1. Beiting M. Diagnosis and Treatment of Childhood Apraxia of Speech Among Children With Autism: Narrative Review and Clinical Recommendations. Language, speech, and hearing services in schools. 2022: 1-22.

PURPOSE: Treatment for children with autism spectrum disorder (ASD) and low verbal ability is a largely neglected area of study. Existing research focuses on language abilities; however, a subset of children with ASD also has speech sound disorders (SSDs). The purpose of this tutorial is to provide clinicians with evidence-based recommendations to guide speech assessment and treatment among children with ASD, low verbal ability, and suspected childhood apraxia of speech (CAS). METHOD: Multifaceted search procedures were used to identify studies that have assessed or treated speech sound production among children with ASD. A narrative review and synthesis of the literature is followed by practical clinical recommendations based on best available evidence. CONCLUSIONS: It is critically important to consider all possible hindrances to the development of functional communication ability for children with ASD. Speech sound production has been identified as a key predictor of expressive language outcomes, yet there are very few studies that address assessment and treatment of SSDs among children with ASD. Less is known about the presentation of CAS among children with ASD and low verbal ability. More research is needed to determine whether existing speech assessment and treatment methods are appropriate for children with ASD, if modifications are needed, or if new methods should be designed.

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2. Bojda A, Srebnicki T, Konowałek Ł, Bryńska A. Weak central coherence – construct conception, development, research methods. Psychiatria polska. 2021; 55(6): 1373-86.

Central coherence allows for integration of different stimuli into a coherent whole. It also enables context-dependent information processing. This term was coined in an effort to arrange multiple observations of cognitive functioning of people with autism spectrum disorder (ASD). Weak central coherence, which is characteristic of ASD, is understood as adivergent cognitive style with a tendency to process incoming information locally. This allows us to describe central coherence as a continuous trait. Despite manifold research programs, a conclusive conceptualization of the construct is still lacking. The open question is whether weak central coherence constitutes alimited ability to integrate stimuli or rather an increased ability to focus on details. An important postulate concerns the establishment of a standard for measuring central coherence and its individual dimensions. Studies of central coherence outside of ASD context are scarce and deal predominantly with eating disorders. The following work is an overview of the current state of knowledge about central coherence construct and methods of research.

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3. Buranova N, Dampf M, Stevenson B, Sohl K. ECHO Autism: Early Intervention Connecting Community Professionals to Increase Access to Best Practice Autism Intervention. Clinical pediatrics. 2022: 99228221090710.

Autism spectrum disorder (ASD) is estimated to affect 1 in 44 children in the United States. Disparities exist related to socioeconomic, racial/ethnic and geographic demographics. Due to the shortages of autism specialists in diagnosis, treatment and education for people with ASD, novel approaches to improve access to best practices are needed to ensure quality services. ECHO Autism: Early Intervention clinic consists of biweekly sessions focused on early identification and management of evidence-based practices for young children with ASD. It is an adaptation of the ECHO Autism clinic that has been proven effective for primary care providers. The clinic provides a safe, virtual learning environment where diverse professionals who work with children at risk or diagnosed with ASD can collaborate and learn together. ECHO Autism: Early Intervention bridges the care gap between autism specialists, community intervention providers, and children with autism to increase capacity for autism intervention best practices in underserved communities. Through participation in this convenient, web-based small group, the providers get specific case guidance on children at risk or diagnosed with autism and share best practices for autism specific interventions. Finally, the clinic connects participants with community resources, and family/caregiver support. In our article, we address the current challenge of access to quality early intervention specific to ASD in rural and underserved communities and how this issue can be addressed through a virtual ECHO Autism clinic. The aim of this concept article is to describe the innovative ECHO Autism: Early Intervention clinic and discuss its benefits and impact in the field.

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4. Dunalska A, Rzeszutek M, Dębowska Z, Bryńska A. Comorbidity of bipolar disorder and autism spectrum disorder – review paper. Psychiatria polska. 2021; 55(6): 1421-31.

Autism spectrum disorder (ASD) is a heterogeneous group of neurodevelopmental disorders that can affect up to 2.6% of the population. Most of these people will have at least one other psychiatric disorder, often diagnosed with a delay or not recognized at all. This study describes the epidemiology, diagnostic difficulties and potential treatment of patients with ASD and comorbid bipolar disorder (BD). The prevalence of bipolar disorder in ASD is estimated at 5-8%. The study with the most numerous group included 700,000 children out of which 9,062 fulfilled ASD criteria at 16 – BD was found to be 6 times more prevalent in this group compared to the control group. Many factors affect the diagnosis. Patients with ASD often have limited insight into understanding the complex emotional states and difficulty in expressing them due to their impairment. The symptoms of bipolar disorder are in their case unspecific and differ from those occurring in the general population, which makes it difficult to make proper diagnosis. Despite the lack of research on the group of patients with ASD, psychometric tools designed to evaluate the general population are used to examine patients. This work aims to show the current state of knowledge and highlight areas that require further investigation.

