1. Al Askar BA, AlBishry FY, Alotaibi NM, Alzaben A, Albishi SM, Almajed AA, Alammari FS, Albarrak AS. Experience of special care patients receiving dental rehabilitation under general anesthesia at King Saud University Dental University Hospital. Sci Rep. 2025; 15(1): 33493.

Patients with special healthcare needs (SHCN) face significant challenges in accessing dental rehabilitation services, particularly under general anesthesia (GA). This study examined the waiting time from screening to pre-anesthesia appointments and association between demographics and clinical factors with the waiting time among the SHCN patients treated at xxx Dental University Hospital. This retrospective study included 210 SHCN patients who had full mouth rehabilitation under GA. Analysis of the collected data showed that the average waiting time from clinical first visit screening appointment to pre-anesthesia clinic assessment was 10.06 ± 12.49 months while average complete dental rehabilitation surgery duration was 213.80 ± 101.98 min. ADHD (attention deficit hyperactivity disorder) patients had the highest waiting time, while ASD (autism spectrum disorder) patients had the least waiting time, which was 14.29 and 9.29 months respectively. Findings indicate that systemic barriers, such as limited operating room (OR) availability and a lack of specialized professionals, contribute to prolonged waiting times and variability in treatment experiences. The study highlights the need for targeted reforms and tailored care approaches to improve access and outcomes for SHCN patients.

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2. Alkhawaldeh RS, AlShaqsi J, Al-Ahmad B, Alkhawaldeh SM, Drogham O. An attention-based multi-residual and BiLSTM architecture for early diagnosis of autism spectrum disorder. Sci Rep. 2025; 15(1): 33608.

The prevalence of autism as a neurological disorder affecting approximately 1 in 54 children diagnosed with the condition and the absence of definitive biomarkers forces clinicians to depend on behavioral observations and history information. The variety of symptom presentations and the dependence on subjective clinical evaluations make the diagnostic process still difficult and require long periods of observing behavior and analysis. Effective and automated methods for early detection of patients are crucial to reducing adverse outcomes. Therefore, we propose a framework model that combines the features of attention layers, Residual layers, and the BiLSTM models as a promising transfer learning model with a multi-phase pipeline that significantly improves detection and recognition performance. The experimental results show that the proposed model obtains effective performance, achieving average values for precision, recall, F1 score, and accuracy scores of 87.5%, 87%, 87.5%, and 87.7%, respectively. These values indicate a balanced performance across the metrics, emphasising the model’s ability to precisely and consistently classify autism-related features. Regarding ROC AUC values, the class-specific ROC AUC values are close to 95%, ensuring the robustness of the model to distinguish autism among images effectively.

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3. Birtwell K, Planner C, Epton T, Gowen E, Corsellis E, Botha M, Longley S, Khan G, Stratton C, Wong G. Optimising general practice support for autistic adults: a realist review protocol. Syst Rev. 2025; 14(1): 184.

BACKGROUND: Mental and physical health conditions are more common in autistic than non-autistic people, including anxiety, depression, suicidality, gastrointestinal problems, cancer, epilepsy, and heart disease. General practice is often the first point of contact for patients, yet research has found that autistic people face barriers to healthcare, report lower satisfaction with healthcare, and have more unmet health needs than non-autistic people. This can be due to misunderstandings about the needs of autistic people, different communication styles, the clinic environment, and challenges making and getting to appointments, compounded by slow dissemination of research findings. Our aim is to find out how, why, and to what extent general practice supports autistic adults with and without intellectual disabilities (ID) throughout their lives, in order to suggest improvements to practice. METHODS: We will conduct a realist review which is a theory-driven systematic review. Electronic databases will be searched including MEDLINE, PsycInfo, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, Scopus, ASSIA and grey literature sources (e.g. Google Scholar). To be included articles must concern general practice, autistic adults aged 18 and over, contain information relevant to a UK setting, and be written in English. Any study design or article type may be included and articles will be assessed for relevance and rigour. In line with realist synthesis methods we will identify relevant contexts, mechanisms and outcomes and develop a programme theory to explain how, why, and when general practice optimally supports (or not) autistic adults. We will also seek to identify resources that are available for and used by general practice to support autistic adults. We will involve stakeholders in each stage of the review including autistic individuals, family members, and healthcare professionals (including general practice staff). The review will be reported in line with the RAMESES publication standards. DISCUSSION: The findings will inform guidance for i) general practice about potentially helpful adaptations to service, and ii) autistic people to help them gain the support they need. This will help to improve access to and engagement with general practice care, and thus potentially improve the health and wellbeing of autistic individuals. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024545403.

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4. Chung H, Job Said A, Tager-Flusberg H, Nelson CA, Wilkinson CL. The association between infant EEG aperiodic exponent and the trajectory of restricted and repetitive behaviors for toddlers with and without autism. J Neurodev Disord. 2025; 17(1): 58.

BACKGROUND: Restricted and repetitive behaviors (RRB) are core features of autism but are also observed in typical development. Our understanding of the neural underpinnings of RRBs is limited. Given that excitation-inhibition (E/I) balance may underlie RRBs, we aimed to evaluate the relationship between aperiodic exponent (as a proxy of E/I balance) and changes in RRBs over time in infants with and without elevated likelihood of autism. METHODS: Resting-state EEG data were collected from 12-to-14-month-old infants and aperiodic exponent was calculated. Parent-reported RRBs were obtained using the Repetitive Behavior Scale-Revised questionnaire to measure the severity and change in RRBs from 12-to-36 months. Multiple linear regressions were conducted to assess relationships between aperiodic and change in RRBs. RESULTS: Marginal effects analysis of linear regressions revealed significant associations such that lower aperiodic exponent was associated with elevated RRBs reported over time across the whole sample ([Formula: see text]=0.31, β= -0.21, p = 0.01), which was more prominently observed in the infants who later received an autism diagnosis (δy/δx = -15.57, p < .001). CONCLUSIONS: Results suggest that early EEG aperiodic activity may serve as a potential correlate of increased manifestation of RRBs. Longitudinal studies are needed to elucidate whether the early trajectory of aperiodic activity in development influences the severity of RRBs in childhood.

