1. Ahn G, Li CE, Liang A, Choi W, Ahn S, Roberts C, Gabrieli JDE. Large Language Model Few-Shot Learning for Predicting Individual Treatment Response to Smartphone-Based Mindfulness in Autistic Adults With Anxiety: Secondary Analysis of a Randomized Controlled Trial. Jmir ai. 2026; 5: e89054.

BACKGROUND: Anxiety disorders are highly prevalent among adults with autism, with 20%-65% experiencing at least one diagnosable anxiety disorder. While mindfulness-based interventions have demonstrated efficacy for anxiety reduction, treatment response varies considerably across individuals. Machine learning approaches offer potential for identifying who is most likely to benefit from smartphone-based mindfulness interventions, enabling personalized treatment recommendations. OBJECTIVE: This study aimed to develop and evaluate machine learning models to predict individual treatment response to a smartphone-based mindfulness intervention for adults with autism. We identified baseline characteristics that distinguish responders from nonresponders and explored few-shot learning with large language models (LLMs) as a complementary approach for low-data clinical prediction. METHODS: We conducted a secondary analysis of a randomized controlled trial comparing a 6-week smartphone-based mindfulness intervention with a waitlist control group in adults with autism. Among 73 participants who completed the intervention, we defined responders as those achieving a ≥7-point reduction in State-Trait Anxiety Inventory state anxiety scores. Baseline predictors included demographic variables; autism trait measures; and self-report questionnaires assessing anxiety symptoms, perceived stress, affect, and mindfulness. To determine which machine learning model was most predictive of response, we trained 6 different models (logistic regression, random forest, extreme gradient boosting [XGBoost], tabular data network [TabNet], TabICL, and Tabular Prior-Data Fitted Network [TabPFN]) using nested 10-fold cross-validation with inner 5-fold cross-validation for hyperparameter tuning and evaluated GPT-4o few-shot learning with tokenized features at 20 to 70 shots. RESULTS: Random forest achieved the highest predictive performance for state anxiety response (area under the curve [AUC] 0.79, 95% CI 0.66-0.91), followed by TabPFN (AUC 0.78, 95% CI 0.64-0.94) and logistic regression (AUC 0.77, 95% CI 0.73-0.81). Higher baseline state anxiety (standardized β coefficient=1.20, P<.001) predicted better treatment response, while higher Autism Spectrum Quotient at baseline (standardized β coefficient=-0.17, P=.001), older age (standardized β coefficient=-0.18, P=.02), and lower childhood pretend play scores (standardized β coefficient=-0.93, P=.007) were associated with poorer response. Few-shot learning with 7-feature tokenization achieved an accuracy of 0.867 at 70 shots, compared to an accuracy of 0.733 for random forest. Prediction of trait anxiety changes was substantially weaker (AUCs 0.46-0.68), likely reflecting the inherent stability of this personality dimension. CONCLUSIONS: Machine learning models successfully identified baseline characteristics predicting state anxiety response to a smartphone-based mindfulness intervention in adults with autism. Few-shot learning with LLMs demonstrated superior performance to traditional machine learning when provided with compact, high-signal feature representations, offering a promising approach for clinical prediction in small-sample settings. These findings demonstrate the feasibility of precision psychiatry in digital mental health interventions for adults with autism. As online mental health interventions become ubiquitous, patients and clinicians can know whether a particular intervention is more or less likely to benefit an individual patient.

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2. Burte B, Tringali S. Beyond Direct Costs: Expanding the Conceptualization of Caregiver Burden in Autism. Autism. 2026: 13623613261466589.

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3. Cheawsamoot C, Thangpong R, Chetruengchai W, Kanlayaprasit S, Kamolvisit W, Kor-Anantakul P, Assawapitaksakul A, Boonsimma P, Poonmaksatit S, Chomtho K, Desudchit T, Shotelersuk V. Long-read genome sequencing increases diagnostic yield in a short-read sequencing unsolved developmental epileptic encephalopathy (DEE) cohort. J Med Genet. 2026; 63(8): 505-10.

Developmental epileptic encephalopathy (DEE) comprises neurodevelopmental disorders with early-onset seizures and developmental impairment. Despite >900 implicated genes, many patients remain undiagnosed after short-read sequencing (SRS). We assessed long-read genome sequencing (LR-GS) in 38 previously unsolved infantile-onset DEE probands (10 singletons, 28 trios). Variant detection included single nucleotide variants (SNVs), structural variants, copy number variants and short tandem repeats in established repeat expansion disease genes. LR-GS identified candidate variants in 8 out of 38 probands (21%) missed by SRS: five large deletions, one SNV in a low-mappability region of NSF, one case resolved via haplotype phasing of compound heterozygous SNVs without parental samples and one case where LR-GS detected an allele missed due to coverage gaps. An additional eight probands (21%) harboured variants technically detectable by SRS but were missed due to newly associated genes, synonymous variants lacking splicing evaluation or prior analytic pipelines. LR-GS substantially increases diagnostic yield in unsolved infantile-onset DEE, supporting its incorporation into clinical workflows as a second-tier genetic test for otherwise unsolved neurodevelopmental disorders.

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4. Côté A, Grégoire P, Courchesne V. [Beyond words: The complexity of differential diagnosis and treatment of severe ritualized behaviors in an autistic adolescent without functional language and with an intellectual disability: A case report]. Sante Ment Que. 2026; 51(1): 245-56.

Autistic youth diagnosed with an associated intellectual disability (ID) represent nearly one third of the autistic population. However, the majority of studies on mental health and autism focus on autistic individuals without ID. Therefore, the mental health needs of autistic youth with an ID are still poorly understood. This case report focuses on the psychiatry follow-up of Nabil (fictitious name), an autistic adolescent with ID who has been treated for nearly 10 years for various symptoms, including ritualized behaviors that are part of a complex and rare diagnostic profile. In terms of neurodevelopmental disorders, in addition to symptoms associated with autism and ID, a diagnosis of attention deficit/hyperactivity disorder (ADHD) and Tourette syndrome was made, but the ADHD diagnosis was not maintained. Catatonia associated with autism has also emerged and is currently in remission. In terms of mental health, a diagnosis of obsessive-compulsive disorder (OCD) was made and behavioral problems were noted, without being attributed to the previous diagnoses. The presented case has three specific objectives: 1-to illustrate the challenges inherent in assessing the intellectual potential of autistic individuals with very low adaptive functioning and the impact on the treatment; 2- to provide avenues for the differential diagnosis of autistic rituals, compulsions, tics, stereotypies, and ADHD within this population and 3- to raise awareness about the underdiagnosis of catatonia in autistic youth.

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5. da Rosa A, Sorato GB, Manjabosco F, Dellazari L, de Bem É B, Falcão AB, Cia LO, Nedel AJL, da Costa MRB, Bezerra OS, Borges RB, Rohde LA, Graeff-Martins AS. Clozapine for Severe Treatment-Resistant Disruptive Behaviors in Youth with Autism Spectrum Disorder: A Prospective Real-World Interventional Study. J Child Adolesc Psychopharmacol. 2026: 10445463261467155.

