1. Abbasi H, Parhiz A, Khoshdooz S, Bakhshimoghaddam F, Doaei S, Gholamalizadeh M. Impact of Omega-3 Fatty Acids Supplementation on Clinical Manifestations in Autism Spectrum Disorders: An umbrella review of meta-analyses. Nutr Res Rev. 2024: 1-27.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition. Omega-3 fatty acids insufficiency has been linked to ASD. This umbrella meta-analysis was performed to investigate the effects of omega-3 supplementation on clinical manifestations in participants with ASD. Based on PRISMA statement, databases including Web of Science, PubMed, and Scopus were systematically searched for published meta-analyses on the effect of omega-3 supplementation on ASD. To assess the risk of bias, the assessment of multiple systematic reviews (AMSTAR)-2 was utilized. The outcomes were core and non-core symptoms of ASD including social withdrawal/lethargy, cluttering speech, hyperactivity, irritability, and stereotypy. Seven meta-analyses eventually remained in the umbrella review. The results revealed that omega-3 fatty acids supplementation caused a significant reduction in cluttering speech in studies conducted on age ≤8 years (ES= -0.30; 95% CI: -0.55, -0.06; P=0.02). Omega-3 supplementation caused a significant reduction in hyperactivity in participants ≤8 years (ES= -0.30; 95% CI: -0.55, -0.06; P=0.02) and in participants who received the supplements for more than 14 weeks (ES= -0.30; 95% CI: -0.55, -0.06; P=0.02). A dosage of ≤1000 mg/d of omega-3 supplementation led to a significant increase in the stereotypy/ restricted and repetitive interests and behaviors (ES= 0.19; 95% CI: 0.03, 0.35; P=0.02). This umbrella review revealed that omega-3 fatty acid may be a beneficial supplement to control cluttering speech and hyperactivity in children lower or equal to 8 years old with ASD.

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2. Carati E, Angotti M, Pignataro V, Grossi E, Parmeggiani A. Exploring sensory alterations and repetitive behaviors in children with autism spectrum disorder from the perspective of artificial neural networks. Res Dev Disabil. 2024; 155: 104881.

BACKGROUND: Restrictive repetitive behaviors (RRBs) and sensory processing disorders are core symptoms of autism spectrum disorder (ASD). Their relationship is reported, but existing data are conflicting as to whether they are related but distinct, or different aspects of the same phenomenon. AIMS: This study investigates this relationship using artificial neural networks (ANN) analysis and an innovative data mining analysis known as Auto Contractive Map (Auto-CM), which allows to discover hidden trends and associations among complex networks of variables (e.g. biological systems). METHODS AND PROCEDURES: The Short Sensory Profile and the Repetitive Behavior Scale-Revised were administered to 45 ASD children’s caregivers (M 78 %; F 22 %; mean age 6 years). Questionnaires’ scores, clinical and demographic data were collected and analyzed applying Auto-CM, and a connectivity map was drawn. OUTCOMES AND RESULTS: The main associations shown by the resulting maps confirm the known relationship between RBBs and sensory abnormalities, and support the existence of sensory phenotypes, and important links between RRBs and sleep disturbance in ASD. CONCLUSIONS AND IMPLICATIONS: Our study demonstrates the usefulness of ANNs application and its easy handling to research RBBs and sensory abnormalities in ASD, with the aim to achieve better individualized rehabilitation technique and improve early diagnosis. PAPER’S CONTRIBUTION: Restricted, repetitive patterns of behaviors and interests and alteration of sensory elaboration are core symptoms of ASD; their impact on patients’ quality of life is known. This study introduces two main novelties: 1) the simultaneous and comparative use of two parent questionnaires (SSP and RBS-R) utilized for RRBs and alteration of sensory profile; 2) the application of ANNs to this kind of research. ANNs are adaptive models particularly suited for solving non-linear problems. While they have been widely used in the medical field, they have not been applied yet to the analysis of RRBs and sensory abnormalities in general, much less in children with ASD. The application of Auto Contractive Map (Auto-CM), a fourth generation ANNs analysis, to a dataset previously explored using classical statistical models, confirmed and expanded the associations emerged between SSP and RBS-R subscales and demographic-clinical variables. In particular, the Low Energy subscale has proven to be the central hub of the system; interesting links have emerged between the subscale Self-Injurious Behaviors and the variable intellectual disability and between sleep disturbance and various RRBs. Expanding research in this area aims to guide and modulate an emerging targeted and personalized rehabilitation therapy.

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3. Cooper K, Burnley A, Allain L, Beresford B, Crane L, Vazquez Morales M, Portway L, Redmayne B, Russell A, Mandy W. Autism Transition to Adulthood Groups (ATAG): protocol for a feasibility RCT of a new peer-group intervention to promote successful transition to adulthood for autistic young people. BMJ Open. 2024; 14(11): e089802.

