1. Andrews DS, Aksman L, Kerns CM, Lee JK, Winder-Patel BM, Harvey DJ, Waizbard-Bartov E, Heath B, Solomon M, Rogers SJ, Altmann A, Nordahl CW, Amaral DG. Association of Amygdala Development With Different Forms of Anxiety in Autism Spectrum Disorder. Biological psychiatry. 2022.

BACKGROUND: The amygdala is widely implicated in both anxiety and autism spectrum disorder. However, no studies have investigated the relationship between co-occurring anxiety and longitudinal amygdala development in autism. Here, the authors characterize amygdala development across childhood in autistic children with and without traditional DSM forms of anxiety and anxieties distinctly related to autism. METHODS: Longitudinal magnetic resonance imaging scans were acquired at up to four time points for 71 autistic and 55 typically developing (TD) children (∼2.5-12 years, 411 time points). Traditional DSM anxiety and anxieties distinctly related to autism were assessed at study time 4 (∼8-12 years) using a diagnostic interview tailored to autism: the Anxiety Disorders Interview Schedule-IV with the Autism Spectrum Addendum. Mixed-effects models were used to test group differences at study time 1 (3.18 years) and time 4 (11.36 years) and developmental differences (age-by-group interactions) in right and left amygdala volume between autistic children with and without DSM or autism-distinct anxieties and TD children. RESULTS: Autistic children with DSM anxiety had significantly larger right amygdala volumes than TD children at both study time 1 (5.10% increase) and time 4 (6.11% increase). Autistic children with autism-distinct anxieties had significantly slower right amygdala growth than TD, autism-no anxiety, and autism-DSM anxiety groups and smaller right amygdala volumes at time 4 than the autism-no anxiety (-8.13% decrease) and autism-DSM anxiety (-12.05% decrease) groups. CONCLUSIONS: Disparate amygdala volumes and developmental trajectories between DSM and autism-distinct forms of anxiety suggest different biological underpinnings for these common, co-occurring conditions in autism.

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2. Arun P, Chavan BS. Survey of autism spectrum disorder in Chandigarh, India. The Indian journal of medical research. 2021; 154(3): 476-82.

BACKGROUND & OBJECTIVES: Prevalence of autism spectrum disorder (ASD) has been reportedly on the rise in western literature. However, accurate data from India are not available. The present study was planned to assess the community-based prevalence of ASD in Chandigarh, India. METHODS: This study was a two-stage survey of representative child population of Chandigarh using stratified random sampling technique, covering 8820 children between the ages 1.5 and 10 yr. Proportionate population from urban (82.3%), rural (4.3%) and slum area (13.4%) were included in the study and screened using Chandigarh autism screening instrument (CASI). Thirty two children scored above cut-off, of whom two had shifted to other places before they could be assessed and 30 were assessed in detail. Detailed assessment was done using Autism Diagnostic Interview-Revised and Childhood Autism Rating Scale-2; diagnosis was made according to the Diagnostic and Statistical Manual-5. Nineteen were diagnosed with ASD. RESULTS: Of the 8451 children screened between the age group of one and a half to 10 yr, 19 (10 boys and 9 girls) were diagnosed as ASD, thus the prevalence of ASD was found to be 2.25 per 1000 (0.69-5.19, 95% confidence interval) children in Chandigarh. No child below the cut-off on the screening instrument was diagnosed as ASD. INTERPRETATION & CONCLUSIONS: The results suggest that the prevalence of ASD in Chandigarh was in tandem with other reports from across India and was lower than western countries.

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3. Conti E, Scaffei E, Bosetti C, Marchi V, Costanzo V, Dell’Oste V, Mazziotti R, Dell’Osso L, Carmassi C, Muratori F, Baroncelli L, Calderoni S, Battini R. Looking for « fNIRS Signature » in Autism Spectrum: A Systematic Review Starting From Preschoolers. Frontiers in neuroscience. 2022; 16: 785993.

