1. Al Jaffal M. Barriers general education teachers face regarding the inclusion of students with autism. Front Psychol;2022;13:873248.

As the number of students diagnosed with autism spectrum disorder (ASD) present in general education (GE) classrooms has increased in the past few decades, GE teachers must adapt to meet the needs of these students. Laws and regulations require students with ASD to be educated in the least restrictive environment, as well as that they be instructed by the teachers who were qualified to teach them. Unfortunately, GE teachers face the challenges supporting students with ASD in GE settings. This qualitative research investigates the barriers that prevent teachers from successfully implementing an inclusive environment in the GE classroom. In total, four elementary school teachers at a school in the northeast of the United States were interviewed and observed. The data were analyzed to identify emerging themes. The findings showed that GE teachers lack training in how to work with students with ASD in their GE classrooms, lack collaboration opportunities with their special education colleagues to better support their students with ASD, and are not provided sufficient resources by their schools and programs to create an appropriate inclusive environment in their GE classrooms. Based on these findings, certain improvements in professional development offerings for in-service general educators on how to teach students with ASD are recommended, such as providing broader training programs that give teachers the opportunity to practice interventions and teaching plans for inclusive classrooms and receive feedback from the training instructor(s). Furthermore, certain additions to the curriculum of pre-service university education programs for GE teachers are suggested. In addition, the research found that schools must make certain resources, including technology, available to GE teachers to meet the requirements of United States law regarding educating students with disabilities, including ASD, in the least restrictive environment, which is the GE classroom.

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2. Alallawi B, Hastings R, Aabe N. Support Needs and Parent Outcomes in Arab Families of Children with Autism Living in the United Kingdom. Brain Sci;2022 (Aug 22);12(8)

Research on the experiences of Arab families of children with autism living in non-Arab countries is scarce. A survey investigated the support needs, psychological distress, and parental relationships of Arab parents (n = 100) of children with autism living in the United Kingdom (UK). The survey consisted of five main questionnaires: a demographic questionnaire, the GO4KIDDS Brief Adaptive Scale, the Family Needs Survey, the Strengths and Difficulties Questionnaire, and the Hospital Anxiety and Depression Scale. Descriptive analysis indicated that the most frequently identified support needs were information, community services, and explaining to others. Parents reported high levels of psychological distress, a high level of parental relationship satisfaction with their spouse, and few parental disagreements about their child with autism. Regression analyses showed that increased child behavior problems predicted more total family needs. Higher levels of child prosocial behavior, the better health status of parents, and a larger number of children in the family were associated with lower levels of parental psychological distress. A longer time living in the UK was associated with more parental disagreement over issues related to the child with ASD. Reducing child behavior problems and increasing child prosocial behavior may be important targets for support and intervention to improve outcomes for Arab parents of autistic children.

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3. Andreou M, Skrimpa V. Re-Examining Labels in Neurocognitive Research: Evidence from Bilingualism and Autism as Spectrum-Trait Cases. Brain Sci;2022 (Aug 22);12(8)

Despite the fact that the urge to investigate bilingualism and neurodevelopmental disorders as continuous indices rather than categorical ones has been well-voiced among researchers with respect to research methodological approaches, in the recent literature, when it comes to examining language, cognitive skills and neurodivergent characteristics, it is still the case that the most prevalent view is the categorisation of adults or children into groups. In other words, there is a categorisation of individuals, e.g., monolingual vs. bilingual children or children with typical and atypical/non-typical/non-neurotypical development. We believe that this labelling is responsible for the conflicting results that we often come across in studies. The aim of this review is to bring to the surface the importance of individual differences through the study of relevant articles conducted in bilingual children and children with autism, who are ideal for this study. We concur with researchers who already do so, and we further suggest moving away from labels and instead shift towards the view that not everything is either white or black. We provide suggestions as to how this shift could be implemented in research, while mostly aiming at starting a discourse rather than offering a definite path.

