1. Ansari S, AdibSaber F, Elmieh A, Gholamrezaei S. The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism. Sleep medicine. 2021; 82: 78-83.

OBJECTIVE: Previous studies have shown that children with autism have sleep disturbances and elevated levels of pro-inflammatory cytokines. This study aimed to evaluate the effect of aquatic exercise on sleep habits and two certain sleep-related cytokines of children with autism spectrum disorders (ASD). METHODS: Forty boys with ASD (aged 6-14) were recruited and randomly assigned to an aquatic exercise (n = 20) or a control group (n = 20). Participants in aquatic exercise group performed water-based activities for 10 weeks/2 sessions per week/60 min, while control group didn’t get any intervention. The serum levels of Interleukin-1 beta (IL-1β) and Tumor necrosis factor-α (TNF-α) and sleep quality were measured before and after the intervention. RESULTS: Results revealed that aquatic exercise may improve sleep quality and reduce the serum levels of IL-1β and TNF-α in children with ASD compared to control group. CONCLUSIONS: Overall, it is recommended that physicians and educators should provide a safe and effective exercise environment for ASD children to alleviate sleep issues and inflammatory biomarkers.

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2. Bradbury KR, Anderberg EI, Huang-Storms L, Vasile I, Greene RK, Duvall SW. Co-occurring Down Syndrome and Autism Spectrum Disorder: Cognitive, Adaptive, and Behavioral Characteristics. Journal of autism and developmental disorders. 2022; 52(3): 1235-46.

The current study explores functioning in individuals with co-occurring Autism Spectrum Disorder and Down Syndrome (ASD+DS; n = 23), individuals with ASD and cognitive impairment (ASD+ID; n = 99) and individuals with idiopathic ID (n = 38). ANCOVA results revealed that individuals with ASD+DS showed strengths in behavioral functioning compared to individuals with ID and more similar behavioral functioning to those with ASD+ID (η(2) = 0.12), with the exception of disruptive behaviors. Cognitive functioning (ɸ(c) = 0.41) and ASD symptomatology (η(2) = 0.11) were more comparable for children with ASD+DS and ASD + ID than for individuals with ID. Individuals with ASD+DS had the lowest overall adaptive skills (η(2) = 0.11). Findings highlight similarities between ASD+DS and ASD+ID groups, emphasizing the importance of ASD identification within the DS population to provide access to specific interventions.

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3. DeMayo MM, Pokorski I, Song YJC, Thapa R, Patel S, Ambarchi Z, Soligo D, Sadeli I, Thomas EE, Hickie IB, Guastella AJ. The Feasibility of Magnetic Resonance Imaging in a Non-Selective Comprehensive Clinical Trial in Pediatric Autism Spectrum Disorder. Journal of autism and developmental disorders. 2022; 52(3): 1211-22.

There is an increasing interest in using magnetic resonance imaging (MRI) as a tool for precision medicine in autism spectrum disorder (ASD). This study investigated the feasibility of MRI scanning in a large comprehensive, inclusive and test heavy clinical trial for children (aged 3-12 years) with ASD, without functioning constraints for participation. Of the 71 participants enrolled who consented to the MRI, 24 participants (38%) successfully completed an MRI scan at baseline along with other assessments. This scanning followed a familiarization procedure at two preceding visits. At post-treatment, 21 participants successfully completed the MRI scan. This study highlights the challenge of completing MRI assessments in ASD populations when conducted as one of a number of tests in a clinical trial.

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4. Di Y, Li Z, Li J, Cheng Q, Zheng Q, Zhai C, Kang M, Wei C, Lan J, Fan J, Ren W, Tian Y. Maternal folic acid supplementation prevents autistic behaviors in a rat model induced by prenatal exposure to valproic acid. Food & function. 2021; 12(10): 4544-55.

Maternal vitamin supplementation has been demonstrated to reduce the risks of a number of neurodevelopmental diseases in children. Autism spectrum disorder (ASD) is a group of neurodevelopment defects with high prevalence but without satisfactory therapy. The present work detected the effects of pregnancy supplementation with folic acid (FA) at different doses on rat models of ASD induced by prenatal exposure to valproic acid (VPA), an anti-epileptic increasing the risk of ASD when administered during pregnancy. The results show that maternal FA supplementation at a high dose (4 mg kg(-1)) prevented the delay in growth and development, and the deficits in social communicative behaviors and repetitive behaviors, possibly by restoring the increased dendritic spine density and rectifying the over-expression of synaptic proteins associated with excitatory neurons and the lower expression with inhibitory ones. The results provided experimental evidence suggesting a possible role of maternal FA supplementation in preventing ASD.

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5. Divan G, Bhavnani S, Leadbitter K, Ellis C, Dasgupta J, Abubakar A, Elsabbagh M, Hamdani SU, Servili C, Patel V, Green J. Annual Research Review: Achieving universal health coverage for young children with autism spectrum disorder in low- and middle-income countries: a review of reviews. Journal of child psychology and psychiatry, and allied disciplines. 2021; 62(5): 514-35.