Accumulating evidence suggests that functional Near-Infrared Spectroscopy (fNIRS) can provide an essential bridge between our current understanding of neural circuit organization and cortical activity in the developing brain. Indeed, fNIRS allows studying brain functions through the measurement of neurovascular coupling that links neural activity to subsequent changes in cerebral blood flow and hemoglobin oxygenation levels. While the literature offers a multitude of fNIRS applications to typical development, only recently this tool has been extended to the study of neurodevelopmental disorders (NDDs). The exponential rise of scientific publications on this topic during the last years reflects the interest to identify a « fNIRS signature » as a biomarker of high translational value to support both early clinical diagnosis and treatment outcome. The purpose of this systematic review is to describe the updating clinical applications of fNIRS in NDDs, with a specific focus on preschool population. Starting from this rationale, a systematic search was conducted for relevant studies in different scientific databases (Pubmed, Scopus, and Web of Science) resulting in 13 published articles. In these studies, fNIRS was applied in individuals with Autism Spectrum Disorder (ASD) or infants at high risk of developing ASD. Both functional connectivity in resting-state conditions and task-evoked brain activation using multiple experimental paradigms were used in the selected investigations, suggesting that fNIRS might be considered a promising method for identifying early quantitative biomarkers in the autism field.

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4. Diamond G, Badir E, Almog S, Badir G, Jaoussy L, Akawi A, Jaber L. Characteristic Neuro-Linguistic Styles in Young Arabic Speaking Children Diagnosed with ASD. Child neurology open. 2022; 9: 2329048×221080271.

Evaluations of all Arabic speaking children age 3-9.0 years with significant speech delays or impairments, referred to a community based, child development center in the public health care system during a 5-year period were reviewed. Use of an inordinate degree of words and expressions in Fossha version of classical Arabic, mainly used in the media, children’s literature and formalized venues, as well as in English, was highly associated with ASD, especially among those who were both more intelligent (IQ> 70), as well as older (greater than 4 years), (Pearson 7.29, Fisher 2-tailed test, p = 0.015). The use of « out of context » speech embedded in ordinary Arabic vernacular was associated with a higher degree of speech stereotypy (p < 0.001) among children with ASD, and unrelated statistically to the number of hours of screen viewing time, jargoning or associative speech. Idiosyncratic speech choices reflect neuro-linguistic mechanisms in social communication- impaired youngsters.

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5. Hariz M. Stereotactic Ablative Surgery in Autism: A Cocktail of Lesioned Brain Targets?. Stereotactic and functional neurosurgery. 2022: 1-2.

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6. Issen T, Hinman JM, Dixon MR. Utilizing the AIM Curriculum to Improve Job Performance in an Educational Setting for Children With Autism and Related Disabilities. Behavior analysis in practice. 2022; 15(1): 172-8.

The current study evaluated the effect of brief, daily present moment awareness activities on the work performance of paraprofessionals working at a school for children with disabilities. A nonconcurrent multiple-baseline design across three participants evaluated changes in staff-initiated interactions with students and staff’s accuracy of data collection on student behavior. Relative to baseline, participants demonstrated an average increase in staff-initiated interactions and an increase in the average percentage accuracy of data collection. Participants averaged 10.02 (range 3.4-16.67) staff-initiated interactions during baseline and 15.38 (range 9.75-24.4) during the intervention phase. Relative to baseline, two of the three participants demonstrated an increase in their average accuracy of data collection on student behavior. Participants’ average data collection accuracy was 56.9% (range 40%-86.67%) during baseline and 91.98% (range 86.41%-100%) during intervention. The average percentage of nonoverlapping data was 61.67% (range 25%-100%) for staff-initiated interactions and 33.33% (range 0%-100%) for data collection accuracy. Implications and possibilities for future research related to acceptance and commitment training interventions in workplace environments are discussed.

