1. Alsaman MA, Elghity RHM. Relationship of the Persistent Primitive Reflexes to Emotional and Behavioral Problems in Autistic and Typically Developing Children. J Autism Dev Disord;2026 (May 7)

PURPOSE: Currently, there is growing evidence that persistent primitive reflexes (PPRs) may be associated with autism spectrum disorder (ASD). PPRs can disturb motor development and negatively affect children’s emotional regulation and social behavior. Therefore, they may be associated with clinical variables involved in ASD such as emotional-behavioral factors. Given this, the current study sought to explore the relationship between PPRs and emotional and behavioral problems involved in ASD. METHODS: The present study investigated seven primitive reflexes in 30 autistic children and 30 typically developing (TD) children, analyzing the relationship between PPRs and emotional and behavioral problems related to ASD. RESULTS: The findings of the study showed that compared to the TD group, children with ASD had higher levels of reflexes’ retention. In addition, the results indicated that various PPRs were related to several emotional and behavioral problems in autistic children. CONCLUSION: The findings highlight the importance of the examination of PPRs as a screening tool for children. Comprehensive investigation of PPRs, particularly in children with ASD, may contribute to a more accurate assessment of problems and higher effectiveness of possible intervention programs.

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2. B BR, Boulton KA, Thomas EE, Yu D, Guastella AJ. Exposure, Extinction, and Cognitive Appraisals in Autistic Adults With Social Anxiety: Evidence From a Structured Speech Exposure Task. Autism Res;2026 (May 7):e70268.

Social anxiety (SA) is highly prevalent among autistic adults, yet little is known about how autistic people respond to common therapeutic strategies, such as exposure tasks. This study examined responses to a structured speech exposure task embedded within an 8-week modified cognitive-behavioral therapy (M-CBT) program. Thirty-two autistic adults with co-occurring SA completed pre- and post-task assessments of anxiety and related cognitive appraisals, including self-focused attention, perceived performance, appearance concerns, and threat appraisals. Participants reported appropriate engagement with the task, characterized by elevated anticipatory anxiety followed by reductions in anxiety during the speech. Responses were largely consistent with CBT models of social anxiety and with reports by those in a social anxiety disorder reference group. Participants overestimated anticipatory anxiety (predicted fear) relative to experienced peak fear during the task. Higher anxiety was associated with greater self-focused attention and stronger threat appraisals, although anxiety correlated positively with self-rated performance. Importantly, the extinction of fear during the speech task was associated with post-treatment response to CBT. Among participants classified as high-extinction, 59% showed clinically significant improvement on the Liebowitz Social Anxiety Scale, Self-Report (LSAS-SR), compared with 25% of those in the low-extinction group. A parallel pattern was observed in a social anxiety disorder comparison group, indicating that the extinction-outcome relationship was similar across autistic and non-autistic adults. This study provides evidence that autistic individuals report fear and anxiety responses in a manner largely consistent with CBT models and that extinction-based processes during exposure are meaningfully associated with treatment response. Further studies employing randomized controlled trials and objective measures of fear are now needed. Many autistic adults experience intense anxiety in social situations, especially when they are the focus of attention. This study looked at how a public speaking task (giving a short speech in front of others) could help reduce that anxiety when used as part of a group therapy program. Thirty‐two autistic adults took part in a modified therapy program that included learning social skills and practicing speeches. Before and after the speech, participants filled out questionnaires about how anxious they felt, how well they thought they did, and how they believed others saw them. Most participants felt less anxious after the speech than they expected, showing that the task helped reduce fear. Interestingly, people who felt more anxious often thought they performed better, which may mean they were trying harder or paying close attention to how they came across. Concerns about appearance didn’t seem to affect anxiety, but did affect lower confidence. A similar pattern of results was seen in non‐autistic people with social anxiety. These results show that with the right support, autistic adults can benefit from public speaking tasks and that therapy should be tailored to their unique experiences and strengths. eng

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3. Ben Saad H, Barki C, Dergaa I, Dhahbi W, Ceylan HI, Chalghaf N, El Omri A, Boussi Rahmouni H. Paracetamol in pregnancy: Navigating clinical uncertainty and avoiding the communication pitfalls of the « measles, mumps, and rubella » – autism controversy: A narrative review. Excli j;2026;25:400-426.

On September 22, 2025, the United States government announced that the Food and Drug Administration (FDA) would modify paracetamol (acetaminophen) labelling to warn of possible associations with autism, advising pregnant individuals to avoid the medication. This contradicts professional medical consensus and high-quality evidence, replicating communication failures of the 1998 MMR-autism controversy that caused vaccine hesitancy, disease outbreaks, and trust erosion. This narrative review synthesized epidemiological evidence on paracetamol safety in pregnancy, analyzed the September 2025 announcement through the measles, mumps, and rubella (MMR)-autism crisis lens, and proposed an evidence-based communication framework. We searched PubMed, Embase, Web of Science, and Google Scholar, supplemented with governmental statements, professional responses, and media analysis. The two highest-quality sibling-control studies (Swedish: 2.5 million; Japanese: 200,000 children) reported no causal associations between prenatal paracetamol exposure and neurodevelopmental outcomes after controlling genetic and familial confounding. Conversely, untreated maternal fever and pain carry established risks including neural tube defects, preterm birth, and maternal morbidity. The governmental announcement employed inflammatory categorical warnings contradicting FDA’s nuanced advisory and scientific consensus. Professional organizations immediately issued strong rebuttals. This replicates MMR failures: governmental statements contradicting evidence, false media balance, and public confusion. The September 2025 announcement represents failure to apply MMR lessons. Healthcare providers must employ evidence-based shared decision-making emphasizing sibling-controlled studies show no causal relationship while untreated conditions carry established harms. The Precautionary Communication Principle provides framework for transparent uncertainty discussion without disproportionate alarm or undermining evidence-based medicine trust. See also the graphical abstract(Fig. 1).

