders among children born to mothers exposed to illicit substances during pregnancy. BMC Med. 2024; 22(1): 581.

BACKGROUND: Exposure to illicit substances during pregnancy may have long-term impacts on children’s neurodevelopment. This study explores subsequent risks for intellectual disability, autistic disorders, and attention deficit and hyperactivity disorders in children born to mothers exposed to illicit substances before or during pregnancy. METHODS: We identified women with illicit drug use by linking the police records from the « Substance Abuse Control Databases » and Taiwan Birth Registration and Birth Notification records from 2004 to 2014. Children whose mothers that had exposed to illicit substances during pregnancy identified from the police records were the « substance-exposed cohort. » A 1:1 ratio exact-matched comparison cohort based on child’s gender, child’s birth year, mother’s birth year, and child’s first use of the health insurance card, as well as a « propensity score (PS)-matched » comparison cohort of children born by substance-unexposed mothers, was established. Multivariate Cox regression analyses with competing risk models were performed. RESULTS: Higher incidences of intellectual disability (adjusted hazard ratio (aHR) = 2.41, 95% confidence interval (CI): 1.15-5.03) and attention deficit and hyperactivity disorder (ADHD) (aHR = 2.35, 95% CI: 1.63-3.28) were found in children prenatally exposed to illicit substances during pregnancy compared to exact-matched non-exposed cohorts. Adjusted risks of ADHD were significantly higher in mothers exposed to substances during pregnancy (aHR = 1.77 (1.42-2.21)) and before pregnancy (aHR = 1.43 (1.14-1.80)) compared to PS-matched unexposed cohorts after adjusting for covariates. CONCLUSIONS: This is one of the first studies using large population-based data linked to criminal records to reveal increased risks of intellectual disability and ADHD in children with prenatal exposure to illicit substances compared to matched unexposed controls. Our results also highlight the importance of preventive measures and interventions for the well-being of both the mother and the child.

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4. Chen Y, Xi Z, Greene T, Mandy W. A systematic review of ecological momentary assessment in autism research. Autism. 2024: 13623613241305722.

Ecological momentary assessments assess people’s in-the-moment thoughts and behaviours in their daily lives in natural environments. The number of ecological momentary assessment studies with autistic people has increased over the last decade. For the first time, this review (1) summarises how well ecological momentary assessment works for allowing autistic people to describe and express their thoughts, emotions and experiences, and (2) provides suggestions for the design of ecological momentary assessment to make this research method more accessible to future autistic participants. In total, we synthesised participation experiences from 930 autistic people. Overall, ecological momentary assessment is generally acceptable for autistic adults aged from 18 to 60 and with average or above-average intelligence and language. We also identified several issues in the ecological momentary assessment procedure and suggested researchers consider these when designing future ecological momentary assessment studies with autistic people. The findings of this review provide evidence that ecological momentary assessment can be used to investigate many different questions with autistic people and suggest a wider application of ecological momentary assessment in future studies with autistic people.

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5. Córdova C, Nóbrega O. Commentary on the Clinical Study of CBD-Rich Cannabis Extract in Children with Autism Spectrum Disorder. Trends Psychiatry Psychother. 2024.

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6. Darwish M, Passarell J, Maxwell K, Bradley H, Bishop KM, Youakim JM. Population Pharmacokinetics of Trofinetide in a Pediatric Population Aged 2-4 Years with Rett Syndrome. Adv Ther. 2024.

INTRODUCTION: Weight-banded trofinetide dosing improved physician- and caregiver-rated efficacy measures and had acceptable tolerability in patients aged 2‒4 years (DAFFODIL study) and 5‒20 years (LAVENDER study) with Rett syndrome (RTT). Selection of weight-banded dosing regimens for these studies was based on population pharmacokinetic (popPK) modeling and exposure simulations. This study applied an updated popPK model to confirm steady-state trofinetide exposures achieved in DAFFODIL patients were within target range. METHODS: A popPK model was developed using data from 14 clinical studies of trofinetide in healthy volunteers and pediatric and adult patients, including the LAVENDER and DAFFODIL studies. Individual exposure measures (area under concentration-time curve over 0-12 h [AUC(0-12)] were generated via integration of the predicted concentration-time profile for each DAFFODIL study participant based on the popPK model and individual empiric Bayesian pharmacokinetic parameter estimates. Distributions of steady-state AUC(0-12) values for each body-weight group were compared against target exposure (AUC(0-12) = 800‒1200 µg·h/mL). RESULTS: Distribution and box plots of simulated steady-state AUC(0-12) values achieved with the weight-banded DAFFODIL dosing regimen used in younger individuals aged 2-4 years with RTT (twice daily trofinetide 5 g [≥ 9 to < 12 kg] or 6 g [≥ 12 to < 20 kg]) indicated good overlap with the target exposure range. Median steady-state AUC(0-12) values for both body-weight bands fell within the target exposure range. CONCLUSIONS: PopPK model-based simulations confirm that the weight-banded dosing regimen used in DAFFODIL is adequate to achieve target trofinetide exposure in 2- to 4-year-olds with RTT. Trofinetide is the first approved treatment for Rett syndrome, a rare genetic condition that affects brain development. To make sure people with Rett syndrome get the same level of trofinetide in their blood, the dose increases as body weight increases, which is called weight-based dosing. The DAFFODIL study looked at how well girls aged 2–4 years with Rett syndrome responded to trofinetide after receiving twice-daily doses of 5 g for girls weighing from 9 up to 12 kg or 6 g for girls weighing from 12 up to 20 kg. In order to check whether the weight-based dosing used in DAFFODIL resulted in blood levels that were known to achieve the best response with trofinetide, researchers used computer modeling called population pharmacokinetics to predict trofinetide blood levels in DAFFODIL. The population pharmacokinetic modeling showed that the amount of trofinetide in the blood over a 12-h time period following a single dose of 5 g (for body weights ≥ 9 to < 12 kg) or 6 g (for body weights ≥ 12 to < 20 kg) achieved the same blood level of trofinetide that is known to be effective in Rett syndrome. These results confirm that the weight-based dosing that was used in the DAFFODIL study was suitable to achieve the best possible outcome with trofinetide in girls aged 2–4 years with Rett syndrome. eng.