OBJECTIVE: Severe disruptive behaviors in youth with autism spectrum disorder (ASD) frequently persist despite conventional treatments, contributing to functional impairment. Although clozapine has antiaggressive properties, evidence guiding its use in treatment-resistant cases in autistic youth remains predominantly observational and retrospective. This study aimed to evaluate systematically and prospectively the effectiveness and safety of clozapine for treatment-resistant disruptive behaviors (TR-DB) in youth with ASD under routine conditions. METHODS: This single-arm, open-label trial enrolled participants aged 10-17 with ASD. Inclusion required TR-DB after ≥2 antipsychotic trials and a Clinical Global Impression-Severity score ≥5. Following flexible titration, clozapine was maintained for 12 weeks. The primary outcome was change on the caregiver-rated Aberrant Behavior Checklist-Irritability (ABC-I). Secondary measures included global improvement, autism symptom severity, adaptive behavior, and caregiver quality of life. Response was defined as ≥30% ABC-I reduction plus a CGI-Improvement (CGI-I) of 1 to 2; remission required ≥80% ABC-I reduction and a CGI-I of 1. RESULTS: Thirty-one participants initiated clozapine treatment (mean age 13.4 years; 90.3% male), and 28 completed the trial. ABC-I scores decreased from 32.0 ± 7.7 to 7.4 ± 5.1 (Cohen’s d(z) -2.5; p < 0.001). Overall, 83.9% responded, and 38.7% remitted. Global severity improved from 6.1 ± 0.6 to 3.8 ± 1.6 (p < 0.001). Significant improvements were observed in daily living skills, caregiver quality of life, and reduced polypharmacy. Adverse drug reactions were mostly mild-to-moderate; however, metabolic changes comprised significant weight gain and triglyceride elevation (both p < 0.05). Serious events included seizures (n = 4) and pneumonia (n = 1). CONCLUSIONS: Clozapine was associated with robust, rapid TR-DB reductions and high retention in autistic youth. However, safety risks mandate rigorous monitoring. Controlled trials are needed to confirm efficacy and refine the benefit-risk profile.

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6. Emovon A, Driggers-Jones L, Engelhard M, Maslow G, Dawson G, Goldstein BA, Franz L. Understanding end-user contexts and identifying design preferences of an artificial intelligence-based clinical decision support tool for early autism detection. JAMIA Open. 2026; 9(4): ooag145.

OBJECTIVES: Building on innovations for autism detection-where artificial intelligence (AI)-based models monitor clinical data within electronic health records-this study evaluates the context for clinical decision support (CDS) deployment and identifies design preferences. MATERIALS AND METHODS: This observational study utilized contextual inquiry to elicit perspectives from 8 clinicians and twenty caregivers during 18- to 24-month well-child visits at Duke-affiliated clinics. Data were analyzed using rapid qualitative analysis techniques. RESULTS: Workflow analysis identified 6 user tasks, 3 technology-user interactions, and 5 clinical decision points. Technologies that streamlined screening included patient portals, digital tablets, and note templates. Clinicians identified 2 major barriers-limited screening tool accuracy and challenges in implementing follow-up steps-and 3 facilitators: electronic screening, early intervention provider input, and staff referral coordination support. For design, CDS should include clear, actionable outputs, with explanations of prediction data, visual summaries linked to next steps, and educational resources. Embedding CDS within the EHR, with outputs delivered at key points during the clinical encounter, along with caregiver-facing materials, would improve workflow efficiency. DISCUSSION: Findings highlight key integration points for an autism detection AI-based CDS tool and stress the need for clinical utility and caregiver-centered communication. Effective design requires alignment with clinical workflow, including the timing of outputs, meaningful explanations, and integration with caregiver communication. CONCLUSION: Findings will inform the design of an AI-based CDS tool for autism detection, providing workflow-informed integration points and user preferences. Future work should refine explainability and optimize delivery of outputs within clinical encounters to support decision-making and caregiver engagement.

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7. Erlid C, Adhora SH, Volkmar FR, Brandlistuen RE, Larsen K, Øien RA. Sex Differences in Early Childhood Trajectories of Internalizing and Externalizing Behaviors in Autism: Findings From the Norwegian Mother, Father and Child Cohort Study (MoBa). J Autism Dev Disord. 2026.

PURPOSE: To examine trajectories of parent-reported internalizing and externalizing behaviors at 18 months, 36 months, and 5 years among children with autism spectrum disorder (ASD) compared with children with no recorded diagnosis (NoDx), and to test whether these patterns differed by sex. METHODS: CBCL-derived internalizing and externalizing scores were constructed from harmonized MoBa items available across the three waves. Linear mixed-effects models tested time x diagnosis x sex effects in the ASD-vs-NoDx sample (N = 61,553), with a secondary ASD-only sex analysis. RESULTS: ASD-NoDx differences were not clearly evident at 18 months, but emerged by 36 months and were clearest at 5 years. Internalizing and externalizing showed significant time x diagnosis effects, but no evidence that diagnosis differences varied by sex. In ASD-only models, sex differences were modest; boys showed higher externalizing than girls only at 5 years. CONCLUSION: Broad CBCL-derived emotional and behavioral differences associated with ASD became more detectable across the toddler-to-preschool transition. Sex differences were small relative to diagnosis-related developmental divergence.

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8. Gontijo JPS, Martins M, Alves LM. Clinical characteristics of Autism Spectrum Disorder in older adults: a scoping review. Trends Psychiatry Psychother. 2026.

INTRODUCTION: Autism Spectrum Disorder (ASD) is a lifelong condition; however, literature regarding its manifestation in old age remains scarce. OBJECTIVE: To synthesize descriptive studies on the clinical characteristics of ASD in the elderly, aiming to improve diagnosis and quality of life. METHODOLOGY: This is a scoping review based on the Joanna Briggs Institute guidelines and reported according to PRISMA-ScR. Searches were conducted in MEDLINE/PUBMED and SCIELO databases, covering the period from 2011 to 2026, focusing on descriptive studies with participants aged over 50 years. Ultimately, 18 articles were selected and analyzed. RESULTS: The evolution of autism symptoms proved to be complex and non-linear; while some behaviors and psychiatric symptoms tend to decline with age, social difficulties may persist or worsen. From a cognitive perspective, data suggest an aging pattern parallel to neurotypicals, although there are reports of specific deficits in working memory and attention. An alarming burden of psychiatric comorbidities was identified, highlighting depression and high rates of suicidality, as well as significant clinical comorbidities. CONCLUSION: Older adults with ASD constitute a vulnerable population. There is an urgent need for prospective longitudinal studies to adequately map the aging trajectories of this population.

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9. Hansford RLW, Davis LE, Griffiths R, Horrill T, Nguyen P, Goldie CL, Hanna TP, Mahar AL. Receipt of cancer care among stage IV non-small-cell lung cancer patients with and without intellectual or developmental disabilities: A population-based retrospective cohort study. Palliat Med. 2026: 2692163261464345.