INTRODUCTION: Autism is a lifelong neurodevelopmental condition diagnosed on the basis of differences in social communication, interaction and repetitive behaviours, including sensory sensitivities. Autistic individuals without intellectual disabilities often face barriers to positive adult outcomes and are at high risk for poor health, including mental health issues, which could be mitigated by improving well-being. Young people should receive support to increase their well-being during the transition to adulthood, when social and family support often reduces. This is the protocol for a feasibility randomised controlled trial (RCT) of an online peer-group intervention, ‘Understanding You, Discovering You’ (UYDY). Objectives included assessing recruitment and retention rates, acceptability of procedures, characterising usual care, assessing the acceptability of UYDY and care as usual (CAU) and calculating outcome measure variances for a full trial. METHODS AND ANALYSIS: This two-arm parallel feasibility RCT includes a nested qualitative evaluation. Seventy participants aged 16-25 years old with a clinical autism diagnosis will be randomised on a 1:1 basis to UYDY or CAU. Exclusion criteria include risk of harm to self or others, receipt of postdiagnostic support in the past 12 months, and literacy levels such that the written session materials are not accessible. UYDY, a 6-week online peer-group intervention, will cover topics such as understanding autism, problem-solving and accessing services, and is facilitated by an autistic person and social care professionals. The main outcomes from the feasibility trial will be collecting data on (1) recruitment and retention rates; (2) the acceptability of randomisation and outcome measurement procedures; (3) CAU accessed by participants; (4) acceptability of the interventions; (5) clinical outcome measure variances (see below). See the Statistical methods section below for how this will be assessed in the current study. Clinical outcomes will be measured at baseline, and 8, 16 and 24 weeks post-randomisation. The primary clinical outcome is well-being, assessed using the Warwick Edinburgh Mental Wellbeing Scale. Secondary clinical outcomes include autism social identification, quality of life, social support and loneliness. Adverse events will be monitored and reported. Carer impact will also be measured. Participants will be recruited from England and Wales via charities and NHS services. Qualitative interviews will be conducted to explore the acceptability of trial participation including randomisation and the interventions. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the HRA and NHS REC (23/WA/0113). Informed consent will be collected from all participants (see online supplemental material for an example consent form). Results will inform the design of a full RCT and will be disseminated through peer-reviewed journals, conferences, and stakeholder events. TRIAL REGISTRATION NUMBER: ISRCTN10513626.

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4. Eisfeldt J, Higginbotham EJ, Lenner F, Howe J, Fernandez BA, Lindstrand A, Scherer SW, Feuk L. Resolving complex duplication variants in autism spectrum disorder using long-read genome sequencing. Genome Res. 2024; 34(11): 1763-73.

Rare or de novo structural variation, primarily in the form of copy number variants, is detected in 5%-10% of autism spectrum disorder (ASD) families. While complex structural variants involving duplications can generally be detected using microarray or short-read genome sequencing (GS), these methods frequently fail to characterize breakpoints at nucleotide resolution, requiring additional molecular methods for validation and fine-mapping. Here, we use Oxford Nanopore Technologies PromethION long-read GS to characterize complex genomic rearrangements (CGRs) involving large duplications that segregate with ASD in five families. In total, we investigated 13 CGR carriers and were able to resolve all breakpoint junctions at nucleotide resolution. While all breakpoints were identified, the precise genomic architecture of one rearrangement remained unresolved with three different potential structures. The findings in two families include potential fusion genes formed through duplication rearrangements, involving IL1RAPL1-DMD and SUPT16H-CHD8 In two of the families originating from the same geographical region, an identical rearrangement involving ANK2 was identified, which likely represents a founder variant. In addition, we analyze methylation status directly from the long-read data, allowing us to assess the activity of rearranged genes and regulatory regions. Investigation of methylation across the CGRs reveals aberrant methylation status in carriers across a rearrangement affecting the CREBBP locus. In aggregate, our results demonstrate the utility of nanopore sequencing to pinpoint CGRs associated with ASD in five unrelated families, and highlight the importance of a gene-centric description of disease-associated complex chromosomal rearrangements.

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5. Failla C, Scarcella I, Vetrano N, Previti S, Mangano RM, Tartarisco G, Vagni D, Pioggia G, Marino F. Autism, intelligence, language, and adaptive behavior, disentangling a complex relationship. Front Psychiatry. 2024; 15: 1411783.

INTRODUCTION: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by a range of intellectual and language abilities. Its heterogeneity is acknowledged in modern diagnostics, complicating research and necessitating precision medicine and a multidimensional approach for individualized treatment and accurate assessment. Intellectual and language functioning influence adaptive skills and symptomatology. Thus, assessing adaptive functioning in a multidimensional and multi-informant manner is crucial, highlighting the importance of comprehensive evaluations. This study explores the interplay between autistic traits, demographic variables, IQ, adaptive functioning, and the applicability of ICD-11 classifications. METHODS: We analyzed data from the initial global evaluation of 60 diverse autistic children (aged 35 to 120 months; IQ range 16 to 118). Parent-reports using the Vineland Adaptive Behavior Scale (VABS-II) were compared with standardized assessments from the PsychoEducational Profile (PEP-3). Children’s intellectual levels were assessed using Griffiths Scales of Child Development (Griffiths III) and the Autism Diagnostic Observation Schedule (ADOS-2) was used for autistic traits. They were further classified according to the ICD-11 diagnostic system, functional language, and intellectual functioning levels. Correlations among variables, group comparisons, and multivariate analyses were performed. RESULTS: The analysis indicates a linear effect of IQ on all adaptive scales and the impact of autistic traits on directly measured adaptive functioning. A factorial effect was observed due to changes concerning specific age, intellectual, and linguistic levels, which do not completely align with ICD-11 categorization. Additionally, a negative correlation between intelligence and measured autistic traits was found. Parental age, education level, and age at childbirth were also found to affect various adaptive scales. DISCUSSION: The study questions the ICD-11’s proposed distinctions in IQ and language functioning for ASD, advocating for more refined categorization and developmental considerations. It underscores the intricate relationship between autistic traits, IQ, and communication skills, casting doubt on the precision of diagnostic tools across the spectrum. Parental reports and direct assessments are essential for comprehensive evaluation, with parental education and age influencing children’s behaviors and skills. The study calls for a nuanced approach to ASD assessment, integrating various metrics and sources of information for a detailed phenotyping necessary for personalized interventions and biological research.

