1. Al-Salihy AAS. Toward an immunological classification of autism spectrum disorder: A PRISMA-ScR-compliant scoping review. J Neuroimmunol;2026 (May 5);417:578962.

Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental condition increasingly linked to disturbances in immune signaling and neuroimmune cross-talk. This PRISMA-ScR-guided scoping review synthesizes contemporary evidence to propose a structured immunological classification of ASD comprising six immune-related subtypes: immune overactivation, immune deficiency, autoimmunity-linked ASD, gut-immune axis dysregulation, post-infectious or immune-triggered onset patterns, and maternal immune activation. Each subtype is defined by characteristic neuroimmune features – including cytokine imbalances, aberrant microglial activation, altered microbiome-immune communication, and prenatal immune priming – reflecting distinct biological pathways through which immune dysfunction may influence neurodevelopment. Based on 42 mapped sources identified through a search strategy that primarily emphasized literature published between 2020 and 2025, while incorporating selected foundational earlier studies through citation chaining when necessary for conceptual and mechanistic context, and spanning human clinical and epidemiological studies, animal models, and integrative neuroimmune reviews, this synthesis identifies candidate biomarkers and immune signatures relevant to each subtype, including systemic and CNS-localized inflammation, autoantibodies, disrupted gut-immune-brain pathways, and maternal cytokine profiles. The framework also clarifies ongoing debates by distinguishing immune-mediated vulnerability and timing-dependent unmasking of susceptibility from assumptions of direct causation regarding environmental or infectious exposures. Conceptualizing ASD along immune-related subtypes provides a foundation for precision-based diagnostic and therapeutic approaches, highlighting opportunities for targeted immunomodulation, microbiome-informed interventions, and biomarker-driven stratification, thereby advancing translational efforts at the interface of immunology, neuroscience, and developmental psychopathology.

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2. Arami A, Lorigooini Z, Ghaderi H, Noori A, Anjomshoa M, Amini-Khoei H. Diosgenin Alleviates Inflammation in the Colon and Hippocampus and Partly Attenuates Comorbid Autistic-like Behaviors in Experimental Colitis in Mice. Curr Pharm Des;2026 (Apr 27)

INTRODUCTION: Inflammatory bowel disease (IBD) is comorbid with behavioral disorders like autism spectrum disorder (ASD). Neuroinflammation is involved in the pathophysiology of ASD. Diosgenin has pharmacological properties. We aimed to assess the potential properties of diosgenin in mitigating comorbid autistic-like behaviors with colitis in mice, focusing on its probable effects on the neuroinflammatory response in the hippocampus. METHODS: Colitis was induced using acetic acid. Forty male mice were divided into five groups and treated intraperitoneally for seven continuous days with 0.9% saline containing Tween 20 at a concentration of 2% (10 ml/kg) or diosgenin (25, 50, and 100 mg/ kg). Behavioral tests, including sociability and social preference indexes, passive avoidance memory, and aggressive-like behaviors, were assessed. Then, the colon and hippocampus were dissected out. A microscopic evaluation of the colon was done. RT-PCR measured TLR4, TNF-α, IL-1β, and NLRP3 gene expression in the hippocampus and colon. RESULTS: Colitis is associated with histopathological alterations in the colon and an increase in the gene expression of inflammatory mediators in the colon. Colitis reduced sociability and social preference indexes, impaired passive avoidance memory, and increased aggressive-like behaviors. These behaviors are accompanied by increased gene expression of inflammatory mediators in the hippocampus. Diosgenin mitigated the negative effects of colitis on the hippocampus and colon. DISCUSSION: Diosgenin attenuated inflammatory responses in the colon, autistic-like behaviors, and expression of genes relevant to neuroinflammation in the hippocampus following colitis. CONCLUSION: Diosgenin likely alleviated autistic-like behaviors following colitis, possibly through the reduction of inflammatory gene expressions in the hippocampus.

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3. Belenger M, Dumont C, Geelhand P, Kissine M. Distinct Pause Patterns in Autism: Effects of Sex and Conversational Context in French-Speaking (Pre)adolescents. J Speech Lang Hear Res;2026 (May 5):1-15.

PURPOSE: We investigated sex differences in the production of pauses in autistic (pre-)adolescents in two conversational contexts: a monologue and an interactive discussion. METHOD: This study included 107 French-speaking participants (M(age) = 12.35 years), 49 autistic (22 females, 27 males) and 58 nonautistic (30 females, 28 males). Speech was elicited from two tasks: a get-to-know conversation and a narrative task. We analyzed the production of filled « uh » and « um » pauses as well as the production of unusually long silent pauses (> 700 ms). RESULTS: Autistic participants produced more silent pauses than nonautistic participants, but no significant group differences were found for filled pauses. Filled pauses occurred more frequently in the get-to-know than in the narratives, which underscores their pragmatic functions. No significant effect of sex was found. CONCLUSIONS: Autism diagnosis and conversational context, but not sex, influenced pause productions. Our results also highlight the importance of cross-linguistic studies, including in autism research, to avoid the overgeneralization of findings from English-speaking populations. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32078268.

