1. Chakraborty S, Bhatia T, Sharma V, Antony N, Das D, Sahu S, Sharma S, Shriharsh V, Brar JS, Iyengar S, Singh R, Nimgaonkar VL, Deshpande SN. Psychometric properties of a screening tool for autism in the community-The Indian Autism Screening Questionnaire (IASQ). PloS one. 2021; 16(4): e0249970.

INTRODUCTION: Currently available screening questionnaires for Autism spectrum disorders were tested in developed countries, but many require additional training and many are unsuitable for older individuals, thus reducing their utility in lower/ middle- income countries. We aimed to derive a simplified questionnaire that could be used to screen persons in India. METHODS: We have previously validated Indian Scale for Assessment of Autism (ISAA), that is now mandated for disability assessment by the Government of India. This detailed tool requires intensive training and it is time consuming. It was used to derive a new screening questionnaire: 1) items most frequently scored as positive by participants with autism in original ISAA validation study were modified for binary scoring following expert review. 2) In a new sample, clinically diagnosed individuals with/without autism were administered the screening tool and ISAA following written informed consent. Its psychometric properties were determined. RESULTS: A 10-item scale named Indian Autism Screening Questionnaire (IASQ) was prepared in Hindi and English. Thereafter 145 parents/caregivers of participants (autism, n = 90, other psychiatric disorders, n = 55) (ages 3-18), were administered IASQ and ISAA (parents/caregivers plus observation) by separate interviewers, blind to each other and to diagnosis. At a cutoff of 1, sensitivity was 99%, specificity 62%, Positive Predictive Value 81%, and Negative Predictive Value 95%. Test-retest reliability was r = 0.767 (CI = 0.62-0.86) and interrater reliability- Krippendorff »s-alpha was 0.872. The area under Receiver Operating Characteristic Curve (ROC) was 95%. There was a significant difference on IASQ-scores between participants with and without a clinical diagnosis of Autism (t = 14.57, p<0.0001). DISCUSSION: The IASQ is a simple, easy to use screening tool with satisfactory reliability and validity, that can be administered to caregivers in 15 minutes and provides information about DSM 5 criteria for autism. It may be applicable outside India, following additional adaptation, for community-based studies.

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2. Dickson KS, Lind T, Jobin A, Kinnear M, Lok H, Brookman-Frazee L. A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. Administration and policy in mental health. 2021; 48(5): 857-83.

Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed.

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3. Fyke W, Alarcon JM, Velinov M, Chadman KK. Pharmacological inhibition of the primary endocannabinoid producing enzyme, DGL-α, induces autism spectrum disorder-like and co-morbid phenotypes in adult C57BL/J mice. Autism research : official journal of the International Society for Autism Research. 2021; 14(7): 1375-89.

Accumulating evidence links dysfunction in the endocannabinoid system (ECS) with the pathology of neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Variants in ECS genes CNR1 and DAGLA are associated with neurological phenotypes in humans. The endocannabinoids (eCBs), 2-AG and AEA, which act at the primary cannabinoid receptor (CB1), mediate behaviors relevant to neurodevelopmental disorders. The overlap between these eCBs is poorly understood. Most ECS studies have focused on stress responses, anxiety, and epilepsy, however, its role in social behavior and communication has only recently come under investigation. This represents a critical gap in our understanding of the ECS and its relationship to ASD. Furthermore, the increasing prevalence of ASD and a lack of therapeutics emphasize a crucial need for novel therapeutic targets. To this aim, we used an inhibitor of the eCB producing enzyme DGL-α, DO34, and the CB1 inverse agonist, rimonabant, to evaluate the role of the primary eCB, 2-AG, in ASD. Adult male C57BL/6J mice were used in a series of behavioral paradigms which assessed social behavior, social communication, repetitive behaviors, anxiety and locomotor activity. DO34 and rimonabant increased anxiety-like behavior, while only DO34 induced hyperactivity, social deficits, and repetitive self-grooming behavior. These data indicate that reduced 2-AG bioavailability, or CB1 inhibition, each induce unique respective behavioral phenotypes relevant to neurodevelopmental disorders, particularly ASD. This suggests fundamental differences in CB1 signaling via 2-AG and the CB1 receptor itself, particularly for social behaviors, and that 2-AG signaling may represent a target for the development of novel therapeutics. LAY SUMMARY: Endocannabinoids play a critical role in the developing nervous system. Alterations in the endocannabinoid system are linked to neurodevelopmental disorders. Studies suggest these variants may play a critical role in the core symptoms of autism spectrum disorder. In this study, pharmacological inhibition of the primary endocannabinoid producing enzyme, DGL-α, induced a constellation of deficits in behavioral domains associated with autism.

