1. Abu-Dahab SMN, Alwawi DA, Alkhamra HA. Do Occupational Therapy Goals for Children with Autism Spectrum Disorder Reflect Participation? A Mapping to the ICF – CY and ICF Core Sets Study. J Autism Dev Disord;2024 (Sep 26)

Autism Spectrum Disorder (ASD) is on the rise worldwide with an increasing acknowledgement that its continuum of care to enhance participation should be multidisciplinary. The International Classification of Functioning, Disability, and Health (ICF) and its derivatives ICF – Children and Youth (ICF – CY) and ICF Core Sets have been increasingly used among health professionals to enhance communication and documentation of outcomes. This study aimed at investigating the comprehensiveness of the ICF – CY and ICF Core Sets with regard to occupational therapy goals and the extent of participation representation in these goals. Forty occupational therapists working with children with ASD stated their most common three long-term goals. The goals were then mapped to the ICF – CY two level classification. The percentage of goals reflecting « Participation » was calculated. The overlap between ICF – CY and the ICF ASD Core Sets was assessed. A total of 155 goals were extracted, of which only seven (4.5%) related to sensory processing were not linked to the ICF – CY categories. 35.1% of the total linked goals were regarded as reflecting « Participation ». 84.5% of ICF – CY categories overlapped with the ICF ASD Core Sets. Categories related to hand function, and taking care of body parts were found to be lacking in the ICF ASD Core Sets. The ICF – CY and the ICF ASD Core Sets may be feasible clinical tools for children with ASD, however, they may not be sufficient to cover occupational therapy goals. Goals also need to be modified to better reflect participation.

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2. Adams D, Malone S, Dargue N, Keen D, Rodgers J, Simpson K, Wicks R, Bullot A, Rapee R. Prevention and Reduction of Anxiety in Autistic Preschoolers Through an Autism-Specific Parent-Mediated Intervention: A Pilot Randomised Controlled Trial Evaluating Short and Longer Term Outcomes. J Autism Dev Disord;2024 (Sep 26)

Anxiety is a common co-occurring condition for autistic preschoolers. Whilst there has been extensive research evaluating anxiety prevention/reduction interventions for neurotypical preschoolers, such research is limited for autistic children. Fifty-seven parents of autistic 4-5-year olds, with varying levels of anxiety, participated in a randomised controlled trial of an autism-specific, parent-mediated intervention (CLK-CUES) to prevent or reduce anxiety in autistic preschoolers. Baseline, short-term (post-intervention) and longer term (12 months follow-up) assessments included child anxiety (ASC-ASD-P and PAS-R), intolerance of uncertainty, and parent well-being. (Trial registration ACTRN12620001322921). There were no reports of harmful effects of the intervention or trial. Linear mixed models show a significant group x time interaction for ASC-ASD-P Total score and the Uncertainty subscale with medium and large effect sizes. Post-hoc analyses show a significant decline for only the intervention group in anxiety (specifically, anxiety around uncertainty) from pre-post intervention, maintained at one year follow-up. There was no change on the PAS-R or other ASC-ASD-P subscales. CLK-CUES shows promise as a way to prevent and reduce anxiety in young autistic children, specifically anxiety related to uncertainty. Trials with larger samples are warranted. Findings also highlight the importance of using measures designed for autistic children.

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3. Burningham O, Chen A, Genovesi E, Belay W, Ahmed I, Ayele M, Girma F, Lakew LT, Hanlon C, Hoekstra RA. Inclusive Education for Children with Developmental Disabilities in Ethiopia: Stakeholder Views on Benefits, Disadvantages and Priorities for Action. J Autism Dev Disord;2024 (Sep 26)

