1. Adams SN. Feeding and Swallowing Issues in Autism Spectrum Disorders. Neuropsychiatric disease and treatment. 2022; 18: 2311-21.

Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children’s adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children’s restrictive diets supplant more healthy food options. When this is combined with the children’s noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices – aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.

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2. Cha WJ, Lee JH. Diminished ability to integrate target stimuli with context during emotional recognition in individuals with broad autism phenotype. Frontiers in psychology. 2022; 13: 934385.

Individuals with broad autism phenotype (BAP) have a tendency not to integrate emotional stimuli with the surrounding context. They have also shown different patterns and abilities in processing positive and negative emotions. This study aimed to examine whether the effect of context on target stimuli could vary depending on the type of target emotion in individuals with BAP. Based on the Broad Autism Phenotype Questionnaire (BAPQ) and Autism-Spectrum Quotient (AQ), 36 individuals with BAP and 33 healthy controls were selected. All the participants performed an overlap-emotional task consisting of six conditions: 2 (congruence: congruent and incongruent) × 3 (emotion: fearful, sad, and happy). Reaction time and accuracy were measured as dependent variables. The results revealed that the individuals with BAP showed no difference in reaction time between the condition of congruence and incongruence, but that the control group was faster to categorize facial expression on the condition of congruence than that of incongruence regardless of the type of target emotion. There were no differences between the two groups in any of the conditions with regard to accuracy. These findings indicate that individuals with BAP tend not to integrate target emotions with contextual information, a feature that could worsen the speed of emotional recognition in individuals with BAP. This study confirmed that the individuals with BAP have different cognition patterns in emotional recognition than the control group.

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3. Cleary M, West S, McLean L, Hunt GE, Hungerford C, Kornhaber R. A Scoping Review of Autism and the Way It Changes the Presentation of Suicidal Thoughts and Behavior Compared to the General Population. Issues in mental health nursing. 2022: 1-20.

Autism spectrum conditions are a group of neurodevelopmental conditions that carries an array of co-occurring diagnoses, including a heightened risk of suicide attempts and suicide. This scoping review examined primary research focusing on autism and suicidality, to understand what is currently known on the topic, including how autism changes the presentation of suicidal thoughts and behavior; and to assess the suicide awareness and prevention education programs currently available for autistic people, their families, and health professionals and support workers. A comprehensive search (November 2021) across Scopus, PubMed and CINAHL identified 39 articles from 38 studies. Three themes emerged, with five subthemes. 1. The prevalence of suicidality in autistic people; 2. The presentation of suicidality in autistic people, including (a) risk of suicidality; (b) gender, age, employment and education; (c) co-occurring psychiatric conditions; (d) autism traits and social communication; (e) intellectual disability; and 3. Autism-specific approaches to suicidal thoughts, behavior and prevention. Findings were mixed, including conflicting evidence on the risk of autism and suicidality, and limited evidence of resources related to autism-specific suicide awareness or information, and education or prevention programs.

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4. Cristiano C, Hoxha E, Lippiello P, Balbo I, Russo R, Tempia F, Miniaci MC. Maternal treatment with sodium butyrate reduces the development of autism-like traits in mice offspring. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie. 2022; 156: 113870.

Several studies indicate a relationship between maternal gut microbiota alteration and increased risk of autism spectrum disorders (ASD) in offspring. The possibility of compensating for such metabolic dysfunction at a very early stage of disease via maternal treatment has not been enough explored. Here, we examined in BTBR mouse model of ASD the effect of maternal treatment with the gut microbial metabolite butyrate (BUT) on the behavioral and synaptic plasticity deficits in juvenile and adult offspring. We show that BUT treatment of BTBR dams rescues the social and partially the repetitive behavior deficits in the offspring. In addition, maternal BUT implementation prevents the cerebellar cortex hypertrophy as well as the Purkinje cells firing and long-term synaptic plasticity deficits in BTBR mice. Our results demonstrate, for the first time, that maternal BUT treatment can improve ASD-like symptoms in offspring thus providing new directions for the early treatment of neurodevelopmental disorders.

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5. de Lima TA, Zuanetti PA, Nunes MEN, Hamad APA. Differential diagnosis between autism spectrum disorder and other developmental disorders with emphasis on the preschool period. World journal of pediatrics : WJP. 2022.

BACKGROUND: Neurodevelopmental disorders are a heterogeneous group of conditions that manifest as delays or deviations in the acquisition of expected developmental milestones and behavioral changes. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in communication and social interaction and by repetitive and restricted patterns of behavior, interests and activities. The aim of this review is to discuss the clinical features of the differential diagnoses of ASD that are prevalent among preschoolers, focusing on their similarities and disparities. DATA SOURCES: The international medical literature search was conducted using PubMed and was revised regarding the subject using single and/or combined keywords as follows: differential diagnosis, preschoolers, diagnostic challenge, attention deficit hyperactivity disorder, intellectual disability, high abilities/giftedness, childhood apraxia of speech, social communication disorder, Landau-Kleffner syndrome, stereotyped movement disorder and excessive screen time. RESULTS: We describe conditions commonly found in clinical practice, taking ASD as a reference. We addressed converging and divergent aspects of behavior, cognition, communication, language, speech, socialization, and stereotypes for the diagnosis of ASD and other disorders identified as potential differential or comorbid diagnoses. CONCLUSIONS: The ranking and characterization of symptoms appear to be essential for better understanding the underlying common ground between children with developmental disorders and children with ASD, thus properly diagnosing and directing social, professional, or medication interventions. This detailed discussion adds to the literature since, although ASD differential diagnoses are frequently mentioned and discussed in textbooks and journal articles, they rarely occupy a prominent place as we aimed herein.