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7. Krakowski AD, Cost KT, Szatmari P, Anagnostou E, Crosbie J, Schachar R, Duku E, Georgiades S, Ayub M, Kelley E, Nicolson R, Pullenayegum E, Barnett-Tapia C. Characterizing the ASD-ADHD phenotype: measurement structure and invariance in a clinical sample. Journal of child psychology and psychiatry, and allied disciplines. 2022.

BACKGROUND: Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) have considerable overlap, supporting the need for a dimensional framework that examines neurodevelopmental domains which cross traditional diagnostic boundaries. In the following study, we use factor analysis to deconstruct the ASD-ADHD phenotype into its underlying phenotypic domains and test for measurement invariance across adaptive functioning, age, gender and ASD/ADHD clinical diagnoses. METHODS: Participants included children and youth (aged 3-20 years) with a clinical diagnosis of ASD (n = 727) or ADHD (n = 770) for a total of 1,497 participants. Parents of these children completed the Social Communication Questionnaire (SCQ), a measure of autism symptoms, and the Strengths and Weaknesses of ADHD and Normal Behaviour (SWAN) questionnaire, a measure of ADHD symptoms. An exploratory factor analysis (EFA) was performed on combined SCQ and SWAN items. This was followed by a confirmatory factor analysis (CFA) and tests of measurement invariance. RESULTS: EFA revealed a four-factor solution (inattention, hyperactivity/impulsivity, social-communication, and restricted, repetitive, behaviours and interests (RRBI)) and a CFA confirmed good model fit. This solution also showed good model fit across subgroups of interest. CONCLUSIONS: Our study shows that a combined ASD-ADHD phenotype is characterized by two latent ASD domains (social communication and RRBIs) and two latent ADHD domains (inattention and hyperactivity/impulsivity). We established measurement invariance of the derived measurement model across adaptive functioning, age, gender and ASD/ADHD diagnoses.

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8. Mason L, Otero M, Andrews A. Cochran’s Q Test of Stimulus Overselectivity within the Verbal Repertoire of Children with Autism. Perspectives on behavior science. 2022; 45(1): 101-21.

Stimulus overselectivity remains an ill-defined concept within behavior analysis, because it can be difficult to distinguish truly restrictive stimulus control from random variation. Quantitative models of bias are useful, though perhaps limited in application. Over the last 50 years, research on stimulus overselectivity has developed a pattern of assessment and intervention repeatedly marred by methodological flaws. Here we argue that a molecular view of overselectivity, under which restricted stimulus control has heretofore been examined, is fundamentally insufficient for analyzing this phenomenon. Instead, we propose the use of the term « overselectivity » to define temporally extended patterns of restrictive stimulus control that have resulted in disproportionate populations of responding that cannot be attributed to chance alone, and highlight examples of overselectivity within the verbal behavior of children with autism spectrum disorder. Viewed as such, stimulus overselectivity lends itself to direct observation and measurement through the statistical analysis of single-subject data. In particular, we demonstrate the use of the Cochran Q test as a means of precisely quantifying stimulus overselectivity. We provide a tutorial on calculation, a model for interpretation, and a discussion of the implications for the use of Cochran’s Q by clinicians and researchers.

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9. Mason L, Otero M, Andrews A. Correction to: Cochran’s Q Test of Stimulus Overselectivity within the Verbal Repertoire of Children with Autism. Perspectives on behavior science. 2022; 45(1): 123.

[This corrects the article DOI: 10.1007/s40614-021-00315-w.].

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10. Naguy A, Al-Humoud AM, Pridmore S, Abuzeid MY, Singh A, Elsori D. Low-Dose Risperidone for an Autistic Child with Comorbid ARFID and Misophonia. Psychopharmacology bulletin. 2022; 52(1): 91-4.

Avoidant/Restrictive Food Intake Disorder and misophonia seem to be overrepresented in autism spectrum disorder. Literature is mute on psychopharmacotherapy in these complex presentations. Here, authors report on a challenging case of low-functioning ASD child with comorbid ARFID and misophonia that responded favorably to a low-dose risperidone. This is followed by a brief discussion of purported pharmacodynamic mechanisms and relevant literature.

