1. Al Saad AJ, Alhassan GM, Albedaiwi MS, Alqattan FF, Alessa FA, Alabdulmohsen HW. Acceptance of COVID-19 vaccination among parents of children with autism and other neurodevelopmental disorders in Saudi Arabia: a cross-sectional study. BMC public health. 2023; 23(1): 1235.

BACKGROUND: Acceptance of COVID-19 vaccination was noticed to be less common among parents of children with autism spectrum disorder (ASD) and other neurodevelopmental disorders. This study aimed to explore the beliefs and willingness of parents of children with neurodevelopmental disorders about COVID-19 vaccine and understand how certain factors influencing the vaccine decision-making process differ between them and other parents’ groups. METHODS: A cross-sectional study was conducted between August to November 2021. An Arabic online survey was distributed in August 2021 to collect the study’s data. 400 parents from all the major regions in Saudi Arabia participated in and shared their beliefs about the new COVID-19 vaccination for their children. RESULTS: Out of 400 participants, 381 of them were eligible to answer the survey (95.2%). The total number of parents of children with neurodevelopmental disorder was 158 (41.5%), was compared to responses of parents of heathy children 223 (58.5%). 85 (53.8%) of them were ready to vaccinate their children with COVID-19 vaccine. While 36 (22.8%) were hesitant, the rest 37 (23.4%) did not want to vaccinate their children at all. Only a small number 16 (10.1%) have beliefs of vaccines as a cause of their child’s neurodevelopmental disorder. A total of 79 out of 131 responses were received from both parents’ groups. Fear of long-term side-effects was the most common reason reported by 41 responders out of 64 (64.06%) from parents of healthy children and 38 responders out of 67 (56.71%) from parents of diagnosed children. Another reason reported by parents of younger children in both groups was the child’s age. Having a healthcare relative worker was significantly associated with the vaccine decision making (p < .001). CONCLUSION: The acceptance rate of COVID-19 vaccination of parents of children with neurodevelopmental disorders was low compared to the parents of healthy children in Saudi Arabia. Authorities can benefit from this study results to offer more accessible information about the vaccine importance and safety to the targeted population.

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2. Belisle J, Burke R, Janota T, Dennis L, Taylor S. Promoting the Emergence of Vocational Knowledge through Equivalence-Based Instruction with a Young Adult with Autism. Behavior analysis in practice. 2023: 1-6.

We sought to evaluate the efficacy of an equivalence-based instructional program to teach vocational information to a young adult. This work has the potential to aid in workplace or vocational programming to teach declarative information about employment settings. We directly reinforced a subset of relations [Employee names (A) to job titles (B) (A-B) and a job titles (B) to a job responsibilities (C) (B-C)] and tested for the untrained emergence of other relations [Employee names (A) to job responsibilities (C) (A-C) and job responsibilities (C) to employee names (A) (C-A)]. In a multiple baseline across employment settings, mastery was observed across trained and derived relations with implications for vocational training. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40617-023-00814-z.

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3. Bhana N, Raulston TJ, Ousley C, Bagawan A. Photographs and Parent Training to Support Conversations about Past Events between Caregivers and Children with Autism. Advances in neurodevelopmental disorders. 2023: 1-13.

OBJECTIVES: Children with autism spectrum disorder experience communication difficulties that can make it challenging to engage in conversations. Their caregivers also often struggle with finding ways to support the child’s communication. Parent-implemented interventions and visual supports are evidence-based practices to support the communication skills of children with autism. METHOD: A multi-method design (single-case multiple probe and qualitative) was used to evaluate the effects of family photographs, training, and telecoaching on parental implementation of communication strategies. Three parents and their children with and at risk for autism participated. RESULTS: Results indicate that the use of photographs increased the communication strategies used by all parents. Telecoaching further increased the overall strategy use for two parents. Interviews with the parents indicate spontaneous generalization and maintenance of strategy use. CONCLUSION: Family photos and naturalistic developmental behavior intervention approaches have the potential to improve communication about past events between parents and children with and at risk for ASD.

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4. Chiapperino L, Hens K. How to talk about autism: reconciling genomics and neurodiversity. Nature medicine. 2023.

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5. Cunha YGO, do Amaral GCB, Felix AA, Blumberg B, Amato AA. Early-life exposure to endocrine-disrupting chemicals and autistic traits in childhood and adolescence: a systematic review of epidemiological studies. Frontiers in endocrinology. 2023; 14: 1184546.

AIMS: Exposure to endocrine-disrupting chemicals (EDCs) during critical neurodevelopmental windows has been associated with the risk of autistic traits. This systematic review of epidemiological studies examined the association between maternal exposure to EDCs during pregnancy and the risk of autism spectrum disorder (ASD) in the offspring. METHODS: We searched PubMed, Web of Science, Scopus, and Google Scholar from inception to November 17, 2022, for studies investigating the association between prenatal exposure to EDCs and outcomes related to ASD. Two independent reviewers screened studies for eligibility, extracted data, and assessed the risk of bias. The review was registered in PROSPERO (CRD42023389386). RESULTS: We included 27 observational studies assessing prenatal exposure to phthalates (8 studies), polychlorinated biphenyls (8 studies), organophosphate pesticides (8 studies), phenols (7 studies), perfluoroalkyl substances (6 studies), organochlorine pesticides (5 studies), brominated flame retardants (3 studies), dioxins (1 study), and parabens (1 study). The number of examined children ranged from 77 to 1,556, the age at the assessment of autistic traits ranged from 3 to 14 years, and most studies assessed autistic traits using the Social Responsiveness Scale. All but one study was considered to have a low risk of bias. Overall, there was no association between maternal exposure to specific ECDs during pregnancy and the occurrence of autistic traits in offspring. CONCLUSIONS: Findings from the epidemiological studies evaluated here do not support an association between prenatal exposure to ECDs and the likelihood of autistic traits in later in life. These findings should not be interpreted as definitive evidence of the absence of neurodevelopment effects of EDCs affecting ASD risk, given the limitations of current studies such as representative exposure assessment, small sample sizes, inadequacy to assess sexually dimorphic effects, or the effects of EDC mixtures. Future studies should carefully address these limitations.

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6. Egan C, McLaughlin N, McGarrell M, Gurrin C, Devlin S, Smyth S. Expert Consensus on the Resource Needs of Autistic Children and Young People in Ireland During the Early Months of the COVID-19 Pandemic. Journal of developmental and physical disabilities. 2023: 1-18.

The COVID-19 pandemic has brought significant changes across society. This Delphi study aimed to gain expert consensus on challenges faced and resource needs for autistic children during the COVID-19 pandemic. Round 1 of the Delphi method employed semi-structured interviews with experts (N = 24) which were thematically analysed in order to identify needs, resource targets and resource development. In a follow-up Round 2 survey participants rated emergent need and resource in order of priority. Round 2 provided consensus on challenges faced with anxiety, routine and wellbeing ranked most important. Direction on resource design was also obtained. Consensus on the challenges and resources was achieved and is being integrated into a needs-based transition resources toolkit. Future studies could make use of the Delphi method to quickly gain consensus on focus of needs in other contexts and communities.

