1. Bharat R, Uzaina, Niranjan S, Yadav T, Newman S, Marriott J, Smith G, Sawlani G. Autism Spectrum Disorder in the COVID 19 Era: New Challenges – New Solutions. Indian pediatrics. 2021; 58(9): 888-9.

This survey explored the support available and the effect of lockdown on children with autism spectrum disorder and their families in India and the United Kingdom. Our findings showed significant problems for children and families due to lockdown. App-based information delivered to parents with support showed encouraging feedback.

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2. Bolic Baric V, Skuthälla S, Pettersson M, Gustafsson PA, Kjellberg A. The effectiveness of weighted blankets on sleep and everyday activities – A retrospective follow-up study of children and adults with attention deficit hyperactivity disorder and/or autism spectrum disorder. Scandinavian journal of occupational therapy. 2021: 1-11.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are often accompanied by sleep problems influencing social, emotional and cognitive functioning in everyday activities. AIM: The aim of this study was to investigate whether the use of a weighted blanket has a positive impact on sleep and everyday activities in individuals with ADHD and/or ASD. MATERIAL AND METHODS: The study included 85 individuals diagnosed with ADHD and/or ASD, 48 children aged ≤17 (57%) and 37 adults ≥18 years (44%), who were prescribed with a weighted blanket. The participants responded via a telephone interview. RESULTS: Findings demonstrated that a weighted blanket improved abilities related to falling asleep, sleeping the whole night, and relaxing during the day. Using a weighted blanket improved morning/evening daily routine, including preparing/going to sleep and waking up in the morning. CONCLUSIONS: Weighted blankets showed positive impact on falling asleep, sleeping the whole night, and relaxing during the day, and they were used frequently by children and adults with ADHD and/or ASD. Findings indicate that a weighted blanket improved morning/evening routine, however this research area needs further investigation using both subjective and objective parameters.

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3. Brewer N, Young RL, Norris JE, Maras K, Michael Z, Barnett E. A Quick Measure of Theory of Mind in Autistic Adults: Decision Accuracy, Latency and Self-Awareness. Journal of autism and developmental disorders. 2021.

Autistic adults often experience difficulties in taking the perspective of others, potentially undermining their social interactions. We evaluated a quick, forced-choice version of the Adult Theory of Mind (A-ToM) test, which was designed to assess such difficulties and comprehensively evaluated by Brewer et al. (2017). The forced-choice version (the A-ToM-Q) demonstrated discriminant, concurrent, convergent and divergent validity using samples of autistic (N = 96) and non-autistic adults (N = 75). It can be administered in a few minutes and machine-scored, involves minimal training and facilitates large-scale, live, or web-based testing. It permits measurement of response latency and self-awareness, with response characteristics on both measures enhancing understanding of the nature and extent of perspective taking difficulties in autistic individuals.

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4. Dean EE, Hagiwara M, Shogren KA, Wehmeyer ML, Shrum J. Promoting Career Design in Youth and Young Adults with ASD: A Feasibility Study. Journal of autism and developmental disorders. 2021.

Recent calls by transition researchers in postsecondary transition have advocated for new approaches to transition services focused on career design, which uses career-related experiences based on a person’s interests to develop goal setting and problem-solving abilities. Youth and young adults with autism spectrum disorder (ASD), who often have limited opportunity for career-related experiences, could benefit from career design intervention. This study examined the feasibility of using the Self-Determined Career Design Model (SDCDM) to enhance transition-related outcomes for twenty-five youth and young adults with ASD. Statistically significant gains were seen in goal attainment and occupational performance. This study provides preliminary evidence that the SDCDM can feasibly enhance outcomes for youth and young adults with ASD.

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5. Goddard H, Cook A. « I Spent Most of Freshers in my Room »-A Qualitative Study of the Social Experiences of University Students on the Autistic Spectrum. Journal of autism and developmental disorders. 2021.

Autistic university students face extra challenges in both their academic and social life. Barriers to socialising appear to be less well understood and supported by universities than academic requirements. Semi-structured interviews were conducted with ten autistic university students to explore their social experiences. Questions explored their social experiences, satisfaction with social life, disclosure of ASD to others, and the impact of mental wellbeing on university life. Thematic analysis indicated most participants were unsatisfied with their social lives and experienced mental health issues. Factors exacerbating social isolation included lack of suitable social events, lack of social support and feeling unable to disclose to peers. Factors which reduced social isolation included joining an autism or special interest society and receiving social mentoring.

