1. Ain G. Caregiver burden and perceived community support as correlates of family quality of life among caregivers of individuals with autism spectrum disorder in Saudi Arabia. Front Psychol. 2026; 17: 1897617.

Families raising a member with autism spectrum disorder face continuing psychological, financial, and logistical demands that can compromise family quality of life, yet Gulf-region evidence on the joint contribution of caregiver burden, perceived support, digital competence, and service accessibility remains scarce. This cross-sectional, exploratory study examined family quality of life and the incremental contribution of these factors among 294 caregivers with complete family-quality-of-life (FQoL) data, drawn from 416 survey respondents caring for an individual with autism spectrum disorder across the five administrative regions of Saudi Arabia between March and April 2026. Participants completed an Arabic questionnaire battery comprising a 25-item family quality of life measure structured on the five Beach Center domains but administered with frequency anchors, together with three measures developed for this study: caregiving difficulties, perceived support from caregiver and online communities, and self-rated digital competence, and a nine-item service accessibility composite. Family quality of life was moderate to good overall (mean = 3.77, standard deviation = 0.30). In hierarchical regression analyses, the final model accounted for 35.7% of the variance in family quality of life within this sample and under this specification. In the primary hierarchical regression model, perceived community support (standardized coefficient = 0.39), caregiver burden (-0.26), and the presence of a comorbid condition (-0.13) were independently associated with family quality of life; the comorbidity association, however, was less robust when professional caregivers were excluded. Self-rated digital competence, service accessibility, household income, educational attainment, and caregiver-reported autism severity were not independently associated with family quality of life once the other variables were included. Family quality of life differed between the mild and moderate caregiver-reported severity groups, but the study provides no reliable evidence concerning the severe group because only 10 participants (3.4%) were so classified, and severity carried no association in the adjusted model. Because the design was cross-sectional, all five composites were developed for this study and none is independently validated, two of them fall below conventional reliability thresholds, and the sample was a non-probability online sample, these findings are exploratory associations that require replication rather than estimates of determinants of family quality of life.

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2. Blandin KJ, Douglas L, Lugo JN, 3rd, Thayil JJ, Lugo JN. Variability in acoustic startle response and prepulse inhibition across adulthood in Fragile X messenger ribonucleoprotein 1 knockout mice. Brain Res. 2026; 1889: 150452.

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3. Borloz E, de Combarieu C, Bourcin L, Felix MS, Fulachier C, Mazet B, Roux JC. Alteration of cholinergic pathway in the enteric nervous system of a mouse model of Rett syndrome. Neurobiol Dis. 2026; 229: 107597.

BACKGROUND AND AIMS: Rett syndrome (RTT) is a severe neurological disorder caused by pathogenic variants in the MECP2 gene associated with gastrointestinal (GI) motility disorders strongly impacting patients’ quality of life. Intestinal motility relies on coordinated neuronal activity in the enteric nervous system (ENS) where MECP2 is highly expressed. Here, we sought to determine whether cholinergic-mediated excitatory neuromuscular transmission could be affected in the ENS of a RTT mouse model and the functional consequences on intestinal motility. METHODS: In this study, 55 days-old wild type (WT) and Mecp2-knock-out (KO) mice were used. After confirming the increase in GI transit time in Mecp2-KO mice in vivo, intestinal mechanical activity was assessed in vitro by evaluating contractile responses of small intestinal muscle to electrical field stimulation (EFS) of the ENS. The function of the cholinergic pathway was evaluated using gene expression, protein, and enzymatic activity quantifications of different factors of the acetylcholine (ACh) metabolism. RESULTS: Our in vivo results confirm that the slowed GI transit previously identified in RTT patients and in the mouse model. In vitro, successive EFS lead to a progressive and rapid decrease in the amplitude of cholinergic contractions in Mecp2-KO mice contrary to WT mice. Levels of ACh are decreased in the ENS of Mecp2-KO mice (-47%, P-value<0.01) due to decreased activity of the synthesizing enzyme choline-acetyltransferase (-39%, P-value = 0.04). In addition to the deficit of ACh, we found that both nicotinic and muscarinic cholinergic receptors are also significantly impacted. CONCLUSION: This is the first report of a major dysfunction of the enteric cholinergic pathway in a mouse model of RTT supporting its direct involvement in GI disorders in this disease. We propose that the rhythmic GI contractions occurring during fed conditions may cause a rapid depletion of the stock of enteric ACh that could largely depress the propulsive efficiency of, or even suppress, peristalsis during digestion.

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4. Bourne MJ, Smeltzer SC, Kelly MM. Clinical nursing faculty perceptions about teaching students to provide care for adults with developmental disability. Res Dev Disabil. 2026; 178: 105408.

BACKGROUND: Adults with developmental disabilities (AWDD) experience health inequities that could be improved with nurses better prepared to address their unique needs. Lack of contact of nursing students with AWDD, which is pervasive in nursing education, contributes to the health inequities experienced by this population. This may be due in part to clinical nursing faculty members’ perceptions about teaching students to provide care to this population. PURPOSE: This study explored the perceptions of clinical nursing faculty about teaching students to provide care for AWDD. DESIGN: This study used a descriptive multi-method design with a nationwide sample of 126 clinical nursing faculty. METHODS: The survey included Likert-style scales for quantitative data analyzed through descriptive statistics, and open-ended questions for qualitative data analyzed thematically. RESULTS: Participating clinical nursing faculty reported positive attitudes toward providing care to AWDD but biases emerged. Perceived self-efficacy to teach students about AWDD included four themes: faculty experience with DD, providing DD care, student knowledge/willingness, and time. Barriers and facilitators to assigning students to AWDD included five themes: attitudes, care complexity, clinical site considerations, extent of DD content, and faculty experience with DD. CONCLUSION: The study findings suggest areas for professional and curricular development to increase learning opportunities for nursing students to provide equitable care to AWDD.

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5. Chown N, Suckle E. Response to Professor Uta Frith questioning whether autism has lost its meaning and is leading to misdiagnosis. Psychol Med. 2026; 56: e331.

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6. Ciai L, Guolin H, Xi C, Rongzhen L, Xionghan L, Xin L, Aiyuan C. Prevalence and risk factors of elopement behavior in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. Front Pediatr. 2026; 14: 1957224.