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4. Iannone AF, De Marco García NV. The Emergence of Network Activity Patterns in the Somatosensory Cortex – An Early Window to Autism Spectrum Disorders. Neuroscience. 2021; 466: 298-309.

Across mammalian species, patterned activity in neural populations is a prominent feature of developing sensory cortices. Numerous studies have long appreciated the diversity of these patterns, characterizing their differences in spatial and temporal dynamics. In the murine somatosensory cortex, neuronal co-activation is thought to guide the formation of sensory maps and prepare the cortex for sensory processing after birth. While pioneering studies deftly utilized slice electrophysiology and unit recordings to characterize correlated activity, a detailed understanding of the underlying circuits remains poorly understood. More recently, advances in in vivo calcium imaging in awake mouse pups and increasing genetic tractability of neuronal types have allowed unprecedented manipulation of circuit components at select developmental timepoints. These novel approaches have proven fundamental in uncovering the identity of neurons engaged in correlated activity during development. In particular, recent studies have highlighted interneurons as key in refining the spatial extent and temporal progression of patterned activity. Here, we discuss how emergent synchronous activity across the first postnatal weeks is shaped by underlying gamma aminobutyric acid (GABA)ergic contributors in the somatosensory cortex. Further, the importance of participation in specific activity patterns per se for neuronal maturation and perdurance will be of particular highlight in this survey of recent literature. Finally, we underscore how aberrant neuronal synchrony and disrupted inhibitory interneuron activity underlie sensory perturbations in neurodevelopmental disorders, particularly Autism Spectrum Disorders (ASDs), emphasizing the importance of future investigative approaches that incorporate the spatiotemporal features of patterned activity alongside the cellular components to probe disordered circuit assembly.

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5. Jassim N, Baron-Cohen S, Suckling J. Meta-analytic evidence of differential prefrontal and early sensory cortex activity during non-social sensory perception in autism. Neuroscience and biobehavioral reviews. 2021; 127: 146-57.

To date, neuroimaging research has had a limited focus on non-social features of autism. As a result, neurobiological explanations for atypical sensory perception in autism are lacking. To address this, we quantitively condensed findings from the non-social autism fMRI literature in line with the current best practices for neuroimaging meta-analyses. Using activation likelihood estimation (ALE), we conducted a series of robust meta-analyses across 83 experiments from 52 fMRI studies investigating differences between autistic (n = 891) and typical (n = 967) participants. We found that typical controls, compared to autistic people, show greater activity in the prefrontal cortex (BA9, BA10) during perception tasks. More refined analyses revealed that, when compared to typical controls, autistic people show greater recruitment of the extrastriate V2 cortex (BA18) during visual processing. Taken together, these findings contribute to our understanding of current theories of autistic perception, and highlight some of the challenges of cognitive neuroscience research in autism.

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6. Jones SC, Gordon CS, Akram M, Murphy N, Sharkie F. Inclusion, Exclusion and Isolation of Autistic People: Community Attitudes and Autistic People’s Experiences. Journal of autism and developmental disorders. 2022; 52(3): 1131-42.

There is limited research examining the inclusion of autistic people in their local communities. This paper reports on two Australian studies which explored this gap, focusing on both autistic people’s experiences and non-autistic people’s attitudes towards autistic individuals. Study One was conducted with primarily non-autistic people (n = 2,383), and Study Two with primarily parents and carers of autistic people (n = 1,297 people). The majority of non-autistic adults perceived discrimination against autistic people in the community; consistent with the experiences of autistic people and their carers. Of particular concern was more negative attitudes towards, and experiences of, autistic adults. There is an urgent need to improve society’s acceptance and inclusion of autistic people of all ages.