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7. Darwish M, Passarell J, Maxwell K, Youakim JM, Bradley H, Bishop KM. Population Pharmacokinetic Modeling to Support Trofinetide Dosing for the Treatment of Rett Syndrome. Adv Ther. 2024.

INTRODUCTION: Oral trofinetide administered using a body weight-banded dosing regimen was approved in the US for the treatment of Rett syndrome (RTT) in patients aged ≥ 2 years. This approval was principally based on efficacy and safety findings of the phase 3 LAVENDER study in girls and women aged 5-20 years with RTT and extended to younger children aged 2-4 years with supporting data from the DAFFODIL study. Weight-banded dosing regimens were selected based on early clinical population pharmacokinetic (popPK) modeling and different scenario simulations. We report the development and application of an updated popPK model to confirm that steady-state trofinetide exposures achieved in individual patients in the LAVENDER study were within target exposure range. METHODS: A previously developed popPK model using data from nine clinical studies was updated based on 13 clinical studies of trofinetide in healthy volunteers and pediatric and adult patients, including the LAVENDER study. PopPK model and empiric individual Bayesian pharmacokinetic parameter estimates were used to generate trofinetide exposures. Covariate data from the pharmacokinetic dataset from LAVENDER study subjects (n = 92) were used to estimate individual steady-state trofinetide exposure (area under concentration-time curve over 0-12 h [AUC(0-12)]). Steady-state exposures in individual patients in the LAVENDER study were used to confirm that the dosing regimens resulted in exposures within the target range. RESULTS: Among 5- to 20-year-olds receiving the LAVENDER BID dosing regimen [trofinetide 6 g (12‒20 kg), 8 g (> 20‒35 kg), 10 g (> 35‒50 kg), and 12 g (> 50 kg)], simulated AUC(0-12) values overlapped with the target exposure range; median AUC(0-12) values were within target exposure range for all weight bands. CONCLUSIONS: PopPK model-based simulations confirm that weight-banded trofinetide dosing used in LAVENDER in girls and women aged 5-20 years with RTT achieved target exposure. Graphical abstract available for this article. Trofinetide is the first approved treatment for Rett syndrome, a rare genetic condition that affects brain development. Researchers first used computer modeling called population pharmacokinetics to show that the dose of trofinetide needs to increase as body weight increases in order to get the same level of trofinetide that is predicted to be effective in the blood of people with Rett syndrome. This dosing method was used in the LAVENDER study in girls and women aged 5–20 years with Rett syndrome, in which four different doses of trofinetide were matched to specific bands or groups of body weight as follows: twice daily doses of 6 g to people weighing between 12 and 20 kg, 8 g for people weighing from 20 kg up to 35 kg, 10 g for people weighing from 35 kg up to 50 kg, or 12 g for people weighing over 50 kg. To confirm that the weight-banded dosing used in LAVENDER resulted in blood levels that fell within the range known to be effective, researchers used an updated model to predict blood levels over time for each of the four weight-banded dosing groups. Researchers showed that the computer simulated blood levels over time for each of the weight-banded dosing groups all fell within the range known to be effective, thus confirming that the weight-banded dosing used in LAVENDER was appropriate, and ensured that people in the study were exposed to the target level of trofinetide. eng.

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8. de Zeeuw CI, Yu SY, Chen J, van Hoogstraten WS, van den Maagdenberg A, Bosman LWJ, Kros L. The modified elevated gap interaction test: a novel paradigm to assess social preference. Open Biol. 2024; 14(12): 240250.

Social deficits play a role in numerous psychiatric, neurological and neurodevelopmental disorders. Relating complex behaviour, such as social interaction, to brain activity remains one of the biggest goals and challenges in neuroscience. Availability of standardized tests that assess social preference is however, limited. Here, we present a novel behavioural paradigm that we developed to measure social behaviour, the modified elevated gap interaction test (MEGIT). In this test, animals are placed on one of two elevated platforms separated by a gap, in which they can engage in whisker interaction with either a conspecific or an object. This allows quantification of social preference in real interaction rather than just proximity and forms an ideal setup for social behaviour-related neuronal recordings. We provide a detailed description of the paradigm and its highly reliable, deep-learning based analysis, and show results obtained from wild-type animals as well as mouse models for disorders characterized by either hyposocial (autism spectrum disorder; ASD) or hypersocial (Williams Beuren syndrome; WBS) behaviour. Wild-type animals show a clear social preference. This preference is significantly smaller in an ASD mouse model, whereas it is larger in WBS mice. The results indicate that MEGIT is a sensitive and reliable test for detecting social phenotypes.

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9. Dell’Osso L, Cremone IM, Chiarantini I, Nardi B, Pronestì C, Amatori G, Massimetti E, Signorelli MS, Rocchetti M, Castellini G, Aguglia E, Politi P, Ricca V, Pini S, Carpita B. Autistic traits are associated with the presence of post-traumatic stress symptoms and suicidality among subjects with autism spectrum conditions and Anorexia nervosa. J Psychiatr Res. 2024; 181: 492-502.

INTRODUCTION: Recently, growing attention has been paid to the presence of undetected Autism Spectrum Disorder (ASD) and subthreshold autistic traits (ATs) among females, and on their gender specific manifestation. In particular, the recent literature focused on the overlap between autism spectrum and eating disorders, which share with ASD not only features such as of cognitive inflexibility but also a link with trauma- and stress-related disorders. In this framework, we aimed to assess the interaction between ATs, stress- or trauma-related symptoms, and the risk of suicidality in subjects with different mental conditions. METHODS: 184 subjects were divided in three diagnostic groups: Broad autism phenotype (BAP), Anorexia Nervosa (AN) and Healthy Controls (HCs) and assessed with the Adult Autism Subthreshold Spectrum (AdAS Spectrum) questionnaire, the Trauma and Loss Spectrum – Self Report (TALS – SR) questionnaire and the Mood Spectrum – Self Report (MOODS – SR) questionnaire. RESULTS: AN subjects reported notable ATs reinforcing the hypothesis that AN might represent an atypical ASD manifestation more common in women. Furthermore, both AN and BAP subjects showed a considerable presence of trauma/stress associated symptoms. The dimension of trauma/stress related symptoms also appeared to be associated with ATs, and to significantly mediate the relationship between ATs and suicidality risk. Lastly, AN were found to have a stronger correlation with the presence of post-traumatic stress symptoms. CONCLUSIONS: the results support the presence of a link between ATs and AN. Moreover, AN seems to be more strongly associated with post-traumatic stress symptoms than BAP. ATs and trauma/stress related symptoms may interact in shaping suicidality risk in these patients.

