1. Ahmad HRM, Hasan Alqudah Q, Elkhalifa HEE, Merghani AS, Abusbaih RR, Ghaleb AN, Mohamed Elhassan OOO, Ahmed A, Jibreel M. Early Warning Signs of Autism: A Systematic Review of Nonverbal Behavioral Markers and Early Developmental Red Flags in Children Under 36 Months. Cureus;2026 (Mar);18(3):e105485.

Early identification of autism spectrum disorder (ASD) remains a priority because clinical diagnosis often occurs after the earliest stages of development, and early behavioral signs can be subtle and variable across children. This systematic review summarized evidence on early nonverbal behavioral markers measured before 36 months that are associated with later-ASD diagnosis or classification. A PRISMA-aligned search was conducted. Eligible studies assessed nonverbal behavioral markers before age three and reported ASD outcomes at a later follow-up. Data were extracted on study design, population, marker domains, assessment methods, and predictive performance when reported. Risk of bias was assessed using tools matched to the study type. Findings were synthesized narratively because studies differed in cohorts, tasks, and outcome definitions. Across the included studies, early ASD-related signals most often appeared as differences in developmental change over time rather than as fixed abnormalities present from birth. Evidence was most consistent for differences in social visual engagement and attention flexibility during the first year of life, with more apparent differences from late infancy into the second year in attention disengagement, repetitive and sensory-linked behaviors, and motor and postural development. Predictive performance for single markers was generally limited. At the same time, combinations across domains and multimodal approaches appeared more useful, although they still require external validation and more transparent reporting before use in practice. Overall, the evidence supports longitudinal surveillance that combines multiple early behavioral domains to improve early risk identification.

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2. Albuquerque MAV, Dias SL, Lima KD, Kok F, Zanoteli E. Neurocognitive and autism spectrum profiles associated with dystrophin isoform disruption in childhood dystrophinopathies: insights from a Brazilian cohort. Eur J Paediatr Neurol;2026 (Apr 20);62:1-5.

AIM: To examine the association between dystrophin isoform disruption and cognitive and behavioral outcomes, including autism spectrum disorder (ASD), in a large cohort of boys with Duchenne muscular dystrophy (DMD) and related dystrophinopathies. METHOD: In this retrospective cohort study (2014-2025), 161 boys with genetically confirmed dystrophinopathy (145 DMD, 14 Becker muscular dystrophy, and 2 intermediate muscular dystrophy) were classified according to predicted involvement of the brain-expressed dystrophin isoforms Dp427, Dp140, and Dp71. Cognitive function was assessed using standardized intelligence measures (WISC-IV or WASI), complemented by comprehensive neuropsychological evaluation. ASD was diagnosed according to DSM-5 criteria and confirmed through multidisciplinary assessment. RESULTS: Intellectual disability (ID) was identified in 63 of 161 patients (39.1%), including 47 (29.1%) with mild and 16 (10.0%) with moderate ID. ASD was diagnosed in 16 patients (10%), and in 81% of cases ASD identification preceded or coincided with the diagnosis of dystrophinopathy. An isoform-dependent gradient was observed: patients with mutations restricted to exons 1-44 (Dp427-only) showed the highest frequency of normal cognition, whereas those with mutations affecting Dp140 or Dp71 exhibited progressively higher rates of ID and ASD. INTERPRETATION: Cognitive impairment and ASD are frequent non-muscular manifestations of childhood dystrophinopathies and correlate closely with disruption of brain-expressed dystrophin isoforms, particularly Dp140 and Dp71. Integrating genetic and neuropsychological assessment into routine clinical care is essential for early recognition and timely intervention.

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3. Awad R, Aga-Mizrachi S, Maoz I, Simchi L, Avital A, Sosnik A. Nose-to-brain administration of cannabidiol-loaded polymeric micelles improves the core behavioral symptoms of autism spectrum disorder. Bioact Mater;2026 (Aug);62:831-845.

Neurodevelopmental disorders including autism spectrum disorder (ASD) affect 5.9% of the global population. Research shows the potential therapeutic use of cannabidiol (CBD) to treat different neurodevelopmental disorders, including ASD. Intranasal drug delivery (i.n.) is a non-invasive and painless administration route that enhances drug bioavailability in the brain bypassing the blood-brain barrier. Various polymeric nanoparticles have been investigated for i.n. delivery with different success levels. In this study, we developed and characterized polymeric micelles of the poly(ethylene oxide)-b-poly(propylene oxide) block copolymer Pluronic® F127 loaded with 25% w/w CBD (based on solid weight) for nose-to-brain delivery in ASD. CBD-loaded polymeric micelles display a hydrodynamic diameter of 41 ± 1 nm by Intensity and 23 ± 1 nm by Number, as measured by dynamic light scattering, and very good compatibility and permeability in the human nasal septum cell line RPMI 2650, an in vitro model of the nasal epithelium. The accumulation of CBD-loaded polymeric micelles administered intranasally in the brain of ASD-like rats is confirmed by bioimaging. The CBD pharmacokinetics upon the i.n. (dose of 5 mg/kg) and oral (15 mg/kg) administration of the loaded polymeric micelles shows a 27.8% increase of the CBD concentration in the brain of ASD-like rats 20 min after i.n. administration, despite the 3-fold decrease in the dose. Finally, the efficacy of this nanoformulation to improve the core symptoms of ASD is demonstrated in behavioral studies in a behavioral model of the disorder in rats.

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4. Bazbaz W, Kartawy M, Khaliulin I, Amal H. Nitric oxide inhibition ameliorates cortical proteomic changes in the Cntnap2(-/-) and Shank3(Δ4-22) mouse models of autism spectrum disorder. Mol Autism;2026 (Apr 20);17(1)

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a strong genetic component, and over a thousand associated genes have been identified, including CNTNAP2 and SHANK3. Our previous work using Cntnap2(-/-) and Shank3(Δ4–22) ASD mouse models implicated dysregulated nitric oxide (NO) signaling in ASD-related behaviors, which were improved by inhibition of neuronal nitric oxide synthase (nNOS) with 7-Nitroindazole (7-NI). However, the molecular mechanisms linking NO signaling to ASD pathology remain poorly defined. METHODS: We performed mass spectrometry-based global proteomic profiling of cortical tissue from both mouse models under baseline conditions and following 7-NI treatment. Systems biology and bioinformatics analyses were used to identify differentially expressed proteins, enriched pathways, and treatment-responsive networks. Cross-model comparisons were performed to assess molecular convergence and overlap with human ASD-risk genes. Behavioral and biochemical assessments were reanalyzed to evaluate ASD-like phenotypes and treatment effects. RESULTS: Treatment with 7-NI improved ASD-like behavioral deficits in Cntnap2 and Shank3 mutant mice, including increased sociability and reduced anxiety-like behavior. 7-NI was also associated with attenuation of cortical protein alterations across synaptic, neuronal, and metabolic pathways, shifting subsets of dysregulated proteins toward wild-type expression levels. Despite distinct genetic mutations, the two models converged at the protein and pathway levels, including treatment-responsive proteins encoded by high-confidence human ASD risk genes. LIMITATIONS: Analyses were restricted to cortical tissue; additional brain regions may reveal complementary mechanisms. Mass spectrometry may underrepresent low-abundance proteins; larger sample sizes could improve statistical power. Potential off-target effects of 7-NI should also be considered. CONCLUSIONS: These findings show that nNOS inhibition improves ASD-like behaviors and is associated with partial normalization of altered cortical proteins across two genetically distinct ASD mouse models that display convergent molecular changes, including proteins encoded by high-confidence ASD risk genes. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13229-026-00716-1.