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6. Deng W, Wang S, Li F, Wang F, Xing YP, Li Y, Lv Y, Ke H, Li Z, Lv PJ, Hao H, Chen Y, Xiao X. Gastrointestinal symptoms have a minor impact on autism spectrum disorder and associations with gut microbiota and short-chain fatty acids. Frontiers in microbiology. 2022; 13: 1000419.

Children with autism spectrum disorder (ASD) experience gastrointestinal (GI) issues more frequently and severely than children who are typically developing (TD). The connections between gastrointestinal problems, microbiota, and short-chain fatty acids (SCFAs) in ASD are still being debated. We enrolled 90 children, 45 of whom were diagnosed with ASD, and examined the impact of GI disorders on ASD. The six-item GI Severity Index questionnaire was used to evaluate gastrointestinal symptoms, while the Social Responsiveness Scale was used to evaluate autism symptoms. Further, the Children’s Sleep Habits Questionnaire and the Children’s Eating Behavior Questionnaire are used to assess sleep and eating disorders in children. We assessed fecal microbiota by 16S rRNA gene sequencing, and SCFA concentrations by gas chromatography/mass spectrometry. The results revealed that children with ASD exhibited a high rate of gastrointestinal issues (78%), as well as higher rates of social impairment and poor sleeping habits, compared to TD children. However, GI disturbances have a minor impact on autism. In addition, the levels of propionic acid, butyric acid, and valeric acid were significantly higher in the ASD group. Besides, the ASD, TD, and GI subgroups possessed distinct microbiome profiles. These findings suggest that gastrointestinal disturbances have no discernible effect on the core symptoms of autism. Although autism may not cause an increase in GI symptoms directly, alterations in metabolites, such as SCFAs, may cause GI symptoms.

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7. Downs J, Blackmore AM, Wong K, Buckley N, Lotan M, Elefant C, Leonard H, Stahlhut M. Can telehealth increase physical activity in individuals with Rett syndrome? A multicentre randomized controlled trial. Developmental medicine and child neurology. 2022.

AIM: To evaluate the effects of a physical activity programme on sedentary behaviour and physical activity in ambulant individuals with Rett syndrome (RTT). METHOD: In this multicentre randomized waitlist-controlled trial, we recruited 43 ambulatory individuals with RTT in Australia and Denmark. Adequate baseline data were obtained from 38 participants (mean age 20 years, range 6-41, SD 10 years 6 months, one male). All completed the trial. Participants received 12 weeks of usual care (n = 19) or a goal-based, telehealth-supported programme in which activities occurred in their familiar environments (n = 19). Sedentary time and daily steps were assessed at baseline, post-test, and 12-week follow-up. The data analyst was blinded to group allocation. RESULTS: Sedentary time decreased in the intervention group by 2.7% (95% confidence interval [CI] -6.0 to 0.6) and increased in the control group by 1.3% (95% CI -4.8 to 7.4). Intervention and control groups increased the number of their steps per day by 264.7 (95% CI -72.2 to 601.5) and 104.8 (95% CI -178.1 to 387.7) respectively. No significant differences were found on any outcomes at post-test. There were three minor adverse events. INTERPRETATION: A goal-based telehealth intervention seemed to produce small improvements in physical activity for individuals with RTT. Families require more support to increase these individuals’ extremely low physical activity levels.

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8. Driscoll NM, Rothschild AW, Luiselli JK, Goldberg S, Crawley J, Fofanah D, Wangaga J. Brief Report: A Pilot Investigation of Safety Concerns Among Direct Service Providers for Adults with Intellectual and Developmental Disabilities. Journal of developmental and physical disabilities. 2022: 1-8.

We designed and distributed a survey that assessed safety concerns experienced by direct service providers (DSPs) (N = 59) of adults with intellectual and developmental disabilities (IDD) in community-based group homes at a single human services organization. Results indicated relatively few safety concerns among the respondents from a list of 25 survey statements. Possible influences on the findings are presented such as safety training of the DSPs, comprehensive safety guidelines in place at the group homes, and conditions occasioned by the COVID-19 pandemic. Current safety research in IDD supports the necessity of assessment to inform prevention and intervention strategies.

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9. Dupuis A, Mudiyanselage P, Burton CL, Arnold PD, Crosbie J, Schachar RJ. Hyperfocus or flow? Attentional strengths in autism spectrum disorder. Frontiers in psychiatry. 2022; 13: 886692.

The comorbidity of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) diagnoses is well established. An ASD diagnosis is associated with elevated ADHD traits and symptoms, as well as strengths in attention. In the ASD literature, attentional strengths have been described as maladaptive (e.g., hyperfocus), in contrast with positive portrayals in the typically developing population (e.g., flow). The objective of this study was to (1) compare profiles of attentional strengths and weaknesses in ASD and ADHD and (2) determine whether attentional strengths in ASD are associated with impairment, poorer cognitive flexibility, and perseveration/perfectionism. In a community sample of 5,744 children and youth, 131 children were reported as having a diagnosis of ASD (mean age 10.3 years) and 346 children were reported as having a diagnosis of ADHD (mean age 10.7 years). We used the Strengths and Weaknesses of Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) rating scale to calculate attentional and hyperactive/impulse control strength and weakness counts and scores. The Autism-Spectrum Quotient Switching factor served as a measure of cognitive flexibility. Impairment was assessed with the Columbia Impairment Scale. We used the symmetry/ordering factor on the Toronto Obsessive-Compulsive Scale as a measure of perseveration/perfectionism. No differences were found between the ADHD and ASD groups in SWAN weakness scores, symptoms, or hyperactive/impulse control strengths; however, autistic children had higher rates of attentional strengths [odds ratio: 5.7, 95% CI (2.8, 11.6), p < 0.0001]. Post-hoc pairwise testing identified four attentional strengths with significantly higher rates in ASD than in ADHD. Attentional strength scores were not associated with impairment or poor cognitive flexibility, but predicted levels of perseveration/perfectionism. The effect of attentional strengths on impairment and cognitive flexibility did not differ between autistic and Control children, but the higher perseveration/perfectionism scores seen in ASD were not found in Control children. ASD is associated with a pattern of attentional strengths that is not found in ADHD Characterizing the full range of attentional abilities in autistic children may explain variability in outcomes such as quality-of-life indicators and identify protective factors, providing targets for strength-based behavioral interventions. The clinical and etiological implications of the subgroup of autistic children with attentional strengths require further investigation.

