1. Al-Mubarak B, Abouelhoda M, Omar A, AlDhalaan H, Aldosari M, Nester M, Alshamrani HA, El-Kalioby M, Goljan E, Albar R, Subhani S, Tahir A, Asfahani S, Eskandrani A, Almusaiab A, Magrashi A, Shinwari J, Monies D, Al Tassan N. {{Whole exome sequencing reveals inherited and de novo variants in autism spectrum disorder: a trio study from Saudi families}}. {Sci Rep};2017 (Jul 18);7(1):5679.
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with genetic and clinical heterogeneity. The interplay of de novo and inherited rare variants has been suspected in the development of ASD. Here, we applied whole exome sequencing (WES) on 19 trios from singleton Saudi families with ASD. We developed an analysis pipeline that allows capturing both de novo and inherited rare variants predicted to be deleterious. A total of 47 unique rare variants were detected in 17 trios including 38 which are newly discovered. The majority were either autosomal recessive or X-linked. Our pipeline uncovered variants in 15 ASD-candidate genes, including 5 (GLT8D1, HTATSF1, OR6C65, ITIH6 and DDX26B) that have not been reported in any human condition. The remaining variants occurred in genes formerly associated with ASD or other neurological disorders. Examples include SUMF1, KDM5B and MXRA5 (Known-ASD genes), PRODH2 and KCTD21 (implicated in schizophrenia), as well as USP9X and SMS (implicated in intellectual disability). Consistent with expectation and previous studies, most of the genes implicated herein are enriched for biological processes pertaining to neuronal function. Our findings underscore the private and heterogeneous nature of the genetic architecture of ASD even in a population with high consanguinity rates.
Lien vers le texte intégral (Open Access ou abonnement)
2. Chen W, Chalhub EG. {{Inattention and Poor Eye Contact Is Not All Autism}}. {Clin Pediatr (Phila)};2017 (Aug);56(9):873-875.
Lien vers le texte intégral (Open Access ou abonnement)
3. Constantino JN, Kennon-McGill S, Weichselbaum C, Marrus N, Haider A, Glowinski AL, Gillespie S, Klaiman C, Klin A, Jones W. {{Infant viewing of social scenes is under genetic control and is atypical in autism}}. {Nature};2017 (Jul 20);547(7663):340-344.
Long before infants reach, crawl or walk, they explore the world by looking: they look to learn and to engage, giving preferential attention to social stimuli, including faces, face-like stimuli and biological motion. This capacity-social visual engagement-shapes typical infant development from birth and is pathognomonically impaired in children affected by autism. Here we show that variation in viewing of social scenes, including levels of preferential attention and the timing, direction and targeting of individual eye movements, is strongly influenced by genetic factors, with effects directly traceable to the active seeking of social information. In a series of eye-tracking experiments conducted with 338 toddlers, including 166 epidemiologically ascertained twins (enrolled by representative sampling from the general population), 88 non-twins with autism and 84 singleton controls, we find high monozygotic twin-twin concordance (0.91) and relatively low dizygotic concordance (0.35). Moreover, the characteristics that are the most highly heritable, preferential attention to eye and mouth regions of the face, are also those that are differentially decreased in children with autism (chi2 = 64.03, P < 0.0001). These results implicate social visual engagement as a neurodevelopmental endophenotype not only for autism, but also for population-wide variation in social-information seeking. In addition, these results reveal a means of human biological niche construction, with phenotypic differences emerging from the interaction of individual genotypes with early life experience. Lien vers le texte intégral (Open Access ou abonnement)
4. DeMayo MM, Song YJC, Hickie IB, Guastella AJ. {{A Review of the Safety, Efficacy and Mechanisms of Delivery of Nasal Oxytocin in Children: Therapeutic Potential for Autism and Prader-Willi Syndrome, and Recommendations for Future Research}}. {Paediatr Drugs};2017 (Jul 18)
In this article, we conduct a comprehensive review of existing evidence for the safety and therapeutic potential of intranasal oxytocin in pediatric populations. Unique considerations for dosing and delivery of oxytocin to the nasal passageway in pediatric populations and methods to promote adherence are reviewed. Intranasal oxytocin has been administered to 261 children in three open-label studies and eight randomized controlled trials. To date, the only published results in pediatric populations have focused on autism spectrum disorder (ASD) and Prader-Willi syndrome (PWS). Results regarding efficacy for improving social impairment in ASD are equivocal, partially due to mixed methodological designs, dosing regimens, and outcome measures. At present, there is no randomized controlled evidence that oxytocin provides benefit to individuals with PWS. There is no clear evidence of a link between oxytocin administration and any specific adverse event. Adverse events have been assessed using medical interviews, open reports, checklists, and physiological assessments. Adverse events reports have been largely classified as mild (n = 93), with few moderate (n = 9) or severe (n = 3) events reported. There were 35 additional adverse events reported, without severity ratings. Severe events, hyperactivity and irritability, occurred at first administration in both placebo and oxytocin groups, and subsided subsequent to discontinuation. We note that adverse event monitoring is inconsistent and often lacking, and reporting of its relationship to the study drug is poor. Only one study reported adherence data to suggest high adherence. Recommendations are then provided for the delivery of nasal sprays to the nasal passageway, monitoring, and reporting of efficacy, safety, and adherence for oxytocin nasal spray trials in pediatric populations.