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6. Godoy-Giménez M, González-Rodríguez A, Cañadas F, Estévez AF, Sayans-Jiménez P. Is it Possible to Assess the Two-Domain Definition of the Broad Autism Phenotype Using the Available Measurement Tools?. Journal of autism and developmental disorders. 2021.

Although, the operationalization of the autism spectrum disorder has been updated around two domains, the broad autism phenotype (BAP) one has not. Additionally, the items of the three common BAP measures, the Broad Autism Phenotype Questionnaire (BAPQ), the Autism Quotient, and the Social Responsiveness Scale (SRS), remain organized around a non-consensual number of factors. We explored whether the items of these measures matched with the two-domain operationalization through a parallel analysis, which has suggested two main components, and two expert judgments which have assessed item wording, relevance, and construct representativeness. A remaining pool of 48 BAP-relevant items suggested a possible under-representation of two subdomains. Despite the relevance of all the BAPQ items, only the SRS ones tapped in all subdomains.

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7. Houtrow A, Elias ER, Davis BE. Promoting Healthy Sexuality for Children and Adolescents With Disabilities. Pediatrics. 2021; 148(1).

This clinical report updates a 2006 report from the American Academy of Pediatrics titled « Sexuality of Children and Adolescents With Developmental Disabilities. » The development of a healthy sexuality best occurs through appropriate education, absence of coercion and violence, and developmental acquisition of skills to navigate feelings, desires, relationships, and social pressures. Pediatric health care providers are important resources for anticipatory guidance and education for all children and youth as they understand their changing bodies, feelings, and behaviors. Yet, youth with disabilities and their families report inadequate education and guidance from pediatricians regarding sexual health development. In the decade since the original clinical report was published, there have been many advancements in the understanding and care of children and youth with disabilities, in part because of an increased prevalence and breadth of autism spectrum disorder as well as an increased longevity of individuals with medically complex and severely disabling conditions. During this same time frame, sexual education in US public schools has diminished, and there is emerging evidence that the attitudes and beliefs of all youth (with and without disability) about sex and sexuality are being formed through media rather than formal education or parent and/or health care provider sources. This report aims to provide the pediatric health care provider with resources and tools for clinical practice to address the sexual development of children and youth with disabilities. The report emphasizes strategies to promote competence in achieving a healthy sexuality regardless of physical, cognitive, or socioemotional limitations.

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8. Javaid SF, Pandarakalam JP. The Association of Creativity with Divergent and Convergent Thinking. Psychiatria Danubina. 2021; 33(2): 133-9.

The inspirational aspect of creativity remains shrouded in mystery. Methodological problems have hindered research into creativity, and such a situation makes the interpretation and comparison of studies problematic. The link between creativity and psychopathology is overstated by the print, electronic, and celluloid media. This paper attempts to explain the creative process from a psychological and psychiatric perspective leaving room for different unexplained aspects of generativity for open discussion. A selective survey of the literature was performed to identify scholarly views of creativity and psychopathology. Data sources included PubMed, Google Scholar, and Scopus. The concept of inspiration was examined from psychological, psychopathological, and biological standpoints. A better understanding of creativity has clinical implications. Psychopathology can facilitate creativity, but it is not the maker of creativity that involves a harmonious blending of divergent and convergent thinking. The present trend in psychiatry of medicalizing all unusual behavior is not at all productive in fostering creativity among children. The cognitively gifted children differ widely from children with autistic spectrum disorders; the creative thinking of gifted children is polythetic, whereas such potentials of autistic individuals are generally monothetic. The study of creativity helps develop an expanded model of the mind. However, research into creativity has produced contradictory results. The assumed link between creativity and mental disorder could be clarified only when we elucidate the creative process. Further research is needed in regard to the psycho-biological nature of creativity, including genetic links, implications for neuropharmacology, and the treatment of pathology or psychological disorders.

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9. Kitamura S, Makinodan M, Matsuoka K, Takahashi M, Yoshikawa H, Ishida R, Kishimoto N, Yasuno F, Yasuda Y, Hashimoto R, Miyasaka T, Kichikawa K, Kishimoto T. Association of adverse childhood experiences and precuneus volume with intrusive reexperiencing in autism spectrum disorder. Autism research : official journal of the International Society for Autism Research. 2021; 14(9): 1886-95.

