1. Faraji R, Ganji Z, Zamanpour SA, Nikparast F, Akbari-Lalimi H, Zare H. Impaired white matter integrity in infants and young children with autism spectrum disorder: What evidence does diffusion tensor imaging provide?. Psychiatry research Neuroimaging. 2023; 335: 111711.

BACKGROUND: Abnormal functional connections are associated with impaired white matter tract integrity in the brain. Diffusion tensor imaging (DTI) is a promising method for evaluating white matter integrity in infants and young children. This work aims to shed light on the location and nature of the decrease in white matter integrity. METHODS: Here, the results of 19 studies have been presented that investigated white matter integrity in infants and young children (6 months to 12 years) with autism using diffusion tensor imaging. RESULTS: In most of the reviewed studies, an increase in Fractional Anisotropy (FA) and a decrease in Radial Diffusivity (RD) were reported in Corpus Callosum (CC), Uncinate Fasciculus (UF), Cingulum (Cg), Inferior Longitudinal Fasciculus (ILF), and Superior Longitudinal Fasciculus (SLF), and in the Inferior Fronto-Occipital Fasciculus (IFOF) tract, a decrease in FA and an increase in RD were reported. CONCLUSION: In the reviewed articles, except for one study, the diffusion indices were different compared to the control group.

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2. Greenwood E, Cooklin A, Barbaro J, Miller C. Autistic patients’ experiences of the hospital setting: A scoping review. Journal of advanced nursing. 2023.

AIM: To explore the factors that affect the experiences of autistic patients in the hospital setting. DESIGN: A scoping review. DATA SOURCES: A systematic literature search using the databases CINAHL, Medline and Google Scholar was undertaken in September 2021 and updated in January 2023. This review is based on the methodological framework of Arksey and O’Malley (International Journal of Social Research Methodology, 8(1):19-32, 2005), which was further refined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: Autistic patients, as well as their families and healthcare staff, face several barriers that can impact their healthcare experiences within hospital settings. Of 211 articles screened, 30 were eligible and included. Through our review, we identified two main themes. The first theme, ‘challenges to hospital experiences’, includes four sub-themes: (1) communication, (2) a mismatch between the needs for autistic patients and the hospital environment, (3) challenges related to parents’ experiences and (4) challenges related to hospital systems. The second theme, ‘facilitators that improve hospital experiences’, includes three sub-themes: (1) provision of care pathways, (2) partnership between parents and experts and (3) facilitators to improve hospital systems. By understanding these themes, we can work to address the barriers that autistic patients and their families face, while leveraging the facilitators to improve their hospital experiences. CONCLUSION: It is critical to understand the experiences of autistic patients in the hospital setting because they present a substantial risk of hospital admission due to their associated acute to chronic health conditions. Additionally, nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. This review further highlights the crucial need to adopt a collaborative and inclusive approach between autistic patients, their families and healthcare staff. To achieve this, co-design initiatives that incorporate the perspectives and lived experiences of the autistic community are necessary. By placing autistic voices at the forefront of these initiatives, it is hoped that changes are meaningful, relevant and can be sustained. IMPACT: Understanding the unique hospital experiences and challenges of autistic patients can improve their quality of life and well-being by reducing stress and anxiety during hospitalization, leading to better health outcomes and potentially shorter hospital stays. It can also promote a more positive view of healthcare among autistic individuals, encouraging them to seek medical care when needed and have broader societal impacts such as reducing healthcare costs and improving the overall health and well-being of the population. Autistic patients present a substantial risk of hospital admission due to their associated acute to chronic conditions. Nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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3. Liu M, Brady NC, Boorom O, Fleming K, Yue J, Liu Q. Prelinguistic communication complexity predicts expressive language in initial minimally verbal autistic children. International journal of language & communication disorders. 2023.

BACKGROUND: Prelinguistic communication complexity refers to the use of different communication forms such as eye gaze, gestures and vocalisations and the degree to which these forms are coordinated and how directed to a communication partner. To date, little is known about the relationship between prelinguistic communication complexity and expressive language in minimally verbal autistic children. AIMS: To test the hypothesis that prelinguistic communication complexity predicts expressive language 12 months later in autistic children and explore whether there are any differences in specific prelinguistic intentional communicative behaviours that are related to later expressive language levels. METHODS & PROCEDURES: This longitudinal study examined 37 minimally verbal autistic children (29-71 months old). The Communication Complexity Scale (CCS) was used to measure participants’ prelinguistic communication behaviours, which were extracted from a semi-structured play interaction at Time 1. The Chinese Communicative Development Inventory (CCDI) was used to examine participants’ expressive language at Time 1 and Time 2 (12 months later). According to Time 2 vocabulary size, participants were divided into two groups: Low CCDI, between 0 and 62 words, and High CCDI, more than 100 words. Linear regression was used to examine the relationship between early prelinguistic communication complexity and later expressive language. Binary logistic regression was used to determine which of the early communication behaviours were uniquely significantly related to later expressive language levels. OUTCOMES & RESULTS: There was a significant positive relationship between prelinguistic communication complexity and expressive language 12 months later, even after controlling for age and concurrent language. Findings revealed a group difference in the frequency of gesture and vocalisation combinations between the Low and High CCDI groups at Time 1. Gesture-vocalisation combinations also predicted better expressive language levels at Time 2. CONCLUSIONS & IMPLICATIONS: Our findings suggest that it may be beneficial to incorporate different complex communication behaviours into prelinguistic intervention targets for minimally verbal autistic children. The CCS hierarchies can be used as a reference for the intervention goals of minimally verbal autistic children. These findings highlight the importance of targeting gesture and vocalisation combinations when autistic children transition from single prelinguistic communication behaviours to multimodal behaviours. WHAT THIS PAPER ADDS: What is already known on this subject Children use eye gaze, gestures and vocalisations to communicate with others before they learn spoken language. There is strong evidence suggest that the frequency of prelinguistic communication predicts later linguistic achievements in autistic children. However, less is known about whether prelinguistic communication complexity also predicts later language and which specific behaviours are most predictive of language outcomes. What this study adds Minimally verbal autistic children who exhibit more complex prelinguistic communication behaviours have better expressive language 12 months later. Gestures combined with vocalisations predict better expressive language in minimally verbal autistic children. What are the clinical implications of this work? When identifying intervention targets for minimally verbal autistic children, the clinicians may reference the prelinguistic communication behaviours from the CCS. The gesture and vocalisation combinations are the key behaviours when targets transit from single form to two-form behaviours.