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4. Breunig S, Schaffer L, Lawrence J, Sheppard A, Grotzinger A. Uncovering the Role of Biological Sex in the Divergent Genetic Profiles of Early and Late-Diagnosed Autism. Res Sq;2026 (May 7)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a significant male prevalence bias. While recent evidence suggests that genetic heterogeneity is indexed by age at diagnosis, males are also typically diagnosed earlier, such that the extent to which these age-specific findings are confounded by shared genetic signal with sex-specific genetic architecture remains unclear. To test this, we leveraged sex- and age of diagnosis-stratified GWAS summary statistics for ASD and applied a multiple regression framework within Genomic Structural Equation Modeling (Genomic SEM). This approach allowed us to disentangle the overlapping genetic variance between sex, diagnostic timing, and 68 clinically relevant phenotypes reflecting a host of different psychiatric, cognitive, health, and social outcomes. Consistent with prior findings, we identified significantly divergent genetic associations with external traits between early- and late-diagnosed ASD subtypes. We also identified few findings for sex-specific associations, along with high genetic correlations across these two traits, which questions the biological basis for disproportionate prevalence rates in males. Multiple regression models confirmed that early-specific associations were not confounded by biological sex. Conversely, the correlations between late-diagnosed ASD and the sex-stratified ASD GWAS were near 1, indicating that late-specific associations may be confounded. Follow-up analyses using an internalizing factor provided support for sex differences in clinical presentation and age at diagnosis, with female-diagnosed and late-diagnosed ASD estimated to have stronger genetic correlations with internalizing traits compared to male and early-diagnosed counterparts. This study underscores the importance of subtyping in genetic analyses and provides a framework to disentangle confounded genetic pathways.

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5. Buell N, Shenkar E, Kirsch S, Poehler D, Khavjou O, Giombi K. Patient-centered burdens and economic outcomes among patients who are veterans, people with intellectual and developmental disabilities, and people living in rural areas and their caregivers: a scoping review. Front Public Health;2026;14:1749239.

BACKGROUND: This review synthesized literature on patient-centered burdens and economic outcomes (PCBEOs) for three populations that may be underrepresented in the literature-military veterans, people with intellectual and developmental disabilities (IDD), and individuals living in rural areas-to better understand how PCBEOs are captured for these populations. METHODS: We searched PubMed, CINAHL, EconLit, Web of Science, and APA PsycInfo (January 2015-April 2025) for U.S.-based studies of PCBEOs due to medical reasons for veterans, people with IDD, or people living in rural areas or their caregivers. We categorized PCBEOs into direct medical costs, direct non-medical costs, indirect impacts, and intangible burdens. We examined population-specific rationales for studying these outcomes reported in the studies. RESULTS: Of 1,549 identified records, 126 met inclusion criteria. Intangible burdens were the most frequently reported PCBEOs (n = 84, 67%), while direct medical (n = 47, 37%) and non-medical costs (n = 28, 22%) were least commonly assessed. Patterns in PCBEOs varied across populations: studies of veterans focused narrowly on intangible burdens (n = 23, 85% of veteran studies), specifically composite measures of caregiver burden (n = 17 studies, 63% of veteran studies on intangible burdens). Studies on people with IDD and rural populations more often examined multiple PCBEO categories, including indirect impacts (IDD n = 33, 58%; rural n = 22, 47%) such as unpaid caregiving time; direct medical costs (IDD n = 25, 44%; rural n = 19, 40%) such as out-of-pocket medical expenses, and direct non-medical costs (IDD n = 14, 25%; rural n = 14, 30%) such as travel costs. Across all groups, few studies assessed the full spectrum of PCBEOs. Most studies (n = 96, 76%) provided research justifications tailored to their study population, though this varied across groups-about half of veteran studies (n = 13, 48%) included justifications, compared with 84% (n = 48) for IDD and 70% (n = 33) for rural populations. CONCLUSION: The frequent reporting of intangible burdens across all populations highlights substantial emotional and psychological strains faced by these groups. Considerable variability in PCBEOs examined across populations reveals gaps in comprehensive assessment of the full range of PCBEOs that each group experienced. These findings underscore the need for systematic data collection to more fully capture the range of burdens for these populations.

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6. de Water JV, Blumenthal K, Alexeeff S, Weiss L, Yolken R, Ashwood P, Croen L, Schauer J. Utilizing maternal autoantibody patterns to predict risk of autism and intellectual disability in offspring. Res Sq;2026 (May 7)

Maternal autoantibody-related autism (MARA) is a subset of autism in which specific patterns of maternal autoantibodies (aABs) in the circulation of pregnant women have been associated with increased autism risk in offspring. While initial MARA studies identified patterns consisting of two maternal aABs that predicted increased risk of autism, other multi-aAB patterns predictive of autism and other neurodevelopmental disorders have not yet been fully assessed. In this study, we aimed to determine if additional patterns of MARA aABs can be used to predict the risk of autism and intellectual disability (ID). We tested maternal plasma samples from the Early Markers for Autism (EMA) study for reactivity to eight proteins with clinical relevance in our initial MARA studies. Least Absolute Shrinkage and Selection Operator (LASSO) statistical modeling was used to identify patterns of three maternal aABs that were predictive of offspring autism and ID risk. We identified novel patterns consisting of three aABs associated with increased risk of autism or ID compared to general population controls (GP). Additionally, we found that specific patterns of three maternal aABs differentially predicted risk of autism with intellectual disability (AU ID) and autism without intellectual disability (AU noID), compared to GP. Overall, novel patterns consisting of three maternal aABs have been identified and can be used to predict child clinical risk of autism, ID, and autism subgroups, AU ID and AU noID.

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7. Ferahkaya H, Selen ATH, Tezer Ş, Akça Ö F, Akkuş A, Kılınç İ, Coşkun F. Concurrent Assessment of Neurotrophic Factors and HPA-Axis Hormones in Early Childhood Autism Spectrum Disorder. J Autism Dev Disord;2026 (May 7)

PURPOSE: Neurotrophic pathways and hypothalamic-pituitary-adrenal (HPA) axis regulation have been implicated in autism spectrum disorder (ASD), yet peripheral findings-particularly in early childhood-remain inconsistent. We examined peripheral neurotrophic factors and HPA-axis hormones in medication-naïve young children with ASD and evaluated their associations with clinical severity. METHODS: This cross-sectional study included 45 medication-naïve children with ASD (18-72 months) and 52 age-matched healthy controls. ASD diagnosis was established per DSM-5, supported by the Childhood Autism Rating Scale (CARS) and the Autism Behavior Checklist (ABC). Morning samples (08:30-09:30) were assayed for serum BDNF, GDNF, NT-3, VEGF, cortisol, and plasma ACTH. Group comparisons used ANCOVA adjusted for age, sex, and BMI-for-age z score (BAZ), with Benjamini-Hochberg false discovery rate (FDR) correction. Within-ASD associations were tested using covariate-adjusted partial Spearman correlations. RESULTS: BDNF was significantly lower in ASD than controls and remained significant after covariate adjustment and FDR correction. No between-group differences were observed for GDNF, NT-3, VEGF, ACTH, or cortisol. Within the ASD group, lower BDNF correlated with higher CARS total scores and higher ABC relating, social and self-help, and total scores. No significant correlations were found between neurotrophic factors and ACTH/cortisol. CONCLUSIONS: In medication-naïve children with ASD aged 18-72 months, peripheral BDNF is reduced and relates to symptom severity and adaptive/social difficulties, whereas other neurotrophic factors and basal HPA-axis hormones do not differ from controls. Longitudinal studies incorporating standardized sampling and diurnal/stress-reactivity indices are needed to clarify developmental dynamics and clinical implications.