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5. Belaïdouni Y, Diabira D, Salin P, Brosset-Heckel M, Valsamides V, Graziano JC, Santos C, Menuet C, Wayman GA, Gaiarsa JL. Leptin antagonism improves Rett syndrome phenotype in symptomatic Mecp2-deficient mice. Neurotherapeutics;2026 (Apr 18);23(3):e00910.

Rett syndrome (RTT) is a severe X-linked neurodevelopmental disorder caused by mutations in MECP2. Elevated circulating levels of the adipocyte hormone leptin are consistently observed in patients and in mouse models, yet their contribution to disease progression has remained unclear. Here, we show that reducing leptin signaling-either pharmacologically or genetically-significantly alleviates RTT-like phenotypes in Mecp2-deficient mice. In males, these interventions preserved general health, prevented weight loss, and improved breathing and locomotor functions. At the neuronal level, they restored excitatory/inhibitory balance in the hippocampus and somatosensory cortex and rescued hippocampal synaptic plasticity. In females, delaying the pathological rise of leptin levels postponed symptom progression. These findings uncover leptin as a key contributor to RTT pathophysiology and position leptin-targeted interventions as a promising therapeutic strategy for this currently untreatable disorder.

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6. Burch K, Sahyoun AM, Abutineh S, Munkhsaikhan U, Alipour M, Zahran G, Ait-Aissa K, Wang Q, Samy S, Kassan A, Ishrat T, Abidi AH, Kassan M. From mouth to mind: Investigating oral microbial contributions to autism spectrum disorder. Neurosci Biobehav Rev;2026 (Apr 20);186:106702.

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent social communication challenges and restricted, repetitive patterns of behavior. ASD arises from both genetic and environmental influences. Growing evidence also points to microbial dysbiosis, especially in the gut and mouth, as a potential contributor to neurodevelopment and symptom patterns. While gut microbiome alterations have been well documented in ASD, the oral microbiota has received comparatively less attention, despite its established roles in systemic inflammation, immune regulation, and even neurological function. Understanding these microbial shifts may help identify early biomarkers and guide oral health interventions to improve outcomes in ASD populations. This narrative review synthesizes current knowledge on the relationship between oral microbiota dysbiosis and ASD, with three primary objectives: (1) to characterize oral microbiome alterations observed in individuals with ASD compared to neurotypical controls; (2) to explore potential mechanisms linking oral dysbiosis to core and comorbid ASD symptoms; and (3) to evaluate therapeutic strategies targeting the oral microbiome as potential interventions for ASD.

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7. Castro VL, Palomino CE, O’Shea J, Ames E, Frazier L, Pritchard A, Lesmana H, Rosas-Acosta G, Swann MJ, Quintana AM. Novel HCFC1 variants identified in patients with ASD/ADHD and previously unreported structural brain malformations reveal the potential for phenotypic expansion. Mol Genet Metab Rep;2026 (Jun);47:101309.

Pathogenic variants in the HCFC1 gene, which encodes a transcriptional cofactor, cause cblX syndrome, intellectual disability, or partial focal epilepsy. HCFC1 encodes a multi-domain precursor protein that undergoes proteolytic cleavage to produce N- and C-terminal fragments that interact non-covalently. Pathogenic variants in the N-terminal kelch domain cause cblX syndrome with high penetrance and severity. However, pathogenic variants in the proteolytic cleavage domain cause focal epilepsy, and pathogenic variants in the C-terminal domain (i.e. acidic) are associated with non-syndromic intellectual disability. Previous studies have loosely associated some variants with neuropsychiatric disorders such as schizophrenia and autism spectrum disorder (ASD), but the gene has not been associated with other neuropsychiatric disorders such as attention deficit hyperactivity disorder (ADHD). In this report, we describe the genotype-phenotype observations for 2 novel HCFC1 variants including one non-coding variant. The presence of ASD/ADHD in this case series indicates that neuropsychiatric features merit routine assessment when interpreting HCFC1 variants of unknown significance, pending larger studies and functional data.

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8. Cervantes PE, Seag DEM, Baroni A, Horwitz SM. Change in Pediatric Psychiatric Emergency Service Clinicians’ Confidence After Training to Improve Care for Autistic Youth At-Risk for Suicide: A Pilot Study. J Dev Phys Disabil;2026;38(2):317-327.

Autistic youth visit the emergency department (ED) for psychiatric concerns, including suicidal ideation and behavior, at elevated rates. However, clinicians often report low levels of training and confidence in addressing suicide risk in autistic youth. In this pilot study, clinicians in a pediatric psychiatric emergency service were trained on community- and evidence-informed recommendations to improve suicide-related care for autistic youth and provided with resources to use with autistic youth for a 3-month period. Ratings on attitudes and confidence were obtained from ten providers before and after the training/implementation period and compared. Ratings of feasibility and utility of strategies and resources were obtained from 15 providers after training/implementation and analyzed. While no changes were found across attitudes items, confidence scores were significantly higher after the training/implementation period than before, particularly in the area of suicide risk assessment. Feasibility and utility ratings were generally high, with endorsement patterns aligning with common organizational and systems-level barriers. This pilot study demonstrated that targeted training and evidence-informed recommendations to improve suicide-related care for autistic youth were associated with increased clinician confidence. As research continues in the development of adapted suicide risk assessment tools and management strategies for autistic youth, it is important that both clinical guidance on best practices is provided and that systems-level barriers are addressed.

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9. Cheung N. A Developmental Taxonomy of Autism and the Precision Timing of the Cheung Glutamatergic Regimen. Cureus;2026 (Apr);18(4):e107120.

Autism spectrum disorder is far more heterogeneous than traditionally assumed, with age at diagnosis reflecting distinct polygenic factors and fundamentally different developmental trajectories rather than simple differences in detection. What was previously described as a single two-stage synaptic course–early overgrowth followed by later depletion–now appears as two mechanistically separable subtypes. Early-diagnosed autism is characterised by a « Failure to Build, » driven by deficits in mitochondrial function, ribosomal biogenesis, and cytoskeletal integrity during initial synapse formation. In contrast, late-diagnosed autism reflects a « Failure to Refine, » arising from astrocyte dysfunction, complement-mediated over-pruning, and LRRK2 dysregulation during adolescent circuit remodelling, with strong transcriptomic convergence to ADHD. Against this backdrop, the Cheung glutamatergic regimen–a low-cost, orally available combination of dextromethorphan, a CYP2D6-inhibiting antidepressant, piracetam, and L-glutamine–is proposed as a ketamine-mimetic plasticity agent. The regimen is contraindicated in the early-diagnosed (« Build ») subtype and in all children under approximately 10 years due to the risk of exacerbating bioenergetic stress and excitotoxicity. However, it may prove restorative in post-pubertal individuals with late-diagnosed autism and ADHD comorbidity by counteracting astrocyte dysfunction, excessive complement tagging, and LRRK2-related pruning dysregulation. This refined, subtype- and timing-specific framework carries important clinical implications and underscores the urgent need for biomarker-stratified randomised trials using synaptic density imaging and circuit-level outcomes. Keywords: autism heterogeneity, synaptic pruning, LRRK2, transcriptome-wide association study, glutamatergic enhancement, precision medicine.

