1. Ahn H, Shin D, Jang DJ. Key effects of inclusive dance for adults with developmental disabilities: embodied agency, relational self-understanding, and conditions of wellbeing. Front Public Health. 2026; 14: 1934739.

INTRODUCTION: This study explored the inclusive dance experiences of adults with developmental disabilities through the lens of embodied agency and critical phenomenology. Most previous research on arts participation has focused on outcomes such as emotional stability, social connectedness, and quality of life. However, less is known about how arts participation, specifically inclusive dance, is experienced and sustained. This study examined how rehearsal and performance experiences engender embodied possibilities, relational self-understanding, and conditions of wellbeing. METHODS: This qualitative case study included three adults with developmental disabilities who had accumulated between 9 and 13 years of participation in an inclusive dance company in Seoul, along with their primary caregivers. Data were collected through in-depth interviews and observations, focusing on repeated rehearsals and performance practices, everyday experiences, and relational interactions. The data were analyzed through repeated readings to identify key themes, using a phenomenological perspective for directional interpretation. RESULTS: Inclusive dance participation was experienced as a process through which participants encountered their bodies and possibilities anew through repeated performances, relational coordination, public recognition, and environmental flexibility. Rehearsal and performance enabled participants to experience their bodies as capable, while their sense of agency was shaped by moving with others and adjusting to shared performance situations. Their performance experiences extended their self-expression and relational self-understanding through public recognition and role-taking. Sustained participation was maintained and negotiated through bodily conditions, temporal arrangements, mobility support, caregiving relationships, and flexible performance environments. DISCUSSION: This study interprets inclusive dance as a participatory experience in which the body, relationships, norms, and everyday world intersect for adults with developmental disabilities. Its contribution lies in suggesting that the meaning of arts participation cannot be understood only as a psychological change or program effect. Rather, inclusive dance can be understood as a process involving embodied agency, normative visibility, relational self-understanding, and conditions of sustained participation.

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2. Akemoğlu Y, Li Z, Zheng Q, Roberts EB, Singh SP, Xiong J. Parent’s AI Coach (PaiCoach): A Single-Case Experimental Study of an AI-Supported Parent Coaching System for Autistic Children. J Autism Dev Disord. 2026.

PURPOSE: Artificial intelligence (AI) may enhance the scalability and immediacy of parent coaching by providing automated, performance-based feedback within naturalistic routines. In this study, we examined the effects of Parent’s AI Coach (PaiCoach), an AI-supported parent coaching system, on parent implementation of evidence-based practices in improving autistic children’s communicative responsiveness during shared book reading. METHOD: Participants included four mother-child dyads with minimally verbal autistic children between 45 and 56 months of age. A concurrent multiple-baseline across participants single-case experimental design was used. Primary dependent variables included parent implementation fidelity and child communicative responsiveness. Visual analysis and Tau-U effect sizes were used to examine functional relations between the introduction of PaiCoach and changes in parent and child outcomes. RESULTS: Visual analysis showed functional relations between the introduction of PaiCoach and increases in parent implementation fidelity with corresponding improvements in children’s responsiveness. Through human validation, we show that PaiCoach adopts 68.6% of AI-generated analyses without modification, whereas 31.4% required some expert editing. Social validity and usability findings indicate high parent satisfaction with PaiCoach and its good usability. Overall, findings provide preliminary evidence for the feasibility of AI-assisted parent coaching and the continued importance of human oversight in current AI-supported systems.

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3. Chakravarty S, Do Q, Li Y, Torres-Lacarra V, Tager-Flusberg H, McGuire JT, Scott BB. Computational mechanisms of perception in autism revealed using games inspired by rodent operant tasks. Sci Adv. 2026; 12(37): eaec9291.

Altered perception is a hallmark of autism spectrum disorder (ASD), yet its underlying mechanisms remain unclear, in part because individuals with greater impairments are often excluded from psychophysics research. Here, we introduce GEODE (gathering evidence to optimize decisions), an online video game designed to measure visual perception across the full autism spectrum. GEODE incorporates feedback-based shaping from animal training to teach task mechanics, customized graphics and storyline elements to sustain engagement, and touchscreen compatibility for broader accessibility, enabling participation from adolescents including those with profound autism. Across a large, heterogeneous cohort, autistic participants successfully played GEODE but showed slower learning and reduced accuracy compared with typically developing siblings. These deficits were best explained by increased noise in the integration of sensory evidence, which scaled nonlinearly with stimulus complexity and tracked standardized survey measures of adaptive functioning more closely than diagnostic category alone. Injecting equivalent noise into artificial neural networks produced agents that recapitulated ASD-like patterns of learning and decision-making. These findings implicate noisy evidence integration as a computational mechanism for altered visual perception across the autism spectrum and establish a scalable, accessible platform for probing altered perception and learning in neurodevelopmental and neuropsychiatric disorders.

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4. Cottle JJ, Arnold ZE, Guest KC, Mrug S, Brisendine AE, Khatri S, O’Kelley SE. Item-Level Sex Differences in Autism Spectrum Disorder Measures: A MIMIC Model Analysis of ADOS-2 and ADI-R in a Referred Pediatric Sample. J Autism Dev Disord. 2026.

PURPOSE: The current study aimed to examine item-level sex differences in the diagnostic measures of ASD traits for children and adolescents referred for an ASD evaluation. By including all those referred for an ASD evaluation, the study aimed to include females who may be mis- or under-diagnosed by current ASD diagnostic procedures. METHODS: The sample included 458 children and adolescents who were referred for an ASD evaluation at a tertiary care clinic. In this sample, 118 individuals (25.8%) were female, 282 (61.6%) were diagnosed with ASD, and the average age was 6.67 years (SD = 3.65). Multiple indicator multiple cause (MIMIC) models were used to examine differential item functioning on the ADOS-2 and ADI-R. RESULTS: Results indicated differential item functioning on a small proportion of ADI-R items (e.g., Circumscribed Interests, Inappropriate Facial Expressions, Imaginative Play, Spontaneous Imitation of Actions) across content areas, whereas there were no item-level sex differences identified on the ADOS-2. CONCLUSIONS: These findings suggest nuanced sex differences in ASD trait presentation among children and adolescents presenting with concern for ASD, as measured by standard diagnostic assessment tools. Future research should continue to explore detailed patterns of sex differences in trait measurement using precise sampling and incorporating additional diagnostic instruments, as a well-informed understanding of sex differences in ASD trait presentation and measurement is critical for addressing the existing sex bias in ASD research and clinical settings. This understanding will help ensure appropriate ASD characterization, identification, and diagnosis.

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5. de Souza Santos W, de Figueiredo BC, Mello RG, Antoniuk S, Dória GMS, Carneiro MCB, Cordeiro ML. Chromosomal Microarray Diagnostic Yield and Copy Number Variants in a Clinically Well-Characterized Cohort with Nonsyndromic Autism Spectrum Disorder from Southern Brazil. Diagnostics (Basel). 2026; 16(18).