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11. Shah PJ, Boilson M, Rutherford M, Prior S, Johnston L, Maciver D, Forsyth K. Neurodevelopmental disorders and neurodiversity: definition of terms from Scotland’s National Autism Implementation Team. The British journal of psychiatry : the journal of mental science. 2022: 1-3.

Adults with neurodevelopmental disorders frequently present to, but fit uneasily into, adult mental health services. We offer definitions of important terms related to neurodevelopmental disorders through unifying research data, medical and other viewpoints. This may improve understanding, clinical practice and development of neurodevelopmental disorder pathways within adult mental health services.

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12. Siani-Rose M, McKee R, Cox S, Goldstein B, Abrams D, Taylor M, Kurek I. The Potential of Salivary Lipid-Based Cannabis-Responsive Biomarkers to Evaluate Medical Cannabis Treatment in Children with Autism Spectrum Disorder. Cannabis and cannabinoid research. 2022.

Introduction: Autism spectrum disorder (ASD) is a group of heterogeneous neurodevelopmental conditions affecting social communication and social interaction. Medical cannabis (MC) treatment shows promising results as an approach to reduce behavioral difficulties, as determined mainly by subjective observations. We have recently shown the potential of cannabis-responsive biomarkers detected in saliva of children with ASD to objectively quantify the impact of successful MC treatment using a metabolomics approach. Since the pathology of ASD is associated with abnormal lipid metabolism, we used lipidomics on the same samples to (1) expand the repertoire of cannabis-responsive biomarkers and (2) provide preliminary insight into the role of MC on lipid metabolism. Materials and Methods: Saliva samples collected from children with ASD (n=15) treated with MC (both before and at the time of maximal impact of treatment) and an age-matched group of typically developing (TD) children (n=9) were subjected to untargeted lipidomics. The study was observational. Each child from the ASD group was receiving a unique individualized MC treatment regimen using off-the-shelf products as permitted by California law under physician supervision for at least 1 year. Doses of tetrahydrocannabinol (THC) ranged from 0.05 to 50 mg and cannabidiol (CBD) from 7.5 to 200 mg per treatment. The ASD group was evaluated for signs of improvement using parental brief Likert scale surveys. Results: Twenty-two potential lipid-based cannabis-responsive biomarkers exhibiting a shift toward the TD physiological levels in children with ASD after MC treatment were identified. Members from all five lipid subclasses known to be present in saliva were characterized. Preliminary lipid association network analysis suggests involvement of two subnetworks previously linked to (1) inflammation and/or redox regulation and (2) oxidative stress. The significant changes in sphingomyelin in this study and in N-acetyl-aspartate (NAA) previously detected in the metabolomics analysis of the same saliva samples may indicate a role of MC in neuron function. Conclusions: Our findings suggest that lipid metabolites in saliva can potentially serve as cannabis-responsive biomarkers and objectively quantify the impact of MC treatment, and indicate a possible mechanism of action for MC. This preliminary study requires further investigation with a larger population and appropriate clinical trial monitoring.

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13. Straub L, Hernández-Díaz S, Bateman BT, Wisner KL, Gray KJ, Pennell PB, Lester B, McDougle CJ, Suarez EA, Zhu Y, Zakoul H, Mogun H, Huybrechts KF. Association of Antipsychotic Drug Exposure in Pregnancy With Risk of Neurodevelopmental Disorders: A National Birth Cohort Study. JAMA internal medicine. 2022; 182(5): 522-33.