OBJECTIVE: Wandering and elopement are common and potentially life-threatening behaviors in children and adolescents with autism spectrum disorder (ASD). Despite extensive research, debates persist regarding the chronic nature of these behaviors, their relationship with cognitive and linguistic functions, and the primary risk factors. This study aims to quantitatively assess the incidence of elopement in this population and systematically evaluate associated risk factors. METHODS: Systematic searches were conducted in PubMed, Embase, Web of Science, and Cochrane Library databases to gather observational studies on the incidence and risk factors of elopement in individuals with ASD (≤18 years old) from the inception of the databases to August 2026. Data were pooled using random or fixed-effect models, and subgroup analyses were performed. This study is registered in PROSPERO (CRD420261456297). RESULTS: Fourteen observational studies were included. Meta-analysis revealed that the pooled incidence of elopement among children with ASD was 46% (95% CI: 36%-56%). Subgroup analysis showed no significant difference between recent (43%) and lifetime incidence (51%) (P = 0.4954), highlighting the chronic nature of this behavior. Additionally, no significant differences were found in elopement risk across genders (40% in males vs. 31% in females, P = 0.4374) or cognitive/linguistic function levels (41% in severe/ID/non-verbal group vs. 45% in mild/without ID/verbal group, P = 0.8434). Risk factor analysis identified comorbid attention-deficit/hyperactivity disorder (ADHD, aOR = 3.00), lack of danger awareness (aOR = 2.20), and communication disorders (OR = 2.24) as highly correlated with elopement behavior. CONCLUSION: Elopement is a prevalent and chronic behavior in children with ASD, unaffected by improvements in cognitive or linguistic abilities, challenging traditional clinical assumptions. In clinical practice, elopement prevention should be part of routine assessments, with interventions focusing on managing comorbidities like ADHD and enhancing safety skills training.

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7. Han JE, Shin Y, Elias R, Swain D, Viggiano A, Lord C, Kim SH. Comparing Intervention Outcome Measures Across Clinic and Home for Young Autistic Children: Brief Observation of Social Communication Change (BOSCC) and Measure of NDBI Strategy Implementation-Caregiver Change (MONSI-CC). J Autism Dev Disord. 2026.

PURPOSE: Growing use of multiple Naturalistic Developmental Behavioral Interventions (NDBIs) across service settings has highlighted the need for flexible outcome measures. However, prior research has been limited by a lack of standardized tools to sensitively capture changes in autistic children’s behavior and caregiver strategy use across contexts. The present study examined the feasibility and reliability of the Brief Observation of Social Communication Change (BOSCC) and the Measure of NDBI Strategy Implementation-Caregiver Change (MONSI-CC) across clinic and home settings, as well as cross-context comparability and associations between child and caregiver behaviors. METHODS: Sixty caregiver-child dyads completed standardized 12-minute caregiver-led play tasks in both clinic and home contexts. During home administration, research staff provided real-time remote support and prompts consistent with clinic procedures. Feasibility and acceptability of home administration were evaluated using descriptive statistics. Reliability was examined in terms of internal consistency, inter-rater reliability, and test-retest reliability. Cross-context comparability and associations between the two measures were examined using paired-sample t-tests and Pearson correlations. RESULTS: Home administration showed high caregiver acceptability and strong fidelity. The BOSCC and MONSI-CC showed generally similar reliability patterns across contexts. Most BOSCC and MONSI-CC scores did not differ significantly between contexts, and several showed significant cross-context associations. Associations between autistic children’s social communication and caregiver strategy use were strongest within the same context but also evident across settings. CONCLUSION: Brief, standardized observational assessments may provide scalable tools for assessing caregiver and child behavior across clinic- and home-based early intervention settings.

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8. Jahanian Najafabadi A, Rastegari A. The active self in autism: multisensory and sensorimotor foundations of bodily self-representation. BMC Psychiatry. 2026; 26(1).

The active self, understood as the embodied sense of self arising from goal-directed action and interaction with the environment, is supported by sensorimotor processes including multisensory integration and proprioception. Atypical self-representation in autism spectrum disorder (ASD) has been proposed to relate to differences in these processes. To clarify this relationship, we conducted a systematic conceptual review of 37 empirical studies published between 2010 and August 2025 examining multisensory and bodily components of the active self in ASD. The literature was synthesized across three themes: (1) multisensory integration, (2) self-bias and self-other differentiation, and (3) motor underpinnings of bodily awareness. Across studies, autistic participants frequently showed differences in multisensory timing and weighting, including reduced or delayed susceptibility to some bodily ownership illusions and greater reliance on proprioceptive or immediate sensory information. Evidence also indicated differences in the flexibility of peri- and interpersonal space, self-other differentiation, agency-related processing, and motor planning and execution. However, findings were not uniform across paradigms, developmental stages, or participant groups, with relatively preserved performance reported under some unimodal or low-noise conditions. Together, these findings support an association between multisensory and sensorimotor processing and several components of bodily self-representation in autism, while substantial methodological and sample heterogeneity limits strong causal or clinical conclusions. Future research should prioritize larger and more representative samples, longitudinal and multimethod designs, standardized experimental paradigms, and objective measures of embodiment to determine whether these mechanisms can ultimately inform individualized assessment and intervention.Clinical trial number Not applicable.

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9. Johnson N, Van Hecke A, Hine J, Singh M, Koth K. Battling the Bottleneck: Evaluating Autism Diagnostic Training in Primary Care. J Autism Dev Disord. 2026.

PURPOSE: The study purpose was to implement and evaluate the STAT™ (Screening Tool for Autism in Toddlers & Young Children 24-36 months old) for primary care providers (PCPs) in a Wisconsin, USA, cohort. It examined the impacts of the training and learning community on knowledge, attitudes, and change in self-reported provider confidence in autism diagnosis. METHODS: This study evaluated the implementation of a developmental assessment training program, for PCPs, using the STAT, followed by a year-long autism learning community involving monthly case-based discussions and knowledge exchange. English-speaking PCPs were assessed pre- and post-training on knowledge, screening and diagnostic practices, attitudes toward autism diagnosis in primary care, and comfort with autism identification and management. Descriptive statistics summarized baseline characteristics and practices. Paired-samples t-tests were used to evaluate pre- to post-training changes in provider comfort. RESULTS: Baseline findings (n=23) PCPs indicated limited use of autism-specific screening and diagnostic tools among PCPs. Among PCPs with matched pre- and post-training data (n = 11), significant improvements were observed across multiple domains of provider comfort identifying autism risk, distinguishing autism from other developmental conditions, making formal diagnoses, and providing diagnostic feedback. Improvements in care coordination domains, such as referral practices and mental health service linkage, were more limited. CONCLUSIONS: STAT training was associated with meaningful improvements in provider confidence, particularly in autism identification and diagnostic decision-making within primary care settings. Training PCPs to diagnose autism in young children with obvious signs, has the potential to reduce diagnostic delays and improve access to early intervention.