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8. Ghanouni P, Michaud PL, Nobbe A, Mello I, Fitzpatrick S, Quigley E, Miller J, Doyle T. The Impact of Autism Spectrum Disorder Severity on the Incidence and Extent of Traumatic Dental Injuries in Children: A Retrospective Observational Cohort Study. Dent Traumatol;2026 (May 7)

INTRODUCTION: Traumatic dental injuries are a common oral health problem among children and have significant health consequences. Children with autism spectrum disorder may face an increased risk of traumatic dental injuries, potentially due to developmental delays, sensory difficulties, and behavioral challenges. However, the relationship between the severity of autism and the extent and occurrence of dental trauma remains unclear. To our knowledge, this is the first study to aim at evaluating the association between the severity of autism and the incidence and severity of dental trauma. METHODS: This retrospective chart review analyzed data from children aged 3-15 years with autism spectrum disorder, who received their health and dental care at a major pediatric health center between 2016 and 2024. A total of 441 patients with autism were included in the study. Statistical analyses were used to examine associations between sex, autism severity, and dental trauma incidence and type/severity. RESULTS: Among the 441 participants, 9.1% experienced at least one dental trauma. No statistically significant associations were found between autism severity and dental trauma incidence (p = 0.136) or severity (p = 0.517). Furthermore, sex was not associated with the occurrence of dental trauma (p = 0.591). CONCLUSION: The severity of autism spectrum disorder and sex are not associated with the occurrence or severity of dental trauma among children. These findings suggest that factors beyond the severity of autism may play a more significant role in the risk and impact of dental trauma in this population. A clearer understanding of additional contributing variables is essential to inform more effective prevention and management strategies for high-risk individuals within this population.

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9. Guo LX, Pace AE. Beyond the Here and Now: Decontextualized Language Use in Conversations Between Preservice Speech-Language Pathologists and Preschoolers With Language Impairment. J Speech Lang Hear Res;2026 (May 7);69(5):2143-2159.

PURPOSE: This study investigated decontextualized talk produced by preschoolers with language impairment. Although literature has highlighted the pivotal transition from using « here and now » to using « there and then » language in typically developing children entering preschool age, there is limited understanding of this phenomenon in children with developmental disorders. METHOD: This study analyzed play-based conversations between four preservice speech-language pathologists (SLPs) and two participant groups: children with autism spectrum disorder (ASD; n = 7) and children with developmental language disorder (DLD; n = 9). Data collection included video-recorded conversation samples and standardized assessments of child receptive language development. For dyadic measures, the study examined group differences in total conversation turns, turn-taking rates, and proportion of decontextualized turns. For child and adult language measures, the study analyzed their speech samples, including mean length of utterance (MLU) in words and number of different words (NDW) per minute, and preservice SLPs’ use of language facilitation techniques during play-based conversations. RESULTS: Our findings revealed that dyads from both groups (DLD, ASD) engaged in decontextualized talk (narratives, explanations). Children’s standardized language measures correlated with decontextualized talk and conversation turns, although no group differences were observed in these measures. Analysis of preservice SLPs’ language behaviors showed equivalent linguistic input (syntactic length, lexical diversity) and comparable use of language facilitation techniques across diagnostic groups. Preservice SLPs’ use of repetition showed strong positive correlations with children’s immediate language outcomes (MLU in words, NDW per minute). When controlling for both child age and adult facilitation technique use, group differences in dyadic measures remained nonsignificant. This lack of group differences may be attributed to the unique features of language elicited from child-led free-play, a small sample size, and the heterogeneity of language profiles even within two diagnostic groups. CONCLUSIONS: Results provide new information about play-based verbal interactions of children with DLD and ASD, suggesting potential for clinicians to incorporate decontextualized talk into interventions. Future studies can examine the effects of decontextualized talk strategies, such as engaging children in narratives and explanations in more structured activities, on their language outcomes.

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10. Hindi I, Meir N. Non-interactive and naturalistic language exposure in autism: An investigation of narrative production in bilingual children. J Commun Disord;2026 (May 7);122:106650.

PURPOSE: This study examines narrative production in autistic bilingual children who acquired English through either naturalistic (interactive) input or non-interactive (screen-based) exposure. Non-interactive language acquisition, often termed « unexpected bilingualism », is a growing but underexplored phenomenon in autism research, especially at the group level. METHOD: We analyzed English and Hebrew narratives from 54 bilingual children aged 4-12, divided into three groups: autistic children with non-interactive English exposure (ASD-NI), autistic children with naturalistic English exposure (ASD-Nat), and typically developing bilingual peers with naturalistic English exposure (TLD-Nat). Narrative samples were assessed for general narrative productivity measures (e.g., type and token counts, lexical diversity, syntactic complexity) and referential expression use (e.g., referential choice, referential ambiguity, and definiteness marking). RESULTS: No significant group differences were found in narrative productivity in either language. As for referential expressions, all groups used more lexical NPs during the character’s introduction and more reduced forms (null/overt pronouns) during subsequent mentions of the character, reflecting typical discourse strategies. However, the ASD-Nat group produced more ambiguous pronouns than the TLD group, while no evidence of elevated ambiguity was observed in the ASD-NI group. No significant differences were observed in definiteness marking. Cross-language convergence was observed in ambiguous pronoun use. Higher verbal Theory of Mind was associated with greater lexical noun use and reduced referential ambiguity, linking clearer discourse marking to stronger socio-cognitive abilities. CONCLUSIONS: These findings highlight the linguistic competence of autistic children acquiring language through non-interactive screen-based input and highlight the importance of recognizing alternative pathways to bilingual development in autism.