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10. Guzick AG, Schneider SC, Kendall PC, Wood JJ, Kerns CM, Small BJ, Park YE, Cepeda SL, Storch EA. Change during cognitive and exposure phases of cognitive-behavioral therapy for autistic youth with anxiety disorders. Journal of consulting and clinical psychology. 2022; 90(9): 709-14.

OBJECTIVE: To evaluate improvement during the (a) cognitive and (b) exposure therapy phases of cognitive-behavioral therapy (CBT) for autistic youth with anxiety disorders. METHOD: Participants were 148 autistic youth (aged 7-13; 77% male; 64% White) with clinically significant anxiety who were randomized to standard or adapted CBT. Clinician-rated anxiety severity was recorded at each appointment. Trajectories of change during (a) the cognitive phase and (b) the exposure phase of treatment were analyzed using piecewise multilevel modeling. RESULTS: Compared to the psychoeducation and cognitive therapy phases, the exposure phase corresponded with significantly more rapid symptom reduction, b = -.11, 95% CI [-.13, -.071]. This finding was true for standard CBT, which included nine sessions prior to exposure initiation (on average), as well as for CBT personalized for autistic youth, which introduced exposure following the fifth session (on average). In contrast, compared with improvements during initial psychoeducation sessions, the introduction of cognitive skills corresponded with significantly slower symptom reduction, b = .066, 95% CI [.020, .11]. This finding was also true for both adapted and standard CBT. CONCLUSIONS: Results underscore the central role of exposure in the treatment of anxiety among autistic youth and question the utility of cognitive strategies without subsequent practice of these skills during exposure. Assuming a working relationship, therapists should consider moving through the preexposure coping phase of CBT quickly. Future research should evaluate the extent to which exposure can maintain its potency while minimizing coping skill preparation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

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11. Hennessy A, Seguin D, Correa S, Wang J, Martinez-Trujillo JC, Nicolson R, Duerden EG. Anxiety in children and youth with autism spectrum disorder and the association with amygdala subnuclei structure. Autism : the international journal of research and practice. 2022: 13623613221127512.

Autism spectrum disorder (ASD) is clinically characterized by social communication difficulties as well as restricted and repetitive patterns of behavior. In addition, children with ASD are more likely to experience anxiety compared with their peers who do not have ASD. Recent studies suggest that atypical amygdala structure, a brain region involved in emotions, may be related to anxiety in children with ASD. However, the amygdala is a complex structure composed of heterogeneous subnuclei, and few studies to date have focused on how amygdala subnuclei relate to in anxiety in this population. The current sample consisted of 95 children with ASD and 139 non-autistic children, who underwent magnetic resonance imaging (MRI) and assessments for anxiety. The amygdala volumes were automatically segmented. Results indicated that children with ASD had elevated anxiety scores relative to peers without ASD. Larger basal volumes predicted greater anxiety in children with ASD, and this association was not seen in non-autistic children. Findings converge with previous literature suggesting ASD children suffer from higher levels of anxiety than non-autistic children, which may have important implications in treatment and interventions. Our results suggest that volumetric estimation of amygdala’s subregions in MRI may reveal specific anxiety-related associations in children with ASD.

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12. Hsiao JH, An J, Hui VKS, Zheng Y, Chan AB. Understanding the role of eye movement consistency in face recognition and autism through integrating deep neural networks and hidden Markov models. NPJ science of learning. 2022; 7(1): 28.

Greater eyes-focused eye movement pattern during face recognition is associated with better performance in adults but not in children. We test the hypothesis that higher eye movement consistency across trials, instead of a greater eyes-focused pattern, predicts better performance in children since it reflects capacity in developing visual routines. We first simulated visual routine development through combining deep neural network and hidden Markov model that jointly learn perceptual representations and eye movement strategies for face recognition. The model accounted for the advantage of eyes-focused pattern in adults, and predicted that in children (partially trained models) consistency but not pattern of eye movements predicted recognition performance. This result was then verified with data from typically developing children. In addition, lower eye movement consistency in children was associated with autism diagnosis, particularly autistic traits in social skills. Thus, children’s face recognition involves visual routine development through social exposure, indexed by eye movement consistency.

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13. Hus Y. Detecting Time Concept Competence in Children with Autism Spectrum and Attention Disorders. Neuropsychiatric disease and treatment. 2022; 18: 2323-48.

