1. Baquerizo-Sedano M, Lancho Pedrazo M, Merino Martínez M, Taype-Rondan Á, Cuesta Gómez JL, Sáiz-Manzanares MC. Electrodermal Activity, Behavior, and Context in Autistic People with High Support Needs: A Retrospective Ecological Study. Healthcare (Basel). 2026; 14(18).

Background/Objectives: Wearable biometric sensors may help characterize autonomic arousal in everyday settings among autistic people with high support needs, a population underrepresented in naturalistic research. This study aimed to describe patterns of autonomic arousal measured using electrodermal activity (EDA) and to explore their relationship with behavioral and contextual records compatible with distress or maladaptive stress. Methods: We retrospectively analyzed routine-care data from 57 autistic people with high support needs attending two specialized services. EDA was recorded for up to 10 days and integrated with behavioral and contextual records collected through a mobile application and stored in ABmonitor. Phase 1 retrospectively analyzed these data using principles derived from Ecological Momentary Assessment. Phase 2 descriptively compared pre- and post-adjustment EDAmax values in five cases with documented contextual adjustments, drawing on principles of Ecological Momentary Intervention, without causal inference. Results: In Phase 1, 19.3% of participants remained within the same arousal category across days, whereas 80.7% showed variable levels. Overall, 22 of 57 participants (38.6%) showed high autonomic arousal on at least one day; among them, 12 had behavioral records compatible with distress, and 5 had a specific contextual factor documented. In Phase 2, descriptive reductions in EDAmax ranging from 4 to 23 µS were observed after contextual adjustments. Conclusions: EDA provides relevant information about autonomic arousal but should not be interpreted as a direct marker of stress. Multimodal ecological monitoring may help generate person-centered clinical hypotheses and inform individualized support in real-world settings.

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2. Bertollo JR, Albright J, Dahiya AV, Scarpa A. On the Road or on the Web: A Pilot Study of a Mobile Clinic and Telehealth for Autism Assessment in Rural Communities. Pract Innov (Wash D C). 2026; 11(1): 1-14.

Rural communities experience barriers that delay autism diagnosis and services, including few providers with autism expertise, unaffordability, geographic isolation, and limited parent/caregiver (hereinafter « caregiver ») education. To address these barriers, the current pilot study assessed the feasibility of delivering autism assessment through a mobile clinic (n = 15) or via telehealth (n = 15) and tested the impact of autism psychoeducation on caregiver autism knowledge and empowerment. Participants included 30 children (aged 1-14 years) and their caregivers. Caregivers of children who received an autism diagnosis (n = 28) were then randomized to either attend psychoeducation sessions or receive comparable printed educational materials. Both mobile and teleassessments exhibited strong feasibility and caregiver satisfaction. Caregiver empowerment (η(2) = .228, p = .002) and autism knowledge (η(2) = .171, p = .015) improved after receiving assessment and psychoeducation services, regardless of delivery modality. These results provide support for accessible modalities of delivering autism diagnostic assessments through mobile health and telehealth formats to increase the accessibility of timely diagnoses in rural areas and highlight the importance of caregiver education in feeling empowered to advocate for their autistic child.

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3. Cardillo R, Lievore R, Toffalini E, Crisci G, Mammarella IC. Communication across autism, ADHD, and non-clinical groups: examining autistic and ADHD traits from a dimensional perspective. Front Psychol. 2026; 17: 1865249.

INTRODUCTION: Communication difficulties are common among youth with Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). However, traits associated with ASD and ADHD are continuously distributed in the general population, raising the question of how communication differences are better described when considering both diagnostic categories and dimensional trait variation. METHODS: This study included 493 Italian children and adolescents aged 7-16 years old (M = 11.35; SD = 2.64): 147 (126 boys) with ASD without intellectual disability, 105 (88 boys) with ADHD, and 241 (203 boys) non-diagnosed (ND) peers. Parents completed standardized measures assessing communication skills, ASD and ADHD traits. RESULTS: Both clinical groups showed significant communication difficulties compared to ND peers, with large effect sizes (ASD-ND: d = -1.67; ADHD-ND: d = -1.00). In this dataset, communication outcomes were more parsimoniously modelled using continuous ASD and ADHD trait measures (BIC = 4151.39) than diagnostic group membership alone (BIC = 4324.75). Both trait dimensions were associated with communication challenges across clinical and non-diagnosed participants, although the association with ADHD traits was weaker. DISCUSSION: These findings suggest that communication difficulties may be usefully described in relation to continuous ASD and ADHD trait variation, while preserving the clinical relevance of diagnostic categories.