BACKGROUND: Autism presents with similar prevalence and core impairments in diverse populations. We conducted a scoping review of reviews to determine key barriers and innovative strategies which can contribute to attaining universal health coverage (UHC), from early detection to effective interventions for autism in low- and middle-income countries (LAMIC). METHODS: A systematic literature search of review articles was conducted. Reviews relevant to the study research question were included if they incorporated papers from LAMIC and focused on children (

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6. Haghighat H, Mirzarezaee M, Araabi BN, Khadem A. Functional Networks Abnormalities in Autism Spectrum Disorder: Age-Related Hypo and Hyper Connectivity. Brain topography. 2021; 34(3): 306-22.

Autism spectrum disorder (ASD) is a developmental disorder characterized by defects in social interaction. The past functional connectivity studies using resting-state fMRI have found both patterns of hypo-connectivity and hyper-connectivity in ASD and proposed the age as an important factor on functional connectivity disorders. However, this influence is not clearly characterized yet. Previous studies have often examined the functional connectivity disorders in particular brain regions in an age group or a mixture of age groups. The present study compares whole-brain within-connectivity and between-connectivity between ASD individuals and typically developing (TD) controls in three age groups including children (< 11 years), adolescents (11-18 years), and adults (> 18 years), each comprising 21 ASD individuals and 21 TD controls. The age groups were matched for age, Full IQ, and gender. Independent component analysis and dual regression were used to investigate within-connectivity. The full and partial correlations between ICs were used to investigate between-connectivity. Examination of the within-connectivity showed hyper-connectivity, especially in cerebellum and brainstem in ASD children but both hyper/hypo connectivity in adolescents and ASD adults. In ASD children, difference in the between-connectivity among default mode network (DMN), salience-executive network and fronto-parietal network were observed. There was also a negative correlation between DMN and temporal network. Full correlation comparison between ASD adolescents and TD individuals showed significant differences between cerebellum and DMN. Our results supported just the hyper-connectivity in childhood, but both hypo and hyper-connectivity after childhood and hypothesized that abnormal resting connections in ASD exist in the regions of the brain known to be involved in social cognition.

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7. Jafarabadi MA, Gholipour K, Shahrokhi H, Malek A, Ghiasi A, Pourasghari H, Iezadi S. Disparities in the quality of and access to services in children with autism spectrum disorders: a structural equation modeling. Archives of public health = Archives belges de sante publique. 2021; 79(1): 58.

BACKGROUND: Socioeconomic disparities in health and healthcare are global issues that affect both adults as well as children. Children with exceptional healthcare needs, especially those with developmental impairments, including Autism Spectrum Disorders (ASD), encounter major disparities in access to and quality of health services. However, disparities in the population of children are rarely studied. The main aim of this paper is to study the socioeconomic disparities in children with ASD by examining the association between their Social Determinants of Health (SDH) status and access to and the quality of services. METHODS: This is a cross-sectional study on 202 children with ASD conducted in 2019 in two provinces including Ardabil and East-Azerbaijan, in the North-West of Iran. A structured, valid questionnaire was used to collect data on demographic, SDH status, quality of services, and access to services in a population of children with ASD aged 2-16-year-old. Around 77% participants were male and the mean age of children was 2 years and 6 months. Structural Equation Modeling (SEM) were used to assess the relationship. RESULTS: Based on the results of this study, the overall mean scores of the quality of services, access to services, and SDH status were 61.23 (30.01), 65.91 (21.89), and 29.50 (22.32) out of 100, respectively. All the associations between the quality and access dimensions and quality (B: 0.464-0.704) and access (B: 0.265-0.726) scales were statistically significant (P < 0.001). By adjusting to covariates, the access was also significantly related to service quality (P = 0.004). Finally, the associations between SDH score with service quality (P = 0.039) and access (P < 0.001) were positively significant. CONCLUSIONS: There are socioeconomic disparities in the quality of and access to services among children with ASD, who use ASD services, in the North-West of Iran. We recommend health/medical centers, where children are diagnosed with ASD, conducting SDH screening and providing families of low-SDH status with specific information about the quality of and access to services for children with ASD. Additionally, medical universities must have a plan to routinely monitor the quality of and access to services provided for the children with low SDH.

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8. Mehri F, Bashirian S, Khazaei S, Jenabi E. Association between pesticide and polychlorinated biphenyl exposure during pregnancy and autism spectrum disorder among children: a meta-analysis. Clinical and experimental pediatrics. 2021; 64(6): 286-92.

