1. Statement of Retraction: Hepatitis B Vaccination of Male Neonates and Autism Diagnosis, NHIS 1997-2002. J Toxicol Environ Health A;2026 (May 21):1.

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2. Alınay HH, Namlı S, Karayağmurlu A. Maternal Autistic Traits and Mentalization in Adolescent Non-suicidal Self-Injury: A Case-Control Study. Clin Child Psychol Psychiatry;2026 (May 21):13591045261454710.

ObjectiveNon-suicidal self-injury (NSSI) is frequently linked to dysfunctional family dynamics. While certain parental characteristics have been identified as risk factors, specific maternal social-cognitive traits remain underinvestigated. This study aimed to examine autistic traits and mentalization skills in biological mothers of adolescents engaging in NSSI.MethodsThe sample consisted of 100 female adolescents divided into three groups: Suicide Attempt and NSSI (n = 34), NSSI-only (n = 41), and healthy controls (n = 25). Biological mothers completed the Autism-Spectrum Quotient (AQ), The Symptom Checklist-90-Revised (SCL-90-R) and the Reading the Mind in the Eyes Test (RMET). Adolescents completed a semi-structured psychiatric interview, the Inventory of Statements About Self-Injury and the Toronto Alexithymia Scale. ANCOVA controlled for socioeconomic confounders.ResultsMothers of adolescents in both clinical groups exhibited significantly lower RMET scores compared to the control group. This deficit remained significant even after controlling for potential confounders such as household income and maternal smoking. While Total AQ scores did not differ between groups, mothers in the clinical groups showed specific deficits in the social skills subscale. Importantly, adolescents who attempted suicide reported significantly higher « interpersonal influence » scores regarding the function of self-harm compared to the NSSI-only group.ConclusionsThese findings suggest that specific maternal deficits in mentalization and social skills may contribute to an invalidating family environment, thereby increasing adolescent vulnerability to self-harm behavior. Furthermore, the results highlight the importance of addressing maternal cognitive-emotional factors in assessment and intervention strategies. Why is this study important? Self-harm among teenage girls is rising and becoming a serious public health issue. While we know family relationships play a role, specific maternal characteristics have not been studied enough. This study looked at “mentalization” skills in mothers of teens who self-harm, their capacity to understand and respond to their child’s mental state. What did we do? We compared three groups of teenage girls: (1) those who engaged in self-harm without ever attempting suicide, (2) those who had attempted suicide in addition to self-harming, and (3) healthy teens with no history of self-harm. We asked their biological mothers to complete a questionnaire about their social skills and autistic traits, and to take a test where they had to guess emotions just by looking at photos of people’s eyes. We also interviewed the teens to understand the reasons behind their self-harm behaviors. What did we find? We found that mothers of teens who self-harm (in both clinical groups) had significantly more difficulty reading emotions from the eyes compared to mothers of healthy teens. Interestingly, these mothers did not report high levels of general autistic traits in the questionnaires; they specifically struggled with the skill of tuning into emotions in the eye test. Additionally, we found a key difference among the teens: those who had attempted suicide reported that they did so to get a reaction from others much more frequently than those who only engaged in self-harm. What does this mean? Our study suggests a link between a mother’s difficulty in reading emotions and her child’s self-harm behavior. Although we do not yet know the exact reasons underlying this relationship, it raises the possibility that missed emotional cues between mother and child may contribute to the issue. Therefore, helping mothers improve their skills in understanding emotions could be a valuable addition to the treatment. eng

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3. Alshaban F, Ghazal I, Al-Faraj F, Aqel S, Al-Harahsheh ST, Lotfy M, Al-Shammari H, Thompson IR, Nasir A, Tolefat M. Impact of COVID-19 pandemic on autism spectrum disorder service providers in Qatar: challenges, insights, and lessons learned. Front Psychiatry;2026;17:1813238.

PURPOSE: The COVID-19 pandemic disrupted essential services, posing unique challenges for individuals with Autism Spectrum Disorder (ASD) who depend on consistent, specialized support. Service providers faced unique challenges in adapting to remote delivery methods, highlighting the fragility of existing systems during crises. This study explored the experiences of ASD service providers in Qatar during the COVID-19 pandemic. METHODS: An online survey of 66 ASD service providers in Qatar was conducted. Data were analyzed using descriptive statistics, chi-square, and likelihood ratio tests, with qualitative responses assessed through thematic analysis. RESULTS: Most service providers (90.9%) worked remotely during the pandemic, with 81.8% engaging in online services. Providers reported significant skill regression in individuals with ASD. Stress levels were notably high (42.4%) and significantly associated with emotional tolls [p = 0.017, LR = 4.887], financial strains [p = 0.008, LR = 4.337], and personal challenges [p = 0.008, LR = 3.203]. Thematic analysis revealed decreased therapy effectiveness and difficulties in balancing work with family responsibilities. CONCLUSION: These findings suggest the importance of adaptive service delivery systems that maintain continuity of care during crises. Strengthening autism service infrastructure and developing resilient models are essential to safeguard autism support for future emergencies.

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4. Baron-Cohen S, Tsompanidis A, Srivastava DP, Mill J, Lancaster MA, Adhya D, Warrier V. The prenatal sex steroid theory of autism after 25 years. Nat Hum Behav;2026 (May 20)

We first proposed the prenatal sex steroid theory of autism 25 years ago to account for a number of then-unexplained observations around autism, including (1) the more frequent diagnosis of autism in male than in female individuals and (2) apparent ‘male-type’ shifts in cognitive traits associated with autism, such as empathizing and systemizing. Here we review 25 years of research testing this theory. Early studies found that higher prenatal testosterone levels were associated with slower social, language and empathy development, greater attention to detail, stronger systemizing and more autistic traits. Subsequent studies suggested that both prenatal androgens and oestrogens are associated with autism. New methods in genetics and using stem-cell-derived neural organoids have further indicated the importance of sex steroid hormones for neurodevelopment, as well as atypical patterns in autism. These new findings support and open new lines of research into the prenatal sex steroid theory of autism.