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4. Erçelebi H, Özbudak P, Menderes D, Temel E, Çolak MY, Serdaroğlu E, Hirfanoğlu T, Aydın K, Serdaroğlu A, Arhan E. Altered sleep spindle characteristics in children with autism spectrum Disorder: A potential neurophysiological marker. Clin Neurophysiol. 2026; 192: 2112405.

OBJECTIVE: Neurophysiological biomarkers for autism spectrum disorder (ASD) remain limited, and sleep spindle alterations reflecting thalamocortical network function are not yet fully characterized; therefore, we aimed to compare sleep spindle features between children with ASD and typically developing peers. METHODS: In this observational cross-sectional study, polysomnography-derived sleep spindle parameters including amplitude, frequency, duration, density, and activity, were analyzed during stage 2 non-rapid eye movement (NREM) sleep in children with ASD and compared with those of age-matched healthy controls. RESULTS: The amplitude, number, density, and activity of sleep spindles were significantly reduced in children with ASD compared to the control group, while spindle duration was significantly longer. Univariate logistic regression analysis revealed that the spindle amplitude, number of spindles, spindle density, and spindle activity were significantly associated with ASD. In the multivariate analysis, a higher number of spindles (p = 0.033, OR = 0.776, 95 % CI: 0.615-0.979) and greater spindle activity (p = 0.015, OR = 0.954, 95 % CI: 0.919-0.991) were significantly associated with a reduced likelihood of ASD. CONCLUSIONS: Sleep spindle abnormalities in ASD may reflect alterations in thalamocortical dynamics and could represent an objective marker of neurodevelopmental dysfunction. SIGNIFICANCE: Quantitative sleep spindle analysis may represent a scalable, non-invasive neurophysiological biomarker with potential applications in early identification, mechanistic research, and outcome monitoring in ASD.

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5. Gnazzo M, Bargiacchi G, Gallai B, Spoto G, Di Rosa G, Baldini V, Parisi L, Maltese A, Roccella M, Germanò E, Esposito M, Carotenuto M. Association Between Toe Walking and Repetitive Behaviors in Children with Autism Spectrum Disorder: A Cross-Sectional Phenotypic Analysis. Medicina (Kaunas). 2026; 62(9).

Background and Objectives: Toe walking (TW) is frequently observed in children with Autism Spectrum Disorder (ASD), yet its clinical significance remains incompletely understood. While previous studies have linked TW to ASD severity and multisystem involvement, its relationship with the behavioral phenotype of repetitive behaviors has not been systematically explored. Materials and Methods: This study analyzed a cohort of 289 children with ASD who underwent comprehensive clinical assessment, including motor evaluation, sleep assessment using the Sleep Disturbance Scale for Children (SDSC), feeding behavior using the Brief Autism Mealtime Behavior Inventory (BAMBI), and detailed behavioral characterization through the Repetitive Behavior Scale-Revised (RBS-R) at the item level. Statistical analyses included non-parametric group comparisons, Spearman correlation analyses, and multivariable regression models. Results: TW was observed in 27.3% of participants. Children with TW showed significantly higher scores in stereotyped behaviors (7.71 ± 2.09 vs. 4.26 ± 2.06, r = 0.756, p(FDR) < 0.001), ritualistic/sameness behaviors (11.78 ± 3.21 vs. 7.05 ± 3.03, r = 0.709, p(FDR) < 0.001), and total RBS-R scores (25.52 ± 4.51 vs. 15.88 ± 4.64, r = 0.867, p(FDR) < 0.001). Correlation analyses revealed a strong association between TW and stereotyped behaviors (ρ = 0.588, p < 0.001) and a moderate association with ritualistic/sameness behaviors (ρ = 0.549, p < 0.001). RBS-R total scores were also correlated with sleep disturbances (ρ = 0.532, p < 0.001). In the multivariate linear model, TW was associated with an adjusted mean increase of 7.77 points in the RBS-R Total Score (B = 7.771, 95% CI 6.603-8.939, p < 0.001, β = 0.551). In the multivariate logistic model, the combined Ritualistic/Sameness behavior domain independently predicted the presence of TW (OR = 1.549, 95% CI 1.366-1.757, p < 0.001). Conclusions: In children with ASD, TW was associated with specific domains of repetitive behavior, particularly stereotyped and ritualistic/sameness patterns. These cross-sectional findings suggest a phenotypic association between motor and behavioral features, without establishing specificity, causality, or a shared underlying mechanism. This multidimensional perspective may support future studies investigating the clinical and biological correlates of TW in ASD.