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5. Dick K, Kaczmarek E, Ducharme R, Bowie AC, Dingwall-Harvey ALJ, Howley H, Hawken S, Walker MC, Armour CM. Correction: Transformer-based deep learning ensemble framework predicts autism spectrum disorder using health administrative and birth registry data. Sci Rep. 2025; 15(1): 33322.

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6. Fayena E, Horesh D, Haruvi-Lamdan N, Golan O. Suicidal Ideation Among Autistic and Non-autistic Adults: The Role of Emotion Regulation Difficulties. J Autism Dev Disord. 2025.

PURPOSE: Autism is characterized by high rates of psychiatric co-occurring conditions, including suicidality. Autistic adults report higher suicidal ideation and behavior compared to non-autistic adults. However, the mechanisms underlying these differences are still unclear. Research in non-autistic adults highlighted the role of emotion regulation difficulties in various psychopathologies, including suicidality. The current study examined the role of emotion regulation as a mediator between autism and suicidal ideation. METHODS: Fifty-one (51) autistic adults (29.41% female, mean age = 24.31, SD = 5.42) with no intellectual disability, and 71 comparable non-autistic adults (40.84% female, mean age = 23.67, SD = 4.63) self-reported on emotion regulation using the Difficulties in Emotion Regulation Scale (DERS) and on suicidal ideation using the Brief Symptoms Inventory (BSI). RESULTS: Significantly higher rates of suicidal ideation and difficulties in emotion regulation were reported by autistic, compared to non-autistic, adults. Higher levels of difficulties in emotion regulation were associated with increased suicidal ideation. Difficulties in emotion regulation, lack of emotional clarity, and limited access to emotion regulation strategies fully mediated the association between having autism and suicidal ideation. CONCLUSION: Results suggest that emotion regulation difficulties in general, and particularly the lack of emotional clarity and limited access to emotion regulation strategies, may play a mechanistic role in the increased suicidal ideation of autistic adults. Interventions targeting emotion regulation strategies and emotional clarity may assist in alleviating suicidal ideation in autistic adults.

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7. Ferrarese L, Asari H. Atypical cortical feedback underlies failure to process contextual information in the superior colliculus of Scn2a(+/-) autism model mice. Nat Commun. 2025; 16(1): 8659.

Atypical sensory integration and contextual learning are common symptoms in autism spectrum disorder (ASD), but how sensory circuits are affected remains elusive. Here we focused on the early visual information processing, and performed in vivo two-photon calcium imaging and pupillometry of mice engaged in an implicit learning task in stable and volatile visual contexts. Wild-type (WT) mice show stimulus-specific contextual modulation of the visual responses in the superior colliculus (SC) and pupil dynamics, whereas SCN2A-haploinsufficient ASD-model mice exhibit abnormal modulation patterns. In both genotypes, feedforward inputs from the retina to SC demonstrate no such contextual modulation. In contrast, feedback inputs from the primary visual cortex (V1) show modulation patterns similar to those of SC cells in WT mice, but no modulation in Scn2a(+/-) mice. Furthermore, chemogenetic perturbation reveals that this top-down signaling from V1 to SC mediates the observed contextual modulation both at the neurophysiological and behavioral levels. These results suggest that the corticotectal input is critical for contextual sensory integration in SC, and its anomaly underlies atypical sensory learning in ASD.

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8. Figueiredo T, Caixeta L. Autism Spectrum Disorders and Personality Disorders: Differential Diagnosis or Comorbidity?. Trends Psychiatry Psychother. 2025.

OBJECTIVE: The clinical overlap between autism spectrum disorder (ASD) and Personality Disorders (PDs) poses significant diagnostic challenges. Shared features-such as social communication difficulties, rigidity, and emotional dysregulation-often lead to misdiagnosis or delayed diagnosis, especially in adults and underrepresented populations (e.g., women). METHODS: This narrative review synthesizes current evidence on the differential diagnosis and comorbidity of ASD and PDs to guide clinical practice. RESULTS: Findings highlight substantial symptom overlap, particularly in social cognition and emotional regulation. For instance, both ASD and Schizotypal PD may exhibit social withdrawal, while ASD and Borderline PD share impulsivity and identity disturbances-though with distinct etiologies (neurodevelopmental vs. trauma-related). CONCLUSIONS: Clinicians must adopt a developmental perspective to disentangle ASD from PDs, integrating longitudinal history, neuropsychological testing, and multidisciplinary evaluations. Future research should prioritize biomarker-based diagnostics and tailored interventions for comorbid presentations.

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9. Gao L, Zhang T, Zhou R, Zhang T, Guo X. Sex heterogeneity of inter-individual functional hierarchical organization similarity in autism spectrum disorder based on the joint embedding analysis. Neuroimage. 2025: 121495.

Autism spectrum disorder (ASD) has been reported to exhibit altered functional connectivity in the brain. While extant research has predominantly examined male samples, sex differences of functional organization in ASD remains poorly characterized. This study aimed to explore the sex heterogeneity of the inter-individual functional hierarchical organization similarity in ASD. Resting-state functional magnetic resonance imaging data from the Autism Brain Imaging Data Exchange database, including 284 males/65 females with ASD and 340 male/119 female neurotypical controls (NCs) were used in this study. A joint embedding method was used to embed the functional connectomes of individuals into a common connectivity space and the inter-individual functional hierarchical organization similarity was further calculated within each group. Two-way analysis of variance (ANOVA) was used to explore sex heterogeneity in the functional hierarchical organization similarity in ASD. Significant diagnosis-by-sex interaction effects on the functional hierarchical organization similarity were observed in the default mode network, frontal-parietal network, subcortical network, dorsal attention network, and undefined network. The predictive analysis of symptom severity showed that the functional hierarchical organization similarity of brain regions with significant diagnosis-by-sex interaction effects can predict the social interaction impairments in males with ASD, whereas this relationship was not detected in females with ASD. These findings emphasize the sex heterogeneity of functional hierarchical organization in ASD and underscore the necessity of considering sex differences in future studies of ASD.