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7. El Mouatasim A, Ikermane M. Control learning rate for autism facial detection via deep transfer learning. Signal, image and video processing. 2023: 1-8.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects social interaction and communication. Early detection of ASD can significantly improve outcomes for individuals with the disorder, and there has been increasing interest in using machine learning techniques to aid in the diagnosis of ASD. One promising approach is the use of deep learning techniques, particularly convolutional neural networks (CNNs), to classify facial images as indicative of ASD or not. However, choosing a learning rate for optimizing the performance of these deep CNNs can be tedious and may not always result in optimal convergence. In this paper, we propose a novel approach called the control subgradient algorithm (CSA) for tackling ASD diagnosis based on facial images using deep CNNs. CSA is a variation of the subgradient method in which the learning rate is updated by a control step in each iteration of each epoch. We apply CSA to the popular DensNet-121 CNN model and evaluate its performance on a publicly available facial ASD dataset. Our results show that CSA is faster than the baseline method and improves the classification accuracy and loss compared to the baseline. We also demonstrate the effectiveness of using CSA with L1-regularization to further improve the performance of our deep CNN model.

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8. Fukui N, Watanabe Y, Motegi T, Hashijiri K, Ogawa M, Egawa J, Enomoto T, Someya T. Relationships among autistic traits, depression, anxiety, and maternal-infant bonding in postpartum women. BMC psychiatry. 2023; 23(1): 463.

BACKGROUND: Although several studies have found significant relationships between autistic traits and depression/anxiety, the relationships between autistic traits and postpartum depression/anxiety remain unclear. Moreover, few studies have examined the relationships between autistic traits and mother-infant bonding while considering depression or anxiety. METHODS: This study used a cross-sectional data analysis design. Participants were 2692 women who completed the Autism-Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), and Mother-to-Infant Bonding Scale (MIBS) at 1 month postpartum. We performed path analysis that included parity, the five AQ subscales (social skills, attention switching, attention to detail, communication, and imagination), both HADS subscales (anxiety and depression), and the two MIBS subscales (lack of affection and anger and rejection). RESULTS: Our path analysis revealed that higher scores for social skills, attention switching, communication, and imagination were associated with higher scores for depression. Higher scores for social skills, attention switching, attention to detail, and communication were associated with higher scores for anxiety. Moreover, difficulties in social skills and imagination were associated with failure of maternal-infant bonding. However, more attention to detail was associated with better maternal-infant bonding. CONCLUSIONS: This study suggests that maternal autistic traits are related to anxiety and depression to a certain degree, but only slightly related to maternal-infant bonding at 1 month postpartum. To improve autistic women’s quality of life and that of their newborns, perinatal mental health issues such as anxiety, depression, and maternal-fetal bonding difficulties should be appropriately addressed.

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9. Galion AW, Farmer JG, Connolly HV, Allhusen VD, Bennett A, Coury DL, Lam J, Neumeyer AM, Sohl K, Witmans M, Malow BA. A Practice Pathway for the Treatment of Night Wakings in Children with Autism Spectrum Disorder. Journal of autism and developmental disorders. 2023.

Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD.

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10. Gibbs AR, Tullis CA, Conine DE, Fulton AA. A Systematic Review of Derived Relational Responding Beyond Coordination in Individuals with Autism and Intellectual and Developmental Disabilities. Journal of developmental and physical disabilities. 2023: 1-36.

As interest in derived relational responding has increased, so have the number of investigations evaluating interventions to promote the emergence of derived responding for individuals with autism, as well as other intellectual and developmental disabilities. However, much of the literature has focused on the relation of sameness, and less is known about interventions to facilitate derived responding in other relations. Systematic searches identified 38 studies contained in 30 articles that met inclusion criteria. These studies were analyzed according to their participants, assessment methods, experimental design, content taught, setting, teaching procedures, derived responses, outcomes, and reliability measures. The quality of the studies was measured using the Single Case Analysis and Research Framework (SCARF). The results of the current review indicate that many learners with autism spectrum disorder and other intellectual and developmental disabilities demonstrate derived relational responding beyond the relation of coordination across varied instructional content and teaching methodologies, but the quality and rigor of the published literature requires the results be interpreted with caution, leading to recommendations for future research.

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11. Gilder J, Charlop MH. Increasing Social Communication by Teaching Texting to Autistic Children. Advances in neurodevelopmental disorders. 2023: 1-12.

OBJECTIVES: In the present study, we increased the social communication of four autistic children by teaching texting conversation skills on smart phones. METHODS: A multiple baseline design across two dyads was used to assess the texting conversation intervention, with additional generalization probes taken across texting partners and FaceTime® sessions. One-month maintenance probes were also assessed. RESULTS: All four participants increased their conversational texting, and their conversation content was novel. Generalization across texting partners occurred, and skills were maintained. Appropriate verbal content spoken during FaceTime® probes was also observed. CONCLUSIONS: Results are discussed in terms of the potential benefits of teaching autistic children social communication through text.

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12. Guo Y, Shen M, Dong Q, Méndez-Albelo NM, Huang SX, Sirois CL, Le J, Li M, Jarzembowski ED, Schoeller KA, Stockton ME, Horner VL, Sousa AMM, Gao Y, Levine JE, Wang D, Chang Q, Zhao X. Elevated levels of FMRP-target MAP1B impair human and mouse neuronal development and mouse social behaviors via autophagy pathway. Nature communications. 2023; 14(1): 3801.

Fragile X messenger ribonucleoprotein 1 protein (FMRP) binds many mRNA targets in the brain. The contribution of these targets to fragile X syndrome (FXS) and related autism spectrum disorder (ASD) remains unclear. Here, we show that FMRP deficiency leads to elevated microtubule-associated protein 1B (MAP1B) in developing human and non-human primate cortical neurons. Targeted MAP1B gene activation in healthy human neurons or MAP1B gene triplication in ASD patient-derived neurons inhibit morphological and physiological maturation. Activation of Map1b in adult male mouse prefrontal cortex excitatory neurons impairs social behaviors. We show that elevated MAP1B sequesters components of autophagy and reduces autophagosome formation. Both MAP1B knockdown and autophagy activation rescue deficits of both ASD and FXS patients’ neurons and FMRP-deficient neurons in ex vivo human brain tissue. Our study demonstrates conserved FMRP regulation of MAP1B in primate neurons and establishes a causal link between MAP1B elevation and deficits of FXS and ASD.

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13. Gupta N, Gupta M. Diagnostic Overshadowing in High-Functioning Autism: Mirtazapine, Buspirone, and Modified Cognitive Behavioral Therapy (CBT) as Treatment Options. Cureus. 2023; 15(5): e39446.