Background/Objectives: Chromosomal microarray analysis (CMA) is widely used in the genetic evaluation of autism spectrum disorder (ASD), yet its diagnostic contribution in clinically nonsyndromic ASD, particularly in Brazilian populations, remains insufficiently characterized. This study aimed to determine the diagnostic yield of CMA and characterize clinically relevant copy number variants (CNVs) in a cohort of individuals with clinically nonsyndromic ASD from southern Brazil. Methods: In this observational cohort study, 215 individuals with clinically diagnosed ASD underwent high-resolution CMA using the Agilent CGH + SNP Array 180K platform. Individuals with dysmorphic features, known or suspected genetic syndromes, major congenital malformations, epilepsy, or macrocephaly/microcephaly were excluded. CNVs were classified according to American College of Medical Genetics and Genomics guidelines, and the diagnostic yield was compared with that of national and international reference cohorts using Fisher’s exact test. Results: Pathogenic or likely pathogenic CNVs were identified in six individuals, corresponding to a diagnostic yield of 2.8% (95% CI, 1.3-6.1%). These included deletions at 2q11.1-q11.2, 2p16.3 (NRXN1), 15q11.2 (BP1-BP2), and 3q29, and duplications at 16p11.2 and 6p22.3-p22.2. Although the diagnostic yield was lower than that reported in phenotypically heterogeneous ASD cohorts, it did not differ significantly from yields observed in comparably selected nonsyndromic subgroups. Conclusions: CMA identified clinically relevant recurrent CNVs at neurodevelopmental loci even in a clinically nonsyndromic ASD cohort. The comparatively low diagnostic yield highlights the substantial influence of clinical and phenotypic selection on the diagnostic contribution of CMA.

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6. Eapen V, Stylianakis AA, Voineagu I. From genotype to phenotype: understanding the genetic basis of autism. Curr Opin Psychiatry. 2026.

PURPOSE OF REVIEW: This paper covers some of the key findings on the topic of genetic influences in autism over the last 12-18 months, which consist of significant conceptual shifts and new insights from recent technological advances. RECENT FINDINGS: Autism is a highly heritable condition, with significant heterogeneity of the genes that influence the development of this condition. The heterogeneity of autism, and multiple pathways contributing to the development of an autistic phenotype, create challenges in our understanding, diagnosis, and management of this condition.Recent studies of common genetic variation and polygenic risk scores have focussed on resolving phenotypic heterogeneity and identifying meaningful autism subtypes. Rare-variant discovery has expanded across ancestries, the X chromosome, noncoding loci, structural variants, and tandem repeats, aided by long-read and pangenome-informed sequencing. Single-cell multiomics, spatial perturbation methods and human organoid models have connected genetic variation to cell-type-specific and developmental phenotypes, while also revealing substantial mutation-specific effects and methodological sensitivity. Genetic testing increasingly provides aetiological diagnoses and informs medical surveillance. Recent developments also illustrate the therapeutic potential of gene-first approaches for selected monogenic neurodevelopmental disorders. SUMMARY: Recent developments have expanded our understanding of the way the genetic basis of autism manifests phenotypically.

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7. Gallego-Jiménez MG, Torrecilla-Manresa S, García-Bravo C. « Listening to the word autism changes everything »: the impact of an Autism Spectrum disorder diagnosis on families. Front Psychol. 2026; 17: 1919815.

INTRODUCTION: An autism spectrum disorder (ASD) diagnosis is a transformative event for families that extends beyond clinical identification and affects the emotional, social and organizational dimensions of everyday life. This descriptive exploratory qualitative study aimed to explore the lived experiences and expectations of Spanish parents during their child’s ASD diagnostic process, as well as the impact of the diagnosis on family life and concerns about the future. METHODS: Seventeen parents of children diagnosed with ASD participated in online semi-structured interviews. Participants received information about the study procedures, interview recording, confidentiality and data handling before providing written informed consent. Interviews were audio-recorded, transcribed verbatim and analyzed using inductive qualitative content analysis. Each interview was initially examined as a distinct experiential account situated within its family and social context before shared and divergent patterns were compared across participants. RESULTS: Three overarching themes were identified: (1) the impact of diagnosis and the process of family adaptation; (2) the emotional impact, coping strategies and reorganization of family life; and (3) concerns about the future. Parents described a prolonged diagnostic process characterized by uncertainty, limited professional validation of their initial concerns and an ambivalent emotional response involving shock, sadness and relief. Grief and adjustment were experienced as non-linear and recurrent processes associated with the reformulation of previously imagined expectations. Parents described coping through peer support, the active search for services and personal assistance, the structuring and anticipation of everyday routines and the flexible adjustment of goals to their child’s abilities. Although these strategies helped parents manage everyday demands, they also required sustained vigilance and considerable effort. The diagnosis additionally intensified the parent-child bond, affected siblings and substantially reorganized family life. Concerns about future autonomy, continuity of care and the availability of adult support remained central. DISCUSSION: These findings highlight the need for clear post-diagnostic guidance, sustained emotional support and coordinated, family-centered services across the life course.

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8. Han X, Weng L, Xu H. Care pathways, service access, and psychosociaasl support needs in children and adolescents with autism spectrum disorder: a narrative review. Front Public Health. 2026; 14: 1840171.

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition that often requires long-term support across healthcare, education, and social care systems. Despite increasing recognition, many children and adolescents continue to experience delayed identification, fragmented care pathways, and unequal access to services. This narrative review synthesizes recent evidence on care pathways, service access, and psychosocial support needs in children and adolescents with ASD, drawing on literature published from 2020 onward, with emphasis on recognition, barriers to diagnosis and post-diagnostic support, service access, family burden, school participation, and transition-related needs. Recent evidence indicates that ASD-related care remains uneven across regions and systems. Delays in referral and assessment, workforce shortages, long waiting times, socioeconomic and geographic disparities, and poor coordination across healthcare, education, and social care remain major barriers to timely support. These structural constraints increase caregiver burden, complicate school participation, and weaken continuity of care during adolescence and transition to adulthood. Families frequently report difficulties navigating complex systems, while schools function as both a major site of support and a major source of unmet need. Improving outcomes requires earlier recognition, more equitable access to multidisciplinary services, stronger family and school support, and better coordination across healthcare, education, and social care sectors. A developmental and systems-oriented approach is likely to better address the changing needs of children and adolescents with ASD.

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9. Hassan S, Nasir S, Pathan S, Syed T, Ghosh A, Gul J, Hamid A, Farid N, Shakouhi MF, Mohammad Saleh LO, Ullah Khan MN. Pregnancy and Neonatal Outcomes Among Women With Intellectual and Developmental Disabilities: A Systematic and Literature Review. Cureus. 2026; 18(8): e114346.

Substantial health and social inequalities exist among women with intellectual and developmental disabilities (IDD), which can have a negative impact on maternal and neonatal health. For this review, an extensive search of the databases PubMed, Embase, Scopus, and Cochrane Library was performed from their inception to June 2026. Retrospective studies on outcomes of mothers and babies with IDD were included if they met the inclusion criteria. The quality was evaluated with the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Retrospective cohort studies comprising more than 8.4 million pregnancies were included. Compared with women without IDD, women with IDD had higher rates of preterm birth (7.4%-2 3.3% vs. 5.0%-11.6%), small for gestational age (SGA) infants (13.1%-17.0%), low birth weight (LBW) (15.1%-15.4%), and neonatal intensive care unit (NICU) admission (13.3%-20.6% vs. 5.0%-11.7%). Adverse neonatal outcomes were also more common, including stillbirth (aOR=2.40, 95% CI 1.70-3.40), neonatal death (aRR=2.31, 95% CI 1.38-3.87), and infant mortality (PR=4.93, 95% CI 3.73-6.43). Maternal IDD was associated with severe maternal morbidity (aRR=1.61-4.82) and maternal mortality (aRR=11.19, 95% CI 2.40-52.19). The results indicate a need to provide targeted prenatal care and multidisciplinary interventions to improve the outcomes of women with IDD and their infants.

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10. Hedlund Å, Unéus D, Wik J, Ingard C, Isakson K, Black MH, Hirvikoski T, Bertilsdotter Rosqvist H. Reclaiming selfhood: towards a conceptualisation of the autistic unmasking process. Front Psychiatry. 2026; 17: 1929738.