The importance of time concept in human existence is « ancient history » celebrated in the biblical book Ecclesiastes. Indeed, our time-sensitive mechanisms are literally carved into our biology and neurology on a molecular level, gifting us with neural clocks. However, time in human consciousness is not the time indicated by physical clocks: time is a subjective reality in our psychological makeup due to the nature of the temporal neural mechanisms and unique properties of physical time. Nonetheless, subjective time requires anchoring to physical time which permeates our language, endeavors, and entire existence, a process hinging on time-related skills such as estimates and measures of passage and duration of time. Moreover, accurate time reading, a critical adaptive life-skill, is imperative for effective function in all societal activities. Because it embodies the complexity of the time construct, it is central to instruction of time concept in primary education. It is often measured in children by clock drawings, a cognitive integrative skill with errors pointing to neuroanatomical differences impacting the integrity of executive function. Time competence in children with atypical neurobiological development and high prevalence, as in autism spectrum disorders (ASD), and attention disorders (ADHD), is often compromised, calling for investigation of its function. This thematic review article aims to: 1) discuss the complexity of time concept and its underlying bio-neurological mechanisms, 2) elucidate difficulties children with ASD and those with ADHD exhibit in temporal development, and 3) demonstrate the use of a set of clinical tools in uncovering temporal competence and ecological executive function in two children with ASD, and a child with ADHD, using a clock drawing task and error analyses; children’s time knowledge questionnaire; a behavior rating parent questionnaire examining ecological executive function, and parent open-ended questions related to their children’s time difficulties. A discussion, directions, and a take-home message round out the article.

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14. Jabarin R, Netser S, Wagner S. Beyond the three-chamber test: toward a multimodal and objective assessment of social behavior in rodents. Molecular autism. 2022; 13(1): 41.

MAIN: In recent years, substantial advances in social neuroscience have been realized, including the generation of numerous rodent models of autism spectrum disorder. Still, it can be argued that those methods currently being used to analyze animal social behavior create a bottleneck that significantly slows down progress in this field. Indeed, the bulk of research still relies on a small number of simple behavioral paradigms, the results of which are assessed without considering behavioral dynamics. Moreover, only few variables are examined in each paradigm, thus overlooking a significant portion of the complexity that characterizes social interaction between two conspecifics, subsequently hindering our understanding of the neural mechanisms governing different aspects of social behavior. We further demonstrate these constraints by discussing the most commonly used paradigm for assessing rodent social behavior, the three-chamber test. We also point to the fact that although emotions greatly influence human social behavior, we lack reliable means for assessing the emotional state of animals during social tasks. As such, we also discuss current evidence supporting the existence of pro-social emotions and emotional cognition in animal models. We further suggest that adequate social behavior analysis requires a novel multimodal approach that employs automated and simultaneous measurements of multiple behavioral and physiological variables at high temporal resolution in socially interacting animals. We accordingly describe several computerized systems and computational tools for acquiring and analyzing such measurements. Finally, we address several behavioral and physiological variables that can be used to assess socio-emotional states in animal models and thus elucidate intricacies of social behavior so as to attain deeper insight into the brain mechanisms that mediate such behaviors. CONCLUSIONS: In summary, we suggest that combining automated multimodal measurements with machine-learning algorithms will help define socio-emotional states and determine their dynamics during various types of social tasks, thus enabling a more thorough understanding of the complexity of social behavior.

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15. Johnston KJ, Chin MH, Pollack HA. Health Equity for Individuals With Intellectual and Developmental Disabilities. Jama. 2022; 328(16): 1587-8.

This Viewpoint discusses 3 types of systemic health inequity experienced by individuals with intellectual and developmental disabilities—stigma, exclusion, and devaluation of worth; underrepresentation in population epidemiology and research; and inadequate access to care and social services—and suggests potential approaches to ameliorating inequities in each of these areas. eng.

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16. Kang J, Li X, Casanova MF, Sokhadze EM, Geng X. Impact of repetitive transcranial magnetic stimulation on the directed connectivity of autism EEG signals: a pilot study. Medical & biological engineering & computing. 2022; 60(12): 3655-64.

To compare the differences in directed connectivity between typically developing (TD) and autism spectrum disorder (ASD) children and identify the potential effects of repetitive transcranial magnetic stimulation (rTMS) on brain connectivity and behavior of children with ASD; 26 TD children (18 males/8 females; the average age was 6.34 ± 0.45) and 30 ASD children (21 males/9 females; the average age was 6.42 ± 0.17) participated in the experiment. ASD children were divided randomly into an experimental group and a control group. The experimental group received 18 rTMS sessions (twice a week for nine weeks), whereas the control group received the same procedures with sham stimulation. Directed transfer function (DTF) was used to calculate the effective connectivity as a way of investigating differences between ASD and TD children while simultaneously evaluating the effectiveness of rTMS for ASD. The results illustrate that the DTF of TD children in the frontal lobe (Fp1, Fp2, F7, F8) and temporal lobe (T7, T8) is higher than that of ASD children in all frequency bands; however, the DTF of ASD children is higher than TD in the midline (Fz, Cz), central lobe (C3, C4), and parietal lobe (P3, P4). In the experimental group of ASD children, the effective connectivity decreased from O1 to T7 and from P7 to Fp1 in the alpha band and from Pz to T8 in the gamma band after stimulation. Significant changes in Autism Behavior Checklist (ABC) scores were also found in social behaviors. Effective connectivity derived from DTF distinguishes ASD from TD children. rTMS provides changes in connectivity and behavior, suggesting its potential use as a viable treatment option for ASD individuals.

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17. Ke X, Song W, Yang M, Li J, Liu W. Effectiveness of music therapy in children with autism spectrum disorder: A systematic review and meta-analysis. Frontiers in psychiatry. 2022; 13: 905113.