BACKGROUND: Little is known about non-curative lung cancer care, including palliative care, for adults with intellectual, or developmental disabilities. Clinical management may vary due to health status, ability to communicate, access to inclusive healthcare, and healthcare bias. AIM: We examined the receipt of cancer-directed consultations, treatments and palliative care among stage IV non-small-cell lung cancer (NSCLC) patients with and without intellectual or developmental disabilities. DESIGN: This was a population-based retrospective cohort study using provincial routinely collected health data. Receipt of consultations with surgeons, medical oncologists, and radiation oncologists, receipt of systemic therapy, radiation, and surgery as well as receipt of palliative care in the year following diagnosis were compared between people with and without intellectual or developmental disabilities. Cause-specific Cox proportional hazards regression, accounting for death as a competing event, was used. SETTING/PARTICIPANTS: Adults diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario, Canada. RESULTS: The study included 33,184 individuals diagnosed with stage IV NSCLC (n intellectual or developmental disabilities = 106). Adults with intellectual or developmental disabilities were significantly less likely to receive any cancer-directed consultation (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.49-0.78), any cancer-directed cancer treatment (HR = 0.52; 95% CI 0.39-0.70), and radiation or systemic therapy (HR = 0.49; 95% CI 0.36-0.66) than non-disabled adults. There was no statistical difference in receipt of palliative care (HR = 1.15; 95% CI 0.93-1.41). CONCLUSION: These findings contribute to an emerging evidence base documenting differences in cancer treatment and outcomes among adults with intellectual or developmental disabilities. Person-center research is needed that examines end-of-life lung cancer care treatment decision-making to identify and mitigate barriers to optimal management.

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10. Hennepe SJT, Voorendonk EM, de Jongh A. The impact of intensive trauma-focused treatment on adults with PTSD and ASD traits: a pre-post intervention study. Eur J Psychotraumatol. 2026; 17(1): 2696633.

Background: Post-traumatic stress disorder (PTSD) often co-occurs with elevated autism spectrum disorder (ASD) traits, potentially affecting treatment response. Empirical data on the impact of ASD traits on the effectiveness of trauma-focused therapy remain scarce.Objective: To investigate the treatment response following intensive trauma-focused therapy in patients with PTSD, comparing outcomes between individuals with high versus low comorbid ASD traits.Methods: 175 patients with PTSD underwent an intensive trauma-focused treatment programme that integrated prolonged exposure, EMDR therapy, psychoeducation and physical activities. Participants were categorised into a high ASD trait group (n = 70) and a low ASD trait group (n = 105) based on scores on the AQ-50. PTSD symptoms were measured pre- and post-treatment using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). A mixed model repeated measures ANOVA was used to analyze the interaction between time and group on CAPS-5 scores.Results: Both groups showed significant reduction in PTSD symptoms following treatment, with large effect sizes (Cohen’s d = 2.89 in the low ASD group and 3.07 in the high ASD group). Overall, 83% of patients lost their PTSD diagnosis post-treatment. A significant decrease in AQ-50 scores was observed in the high ASD traits group with a medium effect size (Cohen’s d = .52), while 31% of these patients shifted to the low ASD traits group after treatment. Reliable clinical improvement in PTSD symptoms was observed in 93% of patients with high ASD traits and 90% of those with low ASD traits. No adverse events or treatment dropouts occurred.Conclusions: Intensive trauma-focused treatment was found effective and safe for patients with PTSD, including those with elevated ASD traits. The results suggest that presence of high ASD traits does not preclude substantial treatment gains or loss of diagnosis, and underscore the relevance of inclusive, tailored trauma-focused therapy approaches for neurodiverse populations. PTSD symptoms decreased from pre- to post-treatment in both individuals with high and low levels of ASD traits, with large effect sizes.Treatment reduced ASD symptoms in individuals with elevated ASD traits.Intensive trauma-focused treatment benefits PTSD patients with elevated ASD traits. eng.

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11. Hollingdale J, Woodhouse E, Deeley Q. The changing landscape of autism diagnostic assessments in the UK. Br J Psychiatry. 2026: 1-2.

The UK is experiencing increasing demand for autism assessments, placing severe pressure on the National Health Service (NHS) and private services. Policy responses remain unproven and cost-driven adaptations have compromised quality of some assessments. This risks misdiagnosis, inappropriate support and growing demand for reassessments, potentially creating greater long-term burden for individuals and services alike.

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12. Jia Y, Qi K, Cai K, Mao Y, Guo H, Wang Q, Chen A. Effects of Virtual Reality-Based Physical Exercise Interventions on Behavioral, Executive Function, and Motor Outcomes in Children and Adolescents With Autism Spectrum Disorder: Systematic Review and Meta-Analysis. J Med Internet Res. 2026; 28: e98579.

BACKGROUND: In addition to core behavioral symptoms, children and adolescents with autism spectrum disorder (ASD) frequently exhibit impairments in executive function and motor performance. Although virtual reality (VR)-based physical exercise interventions are increasingly used in ASD rehabilitation, evidence regarding their multidimensional effects remains limited. OBJECTIVE: This study aimed to systematically review the effects of VR-based physical exercise interventions on behavioral outcomes, executive function, and motor performance in children and adolescents with ASD. METHODS: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines were followed. PubMed (National Library of Medicine), Embase (Elsevier), Web of Science, Scopus (Elsevier), and other databases were searched from inception to May 7, 2026. Eligible studies included randomized and nonrandomized trials involving participants aged 6-18 years with ASD. The interventions consisted of VR-based exercise programs involving physical activity participation, including active video games, motion-sensing interactive training, and augmented reality-based exercise training. Risk of bias was assessed using Risk of Bias 2 (RoB 2; Cochrane Bias Methods Group) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I; Cochrane Bias Methods Group), and certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Random-effects meta-analyses were conducted using Hedges g standardized mean differences (SMDs). RESULTS: A total of 15 studies involving 439 children and adolescents with ASD were included; among them, 9 studies were eligible for meta-analysis. Behavioral outcomes were reported in only 3 studies. Owing to substantial heterogeneity in study designs and assessment instruments, we did not conduct a meta-analysis for these outcomes. Current evidence suggests inconsistent effects on social interaction and stereotyped behaviors. VR-based physical exercise interventions may improve executive function (SMD 0.75, 95% CI 0.32-1.18; I²=0.0%; P=.01; GRADE moderate). However, the prediction interval crossed the line of no effect (-0.12 to 1.63). VR-based physical exercise interventions were associated with improvements in motor performance (SMD 1.08, 95% CI 0.08-2.08; I²=74.3%; P=.04; GRADE low). However, the wide prediction interval suggests substantial between-study variability (-1.31 to 3.47). CONCLUSIONS: Current evidence suggests a relatively consistent positive effect of VR-based physical exercise interventions involving physical activity participation on executive function in children and adolescents with ASD. However, substantial uncertainty remains regarding their effects on motor performance and behavioral outcomes. Unlike previous reviews that primarily focused on general VR interventions, social skills training, or single functional outcomes, this systematic review specifically examined the multidimensional effects of VR-based physical exercise interventions. The findings suggest that VR-based physical exercise interventions may be implemented as adjuncts to conventional exercise or rehabilitation programs rather than as stand-alone interventions. Future large-scale, high-quality randomized controlled trials with larger sample sizes, standardized intervention reporting, and long-term follow-up are needed to further clarify the optimal implementation conditions and underlying mechanisms of different forms of VR-based exercise training.

