1. AlHousni SS, Idris A, Al-Mamari W, Al-Sayegh A. Clinical Phenotypes Associated with NRXN1 Deletions in Five Children with Autism Spectrum Disorder in Oman. Sultan Qaboos Univ Med J. 2026; 26(1): 448-54.

NRXN1 (2p16.3) is essential for synaptic function and has been implicated in autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, the phenotypic features associated with NRXN1 copy number variants remains incompletely characterised, which complicates risk assessment in genetic counselling. This case series describes five children, who were evaluated at the Genetics and Developmental Pediatrics Clinic of a tertiary care hospital in Muscat, Oman, from 2011 to 2023, with rare NRXN1 deletions (57-150 kb). All met DSM-5 criteria for ASD and had speech and language delays with cognitive impairment. Consanguinity was reported in three of the families and two had a family history of ASD. Microcephaly was present in four children and one showed facial dysmorphism. Generalised tonic-clonic seizures were present in one child and one child had comorbid attention deficit hyperactivity disorder. These findings illustrate clinical heterogeneity among children with NRXN1 deletions and supports the need for larger studies to better define genotype-phenotype relationships.

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2. Ames JL, Ferrara A, Feng J, Alexeeff S, Avalos LA, Barrett ES, Bastain TM, Bennett DH, Buckley JP, Carignan CC, Cintora P, Ghassabian A, Hedderson MM, Hernandez-Castro I, Kannan K, Karagas MR, Karr CJ, Kuiper JR, Liang D, Lyall K, McEvoy CT, Morello-Frosch R, O’Connor TG, Oh J, Peterson AK, Quiros-Alcala L, Sathyanarayana S, Schantz S, Schmidt RJ, Starling AP, Woodruff TJ, Volk HE, Zhu Y, Croen LA. Exposure to Organophosphate Ester Flame Retardants and Plasticizers during Pregnancy and Autism-Related Outcomes in the ECHO Cohort. Environ Health Perspect. 2026; 134(4): 423-37.

BACKGROUND: Organophosphate ester flame retardants and plasticizers (OPEs) have myriad uses in industry and consumer products. Increasing human exposure to OPEs has raised concerns about their potential effects on child neurodevelopment during the pregnancy. Objective: We investigated whether OPE urinary concentrations during pregnancy were associated with child’s autism-related outcomes. METHODS: We included 4159 mother-child pairs from 15 cohorts in the NIH Environmental influences on Child Health Outcomes (ECHO) Consortium, with children born from 2006-2020 (median age [interquartile range]: 6 [4,10] years). Nine OPE biomarkers were measured in urine samples collected mid- to late pregnancy. Dilution-adjusted biomarkers were modeled continuously, categorically (high [>median], moderate [≤median], nondetect), or as detect/nondetect depending on their detection frequency. We assessed child autism-related traits via a) parent report on the Social Responsiveness Scale (SRS) and b) clinical autism diagnosis. We examined associations of OPEs with child outcomes, including modification by child sex, using generalized estimating equations to account for clustering by ECHO cohort. RESULTS: Compared with nondetectable concentrations, high exposure to bis-(butoxyethyl) phosphate (BBOEP) was associated with higher autistic trait scores (adj-β 0.97, 95% confidence interval [CI]: 0.42, 1.52) and greater odds of autism diagnosis (adjusted odds ratio [adj-OR]: 1.27, 95% CI: 1.07, 1.50). Bis-(1-chloro-2-propyl) phosphate (BCPP) showed associations with autistic trait scores (BCPP adj-β for high exposure vs nondetect: 0.34, 95% CI: -0.46, 1.13; BCPP adj-β for moderate exposure vs nondetect: 0.72, 95% CI: 0.24, 1.20). High exposure to bis-(2-chloroethyl) phosphate (BCETP) was associated with lower odds of autism diagnosis (adj-OR: 0.76, 95% CI: 0.60, 0.95). Other OPEs showed no associations in adjusted models. Associations between BBOEP and higher autistic trait scores were stronger in males than females. DISCUSSION: Prenatal exposure to OPEs, specifically BCPP and BBOEP, may be associated with a higher risk of autism diagnosis and related traits in childhood.

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3. Amir-Behghadami M, Sadegh Tabrizi J, Heidarabadi S, Barzegar M, Nikniaz A, Azami-Aghdash S. F-words as core components in global early childhood development interventions: a scoping review protocol. BMJ Open. 2026; 16(8): e116396.

INTRODUCTION: Early childhood development (ECD) interventions within global health systems support children aged 0-5 years across a range of developmental needs, including those who are typically developing (healthy), at risk of developmental delay or living with developmental disorders. These interventions address multiple domains of development, yet their conceptual integration remains variable across contexts. The F-words framework-encompassing Functionig, Family, Fitness, Fun, Friends and Future-provides a holistic, strengths-based lens for understanding child development, yet its integration across diverse health contexts remains underexplored. This scoping review protocol adopts the F-words framework as a guiding premise to examine how these components are reflected in ECD interventions globally. METHODS AND ANALYSIS: This scoping review will follow Arksey and O’Malley’s framework, with guidance from the Joanna Briggs Institute, using the Population-Concept-Context approach. Searches will be conducted in major international databases (eg, PubMed/MEDLINE, Scopus, Web of Science) alongside selected regional sources and grey literature. Studies will be screened independently by two reviewers, with disagreements resolved through discussion or a third reviewer. Data will be charted using structured forms aligned with the F-words domains and synthesised narratively to identify key patterns, gaps and implementation factors. ETHICS AND DISSEMINATION: Ethical approval was confirmed by Tabriz University of Medical Sciences (IR.TBZMED.REC.1404.139); no patient involvemet occurs. Findings will be disseminated through peer-reviewed publication and academic forums to inform research, policy and practice in ECD.

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4. Anderer S. Acetaminophen Use During Pregnancy Is Unlikely to Cause Autism or ADHD, New Study Reaffirms. Jama. 2026; 336(5): 358-9.

This Medical News article discusses a new study that adds to existing evidence that acetaminophen use during pregnancy does not appear to cause autism or ADHD. eng.

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5. Aslan C, Kaplan O, Yalçın N, Fidan BB, Çelebier M, Ünal D, Allegaert K. Plasma Metabolic Features Associated with Developmental Regression in Autism Spectrum Disorder: A Pilot Untargeted Metabolomics Study. Int J Mol Sci. 2026; 27(15).