INTRODUCTION: Many autistic people adapt to a neurotypical world through masking, which can lead to exhaustion and harm to mental and physical health. As a result, there is increasingly interest in ‘unmasking’ in ways that improve quality of life and reduce stress. This study analyses qualitative data to explore unmasking among autistic adults. METHODS: This was a neurodivergent-led study. Twenty-nine autistic adults (17 with co-occurring ADHD) were interviewed one to four times as part of a larger project on autistic flourishing. Data related to unmasking were analysed using qualitative content analysis. RESULTS: Unmasking occurred through a circular process consisting of four categories (1): Identify the need to unmask (2), Gain a deeper understanding of one’s masking (3), Using unmasking strategies, and (4) Managing the consequences of unmasking. CONCLUSION: Unmasking can be both challenging and freeing for autistic adults and may be best approached gradually. Supportive environments and professionals who understand masking and its long-term impact and do not encourage masking are important.

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11. Huang HL, Zhu AK, Xu ZY, Zhang J, Wang RL, Ruan DD, Zhu J, Zou J, Xie LJ, Chen X, Chen Q, Zhang JH, Zhang L, Wang XL, Chen Y, Luo YJ, Zhou YF, Gao MZ, Liao LS, Lin Y, Chen L, Wang C, Yu QH, Huang FM, Lin X, Li YF, Luo JW, Zheng ZH. Clinical and genetic analysis of a family with 16p11.2 microduplication syndrome and variable multisystem manifestations. Gene. 2026; 1013: 150388.

16p11.2 microduplication syndrome (OMIM #614671) is a pathogenic recurrent copy-number gain at the 16p11.2 locus and is associated with variable expressivity across neurodevelopmental, growth, and medical phenotypes. Gastrointestinal symptoms have been reported in carrier cohorts, but detailed documentation of gastrointestinal motility and neuromuscular findings remains limited. We performed clinical and genetic analyses in a multigenerational family in which the proband (III1) presented with limb muscle pain, exercise intolerance, and chronic gastrointestinal symptoms. Next-generation sequencing (NGS), low-pass whole-genome sequencing (lpWGS)-based CNV analysis, Sanger sequencing, and qPCR validation identified a 0.8 Mb microduplication at 16p11.2 (BP4-BP5), involving 44 genes including TBX6, inherited from the mother (II2). The proband’s clinical manifestations included developmental delay, pointed chin, low body mass index, gastrointestinal dysfunction (chronic abdominal pain, diarrhea, esophageal motility disorder, and rectal prolapse), forward-leaning gait, mild scoliosis, and limb muscle atrophy with inflammatory muscle involvement. Four family members (II2, III1, III2, and III4) carried the microduplication, but their available clinical features varied in severity and system involvement. The proband’s twin brother (III2) had left ear deafness and epilepsy, individual II2 had blindness from cone-rod dystrophy, and III4 showed more pronounced scoliosis. This family provides a detailed clinical and genetic description of 16p11.2 microduplication carriers with prominent gastrointestinal motility and neuromuscular manifestations, thereby enriching the clinical characterization of this recurrent CNV and supporting substantial intrafamilial phenotypic heterogeneity.

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12. Ishida R, Yamamuro K, Kashida N, Yoshihara T, Takeda T, Takahashi M, Toritsuka M, Makinodan M. Measurement-Dependent Sex-Based Differences in Autistic Traits: Comparing Self-Report, Informant-Report, and Clinician Observation in Adults With Autism Spectrum Disorder. Autism Res. 2026: e70369.

Autistic traits are commonly assessed using self-reported questionnaires, informant-reported measures, and clinician-administered diagnostic instruments; however, the convergence among these approaches and how they vary according to sex remain incompletely understood. We aimed to examine associations and discrepancies among self-reported autistic traits (Autism-Spectrum Quotient Japanese version [AQ-J]), informant-reported traits (Social Responsiveness Scale, Second Edition [SRS-2]), and clinician-rated autism trait intensity (Autism Diagnostic Observation Schedule, Second Edition [ADOS-2], Module 4) in adults with autism spectrum disorder (ASD; n = 219) and typically developing (TD; n = 130) individuals. We also evaluated whether these patterns differed based on sex across measures. AQ-J and SRS-2 scores were higher in ASD than in TD participants. Questionnaire-based measures showed minimal sex differences, whereas ADOS-2 scores were higher in males within the ASD group. Repeated-measures analyses revealed a significant measure-by-sex interaction (p < 0.001, partial η(2) = 0.036). This reflected significantly lower clinician-rated trait intensity in females, despite non-significant questionnaire-based sex differences, with no overall sex difference in mean trait intensity. Self-reported, informant-reported, and clinician-rated assessments capture overlapping but distinct aspects of the autism phenotype, and the pattern of sex differences depends on the measurement modality used.

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13. Kiernan B, Mazurek MO, Nevill RE. An Examination of First Responder Gains Following an Autism Training Based on Personal and Professional Characteristics. J Autism Dev Disord. 2026.

PURPOSE: Autistic people are likely to encounter first responders, which frequently results in ineffective or even harmful experiences for autistic people. Trainings have been developed to improve first responders’ efficacy with responding to situations involving autistic people and their families. The present study examines the impact of professional and personal characteristics on participants’ confidence, self-efficacy, and knowledge in providing first response to autistic people following an autism training. METHODS: This study examined pre- and post- training measures completed by participants compared baseline, outcome, and change scores across participant groups, identifying the influence of professional role, personal relationships, and other demographic characteristics on training gains. RESULTS: Findings show that, regardless of professional role and personal relationship status, participants improved across outcomes following the training. Law enforcement officers entered training with higher self-efficacy and saw less improvement overall. Those with a close and a distal personal relationship showed higher baseline confidence and self-efficacy, and participants with a close personal relationship had higher outcome confidence scores as well. Participants without a personal relationship saw more change in confidence than those with a close or a distal relationship to autism. CONCLUSION: Overall, the autism training improved participant confidence, self-efficacy, and knowledge in responding to situations involving autistic people, regardless of their professional role or relationship to autism. Ensuring that all providers are trained or re-trained, regardless of their personal relationship, goal, or other demographic, is an important step towards improving efficacy of first response for autistic people.

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14. Kim J, Choe MS, Yang WS, Lo C, Liu HW, Kwak TH, Na K, Kiral FR, Xiang Y, Qiu C, Zhong M, Lee M, Tanaka Y, Cakir B, Chung S, Park IH. Elucidating the role of DEAF1 in neurodevelopment and shared molecular pathways in high-risk autism genes using cortical organoids. Sci Adv. 2026; 12(37): eady5166.

Neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and intellectual disability (ID), are genetically heterogeneous. DEAF1 has emerged as a key NDD risk gene, with pathogenic variants linked to DEAF1-associated neurodevelopmental disorder (DAND), but its role in human neurodevelopment remains unclear. Human cortical organoids (hCOs) provide a physiologically relevant model that recapitulates fetal brain development with an authentic human genetic background. Here, we show that a DEAF1 mutation in human embryonic stem cells disrupts chromatin accessibility at neuronal gene loci, leading to significant transcriptional alterations. In hCOs, this mutation results in aberrant progenitor proliferation, disrupted cortical lamination, and impaired neuronal differentiation. Furthermore, we identify WNT signaling, TGFβ superfamily signaling, and cell cycle regulation as commonly dysregulated pathways across multiple ASD-associated genetic perturbations. Pharmacological inhibition of WNT signaling with a Porcupine inhibitor partially rescues phenotypic defects in DEAF1-mutant hCOs. Our findings identify DEAF1 as a critical regulator of neurodevelopment and support pathway-targeted, mutation-independent therapeutic strategies for ASD and related disorders.

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15. Kılıç B, Ünal D, Aslan C, Nalbant K. Mortality characteristics in individuals with autism spectrum disorder across the lifespan: a narrative review. Turk J Pediatr. 2026; 68(4): 555-65.

