1. An W, Ding Z, Zhu Z, Zhang M, Xiao H, Guo P, Yang F, Zhou X. Verbal working memory in children and adolescents with autism spectrum disorders: A meta-analysis review. Acta Psychol (Amst);2025 (Jul 22);259:105253.

In recent years, research has increasingly concentrated on examining verbal working memory (VWM) with autism spectrum disorders (ASD). However, the findings on whether ASD experience impairments in VWM are inconsistent, which could be attributed to various factors, including age, IQ, task variations, and participant heterogeneity. Therefore, this study undertakes a meta-analysis to review the advancements in research on VWM deficits in ASD, exploring the potential influence of factors such as age, IQ, sample size, and test tasks on VWM performance in this population. According to the Boolean algorithm, this study combined keywords related to VWM in children and adolescents with ASD, and published them in Web of Science, PsyCINFO, PubMed, Cochrane Library, Embase, CNKI, and Wanfang Database to find all research findings in ASD related VWM published before 2024, and the final meta-analysis comprised 25 studies. The research conclusion indicate that children and adolescents with ASD have deficits in VWM. In addition, age, IQ, sample size, and testing tasks may not be important factors affecting the VWM in ASD. The conclusion of this study provides theoretical basis and clinical guidance for further exploring the influencing factors and intervention methods of VWM with ASD in the future.

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2. Bortolozzo-Gleich MH, Bouisset G, Geng L, Pino AR, Nomura Y, Han S, Li Y, Leroy F. Impaired vasopressin neuromodulation of the lateral septum leads to social behavior deficits in Shank3B(+/-) male mice. Nat Commun;2025 (Jul 23);16(1):6783.

The neuropeptide arginine-vasopressin (AVP) has been repeatedly associated with the autism spectrum disorder (ASD) but the underlying mechanisms remain unclear. As Shank3B(+/-) male mice, a model of ASD, exhibit deficits in sociability and social aggression, we focused on the lateral septum (LS), a brain region involved in the regulation of motivated behaviors and observed reduced AVP inputs from the bed nucleus of the stria terminalis (BNST) to LS. Manipulating AVP release from the BNST to LS of wild-type male mice, we found that AVP promotes both sociability and social aggression. Blocking the vasopressin receptor 1a (AVPR1a) in LS impaired sociability, while blocking the receptor 1b (AVPR1b) disrupted social aggression. Consequently, selective activation of AVPR1a or AVPR1b rescued the respective behavioral deficits in Shank3B(+/-) male mice. These findings reveal that AVP release in LS modulates two distinct social behaviors via different receptors and highlight a possible strategy to rescue sociability during ASD.

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3. Croyé MA, Freilinger P, Jürgenlimke H, Domes G, Meyer J. Elevated autistic traits and social anxiety, and reduced empathy in adult women with triple X syndrome. J Neurodev Disord;2025 (Jul 23);17(1):41.

BACKGROUND: Triple X syndrome (TXS, 47,XXX) is a sex chromosome aneuploidy affecting females. The condition is associated with cognitive, emotional, and social challenges. While prior research has primarily focused on children, the social and psychological profile of adult women with TXS remains understudied. This study aims to provide a comprehensive assessment of these aspects in adult women with TXS compared to matched controls. METHODS: A cohort of 44 women with TXS (mean age 30.5 years) was compared to 50 age- and education-matched controls (mean age 29.7 years). Standardized assessments measured verbal IQ, psychological distress, chronic stress, emotion regulation, coping mechanisms, social anxiety, empathy, autistic traits, and personality traits. Group comparisons were conducted using ANOVAs and MANOVAs, with additional χ² tests for categorical variables. RESULTS: Depression and trait anxiety did not significantly differ between groups, though both groups exhibited notably high scores. However, a greater number of individuals in the TXS group reported elevated social anxiety and autistic traits, and reduced empathy. Moreover, there were indications of increased self-reported social tensions, personal distress, and somatization within the TXS group. No significant differences were found in personality traits, verbal IQ, chronic stress levels, and emotion regulation. Additionally, TXS participants tended to rely less on the maladaptive coping strategy of alcohol and cigarette consumption. CONCLUSION: Our findings underscore autistic traits, social anxiety, and reduced empathy as significant challenges for adult women with TXS. While cognitive and emotional characteristics were largely comparable to those of age- and education-matched controls, the heightened social difficulties suggest a potential benefit of targeted interventions, such as social skills training, to support affected individuals. Longitudinal studies are essential to understand the long-term progression of these challenges and to develop effective therapeutic strategies.