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6. Fang L, Wang Z, Zhao J, Wu X, Wang S, Gao H, Wu D. Association between human herpesviruses infections and childhood neurodevelopmental disorders: insights from two-sample mendelian randomization analyses and systematic review with meta-analysis. Ital J Pediatr. 2024; 50(1): 248.

BACKGROUND: The potential roles of viral infections in neurodevelopmental disorders (NDDs) have been suggested based on previous studies. Given the high prevalence of human herpesviruses (HHVs), the associations between HHVs infection and the risk of NDDs warrant explored. METHODS: Our study employs a two-sample Mendelian randomization (MR) analysis and systematic review with meta-analysis to investigate whether genetically predicted HHVs infection are linked to three main childhood NDDs-autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and Tourette syndrome (TS). We utilized genetic variants associated with HHV infections in genome-wide association study (GWAS) summary datasets of European populations to establish instrumental variables and statistics for three NDDs obtained from Psychiatric Genomics Consortium. MR analysis was performed using inverse-variance weighted, MR Egger, weighted median, simple median, weighted mode, and MR-PRESSO. In addition, publications associating HHVs infection with three NDDs were systematically searched using PubMed, Web of Science, and three Chinese databases for meta-analyses. RESULTS: The MR results found no evidence to support a link between genetically predicted HHVs infection and the risk of NDDs based on existing datasets. Twenty-seven observational studies on children with HHVs infection and NDDs were considered eligible. Meta-analysis showed that cytomegalovirus and HHV-6 infection were related with ASD, while Epstein-Barr virus and cytomegalovirus infection were associated with TD in Chinese population. CONCLUSIONS: These results contribute to a comprehensive understanding of the possibilities underlying HHV infections in affecting childhood NDDs. Further research is necessary to include larger and more robust statistics of HHV infections and NDDs. TRIAL REGISTRATION: This systematic review was registered at PROSPERO as CRD42024554169. Retrospectively registered 26 July 2024.

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7. Geelhand P, Papastamou F, Jaspard S, Kissine M. Autistic adults display different verbal behavior only in mixed-neurotype interactions: Evidence from a referential communication task. Autism. 2024: 13623613241298376.

Recent research shows that in conversations, both participants influence the outcome. More specifically, conversations do not go as smoothly when autistic and non-autistic people talk together compared to when people of the same neurotype (either all autistic or all non-autistic) talk to each other. In studies finding a « same-neurotype communicative advantage », interaction partners knew about each other’s neurotype. Because of this methodological choice, it is unclear whether mixed-neurotype interactions go less smoothly because participants knew they were interacting with a different neurotype or because each neurotype really has a distinct communication style. In our study, 134 adults were grouped into same-sex pairs: 23 autistic, 23 non-autistic, and 21 mixed-neurotype pairs. The pairs did not know if the other person was autistic or not. They completed an online task where the « Director » instructs the « Matcher » to reorder abstract pictures. Pairs did this task in two ways: by typing in a live chat and by speaking into a microphone without video. The study looked at how long the task took and how much the Director talked/wrote. Results showed that non-autistic pairs were faster to complete the task than autistic pairs and mixed pairs, meaning pairs with at least one autistic person were slower in general to complete the task. Interestingly, in mixed pairs, only autistic Directors produced more words than non-autistic Directors, in both typing and speaking. These findings suggest that even without knowing about their partner’s neurotype and seeing/hearing their partner, autistic adults communicate differently when they interact with a non-autistic person.

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8. Gurba AN, McNair ML, Hargreaves A, Scheerer NE, Ng CSM, Lerner MD. Editorial: Break the stigma: autism. The future of research on autism stigma – towards multilevel, contextual & global understanding. Front Psychiatry. 2024; 15: 1504429.

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9. Ibáñez-Sandoval DN, Hidalgo-Balbuena AE, Velázquez Contreras R, Saderi N, Flores G, Rueda-Orozco PE, Ibáñez-Sandoval O. Striatal interneuron imbalance in a valproic acid-induced model of autism in rodents is accompanied by atypical somatosensory processing. eNeuro. 2024.

Autism spectrum disorder (ASD) is characterized by deficits in social interaction and communication, cognitive rigidity, and atypical sensory processing. Recent studies suggest that the basal ganglia, specifically the striatum (NSt), plays an important role in ASD. While striatal interneurons, including cholinergic (ChAT(+)) and parvalbumin-positive (PV(+)) GABAergic neurons, have been described to be altered in animal models of ASD, their specific contribution remains elusive. Here, we combined behavioral, anatomical, and electrophysiological quantifications to explore if interneuron balance could be implicated in atypical sensory processing in cortical and striatal somatosensory regions of rats subjected to a valproic acid (VPA) model of ASD. We found that VPA animals showed a significant decrease in the number of ChAT(+) and PV(+) cells in multiple regions (including the sensorimotor region) of the NSt. We also observed significantly different sensory-evoked responses at the single-neuron and population levels in both striatal and cortical regions, as well as cortico-striatal interactions. Therefore, selective elimination of striatal PV(+) neurons only partially recapitulated the effects of VPA, indicating that the mechanisms behind the VPA phenotype are much more complex than the elimination of a particular neural subpopulation. Our results indicate that VPA exposure induced significant histological changes in ChAT(+) and PV(+) cells accompanied by atypical sensory-evoked cortico-striatal population dynamics that could partially explain the sensory processing differences associated with ASD.Significance Statement One of the main characteristics of patients with autism spectrum disorder (ASD) is the hypo- or hyper-responses to sensory stimuli. Various studies indicate that a possible explanation for these atypical responses is an imbalance in excitation-inhibition modulated by different types of interneurons. In the present work, we provide evidence that a striatal imbalance in ChAT(+) and PV(+) levels could partly explain behavioral and somatosensory processing differences associated with the valproic acid-induced ASD model.