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4. Cai A, Zhang F, Li J, Wang J, Wu Y, Zhang Y, Gao K, Jiang Y. Compound heterozygous mutations in the SSPOP gene lead to epilepsy and developmental disorders. Brain;2026 (May 5);149(5):1691-1703.

The SSPOP gene, currently classified as a pseudogene in the human genome, encodes the SCO-spondin protein, which plays an important role in human neurodevelopment, although its function remains poorly understood. In this study, we used trio-based whole exome sequencing to identify compound heterozygous SSPOP variants in four children from three unrelated families, including one pair of dizygotic twins. These children exhibited variable phenotypes, including variation in age of onset, seizure semiology, and response to antiseizure medications, along with neurodevelopmental disorders. We demonstrated that SSPOP is a functional gene by confirming its expression at both the transcriptional and protein levels. We analysed 10 brain tissue samples from seven paediatric patients and brain organoids derived from human induced pluripotent stem cells to confirm its expression via qRT-PCR, immunofluorescence and western blotting, supporting its biological function during both pre- and post-natal stages of brain development. In addition, CRISPR-mediated sspo knockout zebrafish demonstrated abnormal neurodevelopment and epileptic discharges in vivo. Together, these findings suggest that SSPOP is a functional gene and a potential contributor to neurodevelopmental disorders and epilepsy.

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5. Chan CM, Stitt KM, Peasah SK, Rosenberg EM, Pierri JN, Good CB. Age-Related Patterns and Longitudinal Trends in Psychotropic Medication Use Among Commercially Insured Children with Autism Spectrum Disorder in the United States: A Claims Database Study. J Child Adolesc Psychopharmacol;2026 (May 5):10445463261448803.

OBJECTIVES: This study aimed to describe changes in psychotropic medication use over time in commercially insured children with autism spectrum disorder (ASD) across age groups and characterize the comorbidity burden in patients with more complex treatment regimens. METHODS: Using deidentified administrative claims from the Workpartners Research Reference Database, we conducted a retrospective cohort study of employee dependents aged 0-17 years with ASD followed for 3 years. Psychotropic medication use was analyzed across three age groups (0-4, 5-9, and 10-17 years). In a subgroup with high treatment complexity, defined as polypharmacy (≥3 drug classes) and/or antipsychotic use, the prevalence of various co-occurring conditions associated with ASD was also described. RESULTS: Among 2747 children with ASD, psychotropic medication use and polypharmacy were more common in older age groups. At Year 1, 32.8% of children aged 10-17 used ≥2 drug classes concurrently, compared with 0.9% and 15.3% in the 0-4 and 5-9 age groups, respectively. From Year 1 to Year 3, medication use increased in younger children but declined in the 10-17 age group. High treatment complexity was observed in 20.5% of children (n = 562) over the entire 3-year study period, most frequently in the 10-17 age group. A higher prevalence of comorbidities, including attention-deficit hyperactivity disorder, mental health conditions, conduct disorders, and irritability and agitation, was observed in those with high treatment complexity compared with those without. CONCLUSIONS: Pharmacologic treatment patterns varied by age in children with ASD, and higher treatment complexity was associated with more frequent diagnoses of co-occurring psychiatric and behavioral conditions. Further understanding of longitudinal treatment trajectories should be explored in future research, such as by contextualizing treatment changes with symptom assessment and evaluating the social impact of treatment complexity.

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6. DiGuiseppi C, Ing C, Blanchard A, Russell MT, Li G. Prevalence of Co-occurring Mental, Neurodevelopmental and Neurological Conditions in Medicaid Beneficiaries With Autism. J Autism Dev Disord;2026 (May 5)