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6. Hridhey F, Gupta N, Khurana P, Miller V, Gupta M. Clinical Use of Valproate and Divalproex in Autism Spectrum Disorder: A Systematic Review of Efficacy and Safety. Cureus. 2026; 18(8): e114420.

The aim of this systematic review is to appraise the current evidence on the efficacy and safety of valproate (VPA), including divalproex sodium (DVPX), in managing irritability, aggression, repetitive behaviors, and other associated symptoms, mostly in the pediatric population with autism spectrum disorder (ASD). Major medical literature databases were searched for randomized controlled trials (RCTs), open-label trials, and any other relevant studies or clinical trials reporting on patients with ASD (predominantly children and adolescents) treated with DVPX/VPA for any reason. A total of 654 abstracts were screened, and four clinical trials were selected for inclusion. Out of these four clinical trials, three were RCTs (n = 13, 27, and 30), and one was an open-label trial. Data were extracted using a standardized form focused on study design and validity domains. Two reviewers independently abstracted data, with discrepancies resolved by consensus. Meta-analysis was not performed due to a lack of homogeneity among the three RCTs. Although most of the studies reported improved overall symptoms, they had different outcome measures. The quality of evidence available is low, and there is a need for higher-powered studies in the future. There is insufficient evidence to make conclusive recommendations on DVPX/VPA for improvement in core symptoms in the pediatric population. However, DVPX/VPA may represent a potential off-label option for selected patients with significant irritability, aggression, and repetitive behaviors associated with ASD.

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7. Kuca J, Stencel M, Pilarski B, Florek S, Pudlo R. Artificial intelligence-supported therapeutic interventions for autism spectrum disorder: a systematic review. Front Psychiatry. 2026; 17: 1833853.

BACKGROUND: The increased prevalence of ASD has generated a pressing demand for flexible therapeutic and educational tools. AI has been suggested as a potential bridge to this gap, but the translation from a model to a clinical application necessitates rigorous assessment. The purpose of the present review is to compile and examine the existing literature to demonstrate AI interventions that have advanced from a proposed model to being used with human participants. METHODS: We systematically searched five databases (Embase, PubMed, ScienceDirect, IEEE Xplore, Web of Science; Jan 2016-Dec 2025) for AI-based ASD interventions. Two reviewers independently assessed eligibility. Inclusion criteria were as followed: (1) participants with confirmed ASD diagnoses; (2) an intervention sample size of N ≥ 6; (3) AI as a central therapeutic, educational, or rehabilitative component; and (4) multi-session protocols with specified timeframes. Study types ranged from system development and feasibility trials to RCTs. RESULTS: 14 studies met inclusion criteria. AI (e.g. robotics, VR, and wearables) functioned as a social mediator, improving social-emotional outcomes (e.g., ADOS, SRS scores) by reducing cognitive load. Significant mechanisms included real-time task adaptation and precise behavioral monitoring via e.g. eye-tracking. However, significant heterogeneity was observed in intervention dosage (median 4-12 hours). Most studies were limited by small, male-dominated samples (N < 20) and a total absence of adult participants. CONCLUSION: Based on the findings, AI seems highly promising for patient-specific ASD therapy via proactive, data-driven scaffolding. In order to move toward implementation of AI in ASD care, more RCTs and crucial augmentation of representation gaps concerning adult and female ASD phenotype studies are required.