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4. Grahn K. Physical activity experiences among children with ADHD and ASD: a qualitative meta-synthesis literature review. Int J Qual Stud Health Well-being;2025 (Dec);20(1):2524460.

PURPOSE: The aim was to analyze and synthesize empirical research on physical activity experiences among children diagnosed with ADHD and ASD. METHODS: A qualitative meta-synthesis was conducted, including 17 articles published between 2010 and 2023. The synthesis encompasses qualitative research on the experiences of children with ADHD and ASD in organized physical activity. Data were categorized into overarching themes based on a socio-ecological model. Each overarching theme was subdivided into themes and sub-themes illustrated with extracts from each study. RESULTS: The research was conducted in several countries, with a predominance of studies from the USA and Canada. Most studies focused on children diagnosed with ASD, with boys being more frequently represented. Various intrapersonal factors were influential, with negative factors including disability-specific constraints, motor skill difficulties, and dissatisfaction with physical activity, while enjoyment of specific activities and positive attitudes towards physical activity were identified as some of the positive factors. In terms of interpersonal factors, interactions with family, friends, teammates, and coaches or teachers shaped both positive and negative experiences. CONCLUSIONS: The findings provide valuable insights into the experiences of children with ADHD and ASD in organized physical activity contexts. Key aspects identified can guide future research and initiatives aimed at including children with ADHD and ASD in organized physical activities.

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5. Heyworth M, McMahon C, Tan DW, Pellicano E. « There is Nowhere Else That I’d Rather be Than with Them »: Parents’ Positive Experiences Parenting Autistic Children. Autism Dev Lang Impair;2025 (Jan-Dec);10:23969415251357222.

BACKGROUND AND AIMS: A significant body of research focuses on the negative outcomes of parenting Autistic children, particularly when parents identify as non-Autistic. Less attention has been paid to the experiences of Autistic parents of Autistic children, and even less to the positive or fulfilling elements of parenting Autistic children, regardless of parent neurotype. This study therefore asked: What do parents value about their Autistic children, and what characterizes parents’ positive relationships with their Autistic children? METHODS: Here, 40 Autistic and 40 non-Autistic parents completed semistructured interviews to understand better their positive experiences of parenting Autistic children. We analyzed participant responses using reflexive thematic analysis, using an inductive approach. RESULTS: We identified five themes: parenting is both challenging and enjoyable and « there’s the good and the bad and the highs and the lows » (theme 1); parents value time with their Autistic children and « there is nowhere else that I’d rather be than with them » (theme 2); parents value their Autistic child’s personality and « just love watching her be who she is » (theme 3); parenting Autistic children is fulfilling and « I know I must be doing something right » (theme 4); and collaboration, learning, and acceptance are key to parenting fulfillment so that « I wouldn’t have it any other way » (theme 5). Overall, parents told us that parenting could be complex and challenging, and that they had good and bad days. But many parents felt happy to parent their Autistic child, and they enjoyed laughing and doing things together with their child. Parents often really liked their Autistic child, who they thought was caring, funny, and interesting, and they described enjoying their child’s company, speaking about the qualities and characteristics they valued in their Autistic child. Some parents felt happy when their child needed them. They liked it when they could help their child and make their child feel safe. This made them feel like they were doing a good job as parent. Parents discussed the personal positive impact of experiencing feelings of self-efficacy and the role of Autistic children in their personal growth. Finally, parents thought that it was important to accept their child and that their life would be different than what they imagined. They reflected on the role of acceptance and flexibility in their experiences of joy and fulfillment. CONCLUSIONS: We show that both Autistic and non-Autistic parents of Autistic children have positive, joyful, and valuable parenting experiences. Our findings have far-reaching implications, including how researchers and practitioners conceptualize parenting Autistic children, and the ways in which parents can be supported to foster such experiences.