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10. Gellert BM, Religioni U, Raczkiewicz D, Ostrowski J, Pinkas J. Knowledge and attitudes toward Autism Spectrum Disorder in Poland – results of a national survey and identification of key areas for educational initiatives. Ann Agric Environ Med. 2025; 32(3): 368-76.

INTRODUCTION AND OBJECTIVE: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by social communication difficulties, repetitive behaviours, and atypical sensory responses. Despite increasing recognition, comprehensive understanding of ASD is lacking among the public and healthcare professionals. The aim of the study was to assess the knowledge and opinions of Polish society on ASD, identifying the weakest areas to inform future educational initiatives. MATERIAL AND METHODS: A cross-sectional survey was conducted from May to June 2024, involving 1,098 respondents, representative of the Polish population. Three questionnaires were used: an author-designed autism knowledge questionnaire, the Polish Autism Knowledge Questionnaire, and the Knowledge about Childhood Autism among Health Workers (KCAHW). Socio-demographic data were also collected. RESULTS: 37% of respondents considered ASD rare, 34% had interacted with someone with ASD, and 18% had a family member with ASD. Genetics (26.5%), maternal alcohol use during pregnancy (10%), and vaccines (7%) were cited as causes. The Internet (85%) and social media (28%) were themain sources of information. The mean KCAHW score was 8.6 ± 5.5, indicating moderate ASD knowledge, with women, younger individuals, and those with higher education or personal contact scoring higher (p<0.001). CONCLUSIONS: Knowledge about ASD in Poland is moderate yet fragmented, with significant gaps that could impede early diagnosis and intervention. Targeted educational campaigns are needed, focusing on specific gaps, along with increased government support for early diagnosis.

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11. Goetmaeckers F, Goris J, Wiersema JR, Verguts T, Braem S. Different exploration strategies along the autism spectrum: diverging effects of autism diagnosis and autism traits. Mol Autism. 2025; 16(1): 47.

BACKGROUND: When faced with many options to choose from, humans typically need to explore the utility of new choice options. People with an autism diagnosis or elevated autism traits are thought to avoid exploring such unknown options, but it remains unclear how autism affects exploration in decision spaces with many options. METHODS: In a large online sample (N = 588), we investigated the impact of autism diagnosis or elevated autism traits on exploration behavior during value-based decision-making in vast decision spaces. We used a 121-armed bandit with spatially correlated choice options, and a dedicated computational model to disentangle generalization, uncertainty-guided exploration, and random exploration strategies. RESULTS: Our findings show that participants with a self-reported autism diagnosis were less likely to explore novel choice options and more likely to exploit known high-value options. Computational modeling suggests they engaged in less uncertainty-driven exploration but exhibited equal random exploration and generalization strategies. Interestingly, among non-diagnosed participants, people with elevated autism traits did not explore less. LIMITATIONS: This study relies on self-reported autism diagnoses and trait measures collected online. This may limit the generalizability of the findings to clinically verified or more diverse autism populations. CONCLUSIONS: Our findings highlight important differences in exploration strategies between clinical and subclinical populations and emphasize the importance of cognitive modeling and using vast decision spaces to better understand autism. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13229-025-00679-9.

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12. Huang Y, Nobel Norrman H, Oliva M, van Leeuwen TM, Fransson P, Bölte S, Neufeld J. Local and Global Visual Processing in Autism: A Systematic Review and Meta-Analysis of Neuroimaging Studies. J Autism Dev Disord. 2025.

PURPOSE: Autism Spectrum Condition (ASC) is linked to altered local and global visual processing. Previous meta-analyses demonstrated brain activation differences across a broad range of visual tasks in ASC compared to non-autistic individuals, suggesting alterations in visual processing. However, a more specific understanding of brain mechanisms underlying detail-oriented visual attention is still lacking. To address this question, we conducted a systematic review and an activation likelihood estimation (ALE) meta-analysis on brain imaging studies assessing 252 individuals with ASC and 263 neurotypical controls (CON). METHODS: We included tasks that either required focusing on details while ignoring global configurations (local visual processing) or vice versa (global visual processing). Using ALE, we performed between-group and within-group meta-analyses across 15 studies involving local and global visual tasks. RESULTS: We found greater activation in the right inferior occipital gyrus (Brodmann Area, BA 19) in ASC compared to CON in the between-group meta-analysis of local and global visual studies. In the within-group analysis, we identified two activation convergences in the thalamus and middle occipital gyrus (BA 19) in the ASC group, and one in the inferior parietal lobule (BA 40) in the CON group. CONCLUSIONS: In line with theories suggesting alterations in local and global visual processing in ASC, our results indicate that autistic individuals may rely more on the visual cortex for local/global visual processing, while non-autistic controls may rely more on parietal regions.

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13. Loizou S, Beresford K, Baudinet J, Herrera-Gener P, Oregan D, Alford C, Tchanturia K, Stewart C. A pilot study investigating the acceptability and feasibility of a group intervention for parents of autistic young people with anorexia nervosa within a specialist eating disorders service. J Eat Disord. 2025; 13(1): 217.

BACKGROUND: Many children and young people presenting with anorexia nervosa will also be autistic. While autistic children and young people may have similar physical health outcomes compared to their neurotypical peers, they are more likely to experience poorer recovery, requiring more intensive treatments. Similarly, parents report needing additional support from mental health services. Parents may benefit from a group intervention as an adjunct to family therapy to help them effectively care for their children and to reduce the psychological impact this may have on them. This study aimed to provide an overview of the group intervention and evaluate its feasibility and acceptability. METHODS: Attendance rates were used to evaluate the feasibility of the group. Parents were invited to evaluate the acceptability of the group with brief quantitative measures each session. Individual qualitative interviews were conducted with six parents to evaluate both feasibility and acceptability. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: 17 parents (mothers n = 8, fathers n = 8, stepmother n = 1) from eight families took part in two pilot groups (group 1 n = 8, group 2 n = 9). Total attendance rate was 66.5%, with one parent from each family attending 85.7% of sessions. On average, sessions were rated highly relevant, useful and improved parents’ understanding of their child. From qualitative interviews conducted with six parents (group 1 n = 4, group 2 n = 2), two main themes were generated: (1) A space for connection and support, (2) From knowledge to practice. Parents spoke of the way the group helped them feel less isolated, gain skills and begin to practice implementing new learning at home. Not all aspects of the group were helpful, and recommendations were made regarding the resources, structure and intensity of the intervention. DISCUSSION: Findings suggest that the intervention is feasible and acceptable. This pilot study replicates previous findings about benefits of additional support for carers. The aim of the current study was to test a new group intervention aimed to support parents of autistic young people with anorexia nervosa. Parents rated each group session and were interviewed to gather feedback on their experiences of attending the group intervention. Most parents who took part in the interviews generally described the group as helpful, particularly in providing a sense of connection and identifying practical ways to support their autistic children with their eating. The positive feedback highlights the group’s potential value. Parents described several challenges to attending and fully engaging with the group, including work and caring commitments, and differences in relating to others who might have had different experiences. Suggestions to improve the group included developing and sharing electronic handouts and offering a follow-up session to reinforce the learning. Parents also felt the group would be more helpful if it was offered earlier in their child’s treatment. eng.

