1. Ascone F, Buzzelli V, Mottarlini F, Di Trapano M, Miglioranza P, Rava A, Feo A, Spano F, Hausman M, Sugaya K, Caffino L, Fumagalli F, Trezza V. Psilocybin improves novel object recognition in a rat model of Fragile X Syndrome through the modulation of the BDNF/TrkB signaling pathway. Neuropsychopharmacology;2026 (Feb 13)

Fragile X Syndrome (FXS) is the most common inherited intellectual disability and a leading monogenic cause of autism spectrum disorder (ASD). As a synaptic disorder, FXS involves the loss of Fragile X messenger ribonucleoprotein 1 (FMRP), leading to abnormal dendrite development and immature dendritic spines. Serotonergic signaling, essential for neuronal development and circuit remodeling, has been implicated in ASD and related conditions, including FXS, raising the possibility that serotonergic modulation could ameliorate neurodevelopmental impairments. This study investigated the therapeutic potential of psilocybin, a serotonergic compound, in the validated Fmr1-(Δ)exon 8 rat model of FXS. Psilocybin microdosing rescued deficits in NOR. Importantly, its benefits on recognition memory persisted despite pretreatment with the 5HT2AR antagonist, volinanserin, or the 5HT1AR antagonist, WAY-100635, indicating that classical serotonergic receptor activation is not required. In contrast, pretreatment with the TrkB receptor antagonist, ANA-12, abolished psilocybin’s effects, implicating BDNF/TrkB signaling as essential. At the molecular level, psilocybin normalized mature BDNF (mBDNF), increased TrkB, and restored downstream AKT signaling in the prefrontal cortex of Fmr1-(Δ)exon 8 rats, pathways strongly linked to synaptic plasticity and cognitive function. These findings demonstrate that psilocybin rescues object recognition memory deficits in this rat model of FXS via BDNF/TrkB-AKT signaling rather than serotonergic receptor mechanisms. By dissociating therapeutic effects from hallucinogenic pathways, our results highlight psilocybin microdosing as a promising therapeutic strategy for neurodevelopmental disorders such as FXS and ASD.

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2. Ben Mansour N, Jarraya S, Masmoudi L, Abdelkefi I, Jallalli D, Dahmen R. Enhancing motor skills through a mindfulness-based program in adolescents with intellectual and developmental disabilities: A randomized controlled trial. Res Dev Disabil;2026 (Feb 11);170:105253.

OBJECTIVES: This single-site randomized controlled trial evaluated the effects of an 8-week mindfulness program on motor performance in adolescents with intellectual and developmental disabilities (IDD). METHOD: A total of forty-seven male participants (mean age: 15.49 ± 0.51 years; mean weight: 61.79 ± 4.19 kg; mean height: 172.53 ± 2.8 cm) were recruited and randomly assigned to one of three groups: a mindfulness group (MG; n = 15), a physical activity group (PAG; n = 16), and a control group (CG; n = 16). The intervention consisted of 16 sessions, lasting 30 min for the MG and 45 min for the PAG, while the CG received no intervention. Motor skills were assessed at baseline (T0) and after the 8-week intervention (T1) using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition Short Form (BOT-2 SF). RESULTS: Following the intervention, the MG showed significant improvements across (1) fine motor precision (p < 0.001), (2) fine motor integration (p < 0.001), (3) manual dexterity (p < 0.001), (4) bilateral coordination (p = 0.002), (5) balance (p = 0.001), (6) running speed and agility (p < 0.001), (7) upper-limb coordination (p < 0.001) and (8) strength (p < 0.001). CONCLUSIONS: Mindfulness practice is an effective, accessible, and low-cost method to improve motor performance in adolescents with IDD, and its integration into school and therapeutic settings supports their physical development and inclusion.

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3. Cui T, Ariffin RB, Wang X, Wang X. Effects of virtual reality exercise on social skills and emotional recognition among children with autism spectrum disorder: a meta-analysis of randomized controlled trials. BMC Psychol;2026 (Feb 14)

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4. Czerwiński A, Dudzic P, Wójtowicz K, Jaszczyszyn I, Bielska W, Wrobel S, Demharter S, Spreafico R, Greiff V, Krawczyk K. ASD: antigen-specific antibody database. MAbs;2026 (Dec);18(1):2623330.