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10. Cooper K, VanDaalen RA, Burnley A, Allain L, Beresford B, Crane L, Islaam L, Morales MV, Portway L, Redmayne B, Russell A, Mandy W. Assessing the feasibility of a co-produced peer-group intervention for supporting wellbeing during the transition to adulthood among autistic 16-25-year-olds (ATAG): a randomised controlled feasibility trial. EClinicalMedicine;2026 (Apr);94:103859.

BACKGROUND: Autistic people, including those without intellectual disability, face challenges during the transition to adulthood, and experience poor adult outcomes. We conducted a feasibility trial of a novel co-produced peer group intervention to support the transition to adulthood in autistic people. METHODS: Autistic 16- to 25-year-olds were recruited to this feasibility randomised controlled trial via autism charities and research databases in England and Wales. Participants needed sufficient literacy abilities to be able to access the intervention materials. Participants were randomly assigned (1:1), via an online randomisation service, stratified by age (16-17 and 18-25 years) to the peer group intervention or care as usual (CAU). Participants in both arms could access CAU, which was the routine care offered to autistic 16-25 year-olds in their region, and so varied by participant. The intervention comprised six hour-long online peer group psychoeducation sessions to improve autism knowledge, autism social identity, and self-advocacy skills. The main outcomes of this feasibility trial were as follows: recruitment and retention rates; the acceptability of randomisation and outcome measurement procedures; CAU accessed by participants; acceptability of the interventions; and clinical outcome measure variances. Clinical outcome measures were collected at baseline, and 8-, 16-, and 24-weeks after randomisation. The primary clinical outcome measure was wellbeing at 16-weeks, using the Warwick Edinburgh Wellbeing Scale [WEMWBS], and all randomised participants were included in the analyses. A co-produced qualitative study investigated trial experiences. The trial is registered with the International Standard Randomised Controlled Trial Number [ISRCTN] registry, ISRCTN10513626. FINDINGS: Seventy participants were recruited between 1st November 2023 and 10th June 2024 (n = 35 per arm). At 16-weeks, the primary clinical outcome measure (wellbeing score) was completed by 74% (n = 26) of the intervention group and 91% (n = 32) of the CAU group. In terms of CAU, across both arms, participants were most likely to have used medications and primary and community care. Adverse events were comparable between arms (intervention group: 6, CAU group: 7). Qualitative feedback indicated that both study procedures and the intervention itself were acceptable. INTERPRETATION: A full trial appears to be feasible. Limitations including retention in the intervention arm and limited sample representativeness would need to be addressed for a full trial. FUNDING: National Institute of Health and Care Research (NIHR) Research for Social Care and Autistica.

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11. Dalvi-Garcia F, Horato N, Cavalieri DC, Quagliato LA, Nardi AE. Unrecognized Even in Death: The Statistical Invisibility of Autistic People in Brazilian Suicide Mortality Records. Trends Psychiatry Psychother;2026 (Apr 19)

OBJECTIVE: Suicide is a leading cause of premature death in Brazil. Some groups are at higher risk of committing suicide, including individuals with Autism Spectrum Disorder (ASD). This study aimed to assess whether autistic people are being identified in Brazilian official mortality records and whether this condition is being acknowledged as a contributing factor to suicide. METHODS: We assessed a standardized version of the Brazilian Mortality Information System (SIM), filtering deaths by suicide from 1996 to 2024 in which the underlying cause of death was intentional self-harm, sequelae of intentional self-harm, or undetermined intent possibly due to self-harm. Variables potentially indicating contributing conditions related to ASD or intellectual disability (ID) were examined. RESULTS: Of 579,121 deaths by suicide, only 81 certificates recorded ASD or ID, and only 16 recognized autistic people. Fifteen were men, with a mean age 33.5 ± 17.2 years. The first certificate listing ID was in 2000; the first mentioning autism was not until 2008. CONCLUSION: Our findings suggest under-reporting of ASD as a factor relevant to suicide and a substantial disparity compared to other countries’ statistics. Improving certifying professional training and integrating datasets may enhance suicide prevention efforts for people with neurodevelopmental conditions.

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12. Hall DA, Loesch D, Svymbersky T, Berry-Kravis E, Ouyang B. Essential tremor-like phenotype in Fragile X carrier women. Clin Park Relat Disord;2026;14:100436.

BACKGROUND: Tremor is a key feature of the neurodegenerative fragile X-associated tremor ataxia syndrome (FXTAS) and typically affects fragile X gene (FMR1) premutation carriers over the age of 55. OBJECTIVE: To determine if tremor occurs in FMR1 premutation carriers who do not meet criteria for FXTAS. METHODS: Data from two cohorts of premutation carriers (n = 97) and controls (n = 22) were analyzed, and included FXTAS rating scale items such as handwriting, spiral drawing, and finger-to-nose maneuver as rated by a movement disorder neurologist who was blinded to gene status. Premutation carriers who met criteria for FXTAS were excluded. Descriptive, univariate and multivariate methods were used to analyze the differences between the groups. RESULTS: FXTAS Rating Scale scores were higher in premutation carriers without FXTAS compared to controls (7 ± 5 vs. 4 ± 3, p = 0.002) and remained significantly higher after correcting for age (p = 0.003). Individual tremor items that were significantly worse included finger-to-nose and spiral drawing. CONCLUSIONS: Isolated hand tremor can be seen in FMR1 premutation carriers who do not meet criteria for FXTAS. Additional work needs to be done to determine if these carriers are at higher risk of developing FXTAS in the future or if this is a benign condition. When clinicians are evaluating and counseling FMR1 premutation carriers with tremor, it should be acknowledged that it is not yet know of the individual will develop FXTAS or whether the tremor will remain isolated.

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13. Hirai T, Umeda N, Ohto-Nakanishi T, Fujioka T, Wakusawa K, Nara T, Tsuchiya KJ, Matsuzaki H. Dihydroxy fatty acids can be used for screening autism traits in toddlers. PCN Rep;2026 (Jun);5(2):e70338.

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14. Högstedt E, Igelström K, Korhonen L, Käcker P, Björk M. Work-related support for autistic individuals: patterns and perceived relevance. Disabil Rehabil;2026 (Apr 20):1-14.

