1. Arora I, Bellato A, Gliga T, Ropar D, Kochhar P, Hollis C, Groom M. What is the Effect of Stimulus Complexity on Attention to Repeating and Changing Information in Autism ?. J Autism Dev Disord. 2021.

Slower habituation to repeating stimuli characterises Autism, but it is not known whether this is driven by difficulties with information processing or an attentional bias towards sameness. We conducted eye-tracking and presented looming geometrical shapes, clocks with moving arms and smiling faces, as two separate streams of stimuli (one repeating and one changing), to 7-15 years old children and adolescents (n = 103) with Autism, ADHD or co-occurring Autism+ADHD, and neurotypical children (Study-1) ; and to neurotypical children (n = 64) with varying levels of autistic traits (Study-2). Across both studies, autistic features were associated with longer looks to the repeating stimulus, and shorter looks to the changing stimulus, but only for more complex stimuli, indicating greater difficulty in processing complex or unpredictable information.

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2. Brice S, Rodgers J, Ingham B, Mason D, Wilson C, Freeston M, Le Couteur A, Parr JR. The importance and availability of adjustments to improve access for autistic adults who need mental and physical healthcare : findings from UK surveys. BMJ Open. 2021 ; 11(3) : e043336.

OBJECTIVES : To investigate autistic people’s views on the importance and availability of adjustments to mental and physical healthcare provision. To explore whether specific categories of adjustments can be identified and to identify any differences in their importance and availability between mental and physical healthcare. DESIGN : Data from two studies, both employing a cross-sectional survey design. SETTING : UK-based autistic adults registered with the Adult Autism Spectrum Cohort-UK were contacted by post or online. In both studies, recruitment was staged over a 12-month period. Non-responders were sent a single reminder letter 2 weeks after initial contact. PARTICIPANTS : 537 autistic adults completed a survey about mental health services (51% response rate), 407 completed the physical health survey (49% response rate). Within these samples, 221 participants completed both surveys. PRIMARY OUTCOME MEASURES : Each study developed a bespoke survey to explore participants’ views on mental and physical health services, respectively. Both included an identical list of adjustments that participants rated based on importance and availability. RESULTS : Three factors of important adjustments were identified : sensory environment, clinical and service context, and clinician knowledge and communication. Adjustments across healthcare settings were widely rated as being important yet rarely available. One significant difference between the importance of adjustments available through mental and physical health services was identified. Participants reported that having access to a clinician who is willing to adapt their approach to suit the person’s preferences was significantly more important for participants attending mental health settings (p=0.001). CONCLUSIONS : Autistic people reported the limited availability of important adjustments in current healthcare provision. To address unmet need and tackle the health inequalities faced by autistic people attending physical and mental healthcare settings, healthcare providers should offer adjustments relating to the three identified factors. Future research should focus on identifying and addressing service provider barriers to implementation.

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3. Christiansen A, Minich NM, Clark M. Pilot Survey : Police Understanding of Autism Spectrum Disorder. J Autism Dev Disord. 2021.

This piliot study assessed the experiences of police officers related to persons with Autism Spectrum Disorder (ASD) via a survey assessing prior experience, comfort, knowledge, and ability to identify autistic persons. Fifty-one officers completed the survey : 52.9% reported previous ASD training, 34.8% reported personal experience with ASD, and 56.9% endorsed low overall knowledge of ASD. Officers reported neutral comfort (mean 3.24) and moderate practical knowledge (mean 3.74) [Likert scale 1-5 ; 5 = highest]. Those with previous training or with personal experience reported higher comfort and knowledge. Those with personal experience were more likely to recognize features of ASD in clinical vignettes. Further study is necessary to understand what additional training about ASD may be helpful to police officers.

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4. Demartini B, Nisticò V, Bertino V, Tedesco R, Faggioli R, Priori A, Gambini O. Eating disturbances in adults with autism spectrum disorder without intellectual disabilities. Autism Res. 2021.