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10. Dreyfuss G. RNA-binding proteins in disease etiology: Fragile X Syndrome and Spinal Muscular Atrophy. Rna. 2024.

All RNAs exist in complexes (RNPs) with RNA-binding proteins (RBPs). Studies in my lab since the 1980s, identified, sequenced and characterized the major pre-mRNA- and mRNA-RBPs (hnRNPs/mRNPs), revealing RNA-binding domains and common features of numerous RBPs and their central roles in post-transcriptional gene regulation. The first links between RBPs and RNPs to diseases emerged serendipitously for fragile X syndrome, as its gene (FMR1) encoded RBP (FMRP), and spinal muscular atrophy (SMA), caused by deficits in survival motor neurons (SMN). Discoveries of the SMN complex and its unanticipated function in RNP assembly, essential for spliceosomal snRNPs biogenesis, advanced understanding of RNA biology and pathogenesis. I reflect on how these and other contributions (e.g., nucleo-cytoplasmic shuttling; telescripting) originated from curiosity-driven exploration and highly collaborative lab culture. The vast RNA and RBP assortments are beneficial, but increase complexity and chances of disorders, making the RNP sphere a rich source for future discoveries.

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11. Efe F, Aksoy H, Ok F, Kocak E, Gunes S. Perception of Internalized Stigma in Parents of Children With Autism Spectrum Disorder: Investigating the Effects of Depression, Anxiety, and Family Functioning. Cureus. 2024; 16(11): e73860.

Introduction Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder that impacts communication, behavior, and social interaction. It is well-documented that parents of children with ASD often experience psychiatric conditions like anxiety and depression. Nevertheless, research on the perception of internalized stigma, family functioning, and their interconnections is scarce. The main objective of our study was to analyze the internalized stigma perceptions, depression, anxiety, and family functioning among parents or caregivers of children diagnosed with ASD. Methods This study was conducted on 102 cases and 101 healthy controls in a cross-sectional case-control study involving patients aged 3-12 years. The research was carried out at the Child Psychiatry Clinic of Adana City Training and Research Hospital and three Family Health Centers in Adana from October 15 to December 15, 2022. Sociodemographic data, family history, families’ knowledge levels about autism, and information about their social lives were collected using a face-to-face structured questionnaire. The Internalized Stigma of Mental Illness (ISMI), Hospital Anxiety and Depression (HAD), and Family APGAR scales were administered. Results The mean ISMI score of the case group was 67.31±8.91. According to the HAD Anxiety scale score, 60.8% of the case group and 14.9% of the control group were at high risk (p<0.001). According to the HAD Depression Scale, 52% of the case group participants and 25.7% of the control group were at high risk (p<0.001). The rate of severe familial dysfunction was 18.6% in the case group and 3.0% in the control group (p<0.001). Conclusion Stigma, anxiety, depression, and family functioning in parents of children diagnosed with ASD lead to various adverse outcomes. Further studies are necessary to prevent these negative experiences for families of children with ASD and to facilitate the integration of these children into society.

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12. Erwin J, Neill S, Vassallo T, Vassallo I, Witton R, Paisi M. Factors Influencing the Oral Health Behaviours of Autistic Children and Young People: A Qualitative Study. Health Expect. 2024; 27(6): e70130.

BACKGROUND: Poor oral health (OH) in childhood can cause pain, affect quality of life and significantly impact adult OH. Autistic children and young people (CYP) experience inequalities in OH and are at higher risk of cavities and gum disease than neurotypical CYP. OBJECTIVE: To provide evidence and insights into the factors affecting the OH behaviours of ACYP from the perspective of ACYP, their parents/carers and Dental Health Professionals (DHPs). METHOD: Semi-structured online or face-to-face interviews were conducted with CYP, parents/carers and DHPs in Southwest England. RESULTS: Nineteen ACYP (aged 5-18 years old), 20 parents/carers and 16 DHPs were interviewed. The themes identified were as follows: Sensory sensitivities and diet; Toothbrushing ‘battles’; Coping with the stresses of daily life in a neurotypical world; Awareness of autism and understanding of challenges to good OH; The impact on parents of trying to care their child’s OH; CYP and parent/carers difficulties in obtaining OH support; What ‘good support’ looks like. CONCLUSIONS: An increased awareness among DHPs, health and social care professionals of autism and the challenges to OH that CYP face is needed. Providing early support, strategies and resources to CYP and their parents/carers has the potential to help establish positive OH behaviours. PUBLIC CONTRIBUTION: The research team worked closely with members of the autistic community on this project. The methods used in this project were developed together with a research advisory group which included four ACYP (aged 9-17) and their parents. The team also worked with members of a youth club for ACYP aged 10-17 years old. All research documents and materials were co-produced. Members of the advisory group (T.V. and I.V.) contributed to the interpretation of the research findings and the writing of this manuscript.

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13. Failla C, Chilà P, Vetrano N, Doria G, Scarcella I, Minutoli R, Scandurra A, Gismondo S, Marino F, Pioggia G. Virtual reality for autism: unlocking learning and growth. Front Psychol. 2024; 15: 1417717.

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14. Fink E, Friedman S, Olthof T, van der Meijden S, Goossens F, Begeer S. Exploring the Interpersonal Goals of Autistic and Neurotypical Adolescents Who Bully Others. J Autism Dev Disord. 2024.