IMPORTANCE: Although antipsychotic drugs cross the placenta and animal data suggest potential neurotoxic effects, information regarding human neurodevelopmental teratogenicity is limited. OBJECTIVE: To evaluate whether children prenatally exposed to antipsychotic medication are at an increased risk of neurodevelopmental disorders (NDD). DESIGN, SETTINGS, AND PARTICIPANTS: This birth cohort study used data from the Medicaid Analytic eXtract (MAX, 2000-2014) and the IBM Health MarketScan Research Database (MarketScan, 2003-2015) for a nationwide sample of publicly (MAX) and privately (MarketScan) insured mother-child dyads with up to 14 years of follow-up. The MAX cohort consisted of 2 034 883 children who were not prenatally exposed and 9551 who were prenatally exposed to antipsychotic medications; the MarketScan consisted of 1 306 408 and 1221 children, respectively. Hazard ratios were estimated through Cox proportional hazards regression, using propensity score overlap weights for confounding control. Estimates from both cohorts were combined through meta-analysis. EXPOSURES: At least 1 dispensing of a medication during the second half of pregnancy (period of synaptogenesis), assessed for any antipsychotic drug, at the class level (atypical and typical), and for the most commonly used drugs (aripiprazole, olanzapine, quetiapine, risperidone, and haloperidol). MAIN OUTCOMES AND MEASURES: Autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disability, speech or language disorder, developmental coordination disorder, intellectual disability, and behavioral disorder, identified using validated algorithms, and the composite outcome of any NDD. Data were analyzed from April 2020 to January 2022. RESULTS: The MAX cohort consisted of 2 034 883 unexposed pregnancies and 9551 pregnancies with 1 or more antipsychotic drug dispensings among women with a mean (SD) age of 26.8 (6.1) years, 204 (2.1%) of whom identified as Asian/Pacific Islander, 2720 (28.5%) as Black, 500 (5.2%) as Hispanic/Latino, and 5356 (56.1%) as White. The MarketScan cohort consisted of 1 306 408 unexposed and 1221 exposed pregnancies among women with a mean (SD) age of 33.1 (5.0) years; race and ethnicity data were not available. Although the unadjusted results were consistent with an approximate 2-fold increased risk for most exposure-outcome contrasts, risks were no longer meaningfully increased after adjustment (eg, pooled unadjusted vs adjusted hazard ratios [95% CI] for any NDD after any antipsychotic exposure: 1.91 [1.79-2.03] vs 1.08 [1.01-1.17]), with the possible exception of aripiprazole (1.36 [1.14-1.63]). Results were consistent across sensitivity analyses. CONCLUSIONS AND RELEVANCE: The findings of this birth cohort study suggest that the increased risk of NDD seen in children born to women who took antipsychotic drugs late in pregnancy seems to be explained by maternal characteristics and is not causally related with prenatal antipsychotic exposure. This finding highlights the importance of closely monitoring the neurodevelopment of the offspring of women with mental illness to ensure early intervention and support. The potential signal for aripiprazole requires replication in other data before causality can be assumed.

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14. Suarez VD, Moon EI, Najdowski AC. Systematic Review of Acceptance and Commitment Training Components in the Behavioral Intervention of Individuals with Autism and Developmental Disorders. Behavior analysis in practice. 2022; 15(1): 126-40.

Acceptance and commitment therapy (ACT) is a contemporary approach to dealing with unhelpful private events and improving psychological flexibility (Hayes et al., 2006) that is often used in psychotherapy (Szabo, 2019). Nonpsychotherapeutic uses of ACT have been referred to as acceptance and commitment training (ACTraining; Moran, 2011, 2015; Szabo, 2019), which refers to the use of one or more of six processes-present moment attention or mindfulness, values clarification, committed action, self-as-context, defusion, and acceptance (Hayes et al., 2006)-implemented outside of psychotherapeutic settings. There has been a recent increase in interest in ACTraining within the behavior-analytic community, which has led behavior analysts to question whether ACTraining is useful to the field of applied behavior analysis (ABA) and whether it is within the scope of practice of behavior analysts. Tarbox et al. (2020) proposed that the use of ACTraining is within the scope of practice of behavior analysts and aligns with the seven dimensions of ABA as outlined by Baer et al. (1968). The purpose of the current study was to provide a systematic review of single-case research designs that measure the behavioral effects of ACTraining components conducted with individuals with autism spectrum disorder or developmental disorders, their parents, and their staff, and to inform clinicians and researchers about what variables have been evaluated and what gaps still exist.