The development of computational models addressing therapeutic antibodies faces significant challenges. Particularly, the prediction of binding affinity across a diverse set of measurements, due to the scarcity of data. A critical data element is the set of antibody-antigen interaction pairs associated with sequences. To address this issue, we developed the Antigen Specific Antibody Database (ASD, https://naturalantibody.com/agab/), a database aggregating antibody-antigen interaction data from multiple studies with standardized formatting and annotations. Our dataset compilation strategy resulted in data from 15 distinct sources, resulting in 1,097,946 unique antibody-antigen interactions (with 9575 unique antigens). The ASD captures diverse affinity measures and qualitative binding assessment, along with metadata including UniProt and PDB identifiers, target protein names, confidence levels, and experimental conditions such as type of measured affinity, source organism, and germline genes. Through this integration drive, we make available an ample resource of interaction data gathered from the public domain to act as a foundation for model development and further data generation.

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5. Jackson SZ, Souders MC, Pinto-Martin JA, Boyd RC, Deatrick JA. The Experience of Depression, Self-Efficacy, and Family Functioning Among Mothers of Children with Autism Spectrum Disorder: A Mixed Methods Study [Formula: see text]. J Am Psychiatr Nurses Assoc;2026 (Feb 14):10783903261417989.

BACKGROUND: Mothers of children with autism spectrum disorder (ASD) report significantly more depressive symptoms, lower maternal self-efficacy, and worse family functioning than mothers of neurotypical children and children with Down Syndrome. There is a need to describe what contributes to high self-efficacy and high family functioning among mothers of children with ASD. AIM: To understand how mothers of children with ASD describe their emotions, maternal self-efficacy, and family functioning, comparing mothers who screen positive and negative for symptoms of depression. METHODS: In this second phase of a larger sequential explanatory mixed methods study, this qualitative descriptive study was conducted using semi-structured individual interviews with mothers of children with ASD. The data were analyzed by hybrid directed content analysis for a presentation of themes. Those themes were then compared across three groups: mothers who screened positive for depression, mothers who screened negative, and mothers whose screening results changed over time. RESULTS: Mothers in the group who screened positive for depression described more child behaviors perceived as problematic, higher caretaking demands, maternal self-efficacy dependent on child’s progress and comparisons to others, more passive coping, and poor family communication. CONCLUSION: Interventions to improve family processes and maternal self-efficacy may be an important complement to individual therapy for treating maternal depression. Intervening at the family level as soon as the child is diagnosed may also help mitigate maternal depressive symptoms. More research is necessary to understand and develop interventions that can improve the experiences of mothers of children with ASD.

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6. Liu CH, Chen YL, Ai W, Ni HC, Lai MC. The impact of autism on the relations between social anxiety, camouflaging, and depression in Taiwanese adolescents. Child Adolesc Psychiatry Ment Health;2026 (Feb 13)

BACKGROUND: Both camouflaging and social anxiety are adolescence-emerging phenomenon, rooted in social situations, and associated with mental health. The directionality between camouflaging and social anxiety in autistic versus non-autistic adolescents is underexplored. This study aims to investigate the inter-relations between camouflaging, social anxiety, and depression, and the moderating role of autism diagnosis on these inter-relations. METHODS: A total of 205 Taiwanese adolescents (100 autistic, 105 non-autistic) completed self-reported measures, including the Camouflaging Autistic Traits Questionnaire, Chinese version (CAT-Q-Ch), Social Interaction Anxiety Scale, Chinese version (SIAS-C), Generalized Anxiety Disorder 7-item (GAD-7), and Patient Health Questionnaire 9-item (PHQ-9). Network analysis was used to examine the inter-relations among items of the CAT-Q-Ch and SIAS-C. Moderated mediation models, adjusted for generalized anxiety, examined the inter-relations among camouflaging, social anxiety, and depression, and how these associations varied by autism diagnosis. RESULTS: Autistic adolescents reported significantly higher scores on camouflaging, depression, generalized anxiety, and social anxiety than non-autistic adolescents. A network analysis showed that items from the CAT-Q-Ch formed two communities, and most SIAS-C items formed a third community, supporting the interpretation that camouflaging and social anxiety are related yet distinct constructs. For both autistic and non-autistic adolescents, social anxiety and camouflaging showed bidirectional indirect associations with depression. Critically, having an autism diagnosis significantly weakened the link between camouflaging and depression, as part of the indirect association between social anxiety and depression via camouflaging. CONCLUSION: The findings highlight the complex inter-relations among camouflaging, social anxiety, and depression, which may differ between autistic and non-autistic adolescents in Taiwan. Camouflaging may serve different functional roles and have different mental health implications for autistic and non-autistic adolescents. Future research should focus on teasing apart the complex conceptual, measurement, and causal mechanisms underlying the inter-relations between social anxiety and camouflaging in autistic versus non-autistic people.