Diagnostic overshadowing (DO) is identified as a contributor to the missed diagnosis of individuals with an autism spectrum disorder (ASD). It has been used predominantly in the scientific literature and clinical settings to describe a phenomenon where a person’s symptoms and behaviors are attributed solely to their primary diagnosis, rather than being recognized due to co-occurring conditions. DO is seen across many developmental disorders; however, females with autism may have a more difficult time getting diagnosed than males with autism because traditional diagnostic criteria for autism are often based on research that has primarily focused on males with autism. Likewise, the efficacy of approved psychopharmacological like selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioral therapy (CBT) in individuals with ASD is not well established. Amidst these challenges, it’s imperative to underscore the need for screening these disorders and provide informed evidence-based treatment alternatives for shared decision-making. Mirtazapine has low but promising findings, though modified CBT has superior empirical support in the treatment of co-occurring conditions associated with ASD.

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14. Lee J, Schwichtenberg AJ, Bliwise D, Ali SZ, Hayat MJ, Clark PC, Spratling R. Simultaneous Recording of Objective Sleep in Mothers and School-aged Children with Developmental Disabilities: A Pilot Study of Actigraphy and Videosomnography. Journal of developmental and physical disabilities. 2023: 1-23.

Mothers of school-aged children ages 3 to 17 years with developmental disabilities (DDs) commonly report sleep problems in their children associated with impaired maternal sleep. However, existing research relies heavily on mothers’ self-reported sleep. This study aimed to determine the feasibility of objectively measuring child and mother sleep-wake patterns using actigraphy and videosomnography. This was an observational pilot study. Mothers wore actigraphy watches and video-recorded their child’s sleep for 7 nights. Mothers also completed a 7-day sleep diary and questionnaires on sleep quality, depressive symptoms, stress, and child sleep problems. Ten mothers (32-49 years) and ten children with DDs (8-12 years) completed this study. Half of the children were boys with autism spectrum disorders. We successfully recruited 77% of eligible mothers for the study during the pandemic. Eight mothers successfully wore the actigraphy, and nine successfully video-recorded their child’s sleep. Mothers rated their participation positively and considered the data collection protocol acceptable. While mothers’ sleep patterns from actigraphy were mostly within recommendations, self-reported sleep quality was poor. Child’s sleep estimates from videosomnography showed children slept substantially less than recommended sleep hours. Mothers also reported a high frequency of child sleep problems. Consistent with this pattern, mothers also endorsed elevated stress and depression. The use of actigraphy and videosomnography is feasible. Objective sleep measurement for mothers’ and children’s sleep is needed with self-report to measure multidimensional aspects of sleep and discrepancies between objective and self-report sleep measures. Future studies can use multi-methods sleep measures and work toward interventions that can improve family sleep and reduce mothers’ stress and depression.

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15. Lee K, Godina F, Pike D. A Social Turn-Taking, Parent Mediated Learning Intervention for a Young Child with Autism: Findings of a Pilot Telehealth Study. Early childhood education journal. 2023: 1-13.

Social turn taking, a preverbal social communication competency often difficult for young children with autism, may be foundational to joint attention when included as a component of interventions for children with autism. In this study, social turn-taking was promoted through a parent mediated learning approach to intervention in a telehealth setting. Following a mixed-methods design, the present study explored the results of this new intervention model for a toddler with autism. The study also sought to understand any changes in the parent-child relationship because of the intervention. Findings indicate that the intervention supported the child’s social communication competencies, including social turn-taking, joint attention, and facial focusing. Qualitative data revealed improvements in the parent-child relationship. These preliminary results lend support for promoting social turn-taking in interventions for children with autism, as well as for following developmental, parent-driven approaches to intervention. Studies with larger sample sizes are needed to understand these findings further. Implications for practice and research in early intervention are presented.

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16. Lievore R, Lanfranchi S, Mammarella IC. Parenting stress in autism: do children’s characteristics still count more than stressors related to the COVID-19 pandemic?. Current psychology (New Brunswick, NJ). 2023: 1-11.

Parents of children with autism spectrum disorders (ASD) experience higher levels of stress than parents of typically-developing (TD) children, due to differences in their children’s emotional functioning. The COVID-19 pandemic exacerbated the cognitive and practical demands on vulnerable populations and their families. The aim of this study was to examine parenting stress levels in parents of children ASD and TD children, considering the children’s emotional functioning (i.e., anxiety and cognitive emotion regulation strategies), and stressful life events deriving from the COVID-19 pandemic. The study involved 64 parent-child dyads comprising children from 7 to 16 years old, divided into two groups: 32 (26 M) children and adolescents with ASD but no intellectual disability, and 32 (26 M) with typical development. Our results show that parents of children with ASD reported higher levels of stress, but factors relating to the child and the context had a different influence on parenting stress in the ASD and TD groups. The higher level of parenting stress in the ASD group seemed to relate more to the children’s emotional characteristics, while the TD group was more affected by the unpredictable stressful events prompted by COVID-19. Families’ mental health should be considered a core aspect of supporting parents having to deal with both their child’s emotional adjustment and the challenges of the COVID-19 pandemic.

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17. Lin Y, Wang Y, Lin C, Ni Q, Jia R, Chang Y, Qi Y. The mediating role of perceived social support: alexithymia and parental burnout in parents of children with autism spectrum disorder. Frontiers in psychology. 2023; 14: 1139618.

BACKGROUND: Parental burnout is a concept that reflects the emotional exhaustion and emotional distance of parents from children due to their inability to cope with the pressure of parenting. It has been confirmed that parents of autistic children are at higher risk for parental burnout. Additional research has suggested a relationship between parental burnout and parents’ personality traits. However, the relationship between alexithymia, an independent personality factor, with parental burnout is little to none. OBJECTIVE: To look into the connection between parental burnout and alexithymia among parents of autistic children. METHOD: Three hundred and one parents were approached for recruitment and data were collected from 203 parents through a cross-sectional survey assessing parental burnout, alexithymia status, and perceived social support. Because the data is not normally distributed, Spearman’s rank correlation coefficient rho(p) was used to assess the correlation between the variables; and then using AMOS to analyze the mediating effects of perceived social support and the moderating effect of gender. RESULT: The result showed that (1) There is a negative association between alexithymia with parental burnout (β = 0.6, p < 0.01), while perceive social support was the negative predictor of alexithymia (β = -0.45, p < 0.01) and parental burnout (β = -0.26, p < 0.01); (2) perceive social support partially mediated the relationship between alexithymia and parental burnout of parents of autistic children, which can explain 16.3% of the total effect; (3) Gender plays a moderating role in the first half of the indirect effect of alexithymia on parental burnout, as evidenced by the significant difference in path coefficients between the male and female models (male: β = -0.10, p < 0.05; female: β = -0.60, p < 0.05). CONCLUSION: Health professionals and policymakers should be aware of parental burnout among parents of autistic children in China and take early intervention steps. Furthermore, they should recognize the negative impact of alexithymia and the positive impact of social support when developing plans to alleviate parental burnout in children with autism, with a particular focus on mothers with alexithymia, who are more likely to experience low social support and burnout than fathers with alexithymia.

