1. Bennewith C, Bellali J, Watkins L, Tromans S, Bhui K, Shankar R. Sublime and extended reality experiences to enhance emotional wellbeing for autistic people: A state of the art review and narrative synthesis. Int J Soc Psychiatry;2024 (Jul 24):207640241261172.

BACKGROUND: Sublime is a centuries old concept of emergent experience arising from immense and threatening awareness provoked by overwhelming fear and dread when faced with an incomprehensible situation as is common to autistic people. Extended Reality (XR) technologies have been used since the mid-1990s, in regulating emotions, behaviour and supporting social skill development for autistic people. AIMS: To understand utility of XR technologies in creating immersive experiences for autistic people to alleviate anxiety and the relationship to the sublime. METHOD: A State of the Art literature review and narrative synthesis was conducted. PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, Web of Science were searched with terms Autism AND Technology. In addition, fields of digital technologies and wellbeing, digital art and mental health, generative arts and the sublime were explored through web searches of grey literature, conversations with digital designers and explorations of extended reality platforms. No time limits were placed. Searches were done in English. Papers were screened and shortlisted using the inclusion criteria applied by two reviewers. RESULTS: Fifty-eight papers/articles met the preliminary inclusion criteria for in-depth review of which 31 were found suitable for the narrative synthesis related to XR technologies and sublime experiences as related to autistic people. Narrative synthesis lent itself to four themes that is current utility of XR Technologies in autism, the impact of immersive experiences on Behavioural, phenomenological and biological markers of autistic people, the Benefits of increased sensory stimulation using XR on autism and an inquiry into the potential of the sublime for autism. CONCLUSIONS: Mixed reality environments that experiment with a broad range of XR technologies including incorporating notions of the sublime, might be beneficial in reducing emotional dysregulation and improving social development in autistic people especially if co-designed with them.

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2. Blackhurst T, Warmelink L, Roestorf A, Hartley C. The Brunswik Lens Model: a theoretical framework for advancing understanding of deceptive communication in autism. Front Psychol;2024;15:1388726.

Due to differences in social communication and cognitive functioning, autistic adults may have greater difficulty engaging in and detecting deception compared to neurotypical adults. Consequently, autistic adults may experience strained social relationships or face increased risk of victimization. It is therefore crucial that research investigates the psychological mechanisms that are responsible for autistic adults’ difficulties in the deception process in order to inform interventions required to reduce risk. However, weaknesses of extant research exploring deception in autism include a heavy focus on children and limited theoretical exploration of underlying psychological mechanisms. To address these weaknesses, this review aims to introduce a system-level theoretical framework to the study of deception in autistic adulthood: The Brunswik Lens Model of Deception. Here, we provide a comprehensive account of how autism may influence all processes involved in deception, including: Choosing to Lie (1), Producing Deception Cues (2), Perceiving Deception Cues (3), and Making the Veracity Decision (4). This review also offers evidence-based, theoretical predictions and testable hypotheses concerning how autistic and neurotypical adults’ behavior may differ at each stage in the deception process. The call to organize future research in relation to a joint theoretical perspective will encourage the field to make substantive, theoretically motivated progress toward the development of a comprehensive model of deception in autistic adulthood. Moreover, the utilization of the Brunswik Lens Model of Deception in future autism research may assist in the development of interventions to help protect autistic adults against manipulation and victimization.

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3. Brede J, Babb C, Jones CRG, Serpell L, Hull L, Adamson J, Baker H, Fox JRE, Mandy W. The clinical characteristics of autistic women with restrictive eating disorders. BJPsych Open;2024 (Jul 26);10(4):e131.

BACKGROUND: Autistic women are at high risk of developing restrictive eating disorders (REDs), such as anorexia nervosa. AIMS: This study provides an overview of the clinical characteristics of autistic women with REDs to (i) enhance understanding of increased risk, and (ii) support the identification of autistic women in eating disorder services. METHOD: We compared self-reported autistic and disordered eating characteristics of: autistic participants with REDs (Autism + REDs; n = 57); autistic participants without REDs (Autism; n = 69); and women with REDs who are not autistic (REDs; n = 80). We also included a group of women with high autistic traits (HATs) and REDs, but no formal autism diagnosis (HATs + REDs; n = 38). RESULTS: Autism + REDs participants scored similarly to Autism participants in terms of autistic characteristics and to REDs participants in terms of experiencing traditional disordered eating symptoms. Autism + REDs participants were distinguished from both groups by having more restricted and repetitive behaviours and autism-specific eating behaviours related to sensory processing, flexibility and social differences. HATs + REDs participants showed a similar pattern of scores to Autism + REDs participants, and both also presented with high levels of co-occurring mental health difficulties, particularly social anxiety. CONCLUSION: The presentation of autistic women with REDs is complex, including both traditional disordered eating symptoms and autism-related needs, as well as high levels of co-occurring mental health difficulties. In eating disorder services, the REDs presentation of autistic women and those with HATs should be formulated with reference to autism-specific eating behaviours and co-occurring difficulties. Treatment adaptations should be offered to accommodate autistic characteristics and related needs.

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4. Buxbaum Grice AS, Sloofman L, Levy T, Walker H, Ganesh G, Rodriguez de Los Santos M, Amini P, Buxbaum JD, Kolevzon A, Kostic A, Breen MS. Transient peripheral blood transcriptomic response to ketamine treatment in children with ADNP syndrome. Transl Psychiatry;2024 (Jul 25);14(1):307.

Activity-dependent neuroprotective protein (ADNP) syndrome is a rare neurodevelopmental disorder resulting in intellectual disability, developmental delay and autism spectrum disorder (ASD) and is due to mutations in the ADNP gene. Ketamine treatment has emerged as a promising therapeutic option for ADNP syndrome, showing safety and apparent behavioral improvements in a first open label study. However, the molecular perturbations induced by ketamine remain poorly understood. Here, we investigated the longitudinal effect of ketamine on the blood transcriptome of 10 individuals with ADNP syndrome. Transcriptomic profiling was performed before and at multiple time points after a single low-dose intravenous ketamine infusion (0.5 mg/kg). We show that ketamine triggers immediate and profound gene expression alterations, with specific enrichment of monocyte-related expression patterns. These acute alterations encompass diverse signaling pathways and co-expression networks, implicating upregulation of immune and inflammatory-related processes and down-regulation of RNA processing mechanisms and metabolism. Notably, these changes exhibit a transient nature, returning to baseline levels 24 hours to 1 week after treatment. These findings enhance our understanding of ketamine’s molecular effects and lay the groundwork for further research elucidating its specific cellular and molecular targets. Moreover, they contribute to the development of therapeutic strategies for ADNP syndrome and potentially, ASD more broadly.

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5. Chang Y, He B, DeMaranville J, Wongpakaran N, Wedding D, Wongpakaran T. Psychometric Properties of the Chinese Version of the Core Symptom Index: A Study among Chinese Parents of Children with Autistic Spectrum Disorders. Eur J Investig Health Psychol Educ;2024 (Jun 26);14(7):1902-1912.

(1) Background: Parents of children with autism spectrum disorders often experience psychological distress, which can affect the quality of childcare they provide. It is crucial to screen for psychiatric symptoms among these parents. The core symptom index (CSI) is a widely recognized tool used to assess general symptoms, including depression, anxiety, and somatic issues. It has proven validity and reliability across diverse Thai populations. Given the cultural similarities between Thai and Chinese populations, the CSI has been successfully implemented within the Chinese population. Nevertheless, it is crucial to research its validity and reliability in the general Chinese population. This study aimed to investigate the psychometric properties of the Chinese version of the CSI among parents of children with autism spectrum disorders using confirmatory factor analysis (CFA). (2) Methods: A total of 794 Chinese parents raising children with autism participated in this study. All completed the CSI, along with the social inhibition subscale of the Interpersonal Problems Inventory and the Couple Satisfaction Index. Factorial validity was assessed using CFA to determine how well the bifactor three-factor model fits the data. Various structural models were compared using model fit indices. Convergent and discriminant validity were examined by exploring correlations with the social inhibition subscale and the Couple Satisfaction Index. Invariance testing of the CSI was conducted across multiple groups based on gender, age, and education using CFA. The reliability of the CSI was evaluated using McDonald’s omega coefficients. (3) Results: The bifactor model emerged as the best-fitting model for the data, suggesting that the total score of the CSI adequately represents overall psychiatric symptoms. The CSI exhibited significant correlations with the social inhibition subscale (r = 0.41, p < 0.01) and smaller correlation coefficients with the Couple Satisfaction Index (r = -0.16, p < 0.05), indicating both convergent and discriminant validity. The invariant test results support scalar invariance levels based on gender and age but only partial invariance for education. The Chinese version of the CSI demonstrated high consistency, with McDonald's omega coefficients ranging between 0.86 and 0.95. (4) Conclusions: The bifactor model of the Chinese version of the CSI is validated, making it a suitable tool for measuring depression, anxiety, and somatization symptoms among parent(s) of children with autism spectrum disorders. Further research on other Chinese populations is encouraged.

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6. Como DH, Goodfellow M, Hudak D, Cermak SA. « A scoping review: Social stories supporting behavior change for individuals with Autism ». J Occup Ther Sch Early Interv;2024;17(1):154-175.