Developmental regression, the loss of previously acquired language and social skills during the second year of life, affects 20-40% of children with autism spectrum disorder (ASD), yet its metabolic underpinnings remain poorly defined. Existing metabolomics studies have focused on amino acid and acylcarnitine alterations, leaving the eicosanoid, sphingolipid, and glycoconjugate axes largely unexamined. Plasma from 25 children with regressive ASD (REG+), 27 with non-regressive ASD (REG-), and 21 typically developing controls (aged 2-6 years) was profiled using untargeted Q-TOF LC/MS (Agilent 6530, ESI+ mode, 100-1700 m/z). From 6657 detected features, a stepwise curation pipeline combining statistical significance (raw p < 0.05 with Benjamini-Hochberg FDR correction, q < 0.05; FC > 1.5), analytical plausibility, endogenous origin verification, and literature-based directional alignment yielded a prioritized set of 14 annotated metabolic features. Exploratory PLS-DA (Partial Least-Squares Discriminant Analysis) visualization showed separation among the three groups within the present dataset; however, diagnostic or predictive performance was not evaluated. The 14-feature panel clustered along four biochemical axes. A feature putatively annotated as prostaglandin E3 (PGE3) showed a 7.13-fold reduction in REG+ versus controls (1.58-fold in REG-; FC REG+/REG- = 4.52). N-Acetylneuraminosyl-(α2-6)lactosamine and aspartylglycosamine were decreased 4.44-fold and 5.42-fold in REG+, respectively, with regression-specific amplification (FC REG+/REG- > 2.0). Six sphingolipid-myelin metabolites showed coordinated biosynthetic depletion and catabolic elevation in both ASD groups without regression specificity. DHEA-S exhibited the largest subgroup differential (FC REG+/REG- = 8.89), with paradoxically greater depletion in the non-regressive group. This exploratory study identified several plasma metabolic features showing abundance differences among children with REG+, REG-, and typically developing controls. These findings are hypothesis-generating and require confirmation using authenticated standards, targeted quantitative methods, and independently recruited cohorts before any diagnostic, predictive, or therapeutic relevance can be established.

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6. Courcy I, Bélanger M, Des Rivières-Pigeon C, Guerrero L, Soulières I. [« I tried so hard to be normal… that I ended up exhausting myself. »: Forms of social exclusion experienced by young autistic adults]. Sante Ment Que. 2026; 51(2): 305-31.

Introduction Autistic people are particularly at risk of experiencing forms of violence, ostracism or discrimination, which lead to social exclusion in the course of their lives. However, very little research has addressed social exclusion from its subjective dimensions (e.g. attitudes, opinions, social representations and self-perception) and the relational contexts in which these experiences take shape and affect well-being and mental health. This article presents the results of qualitative research conducted with young autistic adults in Quebec who took part in asynchronous online discussion groups. It aims to identify the forms of social exclusion shared by the participants to better understand the relational contexts in which these experiences take place. Method Four asynchronous online focus groups were conducted with 23 autistic adults living in Quebec and aged 19 to 31 (average: 24). They all have received a professional diagnosis of autism. For nearly 3 weeks, open-ended questions were asked on a specific topic. A qualitative analysis using open coding was conducted. Results: The results show 4 main sources of exclusion mentioned by the participants: microaggressions, discrimination, victimization and constraints on self-determination. Social exclusion takes place in a variety of relational contexts, in which the entourage and formal services are sometimes seen as supports, sometimes as sources of vulnerability. Strategies of concealment, self-exclusion and camouflage appear to be ways of preventing exclusion, to the detriment of well-being. Discussion Five avenues for improvement in clinical and reception practices in general services are identified: 1. Develop service delivery practices in general and specialized services that are sensitive to the characteristics and needs of autistic people; 2. Adopt a trauma-informed approach and promote environments that support recovery; 3. Improve the flexibility of services and intervention methods in response to the needs expressed by autistic people; 4. Continue awareness-raising efforts to promote greater social acceptance of autism and neurodiversity in schools and the workplace; 5. Establish cross-sectoral collaborations between the education, employment, health, and social services sectors, involving user groups and advocacy organizations, to contribute to the development of truly inclusive practices.

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7. Dalvi P, Kelly O, Grady L, Carris N, Sullivan J, Liu H. Anorexia Nervosa, Schizophrenia, and Autism Spectrum Disorder: A Review of the Role of Tanycytes in Individual and Social Behavior. Cureus. 2026; 18(7): e112030.

Located along the third ventricle of the hypothalamus, tanycytes are a type of glial cell that are prominent components of metabolic, homeostatic, and immunological signaling and transport. Behavioral deficits observed in disorders such as anorexia nervosa (AN), schizophrenia (SCZ), and autism spectrum disorder (ASD) have been observed and can be linked to the various functions of tanycytes. This review investigates the association between tanycytes and AN, SCZ, and ASD, potentially giving insight into the pathogenesis of these disorders. Specifically, attention is paid to the role of tanycytes in immunological and metabolic pathways, as well as their involvement in the hypothalamic parenchyma via extended processes. Knowledge about the basic molecular and behavioral pathology of AN, SCZ, and ASD may help establish the link between tanycytes and behavior, both on the individual and social level. More mechanistic studies are required, as currently available data are just hypothesis-generating and not mechanistically established.

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8. Fellowes S. Autism, Empathy and Neurodiversity. Psychiatr Clin North Am. 2026; 49(3): 493-504.

Autism is typically understood to involve a lack of empathy. This does not fit a neurodiversity position whereby some or all aspects of autism are differences rather than disorders. The double-empathy problem provides a neurodiversity-compatible account whereby there is a mutual lack of empathy between autistic and nonautistic people. The author argues that the double-empathy problem is compatible with some autistic people having significantly reduced capacity for empathy. Portrayals of the double-empathy problem, which do not recognize this, could alienate autistic people who do have empathy deficits, increase conflict between autistic individuals, and increase conflict between autistic and nonautistic individuals.

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9. Feng S, Si X, Lu C, Gao Z, Wang J, Yang Q, Lu S, Su T, Yang J, He X, Wu L. Washed microbiota transplantation improves clinical symptoms, gut microbiota, and metabolic profiles in autism spectrum disorder in a twin cohort. Front Microbiol. 2026; 17: 1885281.