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7. Liu X, Shen M, Liu B. Toward a rapid, non-invasive predictor of washed microbiota transplantation efficacy in pediatric autism spectrum disorder: considerations for clinical translation. J Transl Med;2026 (Feb 13);24(1):193.

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8. Luglio DG, Yu X, Lin JC, Chow T, Martinez MP, Chen Z, Eckel SP, Schwartz J, Lurmann FW, Pavlovic N, McConnell R, Xiang AH, Rahman MM. Prenatal exposure to extreme heat and autism in children. Sci Total Environ;2026 (Feb 12):181373.

Increasing global temperatures have been associated with neural tube defects and neurodevelopmental delays. Effects of gestational temperature exposures on autism, another neurodevelopmental outcome with prenatal risk factors, have not been previously investigated. This study examined associations of weekly maximum and minimum temperature (T(max) and T(min), representing daytime and nighttime temperatures respectively) on development of autism in children in a retrospective birth cohort study from Kaiser Permanente Southern California hospitals from 2001 to 2014. Autism diagnosis by age 5 was identified in electronic medical records with corresponding ICD codes. Weekly average T(max) and T(min) were estimated at the maternal residential addresses during pregnancy using the gridMET model. Cox proportional hazard models with nonlinear distributed lags were used to identify critical windows of exposure with hazard ratios (HR) comparing exposure to temperature at the 90th and 99th percentiles versus the 50th percentile. A total of 4076 children (80% male) in the cohort of 294,937 had autism diagnosis by age 5. Exposure to extreme T(min) during gestational weeks 1-10 and 30-37 were associated with increased risk of autism, with HR (95% CI) 1.154 (1.040, 1.288) for exposure during weeks 1-10, and 1.132 (1.030, 1.246) for weeks 30-37 comparing the 99th percentile to the 50th percentile. No association was observed for T(max). Exposures to high nighttime temperature during early and late pregnancy were associated with autism risk in children, a result of concern in a warming world. Further research is needed to understand why daytime temperature was not associated with autism risk.

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9. Ma B, Du X. Effects of a combined physical activity and educational drama intervention on core symptoms and physical fitness in children with ASD. Sci Rep;2026 (Feb 14)

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10. O’Sharkey K, Mitra S, Chow T, Goodrich AJ, Conlon KC, Nuño M, Bennett DH, Raffuse S, Astaneh M, Zhao Y, Kleeman M, Ritz B, Schmidt RJ. Prenatal exposure to wildfire-related PM(2.5) and autism spectrum disorder in children born in California between 2001-2019. Environ Int;2026 (Feb 6);208:110131.

BACKGROUND: Wildfire smoke is an increasingly prevalent source of air pollution and contains a complex mixture of neurotoxic constituents that could affect neurodevelopment, yet its potential role in autism spectrum disorder (ASD) etiology remains unexplored. We examined associations between wildfire-specific PM(2.5) exposures and ASD risk in California births, considering exposure timing, intensity, and background air pollution. METHODS: We analyzed 8.6 million births in California from 2001 to 2019, linking records to ASD diagnoses in California Department of Developmental Services records through 2022. Wildfire-related PM(2.5) exposures, including biomass burning and wildland-urban-interface (WUI) source tracers, were estimated for preconception, pregnancy, and post-pregnancy periods. Exposure metrics included continuous, percentile-based, and episode-based indicators. Logistic regression was used to estimate odds ratios, adjusting for sociodemographic covariates. Stratified analyses were conducted by background PM(2.5), urbanicity, diagnostic era, and sex. RESULTS: Continuous wildfire-specific exposures during the pregnancy-period were weakly associated with ASD, but stronger effects emerged at high exposure percentiles and during intense wildfire episodes (≥ 35 µg/m(3)). Associations were most pronounced among children in the lowest quartile of prenatal background PM(2.5), with odds of ASD increasing by 50% for those in the > 90th percentile of wildfire PM(2.5) during pregnancy. WUI-related PM(2.5) was associated with ASD in metro areas, suggesting unique toxicity. Effects were stronger in non-metro regions, with the exception of WUI-related PM(2.5), for births occurring after the implementation of DSM-5, and in White children. Sex differences were minimal, but showed stronger effect estimates for WUI-related PM(2.5) and high exposure episodes for males. CONCLUSION: Wildfire smoke exposure during pregnancy may increase ASD risk, particularly in low background air pollution and rural settings. High-intensity wildfire events were most strongly associated with ASD, underscoring the need for targeted policies, such as vegetation management, land use planning, and indoor filtration upgrades in the context of increasing wildfire frequency and severity.