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10. Kilic MA, Karaman V, Gencpinar P, Sakarya Gunes A, Sonmez FM, Aydin HI, Bildik O, Sager SG, Aksu Uzunhan T, Gunay C, Ates Yaman O, Ercelebi H, Basarir G, Gok A, Ersoy M, Sunnetci Akkoyunlu D, Polat H, Turkyilmaz A, Turan B, Uyanik B, Agildere M, Kaymakcalan Celebiler H, Mehtar M, Olgac Dundar N, Pembegul Yildiz E, Kara B, Maras Genc H. Diagnostic timing in cerebral creatine deficiency syndromes: neurodevelopmental and genetic characterization of a multicenter cohort. Eur J Pediatr. 2026; 185(11).

PURPOSE: Cerebral creatine deficiency syndromes (CCDS) are rare inherited neurometabolic disorders comprising two creatine biosynthesis defects-guanidinoacetate methyltransferase (GAMT) and arginine:glycine amidinotransferase (AGAT) deficiencies-and creatine transporter (CRTR) deficiency. Because early diagnosis and presymptomatic treatment are critical, particularly in biosynthesis defects, this study aimed to delineate the clinical features, diagnostic timing, and genetic spectrum of CCDS, and to describe the outcomes of presymptomatically treated patients. METHODS: This was a retrospective, multicenter cohort study. Clinical, radiological, biochemical, and genetic data were reviewed, and all variants were classified according to the gene-specific ClinGen CCDS Variant Curation Expert Panel specifications. Patients with pathogenic or likely pathogenic variants were considered genetically confirmed; patients whose variants remained of uncertain significance (VUS) were described separately and excluded from comparative analyses. RESULTS: Of the 22 enrolled patients, 19 were genetically confirmed. Three presymptomatically treated patients with GAMT deficiency remained asymptomatic. Among the 16 symptomatic, genetically confirmed patients, the median diagnostic interval was 88.5 months (IQR 114; range 10-228). All symptomatic patients had global developmental delay or intellectual disability. Four novel variants were identified: the homozygous p.(Arg189His) variant (AGAT deficiency) was classified as likely pathogenic and the homozygous deletion c.242_327+63del (GAMT deficiency) as pathogenic; two hemizygous variants (CRTR deficiency), p.(Trp55Arg) and p.(Gly253Glu), remained VUS. CONCLUSION: Favorable neurodevelopmental outcomes in patients with GAMT deficiency treated before symptom onset underscore the importance of clinical awareness and timely diagnosis, and support the rationale for newborn screening. The two novel disease-causing variants expand the genetic spectrum of CCDS. WHAT IS KNOWN: • Cerebral creatine deficiency syndromes are rare inherited neurometabolic disorders comprising AGAT, GAMT, and CRTR deficiencies. • Presymptomatic treatment of GAMT deficiency can prevent irreversible neurodevelopmental sequelae. WHAT IS NEW: • Two novel disease-causing variants (likely pathogenic in AGAT deficiency; pathogenic in GAMT deficiency) expand the genetic spectrum; two novel SLC6A8 variants remain of uncertain significance under ClinGen CCDS Expert Panel criteria. • Favorable outcomes in three presymptomatically treated patients with GAMT deficiency support the rationale for newborn screening.

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11. Kim W, Lim C, Seong M, Kim S. A Tangible Multimodal Sensing Interface for Collaborative Task Engagement in Children With Autism Spectrum Disorder: Cross-Sectional Mixed Methods Feasibility Study. JMIR Serious Games. 2026; 14: e86264.

BACKGROUND: Social engagement is critical for the developmental progress of children with autism spectrum disorder (ASD). While tangible technologies and serious games (SGs) show promise, a dual-purpose platform that both facilitates collaborative interaction and enables sensing of collaborative task engagement is required. Existing tangible interfaces often lack integrated sensing capabilities, while devices designed for complex input are typically not optimized for the sensory and interaction needs of this population. OBJECTIVE: This study aims to present InteractiSense, a tangible prototype designed to support collaborative play while enabling engagement estimation for children with ASD through embedded multimodal sensing. Our primary objectives were twofold: (1) to evaluate the prototype’s preference, usability, and workload, and (2) to assess the feasibility of its embedded sensor data in generating valid inputs for preliminary machine learning (ML)-based engagement classification. METHODS: We developed InteractiSense, a spherical, soft-textured prototype embedded with 7 physio-behavioral sensors, alongside a collaborative SG promoting key social skills, and evaluated it against a familiar Xbox controller as a practical baseline. Fifteen children with ASD (mean age 11, SD 3 years; 10 males and 5 females) participated in a cross-sectional feasibility evaluation using a within-subjects mixed methods design. Preference data were analyzed using the McNemar test and Bayesian analysis, and usability and workload scores were compared using 2-tailed paired t tests. Qualitative caregiver interviews on InteractiSense and the SG were analyzed using thematic analysis, with device-related themes contextualizing quantitative findings during interpretation. To validate sensing feasibility, we analyzed the signal-to-noise ratio (SNR) of the sensor data and trained a preliminary extreme gradient boosting (XGBoost) model, comparing it with baseline models to classify binary engagement states using video-coded ground truths. RESULTS: InteractiSense showed a tendency toward higher preference and comparable usability and workload metrics relative to the Xbox controller. Caregivers associated its round shape, soft texture, and simplified configuration with favorable perceptions and noted peer collaboration during the SG and interest in home use. Signal quality varied across sensing modalities: selected modalities provided analyzable data, whereas audio quality was low and pressure data were excluded from SNR and ML analyses. XGBoost achieved 83% (CI 0.76-0.90) balanced accuracy in binary engagement classification, exceeding random and majority-class baselines. CONCLUSIONS: These findings provide initial evidence that InteractiSense can serve as a dual-purpose platform supporting collaborative play and engagement-aware sensing within the same tangible interface. Unlike prior systems focused on either interaction support or separate monitoring, InteractiSense combines embedded multimodal sensing with a social play interface in one platform for children with ASD. This study offers a proof-of-concept for extending tangible play systems toward engagement-related sensing and inference, with implications for future therapeutic and educational tools that monitor play and support adaptive intervention. However, feasibility was shown only at a preliminary level, requiring validation in larger cohorts and over longer observation periods.