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5. Brudno R, Askayo D, Khair D, Shayevitch R, Keydar I, Zmudjak-Olevson M, Lev-Maor G, Zavolan M, Elkon R, Ast G. Histone H1 variants regulate neurodevelopmental transcriptional programs in autism with 16p11.2 deletion. Genome Biol;2026 (May 21)

BACKGROUND: Neurodevelopmental disorders, including autism spectrum disorder, involve widespread transcriptional dysregulation. Copy number variations at 16p11.2 are among the strongest genetic risk factors for autism spectrum disorder, yet the molecular mechanisms by which these copy number variations contribute to neurodevelopmental pathology remain unclear. RESULTS: We identify significant genetic associations between autism spectrum disorder susceptibility and the HIST1 histone gene cluster through genome-wide analysis. Transcriptomic profiling across post-mortem brain tissue, patient-derived neural progenitor cells, neurons, and cerebral organoids reveals consistent upregulation of linker histone variants H1.2 and H1.5 in idiopathic autism spectrum disorder and 16p11.2 hemi-deletion carriers, but not in schizophrenia or bipolar disorder. Functional assays demonstrate that dysregulated H1 expression disrupts gene networks involved in synaptic signaling, chromatin remodeling, and neural differentiation. Mechanistically, we link H1 upregulation to MAZ, a transcription factor encoded within the 16p11.2 locus. MAZ binds the promoter regions of H1 genes and represses their transcription. Knockdown of MAZ leads to H1 overexpression. H1 upregulation alone is sufficient to alter the expression of autism spectrum disorder-associated genes. CONCLUSIONS: Our findings define a MAZ-dependent regulation of H1 dosage as a critical chromatin-mediated mechanism contributing to transcriptional pathology in 16p11.2-associated autism spectrum disorder.

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6. Bugarski-Kirola D, Hofbauer RK, Sameljak S, Marco EJ, Sumiła A, Darwish M, Ortiz S, Liu IY, Nunez R, Zhang PH, Arango C. Pimavanserin for Irritability in Children and Adolescents With Autism Spectrum Disorder: Phase 2 Randomized Trial. J Am Acad Child Adolesc Psychiatry;2026 (May 19)

OBJECTIVE: This study evaluated the efficacy and safety of pimavanserin in children and adolescents with irritability associated with autism spectrum disorder (ASD). METHOD: In this phase 2, randomized, double-masked, placebo-controlled study (NCT05523895), patients were randomized 1:1:1 to low-dose pimavanserin (5-12 years, 10 mg/day; 13-17 years, 20 mg/day), high-dose pimavanserin (5-12 years, 20 mg/day; 13-17 years, 34 mg/day), or placebo for 6 weeks, followed by a 30-day follow-up period. The primary endpoint was the change from baseline at week 6 in the caregiver-rated Aberrant Behavior Checklist-Irritability (ABC-I) subscale score. Key secondary endpoints included week 6 change from baseline in CGI-Severity irritability score, CGI-Improvement irritability score, Repetitive Behavior Scale-Revised, Vineland Adaptive Behavior Scales-Socialization subscale score, and the Caregiver Strain Questionnaire. Treatment-emergent adverse events (TEAEs) were assessed. RESULTS: A total of 216 (93.1%) randomized patients completed double-masked treatment (low-dose pimavanserin, n=76; high-dose pimavanserin, n=78; placebo, n=78). The least squares mean (LSM [95% CI]) improvement in the ABC-I subscale score was not significantly different from placebo for either pimavanserin group (placebo, -9.6 [-11.7, -7.5]; low-dose pimavanserin, -11.2 [-13.3, -9.0]; high-dose pimavanserin, -11.2 [-13.3, -9.1]). No statistically significant differences occurred between placebo and pimavanserin groups for any secondary endpoint. TEAEs were similar across groups (placebo, n=39 [50.0%]; low-dose pimavanserin, n=36 [46.8%]; high-dose pimavanserin, n=43 [53.1%]). No serious TEAEs or deaths occurred. CONCLUSION: Pimavanserin was well tolerated, but selected doses were not demonstrated to be efficacious compared with placebo for the short-term treatment of irritability in children or adolescents with ASD. CLINICAL TRIAL REGISTRATION INFORMATION: A study to evaluate the efficacy and safety of Pimavanserin for the treatment of irritability associated with Autism Spectrum Disorder; https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-005387-22/ES DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way.

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7. Chen M, Zhao K, Gao C, Mei D, Shi S, Wang L, Sun L, Guo J, Bin G, Zhao S, Yan X, He M, Zhang Y, Wang X. Hypoactivity, abnormal development of dendrites relevant to impaired synaptic transmission of calretinin-expressing interneurons in the medial prefrontal cortex underlies social deficits of mouse model in autism. Transl Psychiatry;2026 (May 21)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by core symptoms including impairments in social behavior and communication. The impaired excitatory and inhibitory signals have been implicated in the pathophysiology of social behavior deficits. Altered calretinin (CR)-containing GABAergic interneurons have been observed in ASD, but their roles and underlying mechanisms remain unveiled. Here, using valproic acid (VPA)-exposed mice for CR-Cre and R26::LS-tdTomato (Ai14) model of ASD, we prove that a decreased number of CR interneurons in the mPFC of an animal model for ASD. Double-staining experiments demonstrated the decreased number of CR interneurons stained for c-Fos. Also, reduction in GCaMP7s fluorescence intensity was elicited in sociability and social novelty preference using in vivo fiber photometry, manifesting VPA-induced suppression of CR-positive cell activation. Additionally, we observed the abnormalities of dendrites in CR interneurons including lower dendritic arbors, decreased dendrite complexity, and spine density, paralleled by abnormal development of spine morphology. Intriguingly, the electrophysiological recordings of tdTomato-labeled interneurons revealed that exposure to VPA depressed intrinsic neuronal excitability by decreasing spontaneous and evoked action potential frequencies. These changes were concomitant with impairments of glutamatergic and GABAergic synaptic transmission of CR interneurons. Strikingly, chemogenetic silencing of mPFC CR-expressing interneurons induced social interaction deficits in mice. These sociability impairments can be rescued by optogenetic activation of CR activity in VPA-exposed mice. Our study indicates that prenatal exposure to VPA induced reduced activities, abnormalities in morphological development, and decreased intrinsic excitability as well as accompanying impaired synaptic transmission of CR interneurons. Our findings provide strong evidence for the notion that the CR interneurons has a critical role in the regulation of social behavior in mice and manifest that CR interneurons dysfunction may be implicated in social impairments in ASD.