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4. Shan X, Uddin LQ, Ma R, Xu P, Xiao J, Li L, Huang X, Feng Y, He C, Chen H, Duan X. Disentangling the individual-shared and individual-specific subspace of altered brain functional connectivity in autism spectrum disorder. Biological psychiatry. 2023.

BACKGROUND: Despite considerable effort towards understanding the neural basis of autism spectrum disorder (ASD) using case-control analyses of resting-state functional magnetic resonance imaging data, findings are often not reproducible, largely due to biological and clinical heterogeneity among individuals with ASD. Thus, exploring the individual-shared and individual-specific altered functional connectivity (AFC) in ASD is important to understand this complex heterogeneous disorder. METHODS: We considered 254 ASD and 295 typically developing (TD) individuals from the Autism Brain Imaging Data Exchange to explore the individual-shared and individual-specific subspaces of AFC. First, we computed AFC matrices of ASD compared with TD. Then, common orthogonal basis extraction was used to project AFC of ASD onto two subspaces: an individual-shared subspace which represents altered connectivity patterns shared across ASD, and an individual-specific subspace which represents the remaining individual characteristics after eliminating the individual-shared altered connectivity patterns. RESULTS: Analysis yielded three common components spanning the individual-shared subspace. Common components were associated with differences of functional connectivity at the group level. AFC in the individual-specific subspace improved the prediction of clinical symptoms. The default mode network-related and cingulo-opercular network-related magnitude of AFC in the individual-specific subspace were significantly correlated with symptom severity in social-communication deficits and restricted, repetitive behaviors in ASD. CONCLUSIONS: Our study decomposed AFC of ASD into individual-shared and individual-specific subspaces, highlighting the importance of capturing and capitalizing on individual-specific brain connectivity features for dissecting heterogeneity. Our analysis framework provides a blueprint for parsing heterogeneity in other prevalent neurodevelopmental conditions.

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5. Tang X, Feng C, Zhao Y, Zhang H, Gao Y, Cao X, Hong Q, Lin J, Zhuang H, Feng Y, Wang H, Shen L. A study of genetic heterogeneity in autism spectrum disorders based on plasma proteomic and metabolomic analysis: multiomics study of autism heterogeneity. MedComm. 2023; 4(5): e380.

Genetic heterogeneity poses a challenge to research and clinical translation of autism spectrum disorder (ASD). In this study, we conducted a plasma proteomic and metabolomic study of children with ASD with and without risk genes (de novo mutation) and controls to explore the impact of genetic heterogeneity on the search for biomarkers for ASD. In terms of the proteomic and metabolomic profiles, the groups of children with ASD carrying and those not carrying de novo mutation tended to cluster and overlap, and integrating them yielded differentially expressed proteins and differential metabolites that effectively distinguished ASD from controls. The mechanisms associated with them focus on several common and previously reported mechanisms. Proteomics results highlight the role of complement, inflammation and immunity, and cell adhesion. The main pathways of metabolic perturbations include amino acid, vitamin, glycerophospholipid, tryptophan, and glutamates metabolic pathways and solute carriers-related pathways. Integrating the two omics analyses revealed that L-glutamic acid and malate dehydrogenase may play key roles in the pathogenesis of ASD. These results suggest that children with ASD may have important underlying common mechanisms. They are not only potential therapeutic targets for ASD but also important contributors to the study of biomarkers for the disease.

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6. Zhuang S, Tan DW, Reddrop S, Dean L, Maybery M, Magiati I. Psychosocial factors associated with camouflaging in autistic people and its relationship with mental health and well-being: A mixed methods systematic review. Clinical psychology review. 2023; 105: 102335.

Camouflaging involves hiding one’s autistic characteristics in social situations. This mixed methods systematic review synthesized research on psychosocial factors associated with camouflaging and its relationship with mental well-being. Six databases were searched. The 58 included studies (40 qualitative, 13 quantitative, five mixed methods), encompassed 4808 autistic and 1780 non-autistic participants, and predominantly featured White, female, and late-diagnosed autistic adults with likely at least average intellectual and/or verbal abilities. Following a convergent integrated approach, quantitative data were transformed and synthesized with qualitative data for thematic synthesis. We identified three themes on psychosocial correlates of camouflaging: (1) social norms and pressures of a largely non-autistic world, (2) social acceptance and rejection, and (3) self-esteem and identity; and four themes on psychosocial consequences of camouflaging for well-being: (1) a pragmatic way of exerting individual agency and control; (2) overlooked, under-supported, and burnt out; (3) impact on social relationships; and (4) low self-esteem and identity confusion. Camouflaging emerges as primarily a socially motivated response linked to adverse psychosocial outcomes. A whole society approach towards acceptance and support for autistic individuals to express their authentic selves is needed. Future studies examining psychosocial influences on camouflaging should include participants who more broadly represent the autistic population.

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