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13. Kang J, Li Y, Wu J, Li X, Zhou T. Transcranial direct current stimulation reshapes the high-speed dynamic Organization of the autistic brain: An EEG microstate and brain network analysis. Prog Neuropsychopharmacol Biol Psychiatry. 2026; 149: 111850.

BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by atypical brain network organization and reduced neural flexibility. While transcranial direct current stimulation (tDCS) shows promise in alleviating symptoms, the underlying neurophysiological mechanisms and objective biomarkers remain poorly understood. OBJECTIVE: This study aimed to investigate how targeted tDCS modulates the high-speed dynamic organization of the autistic brain using EEG microstate and complex network analysis. METHODS: In this randomized controlled trial, 52 children with ASD were assigned to either an experimental group (n = 26) receiving a 5-week course of tDCS targeting the left dorsolateral prefrontal cortex (DLPFC) or a control group (n = 26). Clinical symptoms were assessed using the ABC and SRS scales. Resting-state EEG data were analyzed using microstate segmentation, wPLI-based functional connectivity, spatiotemporal variability, and first-order autoregressive modeling of state transitions. RESULTS: Post-intervention, the experimental group showed a significant increase in the occurrence and coverage of microstate A and microstate B, alongside a decrease in microstate C and D duration. Graph theoretical analysis revealed enhanced global and local efficiency, particularly in microstate B networks. Furthermore, tDCS significantly increased temporal variability while reducing spatial noise across microstate windows. Notably, the increase in microstate A occurrence was exclusively and negatively correlated with reductions in ABC and SRS scores, while no such correlations were found for other metrics. CONCLUSION: Targeted tDCS reduces neural rigidity in children with ASD by enhancing spatiotemporal flexibility and optimizing information processing efficiency. Microstate A dynamics may serve as a robust electrophysiological biomarker for monitoring intervention efficacy in pediatric ASD populations.

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14. Le Belle JE, Condro MC, Cepeda C, Oikonomou KD, Tessema K, Dudley L, Schoenfield J, Kawaguchi R, Geschwind D, Silva AJ, Zhang Z, Shokat K, Harris NG, Kornblum HI. Acute rapamycin treatment reveals distinct mechanisms of dysfunction in a maternal inflammation mouse model. Nat Commun. 2026; 17(1).

Maternal inflammatory response (MIR) during early mouse gestation induces a cascade of physiological and behavioral changes associated with autism spectrum disorder (ASD). We have shown that mild MIR causes chronic systemic and brain inflammation, mTOR pathway activation, mild brain overgrowth with regionally specific volumetric changes, sensory processing dysregulation, and repetitive behavior abnormalities. Prior rapamycin studies in autism models focused on chronic treatments that alter or prevent physical brain changes. Here, we focus on acute rapamycin effects to uncover novel mTOR pathway-mediated mechanisms of dysfunction. Within 2 hours, rapamycin rescues neuronal hyperexcitability, seizure susceptibility, functional network connectivity, brain community structure, repetitive behaviors, and sensory over-responsivity in adult MIR offspring. These CNS-mediated effects coincide with altered expression of genes associated with ASD, ion channels, and epilepsy. Our findings demonstrate that mTOR dysregulation drives dysfunctional brain development in MIR offspring but the adult brain remains amenable to rapid functional normalization, rescuing core and comorbid ASD-associated brain and behavior phenotypes. Restoring excitatory/inhibitory imbalance and sensory functional network modularity may be important targets for therapeutically addressing multiple ASD phenotypes.

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15. Li Y, Wu J, Liu N, Li X, Zhou T, Kang J. Disentangling oscillatory and aperiodic neural activity in autism: A spectral parameterization analysis of neurofeedback intervention. Behav Brain Res. 2026; 514: 116396.

BACKGROUND: Autism Spectrum Disorder (ASD) is characterized by atypical neural oscillations and heterogeneous alterations in excitation/inhibition (E/I) balance, the directionality of which varies across individuals, neural circuits, and developmental stages. While Alpha-band neurofeedback (NFB) is a promising intervention, its underlying neurophysiological mechanisms remain unclear, partly due to the conflation of periodic and aperiodic signals in traditional EEG analysis. METHODS: This randomized controlled trial recruited 40 children with ASD, assigned to either an experimental group (Alpha-training NFB) or a no-feedback group. Resting-state EEG and behavioral assessments (SRS, ABC) were collected pre- and post-intervention. We employed spectral parameterization to decompose neural activity into aperiodic (1/f slope, offset) and periodic (periodic alpha power, center frequency) components. RESULTS: NFB training yielded significant behavioral improvements in social cognition and relating skills. Physiologically, the experimental group exhibited a significant steepening of the aperiodic slope (increased exponent), reflecting a reduction in neural noise and potential optimization of inhibitory modulation. Furthermore, we observed enhanced periodic alpha power and an acceleration of the alpha center frequency (ACF), indicative of improved neural efficiency and maturation. These physiological shifts in frontal and occipital regions were significantly correlated with improvements in behavioral scores. CONCLUSION: Alpha-training NFB was associated with improvements in caregiver-rated behavioral scores and modulated spectral features of resting-state EEG in children with ASD. These findings validate the utility of spectral parameterization markers in evaluating neuromodulatory interventions.

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16. Lidstone DE, Mostofsky SH. Speed-Dependent Visual-Motor Tracking Differences in Children With Autism Relate to Core Symptoms. Ann Child Neurol Soc. 2025; 3(4): 274-81.

BACKGROUND AND OBJECTIVES: Children with autism spectrum disorder (ASD) often experience challenges integrating visual information to guide motor behavior, particularly in dynamic (speeded) contexts. We investigated the effects of varying stimulus tracking speed on visual-motor integration (VMI), addressing our hypothesis that ASD diagnosis and symptom severity would be associated with impaired performance on dynamic, speeded (vs. slow/static) VMI. METHODS: Fifty-four children aged 8-12 years (ASD: n = 16; typically developing [TD] controls: n = 38) successfully completed a continuous grip-force tracking task involving three conditions: static, slow, and fast visual trajectories. A linear mixed-effects model was used to examine the effects of ASD (vs. TD) diagnosis on speeded VMI. We further examined the correlation between speeded VMI and both clinician-rated (Autism Diagnostic Observation Schedule, Second Edition [ADOS-2]) and parent-reported Social Responsiveness Scales, Second Edition (SRS-2) autism symptoms. RESULTS: A significant interaction between diagnosis and condition was observed (p = 0.03), indicating that group differences in tracking accuracy varied by stimulus speed. Children with ASD showed significantly greater tracking error than TD peers in the fast condition (ASD: 13.5 ± 1.0 [95% CI: 11.3-15.7]; TD: 10.5 ± 0.7 [95% CI: 9.1-12.0]; p = 0.02), but not in the static (p = 0.80) or slow (p = 0.55) conditions. Both groups showed increased error as speed increased, but the ASD group showed greater impairment under speeded conditions. Higher ADOS-2 Total scores predicted greater error in the fast versus slow (p = 0.009) and fast versus static (p = 0.06) contrasts and in the fast condition alone (p = 0.02). Elevated SRS-2 Total scores were similarly associated with greater error in the fast versus slow (p = 0.02) and fast versus static (p = 0.02) comparisons, though not in the fast condition alone (p = 0.23). DISCUSSION: The findings support difficulty with speeded dynamic VMI as a scalable autism biomarker. Further development of these biomarkers could be helpful to guiding behavioral interventions, for instance, identifying children who would best respond to slowing visual cues during therapy. Future studies should refine assessment tools to extend assessments of dynamic VMI to younger and more affected children and explore developmentally appropriate interventions tailored for children showing difficulties with speeded VMI.