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8. Chotas W, Wallman-Stokes A, Patel RM, Cooper C, Soll RF. Platelet transfusion thresholds for thrombocytopenic infants. Cochrane Database Syst Rev;2026 (May 21);5(5):Cd015341.

RATIONALE: Neonatal thrombocytopenia is frequently treated with platelet transfusion. Thresholds prompting platelet transfusions vary greatly between providers, institutions, and countries. Thresholds for stable non-bleeding infants have ranged from 25,000 to 150,000 per microliter. OBJECTIVES: To assess the benefits and harms of more restrictive platelet transfusion thresholds compared to more liberal thresholds in thrombocytopenic neonates. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, Epistemonikos, and trial registries until June 2025. We checked the reference lists of included studies and systematic reviews where subject matter related to the intervention or population examined in this review. ELIGIBILITY CRITERIA: We included randomized controlled trials (RCTs), quasi-RCTs, and cluster-RCTs that compared platelet transfusion thresholds in thrombocytopenic neonates with or without evidence of major bleeding. We excluded infants with inherited coagulopathies or active extracorporeal membrane oxygenation support. OUTCOMES: Our outcomes were death prior to hospital discharge, major bleeding (onset after study entry) or worsening of existing major bleeding, any hemorrhage (all grades of hemorrhage/bleeding), neurodevelopmental impairment: cerebral palsy and global developmental delay, and any platelet transfusion. RISK OF BIAS: We used the Cochrane RoB 1 tool to assess risk of bias in the included studies. SYNTHESIS METHODS: We calculated risk ratio (RR) and risk difference (RD) with 95% confidence interval (CI) for each outcome. We analyzed and interpreted individual trials separately, and summarized the results narratively, as each comparison was informed by only a single trial. We used GRADE to assess the certainty of evidence for the prespecified outcomes. INCLUDED STUDIES: We included three studies (enrolling a total of 856 participants) comparing different platelet transfusion thresholds in thrombocytopenic neonates. Two of the studies were conducted in high-income settings and one in a lower-middle-income country. All three studies varied with regard to their platelet transfusion thresholds, and were included in separate comparisons based on platelet transfusion thresholds. Liberal or high threshold in the: 1. mild thrombocytopenia range: transfusion for platelet count ≤ 100,000 per microliter compared to transfusion for mild thrombocytopenia (platelet count > 100,000 to 150,000 per microliter); 2. moderate thrombocytopenia range: transfusion for platelet count ≤ 50,000 per microliter compared to transfusion for moderate thrombocytopenia (> 50,000 to ≤ 100,000 per microliter); and 3. severe thrombocytopenia range: transfusion for platelet count < 30,000 per microliter (very severe thrombocytopenia) compared to transfusion for severe thrombocytopenia (30,000 to ≤ 50,000 per microliter). SYNTHESIS OF RESULTS: Liberal or high threshold in the mild thrombocytopenia range The evidence suggests that transfusion for platelet count ≤ 100,000 per microliter may result in little to no difference in the risk of death prior to hospital discharge compared to transfusion for platelet count > 100,000 to 150,000 per microliter (RR 0.72, 95% CI 0.36 to 1.46; 152 participants; 1 study; very low-certainty evidence); however, the evidence is very uncertain. Using a more restrictive platelet transfusion threshold may result in a large reduction in platelet transfusions when compared to using a more liberal threshold (RR 0.36, 95% CI 0.26 to 0.51; 152 participants, 1 study; low-certainty evidence). Major bleeding, any hemorrhage, cerebral palsy, and global developmental delay were not reported in the studies. Liberal or high threshold in the moderate thrombocytopenia range The evidence suggests that transfusion for moderate thrombocytopenia may result in little to no difference in the risk of death prior to hospital discharge compared to transfusion for severe thrombocytopenia (RR 1.13, 95% CI 0.53 to 2.37; 44 participants; 1 study; very low-certainty evidence), while there may be little to no difference in risk of any hemorrhage (RR 1.00, 95% CI 0.52 to 1.91; 44 participants, 1 study; very low-certainty evidence); however, the evidence for both outcomes is very uncertain. Major bleeding, cerebral palsy, global developmental delay, and any platelet transfusion were not reported in the studies. Liberal or high threshold in the severe thrombocytopenia range The evidence suggests that using a more restrictive transfusion threshold may result in little to no reduction of death prior to discharge compared to transfusion for severe thrombocytopenia (RR 0.89, 95% CI 0.63 to 1.25; 1 study, 656 participants; low certainty-evidence). The evidence suggests that transfusion for severe thrombocytopenia may result in little to no difference in major bleeding or worsening of existing major bleeding (RR 0.77, 95% CI 0.51 to 1.17; 1 study, 658 participants; 1 study, low-certainty evidence), any hemorrhage (RR 1.02, 95% CI 0.92 to 1.13; 652 participants; 1 study, low-certainty evidence), cerebral palsy (RR 0.78, 95% CI 0.46 to 1.33; 432 participants; 1 study, low-certainty evidence), or global developmental delay (RR 0.67, 95% CI 0.45 to 1.01; 432 participants; 1 study, low-certainty evidence). Using a more restrictive transfusion threshold probably results in a large reduction in platelet transfusions when compared to transfusion for severe thrombocytopenia (RR 0.59, 95% CI 0.53 to 0.66; 659 participants; 1 study, moderate-certainty evidence). All three studies were considered to be at high risk of performance bias due to their unblinded designs. Two of the studies were small, and all studies lacked precision for the critical outcome of death before hospital discharge. AUTHORS’ CONCLUSIONS: The available evidence is of moderate to very low certainty and comes from only three studies. We found no evidence of a benefit of higher transfusion thresholds for any outcomes of interest, including death or bleeding, when giving a platelet transfusion to babies with higher platelet count levels (when there is less risk of bleeding). Of note, prior individual studies using different methods of analysis have raised concerns regarding the use of higher thresholds. This suggests that the use of lower platelet transfusion thresholds likely reduces platelet transfusions without a concomitant increased risk of death or major bleeding, although there is some uncertainty for critical outcomes. FUNDING: This Cochrane review is funded in part by Vermont Oxford Network. REGISTRATION: Protocol (2024) DOI: 10.1002/14651858.CD015341.