OBJECTIVE: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by impaired social communication, repetitive behaviors, and restricted interests. Dysregulation of the microbiota-gut-brain axis is closely associated with the pathogenesis of ASD. Washed microbiota transplantation (WMT) has emerged as a promising intervention for ASD, but existing cohort studies lack genetically identical controls, making it difficult to distinguish intervention-related changes from genetic and environmental confounding factors. This twin-paired controlled study adopted a study design that minimizes the influence of genetics and shared environment, to explore the associations of WMT with clinical symptoms, gut microbiota, and metabolic profiles in children with ASD. METHODS: Three pairs of age- and environment-matched twins (one ASD-affected, one typically developing sibling) were enrolled. WMT was administered to the ASD participant in each pair. Fecal samples were collected at baseline and post-intervention. Gut microbiota and metabolic profiles were analyzed using metagenomic sequencing and targeted metabolomics, respectively. Clinical outcomes were evaluated using the Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC), Sleep Disturbance Scale for Children (SDSC), and Bristol Stool Form Scale (BSFS). Relevant observations were carried out to explore potential changing trends. RESULTS: After WMT, CARS, ABC, SDSC, and BSFS exhibited small numerical directional shifts toward healthier values, but none reached statistical significance. Gut microbial structure and function presented a shifting trend toward the profile of their typically developing twin siblings. Abnormal lipid and energy metabolism indicators showed partial ameliorative trends, and the number of differential metabolites between ASD patients and healthy siblings was markedly reduced. Tyrosine and phenylalanine metabolic pathways, together with Segatella, Negativibacillus, and Sangeribacter, may be associated with incomplete phenotypic changes in this cohort. LIMITATIONS: Although the twin-pair design has high internal validity and can provide strong causal inference evidence for the effect of microbiota transplantation in treating ASD, this study has limitations such as a small sample size, a single-center non-randomized observational design. All findings in this pilot study are merely descriptive trends, and the relevant mechanism analysis only provides correlational clues. A single session of microbiota transplantation failed to fully adjust aromatic amino acid metabolism in ASD children. No definitive causal relationship can be concluded based on the findings of this small-sample pilot study. CONCLUSION: Under tightly controlled genetic and environmental conditions, gut microbial dysbiosis presents correlational characteristics with ASD-related phenotypes. WMT was associated with consistent remodeling of gut microbial ecology and partial resolution of metabolic dysregulation in ASD children, with multi-omic signatures converging toward healthy twins. Clinical rating scales only displayed non-significant minor numerical shifts, which cannot be interpreted as evidence of clinical symptom improvement. These initial findings provide exploratory mechanistic clues and phenotypic data supporting WMT as a targeted microbiome intervention approach for ASD, and await further validation through large-scale randomized controlled trials. CLINICAL TRIAL REGISTRATION: Identifier ChiCTR2400091105.

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10. Frith U. Autism spectrum disorder: has it lost its meaning and is it leading to misdiagnosis?. Psychol Med. 2026; 56: e240.

BACKGROUND: Since the 1940s, the concept of autism has undergone marked changes, and autism spectrum disorder (ASD) is a wildly heterogenous condition. At the same time, the prevalence of ASD has increased massively. METHODS: This essay considers possible reasons for the changes and their consequences. RESULTS: Among drivers for the increase in prevalence are cultural changes, such as the desire for inclusion, harm avoidance, reliance on self-report, and the acceptance of masking. These have all led to a lowering of the diagnostic threshold. Furthermore, the popularity of the concept of autism boosted numbers via self-diagnosis and a search for identity. CONCLUSIONS: Marked differences now exist between those first diagnosed in childhood and others first diagnosed in adolescence or adulthood. The time has come to examine reasons for these conceptual changes and the consequences for clinical practice and research.

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11. Hashimoto E, Ito H, Hamada M, Nakajima T, Takayanagi N, Myogan M, Murayama Y, Tsujii M. Longitudinal associations among autism and ADHD traits, social maladjustment, and mental health in school-aged children. Psychol Med. 2026; 56: e246.

BACKGROUND: Neurodevelopmental disorder traits are associated with a range of psychosocial difficulties, yet the longitudinal processes linking these traits to mental health remain insufficiently explored. This study examined developmental associations among autism spectrum disorder (ASD) traits, attention-deficit/hyperactivity disorder (ADHD) traits, social maladjustment, and mental health from childhood through adolescence. METHODS: Longitudinal data were drawn from 9,619 students across 11 grade cohorts in mainstream classrooms. Cross-lagged structural equation modeling was used to estimate independent longitudinal associations among ASD traits, ADHD traits, social maladjustment, and mental health, while controlling for confounding factors. ASD and ADHD traits were modeled simultaneously to clarify their unique developmental patterns. RESULTS: ASD traits were consistently associated with later internalizing problems and peer difficulties. ADHD traits were associated with later internalizing and externalizing problems, as well as academic challenges and strained teacher-parent relationships. These associations differed by trait type, suggesting distinct developmental pathways. Several bidirectional associations also emerged: poorer mental health was associated with subsequent social maladjustment, which was subsequently linked to persistent developmental difficulties. CONCLUSIONS: The findings indicate that social maladjustment is involved in the longitudinal associations between developmental disorder traits and mental health and may shape developmental trajectories. These results highlight the need for comprehensive support approaches that consider peer relationships, learning environments, and family-school relationships.

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12. Kaat AJ, Campagna A, Feiner H, Grauzer JM, Hobson AN, Jones M, Lee JP, Sudec LJ, Roberts MY. Developing an integrated algorithm to support autism diagnostic decisions: Model performance and statistical fairness. JCPP Adv. 2026: e70157.

BACKGROUND: Best practices in diagnosing autism spectrum disorder require an expert diagnostician to integrate multiple sources of information, including direct observations, interviews, and rating scales completed by knowledgeable informants. Machine learning methods are well-positioned to integrate disparate information sources to improve classification. This study sought to evaluate whether a machine learning algorithm could support appropriately weighting multiple sources of diagnostically relevant information. METHODS: Telehealth diagnostic assessments were conducted for 639 toddlers (age mean = 30.4, SD = 4.3 months; 29.7% female) already receiving early intervention (EI). The Toddler Autism Symptom Interview (TASI) and the TELE-ASD-PEDS (TAP) were completed during separate visits. Each child’s caregivers and usual EI providers asynchronously completed rating scales of autistic characteristics developed for this study. Calibration and validation data subsets were created using a 2:1 split. The optimal algorithm was developed using elastic net regularized regression in the calibration dataset, which was then evaluated in the validation dataset. Statistical fairness criteria evaluated whether the proposed algorithm functioned similarly across multiple protected group statuses. RESULTS: The prevalence of autism in the sample was 80.4%. The algorithm developed in the calibration dataset included both the caregiver- and EI provider-completed rating scales, four items from the TASI, and six items from the TAP. Model performance was high in both the calibration and validation samples (sensitivity >0.90; specificity >0.75; kappa >0.60), but statistical fairness criteria varied. False positives were relatively rare, but were more common in advantaged groups, which may suggest systematic under-classification by the algorithm in minoritized groups. CONCLUSION: Diagnostic practices for autism require integrating multiple sources of information. Machine learning can support diagnosticians in this effort, as demonstrated here utilizing multiple rating scales, the TASI, and the TAP. However, there is a risk for bias when using machine learning and as such, no algorithm should replace expert clinical judgment.

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13. Kemp E, Juckett L, Sansone IO, Walton KM, Palettas M, Carson TB, Crasta JE. AquOTic: protocol for a type 1 hybrid effectiveness-implementation trial of an occupational therapy-based water competency intervention for children on the autism spectrum. BMJ Open. 2026; 16(8): e117908.