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17. Loubersac J, Picot MC, Belloc F, Boussac M, Baghdadli A. Linking the national health database to the cohort of children with autism spectrum disorders: a mixed approach to optimising the linkage. J Epidemiol Popul Health. 2026; 74(4): 203349.

BACKGROUND: Autism Spectrum Disorders (ASD) are neurodevelopmental disorders with highly heterogeneous clinical profiles, outcomes and care pathways. Linking health administrative databases with cohort studies is an excellent opportunity to study healthcare utilisation by ASD patients. Optimisation of linkage should maximise the linkage rate and minimise potential errors and biases to ensure high quality analyses and the absence of bias. This study aims to describe the linkage strategy between the French national health database (SNDS) and the ELENA cohort database, and to provide advice on optimizing linkage quality. METHODS: The ELENA cohort includes 876 children with a confirmed diagnosis of ASD between 2013 and 2019. The SNDS contains all healthcare services reimbursed by health insurance schemes. We performed deterministic matching on the reference sample and evaluated deterministic and probabilistic approaches on another sample. Performance was assessed using the matching rate and comparison between matched and unmatched groups. RESULTS: We matched 96 % of the reference sample and 53 % of the other sample using either deterministic or probabilistic approach, resulting in a total match rate of 79 % with deterministic or mixed approach. The mixed approach minimized selection bias, producing a linked dataset of 692 children with ASD whose characteristics were comparable to those of the unmatched sample. Probabilistic weighting showed that hospitalization dates were the most discriminating variables for matching. CONCLUSIONS: The mixed linkage strategy optimised match quality while limiting bias, confirming the feasibility of linking clinical ASD cohort data to the SNDS and strengthening future research on healthcare use among children with autism. TRIAL REGISTRATION NUMBER: NCT04292522.

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18. Morton A, Arnold H, Hamrick L, Chase A, Cobb S, Roberts J. Autonomic Nervous System Function and Sensory Sensitivity in 12-Month-Old Infants with the FMR1 Premutation. Int J Mol Sci. 2026; 27(15).

The fragile X premutation (FXpm) is a relatively common condition caused by an expansion of 55-200 cytosine-guanine-guanine (CGG) repeats in the fragile X messenger ribonucleoprotein 1 (FMR1) gene. Previous studies have identified sensory processing challenges in children with the FXpm and reduced autonomic regulation in FXpm infants; no research has examined the relationship between autonomic nervous system (ANS) functioning or molecular variables and sensory responsiveness during infancy. This study examined parent-reported sensory responsiveness and its association with baseline respiratory sinus arrhythmia (RSA), interbeat interval (IBI), and CGG repeat length in 12-month-old infants with the FXpm (n = 35) and neurotypical (NT) controls (n = 55). Results indicated no significant differences in hyporesponsive or hyperresponsive sensory behaviors and no significant associations between baseline RSA or IBI and sensory responsiveness in either group. Within the FXpm group, however, greater CGG repeat length was associated with lower hyperresponsive sensory scores. These findings suggest that sensory processing differences may not be behaviorally evident at 12 months of age despite the presence of biological variability associated with the premutation. The study contributes to the emerging literature on early FXpm development and highlights the importance of examining genetic and physiological factors that may precede later-emerging behavioral phenotypes.

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19. Muthuka JK, Zimunya R, Simengwa A, Onyango C, Oluoch K, Kioko MT, Mbari DF, Nzioki J, Chebungei LK, Kim S, Desire Nshimirimana D. Effectiveness and Types of Interventions for Autism Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression. Cureus. 2026; 18(6): e111009.

This systematic review and meta-analysis aimed to estimate the overall effectiveness of autism spectrum disorder (ASD) interventions and identify sources of heterogeneity using frequentist and Bayesian approaches. A systematic search of PubMed/MEDLINE, Embase, Web of Science, and Scopus was conducted for studies published between January 1, 2004, and April 30, 2025. Primarily, randomized controlled trials with extractable intervention outcomes were included. A total of 41 studies (n = 3,008) were synthesized using random-effects models (restricted maximum-likelihood (REML)), Bayesian hierarchical modeling, meta-regression, and sensitivity analyses following PRISMA guidelines. The pooled random-effects estimate showed a significant positive effect of ASD interventions (effect size = 0.506, 95% CI: 0.392-0.619; z = 8.72, p < 0.001), corresponding to an estimated success proportion of 62% (95% CI: 59%-65%). Heterogeneity was substantial (Qₑ (40) = 238.78, p < 0.001; I² = 82.45%; τ² = 0.069, 95% CI: 0.028-0.137; τ = 0.262), with H² = 5.70 and a wide prediction interval (-0.020 to 1.031), indicating strong between-study variability. Bayesian meta-analysis confirmed a comparable effect (posterior mean = 0.619 (62%), 95% CrI: 0.592-0.646), with τ = 0.273 and I² ≈ 82.5%; Markov Chain Monte Carlo (MCMC) diagnostics indicated stable convergence (R-hat ≈ 1.00). Publication bias analyses indicated significant funnel plot asymmetry (Egger-type regression: z = 3.429, p < 0.001; weighted regression: t = 9.573, p < 0.001), while rank correlation was non-significant (τ = -0.178, p = 0.103). Trim-and-fill analysis imputed 10 studies, reducing the pooled effect to 0.374 (37%; 95% CI: 0.258-0.491; τ = 0.338), although the effect remained significant (p < 0.001). Sensitivity analyses excluding influential studies yielded a stable effect (0.505 (51%), 95% CI: 0.401-0.609), with persistent heterogeneity (I² = 75.49%; Qₑ (38) = 190.21, p < 0.001; τ² = 0.043). Subgroup analyses showed highest effects for digital/technology-based interventions (0.672 (67%); I² = 0%), followed by nutritional (0.635 (64%); I² = 73.81%), behavioral (0.630 (63%); I² = 74.78%), and pharmacological (0.627 (63%); I² = 0%) interventions, while physical/occupational therapies showed lower effects (0.523 (52%); I² = 63.35%) and combined interventions showed borderline effects (0.593 (59%); I² = 19.96%); subgroup differences were significant (Q(5) = 22.63, p < 0.001). Regional effects were similar and non-significant across North America, Europe, and Asia. Meta-regression identified significant moderators including intervention context (Qₘ = 18.159, p = 0.020), outcome domain (Qₘ = 19.588, p = 0.003), age at intervention onset (Qₘ = 17.795, p = 0.003), and intervention category (Qₘ = 31.714, p < 0.001), while follow-up and intervention duration were not significant. Bayesian subgroup analyses confirmed strongest evidence for pharmacological, behavioral, and digital interventions. Overall, ASD interventions demonstrated a moderate and statistically significant overall effect (~0.50-0.62 (50-62%)), with substantial heterogeneity driven primarily by intervention type, context, and participant characteristics. Findings were consistent across frequentist, Bayesian, and sensitivity analyses, supporting robust but context-dependent effectiveness.