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11. Jacokes Z, Beeler-Duden S, Lawson S, Eilbott J, Van Horn JD, Pelphrey K. Autism Sensory Profiles Predict Stimulus-Evoked Insula Connectivity. medRxiv;2026 (Apr 30)

Sensory processing is a common target in autism spectrum disorder (ASD) research, yet the latent structure of sensory experience is disputed. Researchers frequently explore the presence of « subtypes » to categorize sensory heterogeneity, but such discrete models can fail to capture the intrinsic geometry of phenotypic data. In this study, we aim to characterize heterogeneous sensory profiles in ASD and explore if the same characterization can describe neurobiological function. First, we apply unsupervised spectral manifold dimensionality reduction to item-level Sensory Profile data from a large cohort of autistic participants ( n =223) to compare categorical subtyping against continuous models. The behavioral results reveal unstable and irreproducible subtyping solutions; instead, sensory processing differences are best characterized as a continuous, non-linear manifold of sensory severity. To determine the neurobiological relevance of this sensory gradient, we employed voxel-wise linear mixed-effects modeling of insula-seeded functional connectivity ( n =63). We demonstrate that sensory severity predicts a significant decoupling between the insula and sensorimotor cortices during externally driven stimulation involving motion stimuli, but not during resting state. This finding supports the interpretation that sensory-related neural hypoconnectivity is context-dependent and not reflective of intrinsic traits. Further, we identify a significant sex-by-sensory gradient interaction, indicating heightened sensitivity of connectivity patterns to sensory severity in autistic males. These findings indicate that sensory atypicality in ASD points toward a continuous regulatory manifold linked to disrupted social-sensory integration.

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12. James L, O’Halloran CP, Lemley BA, Cornicelli M, Fox J, Winlaw D, Nugent A, Tannous P. ASD Diameter Indexed to Total Septal Length Outperforms Expert Opinion in Predicting Future Candidacy for Percutaneous ASD Closure. Pediatr Cardiol;2026 (May 7)

Percutaneous device closure is an attractive alternative to surgical closure of secundum atrial septal defects (ASDs) for those with suitable anatomy and size. Early surgery (< 2 years of age) allows for a more feasible "mini sternotomy" technique, while device closure is more commonly performed at an older age. Thus, the ability to predict future device-closure candidacy before 2 years of age is needed. Secundum ASD closures after 3 years of age from 2012 to 2023 at a single center were reviewed (n = 54). "Early" echocardiograms (obtained at 12-24 months of age) and "pre-intervention" echocardiograms (the last echo obtained prior to closure and after 36 months of age) for each patient were independently reviewed by echocardiographers who performed standardized measurements. The catheterization team reviewed the same echocardiograms and made recommendations on device closure candidacy. Reviewers were blinded to the paired echocardiograms and eventual interventions. There was moderate agreement in perceived device candidacy by catheterization team consensus between early and pre-intervention echocardiogram (Cohen's Kappa = 0.56, p < 0.001). In a multivariable model, the ratio of maximum ASD diameter indexed to total septal length (ASD/TSL) between 1 and 2 years of age was strongly predictive of eventual perceived candidacy for device closure (Area Under the Curve = 0.92, sensitivity 89%, specificity 89% at the optimal threshold of 0.46) outperforming expert consensus (sensitivity 81%, specificity of 77%). Patients with ASD/TSL < 0.46 on early echocardiograms are likely to be considered device candidates later in life.

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13. Kuang C, Chen F, Nie Y, Gou Z, Yan J, Liu G. Investigating Prosodic Focus Perception and Production in Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. J Speech Lang Hear Res;2026 (May 7);69(5):2092-2111.

PURPOSE: Speakers of all human languages use prosodic changes to encode focus, and the ability to perceive and produce prosodic focus is crucial for developing linguistic and communicative skills. This review aims to explore the performance of prosodic focus perception and production among individuals with autism spectrum disorder (ASD) and to identify potential factors contributing to inconsistent findings in previous studies. METHOD: We conducted a systematic search in three electronic databases and one web search engine to identify peer-reviewed research articles that compared the perception and production of prosodic focus between individuals with ASD and typically developing (TD) individuals. Effect sizes were calculated based on random-effects models. Meta-regression analyses were conducted to assess potential individual and methodological moderators. RESULTS: The comparison of perception accuracy between 441 individuals with ASD and 511 TD individuals revealed that individuals with ASD exhibited impaired prosodic focus perception (Hedges’s g = -0.40), with no significant moderators for heterogeneity across studies. Meanwhile, we compared production accuracy between 483 individuals with ASD and 619 TD individuals, finding that production impairments in ASD were more pronounced (Hedges’s g = -0.85). The moderator analysis revealed that nonverbal IQ and expressive language skills were significant moderators of production accuracy. Besides, individuals with ASD also exhibited greater pitch variation in prosodic focus production. CONCLUSION: Overall, these findings suggest that individuals with ASD exhibit greater difficulties in the production of prosodic focus compared to its perception, and increased pitch variation might be a prosodic feature associated with ASD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31934088.

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14. Mukunya D, Nambozo B, Amanya D, Oguttu F, Okwir J, Musaba MW, Chebet M, Mutonyi S, Nabudere HK, Okwakol G, Burgoine K, Magai DN, Lin PY, Weeks AD, Gladstone M. Effect of probable neonatal sepsis on the development of infants in Eastern Uganda (ENON): a cohort study. BMJ Paediatr Open;2026 (May 7);10(1)

BACKGROUND: Neonatal sepsis is a common cause of mortality and morbidity during the first 28 days of life, particularly in resource-limited settings. Of those infants who survive sepsis, there is a lack of clarity as to the likelihood of developmental difficulties in these children. This study aimed to understand the impact of probable neonatal sepsis on the development of 2-year-old children in Uganda. METHODS: We assessed 404 infants aged between 18 and 36 months using the WHO’s Global Scales for Early Development (GSED) Long Form (directly observed) and Short Form (parent report). This included 100 infants treated for probable neonatal sepsis and were part of a large community infection prevention trial (BabyGel). We then recruited 304 age-matched children from the same communities who took part in the parent trial but had no probable neonatal sepsis. We used linear regression and inverse probability of treatment weighting analyses to calculate measures of association and effect. We adjusted for the clustering effect, trial arm or other confounders. RESULTS: The mean age (SD) of children in our cohort was 23.3 months (4.4) in both groups. GSED development for age Z-scores were significantly lower for the children with a probable sepsis diagnosis compared with those without for both the GSED Short Form -0.22, 95% CI -0.47 to -0.04 and the GSED Long Form -0.33, 95% CI -0.60 to -0.05 when adjusted. An additional model adjusting for HIV exposure as a confounder (only available 373/404) provided similar results with adjusted mean GSED Short Form developmental age Z-scores difference of -0.29, 95% CI -0.53 to -0.04 and -0.33, 95% CI -0.59 to -0.07 for GSED Long Form. CONCLUSION: Neonatal sepsis may be associated with poorer developmental outcomes in resource-limited settings such as Uganda. To ensure better outcomes for these children, it is vital to explore more effective strategies for follow-up, monitoring and early interventions in infants with probable neonatal sepsis.