Social Stories (also known as social narratives) help individuals participate in and understand social situations. This scoping review identifies and synthesizes social narrative research targeting behavior change in individuals with ASD. Using the following questions as a guide: (a) What is the scope of social narrative interventions used for individuals with ASD, (b) What behavior change outcome measures are evaluated, and (c) What research designs are used; five databases were searched from 2007-to-2018. Fifty-six articles met the criteria. Primary outcomes were sorted into two macro-categories: Reduce Disruptive Behaviors and Increase Desired Behaviors. Most, but not all, studies were found to be effective for various behaviors such as aggressive actions, verbal protests, identifying emotions, executive functioning, following directions, and responding in social situations. Social narratives can be used to promote skills/behaviors in individuals with ASD to enable participation, an important goal in occupational therapy practice. They are an accessible and feasible intervention that can be implemented in various settings for behaviors including activities of daily living, social skills, independence, and self-regulation. Most research reviewed the single subject design, which is a limitation of the research as it makes results difficult to generalize. However, through replication, functional relationships can be determined. Additional research utilizing randomized control trials is recommended.

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7. Cotrina-Vinagre FJ, Rodríguez-García ME, Pozo-Filíu LD, Quijada-Fraile P, Martínez-Azorín F. Expanding the genetic and phenotypic spectrum of Baker-Gordon syndrome: a new de novo SYT1 variant. J Genet;2024;103

We report the case of a Spanish pediatric patient with developmental delay, hypotonia, feeding difficulties, visual problems, and hyperkinetic movements. Whole-exome sequencing uncovered a new heterozygous de novo Synaptotagmin 1 (SYT1) missense variant, NM_005639.3:c.930T>A (p.Asp310Glu), in a female proband. This gene encodes the synaptotagmin-1 (SYT1) protein, which is a component of a protein complex involved in the fusion of synaptic vesicles with the presynaptic membrane. Pathogenic SYT1 variants have been associated with Baker-Gordon syndrome (BAGOS), an autosomal dominant neurodevelopmental disorder. Although up to 30 cases have been identified worldwide, to the best of our knowledge, this is the first patient described with mitochondrial respiratory chain deficiencies and rod-cone dysfunction. In conclusion, our data expand both the genetic and phenotypic spectrum associated with SYT1 variants.

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8. David A, Stolar O, Berkovitch M, Kohn E, Hazan A, Waissengreen D, Gal E. Effects of Medical Cannabis Treatment for Autistic Children on Anxiety and Restricted and Repetitive Behaviors and Interests: An Open-Label Study. Cannabis Cannabinoid Res;2024 (Jul 24)

Background: The literature supports the benefits of medical cannabis for core and comorbid symptoms in autistic individuals and anxiety-related symptoms in individuals without autism. However, no study has specifically investigated how cannabidiol (CBD)-rich cannabis affects anxiety subtypes in autistic children or its relationship with restricted and repetitive behaviors and interests (RRBI). Understanding the effects of CBD-rich cannabis treatment on anxiety subtypes and RRBI could offer more precise treatment approaches to managing anxiety symptoms and reducing RRBI frequency in autistic children. Objectives: To examine (1) the impact of CBD-rich cannabis treatment on autistic children’s (1a) anxiety levels and subtypes and (1 b) RRBI and subtypes and (2) whether changes in anxiety explain changes in RRBI following cannabis treatment. Method: In this open-label study, we analyzed data from 65 autistic children (5-12 years) who had participated in research on the effects of CBD-rich cannabis on children with autism. Their parents completed the Repetitive Behavior Scale-revised to assess the frequency and severity of six subgroups of their children’s recurrent behaviors and the Screen for Child Anxiety-Related Emotional Disorders for symptoms related to five types of anxiety disorders. They completed these assessments at three time points: (T1) before treatment, (T2) after 3 months, and (T3) after 6 months of treatment. Results: The results indicated reduced RRBI and symptoms related to various anxiety subtypes in autistic children following 6 months of CBD-rich cannabis treatment. Specifically, we observed significant differences in the autistic children’s overall anxiety and in some anxiety subtypes (i.e., general, social, panic, and separation anxieties). Significant improvements were observed in RRBI, including the total score, and specifically in compulsive, ritualistic, and sameness behaviors. Our findings revealed that reduced anxiety, particularly within the panic- and separation-related subtypes, predicted a subsequent decrease in RRBI, specifically sameness behaviors, following cannabis treatment. Conclusions: The findings of the cannabis treatment’s potential benefits for alleviating anxiety symptoms, leading to reduced RRBI, may provide evidence for the meaningful relationship between these variables and for the potential benefits of cannabis treatment for autistic children. We strongly recommend further double-blind, placebo-controlled studies using standardized assessments to validate these findings.

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9. Fields VL, Tian LH, Wiggins LD, Soke GN, Overwyk K, Moody E, Reyes N, Shapira SK, Schieve LA. Prevalence of Developmental, Psychiatric, and Neurologic Conditions in Older Siblings of Children with and without Autism Spectrum Disorder: Study to Explore Early Development. J Autism Dev Disord;2024 (Jul 25)

This study evaluated developmental, psychiatric, and neurologic conditions among older siblings of children with and without autism spectrum disorder (ASD) to understand the extent of familial clustering of these diagnoses. Using data from the Study to Explore Early Development, a large multi-site case-control study, the analyses included 2,963 children aged 2-5 years with ASD, other developmental disabilities (DD group), and a population-based control group (POP). Percentages of index children with older siblings with select developmental, psychiatric, and neurologic conditions were estimated and compared across index child study groups using chi-square tests and multivariable modified Poisson regression. In adjusted analyses, children in the ASD group were significantly more likely than children in the POP group to have one or more older siblings with ASD, developmental delay, attention-deficit/hyperactivity disorder, intellectual disability, sensory integration disorder (SID), speech/language delays, or a psychiatric diagnosis (adjusted prevalence ratio [aPR] range: 1.4-3.7). Children in the DD group were significantly more likely than children in the POP group to have an older sibling with most of the aforementioned conditions, except for intellectual disability and psychiatric diagnosis (aPR range: 1.4-2.2). Children in the ASD group were significantly more likely than children in the DD group to have one or more older siblings with ASD, developmental delay, SID, or a psychiatric diagnosis (aPR range: 1.4-1.9). These findings suggest that developmental disorders cluster in families. Increased monitoring and screening for ASD and other DDs may be warranted when an older sibling has a DD diagnosis or symptoms.

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10. Fletcher-Watson S. Reporting participatory methods and author positionality in autism. Autism;2024 (Jul 25):13623613241266950.

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11. Floríndez LI, Como DH, Law E, Tran CF, Johnson R, Polido JC, Cermak SA, Stein Duker LI. Oral care interventions for autistic individuals: A systematic review. Autism;2024 (Jul 26):13623613241260171.

Oral care-related challenges are well documented in the autistic community; dental care remains one of the most prevalent unmet health needs among autistic individuals. This review examined interventions designed to improve oral health in autistic individuals from children and adult populations. Through a systematic process, 36 studies were identified. These studies focused on improving home-based oral care skills and routines and reducing fear, anxiety, and/or negative behaviors in the dental clinic. Studies incorporated different types of techniques for facilitating oral care practice, including preparatory interventions to support home-based hygiene activities or improve an approaching dental encounter (n = 29), most often using visual aids, and/or strategies to manage behavioral difficulties exhibited in the dental office (n = 17). Some studies used both approaches (n = 10), combining visual aids prior to a visit with behavior management. Using an evidence-based rubric, we reviewed the methodological quality of the studies and found that most were only « adequate » (n = 8) or « weak » (n = 23) in reporting their evidence. This review has two key findings: (1) there is support for preparatory home-based visual interventions to improve toothbrushing and/or ready patients for dental visits; and (2) distraction or sensory-reducing interventions may also improve experiences in the dental clinic. Only one study purposefully recruited autistic adults, and no studies included intervention elements tailored to race/ethnicity, culture, and/or socioeconomic status. This review highlights the need for more studies investigating the impact of oral care-related interventions for autistic individuals of all ages and identifies a gap in interventions for autistic adults and those from minoritized populations.

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12. Glass D, Yuill N. Evidence of mutual non-verbal synchrony in learners with severe learning disability and autism, and their support workers: a motion energy analysis study. Front Integr Neurosci;2024;18:1353966.

INTRODUCTION: Some research indicates that neurodivergent people are less likely than « neurotypical » people to adapt their movements to a partner’s movements to facilitate interpersonal motor synchrony. Researchers therefore suggest synchrony deficits underlie the social differences associated with autism and other neurodivergences. Intensive Interaction (II) is a client-led approach, where Learning Support Workers (LSW) follow the lead of learners to create balanced and reciprocal interactions. METHODS: We aimed to examine the balance of synchrony in learners with autism and Severe Learning Disabilities and their LSWs in a special education college where learners had prior experience with II. Using Motion Energy Analysis, we assessed the degree to which each partner acted as a leader, and hence which partner acted as a follower, during moments of close synchrony. RESULTS: Overall, learners and LSWs showed higher than chance synchrony. There were no differences in the degree to which each partner led the moments of synchrony, or the amount pairs synchronized with zero-lag, where there was no delay between each partners’ movements. DISCUSSION: The equal balance of leading and following in the learner and LSW pairs demonstrates that both partners consistently adapted their movements to their partner’s movements to facilitate synchrony. The findings tentatively challenge the notion of a synchrony deficit in autism and suggest synchrony can be present in cross-neurotype pairs in comfortable and engaging conditions. We discuss the potential for client-led, movement-based approaches to support smooth interactions across neurotypes.