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9. Cox JC, Tass ESN, Vogeler HA, Andrus ES, Frandsen C, Gabrielsen TP, Orton A, Probst R, McKinnon KK, Heath J, Higham M, Preator B. What do the records say: Autism spectrum disorder and higher education. Res Dev Disabil;2026 (May 21);174:105306.

Individuals with autism spectrum disorder (ASD) report experiencing many difficulties associated with ASD and the pursuit of higher education. This study examines 34 years of data from a large private university in the U.S., comparing students with autism who registered with disability services (n = 177) to matched neurotypical peers on several academic record variables. Results indicate that students with ASD had more failing grades, were more likely to be put on academic discipline status and demonstrated lower average GPAs than their matched peers. Interestingly, autistic students who transferred to the university appeared to have somewhat better academic outcomes than students with autism who began their academic careers at the university. Although these findings are limited to a single institution, they provide valuable insights regarding the experience of students with ASD in higher education. Future research can seek to replicate these findings at other universities, and target sources of academic distress for students with ASD. Additionally, support programs at universities can investigate effectiveness of programming and services for autistic students.

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10. Devi KJ, Pragya P, Agastinose Ronickom JF. Identification of Potential Biomarkers in ASD Integrating RNA Seq Data and Machine Learning Approaches. Stud Health Technol Inform;2026 (May 21);336:2039-2043.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, caused by various epigenetic and genetic factors. This has resulted in an unclear understanding of etiology and biomarkers associated with ASD. In this study, we used RNA Seq datasets integrating with machine learning models to identify the differentially expressed genes (DEGs) between ASD and typical development (TD). The RNA Seq data of 20 ASD and 19 TD were obtained from the NCBI GEO database. We used standard R programming pipeline to pre-process the data. Further, random forest (RF) and eXtreme gradient boosting (XGBoost) models were employed to identify potential genes discriminate between ASD and TD. The model’s performance was assessed using evaluation metrics and the 5-fold-cross validation. The proposed XGBoost models achieved a 5-fold cross validation accuracy, sensitivity, specificity, precision and F1-Score of 67.14%, 67.5%, 67.5%, 67.84%, 75.56% respectively. Further, TCTA gene was common in the top 10 gene signatures identified from RF and XGBoost. These results may aid in developing potential and prognostic biomarkers for effective ASD screening.

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11. Grady-Dominguez P, Bundy AC, Mailloux Z, Schaaf RC. Examining the Validity and Reliability of Evaluation in Ayres Sensory Integration Data Collected With Autistic Children: A Rasch Analysis. Autism Res;2026 (May 20):e70276.

Performance-based assessments of sensory function provide essential insights into sensory integration challenges in autistic children and provide objective, standardized measurement data that can be used to tailor targeted interventions. We sought to evaluate the validity and reliability of data collected using the Evaluation in Ayres Sensory Integration (EASI) for assessing sensory and motor functions in autistic children. We used the Rasch Measurement Model to evaluate data collected with 146 autistic children aged 3-12 years (United States: n = 24, Australia: n = 115, Brazil: n = 7). We analyzed 19 performance-based tests assessing sensory perception, praxis, and motor functions. Rasch analyses examined item fit, unidimensionality, item targeting, and internal reliability. Seventeen of 19 analyzed EASI tests demonstrated strong construct validity, with adequate item-fit and unidimensionality. Fourteen tests met reliability thresholds (person separation reliability ≥ 0.70), while five tests exhibited lower person separation reliability. Some tests showed poor item targeting, potentially limiting their precision for children with stronger sensorimotor abilities. Most EASI tests demonstrate strong validity and reliability for assessing sensory integration in autistic children. Clinicians can use tests meeting reliability thresholds with confidence; tests with lower reliability can provide useful information but should be corroborated with other clinical data. Findings for PF should be considered preliminary given limited sample size. In general, this initial validation of EASI advances the evaluation of sensory integration for autistic children. Many autistic children have differences in how they sense and respond to the world around them. The Evaluation in Ayres Sensory Integration (EASI) is a set of tests that help therapists understand how children use their senses and bodies to move, play, and complete tasks. In this study, we found that most parts of the EASI work well for autistic children, but a few activities need changes to make them more accurate. This means the EASI can help therapists better understand each child’s needs and plan the most helpful intervention and support for them and their families. eng

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12. Haga MR, Lee CM, Burrows CA, Hudock RL. Feasibility of Delivering Facing Your Fears via Telehealth for Autistic Adolescents During the COVID-19 Pandemic. Adv Neurodev Disord;2026 (Jan 28)