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14. Louwen F, Deuster E, McAuliffe FM, Jacobsson B, Geary M, Fleischman S, Kihara AB. Paracetamol (acetaminophen) use during pregnancy and autism risk: Evidence does not support causal association. Int J Gynaecol Obstet. 2025.

Recent political statements linking paracetamol (acetaminophen) use during pregnancy to autism spectrum disorders have created concern among patients and healthcare providers worldwide. This editorial critically examines the scientific evidence, highlighting that the largest and most methodologically rigorous population-based studies employing sibling control analyses demonstrate no causal association between prenatal paracetamol exposure and neurodevelopmental disorders. While some observational studies have suggested potential weak associations, these findings likely reflect confounding by indication and familial genetic factors rather than actual causal relationships. The most robust evidence comes from a Swedish population-based study of 2.48 million children, which found no increased risk when controlling for familial confounding. Major international medical organizations including ACOG, RCOG, and FIGO, and regulatory agencies including the European Medicines Agency continue to recommend paracetamol as the safest analgesic option during pregnancy when clinically indicated. The established risks of untreated pain and fever during pregnancy significantly outweigh theoretical concerns based on methodologically limited studies. Healthcare providers should continue evidence-based counseling while avoiding unnecessary anxiety about this essential medication in obstetric practice.

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15. Lu M, Zou Q, Pang F, Shi K, Lin X. Network Analysis of Parental Emotion Awareness and Emotion Coaching: Associations with Prosocial Behavior in Chinese Autistic Children. J Autism Dev Disord. 2025.

BACKGROUND: Autistic children are likely to have reduced prosocial behavior. Parental emotional management has been reported to exert a significant impact on offspring behavior and relationships during their lifespan. This study aimed to examine the network characteristics of parental awareness of children’s emotions and emotion coaching, and their associations with the prosocial behavior of Chinese autistic children. METHODS: Three hundred parents of autistic children completed measures assessing emotion awareness, emotion coaching, and their children’s prosocial behavior. Central and bridge nodes were assessed using Expected influence (EI) and bridge EI, respectively. A flow network of pro-social behavior in autistic children was used to identify specific links to parental emotion awareness and emotion coaching. RESULTS: Network analyses identified that EC3 (« Solve the child’s sadness problems »), EC7 (« Get close when the child is sad »), and EC2 (« Experience anger with the child ») are central nodes in the network of parental awareness of children’s emotions and emotion coaching. EAC1 (« Aware of the child’s unspoken feelings »), EC7 (« Get close when the child is sad »), and EAC2 (« Easy to know the child’s feelings ») are critical bridge nodes linking emotion awareness and emotion coaching. Additionally, prosocial behavior in autistic children demonstrated the strongest positive correlation with EAC3 (« Easy to know the child’s worries ») and the strongest negative correlation with EC5 (« Anger is worth exploring »). CONCLUSION: These findings provide insights into visualizing the emotion awareness and coaching of Chinese parents of autistic children, highlighting the strong connection between parental emotional management skills and the development of children’s prosocial behavior.

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16. Martín-Fernández J, Caballero-Estebaranz N, Félez E, Del Rosario PP, Pulido FR, Navarro-Peris N, Martínez F, Cervio A, Martín-Monzón I. Introducing e-Motions: a novel intraoperative test for social cognition mapping. Triple validation in normative, schizophrenia, and autism spectrum disorder populations. Acta Neurochir (Wien). 2025; 167(1): 261.

BACKGROUND: Social cognition is essential for daily functioning, as it influences quality of life, return to work, and interpersonal communication. While schizophrenia and autism spectrum disorder (ASD) have been the paradigmatic conditions in which social cognition is markedly impaired, emerging evidence suggests that up to 30% patients with brain tumors may experience persistent deficits in this domain. Despite its clinical relevance, social cognition remains insufficiently studied in neuro-oncology and lacks dedicated intraoperative assessment tools specifically tailored for its use during awake brain surgery. METHOD: This study introduces e-Motions, a new test designed ad hoc to address this gap. The e-Motions test comprises 34 four-second video stimuli depicting two hyper-realistic avatars (one male, one female) expressing complex emotions. These avatars were developed using an AI-based facial motion capture system applied to 60 professional actors. Validation was performed in three groups: (1) healthy adults (n = 226), (2) individuals with schizophrenia (n = 33), and (3) ASD (n = 30). RESULTS: Internal consistency (KR-20), test-retest reliability (ICC), and correlations with established social cognition tools (Reading the Mind in the Eyes [RMET], Ekman-60 faces test [Ekman-60F], and the Movie for the Assessment of Social Cognition [MASC]) were evaluated. The e-Motions test demonstrated high global internal consistency (KR-20 = 0.86) and good test-retest reliability (ICC₂,₁ = 0.73). Scores showed positive moderate correlations with both lower-level mentalizing tests (RME: ρ = 0.44; Ekman-60F: ρ = 0.48) and higher-level mentalizing test (MASC: ρ = 0.57). Discriminative power was strong for distinguishing healthy participants from individuals with schizophrenia (AUC = 0.89) and ASD (AUC = 0.79). CONCLUSIONS: e-Motions test is the first AI-based test created ad hoc for awake brain mapping. Its good internal consistency and significant correlation with low-level and high-level mentalizing tests make this tool a novel, ecological and promising way to identify critical regions involved in social cognition during awake brain mapping. Future studies should be performed to demonstrate its validity preserving this complex higher-order cognitive construct during and after brain tumor surgery.