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7. Karavidas M, de Visser RO. « It’s Not Just in My Head, and It’s Not Just Irrelevant »: Autistic Negotiations of Menopausal Transitions. Journal of autism and developmental disorders. 2022; 52(3): 1143-55.

Physical and psychological changes during menopause can be especially tumultuous for autistic people: difficulties with sensory sensitivity and daily functioning may be exacerbated. Through individual interviews, we examined the language used by seven peri- or post-menopausal autistic people to construct their experiences, and to consider the implications for their wellbeing and identities. Our analysis, which utilised thematic decomposition, yielded three discursive themes. The theme « Uncertainty about Changes » addressed how limited awareness and understanding of menopause combined with difficulties recognising internal states. However, with « Growing Self-Awareness and Self-Care », some participants made conscious efforts to resist negative societal constructions of both autism and menopause. The theme « Navigating Support Options » addressed the interpersonal and systemic barriers participants faced when seeking support. There is a need for accessible information for autistic people experiencing menopause, and greater professional awareness.

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8. Kaur K, Suneja B, Jodhka S, Kaur J, Singh A, Singh SR. Metallic insignia in primary teeth: A biomarker for Autism Spectrum Disorders. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2021; 39(1): 61-6.

BACKGROUND: Lead accumulations have been found in teeth and related to behavior deficits in children, but there is a dearth of studies in exploring the role of zinc and manganese dysregulations in autism spectrum disorders (ASD) using the primary tooth as biomarker. AIMS: The objectives of the study were to evaluate and compare the concentrations of zinc and manganese in the primary teeth serving as biomarker, in typically developing children and children with ASD. SETTINGS AND DESIGN: Twelve primary incisors indicated for extraction were collected from children between the age group 6 and 9 years, for the study. Six primary incisors were obtained from children who had been diagnosed with ASD (study group). The other six teeth were obtained from typically developing children, in the similar age group. METHODS: The primary incisors obtained were analyzed for metal concentrations using the technique Inductively Coupled Plasma Optical Emission Spectrometry. STATISTICAL ANALYSIS: This study was statistically analyzed by student’s t-test. RESULTS: It was observed that there are significant differences in metal concentrations found between tooth samples of ASD children and typically developing children. Zinc concentrations were double and manganese concentrations were three times, in teeth of ASD children group as compared to the children in the control group. CONCLUSIONS: Results of the current study indicate that there are considerable differences in concentrations of zinc and manganese between the two groups and support the contention that there might be an association between metal exposures of a pregnant mother and child during early years of childhood and incidence of ASD.

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9. Li C, Li Y, Fu L, Wang Y, Cheng X, Cui X, Jiang J, Xiao T, Ke X, Fang H. The relationships between the topological properties of the whole-brain white matter network and the severity of autism spectrum disorder: A study from monozygotic twins. Neuroscience. 2021; 465: 60-70.

Twins provide a valuable perspective for exploring the pathological mechanism of autism spectrum disorder (ASD). We aim to analyze differences in the topological properties of the white matter (WM) network between monozygotic twins with ASD (MZCo-ASD) and children with typical development (TD). We enrolled 67 subjects aged 2-9 years. Twenty-three pairs of MZCo-ASD and 21 singleton children with TD completed clinical assessments and diffusion tensor imaging (DTI). Graph theory was used to compare the topological properties of the WM network between the two groups, and analyzed their correlations with the severity of clinical symptoms. We found that the global efficiency (Eg) of MZCo-ASD is weaker than that of TD children, while the shortest path length (Lp) of MZCo-ASD is longer than that of TD children, and MZCo-ASD have three unique hubs (the bilateral dorsolateral superior frontal gyrus and right insula). Eg and Lp were both correlated with the repetitive behavior scores of the Autism Diagnostic Interview-Revised (ADI-R) in the MZCo-ASD group, and the nodal efficiency of the dorsal superior frontal gyrus (SFGdor) was correlated with the ADI-R scores of repetitive behaviors. Left SFGdor nodal efficiency was correlated with Repetitive Behavior and Communication, two core symptoms of autism. The results implicated that MZCo-ASD had atypical brain structural network attributes and node distributions. Using MZCo-ASD, we found that the WM topological properties that correlate with the severity of ASD core symptoms were Eg, Lp, and the nodal efficiency of the SFGdor.