This narrative review provides a comprehensive synthesis of mortality rates and associated risk factors among individuals with autism spectrum disorder (ASD) across the lifespan. Following a search across PubMed, Scopus, and Google Scholar, 31 peer-reviewed studies were identified for synthesis. The findings consistently demonstrate that individuals with ASD experience significantly higher mortality rates compared to neurotypical controls. Analysis shows a distinct developmental shift: in childhood and adolescence, external causes are predominant, with accidents-particularly drowning-accounting for a substantial portion of fatalities, estimated between 70% and 90% in some reports. In contrast, adult mortality is increasingly driven by natural causes. The evidence indicates a reduced life expectancy, with some studies reporting average ages of death as low as 36 years, depending on comorbid conditions. Furthermore, standardized mortality ratios appear notably higher in individuals with co-occurring intellectual disabilities and epilepsy, with some cohorts showing risks several times higher than the general population. A substantial proportion of ASD-related mortality is potentially preventable through targeted safety training, early metabolic screening, and ASD-friendly healthcare practices. Addressing communication barriers and sensory sensitivities in clinical settings is essential for early diagnosis and effective management of chronic conditions to reduce the mortality gap.

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16. Koeda M, Hosokawa E, Kumagai A, Ishikawa Y, Date K, Kyutoku Y, Shimoda K, Kimura M, Dan I. Reduced intra-frontal functional connectivity during a verbal fluency task in depressed individuals with autistic traits: an fNIRS study. Front Hum Neurosci. 2026; 20: 1778517.

BACKGROUND: Depressive symptoms accompanied by autistic traits represent an important source of clinical heterogeneity. While aberrant functional connectivity (FC) within prefrontal networks has been implicated as a shared neural feature of both autism spectrum disorder (ASD) and depression, task-evoked FC abnormalities in individuals experiencing both remain poorly understood. This study employed functional near-infrared spectroscopy (fNIRS) to evaluate task-evoked FC during a verbal fluency task (VFT), with a focus on prefrontal network organization. METHODS: Fifty neurotypical controls and 43 individuals experiencing depressive symptoms were enrolled. The depressive-state cohort was further subdivided into high autistic traits (DP_AQ-high) and low autistic traits (DP_AQ-low) subgroups based on Autism-Spectrum Quotient (AQ) scores. FC among channels in frontal, temporal, and inferior parietal regions was calculated using zero-lag Pearson correlation analysis of oxyhemoglobin (HbO₂) and deoxyhemoglobin (HbR) signals during the VFT. Between-group FC differences were evaluated using ANOVA for the Control versus depressive-state comparison, and medication-adjusted ANCOVA for the DP_AQ-high versus DP_AQ-low comparison, with diazepam-equivalent anxiolytic dosage and imipramine-equivalent antidepressant dosage as covariates. RESULTS: Relative to neurotypical controls, the depressive-state group exhibited decreased interhemispheric frontal FC across both chromophores, alongside network-specific FC increases and decreases. Within the depressive-state group, the DP_AQ-high subgroup consistently demonstrated increased interhemispheric frontoparietal FC across both chromophores, accompanied by localized intra-frontal FC reductions, compared with the DP_AQ-low subgroup. CONCLUSION: These findings suggest that autistic traits modulate task-evoked large-scale network organization within a clinically relevant depressive-state cohort and support the utility of fNIRS-based network analysis for characterizing neurobiological heterogeneity associated with depressive symptoms.

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17. Kong W, Qiu H, Jiang Y, Ge H, Wu W, Huang L, Chu L, Ge L. Research Progress on Bidirectional Regulation of the Microbiota-Gut-Brain Axis in Autism Spectrum Disorder Based on the Immune-Metabolic-Endocrine Interactive Network. Biomolecules. 2026; 16(9).

Autism spectrum disorder (ASD) is a highly heterogeneous neurodevelopmental disorder characterized by core features of social communication deficits and high prevalence of gastrointestinal comorbidities. With its continuously rising global prevalence, current therapeutic modalities remain unable to target and ameliorate the core symptoms of ASD. The microbiota-gut-brain axis (MGBA), a critical pathway mediating crosstalk between the gut microbiota and the brain, has been extensively documented to be deeply involved in the pathological progression of ASD in recent years. However, prior studies have predominantly focused on the unidirectional regulation of the brain by gut microbiota, lacking an integrated account of the bidirectional regulation across immune, metabolic, and endocrine systems. Centered on the immune-metabolic-endocrine interactive network, this review systematically delineates the bidirectional regulatory mechanisms of the MGBA in ASD by integrating recent evidence from microbiota sequencing, animal models, and clinical intervention studies, with the aim of clarifying the bidirectional causal controversy between intestinal microecological disturbance and ASD behavioral abnormalities. This review proposes that in children with ASD, decreased abundance of beneficial intestinal bacteria and disrupted metabolic profiles of short-chain fatty acids synergistically impair intestinal barrier integrity, triggering peripheral chronic inflammation that further drives excessive microglial activation-mediated central neuroinflammation. Subsequently, disturbances in the homeostasis of multiple neurotransmitters including 5-hydroxytryptamine (5-HT), γ-aminobutyric acid (GABA), histamine, and dopamine occur via the vagus nerve and hypothalamic-pituitary-adrenal (HPA) axis, ultimately driving ASD behavioral abnormalities. Conversely, chronic stress and behavioral characteristics associated with ASD reshape the intestinal microecology through neuroendocrine pathways, forming a vicious cycle of « microbiota dysbiosis-immune inflammation-HPA axis hyperactivity-further intestinal microecological imbalance ». This review summarizes the therapeutic efficacy and translational bottlenecks of three types of microecological interventions: fecal microbiota transplantation (FMT), probiotics, and ketogenic diet, and analyzes the current limitations in the field, including pronounced population heterogeneity, unclear cross-talk mechanisms among multiple pathways, and the scarcity of large-sample clinical evidence. Collectively, this review preliminarily elucidates the complete multi-system interactive framework of MGBA regulation in ASD, providing theoretical support for mechanistic research and gut-targeted individualized interventions for ASD.

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18. Li Z, Lv J, Lu F, Yang Y, He Y, Zhu M. Effects of rTMS intervention on resting-state functional brain activityin children with autism spectrum disorders: a resting-state fMRI study. BMC Pediatr. 2026; 26(1).

BACKGROUND: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition with widespread neurobiological alterations. Repetitive transcranial magnetic stimulation (rTMS) is a potential neuromodulation intervention, but its neural mechanisms remain unclear in preschool-aged children with ASD. This study aimed to use resting-state fMRI (rs-fMRI) metrics-ALFF and ReHo and behavioral assessments to investigate neural mechanisms underlying clinical response to low-frequency (1 Hz) rTMS over the left dorsolateral prefrontal cortex (DLPFC) in this population. METHODS: Thirty-four preschool-aged children with ASD (aged 2-6 years) were recruited and randomly assigned to rTMS group (n = 17) or control group (n = 17). After dropout exclusions, 32 children completed the study (16 per group). The rTMS group received 12 weeks of low-frequency (1 Hz) rTMS over the left DLPFC in addition to conventional rehabilitation, while the control group received sham stimulation. Behavioral assessments (ABC, CARS, RBS-R, ATEC) and rs-fMRI scans for ReHo/ALFF were conducted at baseline and post-treatment. RESULTS: The rTMS group showed significantly greater improvements in CARS (t = 2.111, P = 0.043), RBS-R (Z = - 2.175, P = 0.030), and ATEC (t = 2.093, P = 0.044) scores compared with the control group. Post-treatment rs-fMRI analysis revealed increased ReHo in the right caudate nucleus, right angular gyrus, and left anterior cingulate gyrus, and decreased ReHo in the left cerebellar Crus II, left inferior occipital gyrus, and left middle temporal gyrus. Increased ALFF was observed in the right inferior orbital frontal gyrus, right angular gyrus, and right dorsolateral superior frontal gyrus. After controlling for age, sex, and mean frame-wise displacement, the right angular gyrus ALFF remained significantly correlated with ATEC (rₚ = -0.710, P = 0.002), ABC (rₚ = -0.578, P = 0.019), and CARS (rₚ = -0.625, P = 0.009); the right caudate nucleus ReHo remained significantly correlated with ATEC (rₚ = -0.572, P = 0.020). CONCLUSIONS: Low-frequency rTMS targeting the left DLPFC is safe and effective in improving core symptoms in preschool-aged children with ASD, possibly by enhancing spontaneous neuronal activity in cognitive/executive function-related regions. The right angular gyrus and right caudate nucleus may serve as potential neuroimaging biomarkers for treatment response.