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17. McCoy B, Bell L, Wang K, Jin H, Hassiotis A, Strydom A, Downs J, Carter B, Shetty H, Stewart R, Ali A, Sheehan R. Investigating the use and impact of community Care (Education) and Treatment Reviews (C(E)TRs) in people with intellectual disability and autistic people: protocol for a cohort study using electronic health records. BMJ Open. 2025; 15(9): e107889.

INTRODUCTION: Care (Education) and Treatment Reviews (C(E)TRs) are intended to reduce unnecessary psychiatric hospital admission and length of stay for people with intellectual disability and autistic people. The use and impact of C(E)TRs have not been systematically evaluated since their introduction in England in 2015. The aims of this study are to describe the demographic and clinical profiles of people who receive a community C(E)TR and to investigate their effects on admission, length of hospital stay and clinical and functional change. METHODS AND ANALYSIS: We will conduct a retrospective cohort study using de-identified data from electronic health records derived from two large National Health Service mental health providers in London, England, including one replication site. Data will be extracted using the Clinical Record Interactive Search (CRIS) tool for all people with recorded intellectual disability and/or autism who received mental healthcare from 2015. We will identify community C(E)TR events using keyword searches. Community C(E)TRs will be examined in two ways: (1) In a community cohort, we will capture data in the 6-month periods before and after a community C(E)TR and compare this to a matched control group and (2) In a hospital cohort, we will compare groups who did and did not receive a community C(E)TR prior to their admission. We will describe the socio-demographic and clinical profiles of each group and their health service use, and compare C(E)TR and no C(E)TR groups using t-tests (or a non-parametric equivalent). The primary outcomes are admission to a psychiatric hospital (community cohort) and length of psychiatric hospital admission and clinical change (hospital cohort). Admission to psychiatric hospital will be estimated using propensity score weighting and difference-in-differences methods. Cox’s proportional hazard model will be used for length of hospital admission and repeated-measures analysis of variance (ANOVA) will be used to assess clinical change. ETHICS AND DISSEMINATION: Use of CRIS to examine de-identified clinical data for research purposes has overarching ethical approval. This study has been granted local approval by the South London and Maudsley CRIS Oversight Committee. Findings will be disseminated in an open-access peer-reviewed academic publication, at conference presentations, and to service users and carers in accessible formats.

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18. Mengesha AK, Beyna AT, Kidanu GE, Misker MF, Ayele HS. Evaluating general practitioners’ knowledge and attitude of autism spectrum disorder and influencing factors at Gondar University Hospital, Gondar, Ethiopia. Sci Rep. 2025; 15(1): 33744.

ASDs are lifelong neurodevelopmental conditions characterized by impaired social interaction, communication challenges, and repetitive behaviors. This study assessed general practitioners’ knowledge and attitudes toward ASDs at Gondar University Hospital and explored influencing factors. A cross-sectional study (May 1-June 30, 2023) involved 360 participants selected via convenience sampling. Data were collected using a 19-item self-administered questionnaire covering socioeconomic characteristics (4 items), knowledge (10 items), and attitude (5 items), adapted from previous studies with some modifications. The mean age of participants was 31.82 years, with an average of 18 years post-graduation and 16 years of practice. Knowledge and attitude scores averaged 15.83 (SD = 3.265) and 29.54 (SD = 3.206), respectively, indicating moderate levels. Male practitioners exhibited significantly different attitudes from females (p < 0.001). Weak correlations were found between attitudes and age (r = 0.271, p < 0.001) and practice years (r = 0.105, p = 0.046), while no significant correlation existed between knowledge and demographic factors. A weak but significant correlation was observed between knowledge and attitudes (r = 0.004, p < 0.001). General practitioners demonstrated moderate knowledge and attitudes toward ASDs, with attitudes positively linked to experience and knowledge levels.

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19. Moser C, Adams R, Zheng S, Bishop S, Taylor JL. Brief Report: The Vocational and Educational Activities of Transition-Aged Autistic Youth With Low IQ. J Intellect Disabil Res. 2025.

BACKGROUND: Previous research has shown that autistic transition-aged youth with low IQ experience low rates of integrated employment and postsecondary education (PSE) enrolment. Notably, much of this work was conducted over a decade ago, and the landscape of opportunities has changed since that time. Therefore, the present study described the rate of involvement in vocational and PSE activities among a contemporary sample of autistic youth with low IQ residing in the United States. METHOD: Online survey responses were collected from 91 caregivers of autistic youth with low IQ residing in the United States. The survey gathered demographic information and assessed the behavioural functioning of the youth, along with their vocational and educational experiences. RESULTS: Thirty-five per cent of autistic youth with low IQ were not involved in any vocational/PSE activity. Approximately 15% of youth were participating in integrated employment (with or without supports), and 5% were enrolled in a range of degree- and non-degree-seeking PSE programmes. In a follow-up analysis, we found that youth who were engaged in vocational/PSE activities had higher family incomes, higher daily living skills, and lower rates of borderline-to-clinical levels of internalising and externalising behaviours than those who were not engaged in any vocational or PSE activity. CONCLUSIONS: Our findings indicate low participation (~20%) in integrated employment and PSE programmes, despite national efforts to increase these types of activities, and highlight the continued need to remove barriers that prevent engagement in vocational and PSE activities among autistic youth with low IQ.

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20. Mottron L, Lavigne-Champagne A, Bernhardt B, Dumas G, Jacquemont S, Gagnon D. Asymmetric developmental bifurcations in polarized environments: a new class of human variants, which may include autism. Mol Psychiatry. 2025.