INTRODUCTION: Drowning is a leading cause of unintentional death among children on the autism spectrum, emphasising the need for tailored water competency interventions. Autism-related factors such as wandering, sensory differences and limited danger awareness increase drowning risk. Evidence suggests structured aquatic programmes improve water safety, yet guidance on effective components and implementation fidelity in community settings remains limited. METHODS AND ANALYSIS: This type 1 hybrid effectiveness-implementation randomised controlled trial will evaluate AquOTic, an occupational therapy-based water competency intervention for children on the autism spectrum aged 5-9 years. A total of 108 participants will be randomised into three arms: (1) AquOTic delivered by professional student swim buddies, (2) AquOTic delivered by community swim buddies and (3) usual water exposure control. Primary outcomes include water competency and swim skills measured by standardised performance-based and caregiver-report measures. Secondary aims assess implementation determinants (fidelity, engagement, attitudes) using mixed methods, while exploratory analyses calculate costs and resources. ETHICS AND DISSEMINATION: Ethical approval has been obtained from The Ohio State University Institutional Review Board (protocol number: STUDY20250101). Written informed consent will be obtained from parents or legal guardians and assent from children when appropriate. Findings will be disseminated through peer-reviewed publications, conference presentations and partnerships with community organisations involved in autism and water safety. TRIAL REGISTRATION NUMBER: NCT07076264.

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14. Kumazaki H, Kamide H, Miyashita T, Sumioka H, Yoshikawa Y, Ishiguro H. Social Role-based Training Using a Computer Graphics Avatar in a Real-world Commercial Setting for Individuals with Autism Spectrum Disorder: A Quasi-experimental Study. J Med Internet Res. 2026.

BACKGROUND: The lack of social role-based behaviors, such as guiding and assisting others, is a major barrier to employment success and community participation for individuals with autism spectrum disorder (ASD). Enhancing self-efficacy is essential for improving these behaviors. To enhance the self-efficacy of social role-based behaviors, we developed a training system that enables users to perform social role-based behaviors, including guiding and assisting others, using a computer graphics avatar in a real bustling commercial facility (TCR). OBJECTIVE: We aimed to evaluate the feasibility of TCR and its potential to reduce anxiety and enhance self-confidence, motivation, metacognition, and self-efficacy in performing social role-based behaviors in real-world interactions among individuals with ASD. METHODS: Thirty-eight adults with ASD were assigned to either the TCR group (n=20), which received TCR alongside communication guidance from teachers (CGT), or the control group (n=18), which received only CGT, based on the chronological order of enrollment. Both groups underwent a 5-session intervention (days 14, 21, 28, 35, and 42). Anxiety, self-confidence, motivation, metacognition, and self-efficacy related to social role-based behaviors were assessed at days 0, 14, 28, 42, and 56 using self-report and observer ratings. RESULTS: Linear mixed model analyses showed group × time interactions for self-reported self-efficacy at day 56 (t₁₄₄.₀₁₆ = 2.670, P=.008, 95% CI 0.349-2.340). Nominally significant group × time interactions were also observed for self-reported anxiety, self-confidence, motivation, and metacognition, suggesting greater improvements in the TCR group than in the control group. Observer-reported outcomes demonstrated significant group × time interactions for self-efficacy at day 56 (t₁₄₄.₀₁₆ = 4.500, P<.001, 95% CI 0.405-1.039), anxiety at day 56 (t₁₄₄.₀₁₆ = -3.593, P<.001, 95% CI -1.425 to -0.414), and self-confidence at day 56 (t₁₄₄.₀₁₆ = 3.321, P=.001, 95% CI 0.269-1.059), indicating greater improvement in the TCR group than in the control group. Nominally significant group × time interactions were additionally observed for observer-reported motivation at day 56 (t₁₄₄.₀₁₆ = 2.471, P=.015, 95% CI 0.103-0.930). Possible group × time interactions were also observed for observer-reported metacognition at day 56 (t₁₄₄.₀₁₆ = 1.858, P=.065, 95% CI -0.023 to 0.751). CONCLUSIONS: This study is innovative in that TCR enables users to perform social role-based behaviors. Unlike previous studies, TCR integrates opportunities for observing peers and role models, along with real-time encouragement, feedback, and verbal persuasion from a trainer, thereby incorporating multiple sources of self-efficacy. By demonstrating the feasibility of TCR and its potential to enhance self-efficacy in social role-based behaviors, this study contributes to the development of more effective interventions targeting functional social outcomes in individuals with ASD. TCR may support the development of skills relevant to employment and social participation in real-world settings and represents a potential scalable approach for community-based ASD interventions.　.

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15. Levin ME, Aller TB, Kelley HH, Klimczak KS, Covington B. Preliminary Examination of Associations Between Psychological Flexibility Processes of Change and Quality of Life in Digital Acceptance and Commitment Therapy for Autistic Adults. J Clin Psychol. 2026.

An understanding of the relations between psychological flexibility processes and quality of life among autistic adults could help inform treatment development to improve the acceptability of mental healthcare among autistic adults. This pre-registered (https://osf.io/t3pws) secondary analysis of a mixed-methods pilot open trial provides a preliminary test of which subprocesses of psychological flexibility are associated with improvements in quality of life among a sample of 56 autistic adults who received a 6-week digital self-help acceptance and commitment therapy (ACT) intervention. Online self-report assessments were collected at pre-treatment, 6 weeks (post-treatment), and 10 weeks (1-month follow-up). Pre- to post-treatment improvements in values progress and valued action, but not openness to experience, behavioral awareness, or values obstruction, were associated with pre- to follow-up improvements in quality of life. Qualitative themes suggested that psychological flexibility with thoughts, emotions, and behaviors may be experienced as impacting quality of life. An exploratory analysis found that greater adherence to the digital ACT program was associated with greater pre- to post-treatment improvements in awareness and values obstruction, but not other psychological flexibility subprocesses. Although these are preliminary associative findings limited by a single-arm design, they suggest psychological flexibility, especially values, is a promising candidate for future research on mechanisms for improving quality of life among autistic adults.

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16. Liao Y, Zhang S, Zhang X, Tan S, Luo Y, Wan Y, Lyu Y, Xie B, Zhan R, Zhang Y, Chen G, Jia X, Hu Z, Zheng Y, Mao X, Wang H, Tan J, Li F, Peng Y, Xia K, Guo H. X-linked SYTL4 missense variant disrupts RAB27A-dependent vesicle trafficking and synaptic transmission in autism. Proc Natl Acad Sci U S A. 2026; 123(31): e2605483123.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impaired social communication and repetitive behaviors, with genetic studies implicating widespread synaptic dysfunction. However, the contribution of presynaptic vesicle trafficking mechanisms to ASD pathogenesis remains incompletely understood. Here, we identify synaptotagmin-like protein 4 (SYTL4), a RAB27A effector previously characterized in secretory cells, as a regulator of presynaptic function in the mammalian brain. We report a recurrent hemizygous missense variant, R126H, located within the Rab-binding domain of SYTL4 in four unrelated male individuals, consistent with an X-linked recessive mode of ASD, and additionally identify a de novo missense variant in RAB27A (T41A) in an independent ASD family that affects a domain mediating interactions with downstream effectors. Using a R126H knock-in mouse model, we show that R126H knock-in male mice exhibit ASD-relevant behavioral abnormalities accompanied by synaptic deficits in the medial prefrontal cortex. At the molecular level, ASD-associated SYTL4 and RAB27A variants interfere with the interaction between SYTL4 and RAB27A, providing a mechanistic link between human genetic variation and synaptic dysfunction. Together, these findings implicate disrupted SYTL4-RAB27A-dependent vesicle trafficking in ASD pathogenesis and identify SYTL4 and RAB27A as previously unrecognized contributors to autism-associated synaptic deficits and behavior.