Children with developmental disabilities (DD) including intellectual disability and autism, experience exclusion from social life and education in Ethiopia. Including children with DD in mainstream inclusive classes has potential to expand access to education and uphold their right to learn alongside typically developing peers. However, inadequate support in inclusive settings can hinder their participation and educational achievement. This study explores the perspectives of stakeholders on the ways in which inclusive education can support the needs or exacerbate the challenges of children with DD in Addis Ababa, Ethiopia, and on recommendations to address the challenges. Thirty-nine participants with expertise or experience relevant to children with DD, including caregivers, educators, clinicians and other experts, took part in semi-structured interviews. Their responses were analysed using thematic template analysis. The themes developed identify four aspects which are most relevant to the potential positive and negative consequences of inclusive education for children with DD: learning and development, peer relationships, safety in school and inclusion in society. The themes encompass sub-themes of positive and negative consequences, and suggested improvements to facilitate positive effects. Identified priorities for action include enhanced teacher training, awareness-raising initiatives, tailoring infrastructure and manpower to safeguard children with DD and promoting government focus on successful inclusion. These recommendations can be implemented to facilitate well-structured inclusive education, where children with DD are supported to participate alongside typically developing peers, as well as to safeguard against the potential negative consequences of inclusion, paying sufficient attention to the distinctive needs of children with DD.

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4. Cargill MI, Lerner MD, Kang E. The Moderating Effect of Sex on Autistic Trait Emotional Intelligence, Alexithymia, and Empathy. J Autism Dev Disord;2024 (Sep 26)

Autism spectrum disorder (ASD) is associated with differences in social communication, and these differences are related to trait emotional intelligence (TEI), alexithymia, and empathy. Autism is known to present differently in males and females, but research on sex differences in TEI, alexithymia, and empathy is largely relegated to non-autistic people. Therefore, the current research sought to explore individual relationships between autistic characteristics and TEI, alexithymia, and empathy, as well as the possible influence of sex in these relationships. In the current study, autistic and non-autistic adults reported on their autistic characteristics, TEI, alexithymia, and empathy. Based on previous research, it was hypothesized that more autistic characteristics would be associated with less TEI, more alexithymia, and less empathy, and that these relationships would be more prominent amongst males. More autistic characteristics were associated with greater challenges across the three areas of interest. However, only the relationship between TEI and autistic characteristics was moderated by sex, such that males demonstrated higher support needs related to TEI than females. Results from this analysis indicate that adults with more autistic characteristics, regardless of diagnostic status, demonstrate differences in TEI, alexithymia, and empathy. The current analysis may offer additional context to the evolving understanding of empathy and autism by suggesting that TEI and alexithymia could account for differences in empathy. Moreover, sex seems to play a role in the relationship between autistic characteristics and TEI such that differences are especially prominent for males.

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5. Christensen ZP, Freedman EG, Foxe JJ. Autism is associated with in vivo changes in gray matter neurite architecture. Autism Res;2024 (Sep 26)

Postmortem investigations in autism have identified anomalies in neural cytoarchitecture across limbic, cerebellar, and neocortical networks. These anomalies include narrow cell mini-columns and variable neuron density. However, difficulty obtaining sufficient post-mortem samples has often prevented investigations from converging on reproducible measures. Recent advances in processing magnetic resonance diffusion weighted images (DWI) make in vivo characterization of neuronal cytoarchitecture a potential alternative to post-mortem studies. Using extensive DWI data from the Adolescent Brain Cognitive Development(sm) (ABCD®) study 142 individuals with an autism diagnosis were compared with 8971 controls using a restriction spectrum imaging (RSI) framework that characterized total neurite density (TND), its component restricted normalized directional diffusion (RND), and restricted normalized isotropic diffusion (RNI). A significant decrease in TND was observed in autism in the right cerebellar cortex (β = -0.005, SE =0.0015, p = 0.0267), with significant decreases in RNI and significant increases in RND found diffusely throughout posterior and anterior aspects of the brain, respectively. Furthermore, these regions remained significant in post-hoc analysis when the autism sample was compared against a subset of 1404 individuals with other psychiatric conditions (pulled from the original 8971). These findings highlight the importance of characterizing neuron cytoarchitecture in autism and the significance of their incorporation as physiological covariates in future studies.