There is a growing interest in the relationship between autism spectrum disorders (ASDs) and eating disorders (EDs), two relatively common conditions lying on a spectrum from mild to severe clinical features. However, only limited data are available about pathological eating behaviors throughout adults on the autistic spectrum. The aim of the present study is to assess dysfunctional eating behaviors, including EDs manifestations and ASDs-related eating disturbances, in a population of adults with ASDs without intellectual disabilities. We recruited 106 adults on the autistic spectrum, without intellectual disability and 103 neurotypical adults (NAs). Participants completed the « Eating Attitude Test » (EAT-26), to measure symptoms and concerns characteristic of EDs, and the « Swedish Eating Assessment for Autism Spectrum Disorders » (SWEAA), to assess eating behaviors frequently observed within the autistic spectrum. Participants with ASDs scored significantly higher than NA at the EAT-26 and at the SWEAA. Moreover, participants with ASDs scored higher than NA at the EAT-26 subscales Dieting and Bulimia. The difference between groups remained significant after controlling for the effect of age, biological sex, and BMI. These results suggest that adults with ASDs without intellectual disability presented not only a higher prevalence of eating disturbances typical of the autistic spectrum, but also other symptoms of EDs in comparison to NA. LAY SUMMARY : For both scales assessing eating disturbances (EAT-26 and SWEAA), participants with ASDs scored higher than NA, presenting a higher prevalence both of eating disturbances typical of ASDs and of ED symptoms (distorted body image, tendency toward bulimic behaviors, and self-control of eating).

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5. Di Renzo M, di Castelbianco FB, Alberto V, Antonio DV, Giovanni C, Vanadia E, Petrillo M, Davide T, Racinaro L, Rea M. Prognostic factors and predictors of outcome in children with autism spectrum disorder : the role of the paediatrician. Italian journal of pediatrics. 2021 ; 47(1) : 67.

BACKGROUND : Autism spectrum disorder is a complex condition with wide variation in type and severity that involves persistent challenges in social interaction, speech and nonverbal communication, restricted/repetitive behaviours and adaptive behaviours. In recent years, research has deepened the study of the predictive factors of optimal outcome, intended as indicators of positive trajectory in children with a previous diagnosis of autism who, after a therapeutic path, show a significant reduction in the « core » symptoms of autism and a positive evolution in social, adaptive, affective, and relational skills. METHODS : The study included 40 children aged 21 to 66 months, enrolled between 2015 and 2016 for an autism spectrum disorder clinical suspicious. Children were re-evaluated after at least 2 years of therapy and they were divided into two groups : the ASD-ASD group included children with a confirmed diagnosis of ASD, and the ASD-OO comparison group included children who no longer met the criteria for an autism classification. The aim of this retrospective study was to investigate the presence of cognitive, emotional and relational predictors capable of predicting the presence of optimal outcome in with a diagnosis of autism ; the predictors taken into consideration were the intelligence quotient, the play, the emotional contagion and the understanding of other’s intentions. In this way, it is possible to support clinicians in defining a more complete diagnostic framework of autism, using assessment tools that can be administered quickly and therefore suitable for short observation sessions in paediatric patients. RESULTS : The findings showed that 15 out of 40 children, after at least for 2 years, no longer fell into the diagnostic ASD category based on the ADOS-2, DSM-5 and clinical criteria. The children in the ASD-OO group initially had a higher IQ than those in the ASD-ASD group, lower severity of autistic symptoms, greater understanding of intentions, more emotional contagion, and better quality of play. The results suggest that the initial coexistence of skills in these areas at the time of the first diagnostic assessment may allow us to predict the possibility of achieving optimal outcome after 2 years of therapy. CONCLUSIONS : The data of this study highlight the importance of considering, during assessment, intelligence quotient, play, emotional contagion, and understanding of the intentions of others as potential prognostic predictors that can become useful tools for clinicians and paediatricians. This allows us to focus attention, in both the diagnostic and prognostic phases, on emotional-relational variables that can support the clinician in defining a more complete diagnostic framework and in planning a more personalized therapeutic path.

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6. Kim SY, Kim YA, Song DY, Bong G, Kim JM, Kim JH, Yoo HJ. State and Trait Anxiety of Adolescents with Autism Spectrum Disorders. Psychiatry investigation. 2021.