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10. Jin L, Cui H, Zhang P, Cai C. Early diagnostic value of home video-based machine learning in autism spectrum disorder: a meta-analysis. Eur J Pediatr. 2024; 184(1): 37.

Machine learning (ML) based on remote video has shown ideal diagnostic value in autism spectrum disorder (ASD). Here, we conducted a meta-analysis of the diagnostic value of home video-based ML in ASD. Relevant articles were systematically searched in PubMed, Cochrane, Embase, and Web of Science from inception to September 2023 with no language restriction, and the literature search was updated in September 2024. The overall risk of bias and suitability of the ML prediction models in the included studies were assessed using PROBAST. Nineteen articles involving 89 prediction models and 9959 subjects were included. The mean video duration was 5.63 ± 1.23 min, and the mean number of behavioral features during initial modeling was 23.53. Among the 19 included studies, 13 models had been trained. Seven of the 13 models were not cross-validated (c-index = 0.92, 95% CI 0.88-0.96), while 6 of the 13 models were tenfold cross-validated (c-index = 0.95, 95% CI 0.94-0.97). There were 8 validation cohorts (c-index = 0.83, 95% CI 0.77-0.89). The pooled sensitivity and specificity were 0.87 (95% CI 0.77-0.93) and 0.79 (95% CI 0.76-0.81) in the training cohort, 0.90 (95% CI 0.85-0.94) and 0.87 (95% CI 0.72-0.94) in the cross-validation, and 0.81 (95% CI 0.74-0.86) and 0.72 (95% CI 0.68-0.75) in the validation cohort, respectively. These results indicated that this model is a highly sensitive and user-friendly tool for early ASD diagnosis. CONCLUSION: Remote video-based ML may improve clinical practice and future research, particularly by combining advanced technologies such as facial recognition. It is a potential tool for diagnosing ASD in children. WHAT IS KNOWN: • The incidence of pediatric ASD has increased in recent years. • ML based on remote video has shown ideal early diagnostic value. WHAT IS NEW: • The first systematic review and meta-analysis evaluating the diagnostic performance of remote video-based ML for ASD. • Home video-based ML is a valuable diagnostic tool for the early diagnosis of ASD. • Remote video-based ML is convenient and simple to utilize.

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11. Karin E, Geva R, Bar-Yehuda S, Estrugo Y, Bauminger-Zviley N. Movement Coordination’s Link with Common Ground During Dyadic Peer Discourse in Typically Developing and Autistic Speakers. J Autism Dev Disord. 2024.

Common ground (CG)-a pragmatic capability that reflects the construction of shared meaning by two interlocutors during conversation-is widely accepted as crucial for effective communication, but its exploration has been limited in the context of children’s peer-to-peer interaction. Specifically, this study aimed to explore CG differences between typically developing (TD) and autistic populations, CG’s developmental trajectories, as well as the link between CG and motor coordination skills during peer interactions. Study participants included 148 children (6-16 years), comparing 64 TD and 84 autistic children across three age levels. Fixed dyads matched on IQ, age, sex, and mother’s education performed a CG tangram-card task and complementary joint action (JA) tasks to evaluate peer-to-peer movement coordination. Individual motor skills were also assessed. As expected, both autistic and TD groups showed increasing efficacy over the 6-turn CG task (fewer words and shorter duration to communicate), although autistic participants were less efficient than TD participants. Better motor skills and JA synchronization correlated with both groups’ more efficient CG performance. Additionally, the indirect relationship between group (TD/autism) and CG was mediated by motor skills and JA, with age moderating the relationship between JA and CG. Specifically, better motor skills and socio-motor coordination were associated with more efficient CG creation, particularly in younger children (under 10 years). These findings suggest potential novel avenues for early interventions targeting motor and language challenges in autism to enhance pragmatic abilities and peer interactions, offering insights into language development in this population.

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12. Lacroix A, Bennetot-Deveria Y, Baciu M, Dutheil F, Magnon V, Gomot M, Mermillod M. Understanding cognitive flexibility in emotional evaluation in autistic males and females: the social context matters. Mol Autism. 2024; 15(1): 49.

BACKGROUND: Autistic individuals often have difficulty flexibly adjusting their behavior. However, laboratory experiments have yielded inconsistent results, potentially due to various influencing factors, which need to be examined in detail. This study aimed to investigate the hypothesis that the social content of stimuli could play a specific role in some of the flexibility challenges faced by autistic individuals. The second aim was to explore sex differences in this context. METHODS: We analyzed data from 256 adult participants (124 with autism), matched on age, gender, and sex, who performed an emotional shifting task involving unpredictable shifts between positive and negative stimuli. Additionally, the task included both social and non-social conditions. RESULTS: Our results revealed a larger switch cost in the social than in the non-social condition, and this was more pronounced in autistic than in non-autistic individuals. Furthermore, we observed that autistic females differed from autistic males in the non-social condition and from non-autistic females in the social condition. LIMITATIONS: The online nature of the study reduced the control over participant conditions. In addition, further studies are needed to investigate whether these results apply to the broader autism spectrum. CONCLUSIONS: Building on previous research demonstrating a greater switch cost in autistic than non-autistic individuals for socio-emotional stimuli, our study further extends these findings by highlighting that the social context, rather than the emotional nature of the stimuli alone, may play a significant role in the flexibility challenges faced by autistic individuals. Our findings also contribute to the literature on sex differences in autism.