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13. Green CC, Smith J, Bent CA, Chetcuti L, Uljarević M, Benson PR, Hudry K. Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers. J Autism Dev Disord;2024 (Jul 26)

Parenting is a rewarding experience but is not without its challenges. Parents of Autistic children face additional challenges, and as a result can experience lower levels of wellbeing and more mental health problems (i.e., depression, anxiety, stress). Previous studies have identified concurrent correlates of wellbeing and mental health. However, few have investigated predictors of subsequent wellbeing and mental health, or of change over time, among parents of pre-school aged autistic children. We examined child-, parent-, and family/sociodemographic factors associated with change in parents’ mental health and wellbeing across three timepoints (spanning approximately one year) among 53 parents of Autistic pre-schoolers (M = 35.48, SD = 6.36 months. At each timepoint, parents reported lower wellbeing and greater mental health difficulties compared to normative data. There was no significant group-level change over time in parent outcomes. However, individual variability in short-term (~ 5 months) wellbeing and mental health change was predicted by a combination of child- and parent-related factors, while variability in medium-term (~ 10 months) change was predicted by parent factors alone. Parents’ description of their child and their relationship predicted change in both wellbeing and mental health. Furthermore, participating in a parent-mediated intervention (available to a subgroup) was a significant predictor of change in wellbeing. Our findings highlight potentially modifiable factors (e.g., learning healthier coping strategies) that may positively impact both short- and medium-term change in parental outcomes.

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14. Guerra M, Medici V, La Sala G, Farini D. Unravelling the Cerebellar Involvement in Autism Spectrum Disorders: Insights into Genetic Mechanisms and Developmental Pathways. Cells;2024 (Jul 10);13(14)

Autism spectrum disorders (ASDs) are complex neurodevelopmental conditions characterized by deficits in social interaction and communication, as well as repetitive behaviors. Although the etiology of ASD is multifactorial, with both genetic and environmental factors contributing to its development, a strong genetic basis is widely recognized. Recent research has identified numerous genetic mutations and genomic rearrangements associated with ASD-characterizing genes involved in brain development. Alterations in developmental programs are particularly harmful during critical periods of brain development. Notably, studies have indicated that genetic disruptions occurring during the second trimester of pregnancy affect cortical development, while disturbances in the perinatal and early postnatal period affect cerebellar development. The developmental defects must be viewed in the context of the role of the cerebellum in cognitive processes, which is now well established. The present review emphasizes the genetic complexity and neuropathological mechanisms underlying ASD and aims to provide insights into the cerebellar involvement in the disorder, focusing on recent advances in the molecular landscape governing its development in humans. Furthermore, we highlight when and in which cerebellar neurons the ASD-associated genes may play a role in the development of cortico-cerebellar circuits. Finally, we discuss improvements in protocols for generating cerebellar organoids to recapitulate the long period of development and maturation of this organ. These models, if generated from patient-induced pluripotent stem cells (iPSC), could provide a valuable approach to elucidate the contribution of defective genes to ASD pathology and inform diagnostic and therapeutic strategies.

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15. Gülbetekin E, Kardaş Özdemir F, Aşut G. The mediator role of parenting stress in the effect of stigmatization on burnout in parents of children with autism: A structural equality model. J Pediatr Nurs;2024 (Jul 24)

PURPOSE: The purpose of this study was to report on the mediator role of parenting stress in the effect of stigmatization on burnout in parents of children with autism. DESIGN AND METHODS: A descriptive and correlational research design was used in this study. The sample consisted of 146 parents who had children diagnosed with autism spectrum disorder and volunteered to participate in the study. A « Personal Information Form », the « Parents’ Internalized Stigma of Mental Illness Scale », the « Parenting Stress Scale », and the « Parental Burnout Assessment » were used for data collection. RESULTS: In the study, it was observed that the feeling of stigmatization increased as the education level increased and that variables such as the ages of the parent and the child and an increase in the number of children requiring care also affected the feeling of stigmatization. Parenting stress was found to have a « partial mediator » role in the effect of stigmatization on parental burnout. CONCLUSION: Our findings emphasized the heterogeneous correlation between stigmatization, burnout, and stress levels of parents of children with autism. PRACTICE IMPLICATIONS: This study has key implications for pediatric nursing practices. Pediatric nurses can educate the community about autism, what issues should be considered, and how to support parents. Furthermore, nurses can introduce parents who have children with autism to each other and direct them to parent-child activities that can regulate their moods.

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16. Hosseini SJ, Ramezani M, Ashrafzadeh F, Jamali J. Motivation in caregiving among mothers of children with intellectual and developmental disabilities in Iran: A qualitative study. BMC Pediatr;2024 (Jul 25);24(1):472.

BACKGROUND: The motivation of caregivers plays a crucial role in the treatment, follow-up, and care of children with intellectual and developmental disabilities. Previous studies have focused on the older people and end-stage diseases, while giving less attention to the motivation of mothers caring for children with special needs. This study aimed to explore the motivations of mothers caring for children with intellectual and developmental disabilities in Iran. METHODS: This study employed a qualitative approach, guided by the Self-Determination Theory. Purposeful sampling was initially used, followed by theoretical sampling until data saturation was achieved. Data were collected through semi-structured interviews with 26 mothers of children with intellectual and developmental disabilities. Mayring’s seven-step directed content analysis approach was utilized for coding and categorization. The research adhered to ethical standards and ensured data trustworthiness through credibility, dependability, confirmability, and transferability measures. RESULTS: The findings revealed that mothers’ caregiving motivations could be classified into four main categories: (I) intrinsic, (II) identified-extrinsic, (III) introjected-extrinsic, and (IV) external-extrinsic. Additionally, twelve sub-categories were identified within these four main categories. CONCLUSION: The findings revealed that mothers demonstrated varying levels of intrinsic and extrinsic motivations in caring for children with intellectual and developmental disabilities. By recognizing and enhancing the diverse sources of motivation, healthcare providers and policymakers can better support mothers in their caregiving roles, ultimately contributing to improved outcomes for both the mothers and their children.

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17. Kim SA. The long-lasting benefits of pre-kindergarten education on autistic children’s working memory development. Autism;2024 (Jul 26):13623613241265996.

Working memory is an important skill for school success, and it involves holding information in our memory while using it to solve complex problems. However, autistic children often have difficulties with working memory tasks. Also, kindergarteners on the autism spectrum tend to be less school-ready compared with their peers. In addition, children from disadvantaged backgrounds tend to struggle more with working memory and school readiness skills. All preschool-age children on the autism spectrum in the United States are entitled to pre-kindergarten (pre-K) education. However, it is unclear whether attending pre-K helps with children’s working memory development in the long run. This study tested whether attending pre-K benefits children’s working memory development in the long run. It also tested whether pre-K is especially helpful for autistic children’s working memory development. It was found that children who attended pre-K outperformed their peers who did not attend pre-K during the first 2 years of elementary school. However, after first grade, such benefits diminished. Importantly, autistic children who attended pre-K did not demonstrate advanced working memory immediately in kindergarten, but they started to outperform their autistic peers who did not attend pre-K during first grade to third grade. This finding highlights the importance of pre-K education for autistic children in particular. It is also important for educators and parents to understand autistic children’s unique learning paths that may be different from non-autistic children. This article discusses specific ways for educators to take full advantage of the long-lasting benefits of pre-K education in autistic children’s working memory development.

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18. Lee EAL, Milbourn B, Afsharnejad B, Chitty E, Jannings AM, Kealy R, McWhirter T, Girdler S. ‘We are all bringing, like a unique sort of perspective’: The core elements of a strengths-based digital arts mentoring program for autistic adolescents from the perspective of their mentors. Aust Occup Ther J;2024 (Jul 25)

INTRODUCTION: While the adoption of strengths-based approaches to supporting autistic adolescents is growing in popularity, the application of this approach to a digital arts mentoring program has yet to be explored. This study reports on the core elements contributing to the success of a community digital arts mentoring program for autistic adolescents from the mentors’ perspective. This paper presents an in-depth exploration of mentors’ experiences, comprising a component of a broader line of research investigating a digital arts mentoring program for autistic adolescents emphasising positive youth development. METHODS: The digital arts mentoring program spanned 20 weeks across two Australian school terms and was attended by two groups of autistic adolescents (N = 18) aged between 11 and 17 years. A qualitative approach was utilised in exploring the perspective of their mentors (N = 6). Qualitative data were collected at the end of each school term for each group with the mentors using an interpretive phenomenological approach and Colaizzi’s seven-step analysis method. Thirteen individual interviews were conducted with six mentors. CONSUMER AND COMMUNITY INVOLVEMENT: This research was conducted with a disability arts provider to provide a digital arts mentoring program to autistic adolescents. The mentors employed have lived experience with disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety. RESULTS: Five primary themes emerged from the data: positive connections, mentor knowledge and experience, mentoring approaches, autism education, program organisation, resources and environment. Subthemes underpinned the primary themes related to positive connections (three subthemes), mentoring approaches (four subthemes) and program organisation, resources and environment (three subthemes). CONCLUSION: The findings suggest that prior experience, sufficient training, a supportive environment and a flexible and adaptable approach were essential for success. Understanding the core elements of a strengths-based digital arts program in occupational therapy provides a comprehensive framework for utilising clients’ inherent strengths and creativity as therapeutic tool, creating an empowering environment, fostering meaningful outcomes for clients.

