1. Chen SD, Yu Y, Li XK, Chen SQ, Ren J. Parental Self-Efficacy and Behavioral Problems in Children with Autism During COVID-19: A Moderated Mediation Model of Parenting Stress and Perceived Social Support. Psychology research and behavior management. 2021; 14: 1291-301.

PURPOSE: COVID-19 pandemic has been verified as a public health emergency of international concern. During the special period, the health of vulnerable groups, such as children with autism, should be concerned. Some studies have been carried out to investigate the behavioral problems of children with autism during the COVID-19, but underlying mechanisms behind it is not clear. This study examines the role of parenting stress as a mediator in the relationship between parental self-efficacy and behavioral problems in Chinese children as well as the role of perceived social support as a moderator for this mediation effect. METHODS: A total of 439 parents of children with autism (mean age=40.17, SD=5.26) were surveyed and completed five questionnaires (Conners Parent Symptom Questionnaire, Parental Self-Efficacy Questionnaire, Parenting Stress Index-Short Form 15, Perceived Social Support Questionnaire, and Neuroticism Extraversion Openness Five Factor Inventory). The statistical analyses were conducted by SPSS 26.0 and SPSS PROCESS macro. RESULTS: Controlling for neuroticism, which is highly associated with psychological changes in parents, the study found that parental self-efficacy was significantly and negatively correlated with behavioral problems in children with autism. In addition, the relationship between parental self-efficacy and behavioral problems was mediated by parenting stress. Furthermore, parenting stress moderated the indirect relationship between parental self-efficacy and behavioral problems via perceived social support. CONCLUSION: These results provide direct evidences for the inextricable relationship between family, social factors and behavioral problems of children with autism. It suggest that improving perceived social support to enhance parental self-efficacy is critical to buffering against parenting stress and stabilizing children with autism during the COVID-19 pandemic.

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2. Holdman R, Vigil D, Robinson K, Shah P, Contreras AE. Safety and Efficacy of Medical Cannabis in Autism Spectrum Disorder Compared with Commonly Used Medications. Cannabis and cannabinoid research. 2021.

Objective: The objective of this study was to evaluate the safety and efficacy of medications commonly used in autism spectrum disorder (ASD) and compare this to what current research has shown regarding medical cannabis use in this population. Methods: Searches were performed to collect information surrounding currently used medications and their safety and efficacy profiles, biologic plausibility of cannabis use for symptoms of ASD, and studies detailing cannabis’ safety and efficacy profile for use in the ASD population. Results were used to compare medications to cannabis as a proposed treatment. Results: The heterogeneity of ASD produces great difficulties in finding appropriate treatment, leading to many medication changes or treatment trials throughout a patient’s life. Commonly prescribed medications display varying levels of efficacy, safety, and tolerability between patients and symptoms targeted. Some of the most common side effects cited are also considered the most troubling symptoms associated with ASD; aggression, anxiety, irritability, and a negative effect on cognition, leading many patients to discontinue use as the side effects outweigh benefits. Recent case reports and retrospective studies have displayed the potential efficacy, safety, and tolerability of cannabidiol (CBD)-rich medical cannabis use for treating both core symptoms of ASD and many comorbid symptoms such as irritability and sleep problems. Studies have also identified circulating endocannabinoids as a possible biomarker for ASD, providing another possible method of diagnosis. Conclusions: Currently, there are no approved medications for the core symptoms of ASD and only two medications Food and Drug Administration approved for associated irritability. Prescribed medications for symptoms associated with ASD display varying levels of efficacy, safety, and tolerability among the heterogeneous ASD population. At the time of this study there are no published placebo-controlled trials of medical cannabis for ASD and the observational studies have limitations. CBD-rich medical cannabis seems to be an effective, tolerable, and relatively safe option for many symptoms associated with ASD, however, the long-term safety is unknown at this time.

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3. Kanari K, Kikuchi-Ito M. Estimation of the degree of autism spectrum disorder by the slow phase of optokinetic nystagmus in typical adults. Heliyon. 2021; 7(8): e07751.