Inspired by discrete stable alternative states that often coexist with the dominant phenotypes of a species, we propose that asymmetric developmental bifurcations (ADB) may provide a biological framework for grouping autism together with some human alternative organizations rather than with disorders or diseases. These include minority embryological or obstetrical variants, such as twinning and breech presentation, as well as minority information processing variants, such as left-handedness and importantly prototypical autism. Four common contextual, developmental, adaptive, and mechanistic features unify these alternative conditions as ADBs: 1) ADBs occur in a dynamic system formed by an individual and his environment with two polarized stable solutions. 2) The bifurcation occurs in a critical period of development and is significantly shorter than the stable states that precede and follow it. 3) While the frequent branch of the ADB optimizes evolutionary success, its rare branch has an adaptive cost, which is still compatible with survival. 4) Both rare and frequent branches of the ADB are human possibilities, favoured without major/deleterious changes by familial and/or sexual predispositions. Framing autism as a categorical, alternative phenotypic prototype in a polarized choice between social bias and its absence, elucidates autism’s recurrent divergence within the species, its developmental and information processing characteristics, and its adaptive challenges.

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21. Nagpal A, Chopra A, Chan J, Pellecchia M, Divan G. Implementing an Evidence-Informed Teaching Approach for Autistic Students in Bengaluru, India. J Autism Dev Disord. 2025.

PURPOSE: There is a lack of evidence-informed teaching approaches for autistic students, particularly in culturally diverse, low-resource settings. This study implemented a manualized, evidence-informed teaching approach called Classroom Pivotal Response Teaching (CPRT) in an urban special education school in Bengaluru, India. CPRT provides teaching strategies that addresses student motivation, initiation, and generalization during implementation of learning goals. All students in the study had diagnoses of moderate to severe autism, and some also had intellectual disability. METHODS: We assessed the acceptability, feasibility, and implementation fidelity of CPRT using a mixed-methods approach. Eight special educators were trained in CPRT over ten weeks. RESULTS: All eight educators were successfully trained to fidelity, and six of eight teachers maintained fidelity 1.5 to 4 months after training. Further, qualitative data indicated that CPRT was considered acceptable and beneficial, particularly to student engagement, skill acquisition, and speech, as well as teachers’ self-efficacy. CPRT was feasible to educators in individual teaching settings and for high-priority learning goals, as opposed to group settings for all learning goals, due to time and resource constraints.All eight educators were successfully trained to fidelity, and six of eight teachers maintained fidelity 1.5 to 4 months after training. Further, qualitative data indicated that CPRT was considered acceptable and beneficial, particularly to student engagement, skill acquisition, and speech, as well as teachers’ self-efficacy. CPRT was feasible to educators in individual teaching settings and for high-priority learning goals, as opposed to group settings for all learning goals, due to time and resource constraints. CONCLUSION: Overall, this study demonstrates the promise of CPRT in special education settings in India, suggesting the need for a larger-scale efficacy trial.

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22. Naguy A, Abdelaal A, Elsori D, Alamiri B. Lithium Carbonate Monotherapy for Nonaffective Behavioral Decompensation in Low-Functioning Autism. Am J Ther. 2025.

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23. Ononuju UA, Ujari CA. Stigma and Misinformation About Autism Spectrum Disorder (ASD) on Tiktok and Instagram: Content Analysis Using #ASD, #Autism and #ASDinfo. J Autism Dev Disord. 2025.

BACKGROUND: This study investigates the prevalence, nature, and impact of misinformation, stigma, and general information about autism spectrum disorder (ASD) on TikTok and Instagram. OBJECTIVE: The aim of this research was to analyze the content related to ASD on TikTok and Instagram to understand the nature of misinformation, stigma, and their influence on public perceptions of ASD. METHODS: A TypeScript-based scraper was used to extract posts from TikTok and Instagram, focusing on the hashtags #ASD, #Autism, and #ASDinfo. Data was collected over a five-year period from January 2018 to January 2024. RESULTS: The analysis found that misleading statistics (MIS3) were the most common form of misinformation, accounting for 52.5% of all misinformation. Instagram had a higher prevalence of misinformation (85%) compared to TikTok (74%). In terms of stigma, negative stereotypes (STIG1) were most prominent, with TikTok showing a higher frequency of stigma (88.5%) than Instagram (80%). Supportive community posts (INFO2) made up 48.5% of the posts, with Instagram again leading (65%) over TikTok (63.5%), although TikTok had more interactive engagement. Chi-square tests indicated statistical significance for derogatory language (p = 0.049) and personal stories (p = 0.038), both of which were more prevalent on TikTok. No significant differences were found in other categories. CONCLUSIONS: This study highlights the distinct dynamics of misinformation and stigma across social media platforms, with TikTok showing greater negativity and interactive content, while Instagram provided more supportive community posts. The findings emphasize the need for targeted interventions to address the spread of misinformation and harmful stereotypes about ASD on these platforms.

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24. Qin G, Ni H, Ren W, Wang Z, Yan W, Li K, Lin X, Zhang W, Zhang X, Li J, Hou Y, Wu M, Zhang H, Chen L, Xiao X. Gestational diabetes mellitus induces 5-HT system dysfunction and exacerbates an ASD-like phenotype in male offspring by inhibiting the Ahi1/B9D1/Shh axis. Brain Behav Immun. 2025: 106127.

Gestational diabetes mellitus (GDM) is a significant risk factor for autism spectrum disorder (ASD) in offspring. Despite the growing interest in the hypothesis of 5-hydroxytryptamine (5-HT) system dysfunction, the underlying mechanisms remain unclear and require further investigation. In this study, a GDM model was established in mice by feeding them a high fat diet (HFD) and administering an intraperitoneal injection of streptozocin (STZ). Our findings indicated that GDM exposure induced ASD-like behaviors and disrupted 5-HT system function by decreasing the level of Abelson helper integration site 1 (Ahi1) in the dorsal raphe nucleus (DRN) of male offspring. Furthermore, GDM evoked neuroinflammation, accompanied by a notable increase in the concentrations of proinflammatory factors (TNF-α, IL-1βand IL-6). Additionally, Ahi1 knockdown in normal mice mediated by an injection of AAV-Ahi1 in the brain recapitulated ASD-like behaviors and 5-HT system dysfunction, but these effects were blocked by the overexpression of B9 domain-containing protein 1 (B9D1) or meptazinol-mediated pharmacological activation of Ahi1, which ameliorated ASD-like behaviors, neuroinflammation and reversed 5-HT system dysfunction in male offspring of mothers with GDM (GDM-Os). Furthermore, lipopolysaccharide (LPS) induced neuroinflammation inhibited Ahi1 induced 5-HT system dysfunctions in vitro. Based on these findings, the inhibitory effects of meptazinol on GDM-induced ASD-like behaviors could be attributed to the involvement of 5-HT system dysfunction mediated by the Ahi1/B9D1/Shh axis. These findings provide novel insights into the mechanism by which neuroinflammation associated with GDM causes ASD pathogenesis and may pave the way for the development of a new therapeutic strategies for ASD.