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19. Lee KS, Long EL, Catmur C, Hauser TU, Bird G. Information gathering: Dissociable effects of autistic and alexithymic traits in youths aged 6-25 years. Emotion;2024 (Jul 25)

Autistic youths tend to react negatively to uncertain events. Little is known about the cognitive processes associated with this intolerance of uncertainty, most notably the tendency to actively gather information to minimize uncertainty. Past research has relied on self-report measures that may not allow investigation of the multifaceted processes associated with intolerance of uncertainty, including information gathering. Alexithymia (difficulties in identifying and describing one’s own emotions) commonly co-occurs with autistic traits, but its role in information gathering has rarely been considered. Accordingly, 97 typically developing youths (aged 6-25 years) performed an information gathering task in which they were asked to gather information to infer socioemotional (emotional state) and nonsocial (clothing preference) information about another person when information gathering was costly versus not costly. Dimensional autistic traits were associated with more information gathering regardless of costs and information type. Computational modeling suggested this may be because of the delayed emergence of subjective costs of information gathering in high autistic trait individuals, resulting in later guesses. Alexithymia was uniquely associated with inconsistent emotional responses to rewards and losses and to reduced information gathering about emotional states when assessed using parent-report measures. Future validation in youths diagnosed with autism is warranted to test the generalizability of the findings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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20. Leung JW, Loan A, Xu Y, Yang G, Wang J, Chan HM. Reduction of Glyoxalase 1 Expression Links Fetal Methylmercury Exposure to Autism Spectrum Disorder Pathogenesis. Toxics;2024 (Jun 22);12(7)

Glyoxalase 1 (Glo1) is an essential enzyme to detoxify methylglyoxal (MGO), a cytotoxic byproduct of glycolysis. Accumulating studies have shown an important role of Glo1 in regulating cortical development and neurogenesis, potentially contributing to the pathogenesis of autism spectrum disorder (ASD) when impaired. We have previously shown that prenatal exposure to non-apoptotic low-dose methylmercury (MeHg), an environmental pollutant, induces premature cortical neurogenesis and ASD-like behaviors in a rodent model. In this study, we aimed to determine the underlying molecular mechanisms that mediate prenatal MeHg-induced premature neuronal differentiation and abnormal neurodevelopment. Using single-cell RNA sequencing (scRNA-seq) and real-time quantitative PCR (RT-qPCR), we found that prenatal MeHg exposure at a non-apoptotic dose significantly reduced Glo1 gene expression in embryonic cultured radial glia precursors (RGPs). In cultured RGPs, the knockdown of Glo1 expression increased neuronal production at the expense of the cultured RGPs population, while overexpression of Glo1 restored MeHg-induced neuronal differentiation back to normal levels. Furthermore, we found that co-treatment with both MeHg and multiple MGO scavengers or a CREB inhibitor (iCREB) mitigated MeHg-induced premature neuronal differentiation, reinforcing the role of Glo1 and CREB in mediating MeHg-induced neuronal differentiation. Our findings demonstrate a direct link between MeHg exposure and expression of an ASD risk gene Glo1 in cortical development, supporting the important role of gene-environment interaction in contributing to the etiology of neural developmental disorders, such as ASD.

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21. Li C, Wang J, Zhou Y, Li T, Wu B, Yuan X, Li L, Qin R, Liu H, Chen L, Wang X. Sex-related patterns of functional brain networks in children and adolescents with autism spectrum disorder. Autism Res;2024 (Jul);17(7):1344-1355.

Although numerous studies have emphasized the male predominance in autism spectrum disorder (ASD), how sex differences are related to the topological organization of functional networks remains unclear. This study utilized imaging data from 86 ASD (43 females, aged 7-18 years) and 86 typically developing controls (TCs) (43 females, aged 7-18 years) obtained from Autism Brain Imaging Data Exchange databases, constructed individual whole-brain functional networks, used a graph theory analysis to compute topological metrics, and assessed sex-related differences in topological metrics using a 2 × 2 factorial design. At the global level, females with ASD exhibited significantly higher cluster coefficient and local efficiency than female TCs, while no significant difference was observed between males with ASD and male TCs. Meanwhile, the neurotypical sex differences in cluster coefficient and local efficiency observed in TCs were not present in ASD. At the nodal level, ASD exhibited abnormal nodal centrality in the left middle temporal gyrus.

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22. Li S, Zhang N, Li W, Zhang HL, Wang XX. Gastrointestinal problems in a valproic acid-induced rat model of autism: From maternal intestinal health to offspring intestinal function. World J Psychiatry;2024 (Jul 19);14(7):1095-1105.

BACKGROUND: Autism spectrum disorder (ASD) is a developmental disorder characterized by social deficits and repetitive behavior. Gastrointestinal (GI) problems, such as constipation, diarrhea, and inflammatory bowel disease, commonly occur in patients with ASD. Previously, GI problems of ASD patients were attributed to intestinal inflammation and vertical mother-to-infant microbiome transmission. AIM: To explore whether GI problems in ASD are related to maternal intestinal inflammation and gut microbiota abnormalities. METHODS: An ASD rat model was developed using valproic acid (VPA). Enzyme-linked immunosorbent assay and fecal 16S rRNA sequencing were used to test GI changes. RESULTS: VPA exposure during pregnancy led to pathological maternal intestinal changes, resulting in alterations in maternal gut microbiota. Additionally, the levels of inflammatory factors also increased. Moreover, prenatal exposure to VPA resulted in impaired duodenal motility in the offspring as well as increased levels of inflammatory factors. CONCLUSION: GI problems in ASD may be associated with maternal intestinal inflammation and microbiota abnormality. Future research is required to find more evidence on the etiology and treatment of GI problems in ASD.

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23. Linkous O, Soon K, Lee JD, Du A, Shih W, Bearss K, Kasari C, Locke J. Short report: Examining race, ethnicity, sex, and gender among autistic youth and their educators who participated in school-based research. Autism;2024 (Jul 26):13623613241262144.

Schools are the main provider of behavioral health services in the United States (US). Conducting research in schools may help increase access for autistic youth, but there is limited research about who participates in school-based autism research. The researchers examined data spanning 14 years of participation in school-based autism research. All data were collected in the US. Researchers found that in this sample, more than half of the youth identified as racial/ethnic minoritized (REM) youth. However, demographics of sampled youth were significantly different than expected, based on publicly available school-based population demographics. More youth identified as White non-Hispanic than would be expected in those schools. Majority of the sampled educators also identified as White non-Hispanic. High percentages of autistic REM youth suggest school-based autism research may be an effective way of providing services to more diverse populations. However, sampled schools were also not representative of a US national sample, with sampled schools having fewer White non-Hispanic youth than would be expected from US national statistics. Complexity around representation of schools sampled and demographics of service environments suggests a need for more research.

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24. Longmore A, Anagnostou E, Georgiages S, Jones J, Kelley E, Baribeau D. Predictors of Depressive Symptoms in Autistic Youth-A Longitudinal Study From the Province of Ontario Neurodevelopmental Disorders (POND) Network: Prédicteurs des symptômes dépressifs chez les jeunes autistes-une étude longitudinale du Réseau des troubles neurodéveloppementaux de la province de l’Ontario (réseau POND). Can J Psychiatry;2024 (Jul 25):7067437241259925.

OBJECTIVE: The objective of this study was to identify longitudinal predictors of depressive symptoms in autistic children and youth. METHODS: Participants were youth with a diagnosis of autism who were part of the Province of Ontario Neurodevelopmental Disorders Network longitudinal substudy. Depressive symptoms were assessed using the child behaviour checklist (CBCL) affective problems subscale. Univariate and multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between clinical and demographic characteristics at baseline (T1) and clinically elevated depressive symptoms (CEDS) approximately 4 years later (T2). RESULTS: The mean age of participants (n = 75) at T1 was 9.8 years (SD = 2.7) and at T2 was 14.1 years (SD = 2.8). A total of 37% and 35% of participants had CEDS at T1 and T2, respectively. Additionally, 24% of participants had CEDS at both T1 and T2. T1 characteristics associated with T2 CEDS were: loneliness (OR = 3.0, 95% CI, 1.1 to 8.8), self-harm (OR = 4.0, 95% CI, 1.1 to 16.9), suicidal ideation (OR = 3.9, 95% CI, 1.0 to 16.5), more social and adaptive skills (OR = 0.3, 95% CI, 0.1 to 0.9), elevated restricted and repetitive behaviours (OR = 3.8, 95% CI, 1.3 to 11.6), psychotropic medication use (OR = 3.0, 95% CI, 1.1 to 8.4), attention-deficient/hyperactivity disorder (OR = 2.8, 95% CI, 1.1 to 7.8), and T1 CEDS (OR = 8.8, 95% CI, 3.1 to 27.0) (uncorrected for multiple comparisons). Associations persisted after adjusting for age and intelligence quotient (IQ) differences. Age, sex, IQ, teasing/bullying on the CBCL, family psychiatric history and family income were not associated with T2 CEDS. CONCLUSION: Our results highlight both high prevalence and high potential for the persistence of depressive symptoms in autism and emphasize the importance of early support to address loneliness and social participation. Study assessing risk factors for depression in autistic youthPlain Language SummaryObjectiveThe goal of this study was to find risk factors for depression in autistic youth.MethodsThe study included autistic youth who were part of the Province of Ontario Neurodevelopmental Disorders Network. Symptoms of depression were identified using mental health surveys and screening tools completed by parents. We studied 75 youth over two time points, to understand what factors might predict greater depression risk.ResultsThe average age of our study population at the first visit was 10 years old, and 14 years old at the second visit. Our study found that 37% of participants had elevated symptoms of depression at the first visit, and 35% at the second visit. Factors associated with future depressive symptoms included: loneliness, self-harm, suicidal ideation, high levels of restrictive/repetitive behaviours, depressive symptoms at the first visit, and ADHD. Factors that protected against depressive symptoms included high levels of social skills.ConclusionOur results show high levels of depressive symptoms among autistic youth, and the potential for this to persist over time in this population. Our findings emphasize the importance of early supports to address loneliness and social participation. eng

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25. Manley J, Brownlow C, Brömdal A. Supporting the health and wellbeing of trans autistic school-aged youth: a systematic literature review. Int J Transgend Health;2024;25(3):439-455.