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13. Lee JYS, Whittingham K, Mitchell AE. Parental Acceptance and Understanding of Autistic Children (PAUACS) – an Instrument Development Study. J Autism Dev Disord. 2024.

Currently there are no instruments designed to assess parents’ acceptance and understanding of their autistic child. We aimed to develop and evaluate the reliability and validity of a parent-report scale assessing parents’ acceptance and understanding of their autistic child – the Parental Acceptance and Understanding of Autistic Children Scale (PAUACS). A total of 158 parents (74 non-autistic, 42 autistic, 42 questioning; mean age 42.69 years) of autistic children (mean age 10.80 years) completed an online survey comprising the prototype PAUACS as well as validated measures of parental sensitivity, neurodiversity affirming attitudes, autistic traits, mental health, and child adjustment and family experience. A subsample of participants (n = 97; 61.4%) completed the PAUACS questionnaire a second time, 2 weeks later, to assess for test-retest reliability. The final 30-item scale demonstrated excellent internal reliability (α = 0.89) and test-retest reliability (intraclass correlation = 0.92). Exploratory factor analysis revealed a clean structure comprising four distinct factors: Understanding (α = 0.86), Innate (α = 0.74), Acceptance (α = 0.82), and Expectations (α = 0.73). Overall, the PAUACS demonstrates good construct validity. Preliminary evidence of convergent validity and divergent validity was demonstrated. Preliminary evidence suggests PAUACS is a reliable and valid tool in assessing parents’ acceptance and understanding of autistic children.

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14. Lu H, Wang S, Gao L, Xue Z, Liu J, Niu X, Zhou R, Guo X. Links between brain structure and function in children with autism spectrum disorder by parallel independent component analysis. Brain Imaging Behav. 2024.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder accompanied by structural and functional changes in the brain. However, the relationship between brain structure and function in children with ASD remains largely obscure. In the current study, parallel independent component analysis (pICA) was performed to identify inter-modality associations by drawing on information from different modalities. Structural and resting-state functional magnetic resonance imaging data from 105 children with ASD and 102 typically developing children (obtained from the open-access Autism Brain Imaging Data Exchange database) were combined through the pICA framework. Features of structural and functional modalities were represented by the voxel-based morphometry (VBM) and amplitude of low-frequency fluctuations (ALFF), respectively. The relationship between the structural and functional components derived from the pICA was investigated by Pearson’s correlation analysis, and between-group differences in these components were analyzed through the two-sample t-test. Finally, multivariate support vector regression analysis was used to analyze the relationship between the structural/functional components and Autism Diagnostic Observation Schedule (ADOS) subscores in the ASD group. This study found a significant association between VBM and ALFF components in ASD. Significant between-group differences were detected in the loading coefficients of the VBM component. Furthermore, the ALFF component loading coefficients predicted the subscores of communication and repetitive stereotypic behaviors of the ADOS. Likewise, the VBM component loading coefficients predicted the ADOS communication subscore in ASD. These findings provide evidence of a link between brain function and structure, yielding new insights into the neural mechanisms of ASD.

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15. Lunsky Y, Balogh R, Chung H, Durbin A, Lai MC, Tint A, Weiss J, Isaacs B, Lin E. Repeated use of hospital-based services and delayed hospital discharges in a population-based cohort of autistic adults in Canada. Autism. 2024: 13623613241299285.

We know that autistic people have more health problems and are more likely to go to the emergency department and get hospitalized than other people, but we know less about the problems they have once they get to the hospital. In this study, we looked at all autistic adults in Ontario and compared them to adults who were not autistic and to adults who had other kinds of developmental disabilities to see who came back to the emergency department in the month after an emergency department visit, who got re-hospitalized in the month after being sent home from hospital, and who stayed in the hospital longer than they needed to because there was no place appropriate for them to go to. We found that both autistic males and females were more likely to have these things happen to them than the same age- and sex-matched adults who did not have developmental disabilities. We also found that adults with other kinds of developmental disabilities had similar problems to autistic people. This makes us think that we need to work harder to improve health care for autistic adults and adults with other developmental disabilities when they come to hospital. We also need to make community services work better, and work more closely with hospital services, so that people only come to hospital when they need to and that they can go home when they are ready.

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16. McKeon HE, Cotton L, Aldridge R, Cape A, Clout M, Cooper K, Dagnan D, Dawn E, Frost J, Georgakopoulou A, Garfield K, Horwood J, Ingham B, Jervis V, Kessler D, Langdon P, Metcalfe C, Rai D, Realpe A, Russell C, Sheridan H, Slowinska K, Thorn J, Wen L, Wiles N, Russell A. Effectiveness and cost-effectiveness of guided self-help for depression for autistic adults: the Autism Depression Trial (ADEPT-2) – protocol for a multicentre, randomised controlled trial of a remotely delivered low-intensity intervention. BMJ Open. 2024; 14(11): e084729.