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17. Liu M, Wang J, Ren L, Shi J, Cheng Y, Guo Y, Pan X, Zhang Z, Wang C, Zhang W. Refractive Errors, Amblyopia Risk, and Prenatal Factors in Children with Autism Spectrum Disorder: A Cross-Sectional Study. Int J Gen Med. 2026; 19: 620724.

PURPOSE: This study aims to investigate the prevalence of ocular features, particularly refractive errors and amblyopia risk factors (ARFs), in children diagnosed with Autism Spectrum Disorder (ASD). Additionally, it seeks to explore their associations with selected prenatal factors. METHODS: This cross-sectional study included 436 children diagnosed with ASD and 508 typically developing controls, all aged between 2 and 9 years from the Tianjin region. Refractive status was measured using the Spot Vision Screener, while ARFs were determined following the guidelines set by the American Academy of Pediatric Ophthalmology and Strabismus. Information on prenatal variables, such as the mode of delivery, maternal weight gain, and self-reported maternal emotional symptoms was gathered via parental surveys. The data were analyzed statistically using SPSS version 27.0. RESULTS: The results showed that 42.7% of children with ASD presented refractive errors, a rate notably higher than the 36.8% observed in the control group, with hyperopia and astigmatism being the most prevalent conditions. 15.4% of children with ASD were identified as having ARFs, compared to 8.3% in the control group (P <0.05). Notably, 90% of the children with ASD had refractive errors that required correction but were left uncorrected. Prenatal factors, including cesarean delivery (OR = 2.298, P < 0.05) and self-reported maternal emotional symptoms (OR = 5.150, P < 0.05), were found to be significantly associated with both ASD and the presence of refractive errors and amblyopia in this cross-sectional analysis. CONCLUSION: Children with ASD exhibit a higher incidence of refractive errors and ARFs, with prenatal influences playing a significant role. Additionally, the high rate of uncorrected refractive errors in this population highlights a critical gap in visual care. Early diagnosis and treatment, along with targeted management of prenatal risk factors, are critical for improving both visual health and overall developmental outcomes in this group. TRIAL REGISTRATION: Registration number: ClinicalTrials.gov ID NCT06122519. Registration date: October 2023.

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18. Ma D, Peng L, Zhang L, Li W, Gao X. Hierarchical neighbor integration graph attention network for autism spectrum disorder diagnosis. Front Psychiatry. 2026; 17: 1846996.

INTRODUCTION: Early diagnosis of autism spectrum disorder (ASD) based on resting-state functional magnetic resonance imaging (rs-fMRI) is crucial for effective intervention and rehabilitation. Using rs-fMRI, functional brain networks (FBNs) are constructed to represent interactions among brain regions of interest (ROIs), and existing graph neural network-based methods, particularly Graph Attention Networks (GATs), have shown promise for FBN-based ASD diagnosis. However, most current approaches primarily aggregate ROIs through low-order pairwise interactions, while higher-order neighbors are incorporated only implicitly through increased network depth. This strategy often leads to over-smoothing of node representations and limits the capture of informative higher-order brain interactions. METHODS: To address these challenges, we propose the Hierarchical Neighbor Integration Graph Attention Network (HiNIGAT), a general graph learning framework that explicitly models multi-order interactions in FBNs. Specifically, HiNIGAT introduces a multi-order attention mechanism that constrains each attention head to specialize in a distinct neighborhood order, enabling the model to capture brain interactions from local connectivity to global network structure. Furthermore, a bidirectional gated fusion strategy is proposed to adaptively integrate complementary information across multi-order features, facilitating effective local-global representation collaboration. RESULTS: Experiments on the ABIDE-I dataset demonstrate the effectiveness of HiNIGAT. DISCUSSION: The results highlight the importance of explicit multi-order integration for ASD diagnosis.

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19. Mandelli V, Busuoli EM, Godel M, Kojovic N, Sinai-Gavrilov Y, Gev T, Contaldo A, Courchesne E, Pierce K, Golan O, Narzisi A, Muratori F, Colombi C, Rogers SJ, Vivanti G, Schaer M, Ruta L, Lombardo MV. Predicting early intervention outcomes in autism via individual participant data mega-analysis. Mol Autism. 2026; 17(1).

BACKGROUND: Autism early intervention meta-analyses have yielded important insights into questions such as ‘what works’ and ‘for what’ outcomes. However, because these studies primarily rely on study-level summary statistics, they may be limited with regard to more individualized insights. Mega-analyses utilizing individual participant data (IPD-MA) may be useful for these more individualized questions. METHODS: We conducted an IPD-MA on the Autism Early Intervention Research (AEIR) consortium dataset, comprising n = 582 autistic children (n = 121 female) across 11 datasets collected in clinical and community settings in the USA, Switzerland, Italy, Israel, and Australia. Children received between 3 and 27 months of early intervention (age at start 13-60 months) of varying intensity. Of these datasets, one originates from a randomized controlled trial (RCT). Another 7 datasets are paired up into 5 separate controlled-group design studies, while the remaining 3 datasets come from uncontrolled pre-post design studies. Early Start Denver Model (ESDM; n = 281, 62 female) was compared against non-ESDM treatment-as-usual/community approaches (n = 301, 59 female) (e.g., speech and occupational therapy, applied behavioral analysis, pivotal response training). Outcome variables were Mullen Scales of Early Learning (MSEL) age-equivalent scores, Vineland Adaptive Behavior Scales (VABS) standardized scores, and Autism Diagnostic Observation Schedule (ADOS) calibrated severity scores. RESULTS: Predictors such as sex and cumulative intervention intensity were largely not associated with change in outcomes. Age at intervention start and pre-intervention developmental quotient (DQ) were strong moderators across all outcomes. Earlier age at intervention start predicted more positive outcomes, while higher pre-intervention DQ predicted accelerated growth on VABS motor and MSEL outcome measures. Interventions were similar in their effects on MSEL and VABS outcomes. However, for ADOS outcomes, ESDM resulted in significantly declining trajectories over time, with the sharpest decline for high pre-intervention DQ individuals. In contrast, ADOS trajectories in non-ESDM diverge in opposite directionalities (i.e. increases or decreases) depending on individual’s pre-intervention DQ. LIMITATIONS: Data for the IDP-MA was contributed on a voluntary basis and only 1 study was contributed from an RCT. Therefore, the findings may be prone to self-selection bias that may limit generalizability. Inferences from the intervention type comparison (ESDM versus non-ESDM) may be limited due to the heterogeneous approaches lumped together in the non-ESDM category. Larger sample sizes are required for finer-grained comparisons of different intervention types. CONCLUSIONS: Age at intervention start and pre-intervention DQ are key individualized predictors and the latter can interact with intervention type to moderate early intervention response.