Lien vers le texte intégral (Open Access ou abonnement)
5. Filipe MG, Watson L, Vicente SG, Frota S. {{Atypical preference for infant-directed speech as an early marker of autism spectrum disorders? A literature review and directions for further research}}. {Clin Linguist Phon};2017 (Jul 20):1-19.
Autism spectrum disorders (ASD) refer to a complex group of neurodevelopmental disorders causing difficulties with communication and interpersonal relationships, as well as restricted and repetitive behaviours and interests. As early identification, diagnosis, and intervention provide better long-term outcomes, early markers of ASD have gained increased research attention. This review examines evidence that auditory processing enhanced by social interest, in particular auditory preference of speech directed towards infants and young children (i.e. infant-directed speech – IDS), may be an early marker of risk for ASD. Although this review provides evidence for IDS preference as, indeed, a potential early marker of ASD, the explanation for differences in IDS processing among children with ASD versus other children remains unclear, as are the implications of these impairments for later social-communicative development. Therefore, it is crucial to explore atypicalities in IDS processing early on development and to understand whether preferential listening to specific types of speech sounds in the first years of life may help to predict the impairments in social and language development.
Lien vers le texte intégral (Open Access ou abonnement)
6. Fulton AM, Paynter JM, Trembath D. {{Gender comparisons in children with ASD entering early intervention}}. {Res Dev Disabil};2017 (Sep);68:27-34.
BACKGROUND: Males are diagnosed with Autism Spectrum Disorder (ASD) approximately four times as often as females. This has led to interest in recent years of potential under-diagnosis of females, as well as negative consequences for females with ASD due to under-identification. A number of potential explanations for gender bias in diagnosis are discussed including that females and males may present differently despite showing the same core symptoms. Previous research has shown inconsistent findings in comparisons between genders in young children with ASD for whom early intervention is vital. Thus, the aim of the present study was to investigate the social, communication, and cognitive functioning, as well as level of ASD symptoms, in a cohort of children who presented for early intervention to inform understanding of gender differences in this population, as well as to inform understanding of the mechanisms by which gender bias may occur. METHOD: Participants included 254 children (42 females) aged 29-74 months who completed measures of cognition, communication skills, adaptive behaviour, and ASD symptoms on entry to early intervention. RESULTS: Consistent with hypotheses, no significant gender differences were found both overall, and when split by functioning level. However, a similar ratio of males and females was found in both high- and low-functioning groups contrary to predictions. CONCLUSIONS: These results are consistent with some of the previous research that suggests gender differences may not be apparent in clinical samples at this young age. We highlight a need for further research that may use universal screening or longitudinal methods to understand the trajectory of development for females with ASD specifically. Such research could better inform timely and tailored intervention from the preschool years onwards.