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18. López-Bouzas N, Del Moral-Pérez ME. Gamified Environments and Serious Games for Students With Autistic Spectrum Disorder: Review of Research. Review journal of autism and developmental disorders. 2023: 1-13.

The aim of this study is to review the available research (N = 70) derived from the use of Gamified Environments and Serious Games with people with Autistic Spectrum Disorder (ASD), identifying: authorship, nationality, publication period, topic, and design of the investigation. After that, the advantages and limitations observed are identified. Results indicate that most of them are focused on the design and testing of prototypes, (mostly) linked to the increase of social and emotional skills. The revision highlights that the game’s mechanics and dynamics (feedback, rewards, missions, etc.) involve students from motivation. There is unanimous agreement to emphasize the positive impact of these resources to increment self-control, self-conscience, autonomy, and empathy.

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19. Mallan S, Singh S. Syringic acid alleviates valproic acid induced autism via activation of p38 mitogen-activated protein kinase: Possible molecular approach. Environmental toxicology. 2023.

Autism spectrum disorder (ASD) is a multifactorial neurodevelopmental disorder characterized by restrictive and repetitive behavior followed by impairment in social, verbal, and non-verbal interaction and communication. Valproic acid (VPA) is a well-known anti-epileptic drug, but its prenatal exposure to animals causes social impairment, neurotransmitters imbalance, and neuroinflammation with ASD-like phenotypes. Syringic acid (SA) is a polyphenolic compound with anti-inflammatory, anti-apoptotic, antioxidant, and neuromodulator activity. The purpose of study was to investigate the protective effect of Syringic acid (SA) in prenatal VPA-treated rats through behavioral, neuroinflammation, oxidative stress, neurotransmitters, neuronal integrity, and apoptotic marker. Single dose of VPA was administered 600 mg/kg, i.p. on a gestational day (GD) 12th and SA was administrated from PnD 26th to 54th at the dose of 25, 50, and 100 mg/kg, p.o. On PnD 56th behavioral parameters (Pain sensitivity, open field test, narrow beam walks test and social impairment test) were performed and all animals were sacrificed, and brain tissue was isolated for oxidative stress (GSH, CAT, and LPO), neuroinflammation (TNF-α and IL-6) and neurotransmitters (GABA and Glutamate), histopathology (H&E, Nissl), immunohistochemistry (p38 MAPK) analysis. Rat treated with SA dose-dependently prevented behavioral alteration, restored antioxidant enzymes, neurotransmitters level, decreased neuroinflammatory markers, and improved neuronal integrity. Furthermore, immunohistochemistry confirmed the reduced p38 MAPK marker expression by SA in VPA induced autistic behavior.

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20. Marcinechová D, Záhorcová L, Lohazerová K. Self-forgiveness, Guilt, Shame, and Parental Stress among Parents of Children with Autism Spectrum Disorder. Current psychology (New Brunswick, NJ). 2023: 1-16.

A mixed-method approach was used to explore and compare self-forgiveness, guilt, shame, and parental stress in parents of children with autism spectrum disorder (ASD) and parents of neurotypical (NT) children. The data were obtained by the Heartland Forgiveness Scale (Thompson et al., 2005), Guilt and Shame Experience Scale (Maliňáková et al., 2019), Parental Stress Scale (Berry & Jones, 1995) and by open-ended questions. The research sample consisted of 143 parents of children with ASD and 135 parents of NT children from Slovakia. The regression analysis confirmed that guilt, shame, and self-forgiveness explained 23% of the variance in parental stress, while the only significant negative predictor was self-forgiveness. Furthermore, shame mediated the pathway between self-forgiveness and parental stress in parents of children with ASD. Parents of children with ASD experience more shame than parents of NT children. The qualitative analysis obtained a more comprehensive understanding of both groups. Parents of children with ASD mostly experienced shame in regard to their child’s inappropriate behavior or it being misunderstood by society, while parents of NT children mostly did not feel ashamed of their parenting. Acceptance, social support, religious beliefs, and love from the child were the most often mentioned factors helping self-forgiveness in parents of children with ASD. We highlight the importance of self-forgiveness as a potential coping mechanism for parental stress and suggest focusing on negative aspects of shame in parents of children with ASD.

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21. Martin RJ, Crowley-Zalaket J, Gould K, Weddle S, Anderson CM. Behavioral Parent Training via Telehealth for Autistic Children: Further Exploration of Feasibility During the COVID-19 Pandemic. Advances in neurodevelopmental disorders. 2023: 1-14.

OBJECTIVES: Many autistic children exhibit challenging and disruptive behaviors that can present challenges for both children and their families by interfering with acquisition of adaptive skills and affecting family and peer relationships. Behavioral parent training (BPT) is an evidence-based approach to reducing autistic children’s disruptive behavior, but many families face a number of barriers to accessing BPT, such as availability of BPT in their community, and transportation and scheduling challenges. Therefore, we sought to explore the feasibility and promise of effectiveness of adapting an established BPT program to a telehealth format during the COVID-19 pandemic. METHODS: A feasibility trial of BPT via telehealth was conducted with fourteen parents of autistic children. RESULTS: Parents and clinicians were able to implement BPT via telehealth with a high degree of fidelity, and parents rated both BPT and the telehealth format favorably. The program also showed promise of effectiveness in reducing autistic children’s disruptive behavior, improving their adaptive skills, as well as reducing parents’ stress, and improving parents’ sense of parenting competence. CONCLUSIONS: The findings replicate and extend findings from previous studies, further demonstrating the promise of telehealth as a viable alternative format for delivering BPT. We also explore implications for future research, including the opportunity for more thorough evaluation of the effectiveness of BPT via telehealth.