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12. Kılıçaslan F, Öz Ö, Carık C, Mutlu MB, Gürler A. Syndromic Autism in Helsmoortel-Van der Aa Syndrome: From Clinical Suspicion to Genetic Diagnosis. Dev Neurobiol. 2026; 86(4): e70070.

Syndromic autism refers to autism spectrum disorder (ASD) occurring as part of an identifiable genetic syndrome. Helsmoortel-Van der Aa syndrome (HVDAS/ADNP syndrome) is a rare autosomal dominant neurodevelopmental disorder caused by heterozygous pathogenic variants in the ADNP gene. We report a 10-year-old boy with ASD and intellectual disability who exhibited delayed motor and language development, characteristic facial dysmorphism, early tooth eruption, endocrine abnormalities, electroencephalography (EEG) abnormalities, and urogenital findings. Following unremarkable karyotyping and chromosomal microarray analysis (CMA), whole-exome sequencing identified a heterozygous pathogenic de novo frameshift variant, c.1239_1240del, p.(Gln414Valfs*25) in ADNP. This case emphasizes the importance of considering a syndromic etiology in children with ASD accompanied by developmental delay, dysmorphic features, neurological findings, or multisystem involvement, and supports comprehensive genetic evaluation when first-tier testing is unrevealing.

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13. Kourti A, Zikou F, Costarelli V, Papoudi D, Antonopoulou K. Correction: Psychological and Emotional Well-being of Autistic Individuals with an Immigrant Background: Exploring Strengths and Challenges Through a Mixed-methods Systematic Review. J Immigr Minor Health. 2026.

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14. Li X, Zuo F, Cheng Y, Perkins K, Cao F. Two clusters of brain regions with distinct age-related profiles of functional connectivity in autism spectrum disorder. Proc Natl Acad Sci U S A. 2026; 123(42): e2617358123.

Brain functional connectivity changes throughout development, and individuals with autism spectrum disorder (ASD) may follow trajectories that differ from those of typically developing controls. Using large multisite resting-state fMRI cross-sectional datasets, we examined how functional connectivity differences between ASD and typically developing controls change across a broad age range of 5 to 64 y. A data-driven analysis identified two spatially distributed clusters of cortical regions showing distinct age-related profiles of ASD-TD connectivity differences. Cluster 1 was marked by consistent hypoconnectivity across ages, suggesting a stable neural signature of ASD. Cluster 2 was characterized by hypoconnectivity in childhood that gradually diminished with age, suggesting a temporary delay profile. These clusters were systematically organized along the sensory-association axis. Cluster 1 mainly involved lower-rank sensory and sensorimotor cortices, while Cluster 2 mainly involved higher-rank association cortices. Brain-behavior analyses revealed greater and broader ASD symptom associations across ages in the consistent hypoconnectivity profile than the delay profile. Further subtype analyses suggested that social-affect symptoms were associated with greater hypoconnectivity than repetitive behavior symptoms in both clusters. Spatial correlation analyses with neurotransmitter maps revealed associations of Cluster 1 with mGluR5 and of Cluster 2 with GABA(A)α5, providing insight into the neurobiological basis of the two clusters. In a cross-disorder validation analysis, applying the same analytic framework to attention-deficit/hyperactivity disorder did not reveal comparable results. Together, these findings suggest that ASD-related functional connectivity alterations are developmentally heterogeneous and organized along the cortical hierarchy, providing a developmental perspective for understanding the neurobiology of ASD.

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15. Lindly OJ, Abate DJ, Park HJ, Kuhn J, Fuchu P, Feinberg E, Broder-Fingert S. The Influence of Policy on Early Diagnosis and Other Autism Services: A Narrative Review. Rev J Autism Dev Disord. 2025; 12(4): 757-79.

Little is known about how policy-laws, regulations, procedures, administrative actions, incentives, or voluntary practices of governments or other institutions-shapes access to early autism services including diagnosis before age three. Early diagnosis and treatment are considered critical to improve outcomes and to understanding how policy influences on such services could have substantial impact on outcomes for autistic children. We conducted a narrative literature review to determine what is known on how policy impacts early autism diagnosis and treatment. We found 17 articles that describe policy factors promoting early diagnosis and seven articles that identify policy factors affecting variability in autism services. We identified the following themes: (1) state policy factors influence access to diagnosis and other autism services, (2) innovative screening models affect early diagnosis, (3) provider training programs increase autism screening and diagnosis, (4) insurance policy influences autism services variability, and (5) resource availability affects geographic variability in autism services. Although common themes exist, more robust investigation is needed on policy impacting early autism services–beyond insurance and early intervention–and utilizing more rigorous designs.

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16. Liu B, Zhang Z, Thomas N, Das S. Quality of life outcomes associated with stigma in autistic adults and their families: a systematic review. Front Psychiatry. 2026; 17: 1911423.

BACKGROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impaired communication and repetitive and/or restricted behaviors or interests. Autistic adults face stigma in several forms including discrimination, negative judgement and stereotyping, which may contribute to poorer quality of life (QoL) outcomes. Whilst the impact of stigma on QoL in autistic pediatric populations have been extensively studied, autistic adults and their caregivers represent a gap in the literature. AIMS: To examine different types of stigma faced by autistic adults and their family/caregivers and its impact on their quality of life, guided by World Health Organization QoL (WHOQOL) domains. which include physical health, psychological health, social relationships and environment. METHODS: A systematic literature search was conducted in APA PsycInfo, Ovid MEDLINE (R) and Embase for keywords related to ASD and stigma. Studies that were eligible were peer reviewed English articles from 2013 onwards including autistic adults or their caregivers that examined at least one subtype of stigma as defined by this review. Stigma subtypes explored included internalized, public, structural, intersectional and affiliate stigma. RESULTS: A total of 53 studies were included. Experiences of autism related stigma overwhelmingly led to poor quality of life outcomes across mental and physical health domains, relationships and in employment, social and healthcare contexts. Internalized stigma emerged after repeated exposure to experiences of public and structural stigma, resulting in reduced self-efficacy, lowered help seeking behaviors and increased pressure to mask autistic symptoms. Public stigma was largely associated with social exclusion, exacerbating feelings of shame and low self-esteem. Structural stigma, especially in healthcare and workplace environments, reinforced stigma related trauma and reduced participation and engagement. Affiliate stigma placed further strain on family and relationships, brewing resentment and alienation within families. Intersectional stigma across many marginalized identities such as gender, ethnicity and sexuality, compounded the damaging effects of autism related stigma. CONCLUSION: Autism related stigma acts at structural, societal and individual levels, contributing to poor QoL outcomes for autistic adults and their family/caregivers. Future studies should consolidate causal relationships between stigma and QoL, while combatting stigma at multiple levels.