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10. McLaren JL, Lichtenstein JD, Metcalfe JD, Charlot LR, Drake RE, Beasley JB. Psychotropic Use Among Youths With Intellectual and Developmental Disabilities. Psychiatric services (Washington, DC). 2021; 72(9): 988-97.

OBJECTIVE: The authors examined the prevalence and correlates of psychotropic medication prescribing among outpatient youths with intellectual and developmental disabilities. METHODS: The authors reviewed cross-sectional data on medications for 1,333 youths (ages 5-21 years) with intellectual and developmental disabilities who were referred to a community-based mental health crisis service. Descriptive statistics and regression analysis were used to describe the study group and to identify correlates of psychotropic polypharmacy, antipsychotic use, and anticonvulsant use in the absence of a seizure disorder. RESULTS: Most youths were taking psychotropic medications (N=1,139, 86%), often three or more medications (N=733, 55%) from two or more drug classes (N=919, 69%). Most youths received antipsychotics (N=863, 65%), and a third (N=432, 32%) were taking anticonvulsants in the absence of a seizure disorder. Greater severity (number of psychiatric diagnoses and recent psychiatric hospitalization), older age, and living in a group home were significantly correlated with these practices. CONCLUSIONS: Polypharmacy, antipsychotic use, and anticonvulsant use in the absence of seizure disorders were common among youths with intellectual and developmental disabilities referred to the crisis service. Older age, number of psychiatric diagnoses, living in a group home, and psychiatric hospitalization correlate with these prescribing practices. These elevated prescribing rates in a very vulnerable population warrant further study.

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11. McVey AJ, Schiltz HK, Coffman M, Antezana L, Magnus B. A Preliminary Psychometric Analysis of the Difficulties with Emotion Regulation Scale (DERS) Among Autistic Adolescents and Adults: Factor Structure, Reliability, and Validity. Journal of autism and developmental disorders. 2022; 52(3): 1169-88.

Emotion dysregulation is common among autistic people, yet few measures have received psychometric evaluation in this population. We examined the factor structure, reliability, and validity of a commonly-used measure of emotion dysregulation, the Difficulties with Emotion Regulation Scale (DERS), in a sample of 156 autistic adolescents and adults. Data were drawn from the NIH National Database for Autism Research (NDAR) and an author’s existing dataset. Results demonstrated that the factor structure generally conformed to the original 6-factor model, with modifications. Reliability analyses revealed good-to-excellent internal consistencies. Validity analyses indicated that the DERS was positively associated with measures of anxiety, depression, and alexithymia. Our findings provide preliminary evidence for the utility of the DERS in a small autistic sample, with minor modifications.

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12. Millington E, Simmons DR, Cleland Woods H. Brief Report: Investigating the Motivations and Autistic Traits of Video Gamers. Journal of autism and developmental disorders. 2022; 52(3): 1403-7.

Video games are commonly of interest in autism, with autistic adolescents playing twice as much as their Typically Developing peers. The aims of this study are to investigate whether motivations to play video games measured using the Gaming Attitudes, Motivations and Experiences Scales and autistic traits using the Autism Spectrum Quotient can predict time spent playing video games. 57 participants were recruited from internet forums and completed an online questionnaire. The preliminary results revealed that only escapism and social motivation predicted time spent playing games. Further investigation revealed interactions between autistic traits and several motivational scales, including escapism, completionism, and customisation. This has consequences for future research into how autistic people use video games to ease their anxieties.

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13. Morales Hidalgo P, Voltas Moreso N, Canals Sans J. Autism spectrum disorder prevalence and associated sociodemographic factors in the school population: EPINED study. Autism : the international journal of research and practice. 2021; 25(7): 1999-2011.

