1. Berg KL, Mihaila I, Feinstein RT, Shiu CS, Gussin H, Acharya K, Gladstone TRG, Bernard L, Best M, Renz E, Abdallah G, Weldy S, Herrman D, Lynch E, Gerges M, Perez P, Buchholz KR, Msall M, Aaron S, Mutti M, Arnold C, Danguilan C, Argueta I, Hunter M, Pela E, Diviak K, Kuhn J, Berbaum ML, Van Voorhees BW. BEhavioral Health Stratified Treatment (B.E.S.T.) to optimize transition to adulthood for youth with intellectual and/or developmental disabilities. Contemporary clinical trials. 2023: 107374.

Youth with intellectual and/or developmental disabilities (IDD) often struggle with depression and anxiety, which adversely impacts transition to adulthood. Integrated behavioral health care coordination, wherein care coordinators and behavioral health specialists collaborate to provide systematic, cost-effective, patient-centered care, is a promising strategy to improve access to behavioral health services and address factors that impact transition to adulthood, including depression/anxiety symptoms. Current care coordination models (e.g., Title V Maternal and Child Health Bureau [MCHB]) do not include behavioral health services. The CHECK (Coordinated HealthCarE for Complex Kids) mental health model, hereby refined and renamed BEhavioral Health Stratified Treatment (B.E.S.T.), is a behavioral health intervention delivery program designed for integration into care coordination programs. This study aims to determine whether an integrated behavioral health care coordination strategy (i.e., MCHB care coordination plus B.E.S.T.) would be more acceptable and lead to better youth health and transition outcomes, relative to standard care coordination (i.e., MCHB care coordination alone). Results would guide future investment in improving outcomes for youth with IDD. This study is a two-arm randomized clinical trial of 780 transition-aged youth with IDD (13-20 years) to evaluate the comparable efficacy of MCHB Care Coordination alone vs. MCHB Care Coordination plus B.E.S.T. on the following outcomes: 1) decreased symptoms and episodes of depression and anxiety over time; 2) improved health behaviors, adaptive functioning and health related quality of life; 3) increased health care transition (HCT) readiness; and 4) improved engagement and satisfaction with care coordination among stakeholders.

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2. Huang CY, Chen KS, Lee KY, Lin CH, Chen KL. Correction: Different autism measures targeting different severity levels in children with autism spectrum disorder. European archives of psychiatry and clinical neuroscience. 2023.

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3. Nuyttens M, Simons A, Antrop I, Glazemakers I. A longitudinal study of autism spectrum disorder characteristics in adolescents with restrictive type anorexia nervosa during and after underweight. European eating disorders review : the journal of the Eating Disorders Association. 2023.

OBJECTIVES: This prospective, longitudinal study aims to compare the prevalence of autism spectrum disorder (ASD) characteristics in adolescents with anorexia nervosa (AN) during and after underweight in order to help unravel the complex link between both conditions. METHODS: 24 adolescents with AN completed the youth self-report, autism spectrum quotient (AQ) or autism spectrum quotient adolescent version (AQ – adolescent) and a questionnaire designed by the researchers during a state of underweight and after weight recovery. RESULTS: AQ total score and several AQ subscale scores at the time of underweight are significantly higher than after weight recovery with medium to large effect sizes. Linear modelling cannot prove a significant effect of weight gain, internalizing problems or medication use on AQ score, but it does show an association between AQ during underweight and AQ after weight recovery. CONCLUSIONS: The results highlight the complexity of the link between AN and ASD characteristics. Although a clear change in AQ score is seen in part of the participants, this effect cannot be generalized and a link with weight change cannot be demonstrated. It seems likely that ASD characteristics in AN are a combination of trait and state: underweight and starvation might exacerbate potentially present traits. Part of our results may indicate the existence of subgroups based on AQ score during underweight. Our study supports the theory that more ASD characteristics at T1 may result in a poorer outcome and a higher need for specified and intensive treatment.

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4. Palmer M, Fang Z, Hollocks MJ, Charman T, Pickles A, Baird G, Simonoff E. Screening for Attention Deficit Hyperactivity Disorder in Young Autistic Adults: The Diagnostic Accuracy of Three Commonly Used Questionnaires. Journal of autism and developmental disorders. 2023.