BACKGROUND: The effect of exposure to environmental factors on autism spectrum disorders (ASD), especially during pregnancy, is unclear. PURPOSE: This meta-analysis investigated the association between exposure to pesticides and polychlorinated biphenyls (PCBs) during pregnancy and ASD risk among children. METHODS: We searched Scopus, PubMed, Web of Science, and ProQuest for articles published through September 2019. Random-effects models were used to examine the association among studies using pooled odds ratios (ORs) and their 95% confidence intervals (CI). I2 tests were used to measure interstudy heterogeneity. RESULTS: The pooled OR indicated a significant association between PCB and pesticide exposure during pregnancy and ASD risk among children (OR, 1.80; 95% CI, 1.26-2.34; and OR, 1.20; 95% CI, 1.02-1.39), respectively. CONCLUSION: Findings of the present study indicate that exposure to pesticides and PCBs during pregnancy may affect the risk of ASD among children.

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9. Nagano M, Saitow F, Higo S, Uzuki M, Mikahara Y, Akimoto T, Ozawa H, Nishimori K, Suzuki H. Cesarean section delivery is a risk factor of autism-related behaviors in mice. Scientific reports. 2021; 11(1): 8883.

Cesarean section (C/S) is one way of delivering babies, and is chosen when mothers or babies are facing problems or life-threatening conditions during pregnancy. Many meta-analyses have suggested an etiological relationship between C/S delivery and autism spectrum disorders (ASDs). However, as a risk factor for ASDs, C/S delivery has not yet been well studied. Because C/S deliveries have been increasing, it is very important to investigate the causal association between C/S and ASDs. Here, using three approaches, we showed experimentally that C/S delivery induced ASD-like traits in offspring mice, and that some of these changes were ameliorated by one-time oxytocin (OXT) treatment. Treatment with OXT receptor antagonists before natural delivery also induced ASD-related behaviors. Moreover, wild-type mice born to OXT-KO dams showed similar changes. Thus, insufficient OXT exposure from dams to offspring during delivery may be a trigger for ASD-related behaviors.

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10. Sturm A, Williams J, Kasari C. Who gains and who loses? Sociodemographic disparities in access to special education services among autistic students. Autism research : official journal of the International Society for Autism Research. 2021; 14(8): 1621-32.

Little is known about differences in the allocation of special education services to students with autism compared with students with other primary learning differences (e.g., intellectual disability [ID], specific learning disability [SLD]) and the comparative impact of sociodemographic factors on special education service receipt. The present study aimed to compare allocation of services (i.e., quantity and types) between students eligible for special education services under autism, SLD and ID, and to identify differences in sociodemographic predictors (e.g., race, neighborhood income) of service allocation. Data were culled from special education administrative records from a large urban, primarily Hispanic, Latino, or Spanish-serving school district from academic years 2011-2012 to 2016-2017. Participants included N = 76,428 students (N(autism) = 18,151, N(SLD) = 54,001, N(ID) = 4,276) ages 2-18. Results showed that autistic students received, on average, more services than students with SLD. Services received by students served under autism and SLD eligibility were more congruent with areas of need (e.g., language, occupational therapy) relative to students served under ID. Student-level socioeconomic status (free and reduced lunch) was more positively predictive of the number of special education services received than the neighborhood income of the school the student attended. Finally, the most significant racial disparities in service allocation were observed among students served under autism eligibility. The present study demonstrates the critical role of economic resources in the quantity and types of services received, and the desirability of a public education for well-resourced families who are possibly best situated to navigate special education services. LAY SUMMARY: An eligibility of autism in special education confers a significant advantage in the number of services a student receives. Disparity in the quantity of special education services exists among autistic students across many sociodemographic factors. Most notably, greater allocation of services to non-Hispanic, Latino, or Spanish, White American, European American, or Middle Eastern American students and students who do not receive free and reduced lunch.

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11. Waisman-Nitzan M, Gal E, Schreuer N. « It’s like a ramp for a person in a wheelchair »: Workplace accessibility for employees with autism. Research in developmental disabilities. 2021; 114: 103959.

BACKGROUND, AIMS AND METHODS: Participation in employment by individuals with autism spectrum disorders (ASD) remains restricted despite their high motivation and evident abilities. Challenges to employment result from personal characteristics and environmental barriers. This phenomenological research explores the accessibility of a competitive work environment according to the perceptions of adults with ASD. PROCEDURES AND OUTCOMES: We conducted in-depth interviews with 19 employees with ASD, followed by a thematic content analysis. Three themes emerged: (a) the employees’ motivation for employment, (b) challenges and abilities at work, and (c) workplace accessibility (types of accommodations, implementation process). RESULTS AND CONCLUSIONS: The findings contribute a classification of accommodations that addresses the core characteristics of autism-challenges as well as abilities and motivations for employment. Four types of accommodations were identified: job-performance communication, attitudes and interpersonal communication, daily workplace routines, and physical and sensory environments. Hence, this study supports the centrality of environmental factors in successful employment of individuals with ASD. IMPLICATIONS: This study presents an evidence-based foundation for autism-related workplace accessibility. It offers an approach to enhance employees’ abilities, strengths, and motivation for employment, as well as to decrease barriers and challenges. The findings may expand organizational policies regarding accessibility and thereby anchor workplace accommodations within organizations’ corporate cultures.

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