OBJECTIVE : This study examined how state and trait anxiety of adolescents with autism spectrum disorders (ASD) are associated with their demographic characteristics, repetitive and restricted behaviors (RRBs), and internalizing and externalizing problem behaviors. METHODS : A total of 96 participants with ASD (mean age=14.30 years ; 91 males) completed a battery of tests including the State/Trait Anxiety Inventory (STAI), the Autism Diagnostic Interview-Revised, the Social Responsiveness Scale (SRS), and a cognitive test measuring intelligence quotient (IQ). Participants’ parents completed the Child Behavior Checklist (CBCL). Pearson’s correlations among age, IQ, two subscales of the STAI (i.e., STAIS and STAIT, measuring self-reported state and trait anxiety, respectively), and the Anxiety subscale of CBCL (i.e., CBCL-Anxiety, measuring parent-reported trait anxiety) were computed. Subsequently, Pearson’s correlations were computed among the three anxiety measures, RRBs, and problem behaviors, while controlling for participants’ age and IQ. RESULTS : The STAIS and CBCL-Anxiety were both significantly correlated with higher age, sensory sensitivity, depressive symptoms, somatic complaints, and aggressive behaviors. All three anxiety variables were significantly and positively correlated with total SRS RRB scores. Additionally, the STAIS and STAIT were significantly associated with more severe Compulsion/Adherence behaviors, and the CBCL-Anxiety was also significantly associated with more severe Rule-breaking Behaviors. CONCLUSION : Self-reported state anxiety showed association patterns similar to those of parent-reported trait anxiety. Future studies investigating the precise operationalization of different anxiety instruments are needed to accurately measure the anxiety of adolescents with ASD.

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7. Lillie MA, Harman MJ, Hurd M, Smalley MR. Increasing passive compliance to wearing a facemask in children with autism spectrum disorder. Journal of applied behavior analysis. 2021.

The current study taught 6 children with autism spectrum disorder (ASD) to increase passive compliance of wearing a facemask across sequentially increasing durations of time. A changing-criterion design embedded within a nonconcurrent multiple baseline design was used to evaluate the effectiveness of a resetting differential reinforcement of other behavior (DRO) without escape extinction procedure on passive compliance. Terminal probe sessions determined DRO fading intervals. Results showed that 2 participants acquired mastery level passive compliance (30 min) without fading during the initial baseline sessions. The remaining 4 participants acquired mastery level passive compliance following fading intervals within the DRO intervention. Participants’ passive compliance generalized across 2 novel settings. This study replicates previous studies and extends empirical support for the use of DRO without escape extinction interventions for increasing passive compliance with medical devices in children with ASD.

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8. Lyall K, Ames JL, Pearl M, Traglia M, Weiss LA, Windham GC, Kharrazi M, Yoshida CK, Yolken R, Volk HE, Ashwood P, Van de Water J, Croen LA. A profile and review of findings from the Early Markers for Autism study : unique contributions from a population-based case-control study in California. Mol Autism. 2021 ; 12(1) : 24.

BACKGROUND : The Early Markers for Autism (EMA) study is a population-based case-control study designed to learn more about early biologic processes involved in ASD. METHODS : Participants were drawn from Southern California births from 2000 to 2003 with archived prenatal and neonatal screening specimens. Across two phases, children with ASD (n = 629) and intellectual disability without ASD (ID, n = 230) were ascertained from the California Department of Developmental Services (DDS), with diagnoses confirmed according to DSM-IV-TR criteria based on expert clinical review of abstracted records. General population controls (GP, n = 599) were randomly sampled from birth certificate files and matched to ASD cases by sex, birth month and year after excluding individuals with DDS records. EMA has published over 20 papers examining immune markers, endogenous hormones, environmental chemicals, and genetic factors in association with ASD and ID. This review summarizes the results across these studies, as well as the EMA study design and future directions. RESULTS : EMA enabled several key contributions to the literature, including the examination of biomarker levels in biospecimens prospectively collected during critical windows of neurodevelopment. Key findings from EMA include demonstration of elevated cytokine and chemokine levels in maternal mid-pregnancy serum samples in association with ASD, as well as aberrations in other immune marker levels ; suggestions of increased odds of ASD with prenatal exposure to certain endocrine disrupting chemicals, though not in mixture analyses ; and demonstration of maternal and fetal genetic influence on prenatal chemical, and maternal and neonatal immune marker and vitamin D levels. We also observed an overall lack of association with ASD and measured maternal and neonatal vitamin D, mercury, and brain-derived neurotrophic factor (BDNF) levels. LIMITATIONS : Covariate and outcome data were limited to information in Vital Statistics and DDS records. As a study based in Southern California, generalizability for certain environmental exposures may be reduced. CONCLUSIONS : Results across EMA studies support the importance of the prenatal and neonatal periods in ASD etiology, and provide evidence for the role of the maternal immune response during pregnancy. Future directions for EMA, and the field of ASD in general, include interrogation of mechanistic pathways and examination of combined effects of exposures.