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20. Nukala KM, Williquett B, Lilienthal AJ, Thompson DM, Massingham JN, Lye SH, Yu A, Lear BC, Neely GG, Chtarbanova S, Manak JR. Drosophila Prickle Mutants Display Comorbid Neurological Phenotypes and Provide A Genetic Link Between Epilepsy and Autism Spectrum Disorder. bioRxiv. 2026.

Epilepsy affects approximately 30% of individuals with autism spectrum disorder (ASD). Consistent with these observations, while PRICKLE mutations are primarily linked with epilepsy, there is an enrichment of pathogenic DNA sequence variants in PRICKLE genes carried by individuals with ASD. Nonetheless, a connection between PRICKLE function and ASD warrants further investigation. Here, we show that a seizure-prone Drosophila prickle mutant ( prickle-spiny-legs , or pk (sple) ) exhibits learning and memory deficits, increased pain sensitivity, both communication and social interaction difficulties, and restrictive repetitive grooming behaviors, all of which are strongly correlated with ASD, while a non-seizure prone prickle mutant ( prickle-prickle , or pk (pk) ) does not, thereby providing a direct genetic connection between epilepsy and ASD through prickle . Comparing headed versus headless pk (sple) mutants, we also show that the excessive grooming requires higher level cognitive processing from the brain. Finally, both pk (sple) and pk (pk) mutants exhibit circadian rhythm defects, another feature correlated with ASD, as well as distinct yet overlapping neurological anomalies in processes that include innate immune response, oxidative stress response, neuronal cell death, neurodegeneration, motor dysfunction and reduced lifespan, likely reflecting the unique isoform expression patterns observed in the developing CNS. Collectively, this study highlights the broadscale effects of PRICKLE mutations that extend beyond the primary clinical features of epilepsy to include several of the core features of ASD.

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21. Polo-Blanco I, Fernández-Cobos R, Vicente A. Counting, Cardinality and Conservation in Autistic Children. Autism Res. 2026: e70323.

This study examined the understanding of cardinality and conservation in children with and without autism (aged 4-7 years, without intellectual disability), and its relation to counting strategies. A total of 82 children participated in the study, including 41 autistic children (36 boys, 5 girls) and 41 age- and sex-matched non-autistic peers. While both groups demonstrated similar mastery of cardinality, autistic children showed lower performance in conservation tasks. Response times were longer in autistic children during counting tasks. Concerning counting strategies, autistic children relied more on verbal counting with pointing (VCP) and used the rapid recognition strategy (N) less frequently, even for small canonical sets. While both strategies (N and VCP) supported cardinality in both autistic and non-autistic children, only the N strategy appeared closely linked to successful conservation performance. These findings highlight two areas of relative difficulty for some autistic children and point to the potential of targeted interventions to strengthen foundational numerical skills and support later mathematical development. Some autistic children rely heavily on counting strategies that non‐autistic children employ less often (e.g., verbal counting while pointing, even for small numbers). We wondered whether such ways of counting could affect two milestones in mathematical development: cardinality (knowing that the last number counted represents the total number of items in a set) and conservation (realizing that the number of items stays the same even when the arrangement changes). In our study, autistic children aged 4–7 years used rapid, nonverbal counting less often than their non‐autistic peers of the same age, and those who did use this strategy performed better on conservation tasks. These findings highlight two potential areas for intervention that could help autistic children strengthen early numerical skills and support later mathematics learning. eng.

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22. Realpe AX, Norris JE, Lorenc A, Cotton L, Morgan Z, Sadik A, Rai D, Mills N. A Qualitative Study Exploring the Acceptability of Taking Part in a Large Multicentre RCT of Medication for Anxiety in Autistic Adults (the STRATA Trial). Autism. 2026: 13623613261466306.

Autistic adults experience significant physical and mental health inequities yet remain underrepresented in clinical research, with few randomised controlled trials to guide care. Randomised controlled trials (RCTs) of selective serotonin reuptake inhibitors (SSRIs) are limited, underpowered, and rarely focused on anxiety. Anticipating recruitment challenges in a large RCT (« STRATA ») evaluating sertraline for anxiety in autistic adults, we embedded qualitative research to support recruitment, retention, and monitoring trial acceptability. We organised our findings into the theoretical framework of acceptability (TFA) constructs to assess the acceptability of trial design and delivery for autistic adults. We conducted 64 interviews with autistic adults at different trial stages. Data were analysed thematically and mapped to the seven TFA constructs. Participants considered involvement in a blinded medication RCT acceptable across the TFA domains, which they weighed differently when reflecting on anticipated versus experienced aspects of participation. STRATA was a low-burden, ethically sound, and methodologically coherent study for most participants, who reported minimal trade-offs, potential benefits, and self-efficacy in managing anxiety and research participation. Acceptability of trial participation is dynamic and multidimensional, which can be enhanced by meaningful involvement of autistic people throughout the research cycle, accessible participant information design, and responsive ongoing engagement.Lay AbstractAutistic adults often experience poorer physical and mental health than the general population. Yet they are rarely included in clinical research. There have been very few high-quality studies (RCTs) testing medications for anxiety in this group. Most existing studies are small and focus on other outcomes. They don’t provide clear guidance for care. To help address this gap, the STRATA trial tested whether the medication sertraline (an SSRI) can reduce anxiety in autistic adults. Recruiting participants for such trials can be challenging. We included a qualitative study to better understand what helps or hinders people from joining and staying in the trial. We aimed to explore what aspects of the STRATA trial made it easier or more appealing for autistic adults to take part. We used a framework called the theoretical framework of acceptability (TFA) to define acceptability in this context. We interviewed 64 autistic adults at different stages of the trial, including 2 who chose not to take part. Most participants found the trial acceptable when assessed against the seven aspects of the TFA (i.e., how someone feels about taking part, how much effort is needed, whether taking part fits with a person’s values, how well someone understands the study, what someone may have to give up, whether the study is likely to help, and how confident someone feels about taking part). In summary, they felt positive about taking part. They thought the study was ethical and easy to understand and believed it could benefit them. Many also felt more confident in managing their anxiety and contributing to research. STRATA is one of the largest studies of its kind; 318 autistic adults took part across the United Kingdom and Australia. The trial had a very high retention rate. Ninety-two per cent of participants stayed until the main outcome point, and 87% completed the full 52 weeks. How acceptable clinical trials like STRATA are may change during their course, and researchers need to be responsive. To do this well, researchers should involve autistic people meaningfully throughout the research process and from an early stage. Researchers also need to respect individual communication needs and provide clear and accessible information. These approaches were central to STRATA and supported by other studies.