Introduction : This systematic literature review (SLR) aims to synthesize available research which examines the supports required for trans autistic school-aged youth to improve their mental health, wellbeing, and quality of life. Current literature highlights the need to support this specific school-aged population, but the research that synthesizes the existing limited research is lacking. This SLR brings together existing literature and highlights recommended inclusive interventions, programs, support mechanisms, and protective factors needed to support and promote optimal mental health and wellbeing. METHODS: This review followed the 2020 PRISMA Guidelines and included JBI quality appraisal tools of included studies. Three electronic databases were used, with literature search conducted on 18 July 2023. Literature, including book chapters, were assessed against predetermined inclusion and exclusion criteria, with included studies written in English, online full-text availability, peer-reviewed, and reported data relevant to research question. Abstract, full-text review, and quality appraisal were conducted by three independent reviewers to ensure rigor. Findings from included studies were synthesized using thematic analysis. RESULTS: Twenty studies were included for final synthesis with five using qualitative methodologies, two case reports, and 13 cross-sectional studies. The final synthesis comprised five themes, indicating therapy should focus on mental health, particularly internalized feelings and emotions that may lead to suicidal ideation without support, whereas interventions should support executive functioning, communication, and socialization. Clinicians should make adaptions to their clinics and practices to support the neurodivergent-related needs of their clients. Schools should work toward having well-articulated and embedded policies supporting gender affirmation and preventing bullying and ostracization to ensure trans autistic youth develop positive health and wellbeing, and overall good quality of life. CONCLUSIONS: In many cases support measures discussed were limited. The complexities of supporting the needs of school-aged trans autistic youth requires further research, specifically focusing on the voices of trans autistic youth.

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26. May D, Kponee-Shovein K, Neul JL, Percy AK, Mahendran M, Downes N, Chen G, Watson T, Pichard DC, Kennedy M, Lefebvre P. Characterizing the journey of Rett syndrome among females in the United States: a real-world evidence study using the Rett syndrome natural history study database. J Neurodev Disord;2024 (Jul 26);16(1):42.

BACKGROUND: With the advent of the first targeted therapy for Rett Syndrome (RTT), a comprehensive assessment of the journey of RTT is needed to elucidate on present unmet needs in this population. This study characterized females with RTT in the United States and their disease journey with respect to longitudinal treatment patterns, RTT-related outcomes, and changes in disease severity. METHODS: This retrospective cohort study used registry data of females with RTT from the 5211 RTT Natural History Study (RNHS) (November 2015-July 2021). Pharmacological and supportive therapy use, RTT-related outcomes, and RTT severity, as measured by the Clinical Severity Scale and Motor Behavioral Assessment scale, were evaluated following the first RNHS visit. Analyses were conducted overall and in subgroups by RTT type (classic and atypical RTT) and age at first visit (pediatric and adult). RESULTS: A total of 455 females with RTT were included in the study, of whom 90.5% had classic RTT and 79.8% were pediatric individuals. Over a median follow-up of 4 years, use of pharmacological therapies, including prokinetic agents (42.7% vs. 28.3%), and supportive therapies, including physical therapy (87.3% vs. 40.2%) and speech-language therapy (86.8% vs. 23.9%), were more common in pediatric than adult individuals (all p < 0.05). Nearly half (44.6%) of all individuals had a hospital or emergency room visit, with a higher proportion of visits in individuals with classic RTT than atypical RTT and pediatric than adult individuals (both p = 0.001). An increasing trend in clinical severity was observed in pediatric individuals (mean change per year: 0.24; 95% confidence interval [CI]: 0.03, 0.44), while an increasing trend in motor-behavioral dysfunction was observed in pediatric individuals (mean change per year: 1.12; 95% CI: 0.63, 1.60) and those with classic RTT (mean change per year: 0.97; 95% CI: 0.53, 1.41). CONCLUSIONS: Findings from this study highlight the considerable burden of RTT across disease subtype and age. Despite reliance on supportive therapies and healthcare encounters, individuals with RTT experience increasing disease severity and motor-behavioral dysfunction in childhood and adolescence, underscoring the unmet needs of this population and the value of early intervention to manage RTT in the long-term.

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27. McCauley JB, Clarke EB, Schiltz HK, Lord C. Trajectories of positive affect in autistic individuals during the transition to adulthood. Autism;2024 (Jul 26):13623613241263902.

Recent research has revealed informative patterns about health, mental health, self-help skills, autism symptoms, and social skills during the transition to adulthood for autistic individuals. This study expands on these findings by examining how positive affect (e.g. excited) changes from age 15 to 30 years using a group of individuals first referred for autism at an early age. We also examined the agreement between caregiver-report and self-report on positive affect. We found different patterns of stability and change in positive affect across the transition to adulthood that related to differences in autism severity, cognitive abilities, self-help skills, as well as social and work participation in adulthood. The agreement between caregiver-report and self-report was strong in adolescence but became much weaker after the individuals were 23 years. These results have implications for how we measure happiness, positive emotions, or other internal experiences of autistic individuals.

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28. Meulien C, Baghdadli A. A Systematic Review of the Stigma Experienced by People with Autism Spectrum Disorder Associated with Intellectual Disabilities and by Their Family Caregivers. J Autism Dev Disord;2024 (Jul 25)

The purpose of this paper was to explore the social stigma experienced by individuals diagnosed with ASD+ID, and to identify knowledge gaps for future studies by conducting a systematic review of peer-reviewed literature. In this systematic review, we included 12 studies exploring the experience of stigma among people with ASD+ID and/or their caregivers. Our aim was to better understand this experience, but also to explore the strategies used to cope with stigma in this population. Our results confirmed that people with ASD+ID and their caregivers experience at least low to moderate levels of stigma, and that this experience is modulated by internal and external factors (such as parental age, mindfulness traits, ASD symptoms…). In addition, our results show the impact of stigma on community integration, psychological well-being and help-seeking behaviour. The role of family, friends and professional support, as well as the formation of networks to share information, appear in our results to be protective factors against stigma. To our knowledge, this study is the first systematic review to examine the stigmatisation of people with ASD+ID and/or their caregivers. Further research is needed to understand the perspective of people with ASD+ID themselves and to explore other factors that modulate this experience, in particular gender and ethnicity.

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29. Micai M, Saldaña D, Vulchanova M, Riva V. Editorial: Physical and medical conditions associated with autism. Front Psychiatry;2024;15:1447188.

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30. Moschetti A, Giangreco M, Ronfani L, Cervellera S, Ruffilli MP, Nume C, Barbi E, Servidio AG. An ecological study shows increased prevalence of autism spectrum disorder in children living in a heavily polluted area. Sci Rep;2024 (Jul 26);14(1):17159.

The burden of autism spectrum disorder (ASD) is increasing worldwide with genetic, epigenetic, and environmental factors being possibly responsible for the observed epidemiological figures. In the setting of environmental exposure, the city of Taranto, in Southern Italy, represents an interesting case study as it hosts well inside the city one of the biggest steel plants in Europe. This is a cross-sectional ecological study carried out in the year 2020 in the province of Taranto designed to estimate the burden of ASD in the municipalities of Taranto and Statte, classified as high environmental risk areas (Contaminated Site of National Interest-SIN), compared to the other 27 municipalities of the same province. Differences have been evaluated using the Chi Square Test. Children aged 6-11 years identified in SIN municipalities had a statistically significant higher prevalence of ASD than children of other municipalities (9.58 vs. 6.66/1000 respectively, p = 0.002). No statistically significant difference was observed for the 12-18 years group (3.41 vs. 2.54/1000, p = 0.12). The findings observed in this study are suggestive of the association between urban residential proximity to industrial facilities emitting air pollutants and higher ASD prevalence.

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31. Nayak A, Math SB. Unavailability of Screening Tool for Adults with Autism Spectrum Disorder: Indian Context. Indian J Psychol Med;2024 (Jul);46(4):366-367.

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32. Nayar K, Landau E, Martin GE, Stevens CJ, Xing J, Sophia P, Guilfoyle J, Gordon PC, Losh M. Narrative Ability in Autism and First-Degree Relatives. J Autism Dev Disord;2024 (Jul 26)

Narrative is an important communication skill for sharing personal experiences and connecting with others. Narrative skills are often impacted in autism spectrum disorder (ASD) and have important consequences for social interactions and relationships. Subtle differences in narrative have also been reported among first-degree relatives of autistic individuals, suggesting that narrative may also be an etiologically important language-related skill that is influenced by genes associated with ASD. This study examined narrative ability and related visual attention during narration in ASD and first-degree relatives of individuals with ASD (siblings and parents) to understand how narrative and related attentional styles may be variably impacted across the spectrum of ASD genetic influence. Participants included 56 autistic individuals, 42 siblings of autistic individuals, 49 controls, 161 parents of autistic individuals, and 61 parent controls. Narratives were elicited using a wordless picture book presented on an eye tracker to record concurrent gaze. Findings revealed parallel patterns of narrative differences among ASD and sibling groups in the use of causal language to connect story elements and the use of cognitive and affective language. More subtle differences within the domain of causal language were evident in ASD parents. Parallel patterns in the ASD and sibling groups were also found for gaze during narration. Findings implicate causal language as a critical narrative skill that is impacted in ASD and may be reflective of ASD genetic influence in relatives. Gaze patterns during narration suggest similar attentional mechanisms associated with narrative among ASD families.