The current study examined the association between interpersonal social goals (i.e., agentic and communal goals) and bullying behaviour for autistic adolescents (n = 108, M(age) = 15.25 years, SD = 1.65) and neurotypical adolescents (n = 592, M(age) = 13 years, SD = 0.5). Bullying behaviour was assessed using both self- and peer-reported measures. Agentic and communal social goals were assessed using the child version of the Interpersonal Goal Index. Measurement properties of the Interpersonal Goal Index were first examined, and some features were found to differ across autistic and neurotypical adolescents. Bullying behaviour was associated with agentic goals for neurotypical adolescents whereas communal goals were associated with bullying for autistic adolescents, suggesting a mismatch between social goals and social behaviours for this group. This insight suggests that the dynamics of bullying behaviour differ between neurotypical and autistic adolescents, and highlight the need for the development of autistic-led assessment and support for bullying.

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15. Goodrich AJ, Tancredi DJ, Ludeña YJ, Bennett DH, Hertz-Picciotto I, Schmidt RJ. Professionally and non-professionally applied household insecticides during pregnancy and early life and their associations with autism spectrum disorder and developmental delay in the CHARGE case-control study. Environ Res. 2024; 267: 120651.

BACKGROUND: Autism Spectrum Disorder (ASD) is an increasing concern globally, with risks attributed to both genetic and environmental factors, including pesticide exposures. The CHARGE case-control study collected data to examine the relationship between household insecticide use and ASD or developmental delay (DD). METHODS: Participants (n = 1526) aged 2-5 years from the CHARGE study encompassed children with clinically confirmed ASD (n = 810), DD (n = 186), and typically developing controls (n = 530) frequency matched to ASD children by age, sex, and geographic region. Household insecticide use was determined from parent interviews, as were the timing, frequency, and type of applications (professionally or non-professionally applied; indoor, outdoor, and flea applications) from three months pre-conception to the child’s second birthday. Logistic regression models were adjusted for confounders to estimate odds ratios (OR) for ASD or DD associated with insecticide exposure. RESULTS: Professionally applied indoor insecticides were associated with greater than two-fold increased odds of ASD for all time periods (OR: pre-pregnancy, 2.62 (1.26, 5.44); pregnancy, 2.52 (1.41, 4.48); year 1, 2.20 (1.33, 3.64); year 2, 2.13 (1.29, 3.49)). Odds were also elevated for any outdoor application during years 1 and 2 (OR: 1.37 (1.05, 1.79) and 1.34 (1.03, 1.74), respectively), however, significance did not hold after false discovery rate correction. Higher exposure frequency was associated with greater odds of ASD for nearly all application types and time periods. Non-professional indoor insecticide use was associated with increased odds of DD in trimester 3 and the pregnancy period (OR: 1.72 (1.03, 2.89) and 1.58 (1.03, 2.40), respectively). CONCLUSION: Professionally applied indoor insecticides were consistently associated with ASD. The strong trend of increased odds with more frequent exposures, additional evidence for DD, and widespread use of household insecticides support increased regulatory scrutiny and public health interventions to minimize exposure during critical developmental windows.

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16. Hamidi A, Persaud NA, Ganti L, Keeler L. Leo Kanner: The Physician and Pioneer of Autism. Cureus. 2024; 16(11): e73859.

Dr. Chaskel Leib (Leo) Kanner is widely regarded as the father of child psychiatry in the United States. He was a pioneering figure in autism research who paved the way for child psychiatry and our modern-day understanding of autism. His monumental efforts distinguished autism as a distinct neurodevelopmental condition, contributing to the establishment of specific diagnostic criteria that helped shape our current perception of autism. Kanner’s observations and theories recognized autism as an inherent condition, and his lasting contributions continue to influence diagnostic approaches while propelling ongoing, cutting-edge research.

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17. Ishizuka M, Otsuka S, Miyata J, Yoshihara Y, Kubota M, Murai T. Autism-spectrum quotient mediates the relationship between clinical symptoms and quality of life in schizophrenia. Schizophr Res. 2024; 275: 98-106.

BACKGROUND: Social dysfunctions can affect the quality of life (QOL) of patients with schizophrenia. The autism-spectrum quotient (AQ) is a widely used measure of innate autistic traits. However, in patients with schizophrenia, the score may represent the severity of autism-like social dysfunctions as a consequence of symptoms. We tested the hypothesis that AQ would mediate the relationship between clinical symptoms and QOL in patients with schizophrenia, based on the assumption that the AQ measures autism-like social dysfunctions rather than autistic traits in this population. METHODS: We analyzed data from 108 outpatients with schizophrenia. The relationships among the scores on the Positive and Negative Syndrome Scale (PANSS), the Schizophrenia Quality of Life Scale (SQLS), and the AQ were examined using structural equation modeling (SEM). RESULTS: Path analyses of the total scale scores revealed partial mediation, but not full mediation or independent effects. However, both the AQ and PANSS scores could be mediators. SEM including the three domain scores of PANSS, the two factors of the AQ, and the three subscale scores of the SQLS showed a good fit of the AQ mediation model, but not the symptom mediation model, supporting our hypothesis. In this final model, the relationship between negative symptoms and QOL was mediated by autism-like social dysfunctions, whereas positive symptoms directly affected QOL. CONCLUSIONS: Our findings advance our understanding of what the AQ measures when applied to patients with schizophrenia and suggest that autism-like social dysfunctions are important treatment targets for improving QOL in this population.

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18. Kung KTF. Correction: The Chinese 10-Item Empathy Quotient and Systemising Quotient-Revised: Internal Consistency, Test-Retest Reliability, Known-Groups Validity, and Sex Differences in Autistic and Non-Autistic Adults. J Autism Dev Disord. 2024.

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19. Li F, Li Q, Shen Q, Zhang X, Leng H, Liu Y, Zheng X. The Support Needs of Parents of Children With Autism Spectrum Disorder: A Qualitative Study Based on the Nurturing Care Framework. J Adv Nurs. 2024.