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19. Liu H, Zhang G, Li Z, Zhang T, Zhang L, Li Y. RITA-T (rapid interactive screening test for autism in toddlers): a scoping review of psychometric properties, cross-cultural validation, and clinical applications. Front Psychiatry. 2026; 17: 1922791.

BACKGROUND: The Rapid Interactive Screening Test for Autism in Toddlers (RITA-T) is a clinician-administered, interactive screening instrument for toddlers aged 18-36 months that directly assesses core social-communicative abilities through structured play. Since its introduction in 2015, validation studies have emerged across diverse populations and cultural contexts. OBJECTIVE: This scoping review systematically maps the evidence on RITA-T’s development, psychometric properties, cross-cultural validation, clinical applications, and comparison with other level 2 screening instruments. METHODS: A systematic search of PubMed, Web of Science, Scopus, PsycINFO, and CNKI was conducted through June 2026. Studies reporting original data on RITA-T administration in toddlers aged 18-36 months were included. Methodological quality was assessed using the QUADAS-2 tool. RESULTS: Of 48 records identified, 10 original studies met the inclusion criteria: 7 diagnostic validation studies encompassing 659 toddlers across five countries (United States, Canada, Lebanon, Turkey, and China) and 3 implementation or training studies. RITA-T yielded strong psychometric properties across settings, with reported cutoff scores of 14-17, sensitivity of 0.74-1.00, and specificity of 0.50-1.00. Cross-cultural adaptations demonstrated comparable diagnostic accuracy across English, Arabic, Turkish, and Chinese versions. CONCLUSIONS: RITA-T represents an effective level 2 ASD screening tool with robust cross-cultural applicability. Future research should address long-term predictive validity, telehealth adaptation, and cost-effectiveness.

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20. Liu L, Zhao Q, Zhou J, Liu Z, Wu D, He K. Evaluating the therapeutic efficacy of a modified ketogenic diet in children with autism spectrum disorder: a randomized controlled trial. BMC Pediatr. 2026; 26(1).

BACKGROUND: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder marked by persistent impairments in social communication and interaction, together with restricted and repetitive behavior or interests. Recent epidemiological data indicate that the prevalence of ASD has continued to increase worldwide. Current behavioral and pharmacological interventions remain limited in efficacy, particularly for associated comorbidities. In this context, metabolic interventions, especially the ketogenic diet (KD), have attracted growing interest as a potential therapeutic strategy. METHODS: A total of 62 young children with ASD admitted to Hefei Maternal and Child Health Hospital between January 2024 and January 2025 were prospectively enrolled and randomly assigned to a treatment group or a control group (31 per group). Both groups underwent hospital-based rehabilitation training on weekdays and home-based rehabilitation on weekends over a 2-month period. The treatment group additionally received a modified KD, comprising ketogenic nutritional powder and a structured dietary plan, with lunch provided at the hospital on training days while breakfast, dinner, weekend dietary implementation, and home monitoring were managed by caregivers. The control group followed a regular diet along with the same rehabilitation program. Changes in ASD-related symptoms were assessed using the Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS). RESULTS: After two months of intervention, both groups showed significant reductions in ABC and CARS scores compared with baseline (P < 0.05). Between-group comparison of individual change scores showed larger reductions in the treatment group for both ABC (U = 324.000, P = 0.027) and CARS (U = 273.500, P = 0.003). CONCLUSIONS: In this cohort of young children with ASD, the modified ketogenic diet combined with rehabilitation training was associated with greater short-term reductions in ABC and CARS scores than rehabilitation alone. The intervention demonstrated acceptable short-term feasibility. TRIAL REGISTRATION: The Project was registered on China Clinical Trial Registry (ChiCTR) with the identifier ChiCTR2300075057 ,Registered 24 August 2023, https://www.chictr.org.cn/ .

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21. Mei Y, Gao W, Mei X, Ning S, He X, Zhang J, Xue Y. Repetitive transcranial magnetic stimulation for autism spectrum disorder: A systematic review and meta-analysis of treatment regimens, efficacy, and safety. Psychiatry Res. 2026; 366: 117376.

OBJECTIVE: To evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) treatment for autism spectrum disorder (ASD). METHODS: We included RCTs comparing rTMS to sham or non-rTMS controls in individuals with ASD (any age/sex). PubMed, CNKI, and other databases were searched from inception to May 2026 (PROSPERO/CRD420251244998). Random-effects meta-analyses were performed, and certainty of evidence was assessed using GRADE. RESULTS: A total of 53 RCTs (52 references) were included. rTMS significantly improved core ASD symptoms (ABC: SMD=-1.48; CARS: SMD=-0.95; ATEC: SMD=-1.83; SRS: SMD=-0.25; RBS-R: SMD=-0.40) and comorbid symptoms (CSHQ: SMD=-0.96; CBCL: SMD=-0.39), but evidence for executive function remained insufficient. CARS-based subgroup analyses showed no significant differences between low- and high-frequency rTMS (P=0.82) or across stimulation targets (P=0.31). Combining rTMS with special education did not show significant add-on benefits (P=0.34). GRADE indicated low to very low evidence certainty, primarily due to risk of bias (85% open-label), heterogeneity, and publication bias. Adverse events were mild and transient, but over half of the studies (51.9%) did not explicitly report safety data. CONCLUSIONS: Although the meta-analysis suggests rTMS may improve ASD symptoms without serious short-term adverse events, the evidence certainty remains low to very low, and high heterogeneity exists across studies due to variations in protocols, populations, and outcome measures. Therefore, based on current low-certainty evidence, rTMS cannot yet be recommended as routine clinical treatment for ASD. Future research should prioritize double-blind, sham-controlled designs, standardized parameter reporting, and biomarker-guided individualized strategies.

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22. Melo T, do Nascimento MCP, de Carvalho ALV, Donato BL, Prosini P, Heimer MV. Sleep and Awake Bruxism in Children With Autism Spectrum Disorder: Associations With Sleep Indicators and Caregiver Mental Health. Autism Res. 2026: e70366.

Bruxism, a centrally mediated masticatory muscle activity, is highly prevalent in children with autism spectrum disorder (ASD), a population where research remains limited despite the condition’s impact on sleep and quality of life. This study aimed to investigate the frequency of sleep and awake bruxism in children with ASD and analyze their associations with sleep indicators and caregiver mental health. This cross-sectional study included 146 participants (4-18 years old) divided into two groups: 73 with an ASD diagnosis and 73 without ASD. Data were collected from questionnaires administered to caregivers (sociodemographic data, Sleep Disturbance Scale for Children [SDSC], and Depression, Anxiety, Stress Scale [DASS-21]) and from children’s clinical oral examinations. Clinically based sleep bruxism was more frequent in children with ASD, while awake bruxism predominated in the neurotypical group. Caregivers, mostly women, reported significantly higher levels of anxiety and depression in the ASD group (p < 0.05). In the ASD group, higher frequencies of sleep bruxism were observed among children with sleep-onset and maintenance difficulties and among those whose caregivers did not report depressive symptoms; however, these associations did not remain statistically significant after Bonferroni correction for multiple comparisons. The findings suggest that children with ASD have a higher frequency of sleep disturbances and medication use. The association between sleep bruxism and sleep difficulties in the ASD group suggests the preponderance of neurophysiological/sleep regulation mechanisms. Moreover, caregivers face significant socioeconomic impact and psychological distress.