INTRODUCTION: Depression is three to four times more prevalent in autistic people and is related to reduced quality of life. There is a need for empirically supported psychological interventions for depression specifically adapted to meet the needs of autistic adults. ADEPT-2 aims to establish the clinical and cost-effectiveness of an adapted low-intensity psychological intervention (guided self-help) for depression in autistic adults. METHODS AND ANALYSIS: A two parallel-group multicentre pragmatic randomised controlled trial investigating the effectiveness of GSH for depression in autistic adults. Participants (n=248) aged ≥18 years with a clinical diagnosis of autism currently experiencing depression will be randomised to GSH or treatment as usual (TAU). GSH is a low-intensity psychological intervention based on the principles of behavioural activation adapted for autism. GSH comprises informational materials for nine individual sessions facilitated online by a GSH coach who has received training and supervision in delivering the intervention. The primary outcome will be Beck Depression Inventory-II depression scores at 16 weeks post randomisation with follow-up measures at 32 and 52 weeks. Additional measures of anxiety, patient-rated global improvement, quality of life, work and social adjustment, positive and negative affect will be measured 16 and 52 weeks post randomisation. The primary health economic analysis will assess the cost-effectiveness of GSH compared with TAU over 52 weeks, from a societal perspective including the National Health Service, personal social services, personal expenses, voluntary services and productivity. An embedded qualitative study will explore the acceptability, experiences and adherence of participants and therapists to treatment principles. ETHICS AND DISSEMINATION: This trial has been approved by the East of England – Essex Research Ethics Committee on 10 June 2022 (REC Reference number: 22/EE/0091). The findings of the research will be submitted for publication in peer-reviewed journals and disseminated in an appropriate format to trial participants and the wider public. TRIAL REGISTRATION NUMBER: ISRCTN17547011.

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17. Onat M, Nas Ünver AB, Şenses Dinç G, Çöp E, Pekcanlar Akay A. Comparisons between obsessive-compulsive disorder and trichotillomania in terms of autistic traits and repetitive behaviors in adolescents. Nord J Psychiatry. 2024: 1-8.

BACKGROUND: Our study aims to reveal the relationship between autistic traits and repetitive behaviors in adolescents diagnosed with obsessive-compulsive disorder and trichotillomania and to compare them to healthy controls. METHOD: A total of 100 adolescents, 33 of whom were diagnosed with obsessive-compulsive disorder, 32 of whom were diagnosed with trichotillomania and 35 healthy controls, aged 11-18 years, who applied to a Child and Adolescent Psychiatry Outpatient Clinic between February 2023 and July 2023, were included in the study. Participants were evaluated with the Autism Spectrum Quotient (AQ)-Adolescent, Repetitive Behavior Scale-Revised (RBS-R), Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression Scale-Severity (CGI-S). SPSS 25.0 program was used in the analysis. p < 0.05 was accepted as the significance level. RESULTS: It was found that adolescents diagnosed with obsessive-compulsive disorder and trichotillomania had higher autistic trait levels compared to healthy controls, while there was no significant difference between the obsessive-compulsive disorder and trichotillomania groups. While stereotypic, routine, sameness, and restricted repetitive behaviors were more common in the obsessive-compulsive disorder and trichotillomania groups as opposed to healthy controls, it was found that compulsive behavior was more common in the obsessive-compulsive disorder group, and self-injurious behavior was more common in the trichotillomania group compared to healthy controls. CONCLUSION: The findings of our study indicate that adolescents diagnosed with trichotillomania, similar to those with obsessive-compulsive disorder, have a higher level of autistic traits and repetitive behaviors. The authors believe it is crucial to focus on the social skill difficulties these adolescents may be experiencing.

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18. Powell PS, Gonzalez MG, Pazol K, Reyes N, Nadler C, Wiggins L. Child and family characteristics associated with verbal communication difficulties in adolescents with autism and other developmental disabilities. Res Dev Disabil. 2024; 155: 104879.

BACKGROUND: Verbal communication difficulties are associated with a range of adolescent and adult outcomes in individuals with autism spectrum disorder (ASD). Yet there is limited information about contextual factors associated with verbal communication difficulties beyond early childhood, and how youth with ASD compare to youth with other developmental disabilities (DD). AIMS: The current study examined verbal communication difficulties among adolescents with ASD and other DD, and child and family characteristics associated with these difficulties in later in life. METHODS AND PROCEDURES: Children were classified as ASD or other DD between 2 and 5 years old. Caregivers of these same children reported verbal communication difficulties between 12 and 16 years old. Chi square tests examined group differences in adolescent verbal communication difficulties; Poisson regression examined child and family characteristics associated with adolescent verbal communication difficulties. OUTCOMES AND RESULTS: Adolescents with ASD had significantly more verbal communication difficulties (47.4 %) than adolescents with other DD (14.6 %). Factors that predicted verbal communication difficulties in adolescents with ASD and other DD were expressive language abilities and internalizing symptoms in early childhood, having a mother of non-Hispanic Black compared to White race, and having a mother with some college compared to an advanced degree. CONCLUSIONS AND IMPLICATIONS: Almost half of adolescents with ASD had verbal communication difficulties, which was significantly higher than those with other DD. Early childhood and socio-demographic factors like race, education, and insurance were associated with verbal language outcomes. These factors may be useful in identifying and supporting those most likely to benefit from targeted communication services. WHAT THIS PAPER ADDS?: Verbal communication difficulties are common among adolescents with autism. Early childhood and socio-demographic characteristics like race and education are associated with these difficulties. These findings could help better identify and support adolescents with communication difficulties.