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6. Hong YH, Song DY, Yoo H. Sex differences in the prevalence of common comorbidities in autism: a narrative review. Ewha Med J;2025 (Jan);48(1):e79.

Autism spectrum disorder involves challenges in social communication and restricted, repetitive behaviors. Historically, males have received autism diagnoses at comparatively high rates, prompting an underrepresentation of females in research and an incomplete understanding of sex-specific symptom presentations and comorbidities. This review examines sex differences in the prevalence of common comorbidities of autism to inform tailored clinical practices. These conditions include attention deficit hyperactivity disorder, anxiety disorders, conduct disorder, depression, epilepsy, intellectual disability, and tic disorders. Attention deficit hyperactivity disorder is prevalent in both sexes; however, females may more frequently exhibit the inattentive subtype. Anxiety disorders display inconsistent sex differences, while conduct disorder more frequently impacts males. Depression becomes more common with age; some studies indicate more pronounced symptoms in adolescent girls, while others suggest greater severity in males. Epilepsy is more prevalent in females, especially those with intellectual disabilities. Despite displaying a male predominance, intellectual disability may exacerbate the severity of autism to a greater degree in females. No clear sex differences have been found regarding tic disorders. Overall, contributors to sex-based differences include biases stemming from male-centric diagnostic tools, compensatory behaviors like camouflaging in females, genetic and neurobiological differences, and the developmental trajectories of comorbidities. Recognizing these factors is crucial for developing sensitive diagnostics and sex-specific interventions. Inconsistencies in the literature highlight the need for longitudinal studies with large, diverse samples to investigate autism comorbidities across the lifespan. Understanding sex differences could facilitate earlier identification, improved care, and personalized interventions, thus enhancing quality of life for individuals with autism.

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7. Jablonowski K, Hooker B. Unadjusted Analysis of a Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism. Integr Med (Encinitas);2025 (Aug);24(4):10-12.

Madsen et al.’s unadjusted results do not support rejecting the causal link between the MMR (measles, mumps, and rubella) vaccine and autism. The summary statistics and errors in the original publication warrant the release of the raw data. Madsen et al. is a cornerstone publication that forms the basis of the claim that vaccines do not cause autism, and thus, correctness and transparency need to be ensured.

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8. Konowałek Ł, Kotowska-Bąbol M, Łukasik J, Remiszewski P, Wolańczyk T. Quality of life among parents of autistic children: questionnaire validation study and multivariate analysis of associated factors. Front Psychiatry;2025;16:1554368.

Parents of children with autism often experience unique challenges that can impact their emotional wellbeing. The aim of this study was to validate the Polish adaptation of the Quality of Life in Autism Survey (QoLA) and to examine the factors influencing quality of life (QoL) among parents of children with autism spectrum disorder (ASD). The survey was administered to 372 participants, predominantly mothers, and assessed QoL using the QoLA-A and QoLA-B scales alongside established tools such as the Beck Depression Inventory and WHOQOL-BREF. Results showed high reliability for the QoLA-A scale, supported by Cronbach’s alpha (0.93) and omega coefficients, and confirmed an 8-factor model consistent with Schalock’s domains of QoL. The scale showed strong correlations with psychological health, social relationships and environmental factors, validating its criterion and construct reliability. Conversely, QoLA-B showed limitations, capturing only five dimensions and explaining less than 50% of the variance. Important predictors of parental QoL included employment status, material well-being and depressive symptoms, with externalising behaviours in children having a significant negative influence. Intellectual and communication disabilities, although a significant challenge, were not strongly correlated with parental QoL. The findings highlight the need to address socio-economic and mental health support for caregivers, with an emphasis on tailored interventions that enhance parental wellbeing, rather than exclusively targeting child-specific therapies. This comprehensive validation highlights the utility of the QoLA-A and the nuanced factors that influence caregiver QoL.