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11. Oldenburg K, Gibbons T, Welch C, Tint A, Albin M. Describing the communication of autistic people during experiences of distress: A scoping review. Autism;2026 (Feb 14):13623613261417933.

Autistic people can experience distress for many reasons. Some of these reasons may include unsupportive environments; experiences of trauma; sensory overload; burnout, inertia, meltdown and shutdown; pain; and mental health diagnoses such as anxiety. Little is known about how distress can impact communication and what others can do to provide support in these moments. This scoping review explores how communication is described during experiences of distress for autistic people, including communication partner strategies to support these interactions. Following a comprehensive database search, 18 articles were included in this scoping review. Firsthand perspectives of autistic people were discussed in 10 studies. Distress was most often characterized by instances of anxiety and/or stress. Eleven studies discussed non-spoken methods of communication, including gestures, facial expressions and behavioural manifestations (e.g. hitting, screaming) during experiences of distress. Identified facilitators to communication during experiences of distress included the presence of a calm, supportive environment and communicative aids. Understanding the impact distress has on communication is beneficial to both autistic people and those who support them. This review contributes to the body of literature aiming to better understand and support autistic people during moments of distress.Lay abstractPast research talks about (1) how autistic people may communicate and (2) how and why autistic people may experience periods of distress. There is not much research about the way autistic people communicate during periods of distress. We therefore looked at research exploring how autistic people of all ages communicate during periods of distress. Communication includes various methods of sending and receiving information, including spoken and non-spoken communication methods (e.g. observable behaviours, typing, gestures). We explored how often researchers collected firsthand perspectives from autistic people. We also collected information on what made communication easier, or more difficult, during periods of distress. We used a methodological approach called a scoping review to identify and evaluate 18 articles that met our criteria. The most common communication method described in the articles was non-verbal communication, including gestures, facial expressions and observable behaviours such as screaming and hitting. Firsthand autistic perspectives were included in just over half of the studies. Facilitators to communication included a calm, supportive environment and communicative aids relevant to the situation, such as a pain scale. This study will help those who support autistic people, and autistic people themselves, by showing the many ways autistic people may communicate when experiencing distress and describing strategies that can be used to support autistic people in those moments.

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12. Tarantino V, Santostefano A, Catania A, Giordano S, Montalto G, Calistro F, Oliveri M, Turriziani P. Reduced Habituation: A Key to Understanding Sensory Sensitivity in Autism. J Autism Dev Disord;2026 (Feb 14)

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13. Treviño MS, Gerstein ED. Evaluating Emotion Dysregulation in Autism: Validation and Application of the Emotion Dysregulation Inventory to Identify Subgroup Profiles. J Autism Dev Disord;2026 (Feb 14)

PURPOSE: Autistic youth experience high rates of emotion dysregulation, which can significantly impact functioning and quality of life. Despite its clinical significance, emotion dysregulation remains understudied and misunderstood, with few validated measures for use in autistic youth. This study aimed to further validate the Emotion Dysregulation Inventory (EDI) and explore its utility in understanding emotion dysregulation, its relationship with autism symptoms, and its associations with treatment-relevant factors. METHODS: Caregivers of autistic youth aged 6-11, recruited through the SPARK initiative, completed questionnaires on child behaviors, emotions, and experiences. A total of 320 families were included, with oversampling of minoritized racial and ethnic backgrounds. Structural equation modeling was used to confirm the EDI’s two-factor structure and measurement invariance across diverse groups. Latent profile analysis (LPA) and the R3STEP procedure were used to identify subgroups based on emotion dysregulation and autism symptom severity and examine associations with child and family factors. RESULTS: The EDI demonstrated robust psychometric properties, with measurement invariance supporting its use across diverse racial and ethnic groups, as well as for youth with or without a history of language disorder. LPA identified three phenotypic subgroups, each showing meaningful associations with child and family characteristics, including behavioral problems, parental stress, and sleep disturbances. CONCLUSION: This study contributes to our understanding of emotion dysregulation in autism by supporting the EDI’s validity in diverse samples and highlighting associations with autism symptoms, comorbidities, and other challenges. Integrating emotion dysregulation into clinical conceptualizations can improve the quality of care for autistic youth.