PURPOSE: Autistic individuals often face challenges in securing and maintaining employment, despite substantial societal investments in support. However, limited research exists on the nature, sources, and perceived effectiveness of this support. To improve employment outcomes, it is essential to understand how autistic individuals experience and evaluate the support they receive. This study investigates the work-related situation of Swedish adults with a clinically confirmed autism diagnosis, compares support patterns between employed and unemployed individuals, and describe perceptions of support. MATERIALS AND METHODS: A survey was distributed in collaboration with seven psychiatric outpatient clinics in southeastern Sweden, targeting autistic individuals aged 25-35 years. A total of 227 participants completed the survey. Data were analyzed using quantitative statistical methods and qualitative content analysis. RESULTS: Fewer than half of the participants reported current employment. About half had received work-related support. Both employed and unemployed individuals reported similar types of support. While some found the support helpful, many described unmet needs and criticized its relevance, timing, and lack of autism-specific understanding among professionals. CONCLUSION: Current support structures require adaptation, and highlight the need for autism-informed, individualized approaches to support sustainable employment. These findings highlight the importance of developing more responsive and individualized support systems. Autistic individuals often receive support that is poorly timed or not adapted to their needs, indicating that tailored and sustained support is crucial for entering and remaining in employment.Professionals who provide work‑related support often lack autism‑specific knowledge, suggesting that training in neurodiversity and communication strategies may improve rehabilitation outcomes.Support is frequently fragmented across sectors, demonstrating the need for coordinated efforts between healthcare, employment services, and municipalities to ensure effective rehabilitation. eng

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15. Joo MA, Kang NR, Kim JY, Lee HJ. Time Trends in the Comorbid Psychiatric Disorders Among Children and Adolescents With Intellectual Disability in Korea: A Nationwide Study From 2012-2021. J Korean Med Sci;2026 (Apr 20);41(15):e126.

BACKGROUND: Children and adolescents with intellectual disability (ID) frequently experience various comorbid psychiatric symptoms. However, research on the comorbidity of psychiatric disorders in this population remains limited. In this study, we aimed to comprehensively examine the prevalence of psychiatric disorders among children and adolescents with ID in South Korea from 2012 to 2021. METHODS: We obtained data from the National Health Insurance Service-National Health Information Database (NHIS-NHID) on individuals aged 2-18 years who were diagnosed with ID (F70-F79.9) between 2012 and 2021. Psychiatric disorders were identified using the following the International Classification of Diseases, 10th Edition codes: attention-deficit/hyperactivity disorder (ADHD) (F90), autism spectrum disorder (ASD) (F84), language disorder (F80), tic disorders (F95), anxiety disorders (F401-F402, F410-F411, F930-F932), depressive disorder (F32, F33), conduct disorder (F918, F928, F911), and oppositional defiant disorder (ODD) (F913). We analyzed the annual prevalence of comorbid psychiatric disorders. RESULTS: Throughout the study period, males consistently outnumbered females (62.6-65.5% vs. 34.5-37.4%). ADHD had the highest prevalence among psychiatric disorders, increasing from 30.23% in 2012 to 41.77% in 2021. Similar increasing trends were observed for ASD (10.95-15.46%) and depression (10.46-19.37%). Significant sex differences were observed in most disorders: ADHD, ASD, tic disorders, language disorder, conduct disorder, and ODD showed male predominance (P < 0.001), while depressive disorder showed female predominance (P < 0.01). Anxiety disorders showed no significant sex differences. CONCLUSION: This study enhances our understanding of the epidemiology of psychiatric comorbidities in South Korean children and adolescents with ID. The evaluation of comorbid psychiatric disorders in this population is crucial for prognosis, with particular attention needed for ADHD and depressive disorder due to their relatively high prevalence. Future research should focus on preventing and treating psychiatric comorbidities in children and adolescents with ID.

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16. Jordan P, Waddington H, Hammond M, Uljarevic M, Sainsbury WJ, Tupou J. Priorities and Perspectives Regarding Goals and Outcomes of Support for Autistic Children Under 12 Years: A Systematic Review. Autism;2026 (Apr 20):13623613261433132.

Autistic individuals, family members, and professionals often hold differing perspectives on the goals and outcomes of supports for autistic children under 12 years. While traditional approaches prioritise the acquisition of neurotypical behaviours, emerging frameworks emphasise autonomy, self-determination, and well-being. This systematic review synthesised findings from 15 studies using qualitative, quantitative, and mixed-methods designs, which were assessed for methodological quality using the Joanna Briggs Institute checklists. Communication, social inclusion, and child well-being emerged as shared priorities. Notable differences were observed; professionals tended to focus on normative developmental goals such as skill acquisition and behavioural compliance, while autistic individuals and family members more often valued flexibility, self-advocacy, and strengths-based approaches. Tensions persist between medicalised and neurodiversity-affirming paradigms. To ensure supports align with what matters to autistic people, future research should prioritise co-design with autistic individuals and families, embrace cultural responsiveness, and develop tools that can flexibly but consistently assess neurodiversity-affirming outcomes. These steps will support more ethical, inclusive, and meaningful goal-setting practices in autism research and support.Lay AbstractAutistic children, their families, and the people who support them often want different things from autism services. Some approaches still focus on teaching autistic children to behave more like non-autistic children, such as making eye contact or using spoken language. However, many autistic people and families are calling for support that values autistic ways of being and prioritises well-being, comfort, and meaningful participation. This systematic review brought together findings from 15 research studies published in the last 10 years. These studies explored what goals matter most to autistic adults, parents, and professionals when supporting autistic children aged 0-12. We reviewed studies that used interviews, surveys, or mixed methods and assessed their quality using standard research checklists. Across studies, several shared priorities emerged. Communication was important to everyone, but in broad terms supporting children to express themselves in the ways that work best for them, including through alternative augmentative communication or non-spoken communication. Stakeholders also consistently valued children’s emotional well-being, mental health, and feeling safe and understood. Many studies highlighted the importance of autonomy, including supporting children to make choices, develop a sense of identity, and have control in their daily lives. Traditional goals such as reducing autistic traits, encouraging eye contact, or teaching neurotypical social skills were often rated as less important. There was strong agreement that supports should help children build comfort, confidence, and inclusion rather than force conformity.