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20. Marmontel P, Rabelo-da-Ponte FD, Kapczinski F, Gottfried C. Autism-specific spliceosomal transcriptomic signatures in prefrontal cortex contrasted with bipolar disorder. Trends Psychiatry Psychother. 2026.

OBJECTIVE: Understanding the molecular mechanisms of autism spectrum disorder (ASD) and its psychiatric comorbidities, including bipolar disorder (BD), is pivotal for uncovering pathways that shape neurodevelopmental trajectories and clinical heterogeneity. We aimed to identify ASD-specific gene-expression signatures and disrupted biological processes in prefrontal cortex, contrasting them with those observed in BD. METHODS: We performed a comparative transcriptomic analysis of RNA-seq datasets from postmortem prefrontal cortex samples of individuals with ASD or BD and controls. Differential expression was assessed with DESeq2, including batch as a covariate in the BD model. Functional interpretation used Gene Ontology over-representation analysis, KEGG Gene Set Enrichment Analysis and gene-concept network visualization. RESULTS: ASD samples showed 45 differentially expressed genes (DEGs), mainly downregulated non-coding RNAs, particularly small nuclear RNAs and small nucleolar RNAs. Enrichment analysis indicated a convergent profile related to RNA processing, spliceosome assembly and spliceosomal activity. In contrast, BD showed 12 candidate DEGs, mostly upregulated protein-coding genes. BD enrichment involved metal ion response and detoxification, amine and peptide hormone responses, vascular regulation and hydrolase activity, with genes associated with neuroinflammation such as SERPINA3 and CHI3L1 contributing to this profile. No shared DEGs or enriched GO Biological Process terms were observed between ASD and BD. CONCLUSION: These results support transcriptomic divergence in the prefrontal cortex, with ASD characterized by spliceosomal dysregulation, contrasting with metal ion response, vascular regulation and inflammation-associated signals in BD. Our findings provide a transcriptomic framework for future studies investigating disorder-specific molecular mechanisms and candidate signatures in ASD and BD.

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21. Martínez-García JJ, Pérez-Parra JE, de Jesús Vega-Castro R, Robledo-Conde EM, Martínez-Félix A, León-Sicairos N, Angulo-Zamudio UA, Canizalez-Román A. Burden of Co-occurring Conditions and Perinatal Predictors of Epilepsy in Autism Spectrum Disorder: A Cross-Sectional Study of 1015 Children From Northwestern Mexico. J Autism Dev Disord. 2026.

PURPOSE: Children with ASD frequently present with multiple co-occurring conditions affecting clinical management and quality of life. Systematic data on the burden of co-occurring conditions and perinatal risk factors remain scarce in Latin America. This study aimed to characterize the co-occurring condition profile, burden, and perinatal predictors in a large ASD cohort from Northwestern Mexico, examining their relationships with ASD severity and intellectual functioning. METHODS: This retrospective, cross-sectional study reviewed 1015 children with ASD (January 2022-January 2024) at the Sinaloa Autism Center, Culiacán, Mexico. ASD was diagnosed per DSM-5 by a board-certified pediatric neurologist. Severity was assessed using the CARS-2; intellectual functioning was assessed using the WISC-IV in 508 patients (≥ 6 years). Co-occurring condition burden was scored across seven domains. Three binary logistic regression models were constructed for epilepsy, ADHD, and sleep disorders. RESULTS: Of 1,015 children, 83.3% were male (ratio 4.9:1). Median co-occurring condition burden was 3 per patient (IQR 2-4); 58.3% had ≥ 3 simultaneous co-occurring conditions. Language disorder was most prevalent (91.2%), followed by feeding/gastrointestinal disorders (69.8%), sleep disorders (63.2%), ADHD (33.8%), anxiety (12.9%), epilepsy (8.9%), and depression (3.0%). Perinatal asphyxia was the only independent predictor of epilepsy (adjusted OR = 2.02; 95% CI: 1.14-3.57; p = 0.016). ADHD was inversely associated with ASD severity (OR = 0.71; p = 0.015) and positively with higher intellectual functioning (p = 0.016). CONCLUSION: This largest ASD cohort from Northwestern Mexico reveals an extremely high multimorbidity burden. Perinatal asphyxia independently predicts epilepsy in ASD, representing a concrete, preventable target. Systematic multidisciplinary co-occurring condition screening at ASD diagnosis is strongly recommended across all levels of care in Mexico.

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22. Nieuwenhuys-Ruiz V, Gambra L, Cortese S, Lizoain P, Rodriguez-Romero D, Paiva U, Gándara C, Magallón S, Arrondo G. Body weight in autism spectrum disorder: A systematic review and meta-analysis. JCPP Adv. 2026: e70151.

BACKGROUND: Evidence on the relationship of autism spectrum disorder (ASD) to overweight/obesity and underweight is mixed. Moreover, it is unclear how this relationship changes with age. METHODS: We carried out a systematic review (SR) with meta-analysis on the association between ASD and obesity, overweight and underweight across the life span. The study was based on a pre-registered protocol (PROSPERO: CRD42024524084). Web of Science and PubMed were searched until the 8th of April 2025. We assessed the quality of the included studies with the Newcastle-Ottawa scales (NOS). RESULTS: A total of 9075 records were screened, of which 64 studies reporting data on obesity, overweight and/or underweight on ASD and controls general participants were included in the SR and 62 meta-analyzed. We found a significant association between ASD and obesity (OR = 1.93; CI = 1.70-2.19; i (2) = 99.02%), ASD and overweight (OR = 1.73; CI = 1.43-2.09; i (2) = 95.44%) but, at the group level, not ASD and underweight (OR = 1.22; CI = 0.91-1.64; i (2) = 78.37%). There was a statistically significant association between ASD and underweight in adolescents (OR = 1.32; CI = 1.12-1.56) and adults (OR = 2.14; CI = 1.5-3.04). The score on the Newcastle-Ottawa Scale showed that, overall, studies had a medium risk of bias (median = 6, range 1-10). CONCLUSION: Individuals with ASD have an elevated risk of being obese or overweight, and, in adolescents and adults, of underweight. Our study may contribute to the development and implementation of targeted prevention and intervention strategies, aimed at enhancing the physical well-being of individuals with ASD and their caregivers, ultimately improving their quality of life.