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6. Dodds L, Filliter C, Campbell LA, MacDonald NE, Shea S, Dubé E, Smith IM, Mehrabadi A, Filliter JH. Routine vaccine uptake in school-aged autistic and non-autistic youth: A linked database study. Can J Public Health;2024 (Sep 25)

OBJECTIVES: This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers. METHODS: In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive Grade 7 vaccinations between 2011 and 2017 were included in this study. Autism spectrum disorder (ASD) diagnoses were determined from administrative health data. Rates of receipt of any Grade 7 vaccine and of individual vaccines were compared between autistic and non-autistic youth. Subgroup analyses included comparing Grade 7 vaccine receipt between autistic youth and their non-autistic siblings and early childhood vaccine receipt between autistic and non-autistic cohorts. RESULTS: The rates of receipt of any vaccine were 73% among 916 autistic youth and 82% among 49,599 non-autistic youth (adjusted relative risk = 0.91; 95% confidence interval = 0.87-0.95). Similar results were found for individual vaccines. Subgroup analyses revealed lower rates of Grade 7 vaccine receipt among autistic youth compared to among their non-autistic siblings. Rates of early childhood vaccine receipt did not differ between autistic and non-autistic cohorts. CONCLUSION: Autistic youth were under-vaccinated compared to their non-autistic peers for Grade 7 vaccinations. Lower vaccination rates in autistic youth than in their non-autistic siblings suggest that setting-related factors may contribute more to the under-vaccination of autistic youth than parental vaccine hesitancy. Barriers to vaccine uptake for school-aged autistic youth, including those unique to school-based vaccination programs, must be explored and addressed.

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7. Haber T, Davies L, Hinman RS, Bennell KL, Bruce W, Jewell L, Borda A, Lawford BJ. ‘It’s especially good just to know that you’re not the only one’: a qualitative study exploring experiences with online peer support programmes for the Fragile X community. J Intellect Disabil Res;2024 (Sep 25)

BACKGROUND: Accessing peer support can be difficult for people with, or carers of people with, inherited intellectual disabilities. One way to improve access is to provide services online, yet few studies have explored people’s experiences with online peer support programmes. We aimed to explore experiences with such programmes for communities affected by fragile X-associated conditions. METHODS: Qualitative study involving individual semi-structured interviews with 16 people with, or carers of people with, a fragile X-associated condition (n = 4 adult premutation carriers; n = 12 parents/carers of children/adults), who participated in at least one of three online peer support programmes: educational webinars, Facebook discussion group and small peer group sessions via Zoom. Reflexive thematic analysis was used to develop themes. RESULTS: Three overarching themes relating to experiences were as follows: (1) uncertainty and value of shared experiences, (2) support navigating healthcare, (3) advantages being online, but still a place for in-person events. Educational webinars were perceived to be a valuable source of information about fragile X-associated conditions although people had variable information needs. Facebook discussion groups enabled people to connect with others, although participants expressed some competing preferences for how the groups were organised. Zoom peer group sessions were perceived to help participants feel supported by others, but that consistency in organisation was important. CONCLUSIONS: Online peer support programmes were perceived to be beneficial, bridging informational gaps and facilitating social connection. However, participants believed there was still a place for in-person events, some felt educational webinars did not always meet their needs and some had privacy concerns.

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8. Lane-McKinley K, Hogg J, Fung LK. Fatal Shooting of an Autistic Adolescent: What Should We Do?. J Autism Dev Disord;2024 (Sep 26)

Ryan Gainer, a 15-year-old African-American youth on the Autism-spectrum, was shot and killed by police officers in March 2024. The authors reflect on the tragedy of this incident and the harms that such police actions inflict on people living with disabilities and/or mental illnesses, as well as on their families, loved ones, and communities. Drawing on past research and similar incidents in recent years, the authors offer a series of systematic changes which may be effective in reducing the frequency and severity of police use of force on people on the autism spectrum.