Atypical eye movement patterns demonstrated by individuals with autism spectrum disorder (ASD) have the potential to serve as biomarkers for ASD diagnosis. However, instead of estimating individual differences in the degree of ASD from those patterns, many researchers have compared ASD groups with typical development groups. This study investigates the relationship between the Autism-spectrum Quotient (AQ) scores in typical adults, which can evaluate the degree of the traits associated with ASD, as well as the properties of optokinetic nystagmus (OKN), including the gain of the slow phase, the peak velocity and duration of the fast phase, the frequency, and the mean eye position of OKN. A random dot pattern that moved in one direction was presented on the display, and the participants’ eye movements were measured. The results showed a negative correlation between subjects’ AQ scores and the gain of slow-phase OKN. In addition, the correlations between subjects’ AQ scores and the properties of OKN fast phase were not significant. These results indicate that the gain of slow-phase OKN could be a biomarker that estimates individual differences in the degree of ASD, reflected in our findings which considered AQ scores in typical adults.

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4. Langenfeld A, Kroupina M, Palmer A, Gustafson K, Augustyn M. Importance of Trauma-Informed Practice in Evaluation of Children Diagnosed with Autism Spectrum Disorder. Journal of developmental and behavioral pediatrics : JDBP. 2021; 42(8): 690-3.

As part of a multidisciplinary adoption support clinic, Erin, a 5-year-old girl, adopted approximately 6 months before the clinic visit, presents for postadoption evaluation. Erin was born at full term. Her birth history was significant for reported maternal treatment for liver failure during pregnancy. Her previous medical history included hospitalization for a viral illness at age 2 months, recurrent ear infections, and a fractured forearm. Family history was significant for a maternal history of bipolar disorder, depression, anxiety, borderline personality disorder, and concern for substance abuse; a paternal history of attention-deficit/hyperactivity disorder (ADHD) and depression; and full biological brother with a history of ADHD and oppositional defiant disorder. Erin and her brother lived with their parents until she was approximately 3 years old. At that time, there were concerns for poor hygiene, inconsistent medical care, poor school attendance for her brother, financial instability, and significant neglect. Erin was reportedly confined to her crib for hours at a time. She and her older brother were removed from the home because of concerns for significant neglect and placed into foster care. Approximately 3 months after foster placement, Erin underwent testing because of concerns for abnormal behaviors and possible developmental delays. Symptoms included poor sleep, repetitive behaviors such as head banging, delayed speech that primarily involved grunting, and lack of toilet training. She was hyperactive and aggressive and had poor caregiver attachment. On evaluation, she was small for age, poorly groomed, and easily distracted with poor eye contact and did not tolerate interactions with examiners. Neuropsychological testing consisted of symptom checklists and caregiver interview only because she did not tolerate diagnostic testing. She was diagnosed with autism spectrum disorder and global developmental delay with intellectual and language impairments. Over the following year, Erin was transitioned to a second foster family and was subsequently adopted. She received speech, occupational, and physical therapy, along with trauma-informed therapy. She made significant gains in multiple domains and was able to graduate from trauma-informed therapy after 1 year. On examination, Erin greets you with appropriate eye contact and reports that she is feeling « good. » She is verbal and interactive with her brother and parents. She looks to parents for support when asked to participate in the physical examination. She does not display any significant repetitive behaviors. Erin’s parents are concerned that her initial diagnoses of autism spectrum disorder and global developmental delay do not accurately reflect her current level of functioning and are afraid she may have been misdiagnosed. How would you proceed with next steps to address these diagnoses?

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5. Lin Y, Gu Y, Xu Y, Hou S, Ding R, Ni S. Autistic spectrum traits detection and early screening: A machine learning based eye movement study. Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc. 2022; 35(1): 83-92.