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4. Ardakani HA, Taghizadeh M, Shayegh F. Diagnosis of Autism Disorder Based on Deep Network Trained by Augmented EEG Signals. Int J Neural Syst;2022 (Aug 22):2250046.

Autism spectrum disorder is a neurodevelopmental disorder typically characterized by abnormalities in social interaction and stereotyped and repetitive behaviors. Diagnosis of autism is mainly based on behavioral tests and interviews. In recent years, studies involving the diagnosis of autism based on analysis of EEG signals have increased. In this paper, recorded signals from people suffering from autism and healthy individuals are divided to without overlap windows considered as images and these images are classified using a two-dimensional Deep Convolution Neural Network (2D-DCNN). Deep learning models require a lot of data to extract the appropriate features and automate data classification. But, in most neurological studies, preparing a large number of measurements is difficult (a few 1000s as compared to million natural images), due to the cost, time, and difficulty of recording these signals. Therefore, to make the appropriate number of data, in our proposed method, some of the data augmentation methods are used. These data augmentation methods are mainly introduced for image databases and should be generalized for EEG-as-an-image database. In this paper, one of the nonlinear image mixing methods is used that mixes the rows of two images. According to the fact that any row in our image is one channel of EEG signal, this method is named channel combination. The result is that in the best case, i.e., augmentation according to channel combination, the average accuracy of 88.29% is achieved in the classification of short signals of healthy people and ASD ones and 100% for ASD and epilepsy ones, using 2D-DCNN. After the decision on joined windows related to each subject, we could achieve 100% accuracy in detecting ASD subjects, according to long EEG signals.

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5. Banerjee N, Adak P. Birth related parameters are important contributors in autism spectrum disorders. Sci Rep;2022 (Aug 22);12(1):14277.

Autism spectrum disorders is a group of childhood onset neurodevelopmental disorders affecting millions of children across the globe. Characterised by age inappropriate lack of reciprocal social interaction, repetitive behaviours and deficits in communication skills, it has been found to have genetic, epigenetic and environmental contributions. In this work, we wanted to identify the effects of birth related parameters on the disease pathogenesis in an exposed population of West Bengal, India. We have considered age of both parents at birth, difference in parental age, familial history of mental illness, delay in developmental-milestones, birth-weight, birth-order, birth-term, mode of delivery and gestational complications as contributors. We found the parental age and their age difference to be the most important contributors towards ASD in this population. Birth order, sex of the probands, complications during gestation, birth weight, family history of mental illness and birth history also contributed to the condition, although to a lesser extent. Since such types of data are lacking in Indian population, this report adds useful information to the relevant field.

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6. Cheng WM, Smith TB, Butler M, Taylor TM, Clayton D. Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis. J Autism Dev Disord;2022 (Aug 22)

Children with autism spectrum disorder (ASD) have been shown to benefit from parent-implemented interventions (PIIs). This meta-analysis improved on prior reviews of PIIs by evaluating RCTs and multiple potential moderators, including indicators of research quality. Fifty-one effect sizes averaged moderately strong overall benefits of PIIs (g = 0.553), with studies having lower risk of research bias yielding lower estimates (g = 0.47). Parent and observer ratings yielded similar averaged estimates for positive behavior/social skills (g = 0.603), language/communication (g = 0.545), maladaptive behavior (g = 0.519), and to a lesser extent, adaptive behavior/life skills (g = 0.239). No other study, intervention, or participant characteristic moderated outcomes. PIIs with children with ASD tend to be effective across a variety of circumstances.

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7. Cleary M, West S, Hunt GE, McLean L, Hungerford C, Kornhaber R. How People with Autism Access Mental Health Services Specifically Suicide Hotlines and Crisis Support Services, and Current Approaches to Mental Health Care: A Scoping Review. Issues Ment Health Nurs;2022 (Aug 22):1-14.