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33. Phillips S. ‘Does that mean you will be violent?’: A qualitative exploration into Autistic women’s experiences of relationships with lecturers at university. Autism;2024 (Jul 26):13623613241264887.

It is documented that more Autistic woman are becoming university students, but their experiences are not often explored. Eleven Autistic women students made artefacts (such as writing, paintings or poems) and took part in interviews to share their experiences at university. Five participants were undergraduate students and six participants were postgraduate students. The artefacts and words participants shared were looked at closely and some common themes were decided. How lecturers talk to Autistic women students was looked at. Participants said they were lucky if they met helpful lecturers. Also, autism acceptance was explored. Overall, how lecturers treat Autistic women at university is very important. Also, Autistic women students’ opinions about making university a more welcoming place need to be listened to.

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34. Rashidi H, Sadeghian E, Shamsaei F, Tapak L, Seyedi M. Eye movements desensitization and reprocessing with finger movements and Elite mobile health software on guilt feeling of parents of children with autism: A randomized trial. J Psychiatr Ment Health Nurs;2024 (Jul 26)

WHAT IS KNOWN ON THE SUBJECT?: Taking care of an autistic child at home can be tough for parents. They struggle to balance caring for their child and other tasks. This can affect their emotional well-being and cause guilt and other psychological problems. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Eye movement desensitization and reprocessing with finger movements can reduce guilt in parents of autistic children. Eye movement desensitization and reprocessing with Elite mobile health software movements can reduce guilt in parents of autistic children. The bilateral eye stimulation method using finger movements has a more sustained impact than the Elite app’s bilateral stimulation method. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare providers are encouraged to learn Eye Movements Desensitization and Reprocessing. Healthcare providers are encouraged to use these methods to help with psychological issues in children with autism. Psychiatric nurses are encouraged to utilize this treatment approach for parents of children with autism, as well as to help alleviate feelings of guilt more broadly. ABSTRACT: INTRODUCTION: Caring for an autistic child at home can be challenging for parents, as it can make it difficult to balance their responsibilities. This imbalance can negatively affect the emotional well-being of the caregiver and lead to feelings of guilt. While this is a known issue, there may be gaps in knowledge specific to Iran. In this study, a new method was introduced to address this issue. AIM: This study aimed to examine the impact of desensitization with eye movements and reprocessing (EMDR) on reducing parental guilt among autistic children’s families. We aim to examine the effectiveness of two different treatment methods. METHODS: This study involved 90 parents (60 mothers, 30 fathers) of autistic children randomly assigned to either an experimental or control group. The two experimental groups received a 45-min intervention session once a week for 3 weeks, while the control group did not receive any intervention. Data on feelings of guilt was collected using a questionnaire. After 30 days, both groups took a follow-up test. The data were analysed using statistical software. RESULTS: This study found that there were significant differences in guilt feelings among different groups of EMDR therapy and a control group. Specifically, no significant differences were observed in the mean guilt scores between the experimental and control groups at the pre-intervention stage (p > .05). However, the experimental groups exhibited significantly lower mean guilt scores immediately after the intervention and 1 month later than the control group (p < .05). Immediately after the intervention and 1 month later, no significant differences were observed between the two experimental groups (p > .05). CONCLUSIONS: The findings of this study demonstrate the efficacy of desensitization treatment using eye movements and reprocessing in reducing feelings of guilt among autistic children’s parents. In the follow-up phase, it seems that the two-way stimulation method with finger movements is more effective than Elite software in terms of the continuity of the effect. Healthcare providers are encouraged to learn and use these methods to help prevent and treat psychological issues in autistic children.

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35. Salehi AM, Ayubi E, Khazaei S, Jenabi E, Bashirian S, Salimi Z. Neonatal risk factors associated with autism spectrum disorders: An umbrella review. Clin Exp Pediatr;2024 (Jul 19)

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by severe social communication deficits and stereotypical repetitive behaviors. PURPOSE: This umbrella review assessed neonatal risk factors associated with ASD using meta-analyses and systematic reviews. METHODS: We conducted a systematic search of interna-tional databases including PubMed, Scopus, and Web of Science for studies published through April 2022 utilizing pertinent keywords. A random-effects model was used to calculate the odds ratio (OR) and 95% confidence interval (CI). Substantial heterogeneity was considered at values of I2≥50%. A quality assessment of the included studies was performed using the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) checklist. RESULTS: A total of 207,221 children with ASD and 22,993,128 neurotypical children were included. Six meta-analyses were included in this umbrella review. The factors of congenital heart disease (OR, 1.35; 95% CI, 1.17-1.52), macrosomia (OR, 1.11; 95% CI, 1.05-1.18), low birth weight (OR, 1.63; 95% CI, 1.48-1.81), very low birth weight (OR, 2.25; 95% CI, 1.79-2.83), small for gestational age (OR, 1.17; 95% CI, 1.09-1.24), jaundice (OR, 1.74; 95% CI, 1.42-2.12), male sex (OR, 1.47; 95% CI, 1.39-1.55) and 1-minute Apgar score <7 (OR, 1.40; 95% CI, 1.26-1.55) were graded as suggestive evidence (class III). Only 3 studies reported heterogeneity (I2<50%). Based on the AMSTAR2 analysis, the methodological quality was critically low in 3 meta-analyses, low in 2, and moderate in 1. CONCLUSION: Based on these results, clinicians should consider the risk factors for ASD and screen children in clinics.

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36. Samoylov I, Arcara G, Buyanova I, Davydova E, Pereverzeva D, Sorokin A, Tyushkevich S, Mamokhina U, Danilina K, Dragoy O, Arutiunian V. Altered neural synchronization in response to 2 Hz amplitude-modulated tones in the auditory cortex of children with Autism Spectrum Disorder: An MEG study. Int J Psychophysiol;2024 (Jul 23);203:112405.

OBJECTIVE: Some studies have hypothesized that atypical neural synchronization at the delta frequency band in the auditory cortex is associated with phonological and language skills in children with Autism Spectrum Disorder (ASD), but it is still poorly understood. This study investigated this neural activity and addressed the relationships between auditory response and behavioral measures of children with ASD. METHODS: We used magnetoencephalography and individual brain models to investigate 2 Hz Auditory Steady-State Response (ASSR) in 20 primary-school-aged children with ASD and 20 age-matched typically developing (TD) controls. RESULTS: First, we found a between-group difference in the localization of the auditory response, so as the topology of 2 Hz ASSR was more superior and posterior in TD children when comparing to children with ASD. Second, the power of 2 Hz ASSR was reduced in the ASD group. Finally, we observed a significant association between the amplitude of neural response and language skills in children with ASD. CONCLUSIONS: The study provided the evidence of reduced neural response in children with ASD and its relation to language skills. SIGNIFICANCE: These findings may inform future interventions targeting auditory and language impairments in ASD population.

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37. Scharko AM, Mireski SJ. A 16-Year-Old Male with Autism Spectrum Disorder, Psychosis, and Refusal to Accept Any Oral Medication: A Case Report and Use of Long-Acting Injectable Aripiprazole Lauroxil. J Child Adolesc Psychopharmacol;2024 (Jul 24)

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38. Sezerol MA, Davun S. Autism spectrum disorder: evaluation of community-based screening program. Turk J Med Sci;2024;54(3):555-562.

BACKGROUND/AIM: This study was conducted to evaluate the results of autism spectrum disorder (ASD) screenings conducted in a region of İstanbul between 2018 and 2023. MATERIALS AND METHODS: This descriptive study was conducted between April 2018 and February 2023 among 25,839 children aged between 18-36 months who had been screened for autism spectrum disorder in Sultanbeyli, İstanbul. Children between 18-36 months are examined and a form consisting of 5 questions and typical symptoms of ASD is filled. Each question is answered as yes or no. Answering yes to at least one of the questions is sufficient to direct them to child psychiatry. RESULTS: Between 2018 and 2023, a total of 25,839 children were screened for autism spectrum disorders, 1449 children were found to be at risk, and 88 were diagnosed with autism spectrum disorder. According to the sex distribution of the children, the male:female ratio is 3.6:1. The 5-year prevalence was found to be 0.9%. With the effect of the pandemic between 2020 and 2021, screening rates have decreased and the number of diagnoses has decreased. The most common symptom among those diagnosed is delay in speaking, and the second is inability to make eye contact. CONCLUSION: Autism spectrum disorder is a developmental disorder whose prevalence is increasing globally and for which early diagnosis is important. To recognize this disease, it is necessary to increase screening and raise awareness among families. This study will also shed light on future studies on this subject.

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39. Shepherd D, Buchwald K, Siegert RJ, Vignes M. Using network analysis to identify factors influencing the heath-related quality of life of parents caring for an autistic child. Res Dev Disabil;2024 (Jul 26);152:104808.