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15. Nandu M, Reynolds R, Irwin J, Silva CF, Brunton L. Understanding physical activity through the biopsychosocial model of health in young adults (19-30 years of age) with intellectual and developmental disabilities: A mixed methods systematic review. Acta Psychol (Amst);2026 (May 7);267:106961.

INTRODUCTION: As young adults with intellectual and developmental disabilities (IDDs) age, they experience greater risk of developing chronic health conditions and social isolation. PURPOSE: Was to understand the extent that physical activity (PA) was successful at improving the physical, mental and social health and well-being of young adults (19-30 years of age) with IDDs. METHODS: The Joanna Briggs Institute Manual for Evidence Synthesis was used as a guide. A convergent integrated approach to data analysis was used, which involved simultaneous coding of qualitative and quantitative evidence. All data were coded into sub-themes which were organized according to the Biopsychosocial Model of Health. RESULTS: Twenty articles (n = 20) were included in the review (n = 17 quantitative, n = 3 qualitative). PA interventions were reported with a myriad of benefits. Biological sub-themes included improved aerobic fitness, functional fitness, and indicators of body composition. Psychological sub-themes included personal development, self-efficacy, and emotional well-being. Social sub-themes included developing social relationships, community and inclusion. Quality of life included positive affect. CONCLUSION: PA can reduce the risk of developing chronic health conditions while improving self-efficacy, social skills and adaptive behaviours and providing opportunities to exercise autonomy. Sports and combined games/activities were more commonly reported to improve social skills, and help develop teamwork, whereas less structured PAs were more commonly reported to improve independent decision making. PA resulted in improved quality of life for people with IDDs. We recommend PAs for adults with IDDs, appreciating the broad spectrum of PAs this includes and the variety of potential health benefits.

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16. Sandbank M, Bottema-Beutel K, LaPoint SC, Feldman JI, Woynaroski T. The Influence of Language and Cognition on Intervention Effects in Young Autistic Children: A Meta-Regression Analysis. J Speech Lang Hear Res;2026 (May 7);69(5):2112-2127.

BACKGROUND: Young autistic children have a range of language and cognitive abilities and, as a result, may differentially benefit from interventions supporting skills in these and related domains. Although studies have previously examined the extent to which participant characteristics interact with intervention effects, they have primarily restricted the analyses to a single intervention approach. METHOD: In the present study, we drew on data from a comprehensive meta-analysis of group design, nonpharmacological intervention studies for young autistic children to test these effects. Specifically, we conducted a secondary meta-regression analysis to examine whether cognitive and language standard scores and age equivalents at study entry significantly moderated intervention effects across intervention type on adaptive, cognitive, language, and social communication outcomes and separately across outcome type for behavioral, developmental, naturalistic developmental behavioral interventions and technology-based interventions. Cognitive and language ability was quantified using reported or estimated standard scores, and cognitive and language level was quantified using reported or estimated age-equivalent scores. Analyses within outcome type were conducted using a data set of 1,911 effect sizes from 202 independent samples, and analyses within intervention type were conducted using a data set of 2,137 effect sizes from 144 independent samples. RESULTS: Few studies reported standard scores and/or age equivalents for participant language. None of the putative moderators significantly predicted intervention effects by outcome domain (i.e., adaptive, cognitive, language, and social communication). Both cognitive standard and age-equivalent scores positively and significantly predicted effects of technology-based interventions exclusively, but we did not find robust evidence that language standard or age-equivalent scores significantly predicted effects by intervention type. CONCLUSIONS: These findings are exploratory and warrant cautious interpretation. Future intervention researchers should extensively characterize participant samples in terms of their language and cognitive ability to aid meta-analytic investigation. The field would benefit from additional high-quality randomized controlled trials testing whether intervention effects vary by participant characteristics, using preplanned moderator analyses, valid measures, and large representative samples. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31967844.

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17. Satterstrom FK, Jodeiry K, Mahjani B, Hatem G, Park SJ, Klei L, Fu JM, Wigdor EM, Betancur C, Daly MJ, Roeder K, Devlin B, Buxbaum JD, Cutler DJ. Modeling rare coding variation on chromosome X provides insight into the genetics and differential sex prevalence of autism spectrum disorder. medRxiv;2026 (May 7)

Autism spectrum disorder (ASD) is estimated to be up to four times as common in males as in females, yet the causes of this prevalence difference are not well established. One possible driver is genetic variation on the X chromosome, as it contains genes capable of contributing to ASD ( e.g ., PTCHD1, MECP2 ) and is known to play a role in genetic disorders with differential sex prevalence ( e.g ., color blindness). However, a lack of power compared to the autosomes combined with the complexities of modeling its biology have led to the X being largely overlooked in sequencing studies. Here, we develop quantitative X-linked TADA, a new model designed specifically for application to this chromosome, and use it to analyze rare variation from 50,663 individuals with ASD (and 136,670 individuals total). We find 9 genes on the X associated with ASD at a false discovery rate (FDR) < 0.05 and an additional 9 genes at FDR < 0.2, with many of these previously identified as involved in specific neurodevelopmental disorders. Point estimates of the liability conferred by de novo variants on the X are similar in females and males, with both sexes' estimates elevated > 20% above the corresponding autosomal values. We also develop a general theory of how X-linked variation of any additive or non-additive effect influences liability and describe its implications for prevalence. Using this theory and our empirical results, we show how genetic variation on the X could contribute to the sex-differential prevalence of ASD.