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14. Vite TKG, Pavlou A, Pari C, Foulsham T, Cooper N. Resting-State EEG Microstates Across a Dimensional Spectrum of Autistic Traits: From Typical Development to Diagnosed ASD. Behav Brain Res;2026 (Feb 14):116105.

Autism spectrum disorder (ASD) has been linked to atypical large-scale brain dynamics, but it is unclear how these alterations extend across the broader autism phenotype. We applied a seven-class resting-state EEG microstate model (A-G) to adults with clinical ASD and to typically developing adults with high (TD-High) and low (TD-Low) autistic traits, quantified with the Autism-Spectrum Quotient. We compared temporal parameters, spatial coverage, explained variance, and both observed and chance-corrected transition probabilities. Across all microstates, the ASD group showed a globally more fragmented regime than both TD groups, with markedly shorter but more frequent microstate episodes and reduced duration variability. By contrast, TD-High and TD-Low were similar on these global indices. At the network level, Microstate C showed reduced explained variance and coverage in ASD relative to both TD groups. In Microstates E and G, explained variance and coverage increased from TD-Low to TD-High to ASD, with TD-High consistently occupying an intermediate position. Mean GFP and GFP variability for Microstate E were also elevated in ASD relative to both TD groups. Transition analyses revealed reduced short-range transitions within an early A-C ensemble and increased transitions from these states into other microstates in ASD, with TD-High again showing an attenuated, intermediate pattern. Chance-corrected transitions confirmed that sensory/self-related routes occurred less often than expected, whereas routes from these states into other microstates were over-expressed. These findings support a dimensional account in which EEG microstates index autism-related network organisation across clinical and subclinical ranges.

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15. Wadhwani D, Patel SS. Gestational hyperglycemia and autism spectrum disorder: Mechanistic pathways and emerging preventive strategies. Behav Brain Res;2026 (Feb 11);504:116099.

Autism spectrum disorder is a neurodevelopmental disorder characterised by deficits in social communication, restricted interests, and repetitive behaviours. The severity and presentation of symptoms vary greatly among autistic individuals. The etiology of autism is multifactorial, including metabolic, environmental, and genetic factors. Emerging evidence suggests that the maternal metabolic environment, especially gestational diabetes mellitus, has a major impact on fetal neurodevelopment and the subsequent risk of autism spectrum disorder. Epidemiological studies have found that children born to mothers with gestational diabetes mellitus are much more likely to be diagnosed with autism, especially if GDM is identified before 26 weeks of pregnancy. The mechanistic pathways that link maternal hyperglycemia to autism are explored in this review. These include epigenetic suppression of SOD2, impaired neuronal migration through disrupted reelin signalling, elevated oxidative stress from advanced glycation end products, gut dysbiosis and many more, caused by GDM. The cumulative effect of the above factors involves disturbances in the intrauterine environment, which results in abnormal synaptic formation, neuroinflammation, and mitochondrial dysfunction in the developing fetal brain. This review also examines the new therapeutic strategies that can target these pathways, such as RORα agonist, SGLT-2 and DPP4 inhibitors, antioxidants and gut microbiota modification through various dietary interventions and supplementation to support the growth of beneficial microbiota. Thus, early detection and treatment of maternal metabolic disorders during pregnancy may be a promising way to lower the risk of autism in infants and enhance the neurodevelopmental outcomes.

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16. Wang L, Yuan F, Wang Y, Niu X, Cheng Y, Wong PCM, Zhang H. Bridging the Measurement Gap: Cross-Cultural Adaptation and Validation of the Brief Parental Self-Efficacy Scale (BPSES) for Chinese Parents of Autistic Children. J Autism Dev Disord;2026 (Feb 14)

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17. Wojciechowski T. Autism as a Predictor of Deviant Peer Association: Testing for Dual Systems Model Mediation Effects. J Autism Dev Disord;2026 (Feb 14)