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23. Mendes M, Xu CY, Engchuan W, Trost B, Zhou X, Miwa BA, Salazar NB, Iglar J, Thiruvahindrapuram B, Wallich L, de Paiva TH, Tarazona-Santos E, Fernandez B, Borda V, Scherer SW. Characterizing features of the genetic architecture underlying autism from a multi-ancestry perspective. Mol Psychiatry. 2026.

Autism spectrum disorder (ASD; MIM 209850) is reported to vary globally from 0.01% in East Asian populations to 4.36% in certain Australian cohorts. Despite high heritability estimates (61-94%), the genetic architecture underlying ASD susceptibility remains poorly characterized across diverse populations, as most genomic studies have initially focused on individuals of European ancestry. To investigate ancestry-specific genetic contributions to ASD, we analyzed whole-genome sequencing data from three independent ASD cohorts. We identified admixed ASD probands (n = 1 033) and ancestry-matched controls (n = 1 033) and performed admixture mapping (AM). AM using five continental reference populations (European, African, East Asian, South Asian, and Native American) identified five ancestry-specific ASD-susceptibility loci, including one African-related locus at 1p21.2 near S1PR1 and four Native American-associated loci at chromosome 11q13.4. Three of these latter loci were contiguous and encompassed genes previously implicated in ASD, notably SHANK2 and DHCR7, with fine-mapping identifying a significantly associated variant between the two genes (rs77695321; P = 1.52 × 10⁻⁷). The fourth Native American-associated signal at 11q13.4 overlapped the folate receptor genes FOLR1 and FOLR3, with fine-mapping identifying a genome-wide significant variant (rs7950807; P = 5.21 × 10⁻⁸). A secondary admixture mapping analysis restricted to Latin American individuals, incorporating 6 487 Brazilian controls, identified 16 additional ancestry-specific loci across seven genomic regions.

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24. Regnier S, McManus HS, Tillson M, Surratt HL, Knudsen HK, Tidey JW, Stoops WW. Factors influencing engagement in smoking cessation for adults with Intellectual and Developmental Disabilities. Nicotine Tob Res. 2026.

INTRODUCTION: People with Intellectual and Developmental Disabilities (IDD) may experience tobacco use patterns that place them at elevated risk for nicotine dependence. However, there are few available interventions tailored for people with IDD, suggesting people with IDD may rely on approaches developed for people without disabilities. The purpose of this study was to identify factors influencing engagement in tobacco treatment among adults with IDD. METHODS: Semi-structured interviews with key stakeholders (n = 39) were conducted, including adults with IDD who currently smoked cigarettes (n = 10), adults with IDD that had quit or reduced smoking (n = 9), disability service providers (n = 12), and tobacco treatment providers (n = 8). Codes were categorized based as individual, social, and structural factors influencing engagement in treatment. A hybrid inductive/deductive coding process was used: deductively structured using the Practical, Robust Implementation and Sustainability Model framework and inductively coded by the first two authors using participant responses. RESULTS: On the individual level, smoking to cope with stress and manage withdrawal were commonly reported by participants with IDD, while concerns over difficulties with comprehension of treatment components were reported by providers. Exposure to peer and provider cigarette smoking was a common social-level barrier reported by all participant groups. On the structural level, financial and transportation barriers were most commonly reported. CONCLUSIONS: Understanding factors that impact smoking cessation treatment engagement can guide intervention development for adults with IDD. Person centered treatments should include coping-skills training, withdrawal management, and be developed including accessible, tailored materials. Future studies should evaluate these methods among people with IDD.

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25. Shi M, Hu J, Pei J, Qu L, Ye J, Chi B, Li Z, Chen Z, He J, Yuan B. Dual-target deep brain stimulation for severe pediatric autism: Sustained core symptom reduction in a 12-month case study. Clin Neurophysiol. 2026; 192: 2112403.

OBJECTIVE: Core autism spectrum disorder (ASD) symptoms lack effective interventions. While single-target DBS helps comorbid conditions, it fails to improve social deficits. Here we aimed to explore the efficacy of bilateral dual-target DBS targeting the anterior limb of the internal capsule (ALIC) and nucleus accumbens (NAcc) in a pediatric severe ASD patient. METHODS: A 9-year-old girl diagnosed with ASD, presenting with severe symptoms and intellectual disability, underwent bilateral NAcc/ALIC DBS implantation. Standardized assessments, including Autism Treatment Evaluation Checklist (ATEC), Repetitive Behavior Scale-Revised (RBS-R), Autism Behavior Checklist (AuBC), and Childhood Autism Rating Scale-2 (CARS-2), were performed pre-operatively and at 3, 6, 9 and 12 months postoperatively. RESULTS: Clinical assessments revealed significant improvement in core ASD symptoms by the 3-month postoperative evaluation. Specifically, ATEC scores decreased by 65.9%, RBS-R by 85.7%, AuBC by 69.4% and CARS-2 by 17.5%. These benefits persisted for the 12 months follow-up period with the last assessment showing ATEC reduced by 81.3%, RBS-R by 96.4%, AuBC by 86.5%, and CARS-2 by 21.3%. No adverse events occurred. CONCLUSIONS: Bilateral dual-target ALIC-NAcc DBS was feasibility and safety, and resulted in sustained improvement in the core features of severe ASD. SIGNIFICANCE: The present results suggest DBS targeting ALIC and NAcc is a promising neurotherapeutic strategy for ASD.

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26. Shi Y, Yin X, Luo J, Cheng Y, Wei Y, Shi J, Zhou X. Peripheral blood glutamate, glutamine, and GABA in Autism Spectrum disorder: A systematic review and meta-analysis of group differences with an exploratory assessment of diagnostic accuracy. Prog Neuropsychopharmacol Biol Psychiatry. 2026; 150: 111926.