PURPOSE: As more children with autism enter adulthood, updated data on co-occurring conditions throughout the lifespan are needed. We examined mental, neurodevelopmental and neurological (MNN) conditions among people with and without autism overall and by demographics. METHODS: Using Medicaid claims data for beneficiaries aged ≥ 1 year enrolled during 2020, we identified autism and MNN diagnoses using ICD-10 codes. Adjusted prevalence ratios (aPRs) in beneficiaries with versus without autism were calculated using log-binomial models. RESULTS: Among 993,965 beneficiaries with autism, attention-deficit-hyperactivity and conduct disorders (ADHD/CD, 30.5%), intellectual disabilities (ID, 20.4%), and anxiety disorders (19.3%) were most common. Prevalence of every condition except ADHD/CD increased with age and was higher in females. For most conditions, prevalence was lowest in American Indian/Alaska Native (AI/AN) and Hispanic individuals. Every condition except alcohol/drug use disorders was significantly more prevalent in those with autism; aPRs ranged from 1.8 (depression) to 21.2 (ID). APRs were higher in middle and older ages for neurodevelopmental conditions, in children and adolescents for mental and neurological conditions, and in women for neurodevelopmental and neurological conditions. AI/AN beneficiaries had the highest aPRs for nearly all conditions. CONCLUSION: Among publicly-insured individuals, MNN conditions were more common in beneficiaries with than without autism across the lifespan, in both sexes and across racial/ethnic groups. Demographic variation may reflect underdiagnosis of autism in previous generations and females, respectively, and less access to mental health services in some racial/ethnic groups. Screening for ADHD and mental health disorders in youth and adults with autism may improve health outcomes. Screening for ADHD and mental health disorders in youth and adults with autism may improve health outcomes.

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7. Dong D, Vohra S, Jou H, Thompson-Hodgetts S. « The Evidence I Need Is Change in a Child » Healthcare Provider Perspectives on Acupuncture Therapy for Children Diagnosed With Autism Spectrum Disorder (ASD): An Interpretive Description. Glob Adv Integr Med Health;2026 (Jan-Dec);15:27536130261448873.

BACKGROUND: While parents of children and adolescents with autism spectrum disorder (autism) frequently seek complementary medicine to address health and functional concerns commonly experienced by their children, little is known about how conventional healthcare providers view acupuncture. OBJECTIVE: To explore healthcare professionals’ (1) knowledge and views about acupuncture, including laser acupuncture, and (2) perceived reasons for recommending or not recommending acupuncture for children with autism. DESIGN: This interpretive descriptive study involved semi-structured interviews. Purposeful sampling was used to recruit conventional healthcare providers who work with children with autism, including physicians and therapists. Data were coded and analyzed using an inductive thematic analysis approach. RESULTS: 13 healthcare providers were interviewed. Four themes were identified: (1) « Interesting, tell me more »: a lack of familiarity, but interest, in acupuncture for children with autism; (2) « I think we need to explore all avenues »: openness to integrative practices for a complex condition; (3) « The evidence I need is change in a child »: both empirical evidence and clinical experience are important to inform clinical decisions; and (4) Practical considerations to recommending acupuncture. CONCLUSIONS: Acupuncture is a modality that many professionals working with children with autism have not considered recommending due to lack of awareness and knowledge. Yet, the attitudes of our participants toward acupuncture as an adjunct therapy were generally positive. They were curious and open about exploring the evidence, and potential to meet gaps not currently met by conventional therapies. Laser acupuncture generated more interest than needle-based acupuncture. There were a number of barriers to recommending acupuncture, including limited knowledge and cost burden to families.

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8. Franch M, Katlowitz KA, Mickiewicz EA, Belanger JL, Mathura RK, Zhu H, Yan X, Ismail T, Chavez AG, Chericoni A, Paulo D, Bartoli E, Frączek TM, Provenza NR, Sheth SA, Hayden BY. Neural signatures of impaired semantic contextualization in Autism Spectrum Disorder. bioRxiv;2026 (May 5)

Social and communicative deficits are defining characteristics of autism spectrum disorder (ASD). Some theories suggest that these challenges, among other autistic traits, may arise from differences in predictive coding, or how the brain uses context to predict and interpret incoming information. This idea has the potential to link symptoms of autism to specific neurocomputational processes, and is especially promising for communication, whose impairment is a hallmark of ASD. Here we leveraged the ability of large language models (LLMs) to quantify semantic contextualization to analyze a unique dataset of responses from hippocampal neurons obtained during language listening in three mild-to-severe autistic individuals with comorbid epilepsy. Key elements of semantic coding were preserved in all three individuals with ASD: single-neuron response dynamics, representation of word-word semantic relationships, and patterns of context-dependent shifts in meaning. However, relative to controls, ASD resulted in reduced neural signatures of contextualization: (1) neuronal responses were aligned with earlier, less contextual layers of GPT-2, (2) ASD patients had lower effective dimensionality of the neural subspace predicting semantics, (3) neural representations of word meaning were less influenced by preceding context, and (4) neural signatures of lexical surprisal were reduced. Together, these results support theories of autism that emphasize impairments in contextualization, and highlight the power of LLMs as a tool for quantifying the computational basis of neurodevelopmental disorders.