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17. Kawada K, Mimori S, Kuramoto N, Uno K. Prenatal 4-phenylbutyric acid administration during mid-gestation ameliorates ASD-like behaviors by reducing cortical endoplasmic reticulum stress in VPA-induced ICR and BTBR mouse models. AIMS Neurosci;2026;13(1):29-49.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social interaction and repetitive behaviors. Increasing evidence suggests that endoplasmic reticulum (ER) stress contributes to abnormal brain development in ASD; however, whether prenatal modulation of ER stress can prevent ASD-like phenotypes remains unclear. In this study, we investigated the effects of prenatal administration of the chemical chaperone 4-phenylbutyric acid (4-PBA) in two etiologically distinct ASD mouse models: valproic acid (VPA)-exposed Jcl:ICR (ICR) mice and BTBR T(+) Itpr3(tf) /J (BTBR) mice. Social behaviors were evaluated using the three-chamber test, and repetitive behaviors were assessed by self-grooming duration. 4-PBA was administered to mid-gestation mice, and behavioral changes in the male offspring derived-two type ASD model (VPA and BTBR mice) were evaluated. 4-PBA reduced ER stress in the cerebral cortex of the offspring male VPA and BTBR mice. In particular, 4-PBA strongly inhibited the expression of 94-kDa glucose-regulated protein, an ER stress marker, in BTBR male mice. In addition, 4-PBA improved synaptic organizer expression and neuronal maturation, which are diminished in ASD, specifically in the cerebral cortex of VPA mice. Furthermore, 4-PBA improved social reciprocity, a behavior specific to ASD in male VPA and BTBR mice. In conclusion, ER stress during mid-pregnancy is strongly associated with the development of ASD symptoms. Furthermore, the reduction in ER stress by 4-PBA leads to the suppression of ASD symptoms. Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a lack of sociality, and the difficulty in forming social relationships often leads to various social problems. Prenatal administration of 4-PBA to mothers may reduce the risk of developing ASD, and we believe this could be a new approach to prevention.

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18. Lee JD, Kang VY, Terol AK, Joo S. Correction: Examining the Efficacy of Culturally Responsive Interventions for Autistic Children and Their Families: A Meta‑Analysis. J Autism Dev Disord;2026 (Apr 20)

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19. Li L, Huus K, Falkmer M, Zhao Y, Christensen BM. Participation of children with autism spectrum disorder in everyday activities: self-reports and primary caregivers’ proxy-reports. J Pediatr Nurs;2026 (Apr 20);89:100-108.

PURPOSE: This study aimed to examine the level of agreement between children with autism spectrum disorder (ASD) and their primary caregivers regarding the perceived frequency of attendance, level of involvement, and perceived importance of everyday activities. METHODS: A cross-sectional design was employed, recruiting 63 ASD child-caregiver dyads and administering the simplified Chinese version of Picture My Participation (PMPC; Simplified). RESULTS: Among the 19 items included in the PMP-C (Simplified), child-caregiver agreement on attendance and involvement was slight to fair in most domains. The most prominent discrepancies were observed in school and community-based activities, whereas higher agreement was found in home-based contexts. Caregivers tended to underestimate the child’s attendance in personal care and health-related activities, with no universal systematic bias across all areas. Children and caregivers showed a moderate positive correlation in ranking important activities, yet differences remained in the distribution and focus of the rankings. CONCLUSION: Children with ASD and their caregivers demonstrate divergent perceptions of the child’s everyday participation. Caregiver proxy reports do not fully capture children’s subjective lived experiences, especially in social and community contexts, and systematically underestimate perceived independence in personal care and health-related activities. While there is moderate convergence in ranking important activities, distinct value priorities exist for specific daily occupations. IMPLICATIONS FOR PRACTICE: Direct child self-report, supported by visual aids, is feasible and essential for capturing the subjective experiences of children with ASD. A dual-informant approach that combines child self-report and caregiver proxy data can support more person-centered, meaningful participation for children with ASD.

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20. Licona SJ, Garcia ME, Jiménez-Muñoz M, Espinel A, Vernon TW. Spanish-Language Autism Early Intervention Workshops: Evaluating Outcomes of a Translated Pivotal Response Treatment Program. Autism Dev Lang Impair;2026 (Jan-Dec);11:23969415261440820.

BACKGROUND & AIMS: Early intervention efforts can be transformative for young children with autism, and parent involvement is an increasingly common component of many contemporary treatment models linked to enhanced long-term social communication and developmental outcomes. However, Spanish-speaking families face language barriers that limit opportunities to be trained in these strategies, directly contributing to disparities in their children’s developmental outcomes. This study aims to address this barrier by exploring the feasibility, acceptability, and preliminary efficacy of a Spanish-translated and adapted pivotal response treatment (PRT) early intervention model. METHODS: Using a multiple baseline across participant experimental design, the primary objective of this investigation was to evaluate the impact of ongoing participation in a Spanish PRT workshop on parent fidelity (mastery) of treatment implementation and child verbal responses using behavioral coding and parent-report measures. The study included three children with autism aged 18-60 months and their caregiver(s). Parents completed questionnaires, four PRT instructional lessons, and six in-person coaching sessions. Parent-child interaction videos were recorded at intake and after each in-person session to monitor participant process. RESULTS: All participants met fidelity of implementation criteria (>80%) for the PRT strategies, demonstrating the ability to successfully implement the core intervention components. Parents also reported improvements in their self-perceived (a) comprehension of the PRT principles and (b) confidence in applying them effectively. Lastly, children demonstrated improvements in the frequency of their verbal responses. CONCLUSIONS & IMPLICATIONS: These results suggest that the Spanish adaptation of PRT can effectively teach parents to understand and implement basic PRT components and facilitate language development in their autistic children.

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21. Minale EMP, Martone S, Criscuolo C, Marra R, Lasorsa VA, Ruggiero R, Suero T, Capasso M, Andolfo I, Iolascon A, Russo R, Pinelli M. A Complex Neurodevelopmental Phenotype Resembling a Chromatinopathy With Concurrent 7p Duplication and 10p Deletion Involving ZMYND11: A Case Report and Literature Review. Mol Genet Genomic Med;2026 (Apr);14(4):e70164.

BACKGROUND: The complex pathogenetic mechanisms of rare genetic diseases make the diagnostic process highly challenging. Advances in molecular genomic techniques, such as exome sequencing, have improved the identification of copy number variants (CNVs), increasing diagnostic yield. METHODS: We report the case of a female patient with global developmental delay, growth alterations, and dysmorphic features. Clinical exome sequencing did not reveal point mutations. CNV analysis from exome data identified a 6 Mb microdeletion in 10p15.3p14, involving the ZMYND11 gene, and a 7.6 Mb microduplication in 7p22.3p21.3; both rearrangements were subsequently confirmed by chromosomal microarray analysis. Conventional karyotyping revealed a derivative chromosome 10 [46,XX,der (10)], a finding consistent with the possibility of an unbalanced translocation involving chromosomes 7 and 10. The combined cytogenetic and molecular findings are consistent with the possibility that the duplicated 7p segment is inserted into the short arm of chromosome 10. RESULTS: ZMYND11, a dosage-sensitive gene, has been associated with Cornelia de Lange Syndrome (CdLS)-like phenotypes, and its haploinsufficiency is linked to 10p15.3 microdeletion syndrome. Our patient presented a complex phenotype due to the concurrent 7p duplication and 10p deletion, highlighting the importance of ZMYND11 in chromatinopathies. A review of similar cases supports considering ZMYND11 in evaluating chromatinopathy-related features. Notably, she also exhibited unique characteristics that have not been previously described in association with either CNV. CONCLUSION: Next-generation sequencing, capable of detecting both single nucleotide variants and CNVs, is a critical tool for diagnosing neurodevelopmental disorders and uncovering diverse causative variants. This case emphasizes how NGS facilitates the identification of co-occurring CNVs and expands the phenotypic spectrum associated with chromatinopathies. Detailed characterization of such complex phenotypes using NGS is essential for advancing our understanding of rare genetic conditions and improving diagnostic accuracy.