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9. Martins D, Paduraru M, Paloyelis Y. Heterogeneity in response to repeated intranasal oxytocin in schizophrenia and autism spectrum disorders : a meta-analysis of variance. British journal of pharmacology. 2021.

Intranasal oxytocin (OT) has been suggested as a putative adjunctive treatment for patients with schizophrenia and autism spectrum disorders (ASD). Here, we examine available evidence from trials investigating the effects of repeated administrations of intranasal OT on the core symptoms of patients with schizophrenia and ASD, focusing on its therapeutic efficacy and heterogeneity of response (meta-analysis of variance). The repeated administration of intranasal OT does not improve most of the core symptoms of schizophrenia and ASD, beyond a small tentative effect on schizophrenia general symptoms. However, we found significant moderator effects for dose in schizophrenia total psychopathology and positive symptoms, and percentage of included men and duration of treatment in schizophrenia general symptoms. We found evidence of heterogeneity (increased variance) in the response of schizophrenia negative symptoms to intranasal OT compared to placebo, which supports the idea that subgroups of responsive and non-responsive patients might coexist. For other core symptoms of schizophrenia, or any of the core symptom dimensions in ASD, the response to repeated treatment with intranasal OT did not show evidence of heterogeneity.

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10. Oh M, Song DY, Bong G, Yoon NH, Kim SY, Kim JH, Kim J, Yoo HJ. Validating the Autism Diagnostic Interview-Revised in the Korean Population. Psychiatry investigation. 2021.

OBJECTIVE : This study aimed to examine the validity of the Korean version of the Autism Diagnostic Interview-Revised (K-ADI-R) and determine its efficacy in identifying individuals with autism spectrum disorder (ASD). METHODS : Data were pooled from several past and ongoing studies as well as clinical records acquired at Seoul National University Bundang Hospital from 2008 to 2017. The K-ADI-R were administered and scored by trained research reliable examiners. Measurements to investigate the validity of the K-ADI-R was through sensitivity, specificity, positive predictive values (PPV), negative predictive values (NPV), and Cohen’s kappa. RESULTS : A total of 1,271 (age 88.9±62.42 months, male=927) participants were included. The K-ADI-R yielded strong psychometric properties with high sensitivity (86.06-99.27%), specificity (84.75-99.55%), PPV (92.33-99.72%), and NPV (79.43-98.64%). There were significant differences in item scores across the K-ADI-R diagnostic algorithm regardless of age and sex (p<0.001). Agreement between the K-ADI-R and other ASD related measurements ranged between levels of good to excellent. CONCLUSION : Despite language or cultural boundaries, the K-ADI-R demonstrated high levels of sensitivity, specificity, PPV, and NPV within a wide range of participants ; hence, suggesting promising usage as a valuable diagnostic instrument for individuals with ASD.

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11. Pandina G. The role of digital medicine in autism spectrum disorder. Eur Neuropsychopharmacol. 2021.

The field of digital medicine is concerned with the use of technologies as tools for measurement and intervention in the service of human health (Coravos et al, 2019), and may facilitate development of improved therapies for ASD. The use of established and emerging technologies to diagnose, assess, treat, and coordinate care expanded widely over the past ten years. Technologic advances promise to foster earlier and more accurate diagnosis, improved disposition, treatment access and planning, and provide better outcomes and quality of life for individuals with ASD. Two main areas are reviewed below : 1) assessment diagnosis, and outcome, and ; 2) digital therapeutics.