For people with autism spectrum disorder (ASD), the risk of mental illness, including suicidality, has a higher prevalence than the general population. This scoping review explored how people with ASD access suicide hotlines/crisis support services; and current approaches to delivering mental health services (MHS) to people with ASD. A search identified 28 studies meeting the selection criteria with analysis revealing four key findings. The support received by the person with ASD influenced how they accessed MHS; people often encounter barriers to accessing MHS; a separation exists between autism and MHS; and no studies on accessing or delivering MHS through crisis hotlines. The presence of such autism-specific crisis hotlines and the dearth of studies suggest a void in the existing research.

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8. Davidson CJJ, Carpenter P, Mohan R. Autistic psychiatrists: Royal College of Psychiatrists response. Br J Psychiatry;2022 (Sep);221(3):582.

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9. D’Mello AM, Frosch IR, Li CE, Cardinaux AL, Gabrieli JDE. Exclusion of females in autism research: Empirical evidence for a « leaky » recruitment-to-research pipeline. Autism Res;2022 (Aug 22)

Autism spectrum disorder (ASD) is characterized by challenges in social communication and the presence of repetitive behaviors or restricted interests. Notably, males are four times as likely as females to be diagnosed with autism. Despite efforts to increase representation and characterization of autistic females, research studies consistently enroll small samples of females, or exclude females altogether. Importantly, researchers often rely on standardized measures to confirm diagnosis prior to enrollment in research studies. We retrospectively analyzed the effects of one such measure (Autism Diagnostic Observation Schedule, ADOS) on research inclusion/exclusion rates by sex in autistic adults, all of whom had a preexisting community diagnosis of autism (n = 145, 95 male, 50 female). Using the ADOS as a confirmatory diagnostic measure resulted in the exclusion of autistic females at a rate over 2.5 times higher than that of autistic males. We compared sex ratios in our sample to those in other large, publically available datasets that rely either on community diagnosis (6 datasets, total n = 42,209) or standardized assessments (2 datasets, total n = 214) to determine eligibility of participants for research. Reliance on community diagnosis rather than confirmatory diagnostic assessments resulted in significantly more equal sex ratios. These results provide evidence for a « leaky » recruitment-to-research pipeline for females in autism research. LAY SUMMARY: Despite efforts to increase the representation of autistic females in research, studies consistently enroll small samples of females or exclude females altogether. We find that despite making up almost 50% of the initially recruited sample based upon self-report of community diagnosis, autistic females are disproportonately excluded from research participation as a result of commonly used autism diagnostic measures. In our sample, and several other publically available datasets, reliance on community diagnosis resulted in significantly more equal sex ratios.

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10. Inoue M, Tatumi A, Fukuzaki T. Effectiveness of the internet based parent education program on applied behavior analysis for parents of children with autism spectrum disorder. Brain Dev;2022 (Aug 18)

BACKGROUND: Parent education (PE) in autism spectrum disorder (ASD) is recognized as an important component of support for families living with ASD. Specifically, the knowledge of how to interact with children based on applied behavior analysis (ABA) is useful for parents. In this study, a short-term, internet based on-demand PE program was conducted for parents of children with ASD to acquire knowledge of ABA and basic teaching techniques. METHODS: Parents of children with ASD were recruited as study participants. They attended on-demand lectures from their homes, performed homework tasks based on lecture content and emailed them to our team. The General Health Questionnaire 30 (GHQ) and Knowledge of Behavioral Principle as Applied to Children (KBPAC) were assessed before and after the program. RESULTS: Of the 25 participants, 21 attended all programs and completed all homework tasks and pre- and post-assessments. However, communication among participants via the bulletin board was low. KBPAC scores increased significantly from pre- to post-program scores, and GHQ subscales regarding anxiety and mood modulation decreased significantly from pre- to post-program scores. Positive results were obtained in the post-questionnaires as well. CONCLUSION: These findings suggest the practical applicability of an online PE program for parents of children with ASD based on ABA.