AIM: To explore the support needs of parents of children with autism spectrum disorder (ASD) in China under the guidance of the nurturing care framework (NCF). DESIGN: A descriptive qualitative study design was used. METHODS: Fourteen parents of 2-6-year-old children with autism were recruited for face-to-face individual interviews in Chongqing between July and November 2023. NVivo 12.0 software was used to manage the data, and a directed content analysis was performed to extract themes. RESULTS: Five nurturing care needs of parents of children with autism were extracted, including acquisition of health- and disorder-related knowledge and information, maintenance of psychological and physical wellbeing, desire for individualised caregiver skills training, creation of multi-agent social support network, and accessibility of high-quality and coordinated services. CONCLUSION: Parents of children with autism have multidimensional unmet nurturing care needs. It is crucial to address these needs and develop targeted family support programs with consideration of the extracted need components. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE: This study implies that health education, parental empowerment and psychological support should be prioritised in future family support programs. The findings also emphasise the importance of establishing a cross-departmental coordination mechanism and building a multi-agent social support network for families of children with autism. IMPACT: This study expands our understanding on the support needs of families of children with autism and enriches the theoretical connotation of nurturing care framework, and the results may inform the development of tailored support programs for families of children with autism in China. REPORTING METHOD: The results are reported in accordance with the reporting guidelines of the Consolidated Criteria for Reporting Qualitative Studies (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient and public contribution.

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20. Ling W, Wang W, Lu D, Liu Q, Jiang G. Unraveling Copper Imbalance in Autism Spectrum Disorder: Mechanistic Insights from the Valproic Acid Mouse Model. ACS Chem Neurosci. 2024.

Abnormal copper (Cu) levels are often closely associated with neurological disorders including neurodevelopmental conditions, such as autism spectrum disorder (ASD). However, the mechanisms underlying the disruption of Cu homeostasis in critical organs, such as the brain, remain unclear. In this study, we elucidated the molecular mechanisms of Cu imbalance in the brain of a valproic acid (VPA) mouse model along with the changes in specific metabolites. Significant alterations occurred in proteins associated with primary Cu-related metabolism in specific regions of the brain (prefrontal cortex, amygdala, cerebellum, and hippocampus), resulting in a direct elevation of Cu ions within the brain tissues (control: 5.05 ± 0.61 μg/g vs model: 6.28 ± 0.81 μg/g, p = 0.015). Furthermore, the brain metabolic profiles revealed significant upregulation of lipids, particularly phospholipid metabolites. Typical neurotransmitters, for example, dopamine (DA) (p < 0.0001) and serotonin (5-HT) (p = 0.02) were upregulated in amygdala. Other small metabolites like glutathione (GSH) (p = 0.0004) also exhibited notable variation in brain. The potential impact of Cu toxicity on the signaling pathways of key metabolites was then evaluated, providing new insights into the role of Cu in metabolism of neurotransmitters in the brain. Our finding sheds molecular aberrations associated with essential element metabolism in the brain, providing new elemental perspectives for understanding the pathogenic mechanisms underlying ASD.

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21. Moerman F, Van de Vyver H, Warreyn P, Erdogan M, Noens I, Sivaraman M, Vlaeminck F, Wallaert S, Roeyers H. Growth Trajectories of Joint Attention and Play as Predictors for Language in Young Children at Elevated Likelihood for Autism. J Autism Dev Disord. 2024.

This longitudinal study investigated the predictive value of initial level and growth rate of joint attention and play from 10 to 24 months for language abilities of 24-month-old toddlers at elevated likelihood (EL) for autism. (Semi-)structured assessments were used to measure all variables at different timepoints prospectively in younger siblings of children with autism (siblings, n = 48) and children born before 30 gestational weeks (preterms, n = 49). A positive association was found between initial level of play at 10 months and expressive language at 24 months in siblings, but not in preterms. We did not find an association between initial level of play and receptive language. Growth rate of play and initial level and growth rate of joint attention were not related to language abilities in siblings and preterms. Our results indicate that play and expressive language are interrelated, and early play behaviour may contribute to later language. As this association was absent in preterms, they may follow qualitatively different developmental processes. Moreover, future research including different EL-groups is needed to clarify these differential associations. In contrast to previous studies, no association between early joint attention and later language was found. These inconsistent findings warrant further exploration and highlight the importance of exploring alternative aspects of early development, for instance non-social factors, to expand our understanding of language acquisition.

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22. Öztürk E, Aslan Çin NN, Cansu A, Akyol A. Ketogenic diet as a therapeutic approach in autism spectrum disorder: a narrative review. Metab Brain Dis. 2024; 40(1): 67.

The ketogenic diet (KD) originated in the 1920s. It is a dietary model that is low in carbohydrates, adequate in protein, and high in fat content. The diet mimics starvation and increases the production of ketone bodies, leading to ketosis in metabolism. KD is used as an anticonvulsant treatment approach in patients with drug-resistant epilepsy. In addition, it is thought that a KD may have therapeutic potential in the treatment of neurological disorders, including autism spectrum disorders (ASD). Numerous recent studies have demonstrated that a KD can improve behavioural parameters in individuals with ASD. This review aims to address the potential mechanisms of action of the KD and to examine the effects of the KD on individuals diagnosed with ASD. It is likely that this role is mediated through improvements in energy metabolism, reduction of pro-inflammatory cytokine levels, control of neurotransmitters, gene expression and modulation of the gut microbiota. Based on the available evidence, a KD appears to be a safe and effective treatment for ASD.

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23. Posserud MR. Preschool and school-age autism. Tidsskr Nor Laegeforen. 2024; 144(15).

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24. Røe AB, Jullumstrø S, Eig KB, Lydersen S, Nærland T, Høyland AL. Autism diagnoses in school-age children in southern Trøndelag 2016-2019. Tidsskr Nor Laegeforen. 2024; 144(15).