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5. Kalb LG, Singh V, Hong JS, Holingue C, Ludwig NN, Pfeiffer D, Reetzke R, Gross AL, Landa R. Analysis of Race and Sex Bias in the Autism Diagnostic Observation Schedule (ADOS-2). JAMA network open. 2022; 5(4): e229498.

IMPORTANCE: There are long-standing disparities in the prevalence of autism spectrum disorder (ASD) across race and sex. Surprisingly, few studies have examined whether these disparities arise partially out of systematic biases in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the reference standard measure of ASD. OBJECTIVE: To examine differential item functioning (DIF) of ADOS-2 items across sex and race. DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional study of children who were evaluated for ASD between 2014 and 2020 at a specialty outpatient clinic located in the Mid-Atlantic region of the US. Data were analyzed from July 2021 to February 2022. EXPOSURES: Child race (Black/African American vs White) and sex (female vs male). MAIN OUTCOMES AND MEASURES: Item-level biases across ADOS-2 harmonized algorithm items, including social affect (SA; 10 items) and repetitive/restricted behaviors (RRBs; 4 items), were evaluated across 3 modules. Measurement bias was identified by examining DIF and differential test functioning (DTF), within a graded response, item response theory framework. Statistical significance was determined by a likelihood ratio χ2 test, and a series of metrics was used to examine the magnitude of DIF and DTF. RESULTS: A total of 6269 children (mean [SD] age, 6.77 [3.27] years; 1619 Black/African American [25.9%], 3151 White [50.3%], and 4970 male [79.4%]), were included in this study. Overall, 16 of 140 ADOS-2 diagnostic items (11%) had a significant DIF. For race, 8 items had a significant DIF, 6 of which involved SA. No single item showed DIF consistently across all modules. Most items with DIF had greater difficulty and poorer discrimination in Black/African American children compared with White children. For sex, 5 items showed significant DIF. DIF was split across SA and RRB. However, hand mannerisms evidenced DIF across all 5 algorithms, with generally greater difficulty. The magnitude of DIF was only moderate to large for 2 items: hand mannerisms (among female children) and repetitive interests (among Black/African American children). The overall estimated effect of DIF on total DTF was not large. CONCLUSIONS AND RELEVANCE: These findings suggest that the ADOS-2 does not have widespread systematic measurement bias across race or sex. However, the findings raise some concerns around underdetection that warrant further research.

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6. Kumar S, Nandyal SR, Kaushik S, Ibrahim S. Rare case of mesocardia with ostium secundum ASD and double IVC. BMJ case reports. 2022; 15(4).

We report an extremely rare case of mesocardia with double inferior vena cava (IVC) in this case report. The patient’s associated atrial septal defect (ASD) with left to right shunt leading to pulmonary congestion and recurrent episodes of pneumonia was the leading diagnosis for which care was sought at our hospital. The diagnoses of these rare congenital cardiac anomalies were uncovered only after a thorough workup. Mesocardia is extremely rare and accounts for only 0.2% of congenital anomalies. Its association with other cardiac and vascular anomalies, however, warrants a meticulous workup for the identification of such associated conditions-ASD and double IVC being two such anomalies in our patient. The dictum of working up a case of congenital cardiac anomaly for other congenital cardiaovascular anomalies, therefore, found merit in our case.

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7. Oppenheim D, Koren-Karie N, Joels T, Hamburger L, Maccabi Y, Slonim M, Yirmiya N. Attachment to fathers and mothers in preschoolers with an Autism Spectrum Disorder diagnosis. Attachment & human development. 2022: 1-14.

We examined whether the Strange Situation Procedure (SSP) is applicable not only for assessing children with Autism Spectrum Disorder (ASD) and their mothers but also with their fathers. Forty preschoolers with ASD were observed in the SSP with their mothers and 39 with their fathers. Unexpectedly, the SSP was found to be not applicable (NA) to 25% of the SSPs with fathers because levels of attachment behavior were minimal, but all SSPs with mothers were codable. NA children had lower cognitive functioning and more severe symptoms than those not so coded. Insecure children with their fathers had more severe symptoms than secure children, but were not different in their cognitive functioning. No associations between attachment with mother and severity of symptoms/cognitive functioning were found. Attachment was unrelated to parents’ distress or Broad Autism Phenotype. The study raises questions regarding the applicability of the SSP with fathers of children with ASD.

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8. Qiu X, Li X, Zhang S. Decreased Empathy Response to Other’s Pain in Parents of Children With Autism Spectrum Disorder. The Journal of nervous and mental disease. 2022.