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22. Morton JT, Jin DM, Mills RH, Shao Y, Rahman G, McDonald D, Zhu Q, Balaban M, Jiang Y, Cantrell K, Gonzalez A, Carmel J, Frankiensztajn LM, Martin-Brevet S, Berding K, Needham BD, Zurita MF, David M, Averina OV, Kovtun AS, Noto A, Mussap M, Wang M, Frank DN, Li E, Zhou W, Fanos V, Danilenko VN, Wall DP, Cárdenas P, Baldeón ME, Jacquemont S, Koren O, Elliott E, Xavier RJ, Mazmanian SK, Knight R, Gilbert JA, Donovan SM, Lawley TD, Carpenter B, Bonneau R, Taroncher-Oldenburg G. Multi-level analysis of the gut-brain axis shows autism spectrum disorder-associated molecular and microbial profiles. Nature neuroscience. 2023.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by heterogeneous cognitive, behavioral and communication impairments. Disruption of the gut-brain axis (GBA) has been implicated in ASD although with limited reproducibility across studies. In this study, we developed a Bayesian differential ranking algorithm to identify ASD-associated molecular and taxa profiles across 10 cross-sectional microbiome datasets and 15 other datasets, including dietary patterns, metabolomics, cytokine profiles and human brain gene expression profiles. We found a functional architecture along the GBA that correlates with heterogeneity of ASD phenotypes, and it is characterized by ASD-associated amino acid, carbohydrate and lipid profiles predominantly encoded by microbial species in the genera Prevotella, Bifidobacterium, Desulfovibrio and Bacteroides and correlates with brain gene expression changes, restrictive dietary patterns and pro-inflammatory cytokine profiles. The functional architecture revealed in age-matched and sex-matched cohorts is not present in sibling-matched cohorts. We also show a strong association between temporal changes in microbiome composition and ASD phenotypes. In summary, we propose a framework to leverage multi-omic datasets from well-defined cohorts and investigate how the GBA influences ASD.

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23. Palermo EH, Young AV, Deswert S, Brown A, Goldberg M, Sultanik E, Tan J, Mazefsky CA, Brookman-Frazee L, McPartland JC, Goodwin MS, Pennington J, Marcus SC, Beidas RS, Mandell DS, Nuske HJ. A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial. JMIR research protocols. 2023; 12: e45852.

BACKGROUND: As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. OBJECTIVE: We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children’s stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child’s educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). METHODS: We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. RESULTS: The pilot trial will begin by September 2023. CONCLUSIONS: Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. TRIAL REGISTRATION: ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45852.

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24. Pearson E, Opoku MP. ‘From my world to yours…’: exploring the availability of social networks among parents from culturally diverse backgrounds caring for children with developmental disabilities in Australia. Psychology, health & medicine. 2023: 1-12.

This paper reports findings from an ethnographic study of families from culturally and linguistically diverse (CALD) families in Australia caring for children with disability. The study aimed to contribute insights into the unique experiences, challenges and supports that characterise experiences of families of a child with disability living in a country where the mainstream culture is different from their own. Four families from different cultural backgrounds participated in the study over a period of nine months. During this time, they participated in a series of semi-structured interviews during which they shared their encounters with formal early intervention services and reflected on important informal supports. Findings presented here indicate three key areas associated with accessing informal supports that can pose challenges for families who hold values that are different from those of the dominant culture: lack of social support; cultural adaptations, and socialization problems and coping strategies. The findings indicate that formal services could ameliorate feelings of social isolation by enabling parents to access informal supports such as parenting groups.

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25. Prieto LA, Meera B, Barry A, Swarup G, Asmus J, Ku B, Roth K, Foley JT, Columna L. A randomized parent-mediated physical activity intervention for autistic children. Autism research : official journal of the International Society for Autism Research. 2023.

The purpose of this study was to examine the immediate and post effects of a parent-mediated physical activity intervention on the fundamental motor skills of autistic children. We randomly assigned parent-child dyads (n = 31) of autistic children aged 4-11 years into three groups (workshop, an online, or control group). Each dyad participated in a 12-week intervention and was given adapted physical activity equipment and over 200 activities via a mobile application. Children were tested at the start and end of the intervention. The effect size (Cohen’s d ) of the control group for pre-post locomotor and ball skill scores were 0.12 and 0.06, respectively, indicating small effect size. The effect size of the online group for pre-post locomotor and ball skill scores were 49 and 0.26, respectively, indicating medium and small effect sizes. The effect size of the in-person group for pre-post locomotor and ball skill scores were 1.18 and 0.82, respectively, indicating large effect sizes. The outcomes of this physical activity intervention suggest that parents may facilitate the acquisition of fundamental motor skills of their autistic children. Although these results are positive, there is a need to further identify effective interventions for fundamental motor skill development in autistic children. Clinical Trials ID: NCT05159102.

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26. Ré TC, Rieken CJ, Brandt JA, Pacitto GO, Yepez J. Differential Reinforcement of Low Frequency Behavior as an Interdependent Group Contingency for Children Diagnosed with Autism Spectrum Disorder. Journal of behavioral education. 2023: 1-16.

An ABAB reversal design was employed to evaluate the effect of differential reinforcement of low (DRL) frequency behavior as an interdependent group contingency on the frequency of vocal disruptions of five males, 6-14-years old, diagnosed with an autism spectrum disorder. The results showed lower frequencies of vocal disruptions during intervention conditions as compared to baseline conditions; the combination of DRL and interdependent group contingency was effective at reducing the target behavior from baseline levels. Implications of concurrent interventions for the applied setting are discussed.

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27. Rolland T, Cliquet F, Anney RJL, Moreau C, Traut N, Mathieu A, Huguet G, Duan J, Warrier V, Portalier S, Dry L, Leblond CS, Douard E, Amsellem F, Malesys S, Maruani A, Toro R, Børglum AD, Grove J, Baron-Cohen S, Packer A, Chung WK, Jacquemont S, Delorme R, Bourgeron T. Phenotypic effects of genetic variants associated with autism. Nature medicine. 2023.

While over 100 genes have been associated with autism, little is known about the prevalence of variants affecting them in individuals without a diagnosis of autism. Nor do we fully appreciate the phenotypic diversity beyond the formal autism diagnosis. Based on data from more than 13,000 individuals with autism and 210,000 undiagnosed individuals, we estimated the odds ratios for autism associated to rare loss-of-function (LoF) variants in 185 genes associated with autism, alongside 2,492 genes displaying intolerance to LoF variants. In contrast to autism-centric approaches, we investigated the correlates of these variants in individuals without a diagnosis of autism. We show that these variants are associated with a small but significant decrease in fluid intelligence, qualification level and income and an increase in metrics related to material deprivation. These effects were larger for autism-associated genes than in other LoF-intolerant genes. Using brain imaging data from 21,040 individuals from the UK Biobank, we could not detect significant differences in the overall brain anatomy between LoF carriers and non-carriers. Our results highlight the importance of studying the effect of the genetic variants beyond categorical diagnosis and the need for more research to understand the association between these variants and sociodemographic factors, to best support individuals carrying these variants.

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28. Schmidt MM, Lee M, Francois MS, Lu J, Huang R, Cheng L, Weng Y. Learning Experience Design of Project PHoENIX: Addressing the Lack of Autistic Representation in Extended Reality Design and Development. Journal of formative design in learning. 2023: 1-19.