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23. Rider JV, Honey A, LaVerdure AE, O’Mara V, McGrath M. Autistic Parents’ Experiences Accessing Parenting Support: A Systematic Review and Meta-synthesis of Qualitative Research. Autism. 2026: 13623613261464212.

The experiences of autistic adults accessing parenting-related support remain underexplored, particularly in relation to how formal systems shape access and engagement. This qualitative systematic review and meta-synthesis synthesized 12 studies to examine how autistic parents perceive, navigate, and engage with formal parenting supports. Using thematic synthesis, five interrelated themes were identified: (1) judged, dismissed, and misinterpreted as parents; (2) the emotional and practical labor of accessing support; (3) doing it alone: self-reliance, preparation, and emotional cost; (4) service misfit; and (5) when support works: respect, clarity, and autism-informed adaptation. Findings highlight how barriers to parenting support arise through interactions with formal systems, extending prior research on autistic parenting and underscoring the need for rights-based, neurodiversity-affirming, and parent-centric approaches to parenting support, including autism-specific training, co-designed services, and accommodations that reduce burden and foster safe, collaborative partnerships with autistic parents.Lay AbstractMany autistic adults are parents, but their experiences getting help with parenting are not well understood. Most parenting programs and services were designed with non-autistic (neurotypical) parents in mind. This can make support feel confusing, overwhelming, or even unsafe for autistic parents, especially when services do not consider sensory needs, communication preferences, or fears about being judged. In this study, we brought together findings from 12 qualitative research articles that shared the voices of autistic parents. We read the parents’ own words and the original authors’ descriptions, then used a structured approach to identify patterns across the studies. We identified five main ideas. First, many autistic parents felt judged or misunderstood by professionals, who sometimes questioned their parenting ability because of their autism. Second, parents often had to spend a lot of time and energy explaining their needs, pushing for help, and navigating complicated systems. Third, when support was not available, or they did not feel safe, parents often « did it alone, » researching and problem-solving by themselves, sometimes at the cost of their own well-being and family enjoyment. Fourth, services often did not fit the needs of autistic parents. Finally, parents also described what good support looks like: clear and honest communication, respect for their expertise, practical help, and professionals who understand autism. Overall, this review shows that systems need to change, not autistic parents. Services should be designed with autistic parents, not just for them, and should recognize parenting as an important and meaningful part of autistic adults’ lives.

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24. Seng GJ, Lin JY, Huang WL, Lai HY, Kao WC, Chen HL, Gau SS. Feasibility and Preliminary Efficacy of a Caregiver-Assisted Group-Based Naturalistic Developmental Behavioral Intervention Program for Autistic Preschoolers: A Pilot Randomized Controlled Trial. Autism. 2026: 13623613261462574.

Naturalistic Developmental Behavioral Interventions (NDBIs) effectively improve developmental, social, and adaptive outcomes in autistic children, with caregiver involvement further enhancing treatment effects. Although one-on-one NDBI programs are strongly supported by evidence, their reliance on high staff-to-child ratios and certified therapists limits scalability. Group-based NDBI models may represent a more feasible and cost-effective alternative, particularly when implemented with open-access fidelity frameworks and active caregiver participation. This pilot randomized controlled trial compared a caregiver-assisted, group-based NDBI program with a therapist-delivered one-on-one NDBI program in autistic children aged 2 to 5 years. Both interventions were administered twice weekly for 12 weeks, with fidelity monitored using the NDBI Fidelity (NDBI-Fi). Forty autistic children were enrolled, and 38 children were included in the final analyses. Both groups showed significant improvements over time in verbal development, social interaction, adaptive functioning, autistic symptoms, problem behaviors, and caregiver stress. A significant time-by-group interaction was observed for nonverbal development, with significant gains in the one-on-one NDBI group but not in the group-based condition. These preliminary findings suggest that a structured, caregiver-assisted group-based NDBI model that integrates caregivers’ assistance, maintains intervention fidelity, and reduces staffing demands is feasible and associated with changes over time, indicating its potential as a scalable intervention approach.Clinical trial registry: https://clinicaltrials.gov/study/NCT06221943Lay AbstractEarly intervention can help young autistic children improve communication, learning, social skills, and daily functioning. One widely used approach, Naturalistic Developmental Behavioral Intervention (NDBI), teaches skills through play and everyday activities, while actively involving caregivers. However, traditional NDBI is typically delivered one-on-one by trained therapists, which can be costly and difficult for many families to access. This study evaluated a new, group-based NDBI program in which small groups of young children and their caregivers learned together with therapist guidance. Thirty-eight autistic children aged 2 to 5 years received two sessions per week over 12 weeks, with 19 receiving the group program and 19 receiving the therapist-delivered one-on-one intervention. Children in both groups showed meaningful improvements in language, social interaction, adaptive functioning, autistic symptoms, and behaviors. Caregivers in both groups also reported feeling less stressed. The group-based model was feasible and acceptable while supporting positive developmental changes. However, significant improvements in nonverbal development were observed only in the one-on-one intervention group. Overall, these findings suggest that caregiver-assisted group-based NDBI is a promising and more accessible early intervention option, especially in settings where individualized therapy is limited or difficult to obtain.

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25. Shamay-Tsoory SG. From Social Maps to Social Interactions in Autism. Biol Psychiatry. 2026; 100(4): 351-2.

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26. Spackman E, Chetcuti L, Leekam SR, Whitehouse A, Krueger RF, Hedley D, Frazier TW, Hardan AY, Uljarević M. Are Sensory Features a Subdomain of Restricted and Repetitive Behaviors? Evaluating Empirical Support for the DSM-5 Autism Criteria. J Am Acad Child Adolesc Psychiatry. 2026.

OBJECTIVE: Following calls to formally recognize sensory differences in the autism diagnostic criteria, the DSM-5 introduced sensory features as a subdomain of restricted and repetitive behaviors (RRBs). However, this categorization was developed based on expert consensus, rather than being empirically derived. Subsequent psychometric investigations have largely examined the structure of sensory features and RRBs separately, precluding evaluation of whether these constructs are best represented by shared or distinct latent dimensions. METHOD: The current study used cross-measure factor analysis with items from across the Dimensional Assessment of Repetitive Behaviors (DARB) and the Sensory Experiences Questionnaire Version 3 (SEQ-3) to expand coverage of sensory features and to compare the DSM-5 RRB structure with alternative empirically derived structures identified in the literature. The best-fitting first-order model was then operationalized to compare different general factor solutions. RESULTS: Across first-order models, the 4-factor DSM-aligned model showed the poorest fit, whereas a 10-factor empirically derived model showed the best fit. Across bifactor models, the unidimensional general RRB/sensory model showed the poorest fit. Two alternative 2-bifactor structures showed superior fit. Among those bifactor models, an exploratory model-whereby Factor 1 comprised insistence on sameness, restricted interests, unusual interests, repetitive language, obsessive-compulsive behavior, self-injurious behaviors, and sensory hypersensitivity, and Factor 2 comprised repetitive motor behavior, sensory seeking, and sensory hyposensitivity-showed the highest internal consistency and explained the most variance in related clinical variables. CONCLUSION: Findings suggest the need to further revise the RRB DSM-5 criteria, indicating that a unidimensional general RRB/sensory domain may not be empirically valid.