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11. Jensen JM, Nielsen US, Bayat A, Rasmussen MB, Møller RS, Bisgaard AM, Hammer TB. [Genetic testing in autism spectrum disorder]. Ugeskr Laeger;2022 (Aug 22);184(34)

Autism spectrum disorders (ASD) have a complex genetic component comprising both frequent polygenic and rare monogenic factors. Research is conducted in methods used to calculate polygenic risk scores, which are not applicable in clinical practice. Advances in genomic technology have identified several monogenic causes, and genetic testing may be offered to persons with ASD where a monogenic etiology is suspected. Herein, we provide an overview of the current knowledge and present the first national recommendation regarding genetic testing in ASD.

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12. McCowan S, Shaw SCK, Doherty M, Grosjean B, Blank P, Kinnear M. Welcome signs of the road ahead for autistic doctors and patients. Br J Psychiatry;2022 (Sep);221(3):582-583.

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13. Mirza M, Brown-Hollie JP, Suarez-Balcazar Y, Parra-Medina D, Camillone S, Zeng W, Garcia-Gomez E, Heydarian N, Magaña S. Interventions for Health Promotion and Obesity Prevention for Children and Adolescents with Developmental Disabilities: a Systematic Review. Rev J Autism Dev Disord;2022 (Aug 22):1-24.

This systematic review evaluated interventions and relevant outcomes for health promotion and obesity prevention among children and adolescents with developmental disabilities (DD). Twenty-one studies including randomized control trials (n= 9) and quasi-experimental studies (n=12) published between 2010 and 2021 met inclusion criteria related to participant characteristics, intervention type, and child obesity-related outcomes. Five types of intervention programs were identified: aerobic and strength training, sport-based physical activity, aquatic exercise, active video gaming, and diet and lifestyle. Whereas analysis of intervention outcomes, efficacy, and study rigor showed mixed results and weak evidence of effective interventions, this review identified gaps in the literature, promising strategies for addressing obesity in children with DD, and implications for practice and future research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40489-022-00335-5.

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14. Must A, Eliasziw M, Bowling A, Magaña S, Stanish H, Bandini L, Curtin C, Kral TVE. Relationship between Childhood Obesity and Autism Spectrum Disorder Varies by Child’s Age and Parents’ Weight Status in a Sample of Sibling Dyads. Child Obes;2022 (Aug 22)

Background: Children with autism spectrum disorder (ASD) are more likely to have obesity compared to children without ASD, but studies may report biased estimates because of limitations accounting for potentially important factors that may differ between these two groups of children. This study of siblings in « simplex » families (i.e., families that include only one offspring with ASD) avoids these potential pitfalls. Methods: The Simons Simplex Collection was used to create sibling dyads comprising a child with a clinically confirmed diagnosis of ASD and a full sibling without ASD within the same biological family. Child obesity, determined from measured heights and weights, was compared across three child age strata (4-7.9, 8-10.9, 11-18.0 years) and by parents’ weight status using generalized estimating equations log-binomial regression models. Results: Among 1378 sibling dyads, 4-18 years of age, the prevalence of obesity significantly increased with age, with larger sibling differences at older ages. For ages 4-7.9 years, the obesity prevalence for children with ASD was 15.0% compared to 16.2% for siblings (p = 0.57). For ages 11-18.0 years, prevalence for children with ASD was 30.7% compared to 21.4% for siblings (p = 0.003). Parental obesity significantly affected sibling obesity. Conclusion: From this unique data resource that accounted for shared family environments, the prevalence of obesity diverged significantly at older ages between children with ASD and their full siblings without ASD and was associated with parental obesity status similarly for children with and without a diagnosis of ASD. Recognizing these age-related differences has important implications for targeting preventive interventions.