OBJECTIVES: Autistic individuals are more likely to be diagnosed with an anxiety disorder than the general population. Autism and anxiety are often exacerbated by each other, leading to difficulties in treatment. Some telehealth adaptations of cognitive behavioral interventions have been effective and feasible in reducing anxiety in autistic individuals, but the COVID-19 pandemic demonstrated a need for further research in this area. Therefore, the focus of the study was to examine the feasibility and preliminary effectiveness of the virtual administration of Facing Your Fears (FYF) for autistic adolescents with anxiety during the COVID-19 pandemic. METHODS: A clinical sample of 22 adolescents with autism and anxiety (M(age) = 14.33) and their families participated in the 14-week intervention. Data were collected at pre-intervention, post-intervention, and at weekly sessions to assess feasibility (i.e., participant acceptability, adherence, and utility) and clinical outcomes (i.e., anxiety, socioemotional, and behavioral symptoms). RESULTS: The virtual adaptation of FYF was considered feasible through rates of satisfaction (87%), engagement (83%), and usefulness (80%), but struggled with participant retention. Preliminary analyses demonstrate parent-reported decreases in anxiety across the intervention, with 73.5% of participants indicating reduced anxiety toward their targeted fears. Standardized measures show a potential for socioemotional and behavioral improvements. CONCLUSIONS: Despite limitations, findings suggest that the telehealth adaptation of FYF was an important resource during the COVID-19 pandemic for adolescents with autism and anxiety. Future research should incorporate participant feedback to improve the feasibility of virtual interventions.

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13. Hai Y, Yang Y, Zou M, Ye P, Wang J, Feng L, Gong X, Zhang T, Tian M, Sun C, Wu L. Global and regional insights: unravelling the epidemiological factors and burden of autism spectrum disorders with a focus on China from 1990 to 2021. BMJ Paediatr Open;2026 (May 21);10(1)

OBJECTIVES: To assess the trends of autism spectrum disorders (ASD) in China and globally, to extract the epidemiological characteristics and to predict the burden in 2030. Data on the prevalence and disability-adjusted life years (DALYs) for ASD from 1990 to 2021 were collected from the Global Burden of Disease (GBD) database. METHODS: The Join-point regression model was used to analyse changes in the disease burden of ASD over time, and the Auto-regressive Integrated Moving Average (ARIMA) model was employed to predict the trend by 2030. RESULTS: From 1990 to 2021, the age-standardised prevalence and age-standardised DALYs rate of ASD in China were lower than the global average level. However, the average annual percentage change (AAPC) in these rates was 0.22% for prevalence and 0.23% for DALYs, which were higher than the global average levels. It is forecasted that the disease burden of ASD in China showed an uptrend by 2030, corresponding to the age-standardised prevalence of 660.28 per 100 000 and age-standardised DALYs rate of 126.66 per 100 000. In comparison, the global levels are 793.01 per 100 000 and 147.43 per 100 000 by 2030, respectively. CONCLUSIONS: Our findings demonstrate a strong positive correlation between the age-standardised prevalence and DALYs rate of ASD and sociodemographic index (SDI) across most countries. The health impact of ASD has been on an upward trajectory over the past three decades. ASD significantly contributes to health loss, particularly among preschool boys. The disease burden of ASD in China is likely to increase progressively in the future, highlighting the urgency of implementing targeted prevention and control measures.

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14. Hunsche MC, Zaidman-Zait A, Olana M, Szatmari P, Bennett T, Duku E, Georgiades S, Smith IM, Zwaigenbaum L, Elsabbagh M, Vaillancourt T, Bedford R, Kerns CM. Brief report: joint trajectories of anxiety and depression symptoms in an inception cohort of autistic youth. Front Psychiatry;2026;17:1741956.

BACKGROUND AND AIMS: Anxiety and depression symptoms are common among autistic youth, yet little is known about the pattern and relationship of their trajectories from childhood into adolescence, a period of increasing social and academic demands. METHODS: This study used parallel process latent growth curve models to examine joint trajectories, including initial levels and rate of change in caregiver-reported depression and anxiety symptoms across age 7-16 within an inception cohort of autistic youth with varied communication abilities. We also examined autistic traits, sex assigned at birth, emotional reactivity and communication ability as potential predictors. Child anxiety and depression symptoms were estimated from Child Behavior Checklist Anxiety and Affective Problems subscales, completed by caregivers approximately annually. RESULTS: Whereas anxiety symptoms were relatively stable from childhood into adolescence, depression symptoms increased on average; significant heterogeneity of individual trajectories underlaid these overall trends. Findings indicated cross-sectional and longitudinal co-occurrence of anxiety and depression symptoms. Greater autistic traits and emotional reactivity correlated with greater initial anxiety and depression symptoms, but not their trajectories. Stronger communication ability correlated with more initial anxiety, but decreasing anxiety symptoms over time. CONCLUSIONS: Findings indicate group-level changes in depression symptoms and synchronous evolution of anxiety and depression symptoms in autistic youth across childhood and adolescence. This indicates the importance of joint monitoring of anxiety and depression symptoms in this period, with changes being potentially informative for early detection and intervention. Considering how anxiety symptom presentation may evolve across development may be a helpful next step to identifying at-risk subgroups.

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15. Jiraanont P, Wang JY, Durbin-Johnson B, Hwang YH, Hessl D, Rivera SM, Hagerman RJ, Tassone F. Corrigendum to « The apolipoprotein gene: a modulating role on brain volume and cognitive function in carriers of the fragile X premutation » [Neurobiology of Disease 2026 Feb 2; 220:107292, Page 1-13]. Neurobiol Dis;2026 (May 21):107448.