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9. Lin J, Xu X, Li C, Kendrick T, He WQ. Multiple developmental disabilities among American children: prevalence and secular trends 2016-2022. Public Health;2024 (Sep 24);237:22-29.

OBJECTIVES: We aimed to estimate the prevalence of multiple developmental disabilities, identify associated characteristics, and examine trends among American children from 2016 to 2022. STUDY DESIGN: This was a cross-sectional study. METHODS: Using the National Survey of Children’s Health data from 2016 to 2022, we estimated the prevalence of multiple developmental disabilities among children aged 3-17 years. Multiple developmental disabilities were defined as two or more concurrent disabilities from 12 common disabilities. Trends were investigated using log-linear regression. Multivariate log-binominal regression was used to compare the prevalence prior to the COVID-19 pandemic (2016-2019) with prevalence during the COVID-19 pandemic (2020-2022). RESULTS: From 239,534 eligible children (mean age = 10.1 years; male = 51.7%), we found the overall prevalence of multiple developmental disabilities was 10.6%. The most predominant phenotype was attention-deficit/hyperactivity disorder concurrent with behavioural problems (2.1%). Higher prevalence was found among boys, non-Hispanic black children, those from low-household-income families and from families with lower education levels. Prevalence of multiple developmental disabilities increased from 9.8% in 2016 to 11.5% in 2022 (P = 0.014) with significantly higher prevalence during COVID-19 pandemic than before (11.2% vs 10.1%). These increases were found consistently across most sociodemographic groups. CONCLUSIONS: Children from certain socio-disadvantaged groups were disproportionally affected by multiple developmental disabilities, highlighting the need for targeted strategies to improve health. The increasing prevalence during the pandemic suggests the need for ongoing monitoring of the trend and the impact of these conditions.

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10. Liu Q, Yu D. Interaction and association between multiple vitamins and social adaptability and severity of autism: A large-scale retrospective study from China. Autism Res;2024 (Sep 26)

Since children with autism spectrum disorder (ASD) often exhibit selective eating behaviors, it is generally believed that they may have abnormal nutrient structure, leading to aberrant concentrations of some serum vitamins. However, previous studies on serum vitamins in individuals with ASD are mixed. Additionally, the interaction and association between multiple serum vitamin and ASD-related symptoms remain unclear. This study utilized a cross-sectional survey with a large sample size (n = 1235) from China to clarify previous mixed findings, and examine the interaction and association between multiple serum vitamins (including folic acid [FA], vitamin A [VA], vitamin E [VE], vitamin B12 [VB12], and vitamin D [VD]) and social adaptability and symptom severity in children with ASD. Findings found that symptom severity was negatively associated with concentrations of serum VA, VE, VB12, and VD; while, social adaptability was significantly associated with the natural log-transformed concentrations of FA and VB12. Finding also revealed the interaction of VA and VE on the association between both vitamins and severity of ASD symptoms, as well as the interaction of VB12 and FA on the association between both vitamins and social adaptability. In particular, the combination of low concentration of VA and high concentration of VE is associated with the lowest risk of being « severely autistic »; while, the combination of low concentration of FA and high concentration of VB12 is associated with the lowest risk of being « poor social adaptability ». This study offers the evidence for the requirement of considering multiple vitamins comprehensively, as well as valuable references for revealing the association between vitamin disparities and food selectivity in children with ASD.

