1. Ali A, Alexander S, Ko P, Cuffe JSM, Whitehouse AJO, McGrath JJ, Eyles D. Developmental Vitamin D Deficiency in Pregnant Rats Does Not Induce Preeclampsia. Nutrients. 2021; 13(12).

Preeclampsia is a pregnancy disorder characterized by hypertension. Epidemiological studies have associated preeclampsia with an increased risk of neurodevelopmental disorders in offspring, such as autism and schizophrenia. Preeclampsia has also been linked with maternal vitamin D deficiency, another candidate risk factor also associated with autism. Our laboratory has established a gestational vitamin-D-deficient rat model that shows consistent and robust behavioural phenotypes associated with autism- and schizophrenia-related animal models. Therefore, we explored here whether this model also produces preeclampsia as a possible mediator of behavioural phenotypes in offspring. We showed that gestational vitamin D deficiency was not associated with maternal blood pressure or proteinuria during late gestation. Maternal and placental angiogenic and vasculogenic factors were also not affected by a vitamin-D-deficient diet. We further showed that exposure to low vitamin D levels did not expose the placenta to oxidative stress. Overall, gestational vitamin D deficiency in our rat model was not associated with preeclampsia-related features, suggesting that well-described behavioural phenotypes in offspring born to vitamin-D-deficient rat dams are unlikely to be mediated via a preeclampsia-related mechanism.

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2. Bathelt J, Koolschijn PCM, Geurts HM. Atypically slow processing of faces and non-faces in older autistic adults. Autism : the international journal of research and practice. 2021: 13623613211065297.

Some theories suggested that social difficulties in autism arise from differences in the processing of faces. If face-processing difficulties are central to autism, then they should be as persistent as social difficulties across the lifespan. We tested this by asking autistic and neurotypical participants between 30 and 75 years to complete face detection tasks. Both autistic and neurotypical adults responded more slowly with age. When participants had to respond quickly, autistic adults made more errors in face detection regardless of their age. However, when the time constraint was removed, autistic adults performed as well as the neurotypical group. Across tasks, autistic adults responded more slowly when asked to detect both face and non-face stimuli. We also investigated brain activation differences in the face detection task with functional magnetic resonance imaging. The results indicated lower activation in the autism group in the left and right superior frontal gyrus. The superior frontal gyrus is not typically implicated in face processing but in more general processing, for example, keeping instructions in mind and following them. Together with the behavioral results, this suggests that there is no specific deficit in face processing in autistic adults between 30 and 75 years. Instead, the results suggest differences in general processing, particularly in the speed of processing. However, this needs to be investigated further with methods that are more sensitive to the timing of brain activation.

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3. Bowden N, Milne B, Audas R, Clasby B, Dacombe J, Forster W, Kokaua J, Gibb S, Hughes N, MacCormick C, Smiler K, Taylor B, Mirfin-Veitch B. Criminal justice system interactions among young adults with and without autism: A national birth cohort study in New Zealand. Autism : the international journal of research and practice. 2021: 13623613211065541.

Sensationalist headlines and highly publicised criminal cases lead many in the public to believe that people with autism are more likely to engage in criminal behaviour. However, recent studies present an unresolved debate, and indicate this may not necessarily be the case. The aims of this study were to examine the prevalence of criminal justice system interactions among young adults with and without autism, and determine whether offence types differ between these groups. We tracked a national birth cohort until their 25th birthday, detecting criminal justice system interactions from age 17 onwards. Linked health and criminal justice system data were used to identify those with autism and detect interactions with the criminal justice system. We found that young people with autism interacted with the criminal justice system at lower rates compared to those without autism. However, there were considerable differences in the types of offences these young people were charged with. For example, among those charged with an offence, people with autism were more likely to be charged with a serious offence, punishable by 2 or more years in prison. We conclude that although young people with autism are not over-represented in the criminal justice system, disparities in offence types and incarceration rates among those charged with an offence suggest the importance of identification and appropriate response to autism within the criminal justice system.

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4. Chernikova MA, Flores GD, Kilroy E, Labus JS, Mayer EA, Aziz-Zadeh L. The Brain-Gut-Microbiome System: Pathways and Implications for Autism Spectrum Disorder. Nutrients. 2021; 13(12).