An increase in the prevalence of autism spectrum disorder has been reported around the world over the past decade. However, the prevalence data for southern Europe seem to be lower than international reports and notable methodological differences have been reported among studies. The objective of the Neurodevelopmental Disorders Epidemiological Research Project was to estimate the prevalence of autism spectrum disorder in a representative school sample of the province of Tarragona, Spain. The study included a screening procedure through parents (N = 3727) and teachers (N = 6894), and an individual assessment of children at risk and a comparison group (N = 781). The overall estimated prevalence in our sample was 1.53%, being significantly higher than the 0.83% previously registered diagnoses. A total of 3.31% of the children presented subclinical characteristics of autism spectrum disorder. Girls showed a significantly lower estimated prevalence in all the conditions. Severity profiles were distributed as 46% mild, 47% moderate and 7% severe. Psychological support (65%), educational support (65%) and language therapy (51%) were given to children with autism spectrum disorder. Pharmacological treatment was only found among school-aged children (37.5%). Public schools provided more educational supports (72%) than private schools (36%). The heterogeneity of autism spectrum disorder makes it difficult to determine specific associated sociodemographic factors. The results confirmed a high prevalence of autism spectrum disorder in the province, suggesting a current under-diagnosis in public health services. In view of the results, it is important to promote early diagnosis and intervention, especially in particular groups such as girls, children with intellectual disabilities and children from immigrant families.

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14. Nardello R, Guccione F, Gliubizzi C, Marino A, Capizzi M, Mangano S. Resolution of enuresis with aripiprazole in children with psychiatric disorders: two case reports. Journal of medical case reports. 2021; 15(1): 209.

BACKGROUND: Aripiprazole is a third-generation atypical antipsychotic drug that acts as a stabilizer of the dopaminergic and serotonergic system. As partial agonist of the dopamine (D2) and serotonin (5-HT1A) receptors, it appears to be effective in reducing mania in patients with bipolar disorder, tics in Tourette Syndrome, aggression in schizophrenia and autism spectrum disorder. Enuresis has been reported among its side effects. Only a few studies, with conflicting results, have investigated the relationship between aripiprazole and enuresis. CASE PRESENTATION: We report the disappearance of enuresis in a Caucasian girl with intellectual disability and oppositional defiant disorder and in a Caucasian boy with intellectual disability and early-onset psychosis, both following initiation of treatment with aripiprazole. CONCLUSION: The aim of this study was to contribute to the literature on the use of aripripazole in subjects with enuresis. Our findings lead us to suggest that aripiprazole is less burdened with side effects, including bedwetting, than other antipsychotic drugs.

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15. Schafer ST, Gage FH. To eat, or not to eat, that is the question: Neural stem cells escape phagocytosis in autism with macrocephaly. Proceedings of the National Academy of Sciences of the United States of America. 2021; 118(19).

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16. Siracusano M, Calsolaro J, Riccioni A, Gialloreti LE, Benvenuto A, Giovagnoli G, Curatolo P, Mazzone L. TrASDition Training: An online parental training for transition-age youth with autism spectrum disorder. Psychiatry research. 2021; 300: 113930.

Transition to the adult age represents a rather challenging period of life for youth with Autism Spectrum Disorder (ASD) and for their families. Given the actual lack of integrated healthcare systems for autistic young-adults, enhancing parental skills could represent a feasible program to improve skills preparatory for transition in adult life. The online approach, providing easy access to services which otherwise would burden a daily family organization, already strenuous for a family with an autistic person, can represent an innovative way of delivering intervention. Therefore, we developed an online psychoeducational parental training, named TrASDition Training, with a 6 months duration, addressed to parents of autistic youth with and without Intellectual Disability during the transition age. The aim of this study was to longitudinally evaluate the impact of the online parental training on the adaptive functioning, on the repetitive and problematic behaviors of ASD youth (n = 23) and on parental stress. After 6 months of Training, we found a significant improvement in adaptive functioning of ASD participants and a reduction of parental stress.

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17. Snijder MI, Kaijadoe SP, van ‘t Hof M, Ester WA, Buitelaar JK, Oosterling IJ. Early detection of young children at risk of autism spectrum disorder at well-baby clinics in the Netherlands: Perspectives of preventive care physicians. Autism : the international journal of research and practice. 2021; 25(7): 2012-24.