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16. Lage LAS, Vasconconcelos-Moreno MP, Lemann RS, Heidemann CVC, Kapczinski F, Nardi AE. Clinical Constructs and Historical Insights of the Autism Spectrum Disorder in adults. Trends Psychiatry Psychother;2026 (May 21)

OBJECTIVE: Autism spectrum disorder (ASD) is clinically heterogeneous, and adult presentations, especially among individuals requiring Level 1 support, may be subtle, shaped by adaptation, and obscured by comorbidity and diagnostic overshadowing. We review the historical evolution of autism-related constructs and their implications for recognising and interpreting ASD in adults. METHODS: We conducted a narrative review in MEDLINE (PubMed). Searches combined « autism », « autism spectrum disorder », and « ASD » with predefined constructs (central coherence, theory of mind, social skills, sensory processing differences, repetitive behaviours, restricted and intense interests, executive functions, alexithymia, sleep disturbances, motor abnormalities, and camouflaging). A second search focused on adult autism (adulthood, autistic adults, late diagnosis, and compensatory mechanisms). Grey literature was also considered; publications available up to December 2025 were included. RESULTS: The literature reflects a progressive refinement of the autism construct from descriptive behavioural syndromes to mechanism-oriented models that better accommodate phenotypic variability across development. In adults, these constructs help explain how pragmatic-communication difficulties, rigidity, intense interests, sensory reactivity, and executive-attentional differences can coexist with preserved language and intelligence. Recognition of compensatory strategies and social camouflaging helps explain delayed or missed diagnoses and associated distress. Shifts in diagnostic boundaries and awareness complicate inference from apparent prevalence increases. CONCLUSION: A historically grounded, construct-based framework can improve recognition of clinically meaningful adult ASD, sharpen differential diagnosis amid comorbidity, and support nuanced interpretation of changing diagnostic practices and epidemiological findings. It may inform individualized assessment and support planning as occupational, relational, and adaptive demands increase across adulthood substantially.

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17. Maljaars J, De Roo L, Van der Paelt S, Roeyers H, Noens I. Supporting incarcerated autistic individuals: evaluation of an autism awareness training for prison staff. Int J Prison Health (2024);2026 (May 21):1-12.

PURPOSE: Prison environments are particularly challenging for autistic people experiencing incarceration due to a lack of knowledge and awareness of autism among prison staff. The study aimed to evaluate the level of satisfaction and perceived effectiveness of an autism awareness training for prison staff and to assess whether this training improves autism knowledge and reduces stigma towards autistic individuals in a prison setting. DESIGN/METHODOLOGY/APPROACH: The Autism Experience Circuit (AEC), an interactive autism awareness training, has been offered to prison staff. The training was evaluated through an online survey among 31 prison employees who participated in the AEC compared to a control group of 51 other staff members. FINDINGS: Results showed high satisfaction among AEC participants. They especially appreciated the interactive method. For most participants, the AEC led to increased knowledge and understanding of autism, as indicated by their assessment of goal achievement. A significant improvement in autism knowledge, but not in stigma towards autistic people, was found in the AEC group compared to the control group. ORIGINALITY/VALUE: These findings suggest that an autism awareness training can be a valuable first step in making prisons more accommodating for autistic individuals, but additional strategies are necessary to address stigma effectively.

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18. Nutor C, Dunlop AL, Brennan PA. Associations among maternal prenatal depression, maternal autism traits, and child autism traits in the Environmental Influences on Child Health Outcome (ECHO) program. J Neurodev Disord;2026 (May 21)

BACKGROUND: Maternal depression during pregnancy has been associated with increased risk of offspring autism spectrum disorder (ASD) – a highly heritable neurodevelopmental disorder. However, no study to date has taken into account maternal ASD traits in the association between maternal prenatal depression and child ASD. METHODS: This study utilized data from the Environmental Influences on Child Health Outcomes (ECHO) consortium-a large, national prospective longitudinal study-to examine maternal ASD traits as a covariate and moderator in the association between maternal prenatal depression and child ASD traits. Participants were 645 mother-child dyads. Mothers self-reported prenatal depressive symptoms and ASD traits. Child ASD traits were rated by parents using the Social Responsiveness Scale and Child Behavior Checklist. Maternal depression and child ASD diagnoses were either parent-reported or from medical record review. RESULTS: We found that both maternal prenatal depressive symptoms and depression diagnoses predicted child ASD traits (β’s > .04, p’s < .003). These associations remained significant after accounting for maternal ASD traits for the CBCL only (β's > .42, p’s < .001). Maternal prenatal depression did not predict child ASD diagnoses. Maternal ASD traits predicted child ASD traits and diagnoses (β's > .06, p’s < .001). Maternal ASD traits did not moderate the association between maternal prenatal depression and child ASD traits. CONCLUSION: Providers might consider early screening for ASD in children of mothers with a history of elevated depressive symptoms during pregnancy.

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19. Passarini S, Parisi M, Guerrera S, Vicari S, Fucà E. Bridging autism and eating disorders: a scoping review on repetitive and restrictive behavioral patterns. J Eat Disord;2026 (May 21)

INTRODUCTION: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties in social communication and restricted and repetitive behaviors (RBs). Autistic individuals frequently exhibit co-occurring physical and mental health conditions, worsening long-term outcomes. Among these, feeding and eating disorders (FEDs) are particularly prevalent. Autistic traits may increase vulnerability to FEDs, and people with FEDs often display elevated autistic features. In particular, cognitive rigidity in FEDs seems to reflect RBs patterns typical of ASD. The current scoping review aimed to examine the relationship between autistic features and FEDs with specific reference to RBs, and to assess whether this association differs between pediatric and adult populations. METHOD: The review was conducted in accordance with PRISMA guidelines for scoping reviews. A systematic search of PubMed, PsycINFO, and PsycArticles, with no time restrictions, yielded 204 records. Only peer-reviewed articles written in English were considered eligible. Consistent with our hypotheses, the review included research on autistic individuals as well as on individuals with FEDs or meeting established cut-off scores for FEDs. After removing duplicates and screening titles, abstracts, and full texts, 10 studies met the inclusion criteria. RESULTS: The reviewed studies consistently reported an association between ASD and FEDs with respect to RBs across the lifespan. Of them, four focused on pediatric populations while six on adults. While specific types of RBs associated with FED symptoms, such as repetitive or unusually intense interests, are present in both pediatric and adult age, others seem to manifest differently according to the individual’s age. Further, our findings suggest that RBs may play a role in predisposing autistic individuals in developing FED symptoms. CONCLUSION: The current scoping review shows that RBs may play a role in predisposing autistic individuals to FEDs but also it could potentially act as a feature of ASD in FED populations. Overall, our results highlight the need for tailored assessment, evaluation, and treatment approaches that can capture the unique presentation of eating disorder symptoms and autistic features.