Lien vers le texte intégral (Open Access ou abonnement)
7. Haruvi-Lamdan N, Horesh D, Golan O. {{PTSD and Autism Spectrum Disorder: Co-morbidity, Gaps in Research, and Potential Shared Mechanisms}}. {Psychol Trauma};2017 (Jul 20)
BACKGROUND: While autism and trauma were often linked in psychoanalytic theory, very few scientific attempts have been made to explore the associations and comorbidity between the two. Instead, each area has grown separately, yielding large bodies of theoretical and clinical knowledge. THEORETICAL FRAMEWORK: In this article, we suggest several possible pathways that may link trauma and autism. First, autism spectrum disorder (ASD) may serve as a vulnerability marker for posttraumatic stress disorder (PTSD), specifically by increasing the risk for exposure to traumatic events. Second, PTSD, once it has appeared, may exacerbate certain ASD symptoms, for example, through maladaptive coping strategies and reduced help-seeking. Third, there may be shared underlying mechanisms for PTSD and ASD, including neurological abnormalities associated with both disorders, as well as cognitive and behavioral mechanisms, such as increased rumination, cognitive rigidity, avoidance, anger, and aggression. In addition, the unique characteristics of ASD may determine which events are experienced as particularly traumatic (e.g., social insults and degradation, sensory overstimulation, abrupt changes in known routines) and affect both the manifestation and severity of posttraumatic sequelae among diagnosed individuals. CONCLUSIONS AND RECOMMENDATIONS: Research conducted separately in the areas of PTSD and ASD strongly suggests several potential pathways connecting both disorders. We conclude that there is a pressing need for more PTSD-ASD research, focusing not only on the prevalence of traumatic stress in individuals with autism, but also on their potentially unique perception of traumatic events, particularly from the social sphere. Such research may carry important clinical implications. (PsycINFO Database Record
Lien vers le texte intégral (Open Access ou abonnement)
8. Hatfield M, Murray N, Ciccarelli M, Falkmer T, Falkmer M. {{Pilot of the BOOST-A: An online transition planning program for adolescents with autism}}. {Aust Occup Ther J};2017 (Jul 19)
BACKGROUND: Many adolescents with autism face difficulties with the transition from high school into post-school activities. The Better OutcOmes & Successful Transitions for Autism (BOOST-A) is an online transition planning program which supports adolescents on the autism spectrum to prepare for leaving school. This study describes the development of the BOOST-A and aimed to determine the feasibility and viability of the program. METHODS: Two pilot studies were conducted. In Pilot A, the BOOST-A was trialled by six adolescents on the autism spectrum, their parents, and the professionals who worked with them, to determine its feasibility. In Pilot B, 88 allied health professionals (occupational therapists, speech pathologists, and psychologists) reviewed the BOOST-A to determine its viability. RESULTS: Participants rated the BOOST-A as a feasible tool for transition planning. The majority of allied health professionals agreed that it was a viable program. Based on participant feedback, the BOOST-A was modified to improve usability and feasibility. CONCLUSION: The BOOST-A is a viable and feasible program that has the potential to assist adolescents with autism in preparing for transitioning out of high school. Future research will determine the effectiveness of the BOOST-A with adolescents across Australia.
Lien vers le texte intégral (Open Access ou abonnement)
9. Higashida H, Yuhi T, Akther S, Amina S, Zhong J, Liang M, Nishimura T, Liu HX, Lopatina O. {{Oxytocin release via activation of TRPM2 and CD38 in the hypothalamus during hyperthermia in mice: Implication for autism spectrum disorder}}. {Neurochem Int};2017 (Jul 20)
Oxytocin (OT) is a critical molecule for social recognition that mediates social and emotional behaviors. OT is released during stress and acts as an anxiolytic factor. To know the precise molecular mechanisms underlying OT release into the brain during stress is important. It has been reported that intracellular concentrations of free calcium in the hypothalamic neurons are elevated by simultaneous stimulation of cyclic ADP-ribose (cADPR) and heat. We have reported in vitro and in vivo data that supports the idea that release of OT in the brain of male mice is regulated by cADPR and fever in relation to stress conditions. 1) Significantly higher levels of OT release were observed in hypothalamus cultures isolated from subordinate mice in group-housed males compared to dominant males after cage-switch stress; 2) OT concentrations in micro-perfusates at the paraventricular nucleus upon perfusion stimulation with cADPR were enhanced in subordinate mice compared to dominant mice; 3) The OT concentration in the cerebrospinal fluid (CSF) was higher in endotoxin-shock mice with fever compared to controls with no body temperature increase; and 4) In mice exposed to new environmental stress, the CSF OT level transiently increased 5 min after exposure, while the rectal temperature increased from 36.6 degrees C to 37.8 degrees C from 5 to 15 min after exposure. In this review, we examine whether or not cADPR and hyperthermia co-regulate hypothalamic OT secretion during social stress through the elevation of intracellular free Ca2+ concentrations involved in CD38-dependent Ca2+ mobilization and TRPM2-dependent Ca2+ influx. Finally, we propose that the interaction between CD38 and TRPM2 seems to be a new mechanism for stress-induced release of OT, which may result in anxiolytic effects for temporal recovery from social impairments in children with autism spectrum disorder during hyperthermia.