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9. Franco JH, Butler JM, Garza A, Glickman A, Lidov E, Hobson A, Schmitgen EM, Hampton LH. Administering the Communication and Symbolic Behavior Scales in Collaboration With Caregivers in a Virtual Environment: Reliability, Fidelity, and Lessons Learned. Am J Speech Lang Pathol;2026 (May 5);35(3):969-982.

PURPOSE: While telepractice interventions for social communication have been more widely studied, research on telepractice-based assessments, particularly for toddlers, remains limited. Telepractice assessments offer a range of potential benefits, including improved accessibility for families facing logistical challenges such as geographic distance or scheduling conflicts. This study explored the use of the Communication and Symbolic Behavior Scales (CSBS) in a telepractice context, administered by caregivers with virtual coaching. Key research questions examined fidelity of administration, scoring reliability, and caregiver perceptions of the assessment process. METHOD: Thirty infant/toddler younger siblings of autistic children and their caregivers were recruited from an ongoing clinical trial. Participants completed virtual CSBS assessments at three intervals over a 6-month period. Assessment materials were provided through kits mailed to participants’ homes. Caregivers, guided by trained assessors via telepractice, administered the assessments with their children. Video recordings of the sessions were analyzed to evaluate caregiver implementation fidelity and assessor coaching fidelity using standardized criteria. Scoring reliability was examined through interrater comparisons, with a subset of assessments independently rated to ensure agreement. Caregiver feedback on the telepractice process was collected through surveys, capturing both satisfaction and reported challenges. RESULTS: Caregivers administered the CSBS with a high level of fidelity (M = 95.61%), and assessors demonstrated strong fidelity in their coaching and support during the assessments (M = 91.14%). Scoring reliability between raters was robust (intraclass correlation coefficient = .85). While caregivers generally reported positive experiences with the telepractice format, some noted difficulties in maintaining their child’s engagement and adjusting to the structured nature of the assessment process. CONCLUSIONS: The findings suggest that virtual administration of the CSBS is a feasible and reliable method for assessing social communication in young children. This approach has potential to increase accessibility for families facing barriers to in-person services, though further research is needed to refine protocols and address caregiver feedback. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31395810.

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10. Hadjicharalambous V, Fuller D, Pampoulou E. Selection of graphic symbol collections by speech and language pathologists for students with autism spectrum disorder. Augment Altern Commun;2026 (May 5):1-12.

Graphic symbol collections are often implemented in assessment and interventions with clients with autism spectrum disorder (ASD). The selection of the optimal collection is considered by speech-language pathologists (SLPs) a challenging task. Since limited literature exists on the factors that guide this selection specifically for clients with ASD, this study aimed to explore those in detail, for which a qualitative design was followed. Semi-structured interviews were conducted with SLPs who shared their views on the factors that affect this selection. A thematic analysis of the interview transcripts took place. The outcomes showed that SLPs focus on multiple factors, grouped as SLP-related factors (e.g., training on collection(s) of graphic symbols), client-related factors (e.g., age), family-related factors (e.g., opinions on graphic symbol collections), factors related to graphic symbol collections (e.g., iconicity), practical factors (e.g., cost), and assessment/intervention factors. Assessment methods such as trial-error and dynamic assessment to assist with this selection were also reported. The findings revealed the need to support SLPs in optimal symbol collection selection through evidence-based practices, helping to ensure that symbol selection is tailored to the communication needs of students with ASD.

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11. Iida A, Toyota Y, Itagaki T, Yawaka Y, Hasebe A. Oral and Gut Microbiota in Individuals With Autism Spectrum Disorder: A Pilot Case-Control Study. Int J Paediatr Dent;2026 (May 5)

BACKGROUND: Recent studies suggest that gut microbiota play important roles in individuals with autism spectrum disorder (ASD), potentially influencing the development and severity of the condition. Oral bacteria may be directly or indirectly involved in the biological and symptomatic aspects of ASD through their effect on gut microbiota. AIM: This pilot study aimed to characterise compositional alterations in the oral and gut microbiota of individuals with ASD and to identify bacterial taxa in saliva and faeces that may serve as potential microbial indicators of ASD. DESIGN: Salivary and faecal samples were collected from 10 individuals with ASD and 10 typically developing controls. The oral and gut microbiota were evaluated using 16S ribosomal RNA marker-gene sequencing. RESULTS AND CONCLUSION: Distinct features of the oral and gut microbiota were identified that differed between individuals with ASD and typically developing controls. Based on linear discriminant analysis effect size, the relative abundances of the genera Neisseria were higher in the oral microbiota of the ASD groups, whereas the genera Faecalibacterium were enriched in the gut microbiota. These findings highlight the potential relevance of the oral-gut-brain axis in ASD. Additionally, non-invasive sampling of saliva and faeces may be utilised for early ASD screening.