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22. Mithani K, Sauter S, Hagopian LP, Breitbart S, Sriharan S, Kisteroff F, Huynh M, Malik S, Thorpe KE, Huber J, Gorodetsky C, Ibrahim GM. Electrical Stimulation of the Nucleus Accumbens for Severe, Refractory Self-Injurious Behaviour in Children (EASE-SIB): protocol for a randomised double-blinded crossover trial. BMJ Open;2026 (Apr 20);16(4):e110222.

INTRODUCTION: Self-injurious behaviour (SIB) consists of persistent, repetitive movements that can result in serious injury without suicidal intent. These behaviours are prevalent among children with neurodevelopmental disorders, including profound autism. Although many individuals benefit from currently available therapies, some exhibit treatment-refractory SIB that necessitates ongoing use of personal protective equipment and restraint, presumably due to stronger neurobiological drivers. We recently completed a phase I, open-label clinical trial demonstrating the safety, feasibility and preliminary efficacy of bilateral deep brain stimulation targeting the nucleus accumbens (NAc-DBS) in children with profound autism and severe, refractory SIB. The objective of the proposed study is to characterise the effectiveness of NAc-DBS in treating severe, refractory SIB in this unique and vulnerable population. METHODS AND ANALYSIS: A single-centre, randomised double-blinded, crossover trial is proposed. Informed by the results of our pilot study, 25 subjects with autism spectrum disorder and severe, refractory SIB will undergo bilateral NAc-DBS. Following a 4-week recovery period, participants will be randomised to either group A (stimulation ON then OFF) or group B (stimulation OFF then ON). Each block will last 12 weeks, separated by a 2-week washout period. Following completion of the second block, all participants will enter a 6-month open-label phase with stimulation ON. The primary outcome is the difference in the Repetitive Behaviour Scale-Revised total score, between DBS-ON and DBS-OFF conditions. Secondary outcomes include measures of quality of life, caregiver burden, daily logs of SIB events and direct observation of SIB under structured analogues. ETHICS AND DISSEMINATION: The proposed trial has been approved by the institutional Research Ethics Board (1000081171). Trial results will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT06529380.

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23. Morgan PL, Hengyu Hu E. Over-Time Estimates of Sociodemographic Disparities in Autism Identification in U.S. Elementary Schools. Autism;2026 (Apr 20):13623613261434432.

Whether and to what extent sociodemographic disparities in school-based autism identification have been occurring in U.S. elementary schools is currently unclear. We investigated for disparities attributable to race, ethnicity, biological sex, family income, and language use by analyzing repeated cross-sectional data collected on very large samples of U.S. fourth graders participating in the National Assessment of Educational Progress from 2003 to 2022 (ns = 103,150-205,860). Multivariable logistic regression models accounting for potential confounds including student-level academic achievement and school-level resources repeatedly indicated that students of color, females, students from low-income families, and multilingual learners (MLs) are less likely to be identified with autism while attending U.S. elementary schools. These disparities have been largely stable over time, particularly for Black students, females, and MLs. Health and educational policies that ensure equal access to autism supports and services in U.S. elementary schools including by students from historically marginalized communities are warranted. Students of Color, Females, Students from Low-income Families, and Multilingual Learners Are Less Likely to be Identified with Autism While Attending U.S. Elementary SchoolsWhether students who are Black or Hispanic, females, from low-income families, or who are multilingual learners have been less likely to be identified with autism while attending U.S. elementary schools is currently unclear. Prior work reports conflicting findings and has often been unable to approximate contrasts between similarly situated students including those displaying the same levels of academic achievement and who are attending the same schools. Such contrasts of similarly situated students are necessary to better evaluate for the possibility of differential treatment due to biased or discriminatory practices. We used statistical methods to account for potential alternative explanatory factors (e.g. differences in family income, language use, or academic achievement) to better approximate contrasts between similarly situated students. Doing so provides stronger evidence of disparities in school-based autism identification attributable to race, ethnicity, biological sex, family income, and language use and not instead to alternative explanatory factors. To investigate how these disparities have changed across time, we analyzed very large cross-sectional samples of fourth-grade students from 2003 to 2022. These analyses repeatedly indicated that students who are White, boys, those from higher-income families, or students who are English-speaking are more likely to be identified with autism than students of color, females, those from low-income families, or students who are multilingual learners including among those who are displaying similar levels of academic achievement and who are attending the same schools. Although autism prevalence rates have increased for students from historically marginalized communities, students from these communities are still less likely to be identified with autism while attending U.S. elementary schools. Efforts are needed to ensure equal access to autism services and supports among students attending U.S. elementary schools. eng

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24. Muntané G, Shadrin A, Guardiola-Ripoll M, O’Connell KS, Frei O, Naerland T, Vilella E, Andreassen OA. Genetic overlap and shared risk loci between autism spectrum disorder and cardiometabolic traits. Mol Psychiatry;2026 (Apr 20)

Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting 2% of the global population. Beyond core symptoms such as social communication deficits and repetitive behaviors, individuals with ASD are at increased risk of cardiometabolic comorbidities, including obesity, diabetes, and cardiovascular disease. Here, we investigate the shared genetic architecture between ASD and cardiometabolic traits using large genome-wide association studies datasets and advanced statistical approaches: the bivariate causal mixture (MiXeR) model and pleiotropy-informed conditional false discovery rate (pleioFDR). Our results show significant polygenic overlap between ASD and several cardiometabolic phenotypes, despite almost negligible genetic correlation between the traits. Specifically, we observed positive genetic correlations within the shared component for ASD and metabolic traits, such as body mass index (rg=0.03), type 2 diabetes (rg=0.23), and total cholesterol (rg=0.78). In contrast, negative correlations emerged between ASD and cardiovascular traits, including diastolic and systolic blood pressure (rg = -0,22, for both), pulse pressure (rg = -0.25), and coronary artery disease (rg = -0.90). Finally, we identified 100 shared loci between ASD and cardiometabolic traits, mapping to 124 genes and suggesting shared biological mechanisms underlying these phenotypes and pointing to potential therapeutic targets. Shared loci between ASD and metabolic traits predominantly showed concordant effects, whereas those overlapping with cardiovascular traits-particularly blood pressure-related traits-tended to exhibit discordant effects. Together, these findings deepen our understanding of the biological connections between ASD and cardiometabolic comorbidities and may help inform more personalized strategies for managing ASD and its associated long-term health risks.