This paper presents Project PHoENIX, which stands for Participatory, Human-centered, Equitable, Neurodiverse, Inclusive, eXtended reality. The project aims to co-produce research with autistic users to create a virtual reality (VR) environment that is highly usable, accessible, and sensitive to the needs and preferences of these individuals. Project PHoENIX utilizes participatory design within a learning experience design (LXD) frame to locate autistic people, their caregivers, and providers centrally in the processes of immersive technology design and development, as well as research design and execution. An overarching literature review on VR and autism and issues of limited design precedent of VR environments with autistic participants is provided, as well as details on the Project PHoENIX design framework, project description, and project design outcomes. Details are provided on how the online VR environment was co-designed and co-developed through collaborative research with autistic stakeholders while being sensitive to their needs and preferences. Research findings and implications are discussed regarding the design process, constraints, principles, and insights. The paper concludes by discussing lessons learned and how this project can provide much-needed design precedent for advancing the field towards a more inclusive, human-centered, and neurodiverse VR research and development paradigms.

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29. Selten I, Boerma T, Everaert E, Gerrits E, Houben M, Wijnen F, Vorstman J. Behaviors related to autism spectrum disorder in children with developmental language disorder and children with 22q11.2 deletion syndrome. Autism & developmental language impairments. 2023; 8: 23969415231179844.

BACKGROUND AND AIM: Children with Developmental Language Disorder (DLD) are at an increased risk to develop behaviors associated with Autism Spectrum Disorder (ASD). The relationship between early language difficulties and the occurrence of ASD-related behaviors in DLD is poorly understood. One factor that may hinder progress in understanding this relationship is the etiological heterogeneity of DLD. We therefore study this relationship in an etiologically homogeneous group of children, who share phenotypic characteristics with children with DLD: children with the 22q11.2 Deletion Syndrome (22q11DS). We compare children with 22q11DS, to children with DLD and age-matched typically developing children (TD). METHOD: 44 children with 22q11DS, 65 children with DLD and 81 TD children, between 3.0-6.5 years old, participated in a longitudinal cohort study that included a baseline measure and a follow-up measure with a 1-year interval. A parental questionnaire (SRS-2) was used to measure the incidence of behaviors in two key behavioral domains associated with ASD: Social Communication and Interaction and Restricted Repetitive Behaviors and Interests. At baseline, we assessed children’s expressive and receptive language abilities as well as their intellectual functioning with standardized tests. We compared the distribution of ASD-related behaviors between the three groups. We used regression analyses to investigate whether language abilities at baseline predict ASD-related behavior at follow-up, accounting for ASD-related behavior at baseline, demographic variables and intellectual functioning. RESULTS: Both the children with 22q11DS and the children with DLD displayed significantly more ASD-related behaviors than the TD children. Over 30% of children in both clinical groups had scores exceeding the subclinical threshold for ASD in both behavioral domains. Both in 22q11DS and DLD, baseline receptive language scores were negatively correlated with ASD-related behaviors 1 year later, when controlling for baseline SRS-scores. However, this association was statistically significant only in children with 22q11DS, even when controlled for IQ-scores, and it was significantly stronger as than in the TD group. The strength of the association did not differ significantly between 22q11DS and DLD. CONCLUSION: Both children with 22q11DS and children with DLD present with elevated rates of ASD-related behaviors at a preschool-age. Only in children with 22q11DS we observed that weaker receptive language skills were related to increased behavioral problems in the domain of social communication and interaction one year later. IMPLICATIONS: Our findings indicate that relations between early language impairment and other behavioral phenotypes may be more feasible to detect in a subgroup of children with a homogeneous etiology, than in a group of children with a heterogeneous etiology (such as children with DLD). Our results in 22q11DS reveal that receptive language is especially important in predicting the occurrence of ASD-related behaviors. Future research is needed to determine to what extent receptive language predicts the occurrence of ASD-related behaviors in children with DLD, especially among those children with DLD with the weakest receptive language. Clinically, screening for ASD-related behaviors in children with developmental language difficulties is recommended from a young age, especially among children with receptive language difficulties.

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30. Shah S, Sharp KJ, Raju Ponny S, Lee J, Watts JK, Berry-Kravis E, Richter JD. Antisense oligonucleotide rescue of CGG expansion-dependent FMR1 mis-splicing in fragile X syndrome restores FMRP. Proceedings of the National Academy of Sciences of the United States of America. 2023; 120(27): e2302534120.

Aberrant alternative splicing of mRNAs results in dysregulated gene expression in multiple neurological disorders. Here, we show that hundreds of mRNAs are incorrectly expressed and spliced in white blood cells and brain tissues of individuals with fragile X syndrome (FXS). Surprisingly, the FMR1 (Fragile X Messenger Ribonucleoprotein 1) gene is transcribed in >70% of the FXS tissues. In all FMR1-expressing FXS tissues, FMR1 RNA itself is mis-spliced in a CGG expansion-dependent manner to generate the little-known FMR1-217 RNA isoform, which is comprised of FMR1 exon 1 and a pseudo-exon in intron 1. FMR1-217 is also expressed in FXS premutation carrier-derived skin fibroblasts and brain tissues. We show that in cells aberrantly expressing mis-spliced FMR1, antisense oligonucleotide (ASO) treatment reduces FMR1-217, rescues full-length FMR1 RNA, and restores FMRP (Fragile X Messenger RibonucleoProtein) to normal levels. Notably, FMR1 gene reactivation in transcriptionally silent FXS cells using 5-aza-2′-deoxycytidine (5-AzadC), which prevents DNA methylation, increases FMR1-217 RNA levels but not FMRP. ASO treatment of cells prior to 5-AzadC application rescues full-length FMR1 expression and restores FMRP. These findings indicate that misregulated RNA-processing events in blood could serve as potent biomarkers for FXS and that in those individuals expressing FMR1-217, ASO treatment may offer a therapeutic approach to mitigate the disorder.

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31. Shaw W. Inhibition of the Beta-oxidation Pathway of Fatty Acids and Dopamine- Beta-hydroxylase by Phenyl Derivatives of Short- Chain Fatty Acids from Gastrointestinal Clostridia Bacteria is a (the) Major Cause of Autism. Integrative medicine (Encinitas, Calif). 2023; 22(2): 18-25.