Compared to typically developing (TD) children, people with autism spectrum disorder (ASD) have an increased risk of adverse childhood experiences (ACEs). Exposure to ACEs is associated with adult ASD psychological comorbidities, such as posttraumatic stress disorder (PTSD). Occurrence of intrusive event reexperiencing, characteristic of PTSD, often causes social dysfunction in adults with ASD, but its pathological basis is unclear. This study examined brain regions related to the severity of intrusive reexperiencing and explored whether ACE severity was associated with that of intrusive reexperiencing and/or extracted regional gray matter volume. Forty-six individuals with ASD and 41 TD subjects underwent T1-weighted magnetic resonance imaging and evaluation of ACEs and intrusive reexperiencing. Brain regions related to the severity of intrusive reexperiencing in both groups were identified by voxel-based whole brain analyses. Associations among the severity of intrusive reexperiencing, that of ACEs, and gray matter volume were examined in both groups. The severities of intrusive reexperiencing and ACEs were significantly associated with reduced gray matter volume in the right precuneus in individuals with ASD but not in TD subjects. Although the right precuneus gray matter volume was smaller in individuals with ASD and severe ACEs than in those with mild ACEs or TD subjects, it was similar in the latter two groups. However, ACE-dependent gray matter volume reduction in the right precuneus led to intrusive reexperiencing in individuals with ASD. This suggests that exposure to ACEs is associated with right precuneus gray matter reduction, which is critical for intrusive reexperiencing in adults with ASD. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) are at increased risk of adverse childhood experiences (ACEs) and of subsequent manifestation of intrusive reexperiencing of stressful life events. The present study found that reduced gray matter volume in the right precuneus of the brain was associated with more severe intrusive reexperiencing of ACEs by individuals with ASD. These results suggest that ACEs affect neural development in the precuneus, which is the pathological basis of intrusive event reexperiencing in ASD.

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10. Koller J, David T, Bar N, Lebowitz ER. The Role of Family Accommodation of RRBs in Disruptive Behavior Among Children with Autism. Journal of autism and developmental disorders. 2021.

Family accommodation refers to changes in families’ behavior aimed at reducing children’s psychopathology-related distress (Shimshoni et al. in Indian J ournal of Psychiatry 61(Suppl 1):S93-S103, 2019). Family accommodation of RRBs occurs frequently in families of children with autism, is linked to greater symptom severity (Feldman et al. in J Autism Dev Disord 49(9):3602-3610, 2019), and is unexplored in the context of disruptive behaviors. This study examined child and parent factors associated with disruptive behavior in children with autism. Parents (N = 90; age 2-9 years) reported on children’s autism symptomatology, adaptive functioning, and disruptive behavior, alongside parenting stress and family accommodation of RRBs. Such accommodation contributed significantly to predicting disruptive behavior. These findings indicate that parent behavior is associated with the expression of disruptive behavior in this sample, highlighting potential intervention targets for children with autism.

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11. Li J, Chen X, Zheng R, Chen A, Zhou Y, Ruan J. Altered Cerebellum Spontaneous Activity in Juvenile Autism Spectrum Disorders Associated with Clinical Traits. Journal of autism and developmental disorders. 2021.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder. The associations between the cerebellum and clinical traits remain unclear. We performed amplitude of low-frequency fluctuation (ALFF) analysis to explore the associations between spontaneous brain activity and clinical traits. 361 juvenile ASD patients were included from the ABIDEII database. In the ASD group, the mean ALFF values of cerebellum 4 5 were correlated with SRS awareness and communication. The mean ALFF values of cerebellum 6 and vermis 4 5 were both positively correlated with SRS total, awareness, communication, and motivation. In contrast, the mean ALFF values of vermis 1 2 were negatively correlated with SRS total, awareness, and mannerisms. Our study suggests a role of the cerebellum in functional impairments in ASD.

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12. Lischke A, Freyberger HJ, Grabe HJ, Mau-Moeller A, Pahnke R. Alexithymic But Not Autistic Traits Impair Prosocial Behavior. Journal of autism and developmental disorders. 2021.

Social impairments are a core feature of autism-spectrum disorders. However, there is a considerable variability in these impairments. Most autistic individuals show large impairments in social functioning but some autistic individuals show small impairments in social functioning. The variability of these impairments has been attributed to the presence or absence of alexithymia. To address this issue, we capitalized on the fact that alexithymic and autistic traits are broadly distributed in the population. This allowed us to investigate how alexithymic and autistic traits affect social functioning in healthy individuals. Healthy individuals showed impairments on a resource-allocation task that were due to alexithymic but not autistic traits. These findings suggest that alexithymic rather than autistic traits impair prosocial behavior across the autism-spectrum.