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is a common co-occurring condition in autistic individuals. ADHD is sometimes first recognised in young adulthood because ADHD symptoms may be misattributed to autism due to superficial overlap in presentation and diagnostic overshadowing. It should be investigated whether ADHD questionnaires are accurate in screening symptoms in young adults with autism. The current study examined this. METHODS: Participants were autistic young adults (N = 119) who took part in the Special Needs and Autism Project (SNAP), a population-based cohort. ADHD research diagnoses were obtained through the parent-informed Young Adult Psychiatric Assessment. Parents and young adults (self-report sample N = 71) completed ADHD questionnaires (Aberrant Behavior Checklist hyperactivity/non-compliance subscale, Conners Adult ADHD Rating Scales ADHD Index, and Strengths and Difficulties Questionnaire ADHD subscale). Receiver operating characteristic analyses were conducted to explore if the questionnaires discriminated ADHD cases from non-cases. To assess whether results varied by intellectual functioning, subgroup analyses were completed for those with an IQ ≥ 70 vs. <70. RESULTS: Weighted ADHD rates were high. Overall although the measures were performing at or close to adequate levels (area under the curve was 0.66 to 0.79 for parent-report and 0.70 to 0.65 for self-report), no single measure met adequate thresholds for sensitivity and specificity simultaneously. Tool performance was not different for those with an IQ ≥ 70 vs. <70. CONCLUSION: No single measure reported adequate performance for distinguishing ADHD from non-ADHD cases in this sample of young autistic adults. Use of current thresholds may lead to under-diagnosis.

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5. Pappagianopoulos J, Rouch E, Mazurek MO. Extracurricular Activity Participation Among Autistic Children and Adolescents: Buffer for Internalizing Conditions and Foundation for Friendship?. Journal of autism and developmental disorders. 2023.

PURPOSE: Internalizing conditions, such as anxiety and depression, and difficulties with developing and maintaining friendships are common among autistic children and adolescents. Participation in extracurricular activities may buffer against these challenges as they provide naturalistic opportunities to bring peers with shared interests and skills together. As such, the purpose of the current study was to examine associations between sport and club participation and (1) friendship success and (2) co-occurring anxiety and depression in a large sample of autistic youth. METHODS: Secondary analysis was performed using data from the 2018-2019 National Survey of Children’s Health. Participants were 562 autistic children (ages 6-11 years) and 818 autistic adolescents (ages 12-17 years). Within each age group, a series of binary logistic regression analyses were conducted. RESULTS: Club participation was not associated with friendship or internalizing conditions. However, participation in sports was positively associated with friendship success among both children (OR = 2.07, p = .006) and adolescents (OR = 2.35, p = .001). Results also found that adolescents who participated in sports were 34% less likely to have diagnosis of depression (p = .048). CONCLUSION: Findings suggest that participation in sports may play a meaningful role in protecting against depression during adolescence and serve as a context for friendship development across childhood and adolescence. Future research should address barriers to extracurricular activity participation and identify the specific components of sports that are most beneficial to autistic youth to inform activity offerings and the development of interventions targeting friendship formation and mental health outcomes.

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6. Peristeri E, Kamona X, Varlokosta S. The Acquisition of Relative Clauses in Autism: The Role of Executive Functions and Language. Journal of autism and developmental disorders. 2023.

PURPOSE: Relative clauses present a well-known processing asymmetry between object-extracted and subject-extracted dependencies across both typical and atypical populations. The present study aimed at exploring the comprehension of object and subject relative clauses as conceptualized by the Relativized Minimality framework in autistic children and in a group of age- and IQ-matched typically-developing children. The study also explored the way performance in relative clauses would be affected by the children’s language and executive function skills. METHOD: Relative clause comprehension was tested through a sentence-picture matching task and language was tested with a receptive vocabulary task. Executive functions were assessed through backward digit recall and a Flanker test. RESULTS: Object relative clauses were harder to parse for both groups than subject relatives, while number mismatch between the moved object Noun Phrase and the intervening subject Noun Phrase in object relatives boosted both groups’ performances. Typically-developing children’s performance in object relatives was predicted by both language and executive functions, while autistic children failed to use language and did not systematically draw on their executive functions in object relative clause comprehension. CONCLUSION: The findings suggest that relative clause processing in autism follows a normal developmental trajectory, and that difficulty with parsing object relative clauses stems from reduced language and executive functions rather than deficits in the children’s morphosyntactic skills.