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20. Şahin B. Letter: Outcome Measure Selection as a Source of Null Results in Autism Pharmacotherapy: The Case of Brexpiprazole and the ABC-I. J Child Adolesc Psychopharmacol;2026 (May 20):10445463261453242.

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21. Sterling A, Elmquist M, Banasik A, Ciullo B, Edgar TC, Hoover J. The relationship between language and executive functions in adolescents with Down syndrome and fragile X syndrome. J Neurodev Disord;2026 (May 20)

BACKGROUND: Individuals with fragile X syndrome (FXS) and Down syndrome (DS) have significant and pervasive challenges in language (and more specifically grammar) and executive functions (EFs). While these aspects of development are linked in autism and developmental language disorder, there has not been an investigation into this in FXS and DS. Thus, the purpose of this study was: 1) to evaluate the feasibility of experimental tasks for language and EFs, 2) to test if there are differences in language and EFs in DS and FXS, and 3) to test if EFs are related to grammatical abilities in DS and FXS within and between groups. METHODS: Participants included 21 boys with FXS and 25 participants with DS (n = 9 females) between 9-17 years of age; groups were matched on chronological age (variance ratio = 1.13; d = 0.04, p = 0.897) and were similar on nonverbal IQ and vocabulary. Participants completed lab-based assessments including standardized assessments of nonverbal IQ and vocabulary, experimental measures of grammar (i.e., grammatical judgment and sentence imitation), three experimental executive function tasks, and a parent report of executive functions. RESULTS: While there were participants who could not complete the tasks, overall the feasibility was high (72-91% participants completed the tasks). Wilcoxon rank-sum tests revealed no significant group differences in experimental grammar or EF tasks. In contrast, large differences emerged on parent-reported EFs, with greater impairment in FXS for shifting and inhibition. We used generalized linear regression models with Gaussian and binomial distributions to examine the relationships between EFs and grammatical abilities. We found that only working memory significantly predicted grammatical judgment. CONCLUSIONS: Participants with DS and FXS showed similar grammatical production and comprehension skills, contrasting with prior studies that relied on standardized testing and found more impaired production skills for children and adolescents with DS. Our sentence imitation task highlighted expressive grammar skills in DS, while grammaticality judgment posed challenges as a measure of grammar comprehension. Feasbility was good for all tasks, but there was a range, and younger participants in particular seemed to struggle with some of the tasks. The contrast in group differences between experimental and parent-reports of EFs calls into question whether the two measure EFs in a similar manner. Lastly, our study suggests that the language-EF relationships in intellectual disabilities may diverge from patterns documented in neurotypical development and language impairment without intellectual disability.

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22. Sun Y, Day SE, Gilbert TJ, Bell M, Hamilton AFC, Ward JA. Quantification and Visualisation of Interpersonal Synchrony using Wearable Sensors: A Case Study on Autistic and Neurotypical Children. IEEE Trans Neural Syst Rehabil Eng;2026 (May 21);Pp

Interpersonal synchrony (IS), a key indicator of social interactions, is traditionally assessed through video data and manual coding methods, a process that is time-consuming and subjective. This study presents an automated sensor-based framework for quantifying and visualizing IS using time series data collected from wearable sensors, demonstrated through a case study of interactions between autistic and neurotypical children in classroom settings. We evaluated time series similarity measures, including Cross-correlation (CC), Dynamic Time Warping (DTW), and Cross-Wavelet Analysis (XWA), as features for machine learning (ML) models that classify interaction levels, where ground truth labels are derived from video-coded motor coordination as a behavioral proxy for IS. Results show that these similarity-based features outperform conventional statistical features in distinguishing high and low IS using ensemble classifiers. We further compare two approaches for identifying pseudosynchrony: a surrogate data analysis for threshold estimation and a supervised learning approach for direct prediction, providing a systematic evaluation of their methodological trade-offs that has been largely overlooked in prior synchrony research. The developed visualization tools enable dynamic tracking of interaction patterns while filtering out pseudosynchrony. The proposed workflow offers a scalable, objective, and reproducible alternative to manual coding, addressing a key gap in the current literature and supporting broader applications in social, developmental, and rehabilitation research.

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23. Vega N, Vega C. Decreased Sound Tolerance in Autism: A Clinical-Phenomenological Study. Psychopathology;2026 (May 21):1-18.

INTRODUCTION: Decreased sound tolerance (DST) is a common, yet understudied, sensory experience among individuals with autism. Beyond neurobiological or behavioral explanations, DST can be understood phenomenologically as a distinct mode of auditory being-in-the-world. This study examined how adults with autism experience, interpret, and inhabit their auditory world in situations where sound becomes overwhelming or invasive. METHODS: Eight adults with autism were recruited through social media and participated in in-depth semi-structured interviews focused on their experiences with DST. Participants had a prior clinical diagnosis of autism established by a neurologist or psychiatrist (in some cases supported by ADOS-2), which was subsequently verified by the research team according to DSM-5 criteria. The interview guide was designed to collect information about perception, informed by Karl Jaspers’ clinical phenomenology and Maurice Merleau-Ponty’s philosophy of perception as sensitizing frameworks. Data were analyzed using Amedeo Giorgi’s method, which includes holistic reading, delineation of meaning units, transformation into phenomenological-psychological language, and eidetic synthesis. RESULTS: Participants described DST as an embodied and relational shift in how sound was encountered. Certain sounds are experienced as intense, intrusive, or difficult to accommodate, affecting bodily attunement and ongoing activities. The phenomenon fluctuated with emotional state, fatigue, and contextual predictability and was often accompanied by physical exhaustion and a need to recalibrate through rest or withdrawal. Alongside these challenges, participants also reported moments of heightened clarity and attunement, revealing a distinctive way of perceiving and engaging with the auditory world. CONCLUSION: DST in individuals with autism might be understood as a modification in the structure of embodied perception and auditory attunement, beyond a mere sensory alteration. From a phenomenological perspective, DST reflects a particular relational configuration with the auditory world that shapes embodiment, affectivity, and intersubjectivity. These findings contribute to the emerging phenomenological psychopathology of autism by describing how auditory experience can participate in the formation of lived presence and being with others.