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25. Pato CN, Pato MT, Mulle J, Hart RP, Pang Z, Knowles JA, Singh T, Maddhesiya P, Carvalho C, Merikangas A, Medeiros H, Bigdeli TB, Kazemi H, Drake J, Vladimirov VI, Maher BS, Bacanu SA, Neale B, Fanous A. Multiplex Portuguese Families as a Lens into rare mutations and the Shared Genetic Architecture of Schizophrenia, Mood Disorders, and Autism Spectrum Disorders. medRxiv;2026 (Apr 7)

In an analysis of 173 multiplex families from the Portuguese Island Collection (PIC) this study characterizes the shared genetic architecture of serious mental illnesses (SMI) including schizophrenia (SZ) , bipolar disorder (BP) , major depression (MDD) , and autism (ASD) . Within this cohort, co-segregation of psychotic and mood disorders occurred in 28% of families, while 7% demonstrated co-segregation of intellectual disability or ASD with SZ and mood disorder phenotypes. Whole-genome sequencing (WGS) was performed on a three-generation PIC family to identify rare, large-effect variants. This led to the identification of an extremely rare predicted loss of function (LoF) mutation in the Chromodomain Helicase DNA Binding Protein 2 (CHD2) gene. These results demonstrate that high-density multiplex families in founder populations are a powerful resource for mapping rare, large-effect variants that cross clinical diagnostic boundaries, as the identified CHD2 mutation suggests that the disruption of a single neurodevelopmental gene may lead to diverse SMI phenotypes. By combining population and family-based methodologies, this approach leverages shared genetic backgrounds and environments to provide a unique opportunity for cellular studies to explore the biological mechanisms underlying SMI, offering significant potential to inform future functional research and identify novel therapeutic targets.

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26. Picciani BLS, Lima PFS, Carneiro NCR, Plaisant BMM, Vieira MTF, Amaral LD, Borges-Oliveira AC. Evaluation of Conscious Intramuscular Sedation in Children With Autism Spectrum Disorder Undergoing Outpatient Dental Treatment: A Retrospective Observational Cross-Sectional Study. Spec Care Dentist;2026 (Mar-Apr);46(2):e70171.

AIM: To evaluate the safety and efficacy of a conscious intramuscular (IM) sedation protocol combined with inhalational sedation in children with autism spectrum disorder (ASD) undergoing outpatient dental treatment, based on clinical data and dentists’ perceptions. METHODS AND RESULTS: Thirty-seven sedation appointments in 28 patients with ASD were analyzed. Patients received an IM protocol of midazolam 0.1 mg/kg, ketamine 0.7 mg/kg, dexmedetomidine 0.5 mcg/kg, and promethazine 0.3 mg/kg. Data collection included demographics, support needs, use of central nervous system (CNS) depressants, procedures performed, adverse events, sedation time, clinicians’ assessments, and vital signs. Most patients were males (68%); aged 3-12 years and 65% required Level III support. CNS depressants were routinely used in 66% of cases. Surgical procedures occurred in 46% of appointments, and mean sedation time was 40 min. Only five (14%) adverse events were observed, and clinicians rated sedation as excellent in 62% of cases. Vital signs showed minimal variation throughout sedation. No statistically significant association were found between CNS depressant use and adverse events or between sedation success and sex, age, support level, or procedure characteristics. CONCLUSION: This IM sedation protocol appears safe and effective for outpatient dental care in individuals with ASD. Further research is needed to expand equitable access to sedation-based care.

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27. Rosen BF, Sumaria K, Miller CE, Arbuckle C, McNamara T, Callaghan T, Mazhani T, Rowley L, Rivalta-Dallal A, English K, Foulkes E, Julies P. ‘See me Autism’: improving the experience and safety of autistic children in the paediatric emergency department. Arch Dis Child Educ Pract Ed;2026 (Apr 20)

Implementation of co-produced training and resources can improve the experience and safety of autistic children in a paediatric emergency department.

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28. Shin YS, Wang J, Pulver SL, Orlando AM, Romero RA, Cuomo CR, Lauzan IV, Dentry T, Shirley DJ, Christensen D, Unruh KE, Stevens CJ, McKinney WS, Mosconi MW, Vaillancourt DE, Wang Z, Coombes SA. Neuroanatomical patterns of dementia risk in autism spectrum disorder. Front Aging Neurosci;2026;18:1771822.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder. While previous studies have reported a high prevalence of dementia diagnoses in the ASD population, the risk of dementia-related neurodegeneration remains poorly understood. This study aimed to assess dementia-sensitive composite measures of brain structure and brain age across the lifespan in an ASD cohort (ages 7-73) to investigate neuroanatomical features linked to neurodegenerative vulnerability. The composite score and brain age were not significantly different between diagnostic groups when analyses considered the entire cohort, nor when the cohort was split into subgroups based on age. However, age-effects were found for both groups, with negative relationships revealing a decrease in cortical thickness with increasing age. Subgroup analyses showed that the same negative relationship was evident in the old NT group but was absent in the old ASD group, even when controlling for clinical factors. Our findings are consistent with the safeguard or parallel development hypothesis and suggest that conventional dementia-like structural vulnerability is not widespread and generalizable in ASD. Our observations highlight the limitations of current dementia-sensitive composites in assessing neurodegenerative risk in ASD. Developing dementia-sensitive biomarkers for autistic individuals is critical to enhance diagnostic precision and identify clinically significant biomarkers in this cohort.

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29. Wang G, Zhu G, Liu H, Wu L, Zhang Z, Pang P, Si S, Yang G. Integrative multi-omics implicates a CTSB/ITIH-ECM axis in autism spectrum disorder. Neurobiol Dis;2026 (Apr 20);224:107402.

BACKGROUND: Autism spectrum disorder (ASD) is a highly heritable neurodevelopmental condition characterized by marked clinical and biological heterogeneity. Despite substantial progress in genetic discovery, the downstream biological mechanisms linking genetic risk to neurodevelopmental pathology remain incompletely understood. METHODS: We conducted an integrative Mendelian randomization (MR) analysis combining large-scale proteomic, transcriptomic, metabolomic, and single-nucleus RNA sequencing (snRNA-seq) data. Proteome-wide MR analyses across plasma, brain tissue, and cerebrospinal fluid were performed to implicate proteins with putative causal associations with ASD. Candidate proteins were prioritized using transcriptome-wide MR and Bayesian colocalization analyses. Cell-type-specific expression patterns were examined in post-mortem human ASD cortex using snRNA-seq. Functional enrichment, metabolite mediation, and protein-protein interaction analyses were used to contextualize the biological pathways implicated, and drug predictions and docking are utilized for drugability assessment. RESULTS: Proteome-wide MR identified 42 proteins with putative causal effects on ASD risk. Integrated transcriptomic and colocalization analyses prioritized eight high-confidence targets, including ITIH3, ITIH4, CTSB, MDH1, MANBA, LRRC37A2, ESAM, and NMB. snRNA-seq analysis demonstrated cell-type-specific dysregulation of these genes in neuronal and glial populations in the ASD cortex. Convergent analyses implicated disruption of extracellular matrix (ECM) homeostasis, mediated in part through sphingolipid metabolism and imbalance between proteolytic activity and protease inhibition. CTSB showed a risk-promoting association with ASD, whereas ITIH3 and ITIH4 exhibited protective effects. Drugability assessment, including molecular docking, identified seocalcitol as a high-affinity ligand for CTSB. CONCLUSIONS: These findings prioritize a genetically supported ECM-related biological axis underlying ASD risk and suggest that dysregulation of proteolytic balance may contribute to neurodevelopmental vulnerability in ASD. This study provides a human genetics-informed framework for understanding ECM involvement in ASD pathophysiology.