BACKGROUND: We have previously reported a significantly higher prevalence of autism spectrum disorders in southern Trøndelag among preschool children with mothers from a different national background than Norway. In this study, we wanted to investigate whether, in the same period and in the same geographic area, there was also an excess prevalence among school-age children. Additionally, we wanted to identify psychiatric and developmental comorbidities. MATERIAL AND METHOD: We carried out a retrospective review of the medical records of children between 10 and 16 years of age who had been diagnosed with autism in the period 2016-19. RESULTS: Out of a sample of 125 children, 18 had mothers with a different national background. This gave an incidence rate of 0.18 %, against 0.12 % for children with mothers born in Norway (relative risk 1.5; 95 % confidence interval 0.87 to 2.50, p = 0.11). A total of 74 children had been diagnosed with at least one other developmental disorder or psychiatric condition, most commonly ADHD, before they received the autism diagnosis. In four children, the autism spectrum disorder was accompanied by an intellectual disability. INTERPRETATION: Maternal national background appears to be a less significant factor among school-age children than among preschool children who receive an autism spectrum diagnosis, and age at the time of diagnosis should be specified in studies on autism in children and adolescents. Psychiatric comorbidity and other accompanying developmental disorders may suggest shared aetiological factors or increased vulnerability in cases of undiagnosed autism in children.

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25. Salenius K, Väljä N, Thusberg S, Iris F, Ladd-Acosta C, Roos C, Nykter M, Fasano A, Autio R, Lin J. Exploring autism spectrum disorder and co-occurring trait associations to elucidate multivariate genetic mechanisms and insights. BMC Psychiatry. 2024; 24(1): 934.

BACKGROUND: Autism spectrum disorder (ASD) is a partially heritable neurodevelopmental trait, and people with ASD may also have other co-occurring trait such as ADHD, anxiety disorders, depression, mental health issues, learning difficulty, physical health traits and communication challenges. The concomitant development of ASD and other neurological traits is assumed to result from a complex interplay between genetics and the environment. However, only a limited number of studies have performed multivariate genome-wide association studies (GWAS) for ASD. METHODS: We conducted to-date the largest multivariate GWAS on ASD and 8 ASD co-occurring traits (ADHD, ADHD childhood, anxiety stress (ASDR), bipolar (BIP), disruptive behaviour (DBD), educational attainment (EA), major depression, and schizophrenia (SCZ)) using summary statistics from leading studies. Multivariate associations and central traits were further identified. Subsequently, colocalization and Mendelian randomization (MR) analysis were performed on the associations identified with the central traits containing ASD. To further validate our findings, pathway and quantified trait loci (QTL) resources as well as independent datasets consisting of 112 (45 probands) whole genome sequence data from the GEMMA project were utilized. RESULTS: Multivariate GWAS resulted in 637 significant associations (p < 5e-8), among which 322 are reported for the first time for any trait. 37 SNPs were identified to contain ASD and one or more traits in their central trait set, including variants mapped to known SFARI ASD genes MAPT, CADPS and NEGR1 as well as novel ASD genes KANSL1, NSF and NTM, associated with immune response, synaptic transmission, and neurite growth respectively. Mendelian randomization analyses found that genetic liability for ADHD childhood, ASRD and DBT has causal effects on the risk of ASD while genetic liability for ASD has causal effects on the risk of ADHD, ADHD childhood, BIP, WA, MDD and SCZ. Frequency differences of SNPs found in NTM and CADPS genes, respectively associated with neurite growth and neural/endocrine calcium regulation, were found between GEMMA ASD probands and controls. Pathway, QTL and cell type enrichment implicated microbiome, enteric inflammation, and central nervous system enrichments. CONCLUSIONS: Our study, combining multivariate GWAS with systematic decomposition, identified novel genetic associations related to ASD and ASD co-occurring driver traits. Statistical tests were applied to discern evidence for shared and interpretable liability between ASD and co-occurring traits. These findings expand upon the current understanding of the complex genetics regulating ASD and reveal insights of neuronal brain disruptions potentially driving development and manifestation.

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26. Sarovic D, Schneiderman J, Lundström S, Riaz B, Orekhova E, Khan S, Gillberg C. Differential late-stage face processing in autism: a magnetoencephalographic study of fusiform gyrus activation. BMC Psychiatry. 2024; 24(1): 900.

BACKGROUND: Autism is associated with alterations of social communication, such as during face-to-face interactions. This study aimed to probe face processing in autistics with normal IQ utilizing magnetoencephalography to examine event-related fields within the fusiform gyrus during face perception. METHODS: A case-control cohort of 22 individuals diagnosed with autism and 20 age-matched controls (all male, age 29.3 ± 6.9 years) underwent magnetoencephalographic scanning during an active task while observing neutral faces, face-like pareidolic objects, and non-face objects. The fusiform face area was identified using a face localizer for each participant, and the cortical activation pattern was normalized onto an average brain for subsequent analysis. RESULTS: Early post-stimulus activation amplitudes (before 100-200 ms) indicated differentiation between stimuli containing fundamental facial features and non-face objects in both groups. In contrast, later activation (400-550 ms) differentiated real faces from both pareidolic and non-face objects across both groups and faces from objects in controls but not in autistics. There was no effect of autistic-like traits. CONCLUSIONS: The absence of group differences in early activation suggest intact face detection in autistics possessing a normal IQ. Later activation captures a greater degree of the complexity and social information from actual faces. Although both groups distinguished faces from pareidolic and non-face objects, the control group exhibited a slightly heightened differentiation at this latency, indicating a potential disadvantage for autistics in real face processing. The subtle difference in late-stage face processing observed in autistic individuals may reflect specific cognitive mechanisms related to face perception in autism.

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27. Selten I, Ziermans T, Rapoport I, Jonkman K, Geurts HM. Mental health care use of autistic adults: Identifying longitudinal patterns using sequence analysis. Autism. 2024: 13623613241304513.

Many autistic adults experience co-occurring mental health problems, which have a negative effect on their well-being and result in increased use of mental health services. To improve mental healthcare for autistic adults, a better understanding is needed of what type of support they use in real life. Clinical guidelines recommend three kinds of mental health interventions: therapy, counseling, and medication. We investigated the use of these types of interventions in a sample of 445 autistic adults (aged 18-87 years) across a 5-to-7-year period. We found evidence for four different patterns of intervention use, or so-called subgroups: (1) least intervention use, (2) mostly counseling, (3) mostly medication, and (4) mixed intervention use. The group with mixed intervention use consisted of relatively more females and individuals with co-occurring psychiatric conditions, especially compared to the subgroup with the least intervention use. It appeared that many, but not all, autistic individuals used mental health services for an extended period. However, there was considerable variability in the type, combination, and duration of intervention use. This means that determining the optimal support for autistic adults is often a complex task, which requires collaboration of clinical experts and autistic individuals themselves, to make informed decisions.