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13. McCarty MJ, Brumback AC. Rethinking Stereotypies in Autism. Seminars in pediatric neurology. 2021; 38: 100897.

Stereotyped movements (« stereotypies ») are semi-voluntary repetitive movements that are a prominent clinical feature of autism spectrum disorder. They are described in first-person accounts by people with autism as relaxing and that they help focus the mind and cope in overwhelming sensory environments. Therefore, we generally recommend against techniques that aim to suppress stereotypies in individuals with autism. Further, we hypothesize that understanding the neurobiology of stereotypies could guide development of treatments to produce the benefits of stereotypies without the need to generate repetitive motor movements. Here, we link first-person reports and clinical findings with basic neuroanatomy and physiology to produce a testable model of stereotypies. We hypothesize that stereotypies improve sensory processing and attention by regulating brain rhythms, either directly from the rhythmic motor command, or via rhythmic sensory feedback generated by the movements.

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14. Moskaleva PV, Shnayder NA, Nasyrova RF. [Association of polymorphic variants of DDC (AADC), AANAT and ASMT genes encoding enzymes for melatonin synthesis with the higher risk of neuropsychiatric disorders]. Zhurnal nevrologii i psikhiatrii imeni SS Korsakova. 2021; 121(5): 151-7.

Melatonin is the most well-known regulator of the circadian rhythms of all living organisms and the main substrate synthesized at night. There are 4 stages in the synthesis of melatonin. This review focuses on the 2nd, 3rd, and 4th stages. The review is aimed at analyzing publications on molecular genetic association studies on the role of single nucleotide polymorphisms (SNPs) of the DDC (AADC), AANAT and ASMT genes encoding melatonin synthesis enzymes in the pathogenesis of socially significant neuropsychiatric disorders in humans. The authors analyzed the available full-text articles from several databases, as well as materials from electronic resources. Search depth was 15 years. The analysis of these studies over the past decade show the association of some SNPs of the studied genes with the risk of neuropsychiatric disorders such as delayed sleep phase disorder, attention deficit hyperactivity disorder, autism spectrum disorder, migraine, Parkinson’s disease, depression, anxiety, bipolar-affective disorder, schizophrenia.

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15. Muniandy M, Richdale AL, Arnold SRC, Trollor JN, Lawson LP. Inter-relationships between trait resilience, coping strategies, and mental health outcomes in autistic adults. Autism research : official journal of the International Society for Autism Research. 2021; 14(10): 2156-68.

Resilience has been depicted as a key characteristic in the promotion of mental health in the face of stress and adversity. Despite high levels of stress encountered in the autistic population, resilience studies remain scarce. Using data from an Australian longitudinal adult study, this study explored the inter-relationships between trait resilience, coping, and mental health in a sample of autistic adults (N = 78). In particular, we examined the relationship between resilience and use of coping strategies, and the potential mediating role of coping strategies in the relationship between resilience and mental health outcomes. Our findings suggested that increased use of engagement coping (e.g., problem-solving, positive appraisal) and decreased use of disengagement coping (e.g., self-blame, being in denial) strategies were associated with higher levels of resilience. Further, mediation analysis results suggest that disengagement coping mediated the associations between resilience and all three mental health outcomes (i.e., depression, anxiety, and well-being), while engagement coping strategies mediated the relationship between resilience and well-being only. Our results illustrate that coping strategies may be an important mechanism in explaining the resilience-mental health relationship in autistic adults, highlighting the importance of considering stress-related constructs together (i.e., trait resilience and coping) when addressing support and intervention options for mental health difficulties in the autistic adult population. LAY SUMMARY: This research explored how resilience and coping strategies influence the mental health and well-being of autistic adults. We found that resilient autistic adults used more engagement coping strategies, less disengagement coping strategies, and reported better mental health and well-being. Considering stress-related factors together (i.e., resilience and coping) offers a novel perspective to mental health difficulties in autistic adults and may be a vital step in the development of support options in this population.

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16. Murray A, Mannion A, Chen JL, Leader G. Gaming Disorder in Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders. 2021.