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15. Sundberg CT, Sundberg ML. Jack Michael’s Contributions to the Treatment of Autism. Behavior analysis in practice. 2022; 15(1): 1-6.

Jack Michael dedicated his life to teaching behavior analysis. He was passionate about Skinner’s works and his enthusiasm was contagious. Jack’s primary goal for his students was that they be able to analyze behavior like Skinner analyzed behavior, but with a little bit of Jack Michael sprinkled in here and there. Jack is probably best known to behavior analysts for his conceptual contributions to our field (e.g., his work on motivation), but his contributions to the treatment of autism are perhaps his most socially significant achievement. In our tribute to Jack, we will describe how he advanced the treatment of autism not only through his conceptual work and his teaching, but through his role in the development of applied behavior analysis, and in the application of Skinner’s (1957) analysis of verbal behavior to language assessment and intervention for children and adults with language delays.

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16. Wang Z, Lu T, Li X, Jiang M, Jia M, Liu J, Zhang D, Li J, Wang L. Altered Expression of Brain-specific Autism-Associated miRNAs in the Han Chinese Population. Frontiers in genetics. 2022; 13: 865881.

Autism is a complex neurodevelopmental disorder. However, its etiology is still unknown. MicroRNAs (miRNAs) are key post-transcriptional regulators. They play an important role in neurodevelopment and brain functions and may be involved in the pathogenesis of autism. Previous studies indicated altered expression of miRNAs in patients with autism. However, the findings were not consistent, and further explorations were needed. This study aimed to investigate whether miRNAs were dysregulated in autism. We examined the expression of 30 brain-specific autism-associated miRNAs in 110 patients with autism and 113 controls in the Han Chinese population using quantitative reverse transcription-polymerase chain reaction. The results demonstrated that 10 miRNAs (hsa-miR-191-5p, hsa-miR-151a-3p, hsa-miR-139-5p, hsa-miR-181a-5p, hsa-miR-432-5p, hsa-miR-181b-5p, hsa-miR-195-5p, hsa-miR-328-3p, hsa-miR-106a-5p, and hsa-miR-484) were significantly differentially expressed (false discovery rate <0.05). All of them were up-regulated in patients with autism compared with controls. The targets of these miRNAs were enriched for genes and pathways related to neurodevelopment, brain functions and autism. These findings suggested the participation of these 10 miRNAs in the pathogenesis of autism in the Han Chinese population.

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17. Watkins LV, O’Dwyer M, Shankar R. A review of the pharmacotherapeutic considerations for managing epilepsy in people with autism. Expert opinion on pharmacotherapy. 2022: 1-11.

INTRODUCTION: Autism, like other neurodevelopmental disorders (NDDs), has a strong association with epilepsy. There are known common genetic pathways in both autism and epilepsy. There are also specific genetic syndromes associated with both complex epilepsy and the autism phenotype. AREAS COVERED: This review explores the evidence for common genetic etiologies and pathophysiological pathways in relation to both epilepsy and autism. Autism with comorbid epilepsy are associated with a high prevalence of medical and psychiatric comorbidities. This paper discusses how this influences assessment, treatment, and outcomes. The evidence for the treatment of specific seizure types in the context of NDDs is also examined alongside clinical commentary. EXPERT OPINION: Despite the strong association, there is a limited evidence base to support the efficacy and tolerability of anti-seizure medications specifically in autism, with no Level 1 evidence or National Guidance available. Autism and epilepsy should be approached under a NDD model with cautious introduction and titration of anti-seizure medication. Alongside this, there is evidence to support a move toward precision medicine in specific genetic syndromes such as Tuberous Sclerosis Complex and other genetic seizure disorders. The first-line treatments that should be considered for focal seizures include carbamazepine, lamotrigine, and levetiracetam.

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