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28. Shata N, Ali J, N AL, MacNay R. Torticollis as an early manifestation of basilar invagination in a paediatric patient. BMJ Case Rep. 2024; 17(12).

This case report describes the clinical journey of a male patient in early childhood with developmental delay, failure to thrive, worsening right-sided head tilt torticollis and regression of motor skills with spasticity of the lower limbs. The case was complex due to the early onset and gradually worsening symptoms, including a decline in established motor milestones. Genetic testing to investigate the delayed neurodevelopment revealed a FRA10AC1 variant that did not fully explain the patient’s phenotype. Investigations were delayed due to the coronavirus disease 2019 pandemic and other factors related to the patient. Eventually, MRI revealed basilar invagination with cord compression and cord oedema at the C1-C2 junction. Treatment included foramen magnum decompression and management of symptoms using a multidisciplinary approach. Treatment resulted in a remarkable recovery. The patient regained some motor abilities and reached the 50th weight percentile.

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29. Thompson C, Gorey T, Lawler T, Watson G, Wells B, McVeigh JA. ‘I can’t relate to it’: Exploring autistic and non-autistic adults’ perceptions of the Australian Physical Activity and Sedentary Behaviour Guidelines. Health Promot J Austr. 2025; 36(1): e944.

BACKGROUND: Despite sufficient physical activity (PA) being strongly associated with better health outcomes, half of the Australian population does not meet the Australian PA and Sedentary Behaviour Guidelines. This shortfall is more pronounced among autistic adults, who exhibit poorer health outcomes and lower PA levels than non-autistic adults. Despite these disparities, there is a limited understanding of how autistic and non-autistic individuals perceive and interpret the PA guidelines. METHODS: This study investigated how autistic and non-autistic adults perceive and comprehend the Australian PA guidelines. This study used interpretative phenomenological analysis. RESULTS: A total of 15 autistic and 20 non-autistic adults were interviewed, and 4 themes that were largely similar between both groups were identified: (1) Lack of Awareness and Engagement with the PA Guidelines, (2) Misinterpretation of Key Terms and Concepts, (3) Perceived lack of Relevance and Relatability of the PA Guidelines and (4) Lack of Inclusivity. CONCLUSION: The findings underscore the importance of crafting health communication and promotion materials that are more visible, clear, inclusive and engaging for non-autistic and autistic individuals in Australia. SO WHAT?: This study highlights the potential for improving the number of people correctly understanding the PA guidelines by addressing dissemination methods, knowledge and interpretation of the guidelines as some components of the multifaceted process required to achieve behaviour change.

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30. Vidivelli S, Padmakumari P, Shanthi P. Multimodal autism detection: Deep hybrid model with improved feature level fusion. Comput Methods Programs Biomed. 2024; 260: 108492.

OBJECTIVE: Social communication difficulties are a characteristic of autism spectrum disorder (ASD), a neurodevelopmental condition. The earlier method of diagnosing autism largely relied on error-prone behavioral observation of symptoms. More intelligence approaches are in progress to diagnose the disorder, which still demands improvement in prediction accuracy. Furthermore, computer-aided design systems based on machine learning algorithms are extremely time-consuming and difficult to design. This study used deep learning techniques to develop a novel autism detection model in order to overcome these problems. METHODS: Preprocessing, Features extraction, Improved Feature level Fusion, and Detection are the phases of the suggested autism detection methodology. First, both input modalities will be preprocessed so they are ready for the next stages to be processed. In this case, the facial picture is preprocessed utilizing the Gabor filtering technique, while the input EEG data is preprocessed through Wiener filtering. Subsequently, features are extracted from the modalities, from the EEG signal data, features like Common Spatial Pattern (CSP), Improved Singular Spectrum Entropy, and correlation dimension, are extracted. From the face image, features like the Improved Active Appearance model, Gray-Level Co-occurrence matrix (GLCM) features and Proposed Shape Local Binary Texture (SLBT), as well are retrieved. Following extraction, enhanced feature-level fusion is performed to fuse the features. Ultimately, the combined features are fed into the hybrid model to complete the diagnosis. Models such as Convolutional Neural Networks (CNN) and Bidirectional Gated Recurrent Units (Bi-GRU) are part of the hybrid model. RESULTS: The suggested MADDHM model achieved an accuracy of about 91.03 % regarding EEG and 91.67 % regarding face analysis meanwhile, SVM=87.49 %, DNN=88.59 %, Bi-GRU=90.02 %, LSTM=87.49 % and CNN=82.02 %. CONCLUSION: As a result, the suggested methodology provides encouraging outcomes and opens up possibilities for early autism detection. The development of such models is not only a technical achievement but also a step forward in providing timely interventions for individuals with ASD.

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31. Zhang C, Yang L, Wang F, Liu M, Liu Z, Zou M, Wu L. Therapeutic Efficacy of a Synthetic Brain-Targeted H(2)S Donor Cross-Linked Nanomicelle in Autism Spectrum Disorder Rats through Aerobic Glycolysis. ACS Appl Mater Interfaces. 2024.

Autism spectrum disorder (ASD) is characterized by cognitive inflexibility and social deficits, with a notably limited range of brain-targeted medications, particularly in the field of nanomedicine. Herein, we introduce the brain-targeted H(2)S donor cross-linked nanomicelle, named mannose-PEG600-lipoic acid (Man-LA). Man-LA demonstrates enhanced stability and precise brain delivery by interacting with glucose transporter 1 (GLUT1) in astrocytes, facilitating a gradual release of H(2)S that is modulated by glutathione (GSH). In vivo, studies suggest that Man-LA alleviates symptoms of ASD, correlating with increased expression of aerobic glycolysis enzymes, elevated lactate production, and higher H(2)S levels, while preventing damage to hippocampal neurons. In vitro, Man-LA tightly binds to aldehyde dehydrogenase family 3 member B1 (Aldh3b1) in astrocytes, upregulating its expression. This interaction promotes aerobic glycolysis and enhances lactate production. These findings suggest a connection between ASD deficits and the dysregulation of astrocytic aerobic glycolysis, underscoring the role of H(2)S. Identifying the Aldh3b1 gene within aerobic glycolysis pathways provides a promising target for ASD treatment.