OBJECTIVE: To compare the levels of glutamate (Glu), glutamine (Gln), and γ-aminobutyric acid (GABA) in the blood, as well as the Glu/GABA ratio, between individuals with autism spectrum disorder (ASD) and the general population; and to conduct an exploratory assessment of the discriminatory ability of peripheral blood Glu, GABA, Gln, and related ratios in distinguishing between diagnosed ASD cases and healthy or typically developing controls. METHODS: A systematic search of PubMed, Web of Science, and Embase was performed. Cohort and case-control studies were eligible, and reporting followed PRISMA guidelines. Group differences were summarized as standardized mean differences (SMDs) with 95% confidence intervals. Diagnostic data were analyzed separately by biomarker. Because hierarchical bivariate models did not provide stable estimates, sensitivity and specificity for GABA and Glu were pooled separately using univariate random-effects meta-analyses and interpreted as exploratory marginal pooled estimates. Biomarkers represented by fewer than three datasets were reported descriptively. QUADAS-2 was used to assess the risk of bias in diagnostic-accuracy studies, and GRADE was used to assess the certainty of evidence. RESULTS: A total of 21 publications were included. 20 publications contributed 29 biomarker-specific group-comparison datasets, and 5 publications contributed 10 biomarker-specific diagnostic-accuracy datasets; four publications contributed to both analyses. The reported sample totals comprised 804 participants with ASD and 721 comparison participants. Compared with the control group, the ASD group had higher peripheral blood Glu levels (SMD = 1.04, 95% CI: 0.62-1.45, P < 0.001;95% PI: -2.109-4.439); no statistically significant difference was observed in peripheral blood GABA levels (SMD = 0.90, 95% CI: -1.03-2.83, P = 0.36; 95% PI: -8.471-10.272). Furthermore, there was extremely high heterogeneity among the studies, and the direction of effect was inconsistent across different studies. Peripheral blood Gln levels were lower in the ASD group (SMD = -0.78, 95% CI: -1.19 ∼ -0.37, P < 0.001;95% PI: -2.439-0.881). Two studies suggested that the Glu/GABA ratio in peripheral blood may be reduced in the ASD group; however, the current evidence is insufficient to perform a reliable quantitative meta-analysis or draw definitive conclusions. Five publications contributed 10 biomarker-specific diagnostic-accuracy datasets, including 3 for GABA, 4 for Glu, and 1 each for Gln, the Glu/GABA ratio, and the Glu/Gln ratio. For GABA, exploratory marginal pooled sensitivity and specificity were 0.90 (95% CI: 0.77-0.99) and 0.89 (95% CI: 0.70-1.00), respectively. The corresponding estimates for Glu were 0.68 (95% CI: 0.28-0.97) and 0.78 (95% CI, 0.61-0.91). For Gln, the Glu/GABA ratio, and the Glu/Gln ratio, only a single study was available, so no quantitative pooling was performed. The certainty of the GRADE evidence for all indicators was very low. CONCLUSION: The diagnostic analyses yielded exploratory marginal pooled estimates of sensitivity and specificity for GABA and Glu and study-specific estimates for the remaining biomarkers, without establishing overall diagnostic accuracy. However, due to the limited number of included studies, potential selection and spectrum biases inherent in case-control designs, inconsistencies in threshold values across studies, and very low certainty of the evidence, there is currently insufficient evidence to support their use in general-population screening or clinical diagnosis.

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27. Taha H, AlAhmad M, Altawil Z, Albakri A, Alshamasneh M, Daas O, Masri A, Tutunji L, Jönsson L. From Recognition to Diagnosis: Caregiver Response, Help-Seeking Pathways, and Access-Related Factors Associated with Autism Diagnostic Delay in Jordan. Children (Basel). 2026; 13(9).

Background: Autism spectrum disorder (ASD) is often diagnosed well after developmental concerns first emerge, and evidence on factors associated with the duration of the recognition-to-diagnosis pathway remains limited in the Middle East. This study aimed to identify factors associated with the overall recognition-to-diagnosis interval and potential areas for earlier recognition, referral, and access to appropriate assessment. Methods: This multisite cross-sectional survey of 384 caregivers of children with confirmed ASD was conducted across Jordanian governorates. Diagnostic timing was known for 338 participants. Five sequential nested ordinal logistic regression models were fitted on a common complete-case sample (N = 299), successively adding background characteristics, recognition, caregiver response, help-seeking route, and access/professional response variables. Robustness was assessed via grouping-specific binary models, multiple imputation, and bootstrap resampling. Results: Caregivers reported first concerns at a median age of 2.0 years. Among those with known diagnostic timing, 60.7% were in the « 6 Months to 1 Year » delay category or longer, 46.2% were in the « 1-2 Years » category or longer, and 24.0% were in the « More than 2 Years » category. The background characteristics model showed limited explanatory capacity (Nagelkerke R(2) = 0.021), and adding recognition variables did not improve model fit (p = 0.562). Fit improved significantly with caregiver response (p = 0.001), help-seeking route (p = 0.008), and access/professional response (p < 0.001). The final model reached a Nagelkerke R(2) = 0.178, indicating modest overall explanatory capacity. Longer diagnostic delay was independently associated with caregivers who reported that early signs had initially not been acted upon because they were interpreted as part of normal development (AOR = 2.21). It was also associated with first contact via a speech/learning center (AOR = 2.27) or other service (AOR = 2.72) rather than a pediatrician. Caregiver-reported previous professional reassurance that the child did not have ASD was also associated with longer delay (AOR = 2.18). Professional reassurance was the most consistent correlate across sensitivity analyses. Definite appointment difficulty showed a significant Yes-versus-No contrast (AOR = 1.81), although the appointment difficulty variable was not statistically significant in the global test. Sociodemographic factors showed no independent association. Among 11 exploratory barriers, only prior misdiagnosis survived multiplicity correction (AOR = 2.21). Conclusions: In this Jordanian cohort, the length of the recognition-to-diagnosis interval was associated with factors operating after developmental concerns were first recognized, rather than with the timing or breadth of recognition itself. Caregiver response, entry route into care, and professional response emerged as potentially important pathway markers. However, the modest explanatory capacity of the final model indicates that substantial variability in diagnostic delay remains unaccounted for by the measured variables. These findings support provider- and system-level measures, including clearer referral pathways, explicit follow-up when reassurance is provided, improved appointment access, and expanded diagnostic capacity, complemented by caregiver-facing information and support.

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28. Tanner S, Eisner A, Novakovic B, Holland L, Mansell T, England-Mason G, Merrill S, Dewey D, O’Hely M, Symeonides C, Saffery R, Tang MLK, Sly PD, Vuillermin P, Jung CH, Park D, Ponsonby AL. Prenatal exposure to the plasticizer DEHP increases the likelihood of early-life autism and ADHD symptoms through epigenetic programming. Med. 2026: 101291.

BACKGROUND: Growing evidence implicates prenatal exposure to di-(2-ethylhexyl) phthalate (DEHP), a common endocrine-disrupting plasticizer, in the development of autism and attention-deficit/hyperactivity disorder (ADHD). Yet underlying mechanisms remain unclear. METHODS: Here, we examined whether cord blood DNA methylation, a key epigenetic marker, mediates the association between prenatal DEHP exposure and autism and ADHD symptoms in 847 children from the Barwon Infant Study. Autism and ADHD are complex phenotypes driven by alterations in higher-level gene networks and neuronal circuits, where diverse genetic and environmental risk factors converge. Accordingly, rather than a gene-by-gene approach, we employed a data-driven strategy to elucidate broader functional epigenetic signatures of autism and ADHD elicited by DEHP exposure. This included (1) a methylation profile score for DEHP exposure (MPS(DEHP)), and (2) a targeted analysis of DEHP-associated co-methylated gene networks. FINDINGS: Causal mediation analysis showed that both MPS(DEHP) and a network of 531 co-methylated genes mediated the effect of DEHP on increased autism and ADHD symptoms at ages 2 and 4 years (proportion mediated: 0.21-0.80). The co-methylation network was enriched for neural cell-type markers, autism and ADHD risk genes (including FOXP1, SHANK2, and PLXNB1), and targets of endocrine receptors previously linked to DEHP (including estrogen and glucocorticoid receptors), providing biological plausibility. We validated key results in independent blood (n = 66) and postmortem brain (n = 40) DNA methylation datasets. CONCLUSION: These findings provide mechanistic evidence linking DEHP to adverse neurodevelopment and reinforce mounting concerns regarding the risks of prenatal exposure. FUNDING: Funding was obtained from the NHMRC, the Minderoo Foundation, and additional sources (detailed in acknowledgments).

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29. Tekeli Uçar Ö, Eyüboğlu M. Investigation of the Neurocognitive Characteristics of Parents of Children Diagnosed With Autism Spectrum Disorder: A CANTAB-Based Study. Autism Res. 2026: e70363.