Gastrointestinal dysfunction is one of the most prevalent physiological symptoms of autism spectrum disorder (ASD). A growing body of largely preclinical research suggests that dysbiotic gut microbiota may modulate brain function and social behavior, yet little is known about the mechanisms that underlie these relationships and how they may influence the pathogenesis or severity of ASD. While various genetic and environmental risk factors have been implicated in ASD, this review aims to provide an overview of studies elucidating the mechanisms by which gut microbiota, associated metabolites, and the brain interact to influence behavior and ASD development, in at least a subgroup of individuals with gastrointestinal problems. Specifically, we review the brain-gut-microbiome system and discuss findings from current animal and human studies as they relate to social-behavioral and neurological impairments in ASD, microbiota-targeted therapies (i.e., probiotics, fecal microbiota transplantation) in ASD, and how microbiota may influence the brain at molecular, structural, and functional levels, with a particular interest in social and emotion-related brain networks. A deeper understanding of microbiome-brain-behavior interactions has the potential to inform new therapies aimed at modulating this system and alleviating both behavioral and physiological symptomatology in individuals with ASD.

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5. ElNakieb Y, Ali MT, Elnakib A, Shalaby A, Soliman A, Mahmoud A, Ghazal M, Barnes GN, El-Baz A. The Role of Diffusion Tensor MR Imaging (DTI) of the Brain in Diagnosing Autism Spectrum Disorder: Promising Results. Sensors (Basel, Switzerland). 2021; 21(24).

Autism spectrum disorder (ASD) is a combination of developmental anomalies that causes social and behavioral impairments, affecting around 2% of US children. Common symptoms include difficulties in communications, interactions, and behavioral disabilities. The onset of symptoms can start in early childhood, yet repeated visits to a pediatric specialist are needed before reaching a diagnosis. Still, this diagnosis is usually subjective, and scores can vary from one specialist to another. Previous literature suggests differences in brain development, environmental, and/or genetic factors play a role in developing autism, yet scientists still do not know exactly the pathology of this disorder. Currently, the gold standard diagnosis of ASD is a set of diagnostic evaluations, such as the Autism Diagnostic Observation Schedule (ADOS) or Autism Diagnostic Interview-Revised (ADI-R) report. These gold standard diagnostic instruments are an intensive, lengthy, and subjective process that involves a set of behavioral and communications tests and clinical history information conducted by a team of qualified clinicians. Emerging advancements in neuroimaging and machine learning techniques can provide a fast and objective alternative to conventional repetitive observational assessments. This paper provides a thorough study of implementing feature engineering tools to find discriminant insights from brain imaging of white matter connectivity and using a machine learning framework for an accurate classification of autistic individuals. This work highlights important findings of impacted brain areas that contribute to an autism diagnosis and presents promising accuracy results. We verified our proposed framework on a large publicly available DTI dataset of 225 subjects from the Autism Brain Imaging Data Exchange-II (ABIDE-II) initiative, achieving a high global balanced accuracy over the 5 sites of up to 99% with 5-fold cross validation. The data used was slightly unbalanced, including 125 autistic subjects and 100 typically developed (TD) ones. The achieved balanced accuracy of the proposed technique is the highest in the literature, which elucidates the importance of feature engineering steps involved in extracting useful knowledge and the promising potentials of adopting neuroimaging for the diagnosis of autism.

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6. Hellquist A, Tammimies K. Access, utilization, and awareness for clinical genetic testing in autism spectrum disorder in Sweden: A survey study. Autism : the international journal of research and practice. 2021: 13623613211066130.

Several medical professional societies recommend clinical genetic testing for autistic individuals as many genetic conditions are linked to autism. However, it is unclear to what extent autistic individuals and parents of autistic children are offered clinical genetic testing. We conducted a community-based survey to estimate the access, utilization, and awareness for clinical genetic testing in Sweden. In total, 868 parents of autistic children and 213 autistic adolescents or adults participated as respondents. The referral rate for clinical genetic testing after autism spectrum disorder diagnosis was low, with only 9.1% for the autistic children as reported by their parents and 2.8% for autistic adolescents/adults. The autistic children who got referrals were more likely to have intellectual disability and language disorder. We also report that awareness of the clinical genetic testing possibility was low in both respondent groups. We also highlight preferred communication means and needs for information before clinical genetic testing. Our results show that utilization and access are low in Sweden, and more studies should be conducted to report these rates in different countries to analyze the effects of clinical genetic testing on healthcare for autistic individuals. Our results highlight the most important information for the families and how the information should be communicated prior to clinical genetic testing.

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7. Hirano D, Goto Y, Shoji H, Taniguchi T. Comparison of the presence and absence of an intervention to reduce hand stereotypies in individuals with Rett syndrome. Journal of applied research in intellectual disabilities : JARID. 2022; 35(2): 607-22.