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25. Querido AL, Wingelaar TT. Assessing dive fitness in individuals with autism spectrum disorder. Diving Hyperb Med. 2025; 55(3): 220-7.

Scuba diving requires situational awareness, cognitive flexibility, and the ability to adapt to changing conditions. For individuals with autism spectrum disorder (ASD), these demands may pose unique challenges due to differences in executive functioning, sensory processing, and social cognition. This article explores the key considerations in assessing fitness to dive in individuals with ASD, including the impact of comorbidities, medication use, and cognitive abilities on diving safety. To provide a broader perspective, we examine research on ASD and high-risk activities such as driving, where similar cognitive and decision-making challenges exist. Additionally, we discuss the role of neuropsychological assessments in evaluating a diver’s cognitive fitness and the limited but emerging evidence on scuba diving interventions for individuals with ASD. While ASD is not an absolute contraindication to diving, a careful, individualised assessment is essential to determine suitability. This review aims to provide guidance for diving professionals and medical examiners in making informed decisions regarding ASD and scuba diving.

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26. Saeed MA, Jaber OA, Lami F, Jasim SM, Nayeri ND, Sabet MS, Al-Gburi G. Awareness of autism spectrum disorder among public primary school teachers in Iraq. BMC Psychol. 2025; 13(1): 1075.

BACKGROUND: Primary school teachers play a vital role in detecting children with autism spectrum disorder (ASD), thereby allowing early interventions that enhance their quality of life and reduce the burden. This study aims to estimate the awareness levels of Iraqi primary school teachers regarding ASD and assess the association with the teachers’ demographic factors. METHODS: A descriptive study was conducted among primary school teachers affiliated with the Rusafa 1 educational directorate of Baghdad from March 21, 2024, to June 1, 2024, using a structured questionnaire developed by reviewing the DSM-5 criteria for ASD and JM Rey’s IACAPAP Textbook of Child and Adolescent Mental Health. RESULTS: A total of 301 teachers were included. Of whom, 86 (28.6%) had inadequate awareness, with higher scores demonstrated among teachers who had previous contact with ASD children (Ɛ(2) = 0.046, 95% CI = 0.009 to 0.092, Adjusted p < 0.05) or used workshops as a source of information (r = 0.169, 95% CI = 0.048 to 0.275, Adjusted p < 0.05). However, no significant correlation was found with work experience (r = -0.073, adj. p-value = 0.373). Teachers were more likely to recognize repetitive behaviors (79.1%) and inappropriate attachment to toys (72.4%) as symptoms compared to lack of good verbal communication (60.1%). Furthermore, 241 (80.1%) correctly identified the benefits of early diagnosis. However, 215 (71.4%) still believed that ASD can be completely cured. CONCLUSION: Around a quarter of teachers have a limited understanding of ASD, with common misconceptions in identifying risk factors, signs and symptoms, and treatment outcomes. These findings may support future educational initiatives and policy changes, potentially playing a role in ensuring early identification and timely referrals for these children. CLINICAL TRIAL NUMBER: Not applicable.

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27. Sohl K, Linstead E, Heinz K, Lledo EE, Brewer Curran A, Mahurin M, Nanclares-Nogués V, Salomon C, Seal M, Taraman S. Integration of an artificial intelligence-based autism diagnostic into the ECHO Autism Primary Care Early Diagnostic workflow: results of a prospective observational study. JMIR Form Res. 2025.

BACKGROUND: Pediatric specialist shortages and rapidly rising autism prevalence rates have compelled primary care clinicians to consider playing a greater role in the autism diagnostic process. The ECHO Autism: Early Diagnosis Program (EDx) prepares clinicians to screen, evaluate, differentiate, diagnose and provide longitudinal care for autistic children in primary care settings. Canvas Dx is a prescription-only Software as a Medical Device designed to support clinical diagnosis or rule out of autism, including in primary care settings. It is FDA authorized for use, in conjunction with clinical judgement, in 18-72-month-olds with indicators of developmental delay. OBJECTIVE: To assess the feasibility and impact of integrating the Device into the ECHO Autism: EDx workflow. Time from the first clinical question of developmental delay to autism diagnosis is the primary endpoint. Secondary endpoints explore clinician and caregiver experience of device use. METHODS: Children aged 18-72-months-olds with concern for developmental delay indicated by either a caregiver or health professionals were eligible to participate in this prospective observational study. Experienced ECHO Autism: EDx Clinicians were recruited to evaluate the inclusion of the Device as part of their diagnostic evaluations. Outcome data was collected via a combination of electronic questionnaires, standard clinical care record reviews and analysis of Device outputs. Institutional Review Board Approval was provided by the University of Missouri-Columbia (IRB assigned project number 2075722). RESULTS: 80 children and seven clinicians completed the study. On average, time from clinical concern at study enrollment to final autism diagnosis was 39.22 days, compared to 180-264 day waits at adjacent specialist referral centers. The vast majority (93%) of caregivers reported being satisfied with the ECHO Autism: EDx plus Device evaluation their child received and endorsed that they would recommend it to others and that they felt comfortable using the Device. The Device produced determinate autism predictions or rule outs for 52.50% of participants, and in all cases these were consistent with the final clinical determination. Participating clinicians reported Device use was feasible and reduced several challenges associated with their previous diagnostic process, however, they noted it did not obviate the need for additional structured observation in every case. CONCLUSIONS: The ECHO Autism: EDx plus Device workflow offers considerable time savings compared to specialty center referral and was strongly endorsed by caregiver participants. Embedding the Device into the ECHO Autism: EDx workflow was feasible and helped streamline several workflow efficiencies. Clinicians still utilized their training and application and interpretation of DSM-5 criteria when formulating the diagnosis for indeterminate cases. CLINICALTRIAL: Registered with ClinicalTrials.gov (Protocol Identifier: NCT05223374). INTERNATIONAL REGISTERED REPORT: RR2-10.2196/37576.