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12. Siracusano M, Riccioni A, Fagiolo I, Segatori E, Gialloreti LE, Galasso C, Curatolo P, Mazzone L. COVID-19 and social responsiveness : A comparison between children with Sotos syndrome and autismwwwww. Psychiatry Res. 2021 ; 299 : 113851.

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13. Skripkauskaite S, Slade L, Mayer J. Attentional shifting differences in autism : Domain general, domain specific or both ?. Autism. 2021 : 13623613211001619.

Previous research has shown that autistic individuals look at other people less and orient to them more slowly than others. Yet, it is still unclear if this represents general visual differences (e.g. slower looking at any new information, social or not) or a uniquely social difference (e.g. only slower looking to humans but not objects). Here, we aimed to examine how quickly autistic and non-autistic adults look to and away from social (i.e. faces) and non-social information (i.e. squares and houses). We used an attentional shifting task with two images where sometimes the first image disappears before the new image appears (makes it easier to notice the new image) and other times it stays on the screen when the new image appears. In Experiment 1, we showed schematic faces and squares to 27 autistic and 26 non-autistic adults, and in Experiment 2, we showed photographs of faces and houses to 18 autistic and 17 non-autistic adults. In general, autistic adults looked at the new non-social or social images similarly to non-autistic adults. Yet, only autistic adults looked at new social information faster when the first image disappeared before the new image appeared. This shows that autistic individuals may find it easier to notice new social information if their attention is not already occupied.

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14. Yingling ME, Ruther MH, Dubuque EM, Mandell DS. County-level variation in geographic access to Board Certified Behavior Analysts among children with Autism Spectrum Disorder in the United States. Autism. 2021 : 13623613211002051.

This study looked at whether access to Board Certified Behavior Analysts for children with autism spectrum disorder is different between U.S. counties. The study included all U.S. counties and county equivalents in 48 states and D.C. (N = 3108). Between March and May 2019, we combined data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. We assigned Board Certified Behavior Analysts to counties based on their address, matched children in school districts to counties, and determined how many children with autism spectrum disorder there were in a county compared with how many Board Certified Behavior Analysts there were in a county. The results show uneven numbers of Board Certified Behavior Analysts between U.S. counties. More than half of all counties had no Board Certified Behavior Analysts. National maps illustrate clusters of high and low accessibility to Board Certified Behavior Analysts. To improve access to Board Certified Behavior Analysts in underserved areas, we must identify what contributes to the differences in access.

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15. Zhang Y, Zeng J, Wu D, Li X, Chen Y, Dai S, Wang B, Qi Y, Lu J. Effect and safety of acupuncture for autism spectrum disorders : A protocol for systematic review and meta-analysis. Medicine. 2021 ; 100(11) : e22269.

BACKGROUND : Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, which is characterized by impairment in social interaction or communication and lack of flexibility of imagination and behavior. Acupuncture is one of the most common modality of Traditional Chinese medicine (TCM) and has been used to treat various disease in clinical practice for more than 2000 years in China by correcting disharmony and dysregulation of body. It has sometimes been used as a treatment aimed at improving ASD symptoms and outcomes, but its clinical effectiveness and safety has not been rigorously reviewed. We will plan to conduct a systematic review and meta-analysis to summarize the current evidence on the effects and safety of acupuncture for ASD. METHODS : The following databases will be searched : PubMed, the Cochrane Library, Embase, Wanfang Data, China National Knowledge Infrastructure, SinoMed, and VIP. Randomised controlled trials will be included to evaluate the effect and safety of acupuncture on patients with ASD. The primary outcome will be the core features of ASD. The risk of bias will be assessed by the Cochrane risk of bias tool. We will conduct a meta-analysis and sensitivity analysis, as well as a subgroup analysis if high heterogeneity is present, using Revman 5.3. We will use funnel plots to identify potential reporting biases. The Grading of Recommendations Assessment, Development and Evaluation will be used to evaluate the quality of evidence. RESULTS : This study will be to assess the effect and safety of acupuncture for ASD. CONCLUSIONS : This study will assess the effect of acupuncture for ASD and provide reliable evidence for the choice of treatments. ETHICS AND DISSEMINATION : The protocol will not need ethical approval because no issues of participant privacy exist. The results of this systematic review will provide evidence about the effect and safety of acupuncture for ASD. The results will be disseminated through peer review.

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