Lien vers le texte intégral (Open Access ou abonnement)
10. Khramova TV, Kaysheva AL, Ivanov YD, Pleshakova TO, Iourov IY, Vorsanova SG, Yurov YB, Schetkin AA, Archakov AI. {{Serologic Markers of Autism Spectrum Disorder}}. {J Mol Neurosci};2017 (Aug);62(3-4):420-429.
According to WHO data, about 67 million people worldwide are affected by autism, and this number grows by 14% annually. Among the possible causes of autism are genetic modifications, organic lesions of the central nervous system, metabolic disorders, influence of viral and bacterial infections, chemical influence to the mother’s body during pregnancy, etc. The conducted research shows that research papers published until today do not name any potential protein markers that meet the requirements of the basic parameters for evaluating the efficiency of disease diagnostics, in particular high sensitivity, specificity, and accuracy. Conducting proteomic research on a big scale in order to detect serologic markers of protein nature associated with development of autism spectrum disorders seems to be highly relevant.
Lien vers le texte intégral (Open Access ou abonnement)
11. Kuiper MWM, Verhoeven EWM, Geurts HM. {{Heart rate variability predicts inhibitory control in adults with autism spectrum disorders}}. {Biol Psychol};2017 (Jul 15)
Several studies suggest that inhibition difficulties among people with ASD might be related to atypical cardiac vagal control. We examined how low versus high baseline heart rate variability (HRV) influences prepotent response inhibition in 31 males with autism spectrum disorder (ASD; mean age: 32.2; mean IQ: 107.8) compared to 39 typically developing (TD) males (mean age: 30.5; mean IQ: 102.0) by administering a stop signal task. Moreover, we examined whether adding an affective manipulation would alter findings and whether this manipulation affected HRV. Findings indicated that baseline HRV influenced inhibition in ASD males. Specifically, an ASD subgroup with low baseline HRV performed significantly worse compared to an ASD subgroup with high baseline HRV. No influence of baseline HRV was found in TD males. The affective manipulation did negatively influence performance and also altered HRV. Although replication is required, these first findings indicate that baseline cardiac vagal control seems to affect inhibitory control in males with ASD.
Lien vers le texte intégral (Open Access ou abonnement)
12. Lunsky Y, Weiss JA, Paquette-Smith M, Durbin A, Tint A, Palucka AM, Bradley E. {{Predictors of emergency department use by adolescents and adults with autism spectrum disorder: a prospective cohort study}}. {BMJ Open};2017 (Jul 18);7(7):e017377.
OBJECTIVES: To determine predictors of emergency department (ED) visits in a cohort of adolescents and adults with autism spectrum disorder (ASD). DESIGN: Prospective cohort study. SETTING: Community-based study from Ontario, Canada. PARTICIPANTS: Parents reported on their adult sons and daughters with ASD living in the community (n=284). MAIN OUTCOME MEASURES: ED visits for any reason, ED visits for medical reasons and ED visits for psychiatric reasons over 1 year. RESULTS: Among individuals with ASD, those with ED visits for any reason were reported to have greater family distress at baseline (p<0.01), a history of visiting the ED during the year prior (p<0.01) and experienced two or more negative life events at baseline (p<0.05) as compared with those who did not visit the ED. Unique predictors of medical versus psychiatric ED visits emerged. Low neighbourhood income (p<0.01) and living in a rural neighbourhood (p<0.05) were associated with medical but not psychiatric ED visits, whereas a history of aggression (p<0.05) as well as being from an immigrant family (p<0.05) predicted psychiatric but not medical emergencies. CONCLUSIONS: A combination of individual and contextual variables may be important for targeting preventative community-based supports for individuals with ASD and their families. In particular, attention should be paid to how caregiver supports, integrative crisis planning and community-based services may assist in preventing or minimising ED use for this vulnerable population. Lien vers le texte intégral (Open Access ou abonnement)
13. McAuliffe T, Cordier R, Vaz S, Thomas Y, Falkmer T. {{Quality of Life, Coping Styles, Stress Levels, and Time Use in Mothers of Children with Autism Spectrum Disorders: Comparing Single Versus Coupled Households}}. {J Autism Dev Disord};2017 (Jul 20)
This study aimed to examine the influence of differences in household status on the parental stress, coping, time use and quality of life (QoL) among mothers of children with autism spectrum disorders. Forty-three single and 164 coupled mothers completed the survey. Data were analysed using multivariate logistic regression. We found that single mothers were 1.05 times more likely to report lower levels of environmental QoL. Whilst they were 1.73 times more likely to use acceptance coping style, this association did not persist after adjusting for total number of children, household income and employment status. There was no difference in time use and stress between these mothers. Possible environmental issues for single mothers and implications for future research are discussed.