PURPOSE: Deviant peer association is a robust risk factor for offending, that is, any behavior that violates a criminal law. This can include behaviors like drug use, violence, and theft; among others. Autism is a neurodivergent condition characterized by both atypical cognitive development and challenges with social interaction and communication. Despite these impairments, there is a dearth of research focused on the relationship between autism and deviant peer association. Relatedly, there exists no research examining the role that dual systems model constructs (sensation-seeking and impulse control) as mediators of this relationship. This study sought to address these gaps in the literature by examining autism as a predictor of deviant peer association in childhood and whether either or both impulse control or sensation-seeking significantly mediate this relationship. MATERIALS: Waves 1, 3, and 4 of the Adolescent Brain Cognitive Development study were analyzed. Structural equation modeling was used to examine these direct and indirect relationships of interest. RESULTS: Results indicated that autism was associated with lower deviant peer association scores. Lower sensation-seeking scores among youth with autism significantly mediated this relationship, but impulse control did not. CONCLUSION: Autism may be a protective factor against deviant peer association due to diminished sensation-seeking relative to neurotypical peers. Future research should take a developmental perspective on these relationships to examine whether they are consistent at later stages of the life-course.

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18. Zhang L, Wang M, Jiang Y, Wang L, Zheng R, Zhou Z, He F, Jiang H. Study on the Topological Properties of Language Brain Region Networks in Children With Autism Based on Diffusion Tensor Imaging (DTI). J Autism Dev Disord;2026 (Feb 14)

OBJECTIVE: To compare the topological properties of language-related structural brain networks between children with Autism Spectrum Disorder (ASD) and Global Developmental Delay (GDD) and examine their associations with language function. METHODS: Sixty-five children with ASD and fifty-one with GDD underwent diffusion tensor imaging (DTI). Graph theoretical analysis was used to evaluate nodal metrics in language-related structural networks. Hierarchical regression models analyzed whether diagnostic group moderated the relationship between network metrics and language performance. RESULTS: Behaviorally, children with ASD exhibited significantly lower auditory and visual comprehension scores than those with GDD, while expressive language scores were comparable. At the network level, the ASD group showed significantly higher degree centrality in the right middle temporal gyrus (MTG-R). In the ASD group specifically, degree centrality of the MTG-R, and both degree centrality and nodal efficiency of the right angular gyrus (ANG-R), were negatively correlated with language performance. Regression analyses confirmed that diagnostic group significantly moderated these structure-function relationships. CONCLUSION: Children with ASD and GDD exhibit differences in the local topological properties of language networks and distinct patterns of association with language ability. Specifically, increased nodal connectivity in the MTG-R and ANG-R was associated with poorer language outcomes in the ASD group, suggesting disorder-specific differences in structural network organization. This study provides network-level evidence for divergent brain organization underlying language impairment in ASD versus GDD.

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19. Zhu L, Ge X, Peng T, Zhang A. What Configurations Drive Paternal Involvement in ASD Care? An fsQCA of Individual, Intrafamilial, and Extrafamilial Pathways. J Autism Dev Disord;2026 (Feb 14)

PURPOSE: Given the critical role of fathers in the care of children with ASD, while prior research has neglected the mechanism by which multi-level factors interact to shape paternal involvement, this study aims to explore the configurational pathways of multi-level factors influencing the involvement of Chinese fathers of children with ASD, under the guidance of Bronfenbrenner’s ecosystem theory and by adopting the fuzzy-set qualitative comparative analysis (fsQCA) method. Specifically, this study intends to clarify how different combinations of individual, intrafamilial, and extrafamilial factors affect paternal involvement, identify the necessary conditions and key drivers therein. METHODS: This study employed fuzzy-set qualitative comparative analysis (fsQCA) – a method uniquely suited to analyze multi-level interactions – to investigate configurational pathways influencing paternal involvement among 203 Chinese fathers of children with ASD. RESULTS: Necessity analysis showed high-frequency couple interaction as a necessary condition (consistency > 0.9, coverage > 0.5) across all configurations, underscoring intrafamilial dynamics’ primacy. Five configurations emerged, forming three theoretically distinct models according to ecosystem theory: Individual-Familial Synergy, Intrafamilial-Extrafamilial Support, and Integrated Ecosystem. Key drivers included: working within the public institution (individual), high frequency of couple interaction (intrafamilial), high level of community support (extrafamilial), and high level of other support (extrafamilial). CONCLUSIONS: Paternal involvement in ASD care is the result of the conjunctural effect of multi-level factors, and the configurational pathways for high and low involvement are asymmetric. The core role of intrafamilial interaction and the synergy mechanism of individual, family, and external systems provide important insights for formulating targeted interventions to improve paternal involvement.

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