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12. Kalikotay B, Rajeswari D, Shaji JCH. From restless nights to peaceful sleep: mothers’ lived experiences in dealing with sleep problems among children with autism spectrum disorder. BMC Psychol;2026 (May 5)

BACKGROUND: Children with Autism Spectrum Disorder (ASD) experience sleep disturbances, which significantly influence not only the child but also the mother. This study aims to explore mothers’ experiences of their children’s sleep difficulties. METHODS: A qualitative phenomenology approach was employed; 13 mothers of children diagnosed with mild to moderate Autism Spectrum Disorder (ASD) were interviewed utilizing a semi-structured in-depth interview guideline. Colaizzi’s method was used to analyze the data and identify the sleep-related problems and solutions most likely to be experienced by the mothers who lived them. RESULTS: Three primary themes have emerged from the study: (1) unending nights of struggle and exhaustion, (2) exploring a path of knowledge and advice, and (3) Gradual adaptation and perceived improvement. Mothers were experiencing difficulties and often felt exhausted, as evidenced by a prolonged night of struggle and fatigue. Mothers utilized professional assistance and sleep management techniques over time, restoring balance and hope through adaptation, as evidenced by individuals who experienced improved sleep, reduced stress, greater emotional acceptance, and increased confidence. CONCLUSIONS: Mothers of children with ASD expressed challenges in managing sleep disturbances, regularly experienced fatigue, and psychological distress. Children’s sleep improved with appropriate professional guidance and a variety of sleep interventions applied by mothers. Healthcare providers must raise awareness, provide individualized counseling, and advocate for supportive services to help mothers improve their children’s sleep quality and adaptation.

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13. Li Z, Sun Y, Huo X, Ren X, Ding N, Qian X, Li A, Sun T. Prefrontal Cortex 5-HT1A Receptor-Coupled Inwardly Rectifying Potassium Channels Decreased Seizure Susceptibility in Rat Models With Autism Spectrum Disorder. Neural Plast;2026;2026(1):e4005949.

Dysregulation of serotonin 1A receptor (5-HT1A), a G protein-coupled inhibitory receptor, is implicated in the pathogenesis of both autism spectrum disorder (ASD) and epilepsy. The prefrontal cortex (PFC) is particularly vulnerable to the factors that affect neuronal and synaptic development, with abnormal PFC development leading to increased epilepsy susceptibility. This study used 8-OH-DPAT to activate PFC 5-HT1A to investigate its role in attenuating epileptic susceptibility in a valproic acid (VPA)-induced rat model of ASD and potential mechanisms involving Kir3 channel-mediated hyperpolarization. Rats were prenatally exposed to VPA to induce autism-like behaviors, and successful induction was verified through behavioral, morphological, and electrophysiological assessments. Neuronal loss, dendritic complexity, and spine density in the PFC were evaluated using Nissl and Golgi staining. Pentylenetetrazol (PTZ) was used to induce chemical kindling for assessing seizure susceptibility in the ASD model. Spontaneous action potential (sAP) and miniature excitatory postsynaptic current (mEPSC) frequencies were electrophysiologically recorded. The selective 5-HT1A receptor (5-HT1AR) agonist 8-OH-DPAT was used to investigate its anticonvulsant effects. ASD rats exhibited significant neuronal loss, reduced dendritic complexity, and lower dendritic spine density in the PFC. The PTZ-treated ASD group showed reduced seizure onset latency, prolonged stage IV seizure duration, and higher seizure incidence, indicating increased susceptibility to epilepsy. Untreated rats displayed reduced sAP and mEPSC frequencies in PFC pyramidal neurons, suggesting E/I imbalance. However, PTZ treatment increased sAP and mEPSC frequencies, reflecting enhanced neuronal excitability. Treatment with 8-OH-DPAT significantly delayed seizure onset, shortened seizure duration, and reduced seizure incidence. Furthermore, 8-OH-DPAT decreased sAP and mEPSC frequencies. These effects were attenuated after applying tertiapin-Q (TQ), underscoring the role of inwardly rectifying potassium (Kir3) channels in mediating 8-OH-DPAT-induced anticonvulsant effects. In conclusion, PFC 5-HT1AR activity alleviated epileptic activity through Kir3 channel-mediated hyperpolarization. These findings highlight 5-HT1ARs and Kir3 channels as promising therapeutic targets for epilepsy associated with ASD.

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14. Posar A, Visconti P. Autism Spectrum Disorder: The Possible Etiopathogenetic Role of Electromagnetic Pollution. Turk Arch Pediatr;2025 (Dec 22);61(5):450-451.

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15. Pradhan S, Mukherjee P, Chakraborty B. CVAE-guided triage and modular classifiers for multimodal ASD detection. Comput Biol Med;2026 (Jul 1);210:111706.