BACKGROUND: Raising an autistic child is associated with increased parenting stress relative to raising typically developing children. Increased parenting stress is associated with lower parent wellbeing, which in turn can negatively impact child wellbeing. AIMS: The current study sought to quantify parenting stress and parent health-related quality of life (HRQOL) in the autism context, and further understand the relationship between them by employing a relatively novel statistical method, Network Analysis. METHODS AND PROCEDURES: This cross-sectional study involved 476 parents of an autistic child. Parents completed an online survey requesting information on parent and child characteristics, parent’s perceptions of their autistic child’s symptoms and problem behaviours, and assessed their parenting stress and HRQOL. OUTCOMES AND RESULTS: Relative to normative data, parent HRQOL was significantly lower in terms of physical health and mental wellbeing. The structure extracted by the Network Analysis indicated that child age and externalising behaviours were the main contributors to parenting stress, and that externalising behaviours, ASD core behavioural symptoms, and parenting stress predicted HRQOL. CONCLUSIONS AND IMPLICATIONS: Parental responses to child-related factors likely determine parent HRQOL. Findings are discussed in relation to the transactional model, emphasising the importance of both parent and child wellbeing.

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40. Sleyp Y, Matthews HS, Vanneste M, Vandenhove L, Delanote V, Hoskens H, Indencleef K, Teule H, Larmuseau MHD, Steyaert J, Devriendt K, Claes P, Peeters H. Toward 3D facial analysis for recognizing Mendelian causes of autism spectrum disorder. Clin Genet;2024 (Jul 26)

Recognizing Mendelian causes is crucial in molecular diagnostics and counseling for patients with autism spectrum disorder (ASD). We explored facial dysmorphism and facial asymmetry in relation to genetic causes in ASD patients and studied the potential of objective facial phenotyping in discriminating between Mendelian and multifactorial ASD. In a cohort of 152 ASD patients, 3D facial images were used to calculate three metrics: a computational dysmorphism score, a computational asymmetry score, and an expert dysmorphism score. High scores for each of the three metrics were associated with Mendelian causes of ASD. The computational dysmorphism score showed a significant correlation with the average expert dysmorphism score. However, in some patients, different dysmorphism aspects were captured making the metrics potentially complementary. The computational dysmorphism and asymmetry scores both enhanced the individual expert dysmorphism scores in differentiating Mendelian from non-Mendelian cases. Furthermore, the computational asymmetry score enhanced the average expert opinion in predicting a Mendelian cause. By design, our study does not allow to draw conclusions on the actual point-of-care use of 3D facial analysis. Nevertheless, 3D morphometric analysis is promising for developing clinical dysmorphology applications in diagnostics and training.

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41. Subramaniam VR, Goldstein J, Mu L, Kwon CS. In-hospital outcomes in people with autism and epilepsy – A population-based study. Epilepsy Res;2024 (Jul 14);205:107417.

Autism is a common comorbid diagnosis in those with epilepsy. Understanding the health needs and outcomes in patients with this dual diagnosis is important for optimizing healthcare outcomes. We compared hospital-level variables amongst patients with co-occurring autism and epilepsy, to those with epilepsy alone. Non-elective hospital admissions amongst patients with epilepsy alone and co-occurring autism and epilepsy were identified in the 2003-14 National Inpatient Sample (NIS) using previously validated ICD-9-CM case definitions. One patient with co-occurring epilepsy and autism was matched to three epilepsy patients for age and sex. Multinomial logistic regressions were performed to examine outcomes of interest. Compared to those with epilepsy alone (n = 27,762), patients with autism and epilepsy (n = 9254) had a higher odds of transfer to another facility (OR = 1.09, p = 0.048), in-hospital mortality (OR = 1.36, p = 0.011), longer mean length of stay (5.63 days vs. 5.12 days, p < 0.0001), and septicemia (4.21 % vs. 3.08 %, p < 0.0001). Distributions of demographics, insurance type, socioeconomic status, and comorbidities significantly differed between both groups. Our findings demonstrate that patients with comorbid autism and epilepsy are a unique population with health outcomes significantly differing from those with epilepsy alone. Given the effect that dual diagnosis has on hospital trajectory, focused treatment plans must be adopted to optimize care and hospital outcomes in these patients.

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42. Sun H, Shen Y, Ni P, Liu X, Li Y, Qiu Z, Su J, Wang Y, Wu M, Kong X, Cao JL, Xie W, An S. Autism-associated neuroligin-3 deficiency in medial septum causes social deficits and sleep loss in mice. J Clin Invest;2024 (Jul 25)

Patients with autism spectrum disorder (ASD) frequently experience sleep disturbance. Genetic mutations in Neuroligin-3 (NLG3) genes are highly correlative with ASD and sleep disturbance. However, the cellular and neural circuit bases of this correlation remain elusive. Here, we find the conditional knockout of NLG3 (NLG3-CKO) in the medial septum (MS) impairs social memory and reduces sleep. NLG3 knockout in MS causes hyperactivity of MS-GABA neurons during social avoidance and wakefulness. Activation of MSGABA neurons induces social memory deficits and sleep loss in C57BL/6 mice. In contrast, inactivation of these neurons ameliorates social memory deficits and sleep loss in NLG3-CKO mice. Sleep deprivation leads to social memory deficits, while social isolation causes sleep loss, both resulting in a reduction of NLG3 expression and an increase in activity of GABAergic neurons in MS from C57BL/6 mice. Furthermore, MS-GABA-innervated CA2 neurons specifically regulate social memory without impacting sleep, whereas MSGABA-innervating neurons in the preoptic area selectively control sleep without affecting social behavior. Together, these findings demonstrate that the hyperactive MS-GABA neurons impair social memory and disrupt sleep resulting from NLG3 knockout in MS, and achieve the modality specificity through their divergent downstream targets.

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43. Tartaglione AM, Camoni L, Calamandrei G, Chiarotti F, Venerosi A. The contribution of environmental pollutants to the risk of autism and other neurodevelopmental disorders: A systematic review of case-control studies. Neurosci Biobehav Rev;2024 (Jul 23);164:105815.

Exposure to environmental pollutants, such as metals, pesticides, and air pollutants during early life, is a risk factor for neurodevelopmental disorders (NDDs), including Autism Spectrum Disorder (ASD). Our systematic review aimed to select and summarize more recent case-control studies that examined the association between prenatal and early postnatal exposure to environmental pollutants and NDDs. We searched five databases (Web of Science, PubMed, Embase, Scopus, Ovid), screened 2261 records, and included 24 eligible case-control studies. Meta-analyses were conducted on subgroups of at least three studies that shared both the outcome and the exposure. A noteworthy discovery from this literature review is the existence of non-linear or non-monotonic dose-response relationships between the exposure to certain metals and the risk of ASD. The meta-analysis revealed a significant association between exposure to particular matter (PM)(10) during the first year of life and the risk of ASD. Overall, studies included in our systematic review indicate that exposure to several pollutants within the first three years of life was significantly associated with the risk of NDDs.

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44. Thakur A, Bobbette N, Bond V, Gonzales A, Lake J, Lefkowitz G, Mia N, Niel U, Sockalingam S, Streisslberger E, Thomson K, Volpe T, Lunsky Y. Bridging the gap: national virtual education programme for professionals caring for adults with intellectual and developmental disabilities at the time of COVID-19. BJPsych Open;2024 (Jul 25);10(4):e130.

BACKGROUND: The COVID-19 pandemic significantly impacted the mental health of adults with intellectual and developmental disabilities (IDD). During this period of uncertainty and need for up-to-date information, various virtual training programmes demonstrated the role of tele-mentoring programmes. AIM: The aim of this paper is to describe the educational evaluation of the National Extension for Community Healthcare Outcomes – Adults with Intellectual and Developmental Disabilities (ECHO-AIDD), a programme for service providers working with adults with IDD during COVID-19. METHOD: The programme consisted of six sessions, conducted weekly, over two cycles. Each session included didactic teaching by hub team members, COVID-19 news updates, wellness check-ins and a brief mindfulness activity, followed by a 30 to 45 min case-based discussion. The hub structure had an inter-professional approach to team expertise. Those with lived experience were an integral part of the content experts’ hub. Pre-, post- and follow-up evaluation data were collected. RESULTS: Care providers from health and social care sectors (n = 230) participated in the programme. High levels of engagement and satisfaction were reported. Self-efficacy ratings improved from pre- to post-, and were maintained at 8-week follow-up; improvement from pre- to post- was significant (P < 0.0001). CONCLUSION: Exposure to National ECHO-AIDD educational intervention led to improvement in perceived competencies. This study also shows the valuable role of people with lived experience in fostering adaptive expertise in learners. The outreach and scalability support the feasibility of building a national virtual community of practice for IDD service providers. Future studies should focus on studying the impact of these programmes on the health outcomes of people with IDD.

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45. Uğurlu M, Sözer Boz E, Turgut S. Psychometric Properties of the Child Behavior Checklist (CBCL) for Ages 6-18 to Identify Autism Spectrum Disorders (ASD) in a Turkish Parent Sample. J Autism Dev Disord;2024 (Jul 26)

The Child Behavior Checklist for ages 6-18 (CBCL/6-18) is broadly used for psycho-educational assessment in identifying children’s behavior problems in special education and psychology. However, the usefulness of the CBCL/6-18 in a Turkish sample still needs to be investigated. The current study aimed to investigate the psychometric properties of the measures of the CBCL/6-18 within a sample of Turkish parents. The psychometric evaluation includes item calibration using the Partial Credit Model (PCM). We analyzed data from 548 parents who have children with autism spectrum disorder. According to the PCM calibration, the results suggested that the Internalizing, Externalizing, and Total Problem subscales were unidimensional and showed local independence successfully. All subscales demonstrated adequate reliability, indicating that the scale distinguishes between children with different behavior problems. The subscales had varying item step ordering, meaning that transitions from one category to second by parent ratings are relatively straightforward. Some items with easy-to-define behavior problems, for example, Item 42 (constipated), were more likely to be endorsed by parents. Consequently, the CBCL/6-18 has adequate psychometric properties for accurately assessing problem behaviors in children based on parent ratings.