Autism spectrum disorder (ASD) is a highly heritable neurodevelopmental condition whose genetic underpinnings may manifest as subclinical cognitive and behavioral traits in first-degree relatives, including parents of diagnosed individuals. Assessing parental cognitive profiles is valuable for identifying Broad Autism Phenotype (BAP) endophenotypes. Accordingly, this study examined possible cognitive endophenotypes by comparing neurocognitive profiles of parents (mothers and fathers) of children with ASD versus parents of neurotypical children. This cross-sectional study included 124 parents of children aged 2-12 years. Participants’ neurocognitive performance was assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), including the Reaction Time (RTI), Spatial Working Memory (SWM), and Paired Associates Learning (PAL) tasks. The results indicated that parents in the ASD group exhibited significantly poorer performance than the control group on the RTI, which assesses attention and psychomotor speed. Regarding the SWM parameters related to decision making and strategy development, the findings varied across the individual subtests. On the PAL task, which measures visual episodic memory, parents in the ASD group exhibited significantly poorer performance than the control group. In the binary logistic regression analysis, the RTIFMDMT (Five-choice reaction time) variable emerged as the only significant predictor of being a parent of a child with ASD. Furthermore, child autism severity, measured by the Childhood Autism Rating Scale (CARS) and Aberrant Behavior Checklist (ABC), did not correlate with parental performance. In conclusion, the present study suggests that parents of children with ASD may exhibit neurocognitive differences in attention, RTI, and memory domains. These findings support the presence of candidate cognitive endophenotypes in parents, reinforcing the genetic underpinnings of ASD and providing an important reference for family-based early intervention programs as well as future neuroimaging research.

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30. Turkson M, Taiwo M, Polden M, Greening J. Autism Spectrum Disorder, Temporal Lobe Epilepsy, and Treatment-Resistant Schizophrenia With Media-Themed Delusions and Impaired Insight: A Case Report. Case Rep Psychiatry. 2026; 2026: 2386844.

This case report describes a male patient in his 30s diagnosed with autism spectrum disorder (ASD), childhood-onset temporal lobe epilepsy paired with nonepileptic seizures (NES), and treatment-resistant schizophrenia (TRS). The patient was diagnosed with temporal lobe epilepsy in childhood and demonstrated features of ASD during adolescence. His psychiatric symptoms emerged during adolescence, including paranoid delusions, auditory and visual hallucinations, and pseudo-seizures precipitated by psychosocial stressors. He has remained institutionalized in psychiatric care for over two decades due to severe impairments in reality testing and persistent, complex delusions, which are strongly influenced by ASD-related hyperfixations on fictional characters. His symptoms include attributing personal experiences to fictional characters and engaging in media-influenced spiritual battles. Treatment with clozapine has provided partial control of his psychotic symptoms, while sodium valproate has effectively managed his epilepsy. This case highlights the clinical intricacies associated with the coexistence of ASD, epilepsy, and TRS, underscoring the need for patient-specific, multidisciplinary approaches to diagnosis and long-term management.

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31. Wang S, You C, Chen K, Liu L, Xing Y, Lv S, Zou Y, Liang F, Xu Y, Ye Q, Li Y, Xue L, Zhang F, Deng H. Cascading effect of early sensory differences on subsequent autistic traits in infants later diagnosed with autism: a prospective cohort study. J Neurodev Disord. 2026; 18(1).

BACKGROUND: Sensory differences constitute core diagnostic features of autism. The cascading effect model posits that early sensory differences may be prospectively associated with subsequent autistic traits, whereas empirical evidence in infancy remains scarce. This study aims to characterize trajectory differences of early sensory profiles and examine the cascading effect on subsequent autistic traits in infants later diagnosed with autism. METHODS: In this prospective longitudinal study, 134 Chinese infants were followed from 12 to 36 months of age. Trajectory differences in four sensory profiles (sensitivity, avoiding, registration, and seeking) were compared between diagnostic groups using the Toddler Sensory Profile-2. The cascading effect were examined through Structural Equation Modeling and temporally ordered path analysis to test direct and indirect effects of early sensory differences on subsequent autistic traits via the mediation of social skills in autism. RESULTS: Compared to typical development, infants later diagnosed with autism exhibited significantly elevated sensory sensitivity and sensory avoiding, along with elevated sensory registration scores at 12 months, with sensory sensitivity showing differential trajectories over time (F = 3.25, p = 0.004). Elevated sensory avoiding at 18 months exerted an indirect effect on social-communication at 36 months via the mediating role of social skills at 24 months (B = 0.08, p = 0.007). Additionally, temporally ordered path analysis revealed that elevated sensory avoiding at 18 months negatively predicted social skills at 24 months (β = -0.19, p = 0.030). Notably, in an exploratory analysis, increased sensory seeking at 18 months positively predicted adaptive skills at 36 months (B = 0.97, p = 0.031). CONCLUSIONS: Sensory differences emerge as early as 12 months in infants who later receive an autistic diagnosis, with sensory sensitivity demonstrating distinct developmental trajectories. These findings provide prospective evidence to support the cascading effect model in autism, identifying early sensory avoiding as an important early correlate of subsequent social-communicative development. Furthermore, early sensory seeking behaviors may facilitate subsequent adaptive functioning, highlighting the heterogeneous developmental pathways within autism. TRIAL REGISTRATION: www.chictr.org.cn ; Trial No: ChiCTR2100049811; Trial Date:2021.08.10.

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32. Wang Y, Liu J, Li Y, Liu Y, Dai X, Wang X, Chen H, Jia Z, Zheng M. Comparative effectiveness of virtual reality vs. traditional motor games on developmental functioning and motor skills in autistic children spectrum disorder: a cohort study. Front Pediatr. 2026; 14: 1913344.

INTRODUCTION: Autism Spectrum Disorder (ASD) is a prevalent neurodevelopmental condition with progressively increasing prevalence, and traditional sports game interventions often face challenges in achieving sustained improvements in both developmental functioning and motor proficiency. METHODS: This prospective cohort study compared the effects of traditional sports game interventions vs. immersive virtual reality (VR) exergaming on developmental functioning and motor skills in autistic children, and evaluated the long-term stability of outcomes. Assessments using the Gesell Developmental Schedules (GDS) and the PREFIT motor test battery were conducted at three time points: pre-intervention, immediately after the 8-week intervention, and 8 weeks after intervention cessation; both protocols were designed by a hospital-based multidisciplinary team. RESULTS: Immersive VR exergaming demonstrated a trend toward greater improvements in most GDS subdomains and most PREFIT components compared with traditional sports game interventions, with the experimental group showing larger magnitudes of improvement during the intervention period. Scores on some PREFIT subdomains continued to increase during the 8-week follow-up period. DISCUSSION: Due to the non-randomized design and the absence of a no-treatment control group, these findings should be interpreted as preliminary evidence. The potential advantages of immersive VR exergaming warrant further investigation through more rigorously designed randomized controlled trials.

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33. Zhao W, Reich BJ, Hector EC. Estimating covariate effects on functional connectivity using voxel-level fMRI data. Biometrics. 2026; 82(3).

Functional connectivity (FC) analysis of resting-state fMRI data provides a framework for characterizing brain networks and their association with participant-level covariates. Due to the high dimensionality of neuroimaging data, standard approaches often average signals within regions of interest (ROIs), which ignores the underlying spatiotemporal dependence among voxels and can lead to biased or inefficient inference. We propose to use a summary statistic-the empirical voxel-wise correlations between ROIs-and, crucially, model the complex covariance structure among these correlations through a new positive definite covariance function. Building on this foundation, we develop a computationally efficient two-step estimation procedure that enables scalable statistical inference on covariate effects on region-level connectivity. Simulation studies show calibrated uncertainty quantification and substantial gains in validity of the statistical inference over the standard averaging method. With data from the Autism Brain Imaging Data Exchange, we show that autism spectrum disorder is associated with altered FC between attention-related ROIs after adjusting for age and gender. The proposed framework offers an interpretable and statistically rigorous approach to estimation of covariate effects on FC suitable for large-scale neuroimaging studies.

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