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23. Oh A, Park EH. Engagement in gamified virtual reality sports activities and sports participation intention among adolescents with autism spectrum disorder: the mediating roles of immersion and enjoyment. Front Public Health. 2026; 14: 1904037.

BACKGROUND: Adolescents with autism spectrum disorder (ASD) face multiple barriers to sports participation because of cognitive rigidity, sensory processing difficulties, and challenges in social interaction. Gamified virtual reality (VR) sports activities have emerged as a potential approach to support physical activity in this population. However, limited research has examined the psychological mechanisms underlying engagement in gamified VR sports activities among adolescents with ASD. Therefore, this study examined the association between engagement in gamified VR sports activities and sports participation intention among adolescents with ASD, focusing on the mediating roles of immersion and enjoyment. METHODS: A total of 179 adolescents with ASD (aged 10-19 years; 78.2% male) and 179 corresponding proxy respondents (teachers and sports instructors) participated in this study, each forming a one-to-one respondent-participant pair. The participants were recruited from special education schools and sports clubs in South Korea that were equipped with non-immersive VR sports systems. Engagement in gamified VR sports activities, immersion, enjoyment, and sports participation intention were assessed using a structured questionnaire. Confirmatory factor analysis was conducted to evaluate the measurement model, and structural equation modeling with bootstrapping was used to test the hypothesized relationships. RESULTS: Engagement in gamified VR sports activities was positively associated with immersion (β = 0.337, p < 0.001) and enjoyment (β = 0.435, p < 0.001). Both immersion (β = 0.329, p < 0.001) and enjoyment (β = 0.403, p < 0.001) were significantly associated with sports participation intention. In addition, both immersion (95% CI = 0.155 to 0.382, p < 0.001) and enjoyment (95% CI = 0.139 to 0.359, p < 0.001) had significant indirect effects on the relationship between engagement and sports participation intention. CONCLUSION: The findings suggest that both immersion and enjoyment serve as meaningful psychological mediators linking engagement in gamified VR sports activities to sports participation intention among adolescents with ASD. The structured and predictable nature of gamified VR sports environments may be particularly well-suited to the cognitive and sensory characteristics of adolescents with ASD, facilitating psychological involvement and positive affective responses associated with greater sports participation intention. However, given the cross-sectional design and the use of proxy-reported measures, the findings should be interpreted with caution.

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24. Pagán AF, Ortiz M, McCormack-Sadler B, Esparza A, Gogola G, Montiel-Nava C, Loveland KA. « An App That Truly Works for Us »: Co-Designing a Mobile Health Intervention to Support the Transition to Adulthood for the Latino Autism Community. J Technol Behav Sci. 2026.

BACKGROUND: Autistic Latino young adults face significant disparities and a service cliff during their transition to adulthood. While mobile health (mHealth) applications offer a scalable solution, few evidence-based, culturally adapted programs have been successfully transitioned to mHealth platforms for this population. This study aimed to conduct a multi-stakeholder needs assessment to guide the development of a culturally adapted mHealth app designed to accompany the ¡Iniciando!/Launching! treatment program to support young adults transitioning to adulthood. METHODS: This study used a multi-phase, mixed-methods design. An initial needs assessment survey was administered to three key stakeholder groups: autistic young adults (N = 27), their Spanish-speaking parents (N = 26), and program clinicians (N = 9). An iterative refinement process followed, which included qualitative consultations with a Community Advisory Board (CAB) of autistic self-advocates and a User Experience/User Interface (UX/UI) team, a focus group with clinicians (N = 8), and two targeted follow-up surveys to define specific app features. RESULTS: A strong consensus emerged on the need for features supporting executive functioning (e.g., reminders, task management) and practical transition-to-adulthood goals (e.g., employment and education hubs). The iterative design phase translated abstract concepts, like the highly-rated « social games, » into concrete, user-informed specifications, including a scaffolded learning workflow and a gamification-based token economy. Young adults emphasized the importance of a modern user experience and expressed skepticism toward conversational AI, while parents and clinicians stressed that the app must supplement, not replace, human interaction. CONCLUSION: This iterative, community-based approach provides a clear, stakeholder-driven blueprint for creating a highly desired mHealth intervention. By directly integrating the perspectives of end-users, this process ensures the final product is tailored to the specific needs of autistic Latinos, with the potential to reduce health disparities.

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25. Perricone E, Caldaci A, Cacciaguerra G, di Nora A, Parano C, Pavone V. Comparative effectiveness of conservative and surgical interventions for toe walking in children with Autism Spectrum Disorder: a systematic review. Front Med (Lausanne). 2026; 13: 1832930.

INTRODUCTION: Toe walking (TW) is frequently observed in children with Autism Spectrum Disorder (ASD) and may be associated with sensory and motor dysfunctions affecting mobility and quality of life. This systematic review aimed to synthesize current evidence on reported outcomes of conservative and surgical interventions, with attention to unimodal and multimodal conservative strategies. METHODS: A PRISMA-based systematic review was conducted using PubMed, Scopus, and Google Scholar. Studies reporting interventions for toe walking in children with ASD were included. Study characteristics, treatment approaches, outcome definitions, and reported improvement rates were extracted. Because of substantial heterogeneity, findings were summarized descriptively according to a predefined outcome hierarchy. RESULTS: Eight studies including 424 ASD patients, aged 2-16 years, were included. Conservative and multimodal conservative treatment arms generally reported numerically higher improvement values than surgical and unimodal approaches, respectively. However, these summaries were unweighted, study-level descriptions based on heterogeneous and non-equivalent outcome measures. DISCUSSION: Current evidence is of very low certainty and does not allow conclusions regarding comparative effectiveness or treatment superiority. Findings should be considered descriptive and hypothesis-generating only. Further high-quality prospective studies using standardized clinical outcomes and long-term follow-up are required.

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26. Ramnauth R, Shic F, Scassellati B. Robots for Autism Therapy. Autism Res. 2026: e70338.

A growing body of work on robot-mediated therapy suggests that robots can elicit engagement and novel social behaviors among users with autism. In this narrative review, we trace the full historical arc of this field to date, from its inception in 2001 to 2024, covering 304 studies that present a robot for autism support. Early work largely consisted of short, highly structured sessions conducted in controlled laboratory or clinical environments. More recent research has shifted toward longer-term, real-world deployments in which robots operate with greater autonomy and engage users over multiple days or weeks. However, evidence for lasting and generalized benefits is still limited. The literature also remains focused primarily on children, with comparatively little research involving adults or individuals across a wider range of support needs. Despite rapid growth over these past two decades, the research remains fragmented across disciplinary boundaries, with robotics and clinical communities advancing similar goals without a cohesive, shared research framework. To address this, we offer a translational roadmap that details what interventions work, for whom, under which conditions, and why. We highlight current methodological gaps, outline key design considerations, and propose priorities for future research. For over two decades, researchers have tested different ways robots might support autism therapy. The results are encouraging, but we still need a clearer picture of what works, for whom, and why. In this narrative review, we bring together the lessons learned so far and discuss next steps for future research. eng.