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19. Reyes N, Norbert Soke G, Wiggins L, Barger B, Moody E, Rosenberg C, Schieve L, Reaven J, Reynolds AM, Hepburn S. Social and language regression: characteristics of children with autism spectrum disorder in a community-based sample. J Dev Phys Disabil. 2024; 36(4): 713-28.

This study investigated the prevalence, and the developmental, behavior and emotional outcomes of 675 preschoolers with ASD with or without a history of regression, who participated in the Study to Explore Early Development (SEED). The SEED project is a cross-sectional case-control study that collected data between 2007 and 2011. Children’s history of regression, adaptive skills, and behavior problems were assessed using the Autism Diagnostic Interview-Revised (ADI-R), the Vineland Adaptive Behavior Scales-Second Edition (Vineland-2), and the Child Behavior Checklist (CBCL), respectively; and children’s developmental levels were assessed using the Mullen Scales of Learning (MSEL). Findings from this study indicated that 26% of children experienced social and language regression, and of those with regression, 76% had regained lost skills upon completion of the study. Compared to children without a history of regression, children with social regression demonstrated increased internalizing problems and decreased fine motor skills, and children with language regression demonstrated poorer language skills. Also, children with language and social regression displayed poorer adaptive communication skills than children without regression. Children who experienced regression in one area of development demonstrated better outcomes than those who experience regression in multiple areas. To conclude, children with regression are at risk for poorer outcomes during their preschool years.

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20. Soto JG, Pouso-Diz JM, Fernández-Pajarín G, Román-Pena P, Álvarez-Noval A, Blanco-Ulla M, Arán-Echabe E, Ares B, Sesar Á. MR-Guided Focused Ultrasound for the Treatment of Tremor in Fragile X-Associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract. 2024.

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21. Tan Z, Xia R, Zhao X, Yang Z, Liu H, Wang W. Potential key pathophysiological participant and treatment target in autism spectrum disorder: Microglia. Mol Cell Neurosci. 2024: 103980.

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by social and communication deficits, as well as restricted or repetitive behaviors or interests. Although the etiology of ASD remains unclear, there is abundant evidence suggesting that microglial dysfunction is likely to be a significant factor in the pathophysiology of ASD. Microglia, the primary innate immune cells in the central nervous system (CNS), play a crucial role in brain development and homeostasis. Recently, numerous studies have shown that microglia in ASD models display various abnormalities including morphology, function, cellular interactions, genetic and epigenetic factors, as well as the expression of receptors, transcription factors, and cytokines. They impact normal neural development through various mechanisms contributing to ASD, such as neuroinflammation, and alterations in synaptic formation and pruning. The focus of this review is on recent studies regarding microglial abnormalities in ASD and their effects on the onset and progression of ASD at both cellular and molecular levels. It can provide insight into the specific contribution of microglia to ASD pathogenesis and help in designing potential therapeutic and preventative strategies targeting microglia.

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22. Tarzi G, Thakur A, Bobbette N, Pilatzke M, Lefkowitz G, Thomson K, Thatcher A, Hasan S, Fogle A, Blake M, Hines A, Lunsky Y. Evaluation of an Interprofessional Educational Intervention in Mental Health and Intellectual and Developmental Disability for Health and Social Service Trainees. Acad Psychiatry. 2024.

OBJECTIVE: Adults with intellectual and developmental disabilities (IDD) experience high rates of poor mental health and challenges accessing timely and high-quality services. There is limited interprofessional training on mental health care for this population. METHODS: A virtual, synchronous program based on the Project Extension for Community Healthcare Outcomes (ECHO) Ontario IDD Mental Health program was developed for health and social service trainees. Participants represented 10 disciplines across 12 Canadian university or college programs. The program was taught by a team of health and social service providers together with individuals with lived experience and included didactics and case-based discussions. Program evaluation utilized a pre-, post-, and 12-week follow-up survey design with feedback surveys following each session. RESULTS: Fifty participants registered for the program; 34 (68%) completed baseline measures and attended at least two sessions. Overall, participants reported high session satisfaction (average rating of 4.47 of 5). Participants demonstrated significant improvement in self-efficacy regarding communication (p < 0.001), management of mental health needs (p < 0.001), and working across systems (p < 0.001). Participants self-reported feeling more knowledgeable about common comorbidities (p < 0.001), assessing behavioral challenges (p < 0.001), the role of interdisciplinary professionals (p < 0.001), and community resources (p < 0.001). Improvements were maintained at follow-up across outcomes. CONCLUSION: The pilot Project ECHO for health and social service trainees in adult IDD mental health demonstrated high participant satisfaction and positive impact on trainees' self-efficacy and knowledge. Interprofessional educational interventions can be effectively implemented using virtual technology to teach about other mental health populations requiring multisector care.

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23. Thapliyal A, Suri K, Chauhan R, Murugan NA, Maurya SK. Unveiling the role of phytochemicals in autism spectrum disorder by employing network pharmacology and molecular dynamics simulation. Metab Brain Dis. 2024; 40(1): 34.