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11. Michael Z, Brewer N. Detecting criminal intent in social interactions: The influence of autism and theory of mind. Law Hum Behav;2024 (Sep 26)

OBJECTIVE: Defense attorneys sometimes suggest that social-cognitive difficulties render autistic individuals vulnerable to involvement in crime, often arguing that theory of mind (ToM) difficulties that undermine inferences about others’ intentions underpin this vulnerability. We examined autistic adults’ ability to respond adaptively to criminal intent during interactions and whether difficulties were associated with poor ToM. HYPOTHESES: Compared with nonautistic adults, autistic adults were expected to be less likely to respond adaptively to another’s criminal intent and less likely to do so early in interactions, with poorer performance associated with ToM difficulties. METHOD: We developed the Suspicious Activity Paradigm, in which autistic (n = 102) and nonautistic (n = 95) adults listened (as if participating in an interaction) to audio scenarios in which cues suggesting their impending involvement in a crime gradually emerged. At periodic intervals, they were required to indicate how they would react toward the other person’s behavior, with response coding reflecting detection of, and adaptive responding to, suspicious activity. RESULTS: We observed similar patterns of suspicion and adaptive responses in autistic and nonautistic adults as the scenarios progressed. Regardless of diagnostic status, pronounced ToM difficulties and low verbal ability were independently associated with a lower likelihood of reporting suspicion and responding adaptively. CONCLUSIONS: Our results do not support the perspective that autistic adults are uniquely vulnerable to crime involvement due to an inability to recognize and respond adaptively to suspicious behavior. The potential for heightened criminal vulnerability was associated with significant ToM difficulties (and verbal ability) regardless of autism diagnostic status, although such difficulties were more prevalent in the autistic sample. The finding that pronounced ToM difficulties may heighten criminal vulnerability for both autistic and nonautistic individuals challenges the validity of a generalized « autism » legal defense based on assumed rather than measured ToM difficulties. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

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12. Montanaro FAM, Alfieri P, Caciolo C, Spano G, Bosco A, Vicari S. Effects of a combined neuropsychological and cognitive behavioral group therapy on young adults with Fragile X Syndrome: An explorative study. Res Dev Disabil;2024 (Sep 26);154:104839.

BACKGROUND: Fragile X Syndrome (FXS) is an X-linked neurodevelopmental disorder that leads to intellectual disability (ID) along with cognitive-behavioral difficulties. Research on psychosocial treatments in individuals FXS and ID is still lacking. This study aimed to investigate the effectiveness of a combined neuropsychological and cognitive behavioral group therapy (nCBT) among young adults with FXS. METHOD: Ten young adults diagnosed with FXS took part in the second stage intervention of « Corp-osa-Mente » (CoM II), a group nCBT program previously outlined by Montanaro and colleagues in an earlier study, with the participants being the same as in the previous research. This report details the outcomes of an additional twelve-month group sections aimed at enhancing the ability to manage emotions and the socio-communicative skills of these young adults. Caregivers completed measures of adaptive functioning, emotional and behavior problems, executive function, communication skills and family quality of life at pre-treatment (T0) and post-treatment (T1). RESULTS: CoM II showed a decrease in depressive and anxiety symptoms from T0 to T1, along with increased socio-pragmatic and communication skills from pre-test to post-test intervention. Additionally, our analysis revealed improvements in the adapative behavior of participants and in the family quality of life. CONCLUSIONS: These preliminary findings suggest that young adults with FXS and ID experienced positive outcomes through participation in CoM II, a group nCBT. However, it is recommended to undertake additional methodologically rigorous studies, such as randomized controlled trials (RCTs), to substantiate these initially promising findings.

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13. Pearson JN, Martin DLM, Stewart-Ginsburg JH, Malone KM, Manns LD, Johnson JA, Macko J, Rivera AD, Lewis J, Green K, Minerali A. Analyzing Community-Based Support Requests Made by Black Families Raising Autistic Children. J Autism Dev Disord;2024 (Sep 26)