Lien vers le texte intégral (Open Access ou abonnement)
14. Powell PS, Klinger LG, Klinger MR. {{Patterns of Age-Related Cognitive Differences in Adults with Autism Spectrum Disorder}}. {J Autism Dev Disord};2017 (Jul 20)
Little is known about age-related cognitive differences in autism spectrum disorder (ASD). However, given the overlap in cognitive impairments in ASD to those seen in typical aging, it is possible that adults with ASD will face even greater cognitive difficulties as they age. The current study used a cross-sectional design to examine age-related cognitive differences in adults with ASD and age and IQ-matched adults with typical development (age range 30-67 years). Results indicated that both age and diagnosis were related to poorer cognitive performance. However, adults with ASD exhibited pronounced age effects on measures related to executive functioning compared to adults with typical development, suggesting that aging in ASD may disproportionately affect specific cognitive processes.
Lien vers le texte intégral (Open Access ou abonnement)
15. Rajan-Babu IS, Lian M, Cheah FSH, Chen M, Tan ASC, Prasath EB, Loh SF, Chong SS. {{FMR1 CGG repeat expansion mutation detection and linked haplotype analysis for reliable and accurate preimplantation genetic diagnosis of fragile X syndrome}}. {Expert Rev Mol Med};2017 (Jul 19);19:e10.
Fragile X mental retardation 1 (FMR1) full-mutation expansion causes fragile X syndrome. Trans-generational fragile X syndrome transmission can be avoided by preimplantation genetic diagnosis (PGD). We describe a robust PGD strategy that can be applied to virtually any couple at risk of transmitting fragile X syndrome. This novel strategy utilises whole-genome amplification, followed by triplet-primed polymerase chain reaction (TP-PCR) for robust detection of expanded FMR1 alleles, in parallel with linked multi-marker haplotype analysis of 13 highly polymorphic microsatellite markers located within 1 Mb of the FMR1 CGG repeat, and the AMELX/Y dimorphism for gender identification. The assay was optimised and validated on single lymphoblasts isolated from fragile X reference cell lines, and applied to a simulated PGD case and a clinical in vitro fertilisation (IVF)-PGD case. In the simulated PGD case, definitive diagnosis of the expected results was achieved for all ’embryos’. In the clinical IVF-PGD case, delivery of a healthy baby girl was achieved after transfer of an expansion-negative blastocyst. FMR1 TP-PCR reliably detects presence of expansion mutations and obviates reliance on informative normal alleles for determining expansion status in female embryos. Together with multi-marker haplotyping and gender determination, misdiagnosis and diagnostic ambiguity due to allele dropout is minimised, and couple-specific assay customisation can be avoided.
Lien vers le texte intégral (Open Access ou abonnement)
16. Rhodes G, Burton N, Jeffery L, Read A, Taylor L, Ewing L. {{Facial expression coding in children and adolescents with autism: Reduced adaptability but intact norm-based coding}}. {Br J Psychol};2017 (Jul 19)
Individuals with autism spectrum disorder (ASD) can have difficulty recognizing emotional expressions. Here, we asked whether the underlying perceptual coding of expression is disrupted. Typical individuals code expression relative to a perceptual (average) norm that is continuously updated by experience. This adaptability of face-coding mechanisms has been linked to performance on various face tasks. We used an adaptation aftereffect paradigm to characterize expression coding in children and adolescents with autism. We asked whether face expression coding is less adaptable in autism and whether there is any fundamental disruption of norm-based coding. If expression coding is norm-based, then the face aftereffects should increase with adaptor expression strength (distance from the average expression). We observed this pattern in both autistic and typically developing participants, suggesting that norm-based coding is fundamentally intact in autism. Critically, however, expression aftereffects were reduced in the autism group, indicating that expression-coding mechanisms are less readily tuned by experience. Reduced adaptability has also been reported for coding of face identity and gaze direction. Thus, there appears to be a pervasive lack of adaptability in face-coding mechanisms in autism, which could contribute to face processing and broader social difficulties in the disorder.