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17. Madeira L, Esposito CM, Stanghellini G. Embodiment, Enaction, and Attunement in Schizophrenia, Autism, and Psychopathy: A Comparative Phenomenological Review. Psychopathology. 2026: 1.

Schizophrenia spectrum disorders, autism spectrum disorder, and psychopathy may resemble one another at the behavioural surface. All three may involve social difficulties, flattened or atypical affect, unusual communication, interpersonal friction, and impaired social adaptation. Yet their experiential architectures differ in ways that are clinically decisive for differential diagnosis, risk assessment, therapeutic alliance, and environmental design. This narrative review critically synthesizes work in phenomenological psychopathology and 4E cognitive science to clarify how embodiment, enaction, and attunement are altered across these conditions, with attention to lived space, lived time, selfhood, the Other, empathy, and atmosphere. We draw on classical phenomenological psychopathology, contemporary research on minimal self disturbance and anomalous self and world experience, enactive and participatory sense-making accounts of social cognition, and theoretical and empirical literature on autism and psychopathy. Schizophrenia is characterised by instability of minimal self and world openness, including hyperreflexivity, diminished self-affection, altered salience, temporal fragmentation, demarcation disturbances, and atmospheric shifts that may precede overt psychosis. Autism is characterised by differences in embodied sense-making and interactional coordination, frequently involving sensory regulation needs, altered social timing, atypical affordance perception, masking fatigue, and bidirectional mismatch as described by the double empathy problem. Psychopathy is characterised by preserved strategic social understanding with reduced affective resonance, moral emotions, and interpersonal concern, yielding forms of instrumental attunement and distinctive encounter climates. Clinically, targeted phenomenological and second person assessment can improve formulation, reduce diagnostic overshadowing, and guide more differentiated care pathways.

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18. Mukunya D, Ndeezi G, Namazzi G, Tylleskär T, Nambozo B, Musaba MW, Odongkara B, Achora V, Tongun JB, Tumuhamye J, Napyo A, Ssentumbwe V, Nankabirwa V, Tumwine JK. Predicting neurodevelopmental delay among two-year-old infants in Northern Uganda. Glob Health Action. 2026; 19(1): 2748101.

BACKGROUND: Data on neurodevelopmental disabilities in sub-Saharan Africa are scarce. Identifying children at the highest risk of neurodevelopmental delay could enable health workers to target these groups more effectively, improve resource allocation and programmatic focus. OBJECTIVE: To develop and assess a model for predicting neurodevelopmental delay among two-year-old infants in Northern Uganda using easily obtainable predictors. METHODS: We studied children born to women enrolled in a cluster randomized controlled trial (January 2018-March 2019) evaluating the effect of peer counseling on health facility births. At the trial’s final visit (day 50), 1,804 children were enrolled. In November 2020, we followed up 1,421 children (78.8%) and assessed their neurodevelopment at 2 years using the Malawi Developmental Assessment Tool. We used least absolute shrinkage and selection operator penalized regression with 10-fold cross-validation to select the best subset of predictors and assessed model performance using the area under the curve (AUC). RESULTS: Of the 1,421 children, 70 (4.9%; 95% CI: 3.6-6.7%) had neurodevelopmental delays. Of the 19 candidate predictors, six were retained in the final model (lambda = 0.0076): moderate wasting, prolonged neonatal hospitalization (up to 28 days), maternal education, place of birth, preterm birth, and absence of skin-to-skin contact at birth. The model showed strong discriminative power (AUC 0.75) and reasonable calibration (calibration slope 1.37; calibration belt 0.536-0.727). CONCLUSION: We developed a promising tool for identifying infants at increased risk of neurodevelopmental delay in low-resource settings, which could help prioritize children for follow-up and specialized interventions. Main findings: we developed and evaluated a risk prediction model that identified six readily available factors associated with neurodevelopmental delay among infants in Northern Uganda and demonstrated a good ability to distinguish children at increased risk.Added knowledge: this study provides evidence that routinely collected maternal, birth, and early infant characteristics can be used to support early identification of children who may benefit from targeted neurodevelopmental follow-up.Global health impact for policy and action: the findings provide a practical approach for low-resource settings to improve early detection, prioritize limited resources, and guide interventions to reduce the burden of neurodevelopmental disabilities. eng.

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19. Newbutt N, Fan Y, Kang H, Orlando A, Asadizanjani N, Nazef A. Barriers and enablers shaping autistic college students’ pathways into advanced manufacturing careers. Aust J Psychol. 2026; 78(1): 2746627.

OBJECTIVE: Autistic college students are strongly represented in STEM disciplines, yet continue to experience disproportionately poor employment outcomes after graduation. This study explores their lived experiences navigating educational and career pathways into advanced manufacturing, a high-demand sector facing persistent workforce shortages and substantial public investment, yet largely absent from autism and employment scholarship to date. METHOD: Sixteen autistic STEM undergraduates (current or previous) from across the US participated in three 90-minute focus groups conducted via Zoom. Sessions examined students’ career aspirations, job search experiences, perceived barriers, and support needs, and were analysed using thematic analysis to identify enablers and systemic barriers shaping participants’ transitions from education to industry. RESULTS: Participants demonstrated proactive engagement in developing technical skills through coursework, self-directed learning, and hands-on experiences. However, they encountered opaque hiring processes, unclear interview expectations, limited access to prior industry experience, workplace sensory challenges, and fragmented institutional support, often relying on informal networks and AI-based tools to compensate. Participants emphasized inclusive, sensory-aware learning environments, structured career preparation, and autism-informed mentorship as critical bridges between academic training and workforce expectations. CONCLUSIONS: Employment disparities reflect systemic misalignment rather than individual deficits, underscoring the need to redesign education-to-work pathways that recognize and leverage autistic strengths. What is already known about this topic: Autistic college students are strongly represented in STEM education.Autistic graduates often face poorer employment outcomes than their peers.Career and transition support for autistic students are often fragmented and poorly aligned. What this topic adds: Autistic college students build career readiness through coursework, self-learning, and hands-on experiences.Opaque hiring processes and sensory demands create major barriers for autistic students to advanced manufacturing careers.Neuroinclusive mentoring, clearer career preparation, and structured supports may help to improve pathways into work. eng.