OBJECTIVES: This study was to investigated the efficacy of music therapy (MT) in children with autism spectrum disorder (ASD) via a meta-analysis that comprehensively evaluated data from all eligible research in this field. DESIGN: Systematic review and meta-analysis. SETTING: A systematic search of the PubMed, Embase, and Cochrane Library databases from inception to October 2021 to identify studies that administered MT to children with ASD. RESULTS: Eight randomized controlled trials (RCTs) including 608 participants met the inclusion criteria. The meta-analysis showed that MT was associated with a significant increase in social reactions among children with ASD (standardized mean difference (SMD) = 0.24, 95% confidence interval (CI) [0.03, 0.46], I (2) = 0%, P = 0.03). However, MT did not elicit a significant increase in symptom severity (SMD = 0.17, 95% CI [-0.04,0.38], I (2) = 0%,P = 0.12), social adaptive behavior (SMD = 0.02, 95% CI [-0.44,0.48], I (2) = 0%,P = 0.93) or speech (SMD = 0.04, 95% CI [-0.39, 0.47], I (2) = 0%, P = 0.86) in children with ASD. CONCLUSION: MT can improve social skills in children with ASD; however, there does not seem to be a consensus on the persistence of its effects. These findings can inform clinical practice. Promoting the use of MT in children with ASD and improving its symptoms are the ultimate goals.

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18. Kim T, Kwon EH. Investigating socioecological obesogenic factors in children with Autism Spectrum Disorder. Frontiers in public health. 2022; 10: 867456.

Obesity-related information in children with Autism Spectrum Disorder (ASD) is limited, and research findings are contradictory. Thus, this study aimed to use a nationwide non-clinical sample to examine the association of sociological factors with overweight status in children with ASD and reveal the degree of differences in the risk factors for overweight in children with and without ASD. The data for this cross-sectional study, based on the modified ecological system theory model, were obtained from the 2019 National Survey of Children’s Health. The weighted logistic regressions were performed to determine the factors associated with overweight status in children with ASD, controlling for demographics, physical activity-related behaviors, and family and environmental conditions. A total of 529 children were identified (mean age 13.78 years, 83.21% boys). Two-parent households, less healthy parents and households, households with smokers, poor sleep quality, and greater participation in organized activities were associated with a higher likelihood of overweight in children with ASD (all P < 0.05). The determinants of obesity among children with ASD go beyond the individual level; family and community support are important. Therefore, greater attention should be directed toward the families of children with ASD and community-level administrative policies to improve quality of life by preventing or reducing obesity in children with ASD.

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19. Kondaurova EM, Belokopytova, II, Kulikova EA, Khotskin NV, Ilchibaeva TV, Tsybko AS, Popova NK, Naumenko VS. On the role of serotonin 5-HT(1A) receptor in autistic-like behavior: сross talk of 5-HT and BDNF systems. Behavioural brain research. 2022; 438: 114168.

Autism spectrum disorders (ASDs) are some of the most common neurodevelopmental disorders; however, the mechanisms underlying ASDs are still poorly understood. Serotonin (5-HT) and brain-derived neurotrophic factor (BDNF) are known as key players in brain and behavioral plasticity and interact with each other. 5-HT(1A) receptor is a principal regulator of the brain 5-HT system, which modulates normal and pathological behavior. Here we investigated effects of adeno-associated-virus-based 5-HT(1A) receptor overexpression in the hippocampus of BTBR mice (which are a model of autism) on various types of behavior and on the expression of 5-HT(7) receptor, proBDNF, mature BDNF, and BDNF receptors (TrkB and p75(NTR)). The 5-HT(1A) receptor overexpression in BTBR mice reduced stereotyped behavior in the marble-burying test and extended the time spent in the center in the open field test. Meanwhile, this overexpression failed to affect social behavior in the three-chambered test, immobility time in the tail suspension test, locomotor activity in the open field test, and associative learning within the « operant wall » paradigm. The 5-HT(1A) receptor overexpression in the hippocampus raised hippocampal 5-HT(7) receptor mRNA and protein levels. Additionally, the 5-HT(1A) receptor overexpression lowered both mRNA and protein levels of TrkB receptor but failed to affect proBDNF, mature BDNF, and p75(NTR) receptor expression in the hippocampus of BTBR mice. Thus, obtained results suggest the involvement of the 5-HT and BDNF systems’ interaction mediated by 5-HT(1A) and TrkB receptors in the mechanisms underlying autistic-like behavior in BTBR mice.

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20. Kristofik A, Johnson KL. Rehabilitation Services for Young Adults with ASD. Neuropsychiatric disease and treatment. 2022; 18: 2361-6.

Adolescents with Autism Spectrum Disorders (ASD) and their families face many obstacles when they conclude their secondary education. Pilot programs to support the development of life skills for young adults with autism, aiming to improve job outcomes and postsecondary educational prospects, have been increasing to meet the demand for support. Despite an increase in empirically based reports on pilot programs, data show significant differences in the efficacy of existing pilot programs, even when empirically supported methods are applied to programming. To understand how to best utilize existing data to improve outcomes for young adults with ASD transitioning into university and the workforce, a critical review of existing pilot programs is provided. A call is made for the continuous dissemination of data regarding the efficacy of pilot programs as they continue to adjust methods based on available data, as is a call for more data on the effect of community partnerships between pilot programs and employers and universities.

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21. Li C, He WQ. Trends in Autism Spectrum Disorder Among Children and Adolescents in the US From 2016 to 2020. JAMA pediatrics. 2022.

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22. Li Q, Li Y, Yang W. Trends in Autism Spectrum Disorder Among Children and Adolescents in the US From 2016 to 2020-Reply. JAMA pediatrics. 2022.

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23. Lin LY, Chi IJ, Sung YS. Mediating effect of sequential memory on the relationship between visual-motor integration and self-care performance in young children with autism spectrum disorder. Frontiers in psychology. 2022; 13: 988493.