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition, and diagnosis remains challenging when relevant evidence is distributed across behavioural, neuroimaging, physiological, and visual domains. In this work, we propose a screening-guided modular framework for ASD assessment. A Conditional Variational Autoencoder-guided Quantitative Checklist for Autism in Toddlers (Q-CHAT) module estimates ASD risk under incomplete or noisy questionnaire responses and identifies high-risk cases for further analysis. For such cases, five modality-specific classifiers are designed for: (i) structural and resting-state functional Magnetic Resonance Imaging, (ii) facial expression images, (iii) gastrointestinal endoscopy, (iv) synchronized eye-tracking with functional Near Infrared Spectroscopy (fNIRS), and (v) Activities of Daily Living (ADL) motion signals. In the MRI branch, a 3D CNN learns structural representations, a Graph Convolutional Network (GCN) models-based functional connectivity graphs, a parallel temporal 3D CNN captures resting-state functional Magnetic Resonance Imaging (rs-fMRI) dynamics, and phenotypic metadata are encoded using dense layers before fusion-based classification. Facial assessment uses MediaPipe Face Mesh region masks with an attention-based CNN. The ADL branch applies a BiLSTM with attention to handcrafted temporal features. The GI branch fuses visual embeddings with BioGPT-derived class prompts using cross-attention. The eye-tracking and fNIRS branch uses a dual-branch multilayer perceptron that combines gaze statistics with haemoglobin-based features. Because currently available public datasets do not provide all modalities for the same subjects, the downstream branches are trained and evaluated independently on modality-specific cohorts. Accordingly, the final fusion stage is presented as a conceptual late-fusion decision strategy for future patient-level multimodal deployment rather than a fully validated subject-level multimodal experiment. Across their respective benchmark datasets, the individual branches achieved strong performance, including approximately 99.05% for Q-CHAT screening, 95% for MRI-based assessment, 95% for facial analysis, 96% for eye-tracking with fNIRS, 94% for GI-based classification, and 93% for ADL-based assessment, demonstrating the feasibility of the proposed modular framework as a scalable and clinically relevant blueprint for future multimodal ASD studies.

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16. Reichenberg A, Schendel D, Gissler M, Bresnahan M, Francis R, Levine SZ, Sourander A, Parner ET, Windham GC, Yip BHK, Hansen SN, Leonard H, Devlin B, Janecka M, Kodesh A, Sandin S. Risk for Autism Across Generations. Biol Psychiatry;2026 (May 5)

BACKGROUND: Autism spectrum disorder (ASD) has a complex inheritance pattern and is more common in males. Etiological models suggest that majority of ASD risk is transmitted through common and rare de-novo genetic variation. It has been hypothesized that rare variation could be inherited and therefore contribute to the overall risk-burden in subsequent generations, especially through female lineage in disorders with male-skewed sex-ratios. Here we test this hypothesis using multigeneration information on paternal age, because burden of de-novo mutations has been linked to paternal age, and there is a well-established association between older age of fathers and ASD. METHODS: We analyzed combined data from Sweden’s, Denmark’s and Finland’s national registers totaling 12.6 million family-members, including information about parental ages at the time of birth of offspring in two generations, and ASD diagnosis in the third generation. RESULTS: Among the 1,808,892 children in the third generation, 23,397 (1.29%) were diagnosed with ASD. Increased paternal age at the time of birth of a daughter was associated with increased risk of ASD in the daughter’s own offspring. Increased paternal age at the time of birth of a son was not associated with increased ASD risk in the son’s offspring, nor was older maternal age in the first or second generations. We observed that young maternal age at birth of a son or a daughter was associated with ASD risk in their offspring. CONCLUSIONS: Collectively, our results suggest that etiologic risk-factors for ASD could extend over multiple generations through different underlying mechanisms, suggesting new directions for research on genetic and non-genetic risk-factors.

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17. Salviati S, Braccagni G, Corridori E, Sabatini G, Fanti F, Guzzi F, Parenti M, Battista N, Scheggi S, Gambarana C. PPAR-α activation in a model of autism modulates social reward and endocannabinoid signaling selectively in male rats. Neuropharmacology;2026 (May 5);296:110996.