Gaming disorder (GD) is a clinical addiction to video or internet games. This study investigated whether GD symptoms are heightened in adults with autism spectrum disorder (ASD) in comparison to a control group, and explored predictors of GD in 230 adults with ASD and 272 controls. The relationship between GD and gelotophobia was examined. Measures included the Ten-Item Internet Gaming Disorder Test, GELOPH < 15 >, Autism Spectrum Quotient-10 items, Inventory of Parent and Peer attachment, Emotional Regulation Questionnaire, Social Functioning Questionnaire (SFQ) and the NEO-FFI-3. Individuals in the ASD group showed significantly higher symptoms of GD. Peer-attachment, emotional regulation and extraversion significantly predicted GD scores. Gelotophobia and GD were related to each other with a small effect size.

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17. Nayar K, Kang X, Xing J, Gordon PC, Wong PCM, Losh M. A cross-cultural study showing deficits in gaze-language coordination during rapid automatized naming among individuals with ASD. Scientific reports. 2021; 11(1): 13401.

Individuals with autism spectrum disorder (ASD) and their first-degree relatives demonstrate automaticity deficits reflected in reduced eye-voice coordination during rapid automatized naming (RAN), suggesting that RAN deficits may be a genetically meaningful marker of ASD language-related impairments. This study investigated whether RAN deficits in ASD extend to a language typologically distinct from English. Participants included 23 Cantonese-speaking individuals with ASD and 39 controls from Hong Kong (HK), and age- and IQ-comparable groups of previously-studied English-speaking individuals with ASD (n = 45) and controls (n = 44) from the US. Participants completed RAN on an eye tracker. Analyses examined naming time, error rate, measures of eye movement reflecting language automaticity, including eye-voice span (EVS; location of eyes versus the named item) and refixations. The HK-ASD group exhibited longer naming times and more refixations than HK-Controls, in a pattern similar to that observed in the US-ASD group. Cultural effects revealed that both HK groups showed longer EVS and more fixations than US groups. Naming time and refixation differences may be ASD-specific impairments spanning cultures/languages, whereas EVS and fixation frequency may be more variably impacted. A potential underlying mechanism of visual « stickiness » may be contributing to this breakdown in language automaticity in ASD.

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18. Romeo RR, Choi B, Gabard-Durnam LJ, Wilkinson CL, Levin AR, Rowe ML, Tager-Flusberg H, Nelson CA, 3rd. Parental Language Input Predicts Neuroscillatory Patterns Associated with Language Development in Toddlers at Risk of Autism. Journal of autism and developmental disorders. 2021.

In this study we investigated the impact of parental language input on language development and associated neuroscillatory patterns in toddlers at risk of Autism Spectrum Disorder (ASD). Forty-six mother-toddler dyads at either high (n = 22) or low (n = 24) familial risk of ASD completed a longitudinal, prospective study including free-play, resting electroencephalography, and standardized language assessments. Input quantity/quality at 18 months positively predicted expressive language at 24 months, and relationships were stronger for high-risk toddlers. Moderated mediations revealed that input-language relationships were explained by 24-month frontal and temporal gamma power (30-50 Hz) for high-risk toddlers who would later develop ASD. Results suggest that high-risk toddlers may be cognitively and neurally more sensitive to their language environments, which has implications for early intervention.

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19. Siddiqua A, Janus M, Mesterman R, Duku E, Georgiades K, Saxena F, Zhao H, Saunders N. Primary Care Provider and Child Characteristics Associated with Age of Diagnosis of Autism Spectrum Disorder: A Population-Based Cohort Study. Journal of autism and developmental disorders. 2021.

In a cohort of kindergarten children in Ontario, Canada with Autism Spectrum Disorder (ASD) (n = 1522), we tested the association of age at ASD diagnosis and characteristics of (1) the child’s primary care provider and, (2) the child using health administrative databases. We tested the association of primary care practice model and time from developmental delay identification to age at ASD diagnosis. Older age of diagnosis was associated with provider foreign training (vs. domestic) (adjusted Hazard Ratio [aHR] 1.17, 95% CI 1.03, 1.33) but not sex, care model, and years of practice. After developmental delay identification, children with paediatricians had longer time to diagnosis than children with providers in care models (aHR 0.68, 95% CI 0.54, 0.86). Findings can be used to inform primary care provider ASD training.

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20. Simantov T, Pohl A, Tsompanidis A, Weir E, Lombardo MV, Ruigrok A, Smith P, Allison C, Baron-Cohen S, Uzefovsky F. Medical symptoms and conditions in autistic women. Autism : the international journal of research and practice. 2022; 26(2): 373-88.