OBJECTIVE: Visual perception is a skill that contributes to the performance of self-care and important development tasks in early childhood. The relationship between self-care and visual perception is especially significant for young children with autism spectrum disorder (ASD), who have been described as visual learners. However, this relationship is not clearly understood among young children with ASD. We investigated the role of motor-free visual perception on the relationship between self-care and visual-motor integration in young children with ASD. METHODS: A sample of 66 children with ASD aged 48 to 83 months were recruited. Measurements included the Assessment of Motor and Process Skills, the Developmental Test of Visual Perception-Third Edition, and Test of Visual-Perceptual Skills-Third Edition. RESULTS: The results indicated that self-care performance had significant positive correlations with visual-motor integration, visual discrimination, visual memory, visual spatial relationships, and visual sequential memory. Of these, visual sequential memory and visual spatial relationships were the main factors related to self-care performance. Sequential memory was a mediator of the relationship between visual-motor integration and self-care performance. CONCLUSION: This study establishes a deeper understanding of self-care and motor-free visual perception among young children with ASD. Understanding the relationship between visual perception and self-care in young children with ASD may aid professionals in providing self-care interventions for this population.

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24. Lung FW, Chen PF, Shen LJ, Shu BC. Families with high-risk characteristics and diagnoses of attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, and learning disability in children: A national birth cohort study. Frontiers in psychology. 2022; 13: 758032.

BACKGROUND: A national birth cohort study was used to investigate whether high-risk family factors at 1.5-year-olds can increase the risk of attention-deficit/hyperactivity disorder (ADHD) diagnosis when children reach 5.5 years. The pathway relationship of high-risk family factors, children’s developmental conditions, risk of autism spectrum disorder (ASD), and diagnosis of intellectual disability (ID), learning disability (LD), and ASD was also investigated. METHODS: The 1.5-, 3- and 5.5-year-old Taiwan Birth Cohort Study (TBCS) dataset was used (N = 19,185). The high-risk familial factor was measured using five questions assessing whether parents are currently unmarried, unemployed, do not have any social insurance, perceive a « very heavy » economic childcare burden, and at least one of the parents has a disability certification. Developmental conditions were assessed using the Taiwan Birth Cohort Study-Developmental Instrument (TBCS-DI), and ASD risk was measured using the Modified Checklist of Autism in Toddlers. Data on ADHD, ID, LD, and ASD diagnoses were collected at age 5.5. The odds ratio model investigated whether children from families with high-risk factors at 1.5-years were at increased risk of ADHD, ID, LD, or ASD diagnosis at 5.5-years, compared to those children from families without such risks. Structural equation modeling investigated the logistic regression pathway relationship of high-risk familial characteristics, children’s developmental conditions, autism screening, and diagnosis. RESULTS: In the national birth cohort dataset of 19,185 children, 2070 (10.8%) met at least one of the high-risk familial factors. Children who met one high-risk familial factor had a 1.21-fold increased risk for ADHD diagnosis, 1.36-fold increased risk for LD diagnosis, and 1.80-fold increased risk for ASD diagnosis, compared to children from families without risks. High-risk familial factors directly increased the risk of ADHD and ID diagnosis, and indirectly increased the risk of ADHD, ID, LD, and ASD diagnosis through the mediating factor of children’s development. CONCLUSIONS: Children who met more high-risk familial characteristics were at higher risk of ADHD, ID, LD, and ASD diagnosis. Development at three years was predictive of diagnosis at 5.5 years. Thus, developmental screening at age three is vital for interventions. Preventive, family-focused, and/or child-rearing services for at-risk families are important for improving outcomes for these children and their families.

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25. Miller V, Leigers K, Howell D, Kitzman P, Ault M. Using Social Network Analysis to Measure Social Inclusion for Individuals with Intellectual and Developmental Disabilities. Physical & occupational therapy in pediatrics. 2022: 1-15.

The aim of this perspective is to describe the theory and practical steps of using principles of social network analysis to help measure the social inclusion of individuals with intellectual and developmental disabilities (IDD). Social inclusion for those with disabilities has become an important area of focus of rehabilitative professionals in the past decade. Social inclusion is comprised of the domains participation and social interaction. Decreased social inclusion can negatively impact quality of life and health. Individuals with IDD continue to experience barriers to social inclusion such as limited opportunities to socialize and participate in community groups, physical barriers, and the lack of available valued social roles. There are limited methods for measuring social inclusion for individuals with IDD. Social network analysis is one way to analyze and understand social relationships to better understand the social inclusion of individuals with IDD. Providing a way to measure social inclusion may help answer questions about the effectiveness of interventions, ultimately leading to increased social inclusion for individuals with IDD.

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26. Nahar S, Zambelli Z, Halstead EJ. Risk and protective factors associated with maternal mental health in mothers of children with autism spectrum disorder. Research in developmental disabilities. 2022; 131: 104362.

BACKGROUND: Mothers of children with Autism Spectrum Disorder (ASD) experience lower maternal mental health outcomes than mothers of children from other populations, including children with intellectual and developmental disorders. OBJECTIVES: This study explored risk factors associated with maternal mental health. Several factors including maternal resilience, social support, coping, optimism and family functioning acted as protective factors between child behavioural and emotional problems and maternal mental health. METHODS: Mothers of 70 children completed a cross-sectional online survey. Twenty-two children were diagnosed with ASD, 16 children were diagnosed with Dyslexia (DYS) and 32 children had no special educational needs diagnosis (NO SEND). RESULTS: Mothers of children with ASD demonstrated greater maternal mental health problems compared to mothers of children with DYS and NO SEND. Socioeconomic status (SES), child diagnosis, child gender, and child behavioural and emotional problems were significant risk factors associated with reduced maternal mental health. Maternal resilience, family functioning, and practical coping served as protective factors, moderating the relationship between child behavioural and emotional problems and maternal mental health. There is little evidence to suggest social support, optimism, and wishful thinking were protective factors in this relationship between child behavioural and emotional problems and maternal mental health. IMPLICATIONS: There is a need to support mothers of children with ASD through interventions to promote and increase their mental health.