PROBLEM: Autism spectrum disorders (ASD) are pervasive neurodevelopmental disorders and generally accompanied by social disorders, verbal or nonverbal communication defects, inability to concentrate and other negative symptoms that affect the autistic person’s normal life. However, traditional screening methods are time-consuming and public health resources are limited. METHODS: This study proposed a novel technique that combined eye-movement data and machine learning algorithms for predicting autistic traits. We converted raw eye movement data into features, trained and tested a model for early screening. FINDINGS: In the preliminary experiment, 107 participants (average age = 24.84 ± 5.24 years) wore HTC Vive to watch a VR scene for 15-20 s. We explored eight classification models, among which the ensemble model performed best, with 0.73 accuracy, 0.68 precision, 0.81 recall, 0.74 F1-score, and an area under the curve of 0.90. And in the test experiment, 22 participants (average age = 12.68 ± 7.61 years) diagnosed as ASD took the experiment and the ensemble model showed a recall of 0.77. Eye movement data is an effectively distinguishable tool and we find that the proportion of time to observe figure and animal region continuously can distinguish participants with obvious and unobvious autistic traits effectively in the model. CONCLUSION: This study focuses on the detection of autistic traits, and proposes a more objective and faster method for undertaking early screening, which provides possibilities to save precious time to intervene and alleviate its symptoms before making a definite diagnosis.

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6. Meng W, Huan Y, Gao Y. Urinary proteome profiling for children with autism using data-independent acquisition proteomics. Translational pediatrics. 2021; 10(7): 1765-78.

BACKGROUND: Autism is a complex neurodevelopmental disorder. Objective and reliable biomarkers are crucial for the clinical diagnosis of autism. Urine can accumulate early changes of the whole body and is a sensitive source for disease biomarkers. METHODS: The data-independent acquisition (DIA) strategy was used to identify differential proteins in the urinary proteome between autistic and non-autistic children aged 3-7 years. Receiver operating characteristic (ROC) curves were developed to evaluate the diagnostic performance of differential proteins. RESULTS: A total of 118 differential proteins were identified in the urine between autistic and non-autistic children, of which 18 proteins were reported to be related to autism. Randomized grouping statistical analysis indicated that 91.5% of the differential proteins were reliable. Functional analysis revealed that some differential proteins were associated with axonal guidance signaling, endocannabinoid developing neuron pathway, synaptic long-term depression, agrin interactions at neuromuscular junction, phosphatase and tensin homolog deleted on chromosome 10 (PTEN) signaling and synaptogenesis signaling pathway. The combination of cadherin-related family member 5 (CDHR5) and vacuolar protein sorting-associated protein 4B (VPS4B) showed the best discriminative performance between autistic and non-autistic children with an area under the curve (AUC) value of 0.987. CONCLUSIONS: The urinary proteome could distinguish between autistic children and non-autistic children. This study will provide a promising approach for future biomarker research of neuropsychiatric disorders.

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7. Nagy E, Prentice L, Wakeling T. Atypical Facial Emotion Recognition in Children with Autism Spectrum Disorders: Exploratory Analysis on the Role of Task Demands. Perception. 2021; 50(9): 819-33.

People with autism spectrum disorders (ASDs) have difficulty with socio-emotional functioning; however, research on facial emotion recognition (FER) remains inconclusive. Individuals with ASD might be using atypical compensatory mechanisms that are exhausted in more complex tasks. This study compared response accuracy and speed on a forced-choice FER task using neutral, happy, sad, disgust, anger, fear and surprise expressions under both timed and non-timed conditions in children with and without ASD (n = 18). The results showed that emotion recognition accuracy was comparable in the two groups in the non-timed condition. However, in the timed condition, children with ASD were less accurate in identifying anger and surprise compared to children without ASD. This suggests that people with ASD have atypical processing of anger and surprise that might become challenged under time pressure. Understanding these atypical processes, and the environmental factors that challenge them, could be beneficial in supporting socio-emotional functioning in people ASD.

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8. Tyler CV, Jr., McDermott M. Transitioning patients with developmental disabilities to adult care. The Journal of family practice. 2021; 70(6): 280-8.

The pre-visit questionnaire, instructive videos, and Web resources detailed here can help you play a pivotal role in planning, commencing, and solidifying this transition.

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