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9. Lu Y, Tong J, Zhang D, Chen J, Li L, Lei Y, Zhou T, Aragon LV, Becich MJ, Blecker S, Blum NJ, Christakis DA, Hornig M, Hornig-Rohan MM, Jhaveri R, Jones WS, Keebler AB, Kelleher K, Kim S, Mosa ASM, Pajer K, Platt J, Schwenk HT, Taylor BW, Utidjian LH, Williams DA, Prasad R, Elia J, Forrest CB, Chen Y. Risk of neuropsychiatric and related conditions associated with SARS-CoV-2 infection: a difference-in-differences analysis. Nat Commun;2025 (Jul 24);16(1):6829.

The COVID-19 pandemic has been associated with increased neuropsychiatric conditions in children and youths, with evidence suggesting that SARS-CoV-2 infection may contribute additional risks beyond pandemic stressors. This study aims to assess the full spectrum of neuropsychiatric conditions in COVID-19 positive children (ages 5-12) and youths (ages 12-20) compared to a matched COVID-19 negative cohort, accounting for factors influencing infection risk. Using EHR data from 25 institutions in the RECOVER program, we conduct a retrospective analysis of 326,074 COVID-19 positive and 887,314 negative participants matched for risk factors and stratified by age. Neuropsychiatric outcomes are examined 28 to 179 days post-infection or negative test between March 2020 and December 2022. SARS-CoV-2 positivity is confirmed via PCR, serology, or antigen tests, while negativity requires negative test results and no related diagnoses. Risk differences reveal higher frequencies of neuropsychiatric conditions in the COVID-19 positive cohort. Children face increased risks for anxiety, OCD, ADHD, autism, and other conditions, while youths exhibit elevated risks for anxiety, suicidality, depression, and related symptoms. These findings highlight SARS-CoV-2 infection as a potential contributor to neuropsychiatric risks, emphasizing the importance of research into tailored treatments and preventive strategies for affected individuals.

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10. Lukito S, Chandler S, Kakoulidou M, Griffiths K, Wyatt A, Funnell E, Pavlopoulou G, Baker S, Stahl D, Sonuga-Barke E. Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co-produced self-report measure. J Child Psychol Psychiatry;2025 (Jul 24)

BACKGROUND: Mental health problems are elevated in adolescents with ADHD and/or autism. Emotion regulation deficits (ERD) have been hypothesised as a key driver of such difficulties. The Regulating Emotions – Strengthening Adolescent Resilience (RE-STAR) programme is examining an alternative pathway from neurodivergence to mental health problems, mediated by elevated emotional burden (EB) resulting from the interplay of increased exposure and an unusually intense emotional reaction to commonly upsetting events (CUEs). We present the development and application of the My Emotions in School Inventory (MESI), a self-report questionnaire co-produced with neurodivergent young people, focusing on EB in schools – a setting thought to be of particular significance in this regard. METHODS: The MESI, containing 25 school-related CUEs rated on their frequency and the intensity of negative emotions they induce, was completed by secondary school students meeting symptom cut-offs on clinically validated scales of ADHD (n = 100), autism (n = 104), ADHD + autism (n = 79) and neurotypical students (n = 452). Psychometric properties were examined. The ability of the MESI to discriminate adolescents with ADHD and/or autism from neurotypical adolescents, and to predict depression and anxiety, independently of ERD, was explored. RESULTS: Adolescents in the ADHD and/or autism groups experienced higher CUE frequency and intensity of reaction than their neurotypical peers. Overall levels of EB, most robustly indexed by 24 MESI CUEs, were higher in the three neurodivergent groups, though they did not differ from each other. EB in the autism and ADHD groups was generated by distinctly different CUEs. EB and ERD each contributed independently to the prediction of higher depression or anxiety. CONCLUSIONS: Our findings illustrate the potential value of the MESI as an instrument to measure the contribution of EB alongside ERD in relation to adolescent mental health risks in ADHD and/or autism. Future studies need to investigate its role longitudinally.