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27. Petinou K, Hus Y, Segal O. Focus on Issues and Solutions in Autism Spectrum Disorders (ASD). Neuropsychiatric disease and treatment. 2022; 18: 2273-7.

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28. Pikwer A, Yang B, Granström M, Mattsson N, Sadr-Azodi O. General anesthesia in early childhood and possible association with autism: a population-based matched cohort study. Minerva anestesiologica. 2022.

BACKGROUND: In experimental animal studies, exposure to general anesthesia in early childhood may results in changes in infant brain morphology and behavior, potentially leading to the development of autistic behaviors in the long-term. However, in clinical studies the role of exposure to general anesthesia in early childhood and the risk of autism is unknown. METHODS: This is a population-based cohort study including all children aged 0-5 years of age exposed to general anesthesia between 2001 and 2014 and a corresponding matched population without such an exposure. Propensity score calculation was based on 49 variables (including age of parents, malformations, APGAR score, and family income, among others). Quasi-Poisson regression was used to estimate risk ratios (RRs) with 95% confidence intervals (CIs) for the association between exposure to general anesthesia and autism or autism spectrum disorder. RESULTS: In total, 401,750 children exposed to general anesthesia were compared with 1,187,796 unexposed individuals. Autism or autism spectrum disorder were more common in the children exposed to general anesthesia as compared to unexposed children (1.65% and 0.98%, respectively, p < 0.01). There was a statistically significant higher risk of autism or autism spectrum disorder in children exposed to general anesthesia as compared to unexposed children also after propensity score adjustment (RR 1.62, 95% CI: 1.57-1.67). CONCLUSIONS: In conclusion, exposure to general anesthesia in early childhood was associated with an increased risk of autism or autism spectrum disorder. Future studies are needed to asses if general anesthesia may cause autism or if the association is due to other factors.

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29. Samadi SA. The Challenges of Establishing Healthcare Services in Low- and Middle-Income Countries: The Case of Autism Spectrum Disorders (ASD) in the Kurdistan Region of Iraq-Report from the Field. Brain sciences. 2022; 12(11).

The present report from the field tries to present challenges associated with establishing healthcare services for individuals with autism spectrum disorders (ASD) in a low- and middle-income area. The given case that has been highlighted is establishing daycare services focusing on rehabilitation and training services for individuals with ASD, and their caregivers and family members, in the Kurdistan Region of Iraq (KRI). Based on my experience, the associated challenges are divided into three primary levels: personal, professional, and organizational. The report highlights the importance of understanding the challenges associated with establishing healthcare services with the desire to put them under control. Plus, understanding the cultural aspects of the healthcare services for individuals with ASD experiences to address the issues at each level shared. It is concluded in the final part of the report that the key to establishing healthcare quality is to understand attitudes toward healthcare at the personal, professional, and organizational levels. This attitude determines the expectation from the services and defines assistance-seeking behaviors. Results offer insight for stakeholders in the healthcare field, allowing for a better understanding and improvement of availability and access to quality-driven healthcare services. A pre- and in-service training approach is practiced to address the associated challenges of establishing healthcare services at the personal level in KRI. A similar policy might be applicable in other LMICs, where there is a lack of professional and skillful healthcare service providers.

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30. Speranza L, Filiz KD, Goebel S, Perrone-Capano C, Pulcrano S, Volpicelli F, Francesconi A. Combined DiI and Antibody Labeling Reveals Complex Dysgenesis of Hippocampal Dendritic Spines in a Mouse Model of Fragile X Syndrome. Biomedicines. 2022; 10(11).

Structural, functional, and molecular alterations in excitatory spines are a common hallmark of many neurodevelopmental disorders including intellectual disability and autism. Here, we describe an optimized methodology, based on combined use of DiI and immunofluorescence, for rapid and sensitive characterization of the structure and composition of spines in native brain tissue. We successfully demonstrate the applicability of this approach by examining the properties of hippocampal spines in juvenile Fmr1 KO mice, a mouse model of Fragile X Syndrome. We find that mutant mice display pervasive dysgenesis of spines evidenced by an overabundance of both abnormally elongated thin spines and cup-shaped spines, in combination with reduced density of mushroom spines. We further find that mushroom spines expressing the actin-binding protein Synaptopodin-a marker for spine apparatus-are more prevalent in mutant mice. Previous work identified spines with Synaptopodin/spine apparatus as the locus of mGluR-LTD, which is abnormally elevated in Fmr1 KO mice. Altogether, our data suggest this enhancement may be linked to the preponderance of this subset of spines in the mutant. Overall, these findings demonstrate the sensitivity and versatility of the optimized methodology by uncovering a novel facet of spine dysgenesis in Fmr1 KO mice.

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31. Wu Q, Yang T, Chen L, Dai Y, Wei H, Jia F, Hao Y, Li L, Zhang J, Wu L, Ke X, Yi M, Hong Q, Chen J, Fang S, Wang Y, Wang Q, Jin C, Hu R, Chen J, Li T. Early life exposure to triclosan from antimicrobial daily necessities may increase the potential risk of autism spectrum disorder: A multicenter study in China. Ecotoxicology and environmental safety. 2022; 247: 114197.