PURPOSE: Black families experience additional barriers to accessing autism-related supports compared to White families. Community organizations can help mitigate the negative impact of systemic inequities and lack of support that Black caregivers of autistic family members experience. Little is known about the types of support Black families seek from these organizations. Therefore, the purpose of this study was to explore the support needs of Black families raising autistic children as evidenced by communication patterns in a community-based statewide autism organization. Our research questions were: (1) What are the autism-related support needs of Black families raising autistic children; and (2) How do familial demographics influence these support needs? METHODS: We explored the support needs of Black caregivers of autistic family members by analyzing a subset of 1,460 entries (16.8% of the total communication entries) within a database of communication entries from a community-based autism organization in one southeastern state in the United States. We analyzed the frequency of support request types and the relationships between support requests and familial demographics (i.e., rurality, gender, age). RESULTS: We found that Black families most often requested family or individual support, school-related support, and behavioral support. Families requested support with bullying, social services, and health insurance less often. We found significant interactions between the three most requested services and the rurality, gender, and age of the autistic family member. CONCLUSION: We conclude with suggestions for autism support organizations seeking to better meet the needs of Black families.

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14. Rademacher S, Preußner M, Rehm MC, Fuchs J, Heyd F, Eickholt BJ. PTEN controls alternative splicing of autism spectrum disorder-associated transcripts in primary neurons. Brain;2024 (Sep 26)

Phosphatase and tensin homologue (PTEN) is the main antagonist of the phosphatidylinositol-3-kinase (PI3K)/AKT/mTOR signalling pathway and mutated in 10-20% of individuals with autism spectrum disorder (ASD) exhibiting macrocephaly. Hyperactive mTOR signalling is responsible for some aspects during PTEN-ASD progression, e.g. neuronal hypertrophy and -excitability, but PI3K/mTOR-independent processes have additionally been described. There is emerging evidence that PTEN regulates gene transcription, spliceosome formation and pre-mRNA splicing independently of PI3K/mTOR. Altered splicing is a hallmark of brains from individuals with idiopathic and PTEN-ASD, however, molecular mechanisms are yet to be identified. We performed RNA-Seq followed by analysis of altered transcript splicing in Pten-deficient primary cortical mouse neurons, which we compared with published data from PTEN-deficient human neuronal stem cells. This analysis identified that transcripts were globally mis-spliced in a developmentally regulated fashion and cluster in synaptic and gene expression regulatory processes. Strikingly, splicing defects following Pten-deficiency represent a significant number of other known ASD-susceptibility genes. Furthermore, we show that exons with strong 3′ splice sites are more frequently mis-spliced under Pten-deficient conditions. Our study indicates that PTEN-ASD is a multifactorial condition involving the dysregulation of other known ASD-susceptibility genes.

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15. Rea CJ, Lesch K, Hernandez B, Hayes M, Sprecher E, Epee-Bounya A, Wilson K, Shah SN. « I’m His Voice »: Parent Perspectives on Obtaining an Autism Diagnosis and Services and the Influence of Personal and Cultural Factors. J Autism Dev Disord;2024 (Sep 26)

To assess caregiver-reported barriers and facilitators to receiving a diagnosis of Autism Spectrum Disorder (ASD) and accessing services as well as the influence of personal and cultural factors.Participants included 29 parents whose children had been diagnosed with ASD between January 2019 and November 2021 while receiving primary care at one of two urban, hospital-affiliated clinics. Semi-structured interviews and surveys were conducted between May 2022 and June 2023 in both English and Spanish. Transcripts were coded and themes developed using thematic content analysis. In the survey portion of the study, 80% of parents said the experience of getting the diagnosis was « very easy/somewhat easy, » while 28% of parents said the process of accessing autism services was « very difficult. » Four general categories emerged from the qualitative analysis: (1) experience getting the diagnosis, (2) service navigation after diagnosis, (3) need for parent advocacy, and (4) perception of condition by others. Parents generally reported positive experiences with their pediatricians, but some felt their concerns were discounted due to personal factors. The most common frustration expressed was difficulty accessing Applied Behavior Analysis therapy after a diagnosis due to long waiting lists, staff turnover and poor quality. Many parents felt that it would be helpful to have a family navigator to assist with paperwork, insurance complexities, and service access. Parents reported many challenges obtaining an autism diagnosis as well as accessing services. Widespread system change will be required to meet the needs of families equitably and effectively.