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30. Weaver B, Chrysikou E, García-Rodríguez M, Palityka D, Hernandez-Garcia E. Healthcare built environment and behavioural and physiological indicators of stress responses in autism spectrum disorder: Protocol for a mixed-methods systematic review. PLoS One;2026;21(4):e0347308.

INTRODUCTION: Autistic populations are more likely to need healthcare (HC) services due to co-occurring mental health issues, including anxiety and attention-deficit hyperactivity disorders. One of the most significant barriers to delivering optimal medical procedures in autism spectrum disorder (ASD) is the sensory overload in HC settings. Divergent sensory processing, along with unpredictable built environments (BEs), can exacerbate stress-induced anxiety and avoidant behaviour. A growing body of systematic studies links autism-friendly BEs with positive care experiences, yet substantial gaps remain in understanding the effects on behavioural and physiological aspects of emotional responses. This systematic review aims to comprehensively evaluate the HC-BE features that impact on behavioural indicators and non-invasive biomarkers of stress, anxiety and sensory processing in patients with ASD, to establish best practices. METHODS AND ANALYSES: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed. Peer-reviewed articles in PubMed, Embase, Web of Science, Scopus, and PsycINFO databases and Google Scholar will be searched. Studies will be selected if they apply qualitative, quantitative, or mixed-methods designs. Two independent reviewers will select studies at the title and abstract, and full-text screening stages. Data will be extracted by one reviewer and verified by review members using a crowdsourcing approach for quality assurance. Risk of bias will be assessed by one reviewer using the Cochrane Risk of Bias Tools, The Critical Appraisal Skills Programme, and The Mixed Methods Appraisal Tool, and checked by the reviewer with methodological expertise. A results-based convergent synthesis design is planned for data synthesis. DISCUSSION: This review, which converges indicators and patient experiences, will provide a complete overarching picture of the inherent complexities associated with HC-BE and autistic individuals. The findings can inform decisions and recommendations for research and practice. TRIAL REGISTRATION: PROSPERO CRD42024562288.

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31. Young LF, Derham A, Zhu R, Suvrathan A. Deficits in Forelimb Reach Learning in a Mouse Model of Fragile X Syndrome. eNeuro;2026 (Apr);13(4)

Fragile X syndrome is a leading cause of intellectual disability and autism spectrum disorder, for which therapies are limited. A mouse model of fragile X syndrome, the Fmr1 knock-out (KO) mouse, has been particularly valuable for interrogating the molecular, cellular, and circuit mechanisms that underlie the neurological deficits seen in this syndrome. Key deficits in fragile X syndrome include impairments in social behaviors, cognition, and motor learning. Given the difficulties in extrapolating complex human behaviors to mouse models, motor behaviors are a particularly tractable form of learning to study in the mouse. We investigated a form of forelimb reach learning in both male and female Fmr1 KO mice, quantifying different parameters of the task using both manual analysis and DeepLabCut-based tracking of reach trajectories. While Fmr1 KO mice show impaired learning overall, our results showed that the presence or absence of a cue that signals reward alleviated some of the deficits. In addition to a single metric of success in learning, we determined the specific parameters of the motor behavior that were responsible for that success or failure. Our findings provide an essential framework for linking specific behavioral impairments in motor learning to the cellular and circuit mechanisms that support them.

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32. Zhang H, Li J, Hou C, Huang Y, Ma L, Xiong B, Wang J, Weng X. Correspondence between morphological similarity of the left lateral orbitofrontal cortex and neurotransmitter systems in adolescent males with autism. Gen Psychiatr;2026 (Apr);39(2):e70014.

BACKGROUND: Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by pronounced heterogeneity in brain structure, which limits the development of targeted interventions. Morphological brain networks (MBNs) enable the mapping of coordinated structural features across brain regions at the individual level. However, the specific organisation of such networks in ASD and their potential relationships with underlying neurotransmitter systems remain largely unexplored. AIMS: To characterise alterations in cortical thickness-based MBNs among adolescent males with ASD and to test whether these network changes spatially correspond to normative positron emission tomography-derived neurotransmitter receptor/transporter maps. METHODS: In this cross-sectional study, T1-weighted magnetic resonance imaging (MRI) data from 424 adolescent males (207 with ASD, 217 typically developing) in the Autism Brain Imaging Data Exchange were analysed. MBNs were constructed using interregional cortical thickness similarity quantified by Jensen-Shannon divergence. Graph theoretical metrics were computed, and group differences were assessed with permutation tests controlling for age and intelligence quotient (IQ). Spatial correlations between left lateral orbitofrontal morphological similarity and atlas-based neurotransmitter maps were investigated using the JuSpace toolbox. RESULTS: The ASD group exhibited a significantly increased normalised clustering coefficient (t = 2.40, p = 0.020) and decreased nodal centrality in the left lateral orbitofrontal cortex (OFC). This region showed reduced morphological similarity with 65 other brain regions. Furthermore, the OFC-based similarity patterns were significantly associated with the spatial distributions of gamma-aminobutyric acid type A (GABAa), 5-hydroxytryptamine receptor 1A (5-HT1a) and μ-opioid receptor systems (r = 0.22, p = 0.017, spin-corrected). These alterations were robust to stringent cross-family correction. CONCLUSIONS: These findings highlight the left lateral OFC as a structural key hub in adolescent males with ASD. The robustness of these OFC-centred network alterations under stringent cross-family correction, together with their associations with neurotransmitter systems, provides a potential neurobiological basis for targeted interventions in this population.

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33. Ziva A, Ziori E, Pothos E. EXPRESS: Implicit global-local learning in young people with and without autism. Q J Exp Psychol (Hove);2026 (Apr 20):17470218261446884.

Implicit (unconscious) learning ostensibly affects cognitive and social skills in both typical and atypical populations, such as those on the autism spectrum. Research into implicit learning in autism has yielded conflicting results, underscoring the need to explore factors that might influence their implicit learning. One such factor is processing style, specifically processing biases for either global (holistic) or local (detail-oriented) processing. In our experiment we investigated the potential role of processing differences in implicit (and explicit) learning performance in individuals with autism (n=20) and typically developing (TD) individuals (n=22), by using a Global-Local version of the Artificial Grammar Learning (AGL) task. Overall AGL performance and explicit knowledge yielded only a trend towards an interaction suggesting a greater global processing advantage in TD participants compared to participants with autism but no conclusive evidence. The above interaction was further observed in terms of implicit knowledge, with TD participants demonstrating higher levels of implicit structural knowledge compared to individuals with autism during global processing. Implicit knowledge between-group differences during local processing remain weak/inconclusive. Overall, our findings suggest interesting potential processing differences in the implicit learning between individuals with and without autism.

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