Sex-steroids, such as testosterone, are thought to be one of the biological factors implicated in autism. This relies on the sex bias in the diagnosis of autism (boys are approximately four times more likely to be diagnosed than girls) and findings of associations with fetal testosterone levels in traits and abilities related to autism. The current study aimed to examine the association between medical conditions and physical symptoms, which tend to manifest in adulthood, and autism in females. Moreover, we examined their association with autistic traits throughout the spectrum. We focused on autistic women because there is little research focusing on the healthcare needs of autistic women, but those that exist suggest heightened vulnerability, and lower access to medical care. We find that conditions related to steroid hormones function are more frequent in autistic women and that they correlate with autistic traits. Specifically, we found that body mass index, reproductive system diagnoses, prediabetes symptoms, irregular puberty onset, and menstrual irregularities were significantly more frequent in autistic women and were significantly correlated with autistic traits in neurotypical women. The findings have important implications for raising awareness in autistic women of the possibility of medical conditions which might need medical attention. In addition, healthcare providers should consider these associations when performing healthcare maintenance checks and/or screening for autism.

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21. White SW, Smith I, Brewe AM. Brief Report: The Influence of Autism Severity and Depression on Self-Determination Among Young Adults with Autism Spectrum Disorder. Journal of autism and developmental disorders. 2021.

Self-determination (SD) is linked to autonomy and better adult outcomes. Adults with autism spectrum disorder (ASD) are often less independent than cognitively matched peers. Given the frequency with which depression co-occurs in ASD and the established association between depression and SD, we sought to evaluate the influence of both ASD severity and depression on SD among cognitively able emerging adults with ASD. Emerging adults (n = 59) with ASD completed measures of SD, ASD severity, and depression. Both ASD severity and depression were moderately correlated with SD (r = - 0.473; – 0.423, respectively) and with each other (r = 0.625). After controlling for ASD severity, depression did not significantly predict SD. Strengthening SD should be considered in programming to promote independence.

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22. Wirmer J, Sennert M, Hadidi AT. Ano-Scrotal Distance (ASD) : Is it a marker for the severity of chordee?. Journal of pediatric urology. 2021; 17(5): 670.e1-.e5.

OBJECTIVE: To evaluate the relation between ASD and the severity of chordee and hypospadias in a referral center. METHODS: The distance between the anal verge and proximal scrotal edge (ASD) was measured in hypospadias patients between 6 and 18 months between 2016 and 2020 in the operating room under anaesthesia. Patients older than 36 months and younger than 6 months were excluded. The patients were classified according to meatus into: Grade I (glandular or chordee without hypospadias), II (distal), III (proximal) and IV (perineal). Chordee was assessed by erection test and classified into 2 groups; Group I: no chordee or mild chordee <30 and Group II: with severe chordee >30. Short ASD was defined as ≤ 2.0 cm. RESULTS: 817 boys were included. The patients were classified according to the hypospadias grades I (180 pt), II (415 pt), III (120 pt) and IV (102 pt). The median ASD for group I was 3.07 cm (range 1.0-5.5), for group II 3.10 cm (range 1.5-5.0), for group III 2.40 cm (range 1.5-54.5) and for group IV 2.10 cm (range 1.0-3.5). The average ASD of the patients in Grade III and IV (2.26 cm) was significantly shorter than the average ASD of the patients in Grade I and II (3.09 cm) (p < 0.05). 184 patients had an ASD ≤2.0 cm. 38% of patients with glanular hypospadias (grade I) with ASD ≤ 2.0 cm had severe chordee. CONCLUSION: This study shows that short ASD is a helpful marker of the severity of chordee and hypospadias. Patients with glanular hypospadias and short ASD have 38% chance of having severe chordee.

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23. Yan T, Hou Y, Deng M. Direct, Indirect, and Buffering Effect of Social Support on Parental Involvement Among Chinese Parents of Children with Autism Spectrum Disorders. Journal of autism and developmental disorders. 2021.

Parental involvement plays a pivotal role in promoting developmental and educational outcomes for children with autism spectrum disorder (ASD). This study aimed to examine the relationships between social support, parenting stress, and parental involvement by investigating a sample of 245 Chinese parents of children with ASD. Mediation analyses indicated that the relationships between support from family and friends and parental involvement were partially mediated by parenting stress, and support from significant others was directly, positively related to parental involvement. Additionally, support from family and friends moderated the influence of parenting stress on parental involvement in their children’s education. The direct, indirect, and buffering effects of social support on parental involvement were discussed finally.

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