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20. Ng CSM, Marchal O, Chan VCW. Parenting Stress, Coping and Well-Being Among Chinese Parents of Children With Autism Spectrum Disorder. J Autism Dev Disord. 2026.

PURPOSE: Research on coping and parental well-being among Asian parents of children with autism spectrum disorders (ASD) remains limited. This study examined parenting stress, coping strategies, and psychological well-being among Chinese parents in Hong Kong raising children with ASD, compared to parents of typically developing (TD) children. METHODS: A total of 92 Chinese parents in Hong Kong participated in the survey, including 42 parents of children with ASD. Standardized measures were used to assess parenting stress, coping, and psychological well-being. RESULTS: Findings revealed that Chinese parents of children with ASD experienced significantly higher levels of parenting stress, anxiety and depression compared to parents of TD children. They reported using a broad range of coping strategies, including problem-focused, emotion-focused and dysfunctional coping. Subgroup analyses based on educational attainment and household income revealed that elevated parenting stress was consistent across all education levels. Notably, parents at both the highest and lowest ends of each category of education and income reported poorer psychological well-being. Differences in coping strategies between ASD and TD groups were generally not significant, except among parents with mid-range levels of household income and education. CONCLUSION: These findings highlight the urgent need to address parenting stress and psychological well-being among Chinese parents in Hong Kong raising children with ASD, irrespective of socioeconomic background. By situating the study within the Hong Kong cultural context, the research underscores the importance of culturally specific support interventions tailored to the diverse challenges faced by families and extends the broader literature.

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21. Petronis C. « Dr. TikTok »: How algorithms suggest ADHD and autism diagnoses. Soc Sci Med. 2026; 410: 119891.

The internet allows patients to take a more active role in the diagnostic process, as the interactivity of « Dr. Google » and other online symptom-checkers demonstrates. Social media has emerged as a locus where (self-)diagnoses can be made through social interaction with others who identify as holding diagnostic identities. This paper builds on a foundation of research analyzing TikToks about ADHD and autism and the platform’s content recommendation algorithm to examine how users are served content that implies that they occupy a given diagnosis, representing a distinct iteration of Dr. Google. The algorithm, not the user, could trigger the diagnostic process by labeling the user with a diagnosis or other pathologizing characteristics. I analyze how the TikTok algorithm encourages content themes and forms that may alter public perception of the boundaries, characteristics, and prevalence of ADHD and autism, as well as their entanglement with each other and the label of neurodivergence. I engage with the TikTok algorithm using digital ethnographic and discourse analysis approaches to understand « Dr. TikTok » as an example of how diagnostic pathways may be becoming increasingly mediated by AI systems. I find that the TikTok algorithm shapes TikToks about ADHD and autism by encouraging creators to engage in practices like speaking in second-person to the viewer and positioning relatable experiences as a form of subjective diagnostic expertise, situating these videos as paradoxically hyperpersonalized, yet inclusive. This study contributes to the sociology of medicine by showing how AI systems could intervene in and reorder the traditional diagnostic process.

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22. Ramsey VL, Sadighi T, Clemons A, Mandalis CD. Barriers and Opportunities in Anesthesia Care for Patients With Intellectual and Developmental Disabilities: A Qualitative Study. Aana j. 2026; 94(5): 371-8.

Health disparities among individuals with intellectual and developmental disabilities (IDD) remain a significant public health concern requiring complex, interdisciplinary care tailored to communication, behavioral, and individualized needs. Despite frequent exposure to surgical and procedural interventions, nurse anesthesiology programs provide limited formal education to prepare clinicians for this population. Most importantly, the role of nurse anesthesiologists across the perioperative continuum remains underrepresented in discussions of IDD-focused care. This qualitative phenomenological study explored perceived curricular needs related to IDD within nurse anesthesiology education to inform targeted instructional strategies. Four major themes emerged: 1) communication and patient-centered care, 2) barriers to care delivery, 3) educational gaps and training needs, and 4) strategies for improving care and professional development. Participants consistently identified significant gaps in structured training and professional development related to improving care delivery. Many described relying heavily on experiential, self-directed, or trial and error learning approaches because of the absence of formalized education and mentorship opportunities. Limited access to continuing professional development, evidence-based training resources, and organizational support further contributed to variability in confidence and preparedness. These findings highlight important areas for growth, particularly the need for standardized training programs, ongoing educational support, and accessible professional development initiatives to strengthen competency, confidence, and quality of care.

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23. Rao NK, Veeranki YR. Automated autism spectrum disorder detection using EEG signals and time-frequency visibility graphs. Neuroscience. 2026; 614: 273-83.

Early and objective screening of Autism Spectrum Disorder (ASD) remains challenging because conventional diagnosis primarily relies on behavioural assessment and clinical observation. To address this limitation, this study proposes a dual-domain computational framework for automated EEG-based ASD classification by integrating complementary time-frequency analysis with Horizontal Visibility Graph (HVG)-based network modelling. Four time-frequency decomposition techniques, namely the Short-Time Fourier Transform (STFT), Discrete Wavelet Transform (DWT), Wigner-Ville Distribution (WVD), and Superlet Transform (SLT), were employed to characterise the non-stationary dynamics of resting-state EEG signals. The resulting time-frequency representations were transformed into HVG networks, from which 17 graph-theoretic descriptors were extracted and evaluated using conventional machine learning classifiers, including a Soft Voting Ensemble. Among the investigated methods, the DWT-HVG framework combined with the Soft Voting Ensemble achieved the best performance, yielding an accuracy of 93.54%, sensitivity of 94.32%, specificity of 92.76%, F1-score of 93.62%, balanced accuracy of 93.54%, and an Area Under the Curve (AUC) of 98.17% using stratified 10-fold cross-validation. Statistical analysis using the Wilcoxon signed-rank test further confirmed the superiority of the DWT-based representation over the STFT, WVD, and SLT-based approaches. These findings demonstrate that integrating multiresolution time-frequency analysis with HVG-based graph-theoretic feature extraction provides an accurate, interpretable, and computationally efficient framework for objective EEG-based ASD screening.