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28. Wang HFW, Smith SS, O’Flaherty M, Trost SG, Thomas G, Walker JL, Fortnum K, McNaughton S, Cairney J, Bourke M. Associations Between Screen Time, Sleep Quality, Diet Quality and Food Selectivity Among School-Aged Autistic Children. J Autism Dev Disord. 2025.

PURPOSE: Autistic children are more likely to experience challenges with poor diet quality or selective eating behaviours in comparison to neurotypical peers, which may predispose them to nutrient deficiencies and suboptimal weight status. Thus, it is crucial to identify factors associated with these two unfavourable dietary behaviours in autistic children. This cross-sectional study examined the associations between screen time and sleep quality with diet quality and food selectivity among autistic children, and the extent to which screen time was indirectly associated with diet quality and food selectivity through sleep quality. METHOD: The parents of 628 autistic children aged 7-12 years in Australia reported on their child’s screen time, sleep quality, diet quality and food selectivity via an online questionnaire. RESULTS: Structural equation modelling of the hypothesised mediation model revealed significant associations between screen time and sleep disturbances (β = 0.118, 95%CI = 0.032, 0.204, p = .007), and between sleep disturbances with lower diet quality (β = -0.077, 95%CI = -0.153, -0.001, p = .047) and higher food selectivity (β = 0.198, 95%CI = 0.119, p < .001). Sleep disturbances only weakly explained the indirect association between screen time and food selectivity (β = 0.023, 95%CI = 0.004, 0.043, p = .018), whereas the indirect association between screen time and diet quality through sleep disturbances was non-significant (β = -0.009, 95%CI = -0.020, 0.002, p = .110). CONCLUSION: Higher screen time and poor sleep quality emerged as significant factors associated with unfavourable dietary behaviours among autistic children.

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29. Wolpe SM, Lee MN, Koenig J, Tien I, McLean K. Acceptance, Social Preparation, and Psychoeducation: Autistic Young Adults’ Recommendations for Transition to Adulthood. J Autism Dev Disord. 2025.

BACKGROUND: Little research has explored the experiences of autistic adults retroactively recalling the preparation they did (or did not) receive for adulthood. The current study explores autistic young adults’ experiences transitioning into the responsibilities and challenges of adulthood through semi-structured interviews. METHODS: Seventeen autistic adults were interviewed (M(age)=26.7 years). Themes related to preparation for transitioning into adulthood from high schools and families were analyzed. Data analysis was conducted through the theoretical frameworks of the Social Model of Disability (Oliver, 1990) and Transition Theory (Schlossberg, 1981). Reflexive thematic analysis (Braun & Clarke, 2024a, b) was used. RESULTS: Participants relayed Constructive Experiences surrounding Study Strategies, Mentorship, and Learning Life Skills in preparing them self-sufficiency in adulthood, the Destructive Experiences of Discouragement and Insults from people in positions of authority and forced Suppression of their authentic selves. Participants recalled being Underestimated and Infantilized. Participants suggested that high schools offer specific Social Preparation, emphasizing Study Skills and Family Involvement in transition preparation, and offering Psychoeducation to families. Lastly, participants suggested that families practice Understanding, Acceptance, Honesty, and offer Support for Executive Functioning. CONCLUSION: This work builds on prior research of autistic individuals’ experiences by primarily focusing on preparation for employment and postsecondary education, in addition to providing primarily recommendations for how preparation services can be improved. The results from this study provide guidance on next steps for improving transition-related resources for autistic teens, families, and high schools in preparing for this critical next stage in life.

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30. Yeung MK, Li CTY, Chung HCW, Au TH, Lee SY, Bai J. Autistic traits are associated with lower perceived executive function but not poorer executive function task performance in the general population: complementary meta-analytic evidence. Mol Autism. 2025; 16(1): 48.

BACKGROUND: Autistic individuals generally exhibit real-world executive function (EF) difficulties and perform poorly on EF tasks. However, while autistic traits are distributed continuously throughout the general population, the relationships between autistic traits and EF among nonclinical individuals remain unclear. Here, we conducted complementary meta-analyses to clarify the relationships between autistic traits and various aspects of EF in the general population. METHODS: A literature search was conducted using PubMed, PsycINFO, and Web of Science on July 11, 2025. After screening by two independent reviewers, 39 articles that reported 40 studies were included. These studies either compared EF between groups with high and low autistic traits, based on a cutoff, or investigated the relationships between continuous measures of autistic traits and EF. RESULTS: We found significant negative associations between autistic traits and EF among nonclinical individuals across EF processes. Notably, these relationships were observed only when EFs were measured using questionnaires rather than behavioral tasks. Specifically, random-effects and robust Bayesian meta-analyses revealed significant, strong correlations between higher autistic traits and poorer ratings on EF questionnaires, with primarily substantial evidence supporting the presence than absence of relationships. In contrast, the meta-analyses indicated nonsignificant, very weak correlations between higher autistic traits and poorer performances on EF tasks, with primarily substantial evidence supporting the absence than presence of relationships. LIMITATIONS: These findings were mainly based on self-reported measures of autistic traits in adults and derived from single studies without follow up or replication. CONCLUSIONS: Autistic traits are associated with lower perceived real-world EF behavior rather than poorer EF task performance in the general population. These findings underscore the importance of paying closer attention to addressing the concerns of individuals with high autistic traits and their parents regarding their own and their children’s EF behavior. Based on the available evidence, we construct a picture of the relationships between autistic traits and EF across the trait’s continuum. REGISTRATION: This study was preregistered at https://osf.io/zncv3 .

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