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24. Yankowitz LD, Pargi MK, DeJardin E, Zampella CJ, Guthrie W, Pandey J, Keith Bartley G, Chen D, McDonald DQ, Manakiwala A, Khanna M, Keen K, Buboltz G, Yang A, Herrington JD, Sariyanidi E, Schultz RT, Tunç B. Automatic measurement of social gaze during naturalistic conversations in autism. J Psychiatr Res;2026 (May 16);200:93-102.

Standardized, granular measurement of social communication behaviors, such as social gaze during natural interactions, is needed for a range of psychiatric applications including diagnosis and detecting clinical change in conditions such as autism. Computational approaches show promise in automatically measuring social behaviors within natural settings. This study aims to automatically measure social gaze features from videos of dyadic conversations, characterize autism-related differences, and capture individual-level differences. 46 autistic Participants and 36 neurotypical Participants, aged 8-29 years, engaged in a brief video-recorded conversation with a research staff member (Partner). An automated social gaze detector was trained to detect whether each partner was looking at the other and achieved 89% cross-validated accuracy with human annotations. Comparing detailed automatic gaze measurements, autistic Participants spent less time looking at Partners and engaging in mutual gaze than neurotypical Participants did. They also initiated mutual gaze less frequently and had shorter mutual gaze episodes, but did not differ in mutual gaze counts. A social gaze summary score fusing individual variables correlated specifically with ADOS-2 Social Affect scores and not Restricted and Repetitive Behavior scores. A cross-validated multivariate classification model using gaze features was able to make individual-level diagnostic prediction (autism versus neurotypical) with 73% accuracy. This study provides a framework for automatically quantifying social gaze behaviors with high granularity and demonstrates its use in psychiatric research. This framework has a potential for enhancing measurement of social skills and tracking therapeutic progress in autism and other psychiatric conditions.

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25. Yurttutan S, Geçkil E. Effects of mindfulness-based stress reduction on levels of depression, anxiety, stress, and hopelessness in parents of children with autism: A randomized controlled trial. J Pediatr Nurs;2026 (May 21);89:472-481.

AIM: This study aimed to evaluate the effects of a Mindfulness-Based Stress Reduction (MBSR) program on depression, anxiety, stress, and hopelessness among parents of children with autism (Autism Spectrum Disorder [ASD]). METHOD: A pre-test-post-test, parallel-group randomized controlled trial was conducted in two institutions providing education for children with ASD in Konya, Türkiye. The sample included 96 parents randomized into intervention (n = 48) and control (n = 48) groups using block randomization. The intervention group participated in an eight-week MBSR program delivered in weekly sessions, while the control group received routine monitoring. Data were collected at baseline, post-intervention, and four-week follow-up using a Personal Information Form, the Depression, Anxiety, and Stress Scale-21 (DASS-21), and the Beck Hopelessness Scale (BHS). Statistical significance was set at p < 0.05. RESULTS: No significant differences were observed between groups at baseline. Compared with the control group, the intervention group demonstrated significantly lower levels of depression, anxiety, and stress at both post-test and follow-up. No significant between-group differences were found in total hopelessness scores. CONCLUSION: The MBSR program was effective in reducing depression, anxiety, and stress among parents of children with ASD. However, overall hopelessness did not change significantly, suggesting that this construct may be less responsive to short-term interventions. PRACTICE IMPLICATIONS: Nurse-delivered MBSR programs may be effective in reducing psychological distress among parents of children with ASD and can be integrated into family-centered care practices.

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26. Zhan J, Lee HK. Before synapses are lost: Do endogenous retroviruses drive microglial overpruning in autism spectrum disorders?. Neuron;2026 (May 20);114(10):1699-1701.

Endogenous retroviruses (ERVs) are epigenetically silenced genomic elements whose reactivation can influence host gene regulation. In this issue of Neuron, Chen et al. identify ERV-derived RNA-DNA hybrids that activate neuronal C4b, driving microglial synaptic overpruning and autism-like behaviors.

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27. Zhong Z, Lin C, Cao Y, Luo Y, Ding N, Ding W, Yang Y. Limosilactobacillus reuteri ameliorates maternal immune activation-induced autism-like behaviors by reprogramming lipid biosynthesis in the gut epithelium. Brain Behav Immun;2026 (May 19);137:106813.

Autism spectrum disorder (ASD) is frequently associated with gastrointestinal dysfunction and dysbiosis. Here, we demonstrate that the probiotic Limosilactobacillus reuteri (L. reuteri) ameliorates behavioral deficits and cortical dysfunction in offspring from a maternal immune activation (MIA) mouse model of ASD through two synergistic gut-brain pathways. Mechanistically, L. reuteri restores gut barrier integrity and attenuates inflammation by reprogramming colonic lipid metabolism toward cholesterol biosynthesis. Critically, cholesterol synthesis is indispensable for L. reuteri’s therapeutic effects, as demonstrated by the fact that statin-mediated inhibition of cholesterol synthesis abolishes the benefits on gut barrier function and neurobehavior. Moreover, L. reuteri elevates serum levels of N-oleoyldopamine (OLDA), an endogenous lipid amide that crosses the blood-brain barrier and attenuates neuroinflammation. Exogenous OLDA administration alone is sufficient to attenuate neuroinflammation and ameliorate neurobehavioral and cortical dysfunction in MIA offspring. Together, these findings delineate a gut-brain axis mechanism by which L. reuteri counteracts MIA-induced autism-like behaviors, highlighting the therapeutic potential of targeting microbial-lipid crosstalk in ASD.

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