We aimed to investigate pain empathy ability and self-reported empathy among parents of children with autism spectrum disorder (ASD). Twenty-four parents of children with ASD and 26 parents of typically developing children completed the Empathy Quotient (EQ) self-report scale and responded to painful or neutral images during an empathy-for-pain paradigm test. Parents of children with ASD had lower EQ scores, lower accuracy, and longer reaction time (RT) for pain empathy task response (all p < 0.05) compared with controls. There was a negative relationship between cognitive empathy, social skills, total EQ scores, and RT of response in parents of children with ASD. Our findings indicate that self-reported empathy deficits and decreased empathy response to the sight of others' pain in parents of children with ASD are part of a broader autistic phenotype.

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9. Salazar de Pablo G, Jordá CP, Vaquerizo-Serrano J, Moreno C, Cabras A, Arango C, Hernández P, Veenstra-VanderWeele J, Simonoff E, Fusar-Poli P, Santosh P, Cortese S, Parellada M. Systematic Review and Meta-analysis: Efficacy of Pharmacological Interventions for Irritability and Emotional Dysregulation in Autism Spectrum Disorder and Predictors of Response. Journal of the American Academy of Child and Adolescent Psychiatry. 2022.

INTRODUCTION: Emotional dysregulation and irritability are common in individuals with autism spectrum disorder (ASD). We conducted the first meta-analysis assessing the efficacy of a broad range of pharmacological interventions for emotional dysregulation and irritability in ASD and predictors of response. METHOD: Following a pre-registered protocol (PROSPERO: CRD42021235779), we systematically searched multiple databases until 01/01/2021. We included placebo-controlled randomized controlled trials (RCTs) and evaluated the efficacy of pharmacological interventions and predictors of response for emotional dysregulation and irritability. We assessed heterogeneity using Q statistics and publication bias. We conducted sub-analyses and meta-regressions to identify predictors of response. The primary effect size was the Standardized Mean Difference. Quality of studies was assessed using the « Cochrane Risk of Bias Tool » (RoB2). RESULTS: 2,856 individuals with ASD in 45 studies were included, of which 26.7% of RCTs were at high risk of bias. Compared to placebo, antipsychotics (1.028, 0.824 to 1.232) and medications used to treat ADHD (0.471, 0.061 to 0.881) were significantly better than placebo in improving emotional dysregulation and irritability, while evidence of efficacy was not found for other drug classes (p>0.05). Within individual medications, evidence of efficacy was found for aripiprazole (1.179, 0.838 to 1.520) and risperidone (1.074, 0.818 to 1.331). Increased rates of comorbid epilepsy (β=-0.049, p=0.026) were associated with a lower efficacy. CONCLUSION: Some pharmacological interventions (particularly risperidone and aripiprazole) have proved efficacy for short-term treatment of emotional dysregulation and irritability in ASD and should be considered within a multimodal treatment plan, taking into account also tolerability profile and families’ preferences.

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10. Williams ZJ. Race and Sex Bias in the Autism Diagnostic Observation Schedule (ADOS-2) and Disparities in Autism Diagnoses. JAMA network open. 2022; 5(4): e229503.

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11. Zetler NK, Cermak SA, Engel-Yeger B, Baranek G, Gal E. Association Between Sensory Features and High-Order Repetitive and Restricted Behaviors and Interests Among Children With Autism Spectrum Disorder. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 2022; 76(3).

IMPORTANCE: Children diagnosed with autism spectrum disorder (ASD) are often referred to occupational therapy practitioners so their sensory features and their repetitive and restricted behaviors and interests (RRBIs) can be addressed. RRBIs include an insistence on sameness, narrow interests, rigid routines, and rituals. However, there is a paucity of knowledge concerning the association between sensory features-across patterns, modalities, and contexts-and high-order RRBIs among children with ASD who are cognitively able. OBJECTIVE: To examine the association between sensory features across sensory patterns, modalities, and contexts and high-order RRBIs in children with ASD. DESIGN: Correlational clinical study based on parent questionnaire responses. SETTING: General education system in Israel. PARTICIPANTS: Parents of 39 cognitively able school-age children with ASD (ages 6-10 yr; 34 boys and 5 girls), recruited by means of convenience sampling. OUTCOMES: High-order RRBIs were assessed with relevant subscales from the Repetitive Behavior Scale-Revised (RBS-R), and sensory features across patterns, modalities, and contexts were examined with the Sensory Experiences Questionnaire, Version 2.1. The study hypotheses were formulated before data were collected. RESULTS: Significant correlations were observed between the high-order RRBIs of children with ASD and their sensory features across patterns, sensory modalities, and contexts. Fifty-one percent of the total RBS-R scores were predicted by sensory hyperresponsiveness, and an additional 11% were predicted by sensory-seeking behaviors. CONCLUSIONS AND RELEVANCE: The hypotheses concerning the association between sensory features and high-order RRBIs were confirmed. The findings enhance occupational therapy practitioners’ understanding of this association and may assist in the planning of more efficient interventions. What This Article Adds: The findings enhance clinical knowledge concerning the association between sensory features and high-order RRBIs and may lay a better foundation for occupational therapy interventions for children with ASD and their families.

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