Social difficulties in autism spectrum disorder (ASD), including reduced sensitivity and responsiveness to the rewarding value of social stimuli (social anhedonia), may arise from dysregulation of dopaminergic and endocannabinoid (eCB) pathways. We examined whether social reward processing was restored in male and female rats prenatally exposed to valproic acid (VPA) by PPARαs activation which modulates dopaminergic and eCB transmission. After 4-week administration of the PPARα agonist fenofibrate (FBR), social interaction and social reward sensitivity were assessed, and levels of eCBs and related markers measured in the nucleus accumbens (NAc) and medial prefrontal cortex (mPFC). In VPA-exposed male rats, FBR administration reinstated social behavior, increased N-palmitoyl ethanolamine (PEA) levels in the NAc and normalized fatty-acid amide hydrolase (FAAH) levels in the NAc and mPFC. In contrast, VPA-exposed female rats showed very subtle ASD-like social deficits, different patterns of eCB alterations, with decreased N-oleoyl ethanolamine (OEA) levels in both regions, and divergent responses to FBR. Overall, these findings suggest that FBR modulation of the eCB system contribute to improving social behavior in VPA-exposed male rats. Moreover, differences in eCB signaling in male and female rats may play a role in the development of sex-divergent phenotype following prenatal VPA exposure.

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18. Still MEH, Alberts A, Nagda P, Fleeting C, Smith I, Ockerman K, Han S, Governale L, Ching J. Could Autism Spectrum Disorder Be Associated With Craniosynostosis?. J Craniofac Surg;2026 (May 5)

INTRODUCTION: Craniosynostosis is a common pediatric condition that results in variable symptoms that range from asymptomatic cosmetic deformities to severe signs of intracranial hypertension. Little is understood about the relationship between craniosynostosis and neurocognitive and neurodevelopmental symptoms, including autism spectrum disorder (ASD). OBJECTIVE: The purpose of this study is to compare skull vault measurements between patients with ASD and craniosynostosis to determine if those with ASD have abnormal findings related to synostotic changes. METHODS: The authors performed a retrospective chart review of pediatric patients with CT scans of the head to compare several cranial vault measurements between children with craniosynostosis, those with ASD, and those with neither diagnosis. RESULTS: One hundred ninety-eight patients’ CT scans were reviewed. Of those with sagittal craniosynostosis, significant differences were found in cephalic index, interparietal distance, intercoronal distance, and metopic severity index between controls and those with craniosynostosis, but not between controls and those with ASD, nor between those with craniosynostosis with or without ASD. Of those with metopic craniosynostosis, significant differences were found in metopic angle, interparietal distance, intercoronal distance, and metopic severity index between controls and those with craniosynostosis, but not between controls and those with ASD, nor between those with craniosynostosis with or without ASD. There were no significant measurement differences between those with craniosynostosis alone and those with craniosynostosis and ASD diagnosis in either type of craniosynostosis. CONCLUSIONS: No significant differences were found in cranial vault measurements of patients with ASD versus controls. Among patients with craniosynostosis, those who also had ASD did not have significantly different measurements, although the population was small. It is likely that the 2 diagnoses are incidental rather than causal.

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19. Tung CB, Lu YC, Sun CK, Cheng YS, Chen CM, Hung KC. Therapeutic effects of tDCS on behavioral symptoms of autism spectrum disorders in children and adolescents: A systematic review and meta-analysis of randomized sham-controlled trials. Brain Dev;2026 (May 5);48(3):104544.

OBJECTIVE: This study aimed at investigating the effectiveness of transcranial direct current stimulation (tDCS) in improving autism spectrum disorder (ASD)-related behavioral symptoms in children and adolescents. METHODS: Randomized placebo-controlled trials (RCTs) recruiting children/adolescents were identified from major databases using the keywords « tDCS » and « ASD ». Outcomes included improvement in ASD-related overall/core symptoms and treatment acceptability. Effect sizes of continuous and categorical data were expressed as standardized mean difference (SMD) and odds ratios (ORs), respectively, with 95% confidence intervals. RESULTS: Meta-analysis of nine RCTs (278 participants, mean age = 8.1) showed improvement in overall behavioral symptoms, social function, and communication in the tDCS group compared with sham-controls [SMD = -0.50, p < 0.01; SMD = -0.40, p = 0.02 (seven studies) and SMD = -0.34, p = 0.04 (six studies), respectively] without difference in symptoms of restricted and repetitive behaviors (SMD = -0.36, p = 0.06). Subgroup analysis revealed greater improvement in studies enrolling only children than those that also recruited adolescents (SMD = -0.70 vs. -0.06, respectively, p = 0.03). No difference was noted in treatment acceptability (i.e., the number of participants withdrawing from a study) between the tDCS and sham-controlled groups. CONCLUSIONS: Our study supported tDCS use for improving overall behavioral symptoms of ASD in children and adolescents, mainly those pertinent to socio-communication, with fair treatment acceptability.