BACKGROUND: A The author’s comprehensive evaluation of the biochemical metabolomic literature over more than 40 years discusses multiple studies documenting abnormal elevations of the neurotransmitter dopamine and its metabolites as well as inhibitors of dopamine beta hydroxylase (DBH) from Clostridia bacteria in urine samples and cerebrospinal fluid samples of children with autism. AIMS OF REVIEW: The evaluation intends to elucidate the reasons for the elevation of dopamine and its metabolites in urine and their relationship to increased Clostridia colonization of the gastrointestinal tract in children with autism. In addition, to the evaluation of Clostridia metabolism and its effects on abnormal dopamine metabolism in autism, a secondary aim intends to demonstrate as a hypothesis that one particular metabolite of Clostridia bacteria-3-hydroxy-(3-hydroxyphenyl)- 3-hydroxypropionic acid (HPHPA)-may cause even more severe effects on in autism than other metabolites by leading to depletion of free coenzyme A (CoASH). This depletion of free Coenzyme A leads to a deficiency of cholesterol and activated palmitic acid needed for activation of the key brain developmental protein sonic hedgehog, which has recently been research has shown to be severely abnormal in severe autism. KEY SCIENTIFIC CONCEPTS OF REVIEW: Laboratories throughout the world have consistently found high quantities of HPHPA and 4-cresol in high percentages of urine samples of children with autism. Those inhibitors, which intestinal Clostridia bacteria produce, cause an elevation in dopamine and its metabolites, which affect the brain’s and the sympathetic nervous system’s key enzyme dopamine-beta-hydroxylase (DBH). Excessive dopamine and its toxic metabolites due to these DBH inhibitors may cause brain damage due to excessive unstable dopamine quinones, toxic adducts of dopamine disrupting brain mitochondrial energy production, and oxygen superoxide. HPHPA, a short chain phenyl compound, may have additional biochemical effects on the brain in autism, causing a reduction in free CoASH needed to produce the CoA palmitic acid derivative necessary to activate the key brain developmental protein sonic hedgehog. The depletion of CoASH appears to be a new therapeutic target to reverse the adverse effects of the HPHPA metabolite on the beta oxidation of fatty acids and cholesterol synthesis that are prevalent in autism. CONCLUSIONS: Variations in the severity of autism could be based on the types and concentrations of the Clostridia markers produced and the extent to which these markers, such as HPHPA, have depleted critical lipids, such as cholesterol and CoA palmitic acid derivative. Patients need those lipids for the activation of the developmental protein sonic hedgehog. In addition, the sequestration of coenzyme A by short chain adducts of Clostridia leads to the depletion of critical free CoASH, needed throughout intermediary metabolism, and creates a biochemical storm that especially affects brain function.

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32. Shieh M, Amkraut K, Spiridigliozzi GA, Adayev T, Nicholson K, McConkie-Rosell A, McDonald M, Pennington M, Sebastian S, Lachiewicz AM. High performing male with fragile X syndrome with an unmethylated FMR1 full mutation: The relevance of clinical and genetic correlations. Clinical case reports. 2023; 11(6): e7371.

A high performing male with an unmethylated full mutation in the fragile X messenger ribonucleoprotein 1 (FMR1) gene surpassed our expectations into young adulthood. Although initial genetic findings helped make a correct fragile X syndrome (FXS) determination, the report was insufficient. Ten years later, we repeated and conducted additional genetic and clinical studies to determine whether more information could assist with treatment and counseling. The genetic findings were very consistent with his high functioning and would have enabled us to be more confident about a good developmental outcome had they been available previously. As FXS enters the mainstream of well-understood genetic disorders and technological advancements improve genetic tests, it should be clearer to clinical providers what a full FXS assessment could include to provide high quality information for care. For individuals with FXS who are high functioning, their families and clinical professionals would benefit from knowing more genetic findings, including, most importantly, methylation status, but also the FMR1 protein (FMRP) level and mRNA level. While we now know that obtaining only the CGG repeat number is not always adequate to inform accurate clinical care, future studies are likely to show the benefit of studying other biomarkers, such as mRNA levels.

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33. Soltiyeva A, Oliveira W, Madina A, Adilkhan S, Urmanov M, Hamari J. My Lovely Granny’s Farm: An immersive virtual reality training system for children with autism spectrum disorder. Education and information technologies. 2023: 1-21.

One of the biggest difficulties faced by children with Autism Spectrum Disorder during their learning process and general life, is communication and social interaction. In recent years, researchers and practitioners have invested in different approaches to improving aspects of their communication and learning. However, there is still no consolidated approach and the community is still looking for new approaches that can meet this need. Addressing this challenge, in this article we propose a novelty approach (i.e., an Adaptive Immersive Virtual Reality Training System), aiming to enrich social interaction and communication skills for children with Autism Spectrum Disorder. In this adaptive system (called My Lovely Granny’s Farm), the behavior of the virtual trainer changes depending on the mood and actions of the users (i.e., patients/learners). Additionally, we conducted an initial observational study by monitoring the behavior of children with autism in a virtual environment. In the initial study, the system was offered to users with a high degree of interactivity so that they might practice various social situations in a safe and controlled environment. The results demonstrate that the use of the system can allow patients who needed treatment to receive therapy without leaving home. Our approach is the first experience of treating children with autism in Kazakhstan and can contribute to improving the communication and social interaction of children with Autism Spectrum Disorder. We contribute to the community of educational technologies and mental health by providing a system that can improve communication among children with autism and providing insights on how to design this kind of system.

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34. Tomczak MT, Kulikowski K. Toward an understanding of occupational burnout among employees with autism – the Job Demands-Resources theory perspective. Current psychology (New Brunswick, NJ). 2023: 1-13.

This article aims to gain insight into the phenomenon of occupational burnout among employees with autism based on the theoretical framework of the Job Demands-Resources theory and the literature on employees with autism in the workplace. Firstly, we argue that although the resources and demands of the neurotypical and neurodivergent employees might be different, the theoretical mechanism of occupational burnout formation remains similar among the neurotypical and neurodivergent employees, leading to the similar burnout experience. Next, we distinguish key demands that might drain neurodiverse employees’ energy, and spark burnout, and propose a set of resources that might foster their achievement of work goals and mitigate demanding working conditions. We emphasise that the nature of job demands/resources that may cause burnout is not universal but might depend on how employees evaluate them, thus neurotypical and neurodiverse workers who evaluate the same work characteristics differently might complement each other, increasing organisational diversity without losing productivity. Our conceptual elaboration contributes to the theory and practice of healthier workplaces by providing tools and inspiration to managers, policymakers, and all stakeholders interested in creating a diverse and productive workplace. Moreover, our work might spark a much needed debate on occupational burnout among employees with autism and encourage conducting further empirical studies.

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35. Unholz-Bowden EK, Girtler SN, Shipchandler A, Kolb RL, McComas JJ. Use of Augmentative and Alternative Communication by Individuals with Rett Syndrome Part 2: High-Tech and Low-Tech Modalities. Journal of developmental and physical disabilities. 2023: 1-21.

The vast majority of individuals with Rett syndrome do not utilize natural speech and therefore require alternative and augmentative communication (AAC). The purpose of the current study was to investigate the use of high- and low-tech AAC modalities by three individuals with Rett syndrome given similar instruction for using both modalities. For all participants, the number of sessions to criterion and cumulative number of trials with independent requests during simultaneous or alternating instruction in the use of a high- and low-tech AAC modality were investigated. Parents conducted all sessions with remote coaching from a research assistant via telecommunication. Each participant exhibited idiosyncratic response patterns in terms of use of their high- and low-tech AAC modalities during instruction but ultimately demonstrated the ability to use both modalities to make requests. Implications for future research and practice pertaining to AAC of individuals with complex communication needs are discussed. This paper is a companion to Girtler et al. (2023).