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18. Shafer RL, Wang J, Qu H, Simpson JP, Terza M, Shirley DJ, McKinney WS, Pulver S, Orlando AM, Romero RA, Karmakar B, Mosconi MW, Wang Z. Gait variability development in autistic individuals across childhood and adulthood. Res Sq;2026 (May 7)

Atypical sensorimotor behaviors are prevalent in autism spectrum disorder (ASD), often emerging in infancy and persisting into early adulthood. Prior focus on qualitative metrics and developmentally specific motor skills has limited understanding of sensorimotor differences in ASD across the lifespan. The present study quantified gait kinematics in ASD across a wide age range, including analysis of 60 autistic individuals (ages 4-35 years) and 53 age-, sex-, and performance IQ-matched neurotypical (NT) controls. Autistic individuals differed from NT controls on seven gait variables reflecting within-subject variability of gait kinematics. These seven gait variability metrics were integrated into a canonical correlation analysis (CCA) with select demographic features (group, age, sex, IQ) to derive a composite gait variability score that accounts for the multicollinearity of gait variability and demographic metrics. The composite score revealed increased gait variability in autistic individuals relative to NT controls. Gait variability was negatively associated with age across the sample. Age-by-group interactions suggested that gait variability is more severely elevated in autistic individuals during adolescence and adulthood relative to childhood. Increased gait variability also was associated with more severe clinically rated ritualistic behaviors in autistic individuals. This study leverages a novel approach to define a multidimensional component score of gait variability in ASD from childhood to adulthood. Results indicate that gait variability is elevated in ASD, and that the severity of variability differences increases with age during adolescence and into adulthood. These findings suggest that autistic individuals show an attenuated development of sensorimotor feedback and motor planning processes that are involved in maintaining accuracy and stability of movements.

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19. Taş SA, Tezcan S, Karabulut DG, Şenol H. Environmental Restriction Questionnaire: cross-cultural adaptation, reliability and validity of Turkish version in young children with developmental disabilities. BMC Public Health;2026 (May 7)

BACKGROUND: Children with developmental disabilities often face environmental barriers that limit their participation in daily activities. Environmental Restriction Questionnaire (ERQ) requires cross-cultural adaptation and validation to be used in Turkish populations. The aim of this study was to evaluate cross-cultural adaptation, reliability, and validity of the Turkish version of the Environmental Restriction Questionnaire (ERQ) in young children with developmental disabilities. METHODS: Participants were a total of 220 children, aged between 4 and 6 years, who had developmental disabilities (mean age: 4.95 ± 0.9) and their parents. The Environmental Restriction Questionnaire (ERQ) was translated from English into Turkish and underwent cross-cultural adaptation. Construct validity was evaluated using confirmatory factor analysis, and concurrent validity was determined using the correlation between ERQ and CASP with Spearman’s correlation analysis. For reliability of ERQ, Cronbach’s alpha (α) and Intraclass Correlation Coefficient (ICC) were used. RESULTS: For reliability of ERQ, high Cronbach’s α and intraclass correlation coefficient (ICC) values were found for the ERQ total and subscale scores (ICC = 0.80-0.90) (Cronbach’s α = 0.84-0.93). Construct validity showed poor model fit (Root Mean Square Error of Approximation (RMSEA) = 0.112; Goodness of Fit Index (GFI) = 0.648) suggesting that the proposed factor structure was not adequately supported. Concurrent validity analyses revealed weak to moderate negative correlations between ERQ and CASP scores (r = - 0.351 to - 0.135; p < 0.05). CONCLUSION: The ERQ appears to be a reliable, cross-culturally adapted instrument; however, its structural validity was not adequately supported, and its applicability should be interpreted with caution. While the Turkish version of the ERQ demonstrates good reliability, construct validity analysis indicated poor model fit, suggesting that the factor structure requires further investigation.

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20. Trew S, Lawson W. From Disruption to Connection: A Family-Based Practice Model for Enhancing Relationships in Families of Autistic Adolescents. Child Psychiatry Hum Dev;2026 (May 7)

Research examining family relationships in families with autistic members remains limited, and integrative frameworks that translate evidence into family focused practice are scarce. Existing interventions often prioritise individual symptom management rather than strengthening family relationships and connectedness. This article presents an evidence informed practice model designed to enhance relationships and connectedness in families of autistic adolescents, grounded in systems theory. The model draws on qualitative research with 44 participants from 18 families, including autistic adolescents, parents and siblings. Family relationship experiences and dynamics were explored, with seven key findings informing the conceptual framework and practice model. Disruptive factors such as stress, conflict, caregiver burden and challenges in relating contributed to withdrawal and disconnection, while connective factors including communication, teamwork, routines and shared positive experiences supported bonding. The practice model comprises six elements and is guided by ten principles across family structure, roles, communication and adaptive patterns. This model addresses gaps in holistic family support and offers practitioners evidence informed, family centred strategies that build on strengths while addressing relational challenges.

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21. Trew S, Russell DH. Family Adaptation in Families with Autistic Members: A Scoping Review and Thematic Synthesis of Relational Systems, Context, and Development. Child Psychiatry Hum Dev;2026 (May 7)

This scoping review synthesizes empirical research on how autistic family members shape family dynamics across relational subsystems, cultural contexts, and developmental stages. A comprehensive search conducted in January 2025 across five databases using the SPIDER framework yielded 102 studies analysed through convergent integrated three-stage thematic analysis informed by family systems theory. Five interconnected themes emerged: family identity reconstruction and role adaptation; emotional climate and communication patterns; cultural, societal, and structural contexts; pathways to resilience and positive adaptation; and developmental trajectories across the lifespan. These themes were integrated into an interpretive conceptual model in which communication emerged as a cross-cutting relational process, family adaptation unfolded across developmental time, and contextual conditions shaped which adaptive pathways were more or less available. Across studies, adaptive flexibility was a recurring feature of more positively adapting families, and caregiver mental health, especially maternal mental health in a mother-dominated evidence base, appeared closely linked to family emotional climate. A dedicated analysis reinterprets findings through a neurodiversity-informed lens, proposing foundational shifts toward investigating family adaptation with rather than to autism. Critically, autistic perspectives remain largely absent: of the 102 included studies, only five included autistic self-report as a primary data source. Future research must centre autistic voices, employ integrated longitudinal designs, and address structural barriers supporting equitable family systems.

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22. V N, K A. Diagnosing autism spectrum disorders using ensemble-aided weighted fused features and attention-based residual LSTM with brain MRI images. Psychiatry Res Neuroimaging;2026 (Apr 24);361:112230.