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24. Robbins AL, Preciado C, Demopoulos C. Sex differences in neuropsychological profiles of youth with autism spectrum disorder. Child Neuropsychol. 2026: 1-29.

Autism spectrum disorder (ASD) is more prevalent in males, and females are underrepresented in the extant autism research literature, resulting in limited knowledge and historical misconceptions about female presentations. One such misconception is that females with ASD are more likely to be cognitively impaired than males. Empirical studies of sex differences in cognition have focused mainly on IQ and proposed superior performance in males diagnosed with autism. Little research has examined sex differences in broader neuropsychological functioning in autism. In this study, we used multivariate analyses of covariance (MANCOVAs) to compare performance on eight domains of neuropsychological (i.e. Intellectual Abilities, Language, Executive Functioning, Attention, Sensorimotor Skills, Social and Adaptive Functioning, and Emotional and Behavioral Functioning) in 101 autistic children and adolescents aged 8-17 years who were assigned male (MSAB; n = 61) and female (FSAB; n = 40) sex at birth. Follow‑up univariate analyses of covariance (ANCOVAs) were performed on individual measures within domains of functioning where group differences were identified. Significant sex differences were observed in the domains of Language, Executive Functioning, and Emotional and Behavioral Functioning. Follow-up univariate analyses indicated that females scored higher on measures of expressive language and vocabulary, made fewer nonperseverative errors, and had higher levels of parent-reported internalizing problems. Together, these findings do not support previous misconceptions of greater cognitive impairment in females with ASD. In contrast, these results suggest that females with autism may show relative strengths in verbal expression and problem-solving; however, they also may experience higher levels of internalizing symptoms.

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25. Roychowdhury B, Jalihal S, Ankola AV, Sankeshwari RM, Coutinho DA, Sakthi K, Dutta D, Santhosh VN. Comparative effectiveness of triple-headed and conventional toothbrushes for plaque control and gingival health in children and adolescents with autism spectrum disorder: A randomized controlled trial. J Am Dent Assoc. 2026.

BACKGROUND: Children and adolescents with autism spectrum disorder (ASD) are prone to poor oral hygiene due to motor and sensory challenges. This trial evaluated whether a triple-headed toothbrush (THT) improves gingival health and plaque control more effectively than a conventional toothbrush (CT). METHODS: A multicenter, single-blind randomized controlled trial enrolled 102 children aged 7 through 18 years with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition level 1 or 2 ASD across 3 special schools in India, randomized 1:1 to THT or CT. All participants received standardized oral health education and caregiver-supervised twice-daily brushing for 3 months. Plaque and gingival index scores were recorded by a calibrated, blinded examiner at baseline and at 3 months. RESULTS: At 3 months, THT use produced significantly greater reductions in plaque (Hodges-Lehmann estimator, -0.50; 95% CI, -0.63 to -0.31; P < .001; r = 0.60) and gingival (Hodges-Lehmann estimator, -0.25; 95% CI, -0.44 to -0.13; P < .001; r = 0.39) scores than CT, with pronounced improvements on the lingual surface. Both groups showed significant within-group reductions. THT acceptability improved significantly over the study period. CONCLUSIONS: A THT produced superior plaque and gingival improvements compared with a CT in children and adolescents with ASD, with pronounced lingual surface benefits and increasing acceptability over time. PRACTICAL IMPLICATIONS: For families supporting children with ASD in resource-limited settings, a THT offers a cost-effective, technique-forgiving alternative to CTs, improving oral hygiene outcomes when used with caregiver supervision. This clinical trial was registered at Clinical Trials Registry-India. The registration number is CTRI/2024/12/078552.

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26. Saleh MG, Melch M, Triolo E, Bloy L, Blaskey L, Brodkin ES, Roberts TPL. DEW-MEGA-PRESS of phosphorylethanolamine and glutathione: Reproducibility and feasibility in individuals with autism. Brain Res Bull. 2026; 245: 112122.

PURPOSE: To demonstrate double-editing (DEW) MEGA-PRESS editing of phosphorylethanolamine (PE) and glutathione (GSH) in vivo, estimate measurement variability, and conduct a feasibility study on individuals with autism. METHODS: 13 participants with autism spectrum disorder (ASD), with an average age of 28.00 ± 4.81 years, and 14 typically developing (TD) participants, with an average age of 29.33 ± 5.36 years, were enrolled in the study. DEW-MEGA-PRESS at a Siemens 3 T MRI scanner was used to edit both PE and GSH (ON(PE)/ON(GSH) = 3.98/4.56 ppm). Within-subject variability was examined in 15 participants (11 TD and 4 ASD) using repeated scans conducted at 4 and/or 12 weeks after baseline. Finally, differences in PE and GSH between the two groups were assessed using linear mixed-effects models. RESULTS: In vivo experiments show excellent separation between the PE (3.22 ppm) and GSH (2.95 ppm) signals. Within- and between-subject reproducibility assessments revealed coefficients of variation (CV) of 9.0/18.5% for PE and 7.4/10.3% for GSH. Although GSH showed no statistically significant differences, PE levels were significantly higher in ASD than in TD (p < 0.05), and only TD showed a decrease in PE with aging (p < 0.05). CONCLUSION: In vivo experiments demonstrate excellent separation between PE and GSH, and good within-subject reproducibility, supporting the stability of the approach. Between-subject variability exceeded within-subject variability for both chemicals, suggesting that biological differences between individuals dominate over measurement noise and supporting the feasibility study assessing differences between TD and ASD.

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27. Shibukawa S, Takabayashi K. Integrating neurofluid dynamics and brain network development to understand clinical trajectories in autism spectrum disorder. Psychiatry Clin Neurosci. 2026.

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28. Su J, Li L, Wang Y, Fan T. Effects of exercise interventions on fundamental motor skills in children and adolescents with autism spectrum disorder: a meta-analysis with meta-regression analyses of randomized controlled trials. Front Psychiatry. 2026; 17: 1954728.