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16. Sameea AA, Abd El-Wahab EW, Osman SO. Risk of Autism Spectrum Disorder (ASD) Among 18 to 48 Month Old Children: A Multi-Center Study in Qatar. Glob Pediatr Health;2024;11:2333794×241284476.

Background. Little is known about autism spectrum disorder (ASD) in Qatar. The lack of consensus in ASD screening has led to differences in the reported prevalence with escalating rates over time. Objective(s). To screen for ASD and to identify associate factors among Qatary children aged 18 to 48 months. Methods. A cross-sectional study included 600 eligible children at 10 Primary Health Care Centers (PHCCs) in Qatar. Identification of ASD was based on the M-CHAT™ criteria. Results. The number of ASD screen-positive children in the M-CHAT™ was 25.13 per 10.000, and was significantly associated with older maternal age (10.5%) and history of neonatal hyperbilirubinemia (20.0%) [AOR] = 4.88; 95%[CI]: 1.50-16.30)]. The Odds of detecting ASD was lower in children below 2 years of age (AOR = 0.92; 95% CI: 0.87-0.98]). Conclusion. This study demonstrates the utility of M-CHAT™ for ASD screening in PHCCs. Identification of the factors associated with positive ASD screening can highlight areas suitable for future intervention.

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17. Stroupková L, Vyhnalová M, Kolář S, Knedlíková L, Packanová I, Bittnerová AM, Nováková N, Kučerová HP, Horák O, Ošlejšková H, Theiner P, Danhofer P. Use of Telehealth in Autism Spectrum Disorder Assessment in Children: Evaluation of an Online Diagnostic Protocol Including the Brief Observation of Symptoms of Autism. J Autism Dev Disord;2024 (Sep 26)

The COVID-19 pandemic revealed the need to develop the field of remote assessment for autism spectrum disorders (ASD). The purpose of the study was to evaluate an online assessment protocol that includes the Brief Observation of Symptoms of Autism (BOSA). The online protocol consisting of BOSA and the Autism Diagnostic Interview-Revised (ADI-R) was administered by experienced examiners to 29 children with suspected ASD. The participants were then evaluated by clinical psychologists in a standard clinical setting using the Autism Diagnostic Observation Schedule-2 (ADOS-2) and other methods, and the ASD diagnosis was confirmed or ruled out. The results show substantial to moderate inter-rater agreement between the online and face-to-face raters with the value of Cohen’s Kappa = 0.66 (P < 0.001); this corresponds with 79.8% agreement. The sensitivity of the protocol was approx. 94.7%, the specificity was 70%, the positive predictive value was 85.7%, and the negative predictive value was 87.5%. Further, direct false positive or false negative diagnostic conclusions based on the online protocol were absent when the possible conclusion of "I cannot decide" was included. The items B9 Showing, B10 Spontaneous Initiation of Joint Attention, B1 Unusual Eye Contact, B3 Facial Expressions Directed to Others, and C2 Imagination/Creativity were shown to be well observable in BOSA when related to ADOS-2 scoring. The results indicate that the protocol consisting of BOSA and ADI-R administered by an experienced examiner is a promising combination of tools for remote autism assessment.

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18. Wu YX, Li MJ, Liu Y, Guo M, Lan MN, Zheng HJ. ASPG and DAD1 are potential placental-derived biomarkers for ASD-like symptom severity levels in male/female offspring. Placenta;2024 (Sep 26);155:78-87.