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15. Nouri Z, Sarmadi A, Narrei S, Sehhati M, Tabatabaiefar MA. Whole exome sequencing identified a novel LAMA2 frameshift variant causing merosin-deficient congenital muscular dystrophy in a patient with cardiomyopathy, and autism-like behavior. Neuromuscul Disord;2022 (Jul 23)

Muscular dystrophy (MD) is a group of multiple muscle diseases, which causes severely impaired motor ability, degeneration and dysfunctions in the musculoskeletal system, respiratory failure and feeding difficulties. LAMA2-related MD is caused by pathogenic variants in the LAMA2 gene, encoding laminin a2 chain, a component of the skeletal muscle extracellular matrix protein laminin-α2β1γ1. We performed clinical examination and molecular genetic analysis in a patient with congenital MD (CMD), and autism-like phenotype. We performed whole exome sequencing (WES) to find possible genetic etiology of CMD in an Iranian non-consanguineous patient. The pathogenicity of the variants was assessed using various Bioinformatics tools. American College of Medical Genetics and Genomics (ACMG) guidelines were used to interpret the variant and Sanger sequencing in the patient and her family was applied for the confirmation of the variant. WES results showed a novel frameshift homozygous variant (p.Tyr1313LeufsTer4) in the LAMA2 gene leading to the CMD phenotype. This variant resides in a highly conserved region and was found to be co-segregating in the family. It fulfils the criteria of being pathogenic. We successfully identified a novel LAMA2 pathogenic variant in an Iranian patient suffering from CMD and autism using WES. Identification of disease-causing variant in autosomal recessive disorders such as CMD can be useful in genetic counseling, prenatal diagnosis, and predicting prognosis of the disease.

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16. O’Neill L, Sim I, O’Hare D, Whitaker J, Mukherjee RK, Razeghi O, Niederer S, Wright M, Chiribiri A, Frigiola A, O’Neill MD, Williams SE. CArdiac MagnEtic resonance assessment of bi-Atrial fibrosis in secundum atrial septal defects patients: CAMERA-ASD study. Eur Heart J Cardiovasc Imaging;2022 (Aug 22);23(9):1231-1239.

AIMS: Atrial septal defects (ASD) are associated with atrial arrhythmias, but the arrhythmia substrate in these patients is poorly defined. We hypothesized that bi-atrial fibrosis is present and that right atrial fibrosis is associated with atrial arrhythmias in ASD patients. We aimed to evaluate the extent of bi-atrial fibrosis in ASD patients and to investigate the relationships between bi-atrial fibrosis, atrial arrhythmias, shunt fraction, and age. METHODS AND RESULTS: Patients with uncorrected secundum ASDs (n = 36; 50.4 ± 13.6 years) underwent cardiac magnetic resonance imaging with atrial late gadolinium enhancement. Comparison was made to non-congenital heart disease patients (n = 36; 60.3 ± 10.5 years) with paroxysmal atrial fibrillation (AF). Cardiac magnetic resonance parameters associated with atrial arrhythmias were identified and the relationship between bi-atrial structure, age, and shunt fraction studied. Bi-atrial fibrosis burden was greater in ASD patients than paroxysmal AF patients (20.7 ± 14% vs. 10.1 ± 8.6% and 14.8 ± 8.5% vs. 8.6 ± 6.1% for right and left atria respectively, P = 0.001 for both). In ASD patients, right atrial fibrosis burden was greater in those with than without atrial arrhythmias (33.4 ± 18.7% vs. 16.8 ± 10.3%, P = 0.034). On receiver operating characteristic analysis, a right atrial fibrosis burden of 32% had a 92% specificity and 71% sensitivity for predicting the presence of atrial arrhythmias. Neither age nor shunt fraction was associated with bi-atrial fibrosis burden. CONCLUSION: Bi-atrial fibrosis burden is greater in ASD patients than non-congenital heart disease patients with paroxysmal AF. Right atrial fibrosis is associated with the presence of atrial arrhythmias in ASD patients. These findings highlight the importance of right atrial fibrosis to atrial arrhythmogenesis in ASD patients.

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17. Pan S, Wang X, Lin L, Chen J, Zhan X, Jin C, Ou X, Gu T, Jing J, Cai L. Association of sugar-sweetened beverages with executive function in autistic children. Front Nutr;2022;9:940841.