PURPOSE: The objective of this study was to systematically evaluate the effects of exercise interventions on fundamental motor skills (FMS) in children and adolescents with autism spectrum disorder (ASD) and determine whether distinct FMS domains demonstrate differential responses to exercise dosage and intervention characteristics. METHODS: A comprehensive search of PubMed, the Cochrane Library, Embase, and Web of Science up to July 2026 identified 31 RCTs. Standardized mean differences were calculated to evaluate the effects of exercise interventions on object control, locomotor, and stability skills. Subgroup and meta-regression analyses examined the effects of intervention characteristics and exercise dosage, while sensitivity analyses and risk of bias assessments evaluated the robustness of the findings. RESULTS: Exercise interventions significantly improved all three dimensions of FMS in children and adolescents with ASD: Object control skills (OCS) (Hedges’ g = 1.13, 95% CI: 0.67 to 1.59), Locomotor skills (LMS) (Hedges’ g = 1.19, 95% CI: 0.87 to 1.51), and Stability skills (SS) (Hedges’ g = 1.08, 95% CI: 0.68 to 1.49). Further analyses revealed domain-specific responses to exercise dosage. Longer exercise session time was associated with greater improvements in OCS, supported by both subgroup analyses and meta-regression. For LMS, greater effects were observed with three sessions per week and interventions lasting ≤ 10 weeks in subgroup analyses, although these findings were not confirmed by meta-regression. No significant dose-related associations were identified for SS. CONCLUSION: Exercise interventions improve OCS, LMS, and SS in children and adolescents with ASD. Different FMS domains may show distinct responses to exercise dosage, suggesting that future exercise programs may need to consider the specific characteristics of targeted motor domains. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251139963, identifier CRD420251139963.

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29. Tschiedel C, Heller V, Wathsack L, Kern F. Accomplishing classroom activity transitions with autistic children: A situated and multimodal approach to communicative competence. Clin Linguist Phon. 2026: 1-20.

This paper explores how transitions between different conversational activities are accomplished in classroom interactions with autistic children. These transitions are pervasive phenomena in interaction that require participants to use both verbal and bodily behaviour to display their involvement with new partners and activities. Drawing on 60 hours of video recordings and employing a multimodal conversation-analytic approach, the study examines instances of transitions in which troubles arise. The analysis focuses on how autistic children deal with transitions and how their co-participants respond to their ‘uncommon’ use of bodily resources. We demonstrate co-participants’ various practices with three examples ranging from upgraded directives, over mockery, to disregard. These practices create differential opportunities for the autistic children to display their communicative competence. This interactional perspective challenges deficit-oriented models of communicative behaviour and contributes to a more dynamic and co-constructive understanding of communicative competence.

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30. Wang X, Li R, Li Y, Wang D, Cai Y, Liu X. Salidroside enhances hippocampal neurogenesis in a valproic acid-induced mouse model of autism by suppressing neuroinflammation. Int Immunopharmacol. 2026; 187: 117195.

OBJECTIVE: Neuroinflammation plays a pivotal role in the pathogenesis of autism spectrum disorder (ASD) and represents a potential therapeutic target. Salidroside (SLDS), a bioactive compound isolated from Rhodiola rosea L., exhibits potent anti-inflammatory and neuroprotective effects in various neurological disorders; however, its therapeutic efficacy in ASD remains to be fully established. This study investigated whether SLDS ameliorates autism-like behaviors and hippocampal neuroinflammation in a valproic acid (VPA)-induced mouse model. METHODS: A total of 92 male C57BL/6 J mice were randomly assigned to four groups (n = 23 per group). Mice received a subcutaneous injection of VPA or saline on postnatal day 14 (P14), followed by intraperitoneal administration of SLDS or saline from postnatal day 28 (P28) for seven consecutive days. Behavioral assessments were conducted at 8 weeks of age. Hippocampal neuroinflammation, microglial polarization, and neurogenesis were analyzed by molecular, immunofluorescence, and histological techniques. RESULTS: VPA-exposed mice exhibited social interaction deficits, increased repetitive behaviors, elevated levels of pro-inflammatory cytokines, upregulated expression of inflammation-related proteins, microglial activation, and impaired hippocampal neurogenesis. SLDS treatment significantly attenuated these VPA-induced abnormalities. CONCLUSION: Collectively, these findings suggest that SLDS represents a promising therapeutic candidate for ASD by mitigating neuroinflammation and restoring hippocampal function. Nevertheless, given that these observations are derived from preclinical models, further validation in translationally relevant experimental systems and clinical investigations is warranted before extrapolation to human therapeutic applications.

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31. Yin BY, Deng YY, Chen X, Zhao JY, Ni YX, Zhong SS, Zou FY, Shen LS, Luo XW, Zhou X, Zhang JL, Zhou WY, Deng HZ, Guo RM. Neuroclearance dysfunction in autism with sleep disorder: MRI evidence and mediation by systemic iron deficiency. J Affect Disord. 2026; 411: 122035.

BACKGROUND: Sleep disturbances are highly prevalent in children with autism spectrum disorder (ASD) and exacerbate neurodevelopmental impairments. Yet, the mechanistic link between sleep disruption, brain fluid clearance, and systemic trace element status remains unclear. METHODS: We enrolled 230 children with ASD (114 with sleep disorder, ASD-SD; 116 without, ASD-nSD) and 110 typically developing controls. Neuroclearance function was quantified using diffusion kurtosis imaging along the perivascular space (DKI-ALPS), free water fraction (FW), and perivascular space volume fraction (PVSVF). Serum iron (Fe), lead (Pb), and magnesium (Mg) were measured. Group comparisons, correlations, ROC analysis, and mediation modeling assessed relationships among sleep, iron status, and neuroclearance. RESULTS: ASD-SD children exhibited significantly reduced ALPS indices and elevated FW compared with ASD-nSD and controls, indicating impaired perivascular clearance. Serum Fe was markedly lower in ASD-SD, whereas Pb was elevated; Mg showed no significant differences. ALPS indices strongly correlated with Fe levels (r = 0.75-0.95). Mediation analysis revealed that iron deficiency partially reduced ALPS via increased FW, supporting a hypothesized « Fe deficiency → cerebral edema → impaired neuroclearance » pathway. Combined ALPS and serum Fe distinguished ASD-SD from ASD-nSD and controls with high accuracy (AUC up to 0.94). CONCLUSION: Children with ASD and comorbid sleep disorder exhibit pronounced neuroclearance dysfunction linked to systemic iron deficiency. The combination of DKI-ALPS and serum Fe shows potential as a candidate biomarker for ASD-SD, highlighting a potential cascade from sleep disruption to impaired neuroclearance and suggesting targeted interventions integrating iron supplementation and sleep optimization.

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