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11. Mahmud F, Kang E, McDonald RG, Wallace D, Masia Warner C. Disentangling the association between cognitive flexibility and anxiety in autistic youth: real-world flexibility versus performance-based task switching. Front Psychiatry;2025;16:1570185.

INTRODUCTION: Anxiety symptoms are highly prevalent among autistic youth yet remain under-recognized and undertreated, in part, due to a limited conceptual understanding of autistic cognition. Emerging evidence suggests that autistic differences in cognitive flexibility (CF) may be associated with a greater likelihood of developing and maintaining anxiety symptoms, relative to non-autistic youth. However, further work is needed to elucidate mechanisms of anxiety vulnerability that could inform potential targets for anxiety treatment in autistic youth. The current study aims to examine the associations between CF and anxiety in this population. Given the complexity of CF as a multifaceted construct, we used a multi-method approach to measure CF in order to tease apart its relationship with anxiety symptoms. Specifically, we hypothesized that real-world flexibility difficulties (assessed by survey measures), and poorer task switching performance (assessed by neurocognitive lab measures), would be associated with higher anxiety. METHODS: Participants included forty 8-17-year-old autistic children (11 female, 29 male), along with their parents. Anxiety symptoms were measured by parent- and self-report using the Anxiety Scale for Children with Autism Spectrum Disorder. Task switching performance was measured using the Trail Making, Verbal Fluency, and Color-Word Interference tests from the Delis-Kaplan Executive Function System, administered to children in a controlled lab setting. Flexibility challenges in real-world settings were assessed by parent- and self-report using the Flexibility Scale and Shift subscale from the Behavior Rating Inventory of Executive Functioning (BRIEF-2; BRIEF-SR). Autistic traits were measured by parent-report using the Social Responsiveness Scale (SRS-2). RESULTS: Multiple linear regression analyses revealed that reduced real-world flexibility was a significant predictor of anxiety, according to both parent- and self-report, even after controlling for autistic traits. Poorer task switching performance, however, was not associated with increased anxiety. DISCUSSION: Our findings are consistent with previous literature suggesting that real-world CF challenges are linked to anxiety in autistic youth. The current study also offers preliminary evidence for the distinction between real-world CF and performance-based CF regarding their relationship to anxiety among autistic youth. Findings may help inform targeted assessment and treatment approaches for anxiety in this vulnerable population.

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12. Ruaño G, Uscătescu LC. From Misophonia Through Puberphonia: Window Toward Gender Dysphoria in Autism?. Autism Res;2025 (Jul 24)

Autism is characterized by distinct patterns of social communication, interests, and behaviors. Gender incongruence involves a mismatch between one’s experienced and assigned gender, often accompanied by significant distress (i.e., gender dysphoria). Recent studies revealed that autistic individuals report gender dysphoria more frequently than the general population and are overrepresented in gender clinic settings. Autistic individuals also report hypersensitivity to certain sensory stimuli, which can elicit distress. When this distress is triggered by certain auditory stimuli (e.g., one’s or others’ biological sounds such as chewing or swallowing) it is categorized as misophonia. Misophonia appears to be highly prevalent in autism. We propose that a lesser-studied phenomenon, puberphonia, could exemplify an attempt to reduce the distress elicited by misophonia in a certain category of individuals. Puberphonia is characterized by an unusually high-pitched voice, predominantly in teenage boys and men, that can occur in the absence of identifiable physical causes. The psychogenic aspects of puberphonia are just beginning to be explored. We hereby propose an exploratory direction, suggesting that puberphonia may be an individual’s attempt at diminishing a distressing auditory stimulus (misophonia) due to their deepening voice. This, in turn, may be an indicator of unrecognized gender dysphoria. Given that voice pitch has also been reported to be higher in autistic males compared to controls, we further ask whether autism is more prevalent among cases of psychogenic puberphonia. Finally, we wish to draw attention to the need for research on the epidemiology and overlap of puberphonia, gender dysphoria, misophonia, and autism.