BACKGROUND: We investigated how many individuals with Rett syndrome were undergoing interventions to reduce stereotypic hand movements and the factors determining the presence or absence of an intervention. METHOD: A questionnaire was sent to 194 families. Each survey item was compared between the intervention and non-intervention groups according to the presence or absence of interventions to reduce hand stereotypies. RESULTS: Information was acquired from 72 cases; 72.1% of individuals had received an intervention to reduce stereotypies at some point in their lives. An upper limb splint was the most common intervention. Age, locomotor and reaching function, diagnostic age, frequency and type of stereotypy, joint contractures and stereotypy-associated problems separated the presence or absence of a current or past intervention. CONCLUSIONS: Interventions for stereotypy-associated problems are important and there are several variables related to whether an intervention is received.

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8. Kadouh NK, Lang S, Shamoun M, Scott EL, Singh SA, Smith MA. Mexiletine: An adjuvant option for refractory pain in patients with sickle cell disease and comorbid autism spectrum disorder. Pediatric blood & cancer. 2021: e29526.

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9. Muharib R, Dowdy A, Rajaraman A, Jessel J. Contingency-based delay to reinforcement following functional communication training for autistic individuals: A multilevel meta-analysis. Autism : the international journal of research and practice. 2022; 26(4): 761-81.

Functional communication training, an intervention for challenging behavior rooted in principles of applied behavior analysis, has copious empirical support dating back to the mid-1980s for autistic individuals. Recently, there has been a concerted effort to thin reinforcement delivery during functional communication training using contingency-based delays that, in turn, are designed to enhance practicality and feasibility while not compromising efficacy. In this synthesis, we meta-analyzed the literature base with the goal of investigating both combined and across type effectiveness of contingency-based delays. We also aimed to investigate moderating variables that might impact intervention outcomes. Findings showed that contingency-based delays were effective for individuals with an autism spectrum disorder diagnosis and most effective when the delay incorporated some form of positive reinforcement. In addition, differential reinforcement of alternative-based delays was overall more effective when compared to differential reinforcement of other behavior-based delays. Noteworthy moderating variables found to impact contingency-based delay efficacy included the intervention dosage and the topography of behavior. We discuss these findings and highlight directions where additional empirical research is warranted to improve our understanding about contingency-based delays for individuals diagnosed with autism spectrum disorder.

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10. Panceri JAC, Freitas É, de Souza JC, da Luz Schreider S, Caldeira E, Bastos TF. A New Socially Assistive Robot with Integrated Serious Games for Therapies with Children with Autism Spectrum Disorder and Down Syndrome: A Pilot Study. Sensors (Basel, Switzerland). 2021; 21(24).

This work introduces a new socially assistive robot termed MARIA T21 (meaning « Mobile Autonomous Robot for Interaction with Autistics », with the addition of the acronym T21, meaning « Trisomy 21 », which is used to designate individuals with Down syndrome). This new robot is used in psychomotor therapies for children with Down syndrome (contributing to improve their proprioception, postural balance, and gait) as well as in psychosocial and cognitive therapies for children with autism spectrum disorder. The robot uses, as a novelty, an embedded mini-video projector able to project Serious Games on the floor or tables to make already-established therapies funnier to these children, thus creating a motivating and facilitating effect for both children and therapists. The Serious Games were developed in Python through the library Pygame, considering theoretical bases of behavioral psychology for these children, which are integrated into the robot through the robot operating system (ROS). Encouraging results from the child-robot interaction are shown, according to outcomes obtained from the application of the Goal Attainment Scale. Regarding the Serious Games, they were considered suitable based on both the « Guidelines for Game Design of Serious Games for Children » and the « Evaluation of the Psychological Bases » used during the games’ development. Thus, this pilot study seeks to demonstrate that the use of a robot as a therapeutic tool together with the concept of Serious Games is an innovative and promising tool to help health professionals in conducting therapies with children with autistic spectrum disorder and Down syndrome. Due to health issues imposed by the COVID-19 pandemic, the sample of children was limited to eight children (one child with typical development, one with Trisomy 21, both female, and six children with ASD, one girl and five boys), from 4 to 9 years of age. For the non-typically developing children, the inclusion criterion was the existence of a conclusive diagnosis and fulfillment of at least 1 year of therapy. The protocol was carried out in an infant psychotherapy room with three video cameras, supervised by a group of researchers and a therapist. The experiments were separated into four steps: The first stage was composed of a robot introduction followed by an approximation between robot and child to establish eye contact and assess proxemics and interaction between child/robot. In the second stage, the robot projected Serious Games on the floor, and emitted verbal commands, seeking to evaluate the child’s susceptibility to perform the proposed tasks. In the third stage, the games were performed for a certain time, with the robot sending messages of positive reinforcement to encourage the child to accomplish the game. Finally, in the fourth stage, the robot finished the games and said goodbye to the child, using messages aiming to build a closer relationship with the child.