Autism Spectrum Disorder (ASD) comprises a myriad of disorders with vast pathologies, aetiologies, and involvement of genetic and environmental risk factors. Given the polygenic aspect of ASD, targeting several genes/proteins responsible for pathogenesis at once might prove advantageous in its remediation. Various phytochemicals have been proven to possess neuroprotective, anti-inflammatory, and antioxidant properties by alleviating symptoms and targeting a complex network of genes/proteins related to disease pathology. However, the effects of many of these phytochemicals on ASD are enigmatic, and their molecular targets and molecular mechanisms are still elusive. Here, we provide a comprehensive comparative study on the therapeutic potential of 6 phytochemicals viz. Cannabidiol, Crocetin, Epigallocatechin-3-gallate, Fisetin, Quercetin, and Resveratrol based on their neuroprotective properties in managing ASD. We aimed to identify and target a network of core proteins in the pathology of ASD via phytochemicals using network pharmacology, molecular docking, and simulation studies. The methodology includes screening genes/proteins implicated in ASD as targets of each phytochemical, followed by network construction using Protein-Protein Interactions, Gene Ontology, and enrichment analysis. The constructed network was further narrowed down to the hub genes in the network, followed by their spatio-temporal analysis, molecular docking, and molecular dynamics simulation. 6 core genes were obtained for ASD, 3 of which are directly involved in disease pathogenesis. The study provides a set of novel genes that phytochemicals can target to ameliorate and regulate ASD pathogenesis. Cannabidiol can inhibit ABCG2, MAOB, and PDE4B, Resveratrol can target ABCB1, and Quercetin can regulate AKR1C4 and XDH. This study demonstrated the potential of phytochemicals to target and regulate ABCG2, ABCB1, AKR1C4, MAOB, PDE4B, and XDH, which in turn modulate the dysfunctional network present in the ASD pathology and provide therapeutic potential in the management of ASD.

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24. Wallace GL, Said AJ, McQuaid GA. Elevated parkinsonism symptoms in autism during middle and older adulthood are linked with psychosocial, physical health, and mental health outcomes. Autism Res. 2024.

Evidence is growing for a link between parkinsonism, or the motor symptoms associated with Parkinson’s Disease and autism. However, research to date has yet to examine whether the presence of these motoric symptoms impacts critical adult outcomes in autism. Therefore, the current study utilized a screening measure to bifurcate a relatively large (n = 379) sample of middle and older age autistic adults (40-83 years) into parkinsonism screen positive (n = 119) versus parkinsonism screen negative (n = 260) groups in order to compare them on broad metrics of daily living skills and subjective quality of life as well as non-motoric features linked to parkinsonism, namely memory problems, sleep quality, and depression symptoms. Overall, co-occurring parkinsonism was linked with lower subjective quality of life, more memory problems, lower sleep quality, and greater depression symptoms in autistic adults. Taken together, these findings implicate an important co-occurring motoric phenotype in middle and older adulthood for autistic people that could have significant real-world impacts yet has been largely neglected in the extant literature to date.

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25. Wang XN, Zhang T, Han BC, Luo WW, Liu WH, Yang ZY, Disi A, Sun Y, Yang JC. Wearable EEG Neurofeedback Based-on Machine Learning Algorithms for Children with Autism: A Randomized, Placebo-controlled Study. Curr Med Sci. 2024.

OBJECTIVE: Behavioral interventions have been shown to ameliorate the electroencephalogram (EEG) dynamics underlying the behavioral symptoms of autism spectrum disorder (ASD), while studies have also demonstrated that mirror neuron mu rhythm-based EEG neurofeedback training improves the behavioral functioning of individuals with ASD. This study aimed to test the effects of a wearable mu rhythm neurofeedback training system based on machine learning algorithms for children with autism. METHODS: A randomized, placebo-controlled study was carried out on 60 participants aged 3 to 6 years who were diagnosed with autism, at two center-based intervention sites. The neurofeedback group received active mu rhythm neurofeedback training, while the control group received a sham neurofeedback training. Other behavioral intervention programs were similar between the two groups. RESULTS: After 60 sessions of treatment, both groups showed significant improvements in several domains including language, social and problem behavior. The neurofeedback group showed significantly greater improvements in expressive language (P=0.013) and cognitive awareness (including joint attention, P=0.003) than did the placebo-controlled group. CONCLUSION: Artificial intelligence-powered wearable EEG neurofeedback, as a type of brain-computer interface application, is a promising assistive technology that can provide targeted intervention for the core brain mechanisms underlying ASD symptoms.

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26. Zhou S, Chen Z, Liu Y. The relationship between autistic traits and problematic smartphone use in adolescents: The serial mediating role of anxiety and executive dysfunction. BMC Psychol. 2024; 12(1): 683.

BACKGROUND: Based on the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study aimed to explore the relationship between autistic traits and problematic smartphone use (PSU) among Chinese adolescents and to examine the serial mediation effect of anxiety and executive dysfunction in the association between autistic traits and PSU. METHODS: The Autism-Spectrum Quotient, Smartphone Addiction Scale, the trait version of the State-Trait Anxiety Inventory, and Dysexecutive Questionnaire were administered to a sample comprising 412 senior high school students (average age = 17.05 years, SD = 0.65). Structural equation models were utilized to explore the simple and serial mediating role of anxiety and executive dysfunction played in the association between autistic traits and PSU. RESULTS: This study found that social rather than non-social autistic traits were positively associated with anxiety, executive dysfunction, and PSU. Furthermore, after controlling for gender, anxiety and executive dysfunction acted as sequential mediators in the connection between social autistic trait and PSU. However, non-social autistic trait did not predict anxiety, executive dysfunction, or PSU. CONCLUSION: This study supports the I-PACE model and deepens understanding of PSU formation. Furthermore, the findings underscore the importance of addressing social challenges faced by adolescents with high autistic traits, providing a viable potential intervention pathway to promote healthy smartphone use in this population.

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