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13. Shi S, Song S, Wang H, Li P, Zhang X. Effects of TEACCH on social functioning in individuals with autism spectrum disorders: a systematic review and meta-analysis. BMC Pediatr;2025 (Jul 24);25(1):569.

OBJECTIVE: To investigate the effects of Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) on social functioning in individuals with autism spectrum disorders (ASD). METHODS: Relevant studies on TEACCH intervention in ASD individuals were systematically searched in PubMed, The Cochrane Library, Embase, CNKI, and Wanfang from inception to March 2024. The main outcome measures were social, cognitive performance, fine motor, communication, daily living, imitation, and cognitive verbal skills. Data were meta-analyzed using R studio (4.1.2). RESULTS: Eleven studies involving 701 ASD individuals were included in this study. The TEACCH group had significantly higher socialization score [MD = 0.6, 95% CI(0.2, 1.0)], Cognitive Performance Scale score [MD = 1.34, 95% CI(0.09, 2.58)], and fine motor score [MD = 0.7, 95% CI(0.4, 1.0)] but significantly lower Autism Behavior Checklist score [MD = -1.57, 95% CI(-2.11, -1.02)], Childhood Autism Rating Scale score [MD= -0.7, 95%CI(-1.0, -0.3)], and Autism Treatment Evaluation Checklist score [MD= -0.7, 95% CI(-1.0, -0.3)] compared to the control group. There were no significant differences in other outcome measures. CONCLUSION: TEACCH is a promising intervention for improving the social skills, cognitive performance, and fine motor functions of ASD individuals. However, further studies are warranted to confirm the effectiveness of TEACCH on ASD core symptoms.

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14. Shimoni HN, Gindi S, Zilbershot Fink E, Ben Shabbat Seri M, Levy E, Hutter-Beeri D, Hadaya Cohen M, Leitner Y. [DIAGNOSING AUTISM SPECTRUM DISORDER (ASD) IN MEDICAL SETTINGS: THE PEER GROUP OBSERVATION TECHNIQUE- THREE CASE STUDIES]. Harefuah;2025 (Jul);164(7):412-417.

This study introduces a group observation technique to enhance the diagnostic evaluation of Autism Spectrum Disorder (ASD) in children and adolescents. Conducted by a physician and a psychologist, the procedure involves six consecutive 50-minute sessions over six weeks, designed for individuals aged 6-18 years in a peer group setting. Three case studies illustrate the technique. By considering social context and peer interactions over time, this method helps resolve ambiguities and discrepancies in the ASD diagnostic process, uncovering alternative explanations for behaviors observed in single meetings between a psychologist and neurologist/psychiatrist with a patient. Detailed case descriptions demonstrate the value of this approach. The group observation provides unique insights into social communication and restricted behaviors, offering a valuable addition to current ASD diagnostic practices.

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15. Thye M, Hoffman P, Mirman D. Neural correlates of social and thematic semantics in autistic and non-autistic adults. Soc Cogn Affect Neurosci;2025 (Jul 24)

Conceptual knowledge-about objects, events, and social behaviour-is represented within the semantic system, but it is unclear if different conceptual categories engage the same portions of the system. This is perhaps most relevant for event-based, or thematic, knowledge and social knowledge which is acquired through social experiences. The present study investigated neural specialisation for social concepts by examining whether distinct semantic regions or hubs represent taxonomic versus thematic relations and social versus non-social relations. Specialization was examined in two groups with different social experiences: autistic and non-autistic adults. There were minimal behavioural and no neural differences between groups, suggesting that differences in social experiences between autistic and non-autistic people may be better understood at the interactional level. In whole-brain analyses across both groups, taxonomic relations engaged the semantic control network to a greater extent than thematic relations did, and n overlapping portion of the rostroventral area of left angular gyrus was engaged by both thematic (relative to taxonomic) and social (relative to non-social) relations. Region of interest analyses revealed a more complex pattern within bilateral angular gyri. The results suggest that angular gyrus represents conceptual knowledge in a graded fashion, including specialisation for thematic and social relations.