To improve early detection of autism spectrum disorder in preventive care, a Dutch guideline was developed 5 years ago. The guideline provides preventive care physicians at well-baby clinics action-oriented advice and describes a step-by-step approach for children identified at an increased risk for autism spectrum disorder during general healthcare surveillance. The present qualitative study evaluated adherence to the guideline and studied barriers regarding early detection of autism spectrum disorder at well-baby clinics. Interviews were undertaken with 12 preventive care physicians (one representative per province). It was found that the vast majority of participants did not follow-up general surveillance with an autism spectrum disorder -specific screener as prescribed by the guideline. Six barriers (limited knowledge about autism spectrum disorder symptoms in infant and toddlerhood, professional attitude toward early detection, problems in discussing initial worries with parents, limited use of screening instruments, perceptions toward cultural and language differences and constraints regarding availability of healthcare services) were found. The results of this study highlight the importance of an integrative approach, raising awareness of the benefits regarding early detection of autism spectrum disorder in preventive care, the need of continuous investment in easy and accessible training and active screening, and a closer collaboration between preventive care organizations and autism spectrum disorder experts.

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18. Ward EK, Braukmann R, Weiland RF, Bekkering H, Buitelaar JK, Hunnius S. Action predictability is reflected in beta power attenuation and predictive eye movements in adolescents with and without autism. Neuropsychologia. 2021; 157: 107859.

Most theoretical accounts of autism posit difficulties in predicting others’ actions, and this difficulty has been proposed to be at the root of autistic individuals’ social communication differences. Empirical results are mixed, however, with autistic individuals showing reduced action prediction in some studies but not in others. It has recently been proposed that this effect might be observed primarily when observed actions are less predictable, but this idea has yet to be tested. To assess the influence of predictability on neural and behavioural action prediction, the current study employed an action observation paradigm with multi-step actions that become gradually more predictable. Autistic and non-autistic adolescents showed similar patterns of motor system activation during observation, as seen in attenuated mu and beta power compared to baseline, with beta power further modulated by predictability in both groups. Bayesian statistics confirmed that action predictability influenced beta power similarly in both groups. The groups also made similar behavioural predictions, as seen in three eye-movement measures. We found no evidence that autistic adolescents responded differently than non-autistic adolescents to the predictability of an observed action. These findings show that autistic adolescents do spontaneously predict others’ actions, both neurally and behaviourally, which calls into question the role of action prediction as a key mechanism underlying autism.

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19. Willsey HR, Exner CRT, Xu Y, Everitt A, Sun N, Wang B, Dea J, Schmunk G, Zaltsman Y, Teerikorpi N, Kim A, Anderson AS, Shin D, Seyler M, Nowakowski TJ, Harland RM, Willsey AJ, State MW. Parallel in vivo analysis of large-effect autism genes implicates cortical neurogenesis and estrogen in risk and resilience. Neuron. 2021; 109(8): 1409.

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20. Zamami Y, Shinzato H, Kurihara K, Koda M, Nakamura A, Kondo T. Prevalence and profile of depressive mixed state in patients with autism spectrum disorder. Psychiatry research. 2021; 300: 113932.

PURPOSE: The present study aimed to clarify prevalence and profile of depressive mixed state (DMX) in depressed individuals with autism spectrum disorder (ASD). PATIENTS AND METHODS: The Quick Inventory of Depressive Symptomatology Self-Report Japanese version (QIDS-SR-J) and global assessment of functioning (GAF) were administered to 182 consecutive patients (36 ASD and 146 non-ASD subjects) with a major depressive episode (MDE). DMX was categorically diagnosed according to the criteria for mixed depression (MD) by Benazzi and mixed features (MF) specifier by DSM-5. Severity of DMX was assessed by the self-administered 12-item questionnaire for DMX (DMX-12). Clinical backgrounds and incidence/severity of DMX were compared between the ASD and non-ASD groups. RESULTS: ASD patients showed higher prevalence of MD than non-ASD patients (36.1% versus 18.5%). Mood lability, distractibility, impulsivity, aggression, irritability, dysphoria and risk-taking behavior as mixed symptoms were more prevalent in ASD patients than those in non-ASD patients, together with higher scores of total DMX-12 and its disruptive emotion/behavior cluster. Multiple regression analysis revealed significant contribution of ASD to the disruptive emotion/behavior symptoms. CONCLUSION: Careful monitoring and management of potential DMX are warranted in depressed ASD individuals.

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