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11. Pickard K, Meyer A, Reyes N, Tanda T, Reaven J. Using evaluative frameworks to examine the implementation outcomes of a cognitive behavioral therapy program for autistic students with anxiety within public school settings. Autism : the international journal of research and practice. 2022; 26(3): 640-53.

Cognitive behavioral therapy helps to treat anxiety symptoms in autistic youth, but it is difficult for families to access cognitive behavioral therapy in the community. Training school providers to deliver cognitive behavioral therapy may help autistic youth and their families to access these programs. Unfortunately, we do not know how cognitive behavioral therapy programs can be delivered by school providers and how these programs help the autistic students who access them. This study addressed this gap and was part of a larger study that looked at the effectiveness of Facing Your Fears-School-Based in 25 public schools. The study goals were to understand whether Facing Your Fears-School-Based helped students and the factors that made it easy or difficult to deliver Facing Your Fears-School-Based in schools. Thirty providers participated in interviews guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Participants shared information that fell into several major categories that included (1) delivering Facing Your Fears-School-Based to many different students; (2) the positive impact of Facing Your Fears-School-Based on students’ school participation; and (3) plans to continue using Facing Your Fears-School-Based. School providers also shared that Facing Your Fears-School-Based was easy to use for non-mental health providers and reported adapting Facing Your Fears-School-Based to meet student needs. The results of this study suggest that Facing Your Fears-School-Based may help autistic students and highlight the importance of using mental health programs in schools that are flexible, able to be adapted, and that are able to be used by many different types of school providers.

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12. Rosello R, Martinez-Raga J, Mira A, Pastor JC, Solmi M, Cortese S. Cognitive, social, and behavioral manifestations of the co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder: A systematic review. Autism : the international journal of research and practice. 2022; 26(4): 743-60.

This work aimed to review recent research on the characteristics of individuals who have both autism spectrum disorder and attention-deficit/hyperactivity disorder due to their high co-occurrence. Thirty-four studies were analyzed and main findings summarized in two content domains focusing on areas that could enhance our understanding of the cognitive and behavioral characteristics of individuals with autism spectrum disorder + attention-deficit/hyperactivity disorder (ASD+). Most of the results suggested that ASD+ is a co-occurring condition associated with more severe impairments in cognitive functioning, adaptive behavior, and increased likelihood to present more emotional/behavioral problems. These results will be helpful to provide improved care plans for individuals with both attention-deficit/hyperactivity disorder and autism spectrum disorder.

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13. Shire SY, Shih W, Barriault T, Kasari C. Exploring coaching and follow-up supports in community-implemented caregiver-mediated JASPER intervention. Autism : the international journal of research and practice. 2022; 26(3): 654-65.

The next step for communication interventions for young children with autism include coaching/teaching for caregivers that have been tested in university clinics and testing these interventions in real world systems with early intervention providers who serve children and families in their communities. However, there are few projects that have tested how well the intervention can be transferred to community providers and what types of progress children and caregivers make in these services. This project took place in partnership with a community early intervention agency in the province of Ontario, Canada. The agency provided government-funded public health services. The agency was funded to take part in a pilot program to try out one of four early intervention models that included coaching for caregivers and was designed to support children’s social engagement, play, and communication skills. The team decided to test two ways to start the intervention: (a) begin with observation of the practitioner for 4 weeks and then start coached practice with the child and (b) start coaching immediately. The team also tested two ways to support families for 3 months after intervention: (a) group booster sessions and (b) individual visits. The practitioners delivered the intervention well (M = 83%), and overall, caregivers and children made significant gains by the end of intervention in both observation + coaching and coaching. Attendance for follow-up boosters was variable with fewer families attending groups. More research is needed to test different strategies and roles to individualize interventions for caregivers with a range of goals and learning styles.

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14. Stogiannos N, Carlier S, Harvey-Lloyd JM, Brammer A, Nugent B, Cleaver K, McNulty JP, Dos Reis CS, Malamateniou C. A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia. Autism : the international journal of research and practice. 2022; 26(4): 782-97.

Autistic patients often undergo magnetic resonance imaging examinations. Within this environment, it is usual to feel anxious and overwhelmed by noises, lights or other people. The narrow scanners, the loud noises and the long examination time can easily cause panic attacks. This review aims to identify any adaptations for autistic individuals to have a magnetic resonance imaging scan without sedation or anaesthesia. Out of 4442 articles screened, 53 more relevant were evaluated and 21 were finally included in this study. Customising communication, different techniques to improve the environment, using technology for familiarisation and distraction have been used in previous studies. The results of this study can be used to make suggestions on how to improve magnetic resonance imaging practice and the autistic patient experience. They can also be used to create training for the healthcare professionals using the magnetic resonance imaging scanners.

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