One of the neuro-developmental conditions is called Autism Spectrum Disorder (ASD), which causes changes in the behavior of the patients, and it delays language and social interactions. Details about the functional activity of the brain are provided by Magnetic Resonance Imaging (MRI). Studying each MRI scan of the patients is laborious and time-consuming for doctors and specialists. To tackle these limitations, this paper develops an advanced deep learning diagnosis method. In the beginning, the necessary MRI images are gathered from the available data resource. The input brain images are subjected to an Ensemble Deep Convolutional Neural Network (EDCNN) for feature extraction, which makes the diagnosis easier by reducing the complexities. The ensemble model is created by the integration of the Visual Geometry Group (VGG16), Residual Network (ResNet), and Inception approaches. Further, the resultant features are fused with weights that are optimized using the Improved Random Uniform Number-aided Humboldt Squid Optimization Algorithm (IRUN-HSOA); thus, the weighted fused feature is obtained. The resultant weighted fused feature is fed into Attention-based Residual Long Short-Term Memory (ARLSTM) for the ASD diagnosis. Further, the developed model is compared with different state-of-the-art techniques, and the suitability of the model is discussed for prospects.

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23. Wang J, Cheng Z, Liu M, Zhang Y, Jiang Y, Liu T, Ren J, Wu L, Zou M, Sun C. Mitochondrial Gene Signature Reveals Novel Diagnostic Biomarkers for Autism Spectrum Disorder. Mol Neurobiol;2026 (May 7);63(1)

Autism Spectrum Disorder (ASD) pathogenesis remains unclear, with mitochondrial dysfunction implicated as a key contributor. Reliable mitochondrial-related diagnostic biomarkers are lacking, hindering early detection and mechanistic studies. This study integrated transcriptomic data from postmortem ASD cortical tissues (GSE28521 for training; GSE64018 for validation) with mitochondrial-related genes (MRGs) from MitoCarta3.0. Mitochondrial pathways were investigated using gene set enrichment analysis (GSEA). Candidate ASD-mitochondria (ASD-MIT) genes were identified by combining differential expression analysis, weighted gene co-expression network analysis (WGCNA), and MRGs. Machine learning algorithms (LASSO, Random Forest, and SVM-RFE) were applied to screen hub genes. Diagnostic performance was evaluated using a linear predictive model, an artificial neural network (ANN), and a nomogram. Single-sample GSEA (ssGSEA) was used to assess associations between hub genes and mitochondrial pathway activity. Biological validation included qPCR in BTBR mice and protein localization analysis using the Human Protein Atlas (HPA). GSEA revealed significant downregulation of mitochondrial pathways in ASD. 22 candidate ASD-MIT genes were identified, from which three hub genes-IDH3A, MRPL2, and CHCHD4-were consistently selected by all three machine learning models. The three-gene panel demonstrated strong diagnostic ability (AUC = 0.910), confirmed by the ANN model (AUC = 0.903). The nomogram achieved excellent predictive accuracy (C-index = 0.964). Importantly, ssGSEA analysis showed that these genes were strongly associated with mitochondrial pathway activity, particularly mitochondrial calcium ion transport. qPCR validated significant downregulation of Idh3a and Mrpl2 in BTBR mice, and HPA confirmed mitochondrial localization and brain expression. This study identifies a mitochondrial gene signature associated with ASD and highlights IDH3A, MRPL2, and CHCHD4 as promising diagnostic biomarkers. These findings advance understanding of mitochondrial dysfunction in ASD pathogenesis and further suggest that disruption of mitochondrial Ca(2)⁺-energy coupling may represent a key mechanistic feature of the disease.

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24. Wang X, Zhang K, Li J, Chen Y. [Prenatal diagnosis and genetic analysis of 13 fetuses with 16p11.2 microdeletion/microduplication]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi;2026 (Jun 10);43(6):415-421.

OBJECTIVE: To explore the ultrasound finding, pregnancy outcome, and follow-up of fetuses with 16p11.2 microdeletion/microduplication to provide a basis for genetic counseling. METHODS: Thirteen fetuses with 16p11.2 microdeletion/microduplication detected by chromosomal microarray analysis (CMA) at the Genetic Testing Center of Women’s and Children’s Hospital Affiliated to Qingdao University between January 2021 and March 2024 were selected as study subjects. Prenatal ultrasound finding, results of genetic testing and family verification, pregnancy outcome, and postnatal conditions were retrospectively analyzed. Data were analyzed using descriptive statistical analysis. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: QFELL-YJ-2024-159). RESULTS: Among 4 985 fetuses undergoing prenatal diagnosis, 13 (0.26%) were detected with 16p11.2 microdeletion/microduplication. Among these, 8 were microdeletions with a size ranging from 0.174 Mb to 0.84 Mb, and 5 were microduplications with a size ranging from 0.59 Mb to 0.89 Mb. The main prenatal ultrasound findings included cardiovascular abnormalities, vertebral developmental abnormalities, and nuchal translucency thickening. Parental tracing was performed in 12 of the 13 fetuses, with five cases verified to have a de novo origin, and seven originated from a phenotypically normal parent. Following genetic counseling, eight couples had opted induced labor, one couple with twin pregnancy had selected reduction of the abnormal fetus, whilst four couples had chosen to continue with the pregnancy. At follow-up, the liveborn infants were aged between 16 and 26 months, with one diagnosed with congenital heart disease, one with infantile epilepsy, and two showing no abnormality in growth and development. CONCLUSION: CMA testing holds a significant value for the prenatal diagnosis of 16p11.2 microdeletion/microduplication. For fetuses with positive results, it is necessary to consult and conduct long-term follow-up in conjunction with prenatal ultrasound and parental tracing results in order to provide appropriate guidance for pregnancy decision and selection of reproductive methods.

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25. Wong CHM, Chan CKY, Wong PWC. Community education program on autism spectrum disorder: a case study of an ecosystem intervention involving family, school, NGO, and community stakeholders. Front Public Health;2026;14:1789943.

BACKGROUND: This paper documents the JC A-Connect: Jockey Club Autism Support Network community education program, which was a decade-long, territory-wide, and cross-sectoral initiative in Hong Kong, China. It was created in response to the rise of students with autism spectrum disorder (ASD) in mainstream schools which posed challenges to support their adaptation. The program came timely as the number of autistic students doubled during the project implementation period. PROGRAM: Unlike other initiatives that directly served the autistic individuals, this program delivered at the wider social networks aiming to promote social inclusiveness and empower the family, school, and community stakeholders. Three core strategies were formulated: (1) Iconic Character and Storybooks-An iconic character, Bling Bling, was created by the company of Mr. Men Little Miss, and five storybooks were written to equip readers with strategies to communicate with autistic children. (2) Media Promotion and Online Learning-Traditional media and social media were employed to disseminate the sharing from experts and families with autistic children to offer a balanced and constructive understanding of ASD. Free online learning resources were created. (3) Events for Public Engagement and Community Inclusion-Events were organized to educate the public, empower professionals, create positive community experiences for families with developmental delays and disabilities, and encourage mutual appreciation and respect among students. OUTCOMES AND REFLECTIONS: The program organized 56 public events, and created 2 online courses, 47 media promotion, 12 newsletters and over 60 free resources. Participants reported that the program helped them learn about ASD, and they became supportive toward building an autism-friendly environment. There were four factors leading to positive outcomes: The use of an ecological model for program planning and implementation, a strategic stakeholder management plan, an attractive icon, and a sustainability mindset. CONCLUSION: Through this case study, we seek to share our experiences in developing a cross-sectoral health program and to inspire health professionals and policy makers to consider intervening at social systems for systemic changes in communities. We acknowledge that the development, implementation, and sustainability of our strategies require multidisciplinary expertise and financial investment, and this calls for strategic planning, community-wide participation, and shared ownership.