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27. Seese S, Matar A, Mendes L, Gulsrud A, Kasari C. Optimizing joint engagement in autism: considering toddler developmental abilities and caregiver stress. Front Child Adolesc Psychiatry. 2026; 5: 1858019.

INTRODUCTION: Play interactions between caregivers and their toddlers provide a critical context for the emergence of joint engagement, a state that supports early learning andsocial communication. Differences in toddler’s developmental characteristics and caregiver experiences may influence how joint engagement is established during these interactions. This study examined whether toddler characteristics, including age, cognitive abilities, language abilities (expressive and receptive), and caregiver stress attenuated or amplified the association between caregiver strategy use and joint engagement in toddlers with autism. METHODS: Participants include 80 toddlers with autism (M age = 26.26 months) and their caregivers. Toddler cognitive and language abilities were assessed at baseline (prior to any intervention) using the Mullen Scales of Early Learning, and caregiver stress was measured using the Parenting Stress Index. Caregiver strategies and child engagement were observationally coded during a 10-min caregiver-child free-play interaction. RESULTS: Results indicated that age, cognitive abilities, expressive and receptive language significantly moderated the association between caregiver strategy use and joint engagement. The positive association between higher quality caregiver strategies and joint engagement was stronger for toddlers who were older and had more advanced cognitive and language abilities. In contrast, caregiver stress attenuated this relationship, such that higher quality caregiver strategies were less predictive of joint engagement at higher levels of stress. DISCUSSION: These findings suggest that the impact of caregiver strategies on engagement is shaped by both toddler developmental capacities and caregiver well-being, highlighting the importance of tailoring caregiver-mediated interventions to account for individual differences in the toddler – caregiver dyad to optimize joint engagement outcomes.

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28. Su J, Li L, Wang Y, Fan T. Effects of exercise interventions on executive function in autism spectrum disorder: a three-level meta-analytic review. Front Psychiatry. 2026; 17: 1780503.

OBJECTIVE: This study aimed to use a three-level meta-analysis to examine the effects of exercise interventions on executive function (EF) in children and adolescents with autism spectrum disorder (ASD), and to explore the relationship between exercise dose and intervention effects through subgroup analyses. METHODS: A systematic search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library from database inception to November 17, 2025. All included studies were randomized controlled trials. A three-level random-effects model was applied to integrate multiple dependent effect sizes. Hedges’ g was used to calculate effect sizes, and negative values indicated improvements in EF following exercise interventions. Study quality was assessed using the PEDro scale, and publication bias was evaluated using Egger’s regression and the trim-and-fill method. RESULTS: Seventeen studies involving 626 participants were included. Exercise interventions produced a moderate and significant improvement in EF (g = -0.34, p < 0.0001) with low heterogeneity (Q = 50.42, p =0.268). Subgroup analyses showed that only intervention duration significantly moderated the effects, with programs lasting ≥10 weeks yielding the greatest benefits. CONCLUSION: Exercise interventions significantly improve EF in children and adolescents with ASD, with the largest effect sizes observed in interventions lasting ≥10 weeks. Further large-scale studies are needed to clarify dose-response relationships and inform optimal exercise prescriptions. This meta-analysis was designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251236112.

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29. Wang X, Li R, Li Y, Wang D, Cai Y, Liu X. Salidroside enhances hippocampal neurogenesis in a valproic acid-induced mouse model of autism by suppressing neuroinflammation. Int Immunopharmacol. 2026; 187: 117195.

OBJECTIVE: Neuroinflammation plays a pivotal role in the pathogenesis of autism spectrum disorder (ASD) and represents a potential therapeutic target. Salidroside (SLDS), a bioactive compound isolated from Rhodiola rosea L., exhibits potent anti-inflammatory and neuroprotective effects in various neurological disorders; however, its therapeutic efficacy in ASD remains to be fully established. This study investigated whether SLDS ameliorates autism-like behaviors and hippocampal neuroinflammation in a valproic acid (VPA)-induced mouse model. METHODS: A total of 92 male C57BL/6 J mice were randomly assigned to four groups (n = 23 per group). Mice received a subcutaneous injection of VPA or saline on postnatal day 14 (P14), followed by intraperitoneal administration of SLDS or saline from postnatal day 28 (P28) for seven consecutive days. Behavioral assessments were conducted at 8 weeks of age. Hippocampal neuroinflammation, microglial polarization, and neurogenesis were analyzed by molecular, immunofluorescence, and histological techniques. RESULTS: VPA-exposed mice exhibited social interaction deficits, increased repetitive behaviors, elevated levels of pro-inflammatory cytokines, upregulated expression of inflammation-related proteins, microglial activation, and impaired hippocampal neurogenesis. SLDS treatment significantly attenuated these VPA-induced abnormalities. CONCLUSION: Collectively, these findings suggest that SLDS represents a promising therapeutic candidate for ASD by mitigating neuroinflammation and restoring hippocampal function. Nevertheless, given that these observations are derived from preclinical models, further validation in translationally relevant experimental systems and clinical investigations is warranted before extrapolation to human therapeutic applications.

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30. Wang Z, Long Y, Li H, Reed P, Ma X, Shi Y, Zhang L. Parenting Stress, Parental Attitudes, and Parent-Reported Autism Symptoms of Children and Adolescents With Autism Spectrum Disorder: A Network Analysis and Subgroup Comparison by Severity. Autism Res. 2026: e70337.

Autism spectrum disorder (ASD) presents substantial challenges for individuals and families, particularly through elevated parenting stress. Previous research has established that parenting stress is influenced by multiple interrelated factors, including parental attitudes toward ASD and parent-reported autism symptoms. Yet, the structural relations among these factors remain poorly understood. This study applied network analysis to delineate the interconnections among parenting stress, parental attitudes, and parent-reported autism symptoms in 997 parents of children and adolescents with ASD (aged 1-18 years). Network structures were compared across subgroups defined by mild, moderate, and severe levels of autism symptoms. Using Gaussian Graphical Models with EBICglasso, the analysis identified central and bridge nodes. In the overall network, « Difficult Child » showed the highest node and bridge strength. Network structure, global strength, and node strength did not differ significantly across severity subgroups after correction for multiple comparisons, which is consistent with a broadly stable network organization of parenting stress across autism severity levels. Across all severity groups, « Difficult Child » consistently emerged as the most central node, highlighting it as a potentially shared intervention-relevant target for supporting families of children with ASD across the autism severity spectrum.

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