The association between sugar-sweetened beverages (SSBs) consumption and executive function (EF) among typically developing (TD) children has been investigated in previous studies but with inconsistent results. Furthermore, this relationship has been less investigated among autistic children who perform worse in EF compared with TD children. In this study, we aimed to investigate the association between SSB consumption and EF in autistic children, and whether the association between SSB and EF in autistic children is different from that in TD children. We recruited 106 autistic children and 207 TD children aged 6-12 years in Guangzhou, China. Children’s EF was assessed by using the Chinese version of parent-reported Behavior Rating Inventory of Executive Function, Stroop Color-Word Test, and working memory subscales of the Chinese version of Wechsler Intelligence Scale for children, Fourth edition. Meanwhile, we assessed children’s dietary intake and SSB consumption with a validated Food Frequency Questionnaire. In this study, 70 (66.0%) autistic children consumed SSB and 20 (18.9%) of them consumed more than two servings SSB a week. Among autistic children, over two servings per week SSB consumption was associated with poorer performance in emotional control [β = 7.20, 95% confidence interval (CI): 0.94-13.46] and plan/Organize (β = 6.45, 95% CI: 0.27-12.63). The association between over two servings/week SSB consumption and emotional control among autistic children was significantly different from that among TD children (β (ASD) = 7.20; β (TD) = -3.09, Z = 2.72, p = 0.006). Results of this study show that SSB consumption was associated with an impairment in some subscales of EF in autistic children. Furthermore, the association between SSB and EF in autistic children might be different from that in TD children.

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18. Pavlopoulou G, Burns C, Cleghorn R, Skyrla T, Avnon J. « I often have to explain to school staff what she needs ». School experiences of non-autistic siblings growing up with an autistic brother or sister. Res Dev Disabil;2022 (Oct);129:104323.

BACKGROUND: Recent autism research has evidenced a shift from psychological outcomes to contextualised approaches to understanding the varying needs of non autistic siblings of autistic children across different systems. Yet, there is limited research exploring the lived experiences of siblings in their school context. METHODS: First, a group of school aged sibling advisors worked with the first author to codesign research aims, methods and dissemination practices around the topic of the school experiences of siblings who grow up with an autistic brother or sister in the UK. Then, 28 school-aged siblings of autistic children completed adapted photo-elicitation interviews, to discuss their school experiences. A background questionnaire was also administered to their parents and carers. RESULTS: Thematic analysis was employed. The master themes included: (i) Impact of home experiences in schoolwork, including limited personal time and sleep disruptions (ii) Siblings’ school interactions impact on overall school experience, including a wide range of both typical and difficult experiences such as school day disruptions, (iii) Varied perceived levels of support and understanding, including emotional and/or educational support by family members and a sense of connectedness with peers and teachers who are autistic themselves or connected to someone with a diagnosis of autism. IMPLICATIONS: The results underline the ways home experiences can have an impact on school life of siblings, the positive contribution of the autistic school staff and/or staff who have an autistic family member and the need for an organisational culture of inclusivity and widespread acceptance and awareness around issues of neurodiversity. Our findings suggest several implications for school psychologists in core functions of the educational psychologists’ role including training, consultation, assessment, and whole school support. DATA AVAILABILITY STATEMENT: The datasets generated for this study are not readily available because they include sensitive data (photos of siblings’ houses, family members, personal objects, and school timetables). Requests to access the datasets should be directed to corresponding author.

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19. Qi X, Yang T, Chen J, Dai Y, Chen L, Wu L, Hao Y, Li L, Zhang J, Ke X, Yi M, Hong Q, Fang S, Wang Y, Wang Q, Jin C, Jia F, Li T. Vitamin D status is primarily associated with core symptoms in children with autism spectrum disorder: A multicenter study in China. Psychiatry Res;2022 (Aug 22);317:114807.