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32. Zhang H, Chen S, Yu J, Niu X, Wang X, Wang L. Association between adherence to behavioral intervention and capability well-being among parents of autistic children: a cross-sectional study from China. BMC Psychiatry. 2024; 24(1): 922.

BACKGROUND: High adherence to behavioral interventions among parents of autistic children contribute to improvement in children’s behaviors and parental outcomes. However, most of previous studies focused on the effects of intervention adherence on health-related well-being among parents, which is inadequate to capture the multi-dimensional parental burden of caring for autistic children. The aim of this study is to assess the association between parents’ adherence to behavioral intervention and their capability well-being. METHODS: A cross-sectional study was conducted among caregivers of autistic children aged 1-17 years with a confirmed diagnosis in China. A total of 213 parents of autistic children who were currently receiving behavioral intervention were considered in this study. Parental adherence to behavioral intervention was evaluated by the 5-item General Adherence subscale of the Medical Outcome Study. Capability well-being was assessed using the Investigating Choice Experiments Capability Measures for Adults (ICECAP-A), including the domains of stability, attachment, autonomy, achievement, and enjoyment. The index scores for each domain were computed based on the preference-based value set in the United Kingdom, ranging from 0 to 1. Multivariate linear regression analyses were conducted to assess the relationship between intervention adherence and parental well-being. Intervention adherence as well as the variables with p < 0.1 in the univariate analyses were included in multivariate linear regression analyses. RESULTS: The mean overall score of ICECAP-A was 0.681 (0.205). In the univariate analyses, intervention adherence was positively associated with stability, autonomy, achievement, and enjoyment (p < 0.05), while the relationship between intervention adherence and attachment was not significant (p = 0.07). After controlling for the confounders in the multivariate linear regression analyses, intervention adherence was positively associated with achievement (β = 0.0004) and enjoyment (β = 0.0004). CONCLUSIONS: The overall capability well-being among parents of autistic children was worse than that of the general population and caregivers of adult patients with chronic diseases. Adherence to behavioral interventions was positively associated with parental well-being in terms of achievement and enjoyment. Health professionals should involve parents in behavioral interventions and encourage them to implement therapeutic strategies on a routine basis. Customized interventions are warranted to improve capability well-being targeting at vulnerable groups.

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33. Zhang Q, Yang X, Qiu J, Lu W. Systemic heterogeneity in autism spectrum disorder revealed by individualized structural covariance network analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2024; 136: 111224.

BACKGROUND AND PURPOSE: Autism spectrum disorder (ASD) is clinically heterogeneous, and resent neuroimaging studies have shown the presence of brain structural heterogeneity in ASD. However, there is currently a lack of evidence for systemic level brain structural heterogeneity. This study aimed to reveal the heterogeneity of brain structural changes at the systemic level in ASD patients through individual differential structural covariance network (IDSCN) analysis. MATERIALS AND METHODS: We included 803 neurotypical controls (NCs) and 650 ASD patients from 24 sites and the corresponding structural magnetic resonance and clinical data. 516 ASD patients were used as training group, and 134 ASD patients were selected as an independent validation group. In the training group, we constructed IDSCN for each ASD patient, identified differentiated structural covariance edges, and resolved systemic heterogeneity using K-means clustering algorithm. We then conducted statistical analyses on the demographical and clinical data of the ASD subgroups, and performed correlation analyses between structural covariance edges and clinical profiles within each ASD subgroup. We also tested the reliability of the IDSCN in the validation group. RESULTS: The results of the training and validation groups were similar, revealing two subtypes of ASD, with 17 brain connections showing differences between the two subtypes. There were differences in clinical profiles between the two subgroups in restricted repetitive behavior score from autism diagnostic interview-revised (ADI_RRB_TOTAL), total score of autism diagnostic observation schedule (ADOS), social interaction score from ADOS and stereotyped behaviors score from ADOS. In both datasets, we also found a significant correlation between ADI_RRB_TOTAL scale and the Z-score for edges between the bilateral ventral tegmental area (VTA) and between the left VTA and right substantia nigra pars compacta. CONCLUSION: ASD exhibited brain structural heterogeneity at the systemic level, mainly involving nucleus in the subcortical regions and brainstem, which can affect RRB in ASD patients. The two subtypes discovered in this study have the potential to be applied in precise diagnosis and treatment of the disorder.

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34. Zheng S, Farmer C, Taylor JL, Adams R, Olson L, Bishop S. Patterns and correlates of two-year changes in depressive symptoms for autistic adults. Front Psychiatry. 2024; 15: 1461704.

BACKGROUND: Autistic adults are at elevated risk for depression. However, longitudinal data on the trajectory of depressive symptoms and its associated factors in autistic adults are scarce. METHODS: A community sample of 315 autistic adults participated in a two-year longitudinal study from the beginning of (March 2020) to the recovery from the COVID-19 pandemic (March 2022). They provided five waves of data on self-reported depressive symptoms and sociodemographic and life circumstances information. RESULTS: Multilevel model results showed that autistic adults reported large between-individual variability in self-reported depressive symptoms, and on average, they experienced an increase (i.e., worsening) in self-reported depressive symptoms over the two years of the study. Autistic adults with a depression history and lower annual household income reported higher levels of depressive symptoms. More importantly, autistic adults reported lower depressive symptoms when they were engaged in work or school, and those who had higher levels of depressive symptoms at the start of the study were more reactive to changes in work or school participation. CONCLUSIONS: Findings from the current study have implications for potential venues of depression treatment in autistic adults around promoting employment/education, providing symptom monitoring, and addressing mental health disparities for those with lower incomes.

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