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20. Turpin V, Aburto MR. Altered Intestinal Neurotransmission in Autism Spectrum Disorder: Expanding the Molecular Landscape of the Gut-Brain Axis. Dig Dis Sci;2026 (May 5)

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21. Wang W, Chen L, Liu Z, Qiu X, Wu D, Huo Y, Wang X, Zhang J, Zhao Y, Zhang Y, Wang Y, Zhu D, Chen J. Cross-Cultural Adaptation and Validation of the Simplified Chinese Version of the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist. Am J Speech Lang Pathol;2026 (May 5);35(3):1252-1267.

PURPOSE: This study aimed to adapt and validate the Communication and Symbolic Behavior Scales Developmental Profile Infant-Toddler Checklist (CSBS-DP-ITC) for infants aged 6-24 months in mainland China (Simplified Chinese version), ensuring its effectiveness in identifying communication delays and neurodevelopmental risks. METHOD: A cross-sectional validation study was conducted with 296 infants (M(age) = 15 months; interquartile range: 11-19 months) recruited from Shanghai Children’s Hospital. The CSBS-DP-ITC underwent systematic cross-cultural adaptation (forward translation, synthesis of translations, back-translation, expert committee review, pretesting, and final documentation review). Reliability was assessed using internal consistency (Cronbach’s α, McDonald’s ω), split-half reliability, and test-retest reliability (Spearman ρ; n = 130). Validity was evaluated using exploratory/confirmatory factor analysis (EFA/CFA), convergent/discriminant validity, and criterion validity against the Gesell Developmental Schedules (GDS)-Chinese version and known-groups validity. RESULTS: The scale demonstrated excellent overall internal consistency (α = .92, ω = .93) and split-half reliability (.91). Test-retest reliability was strong at ≤ 90 days (ρ = .94-.96), but it declined over longer intervals. EFA and CFA confirmed the three-factor structure (social, speech, and symbolic; χ(2)/df = 2.88, Comparative Fit Index/Tucker-Lewis Index = 0.95, root-mean-square error of approximation = 0.080), although the discriminant validity between the social and symbolic composites was suboptimal (r = .88). Criterion validity with the GDS was moderate for the speech-language domain (κ = .50). Known-groups analysis showed significantly lower CSBS-DP-ITC scores in infants with developmental delay (p < .001). Notable ceiling effects (emotion/eye gaze, communication) and floor effects (words) were observed. CONCLUSIONS: The Simplified Chinese CSBS-DP-ITC exhibited robust reliability and acceptable validity for screening early communication skills among mainland Chinese infants. Generalizability may be constrained by urban, highly educated samples, and future studies should include rural populations. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.32048631.

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22. Zhang C, Wang R, Capal JK, Srivastava S, Filip-Dhima R, Bebin EM, Krueger DA, Northrup H, Wu JY, Warfield SK, Sahin M, Zhang B. A two-step temporal data augmentation and supervised learning framework for predicting autism diagnosis at 36 months in patients with tuberous sclerosis complex. Comput Biol Med;2026 (Jul 1);210:111719.

BACKGROUND: Autism spectrum disorder (ASD) affects approximately 25-50% of children with tuberous sclerosis complex (TSC). Early identification of ASD in this high-risk population is crucial for timely intervention but remains challenging due to the heterogeneous clinical presentation and complex interplay of genetic, neurological, and environmental factors. This study aimed to integrate longitudinal diffusion tensor imaging (DTI) metrics with early behavioral features using supervised learning algorithms to predict ASD outcomes at 36 months. METHODS: Data were obtained from the children enrolled in the TSC Autism Center of Excellence Research Network study. Four DTI metrics: axial diffusivity, fractional anisotropy, mean diffusivity, and radial diffusivity, were measured across 27 major white matter tracts at up to four irregular time points. To account for variability in acquisition timing, we developed a two-step data augmentation algorithm to interpolate each subject’s data to standardized ages of 12, 24, and 36 months. In addition, 9 behavioral features from the ADOS-2 and ADI-R assessments at 24 months were included. Supervised learning algorithms were trained to predict ASD diagnosis at 36 months under two input settings. RESULTS: Performance of the supervised learning algorithms was evaluated with accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve as performance metrics. Regularized logistic regression models, least absolute shrinkage and selection operator and elastic net, demonstrated the most balanced overall performance across most evaluation metrics. Comparing input settings, Setting 1 (DTI at 24 months + behavioral features) achieved comparable or slightly improved performance relative to Setting 2 (DTI at 12 and 24 months + behavioral features) in predicting ASD diagnosis. CONCLUSION: Integrating early neuroimaging and behavioral data suggests potential for prediction of ASD outcomes at 36 months in children with TSC. This multimodal machine learning framework highlights 24-month DTI and behavioral measures as key early biomarkers and demonstrates the effectiveness of regularized regression techniques for small-sample, heterogeneous clinical datasets.

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