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36. Wang X, Sun Z, Yang T, Lin F, Ye S, Yan J, Li T, Chen J. Sodium butyrate facilitates CRHR2 expression to alleviate HPA axis hyperactivity in autism-like rats induced by prenatal lipopolysaccharides through histone deacetylase inhibition. mSystems. 2023: e0041523.

Short-chain fatty acids (SCFAs, especially butyric acid) have been demonstrated to play a promising role in the development of autism spectrum disorders (ASD). Recently, the hypothalamic-pituitary-adrenal (HPA) axis is also suggested to increase the risk of ASD. However, the mechanism underlying SCFAs and HPA axis in ASD development remains unknown. Here, we show that children with ASD exhibited lower SCFA concentrations and higher cortisol levels, which were recaptured in prenatal lipopolysaccharide (LPS)-exposed rat model of ASD. These offspring also showed decreased SCFA-producing bacteria and histone acetylation activity as well as impaired corticotropin-releasing hormone receptor 2 (CRHR2) expression. Sodium butyrate (NaB), which can act as histone deacetylases inhibitors, significantly increased histone acetylation at the CRHR2 promoter in vitro and normalized the corticosterone as well as CRHR2 expression level in vivo. Behavioral assays indicated ameliorative effects of NaB on anxiety and social deficit in LPS-exposed offspring. Our results imply that NaB treatment can improve ASD-like symptoms via epigenetic regulation of the HPA axis in offspring; thus, it may provide new insight into the SCFA treatment of neurodevelopmental disorders like ASD. IMPORTANCE Growing evidence suggests that microbiota can affect brain function and behavior through the « microbiome-gut-brain » axis, but its mechanism remains poorly understood. Here, we show that both children with autism and LPS-exposed rat model of autism exhibited lower SCFA concentrations and overactivation of HPA axis. SCFA-producing bacteria, Lactobacillus, might be the key differential microbiota between the control and LPS-exposed offspring. Interestingly, NaB treatment contributed to the regulation of HPA axis (such as corticosterone as well as CRHR2) and improvement of anxiety and social deficit behaviors in LPS-exposed offspring. The potential underlying mechanism of the ameliorative effect of NaB may be mediated via increasing histone acetylation to the CRHR2 promoter. These results enhance our understanding of the relationship between the SCFAs and the HPA axis in the development of ASD. And gut microbiota-derived SCFAs may serve as a potential therapeutic agent to neurodevelopmental disorders like ASD.

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37. Wang Y, Long H, Zhou Q, Bo T, Zheng J. PLSNet: Position-aware GCN-based autism spectrum disorder diagnosis via FC learning and ROIs sifting. Computers in biology and medicine. 2023; 163: 107184.

Brain function connectivity, derived from functional magnetic resonance imaging (fMRI), has enjoyed high popularity in the studies of Autism Spectrum Disorder (ASD) diagnosis. Albeit rapid progress has been made, most studies still suffer from several knotty issues: (1) the hardship of modeling the sophisticated brain neuronal connectivity; (2) the mismatch of identically graph node setup to the variations of different brain regions; (3) the dimensionality explosion resulted from excessive voxels in each fMRI sample; (4) the poor interpretability giving rise to unpersuasive diagnosis. To ameliorate these issues, we propose a position-aware graph-convolution-network-based model, namely PLSNet, with superior accuracy and compelling built-in interpretability for ASD diagnosis. Specifically, a time-series encoder is designed for context-rich feature extraction, followed by a function connectivity generator to model the correlation with long range dependencies. In addition, to discriminate the brain nodes with different locations, the position embedding technique is adopted, giving a unique identity to each graph region. We then embed a rarefying method to sift the salient nodes during message diffusion, which would also benefit the reduction of the dimensionality complexity. Extensive experiments conducted on Autism Brain Imaging Data Exchange demonstrate that our PLSNet achieves state-of-the-art performance. Notably, on CC200 atlas, PLSNet reaches an accuracy of 76.4% and a specificity of 78.6%, overwhelming the previous state-of-the-art with 2.5% and 6.5% under five-fold cross-validation policy. Moreover, the most salient brain regions predicted by PLSNet are closely consistent with the theoretical knowledge in the medical domain, providing potential biomarkers for ASD clinical diagnosis. Our code is available at https://github.com/CodeGoat24/PLSNet.

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38. Zhang R, Cheng G, Wu L. Influence of instructor’s facial expressions in video lectures on motor learning in children with autism spectrum disorder. Education and information technologies. 2023: 1-14.

During the COVID-19 pandemic, video materials have played crucial roles in supporting learning among children with autism spectrum disorder (ASD). This study aimed to explore the effects of the instructor’s facial expressions in video lectures on attention and motor learning in children with ASD versus typically developing (TD) children. A total of 60 children were randomly assigned to four groups: (1) ASD-happy, (2) ASD-neutral, (3) TD-happy, and (4) TD-neutral. Both happy groups paid more attention to the video lectures. The ASD groups achieved higher accuracy and fidelity of motor learning when the instructor smiled. Results revealed that greater attention to video lectures predicted better performance in children with ASD. This study has practical implications for the design of learning materials for children with ASD: An instructor should be encouraged to show a happy expression to promote learning.

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39. Zhen Lim TX, Pickering TA, Lee RH, Hauptman I, Wilson ML. Hypertensive disorders of pregnancy and occurrence of ADHD, ASD, and epilepsy in the child: A meta-analysis. Pregnancy hypertension. 2023; 33: 22-9.

AIM: To synthesize epidemiologic literature pertaining to the association between preeclampsia (PE), attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and epilepsy. METHOD: A systematic search of PubMed and Embase was performed supplemented by hand-searching of reference lists of eligible studies. Two independent reviewers screened abstracts following a prepared protocol. Data extraction and quality appraisal using the Newcastle Ottawa Scale were performed by an independent reviewer. PRISMA guidelines were followed throughout. Random-effects meta-analyses were performed. Adjusted pooled Odds Ratios and their 95% confidence intervals were reported. RESULTS: Fifteen out of 121 identified studies were eligible for inclusion. Six reported adjusted estimates for ADHD, resulting in a pooled odds ratio of 1.29 (95% CI: 1.20, 1.38). Eight reported adjusted estimates for ASD, resulting in a pooled odds ratio of 1.27 (95% CI:1.22, 1.32). Three reported adjusted estimates for epilepsy, resulting in a pooled odds ratio of 1.35 (95% CI: 1.12, 1.63). INTERPRETATION: Intrauterine exposure to PE increased the risk of ADHD, ASD, and epilepsy, though it is unclear whether the true association is with pre-term birth. To our knowledge, this is the first meta-analysis to quantify the association between PE and epilepsy. The results of this meta-analysis can inform screening strategies among children born to preeclamptic mothers for early identification and treatment.

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