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26. Yan C, Xu J, Duan K, Xiang Y, Li H. Sensory processing differences and behavioural problems in children with autism: a retrospective study using statistical modelling and multi-output machine learning. BMJ Paediatr Open;2026 (May 7);10(1)

BACKGROUND: Sensory processing differences (SPDs) are common in children with autism, yet their specific contributions to behavioural problems remain insufficiently explored. To examine how SPDs relate to behavioural problems in children with autism and to identify key sensory predictors and sensory-based subtypes associated with behavioural risk. METHODS: The retrospective study included 127 children with autism (1-7 years) who received rehabilitation training at a tertiary children’s hospital between 2020 and 2024. Fifteen SPD features across visual, auditory, tactile, gustatory/olfactory and vestibular/proprioceptive modalities (covering sensitivity, hyporesponsivity and seeking behaviours) and six behavioural problems were coded as binary variables based on parent-reported questionnaires. Associations were analysed using Phi correlations and logistic regression. A multi-output random forest with Shapley Additive Explanations (SHAP) evaluated the joint predictive value of SPDs. Hierarchical clustering using Jaccard distance was used to identify sensory subtypes and compare behavioural profiles. RESULTS: Vestibular/proprioceptive seeking was positively associated with frequent tantrums (φ=0.30) and emerged as an independent predictor (OR=3.83, 95% CI 1.65 to 8.90). Visual seeking was negatively associated with difficulty adapting to routine changes (φ=-0.23; OR=0.34, 95% CI 0.15 to 0.78). The multi-output random forest showed moderate performance. SHAP analysis highlighted auditory sensitivity and multiple seeking behaviours as major contributors. Clustering revealed a ‘multi-sensory seeking’ subtype with higher rates of tantrums. CONCLUSIONS: SPDs are meaningfully linked to behavioural problems in autism. Vestibular/proprioceptive seeking and auditory sensitivity are key behavioural risk indicators, while visual seeking may support adaptability. Sensory-based profiling has the potential to identify children at elevated behavioural risk and guide personalised intervention planning.

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27. Zhong SS, Deng YY, Zou FY, Luo XW, Yin BY, Zhao JY, Ni YX, Shen LS, Zhou X, Zhang JL, Lin ZP, Guo RM. Altered Neurite Microstructure and Trace Element Imbalance in Children with ASD and Language Delay. Biol Psychiatry Cogn Neurosci Neuroimaging;2026 (May 7)

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental condition of complex etiology. Although not a core diagnostic feature, many children with ASD show language delay (LD) early on. This study investigates changes in trace elements (lead-Pb and iron-Fe) and neurite microstructure via Neurite Orientation Dispersion and Density Imaging (NODDI), and their relationships with language phenotypes. MATERIALS AND METHODS: This study included 105 children with ASD with LD (ASD-LD), 107 with ASD without LD (ASD-nLD), and 108 typically developing (TD). NODDI MRI quantified intracellular volume fraction (ICVF), isotropic volume fraction (ISOVF), and orientation dispersion index (ODI) of 76 nuclei or brain regions. Serum Fe and Pb were measured. Multivariate analyses and mediation models examined group differences, element-structure correlations, and pathways affecting language function. RESULTS: The ASD-LD showed decreased ICVF and ODI in language regions, including the superior, middle, and inferior temporal gyrus, the inferior parietal lobule, and the precuneus. Serum Fe was lower, and Pb was higher in children with ASD-LD compared to both ASD-nLD and TD groups (P < 0.001). Specifically, within the ASD-LD group, ODI values in key language-related brain regions correlated positively with Fe levels and negatively with Pb levels. Mediation analysis indicated Fe deficiency influenced LD both directly and indirectly through reduced ODI. CONCLUSIONS: Children with ASD-LD exhibit impaired neurite microstructure in the language region, characterized by reduced ICVF, ISOVF, and ODI, alongside a "low Fe-high Pb" imbalance. Fe deficiency affected language function by lowering ODI, while elevated Pb may exacerbate neurite simplification. Results underscore trace elements-neurite microstructure interplay in ASD-LD.

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28. Zhu J, Machalicek W, Wei Q. Remote delivery of culturally adapted prevent-teach-reinforce for families with Chinese American families of young autistic children. Front Psychiatry;2026;17:1783825.

INTRODUCTION: Chinese American families of autistic children remain underrepresented in the autism intervention literature. METHODS: The current study examined the efficacy and social validity of a culturally adapted and telepractice version of Prevent, Teach, and Reinforce for Families (PTR-F) for Chinese American families of young autistic children in the U.S. Two independent randomized multiple baseline designs across six mother-child dyads were used to examine the effects of the culturally adapted PTR-F intervention program when delivered by mothers on the decreased rate of target child challenging behavior. RESULTS: A clear functional relation was demonstrated between the intervention and increased behavior support plan (BSP) strategy use for all mothers. Following parent education and coaching, all six mothers demonstrated immediate and sustained increases in BSP implementation fidelity, reaching at least 80% fidelity. A clear functional relation was demonstrated between increased parent strategy use and decreased child challenging behavior for two of the six Dyads and weaker but present participant level effects for Dyads 1,2,3, and 4 due to decreasing baseline trends in challenging behavior and lack of clinically significant decreased challenging behavior for Dyad 4. Social validity findings indicated high parent satisfaction with the intervention goals, procedures, and outcomes, as well as strong acceptability of the telepractice delivery model. DISCUSSION: These findings have implications for the development and delivery of culturally adapted, family centered telepractice intervention to reduce children’s challenging behavior and expand equitable access to evidence-based autism services for underserved populations.

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