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46. van de Meent I, Koomen L, de Boer R, Le Clercq L, Janssen D, Boute M, Maat A, van Dellen E, Cahn W. Forward head posture associated with reduced cardiorespiratory fitness in psychotic disorders compared to autism spectrum disorder and healthy controls. Sci Rep;2024 (Jul 26);14(1):17143.

Individuals with psychotic disorders often lead sedentary lives, heightening the risk of developing forward head posture. Forward head posture affects upper cervical vertebrae, raising the likelihood of daily discomforts like skeletal misalignment, neck pain, and reduced cardiorespiratory fitness. Improving cardiorespiratory fitness in psychotic disorders is relevant, given its proven benefits in enhancing physical and mental health. This study investigates forward head posture by measuring craniovertebral angles in psychotic disorders and the relationship with reduced cardiorespiratory fitness. To determine whether forward head posture is specific to psychotic disorders, we also included individuals with autism spectrum disorder and healthy controls. Among 85 participants (32 psychotic disorders, 26 autism spectrum disorder, 27 healthy controls), photogrammetric quantification revealed a significantly lower mean craniocervical angle in psychotic disorders compared to autism spectrum disorder (p =  < 0.02) and the healthy control group (p =  < 0.01). Reduced craniovertebral angle is related to diminished cardiorespiratory fitness in psychosis (R(2) = 0.45, p =  < 0.01) but not in other control groups. This study found reduced craniovertebral angles, indicating forward head posture in psychotic disorders. Moreover, this relates to diminished cardiorespiratory fitness. Further research is needed to examine the underlying causes and to investigate whether this can be reversed through physical therapy.

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47. Yang G, Wang Y, Jiang Y. Social perception of animacy: Preferential attentional orienting to animals links with autistic traits. Cognition;2024 (Jul 23);251:105900.

Animate cues enjoy priority in attentional processes as they carry survival-relevant information and herald social interaction. Whether and in what way such an attention effect is associated with more general aspects of social cognition remains largely unexplored. Here we investigated whether the attentional preference for animals varies with observers’ autistic traits – an indicator of autism-like characteristics in general populations related to one’s social cognitive abilities. Using the dot-probe paradigm, we found that animal cues can rapidly and persistently recruit preferential attention over inanimate ones in observers with relatively low, but not high, autistic traits, as measured by Autism-Spectrum Quotient (AQ). Moreover, individual AQ scores were negatively correlated with the attentional bias toward animals, especially at the early orienting stage. These results were not simply due to low-level visual factors, as inverted or phase-scrambled pictures did not yield a similar pattern. Our findings demonstrate an automatic and enduring attentional bias beneficial to both rapid detection and continuous monitoring of animals and reveal its link with autistic traits, highlighting the critical role of animacy perception in the architecture of social cognition.

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48. Yang Y, Cho S, Covello M, Knox A, Bastani O, Weimer J, Dobriban E, Schultz R, Lee I, Parish-Morris J. Automatically Predicting Perceived Conversation Quality in a Pediatric Sample Enriched for Autism. Interspeech;2023 (Aug);2023:4603-4607.

Social interaction quality ratings derived from short natural conversations can differentiate children with and without autism at the group level. In this work, we explored conversations between children and an unfamiliar adult who rated their social interaction success on six dimensions. Using hand-crafted acoustic and lexical features, we built different classifiers to predict children’s dimensional conversation quality. The best classifier achieved 61% accuracy, which outperformed human raters (49%). Follow-up analyses revealed that a subset of features determined communication quality scores. Additionally, we extracted acoustic features using a pretrained audio transformer and improved our prediction to 68%. This study suggests that automatically predicting conversation quality could be an inexpensive and objective way to monitor intervention progress in children with communication challenges, and could be used to identify intervention targets for improving conversational success.

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49. Yu L, Liu Y, Xia J, Feng S, Chen F. KCNH5 deletion increases autism susceptibility by regulating neuronal growth through Akt/mTOR signaling pathway. Behav Brain Res;2024 (Jul 26);470:115069.

Recent clinical studies have highlighted mutations in the voltage-gated potassium channel Kv10.2 encoded by the KCNH5 gene among individuals with autism spectrum disorder (ASD). Our preliminary study found that Kv10.2 was decreased in the hippocampus of valproic acid (VPA) – induced ASD rats. Nevertheless, it is currently unclear how KCNH5 regulates autism-like features, or becomes a new target for autism treatment. We employed KCNH5 knockout (KCNH5(-/-)) rats and VPA – induced ASD rats in this study. Then, we used behavioral assessments, combined with electrophysiological recordings and hippocampal brain slice, to elucidate the impact of KCNH5 deletion and environmental factors on neural development and function in rats. We found that KCNH5(-/-) rats showed early developmental delay, neuronal overdevelopment, and abnormal electroencephalogram (EEG) signals, but did not exhibit autism-like behavior. KCNH5(-/-) rats exposed to VPA (KCNH5(-/-)-VPA) exhibit even more severe autism-like behaviors and abnormal neuronal development. The absence of KCNH5 excessively enhances the activity of the Protein Kinase B (Akt)/Mechanistic Target of Rapamycin (mTOR) signaling pathway in the hippocampus of rats after exposure to VPA. Overall, our findings underscore the deficiency of KCNH5 increases the susceptibility to autism under environmental exposures, suggesting its potential utility as a target for screening and diagnosis in ASD.

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50. Zhong X, He M, Lei L, Li X, Pan C, Wang B, Pen L, Li X. Validation of the Chinese version of the autism spectrum knowledge scale general population version (ASKSG) with a parent sample. J Pediatr Nurs;2024 (Jul 23)

BACKGROUND: The early detection and diagnosis of autism spectrum disorder (ASD) in children are a first step in determining follow-up assessments and personalized treatment plans. Parents play an extremely crucial role in children’s development; therefore, it is essential to identify a valid and reliable instrument to evaluate the knowledge of parents about ASD. The aim of this study was to translate and determine the psychometric properties of the Autism Spectrum Knowledge Scale General Population Version (ASKSG) with a parent sample. DESIGN AND METHODS: A cross-sectional study was conducted with 858 parents of children aged 0-14 years in China. The demographic characteristics form and ASKSG were used for data collection. The psychometric properties of the ASKSG were evaluated by examining reliability, exploratory factor analysis (EFA), categorical confirmatory factor analysis (CCFA), unidimensionality, person and item reliability, item fit and item difficulty, and item-person mapping. RESULTS: The Cronbach’s alpha coefficient of the ASKSG was 0.865. In terms of EFA, principal component analysis revealed a fixed number of five factors, explaining 41.642% of the total variance. For the CCFA, the structure of the thematically derived five-factor model was observed to be a marginal fit to the data. The eigenvalue was 31.00, with a variance of 62.7%. The person reliability was 0.85, and the person separation was 2.38. The item reliability was 1.00, and the item separation was 15.02. The infit and outfit statistical analysis fell within acceptable ranges from 0.75 to 1.35, and the item difficulty ranged from -2.43 to 2.44. An item-person map with excellent targeting would be symmetric along the vertical axis from more difficult endorsement at the top (question 1 and question 20) to easier endorsement at the bottom (question 1). Some items do appear to function differently across sexes, and they assess the latent trait unequally across both sexes. CONCLUSIONS: The Chinese version of the ASKSG is a reliable and valid tool for assessing knowledge of parents about ASD. PRACTICE IMPLICATIONS: Chinese ASKSG now offers medical professionals and teachers a robust means of assessing parental knowledge about ASD. Therefore, professionals may use the scale to help them screen or identify parents who are in need of additional support or advice.

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51. Zhou Y, Jia G, Ren Y, Ren Y, Xiao Z, Wang Y. Advancing ASD identification with neuroimaging: a novel GARL methodology integrating Deep Q-Learning and generative adversarial networks. BMC Med Imaging;2024 (Jul 25);24(1):186.

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects an individual’s behavior, speech, and social interaction. Early and accurate diagnosis of ASD is pivotal for successful intervention. The limited availability of large datasets for neuroimaging investigations, however, poses a significant challenge to the timely and precise identification of ASD. To address this problem, we propose a breakthrough approach, GARL, for ASD diagnosis using neuroimaging data. GARL innovatively integrates the power of GANs and Deep Q-Learning to augment limited datasets and enhance diagnostic precision. We utilized the Autistic Brain Imaging Data Exchange (ABIDE) I and II datasets and employed a GAN to expand these datasets, creating a more robust and diversified dataset for analysis. This approach not only captures the underlying sample distribution within ABIDE I and II but also employs deep reinforcement learning for continuous self-improvement, significantly enhancing the capability of the model to generalize and adapt. Our experimental results confirmed that GAN-based data augmentation effectively improved the performance of all prediction models on both datasets, with the combination of InfoGAN and DQN’s GARL yielding the most notable improvement.

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