INTRODUCTION: An early evaluating system for autism spectrum disorder (ASD) severity is crucial. Questionnaire survey is challenging for accurately assessing the severity levels for ASD in children. METHODS: Offspring with ASD-like phenotypes were induced by treating pregnant mice with Poly (I:C) at GD12.5 and the placentae corresponding to the offspring were obtained by caesarean. The autism severity composite score (ASCS) for offspring was calculated through behavioral tests. HE staining and immunohistochemistry were used to observe the morphology of placenta. Candidate biomarkers were identified by weighted protein co-expression network analysis (WPCNA) combined with machine learning and further validated by ELISA. Sperman’s was used to analyze the correlation between biomarkers and metabolome. RESULTS: The placental weight and mean vascular area of male offspring with ASD-like phenotypes were significantly decreased compared with typical mice. According to the WPCNA, four modules were identified and significantly correlated with ASCS of offspring. Two biomarkers (ASPG and DAD1) with high correlation with ASCS in offspring were identified. DISCUSSION: VEGF pathway may contribute to sexual dimorphism in placental morphology within mice with ASD-like phenotypes in term. The placental ASPG and DAD1 levels could reflect ASD-like symptom severity levels in male/female mice offspring.

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19. Xu F, Gage N, Zeng S, Zhang M, Iun A, O’Riordan M, Kim E. The Use of Digital Interventions for Children and Adolescents with Autism Spectrum Disorder-A Meta-Analysis. J Autism Dev Disord;2024 (Sep 26)

This comprehensive meta-analysis aimed to assess the effectiveness of digital interventions in improving developmental skills for children and adolescents with autism spectrum disorder (ASD). We conducted a systematic literature search based on three databases. A pre-test adjusted between-group standardized effect size was computed for effect size synthesis. We utilized a robust variance estimation model to analyze overall treatment effect. Moderator analyses and publication bias were also addressed. Twenty-eight studies (150 effect sizes) using randomized control trials (RCT; n = 22) or quasi-experimental designs (QED; n = 6) were included. Most studies (n = 22) included social-emotional skills as primary outcomes. The meta-analysis revealed a medium to large overall effect size, with Hedges’ g = 0.62, 95% CI [0.36, 0.88], p < 0.001. We found that digital interventions have a statistically significantly large effect on enhancing social-emotional skills compared with language and communication skills, cognitive skills, daily living skills, and physical skills. The results of moderator analyses indicated that computer-based interventions have larger effect sizes in comparison to tablet/smartphone-based interventions. No statistically significant differences were observed between studies utilizing RCT and those using QED. We recommended the integration of digital interventions as supplemental resources in behavioral and educational interventions. Further research needs to focus on more females, young children, and adolescents with ASD in digital intervention research.

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20. Ziva A, Ziori E. Implicit learning in children and adolescents with and without autism spectrum disorders: Exploring the effects of individual differences. Q J Exp Psychol (Hove);2024 (Sep 26):17470218241281639.

Implicit learning plays an important role in the acquisition of various skills that are often deficient in individuals with autism spectrum disorder (ASD). The present study examines the implicit learning ability of children and adolescents with ASD, by comparing it to that of a typical group of peers, using the Artificial Grammar Learning (AGL) task. In addition, this study investigates whether the above ability is associated with individual characteristics, namely intelligence quotient (IQ), ASD symptoms severity, and individual perception style (global/holistic or local/focused). The sample consisted of 20 individuals with mild to relatively severe ASD symptoms and 20 age- and gender-matched typically developing (TD) individuals. The unconscious (implicit) nature of learning was assessed via a subjective measure, the « no-loss gambling » method, which allows an unbiased evaluation of the confidence accompanying each judgement. The results provided evidence of implicit learning, which was preserved in the ASD group, although reduced relative to the typical group. Multiple linear regressions with interaction terms between group and participants’ scores on the Wechsler Abbreviated Scale of Intelligence (WASI), the Childhood Autism Rating Scale (CARS), and performance on a Navon-type task examined whether the possible relationships between each of the above scores and AGL and implicit learning differ in the two groups. Implicit learning was not significantly associated with IQ, ASD symptoms severity, or individual perception style (except for perception style in terms of reaction times [RTs] for the TD group). These results confirm and extend earlier findings supporting the resilience of implicit learning to individual differences.

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