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16. Tschida J, Peeran I, Drahota A. Using community engagement to adapt anxiety cognitive behavioural therapy for autistic youth receiving services in Michigan community-based organisations: protocol for a mixed methods study. BMJ Open;2025 (Jul 22);15(7):e095564.

INTRODUCTION: Anxiety disorders are among the most common co-occurring mental health conditions experienced by autistic youth. Without appropriate intervention, anxiety disorders and related difficulties experienced by autistic youth can remain well into adulthood, causing reduced quality of life. Behavioral Interventions for Anxiety in Children with Autism (BIACA) is a manualised, modular evidence-based cognitive behavioural therapy with demonstrated efficacy in reducing or fully remitting anxiety symptoms and improving overall adaptive functioning for autistic youth. However, BIACA has been developed and tested mostly in academic research laboratories and has involved a limited number of community clinicians. Thus, certain characteristics (eg, length, complexity) may require adaptation to facilitate adoption and use in community settings. METHODS AND ANALYSIS: This mixed methods study will use and evaluate a community-engaged, intervention adaptation method (ie, Adapted version of the Method for Program Adaptation through Community Engagement (AM-PACE)) to develop an adapted version of BIACA for community use. In the current study, the AM-PACE method will involve: (1) a Community Advisory Board (CAB), (2) structured process to identify core components, (3) community feedback via surveys and semistructured interviews and (4) role play exercises with intended clients. Thereafter, community-based providers (N=200) will be asked to evaluate the feasibility, acceptability, appropriateness, usability and intent to use for the original BIACA intervention and adapted BIACA intervention. Repeated measures Analysis of Variance (ANOVA) will be conducted to determine whether programme type predicts provider ratings. Higher provider ratings for the adapted BIACA intervention may indicate adaptations identified through AM-PACE-enhanced potential for BIACA to be equitably implemented in community settings. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Michigan State University Institutional Review Board. Research findings will be published in peer-reviewed journals, presented at international conferences and disseminated in alignment with CAB recommendations. REGISTRATION: This study has been registered on Open Science Framework: https://doi.org/10.17605/OSF.IO/Z54MD.

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17. Zhai Q, Wu Y, Wu Y, Ji Y, Li Y, Xu R, Zhong Y, Xiao B, Zhou L. Cognitive behavioural therapy and related interventions for sleep disorders in children and adults with autism spectrum disorder: protocol for a systematic review and meta-analysis. BMJ Open;2025 (Jul 22);15(7):e101084.

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by deficits in social communication and repetitive behaviours, often accompanied by sleep disturbances. These sleep problems, including prolonged sleep latency and fragmented sleep, affect more than half of autistic individuals, exacerbating functional impairments and diminishing quality of life. Cognitive behavioural therapy (CBT) has shown promise in addressing sleep disturbances in ASD, with preliminary studies indicating improvements in sleep quality. However, no systematic review has comprehensively summarised the effects of CBT on sleep in autistic individuals. METHODS AND ANALYSIS: This systematic review and meta-analysis will synthesise evidence on the efficacy of CBT for improving sleep quality in individuals with ASD. We will search multiple databases (eg, PubMed, Web of Science) for studies published until May 2025. Inclusion criteria encompass randomised controlled trials, single-arm studies and observational studies involving children and adults with ASD and moderate sleep problems. Interventions targeting sleep quality using CBT techniques will be considered. Data extraction will focus on study details, participant information, intervention specifics and sleep outcome measures (eg, total sleep time, sleep onset latency, etc). Risk of bias will be assessed using tools such as Cochrane Risk of Bias Tool V.2, Risk Of Bias In Non-randomised Studies-of Interventions and Review Manager 5.3. A meta-analysis will be conducted using Stata 18, with heterogeneity evaluated using the I² statistic and Cochran’s Q test. ETHICS AND DISSEMINATION: Given that the dataset for this investigation is derived from publicly accessible databases, there is no direct interaction with patients; thus, ethical approval is not required. PROSPERO REGISTRATION NUMBER: CRD42025643701.

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