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8. Lu S, Deng L, Jia X, Lang X, Diao L, Wang Y, Wen P. A masking effect of vitamin D on ASD symptom severity: mediation by developmental level and altered predictive features in vitamin D insufficiency. Front Psychiatry. 2026; 17: 1900932.

BACKGROUND: Symptom severity in children with autism spectrum disorder (ASD) correlates with developmental level. Vitamin D is crucial to developmental level. Studies show inconsistent findings on serum 25(OH)D and ASD symptom severity. This study explores their association and the mediating role of developmental level. METHODS: A total of 699 children aged 24-71 months were enrolled. Serum 25(OH)D levels were measured and children were categorized into normal vitamin D (NVD) and vitamin D insufficiency (VDI) groups. Symptom severity and developmental level were assessed using the Childhood Autism Rating Scale (CARS) and the Gesell Developmental Schedule (GDS). Structural equation modeling (SEM) was used to analyze mediating effects, and machine learning algorithms were employed to assess the predictive importance of developmental dimensions. RESULTS: In the total sample, SEM revealed a masking effect: the indirect effect of serum 25(OH)D levels on CARS scores via developmental level was negative, whereas the direct effect was positive, offsetting each other and resulting in a non-significant total effect. The mediating effect was attenuated in the VDI group. Machine learning analysis further revealed that language dominates in the NVD group, whereas in the VDI group, the dominance of language is diminished, the predictive importance of personal-social also declines, and fine motor and gross motor show enhanced predictive importance. CONCLUSION: Vitamin D insufficiency may weaken the predictive importance of language and personal-social while enhancing motor domains. Sufficient vitamin D was associated with better developmental levels and lower symptom severity, highlighting the potential research relevance of nutritional considerations in studies of ASD symptom severity.

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9. McMahon MXH, Kucelin A, Hill A, Payton A, Rubio EK, Proctor KB. Intensive multidisciplinary feeding intervention to address malnutrition and saliva pooling in two autistic adolescents with avoidant/restrictive food intake disorder. Eat Disord. 2026: 1-9.

Avoidant-restrictive food intake disorder (ARFID) in autistic youth may present with heterogeneous symptoms. The present case series illustrates the treatment of two autistic adolescents with fear-based ARFID who both displayed significant regressions in feeding that led to precipitous weight loss, malnutrition, and nasogastric tube placement. Both patients refused all oral intake and had stopped swallowing saliva. Developmental and social barriers likely delayed access to care. This case series illustrates the multiple, intersecting challenges imposed by medical and developmental conditions and provides trauma-informed recommendations for clinical practice.

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10. Tatlı B, Kamer İ. A phenotype- and potency-gated extracellular vesicle allocation hypothesis for autism. Front Child Adolesc Psychiatry. 2026; 5: 1942419.

Autism is a heterogeneous neurodevelopmental condition for which a single extracellular vesicle (EV) product is unlikely to match every biological context. We hypothesized that four development-coded EV candidates should be allocated by convergent phenotype, biomarker, and patient-derived functional response rather than diagnosis alone. EXO2, a cord-blood-plasma EV candidate, was tested only in an immune-inflammatory endophenotype characterized by regression or severe irritability along with objective inflammatory activity, after excluding pain, sleep disorder, epilepsy, infection, and other mimics. EXO3, a dental-pulp mesenchymal-stromal-cell EV candidate, was tested in a synaptic-developmental endophenotype with prominent language impairment or intellectual disability, but only if the patient-derived neurons show improved neurite, synaptic, and network function. EXO1, a Wharton-jelly mesenchymal-stromal-cell EV candidate, was tested in a circuit-plasticity endophenotype dominated by abnormalities in social communication, sensory, and repetitive behaviors using a concordant neuronal-network assay. R-EXO, an umbilical-cord-tissue mesenchymal-stromal-cell EV candidate, remained an exploratory option for a neurovascular-barrier/extracellular matrix endophenotype. Regression, language delay, or behavior alone are not selection biomarkers. Each lot must pass identity, purity, safety, and phase-specific potency gates. Sequential use of EXO2, followed by EXO1, EXO3, or, in exceptional cases, R-EXO is predicted to outperform ungated or simultaneous use when inflammation masks a residual developmental mechanism. This is a falsifiable preclinical framework and does not support clinical administration.

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