Lien vers le texte intégral (Open Access ou abonnement)
17. Shimojima K, Ondo Y, Okamoto N, Yamamoto T. {{A 15q14 microdeletion involving MEIS2 identified in a patient with autism spectrum disorder}}. {Hum Genome Var};2017;4:17029.
We describe a 9-year-old male patient with a 15q14 microdeletion including MEIS2. The patient was born with a ventricular septal defect and submucosal cleft. Mild developmental disability and autism spectrum disorder diagnosed in childhood were also considered to be consequences of MEIS2 haploinsufficiency. The relatively mild developmental delay and lack of additional phenotypic features in this patient indicate that only MEIS2 plays an important role in the observed phenotypic features in the heterozygous state.
Lien vers le texte intégral (Open Access ou abonnement)
18. Shivers CM, Krizova K, Lee GK. {{Types of strain among family members of individuals with autism spectrum disorder across the lifespan}}. {Res Dev Disabil};2017 (Sep);68:42-51.
BACKGROUND: Although increased caregiver strain is often found among family caregivers of individuals with autism spectrum disorder, it is still unclear as to how different types of strain relate to amount and types of caregiving across the lifespan. AIMS: The present study examined different types of strain (i.e. subjective internalized strain, subjective externalized strain, and objective strain) and how such strain relates to the amount of caregiving responsibilities. METHODS: Data was collected via online survey from a sample of 193 family caregivers of individuals with ASD from the United States, Canada, and the Republic of Ireland. Participants completed measures of strain and caregiving responsibilities, as well as coping, demographics, and services needed and received by the individual with ASD. RESULTS: Caregivers reported higher levels of objective strain than subjective, and caregiving responsibility was related to objective and subjective internalized strain. Coping style was strongly correlated with all types of strain, and unmet service needs were significantly related to objective and subjective internalized strain. Caregiving behaviors were only related to objective strain. CONCLUSION: The present results indicate that, although caregiving responsibility is related to objective and subjective internalized strain, the relationship is perhaps not as strong as the relationship between coping mechanisms and strain. Future research is needed to understand different types of strain and develop strategies to help caregivers.
Lien vers le texte intégral (Open Access ou abonnement)
19. Wu J, Jackson L. {{Inverse relationship between urban green space and childhood autism in California elementary school districts}}. {Environ Int};2017 (Jul 20);107:140-146.
Green space has a variety of health benefits. However, little is known about its impact on autism, the fastest-growing neurodevelopmental disorder in children. This study examined the relationship between green space and childhood autism prevalence. Autism count data in 2010 were obtained for 543 of ~560 public elementary school districts in California. Multiple types of green space were measured in each school district, including percentages of forest, grassland, and average tree canopy and near-road tree canopy. Their associations with autism prevalence were evaluated with negative binomial regression models and spatial regression models. We observed inverse associations between several green space metrics and autism prevalence in school districts with high road density, the highly urbanized areas, but not in others. According to negative binomial regression models, adjusted rate ratios (RR) for the relationships in these school districts between autism prevalence and green space metrics in 10% increments were as follows: for forest, RR=0.90 (95% confidence interval [CI]: 0.84-0.95); for grassland, RR=0.90 (95% CI: 0.83-0.97); for average tree canopy, RR=0.89 (95% CI: 0.83-0.95), and for near-road tree canopy, RR=0.81 (95% CI: 0.73-0.91). These results suggest that increases of 10% in forest, grassland, average tree canopy and near-road tree canopy are associated with a decrease in autism prevalence of 10%, 10% 11% and 19%, respectively. In contrast, urban land and road density were positively associated with autism prevalence. The results of spatial regression models were consistent with those obtained by negative binomial models, except for grassland. Our study suggests that green space, specifically tree cover in areas with high road density, may influence autism prevalence in elementary school children beneficially. Further studies are needed to investigate a potential causal relationship, and the major mechanisms that may underlie the beneficial associations with green space, such as buffering traffic-related air pollution and noise.