OBJECTIVE: We aimed to investigate the relationship between vitamin D status and core symptoms and neurodevelopmental levels in children with ASD with a multicenter survey. METHODS: We enrolled 1321 ASD children and 1279 typically developing (TD) children aged 2-7 years from 13 cities in China. ASD symptoms were assessed with the Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS) and Childhood Autism Rating Scale (CARS), and neurodevelopmental levels were evaluated with the Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016). RESULTS: Children with ASD had lower serum 25(OH)D levels than TD children. Serum 25(OH)D levels were negatively associated with CARS and communication warning behavior of CNBS-R2016 scores, and were not associated with the development quotients of ASD children. ASD Children were grouped based on the quartiles for 25(OH)D levels in the controls, and children in the first to third quartiles had higher SRS social communication and/or CARS and communication warning behavior of CNBS-R2016 scores than those in the fourth quartile. CONCLUSIONS: Serum 25(OH)D levels were primarily associated with core symptoms in children with ASD, and individuals with relatively lower 25(OH)D levels displayed worse autistic symptomatology. More research is needed to determine whether vitamin D supplements would be a useful treatment for ASD.

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20. Raghavan K, Dedeepiya VD, Kandaswamy RS, Balamurugan M, Ikewaki N, Sonoda T, Kurosawa G, Iwasaki M, Preethy S, Abraham SJ. Improvement of sleep and melatonin in children with autism spectrum disorder after β-1,3/1,6-glucan consumption: An open-label prospective pilot clinical study. Brain Behav;2022 (Aug 22):e2750.

INTRODUCTION: Poor sleep quality is a major problem in patients with autism spectrum disorder (ASD), and is attributed to low melatonin levels. Melatonin supplementation is recommended; however, its effectiveness varies. β-Glucans have previously been shown to improve melatonin levels in animal studies. Herein, we examined the effectiveness of Aureobasidium pullulans (Nichi Glucan), a species of black yeast that contains beta-1,3/1,6-glucan, in a pilot study of children with ASD. METHODS: Thirteen children (age, 2.5-13 years) with ASD were recruited for the study. The control group consisted of four patients (Gr. 1), while nine patients were classified into the treatment group (Gr. 2). Gr. 2 received 1 g of Nichi Glucan along with conventional therapy, whereas the Gr. 1 (control) patients received conventional therapy alone for 90 days. Serum melatonin levels and sleep patterns, assessed using a subjective questionnaire, were evaluated before and after treatment. RESULTS: In Gr. 2, the average serum melatonin level increased from 238.85 ng/dl preintervention to 394.72 ng/dl postintervention. Eight of nine participants (88%) in Gr. 2 showed improvements in sleep pattern and quality, while no improvement was observed in the participants in Gr. 1. CONCLUSION: The consumption of Nichi Glucan for 90 days resulted in visible improvement in sleep quality, sleep pattern, and serum melatonin levels, which was reported for the first time by our study. A larger multicenter study is required to validate our findings.

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21. Selick A, Durbin J, Hamdani Y, Rayner J, Lunsky Y. Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res;2022 (Aug 22);6(8):e38916.

BACKGROUND: The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. OBJECTIVE: The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. METHODS: We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. RESULTS: We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that « one size does not fit all, » and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients’ abilities to access necessary health care. CONCLUSIONS: This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models.

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22. Wang Y, Hu D, Wu Z, Wang L, Huang W, Li G. Developmental abnormalities of structural covariance networks of cortical thickness and surface area in autistic infants within the first 2 years. Cereb Cortex;2022 (Aug 22);32(17):3786-3798.