BACKGROUND: Autism spectrum disorders (ASD) are a group of complex neurodevelopmental disorders with unclear etiologies. Our recent work indicated that maternal exposure to triclosan (TCS) significantly increased the autistic-like behavior in rats, possibly through disrupting neuronal retinoic acid signaling. Although environmental endocrine disruptors (EEDs) have been associated with autism in humans, the relationship between TCS, one of the EEDs found in antibacterial daily necessities, and autism has received little attention. OBJECTIVE: The aims of this multicenter study were to evaluate TCS concentrations in typically developing (TD) children and ASD children, and to determine the relationship between TCS levels and the core symptoms of ASD children. METHODS: A total of 1345 children with ASD and 1183 TD children were enrolled from 13 cities in China. Ages ranged between 2 and 7 years. A questionnaire was used to investigate the maternal use of antibacterial daily necessities (UADN) during pregnancy. The core symptoms of ASD were evaluated using the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Social Response Scale (SRS), and the Children Neuropsychological and Behavior Scale-Revision 2016 (CNBS-R2016). The TCS concentration was measured using LC-MS/MS. RESULTS: Maternal UADN during pregnancy may be an unrecognized potential environmental risk factor for ASD (OR=1.267, P = 0.023). Maternal UADN during pregnancy strongly correlated with TCS levels in the offspring (Adjusted β = 0.277, P < 0.001). TCS concentration was higher in ASD children (P = 0.005), and positively correlated with ABC (Sensory subscales: P = 0.03; Social self-help subscales: P = 0.011) and SRS scale scores (Social awareness subscales: P = 0.045; Social communication subscales: P = 0.001; Autism behavior mannerisms subscales: P = 0.006; SRS total score: P = 0.003) in ASD children. This association was more pronounced in boys than in girls. CONCLUSION: To our knowledge, this is the first case-control study to examine the correlation between TCS and ASD. Our results suggest that maternal UADN during pregnancy may be a potential risk of ASD in offspring. Further detection of TCS levels showed that maternal UADN during pregnancy may be associated with excessive TCS exposure. In addition, the level of TCS in children with ASD is higher than TD children. The higher levels of TCS in children with ASD may be significantly associated with more pronounced core symptoms, and this association was more significant in male children with ASD.

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32. Wu S, Wang P, Yao L. Study on the Influence of Urban Built Environment Factors on the Social Behavior of ASD Children. Journal of environmental and public health. 2022; 2022: 8963416.

The use of urban space by vulnerable groups, especially ASD children with social anxiety, is an important part of building sustainable urban development. In this study, we focus on the play behavior of ASD children from the perspective of urban planning; then, we discussed how the urban built environmental factors affect the social behavior of ASD children. In this paper, 220 parents of ASD children were given questionnaires and 197 valid questionnaires were obtained after removing invalid ones. Stepwise regression was adopted to further accurately analyze the influence of each factor index in the built environment on children’s social behavior. The results showed that multiple urban built environment factors had significant influence on the social behaviors (observation, participation, retreat, and concealment) of children with autism at three stages: before departure, during journey, and arrived at destination. The purpose of study is to fully consider the use of urban space by ASD children when urban researchers or urban planners construct sustainable urban forms, formulate urban design guidelines, and implement old city renewal strategies.

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33. Zacharov O, Huster RJ, Kaale A. Working memory in pre-school children with autism spectrum disorder: An eye-tracking study. Frontiers in psychology. 2022; 13: 922291.

Working memory (WM) was examined in pre-school children with Autism spectrum disorder (ASD) and children with typical development using eye-tracking technology. The children were presented with a digital A-not-B task (with a short and a long waiting condition) where they passively viewed animations of a moving train. Moreover, the current study investigated the relationship between non-verbal mental age (NVMA) and the performance on the task. No group differences were found in the average looking durations between the ASD and typically developing (TD) groups on either the short or long waiting conditions. Although the NVMA of the ASD group was lower than that of the TD group there were no correlations between NVMA and task performance in either group. The results suggest that WM in young children with ASD might not be different from that of TD children. However, the results might be due to ceiling effects of the task and thus needs to be further investigated.

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34. Zhao J, Zhang X, Lu Y, Wu X, Zhou F, Yang S, Wang L, Wu X, Fei F. Virtual reality technology enhances the cognitive and social communication of children with autism spectrum disorder. Frontiers in public health. 2022; 10: 1029392.

OBJECTIVE: We aimed to explore the impact of using virtual reality technology to intervene in and encourage the developmental behavior areas of cognition, imitation, and social interaction in children with autism spectrum disorder. METHODS: Forty-four children with autism spectrum disorder were divided randomly into an intervention group and a control group, with each group consisting of 22 participants. Incorporating conventional rehabilitation strategies, virtual reality technology was used with the intervention group to conduct rehabilitation training in areas including cognition, imitation, and social interaction. The control group was provided conventional/routine clinical rehabilitation training. The children’s cognitive development was evaluated before and 3 months after intervention. RESULTS: After intervention, the developmental abilities of both groups of children in the areas of cognition, imitation, and social interaction were improved over their abilities measured before the intervention (P < 0.05). However, post-intervention score differences between the two groups demonstrated that the intervention group levels were better than the control group levels only in the areas of cognition and social interaction (P < 0.05). CONCLUSION: Combining virtual reality with conventional rehabilitation training improved the cognitive and social development of children with autism spectrum disorder and supported the goal of improving the rehabilitation effect.

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35. Zhao W, Li Q, Zhang X, Song X, Zhu S, Shou X, Meng F, Xu X, Zhang R, Kendrick KM. Language Skill Differences Further Distinguish Social Sub-types in Children with Autism. Journal of autism and developmental disorders. 2022.

This study investigated heterogeneity in language skills of children with autism and their relationship with different autistic social subtypes. Data from 90 autistic and 30 typically developing children were analyzed. Results showed that autistic social subtypes varied in language skill problems (aloof > passive > active-but-odd). There was a negative association between aloof dimension scores and language performance but positive for the active-but-odd dimension and no association in the passive one. Moreover, aloof dimension score was the main contributor to language performance. A receiver operating characteristic analysis suggested language vocabulary as an additional component in differentiating autistic social subtypes. These findings demonstrate that variations in language skills in autistic children provide additional information for discriminating their social subtype.

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