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7. Rahmatinia M, Mohseni-Bandpei A, Khodagholi F, Abdollahifar MA, Amouei Torkmahalleh M, Hassani Moghaddam M, Hopke PK, Ghavimehr E, Bazzazpour S, Shahsavani A. Exposure to different PM(2.5) extracts induces gliosis and changes behavior in male rats similar to autism spectrum disorders features. Environmental pollution (Barking, Essex : 1987). 2023: 122804.

Epidemiological studies have documented that exposure to fine particulate matter (PM(2.5)) could affect neurodevelopment, thereby leading to autism spectrum disorders (ASD). Nevertheless, there is little laboratory data to support this epidemiological evidence. In the current study, we carried out a series of experiments to assess whether developmental exposures to different extracts of PM(2.5) can result in ASD-like behavioral, biochemical, and immunohistochemical characteristics in male rat offspring. PM(2.5) samples were collected daily for a year, and monthly composites were extracted with an acetone-hexane mixture. The extracts were analyzed for their chemical constituents. Three groups of rats were exposed to the different PM(2.5) extracts during pre- and postnatal periods. All exposed groups of rats exhibited typical behavioral features of ASD, including increased repetitive and depression-related behaviors. We also found microglia and astrocytes activation and decreased concentrations of oxytocin (OXT) in the brain regions of exposed rats compared with control rats. Comparing the current results with a prior study, the induced biological effects followed a sequence of whole particles of PM(2.5) > organic extract > inorganic extract. These findings indicated that exposure to PM(2.5) can elicit ASD-like features in rats and raise concerns about particulate matter as a possible trigger for the induction of ASD in humans; therefore, mitigating the contents of the PAHs and metals could reduce the PM(2.5) neurotoxicity.

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8. Scattoni ML, Fatta LM, Micai M, Sali ME, Bellomo M, Salvitti T, Fulceri F, Castellano A, Molteni M, Gambino G, Posada M, Romano G, Puopolo M. Autism spectrum disorder prevalence in Italy: a nationwide study promoted by the Ministry of Health. Child and adolescent psychiatry and mental health. 2023; 17(1): 125.

BACKGROUND: This nationwide study aimed to estimate Autism Spectrum Disorder (ASD) prevalence in 7-9-year-old Italian children. Promoted by Italy’s Ministry of Health and coordinated by the National Observatory for Autism at the National Institute of Health, it covered schools in northern (Lecco and Monza-Brianza), central (Rome and its province), and southern (Palermo and its province) regions from February 24, 2016, to February 23, 2018, using a multi-stage approach defined by the European Union’s ASD network. METHODS: Phase one identified ASD-diagnosed children in mainstream schools through local Ministry of Education (MoE) disability registries. Phase two had a subset of schools screen 7-9-year-olds using the Social Communication Questionnaire-Life version (SCQ-L). Those with SCQ-L scores of 15 + underwent clinical consultation for ASD symptoms, cognitive abilities, and life skills. To counter potential false negatives, 20% scoring 11-14 were randomly assessed via Autism Diagnostic Interview-Revised (ADI-R). RESULTS: MoE data revealed 9.8 per 1000 certified ASD children in the north, 12.2 in the central, and 10.3 in the south. In phase two, 35,823 SCQ-L questionnaires were distributed across 198 schools (northern: 11,190 in 49 schools, central: 13,628 in 87 schools, southern: 11,005 in 62 schools). Of SCQ-L respondents, 2.4% (n = 390) scored above the 15 cutoff. Among these, 100 had ASD diagnoses, and 50 had other diagnoses. Among 115 families assessed, 16.5% (n = 19) received ASD diagnoses. CONCLUSIONS: The estimated prevalence of ASD in Italy was 13.4 (11.3-16.0) per 1,000 children aged 7-9 years, with a male-to-female ratio of 4.4:1. It will guide national policies in enhancing services tailored to the specific needs of autistic children.

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