Converging evidence supports that a collection of brain regions is functionally or anatomically abnormal in autistic subjects. Structural covariance networks (SCNs) representing patterns of coordinated regional maturation are widely used to study abnormalities associated with neurodisorders. However, the possible developmental changes of SCNs in autistic individuals during the first 2 postnatal years, which features dynamic development and can potentially serve as biomarkers, remain unexplored. To fill this gap, for the first time, SCNs of cortical thickness and surface area were constructed and investigated in infants at high familial risk for autism and typically developing infants in this study. Group differences of SCNs emerge at 12 months of age in surface area. By 24 months of age, the autism group shows significantly increased integration, decreased segregation, and decreased small-worldness, compared with controls. The SCNs of surface area are deteriorated and shifted toward randomness in autistic infants. The abnormal brain regions changed during development, and the group differences of the left lateral occipital cortex become more prominent with age. These results indicate that autism has more significant influences on coordinated development of surface area than that of cortical thickness and the occipital cortex maybe an important biomarker of autism during infancy.

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23. White AM, An X, Debiec J. Intact maternal buffering of stress response in infant rats despite altered responsivity towards maternal olfactory cues in the valproic acid model of autism-like behavior. Front Behav Neurosci;2022;16:959485.

Disrupted processing of social cues and altered social behaviors are among the core symptoms of autism spectrum disorders (ASDs), and they emerge as early as the first year of life. These differences in sensory abilities may affect the ability of children with ASDs to securely attach to a caregiver and experience caregiver buffering of stress. Prenatal exposure to valproic acid (VPA) has been used to model some aspects of ASDs in rodents. Here, we asked whether prenatal VPA exposure altered infant rats’ behavioral responsivity to maternal olfactory cues in an Odor Preference Test (OPT) and affected maternal buffering of infants’ stress responsivity to shock. In the odor preference test, 1-week old rats treated with VPA during pregnancy appeared to have impaired social recognition and/or may be less motivated to approach social odors in early infancy. These effects were particularly prominent in female pups. In 2-week old rats, VPA-exposed pups and saline-exposed pups showed similar preferences for home cage bedding. Although VPA-exposed pups may initially have a deficit in this attachment-related behavior they do recover typical responses to home cage bedding in later infancy. Both control and VPA-exposed pups showed robust stress hormone responses to repeated shocks, an effect which was blocked when a calm mother was present during shock exposure. No sex differences in the effect of maternal presence on the stress response to shock and no interactions between sex and prenatal drug exposure were observed. Although VPA-exposed pups may show impaired responsivity to maternal cues in early infancy, maternal presence is still capable of regulating the stress response in VPA-exposed pups. In this study we demonstrate the importance of utilizing multiple batteries of tests in assessing behavior, dissecting the behavior on one test into different components. Our results inform about the underlying behavioral characteristics of some of the ASD phenotypes, including sex differences reported by clinical studies, and could shed light on potential opportunities for intervention.

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24. Zhang Y, Li D, Yang T, Chen C, Li H, Zhu C. Characteristics of emotional gaze on threatening faces in children with autism spectrum disorders. Front Psychiatry;2022;13:920821.

Most evidence suggested that individuals with autism spectrum disorder (ASD) experienced gaze avoidance when looking at the eyes compared to typically developing (TD) individuals. Children with ASD magnified their fears when received threatening stimuli, resulting in a reduced duration of eye contact. Few studies have explored the gaze characteristics of children with ASD by dividing emotional faces into threatening and non-threatening pairs. In addition, although dynamic videos are more helpful in understanding the gaze characteristics of children with ASD, the experimental stimuli for some of the previous studies were still emotional pictures. We explored the viewing of dynamic threatening and non-threatening faces by children with ASD in different areas of interest (AOIs). In this study, 6-10 years old children with and without ASD viewed faces with threatening (fearful and angry) and non-threatening (sad and happy) expressions, respectively, with their eyes movements recorded. The results showed that when confronted with threatening faces, children with ASD, rather than TD, showed substantial eye avoidances, particularly non-specific avoidances in the fixation time on the mouths and significantly less time gazing at the mouths in any emotions, which was not observed for non-threatening faces. No correlations were found between the severity of symptoms and characteristics of gaze at the eyes and mouths in children with ASD. These results further enhance the understanding of the gaze characteristics of children with ASD on threatening and non-threatening faces and possibly provide additional evidence for their social interaction improvements.

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