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27. Stacey J, Thompson H, Ashwin C. A mixed-methods feasibility pilot study of a psychoeducation program for caregivers of autistic children with type 1 diabetes. Fam Syst Health. 2026.

INTRODUCTION: Autism spectrum disorder is more prevalent in children with Type 1 diabetes (T1D) than the general population, and autistic children with T1D encounter additional challenges compared with children with either condition alone. This presents unique challenges for their caregivers, and key models emphasize the need for the expansion of social networks to support caregivers and improve their physical and mental health. The present study aimed to evaluate the feasibility of a psychoeducation compassion-focused therapy (CFT)-based program developed for caregivers of autistic children with T1D. METHOD: A total of 11 caregivers attended the program, delivered by an assistant psychologist and trainee clinical psychologist (both English-speaking), which included three 90-min psychoeducation workshops utilizing CFT principles to target caregivers’ specific needs. Feasibility was evaluated using recruitment, attendance, retention, and data completion metrics, and a thematic analysis was completed on qualitative data collected in August 2023 from seven participants (six mothers and one grandmother). RESULTS: The thematic analysis developed five themes, including perceived value from peer support, gaining knowledge, developing coping skills, managing emotional states, and long-term peer support. The metrics related to recruitment, attendance, and retention supported the feasibility of program delivery, along with moderate feasibility for research data collection. DISCUSSION: The findings offer evidence for the feasibility of delivering the psychoeducation CFT-based program within U.K. health care services and perceived benefits in social support, well-being, and self-efficacy, which reflects the perceived usefulness and appropriateness of the program to the participants. Further research is required to improve data collection procedures and evaluate program effectiveness. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

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28. Wan Y, Xiao H, Chen H, Zhang X, Guo S, Zhao W. Multiplex gray and white matter networks in autism spectrum disorder: differential topological alterations and transcriptomic associations. Prog Neuropsychopharmacol Biol Psychiatry. 2026; 149: 111856.

Autism spectrum disorder (ASD) is classically conceptualized as a dysconnectivity syndrome. However, most studies have examined structural and functional connectivity in isolation, leaving the coupling mechanisms between brain structure and function, particularly the contribution of white matter, poorly understood. To systematically characterize connectome pathology in ASD, we analyzed multimodal imaging data from 580 participants (240 with ASD, 340 typical controls) in the Autism Brain Imaging Data Exchange II dataset. We constructed multilayer brain networks integrating gray and white matter layers and quantified topological alterations using multiplex clustering and participation coefficients. Imaging-transcriptomic analysis was performed using the Allen Human Brain Atlas to link network changes to molecular pathways. The results revealed widespread whole-brain topological reorganization in white matter multiplex networks, involving the corpus callosum and major fiber tracts, with gene expression enriched in immune regulation and cellular metabolism pathways. The gray matter multiplex networks exhibited localized hyper-clustering centered on the cortico-striatum-thalamic-cortical circuit and the default mode network associated with genes implicated in cell adhesion and synaptic transmission. Notably, no significant group differences were observed in the multiplex participation coefficient, which indexes cross-layer integration, suggesting that the overall cross-layer connectivity distribution remains relatively stable. These findings delineate the co-occurring patterns of gray matter hyper-clustering and widespread white matter topological alterations in ASD and establish a multilevel framework bridging macroscopic connectome disruptions to the underlying molecular mechanisms, offering an integrated perspective on ASD heterogeneity.

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29. Wang Y, Ma Z, Wang Z, Xu X, Xia Z, Zhang H, Zhang J, Zong Y, Ke X, Li Y. Group-wise sparse coding for the discovery of functional connectivity-based biomarkers in children and adolescents with autism spectrum disorder. Front Psychiatry. 2026; 17: 1743755.

BACKGROUND: Autism spectrum disorder (ASD) is currently diagnosed through behavioral observations and evaluations, but there is still a lack of objective and consistent biomarkers. Children and adolescents with ASD exhibit impairments in advanced social, emotional, and cognitive functions, such as a lack of empathy. In general, the concept of empathy encompasses several socio-emotional and cognitive components based on interacting brain circuits. Identification of disease-related biomarkers at the brain network level could provide a crucial avenue for advancing ASD imaging research and improving diagnostic accuracy. METHODS: This study examined 80 individuals with ASD aged 6-16 years old and 50 matched control subjects, using resting-state functional magnetic resonance imaging and clinical psychological assessment datasets. Specifically, a set of functional brain networks was constructed using dictionary learning and sparse coding (DLSC) in a group-wise manner. Then, the localized common functional brain networks from both the ASD and matched control groups were automatically decomposed into a set of regions of interest (ROIs) for further functional connectivity analyses. RESULTS: Using the derived functional connectivity matrix, we investigated three parameters, namely, correlation, partial correlation, and tangent embedding, to differentiate participants with ASD from control subjects. We achieved classification accuracies of 95%, 100%, and 100%, respectively, indicating that the proposed DLSC method could extract representative and characteristic brain ROI atlases for both ASD and control participants. Further analysis of functional connectivity results showed that ASD participants had multiple atypical connections, especially those connecting the left inferior temporal and left inferior parietal regions, which belonged to the temporoparietal junction (TPJ), and connections related to the right insula and anterior cingulum, which belonged to the salience network (SN). Together, our results suggest that individuals with ASD exhibited a lower empathy capability than control subjects. CONCLUSION: Our results suggest that DLSC can effectively extract robust brain ROI atlases. Functional connectomes with high differentiation powers were mainly distributed within the brain networks of SN, social brain networks (SBNs), and the theory of mind (ToM) network (including the TPJ hub). Children and adolescents with ASD exhibited lower empathy capabilities than control subjects, which may be attributed to dysfunctions in the salience and social brain networks. CLINICAL TRIAL REGISTRATION: https://www.chictr.org.cn, identifier ChiCTR-ROC-17012877.

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30. Wong SC, Abdullahi SM, Vangala S, McDonald NM, Wilson RB. Early motor trajectories in infants at increased genetic likelihood for autism. Front Dev Psychol. 2026; 4.

INTRODUCTION: Infants with an older sibling with autism spectrum disorder (ASD) (EL-AutSib) and infants with tuberous sclerosis complex (EL-TSC), a genetic neurodevelopmental syndrome highly associated with ASD, exhibit motor and other developmental differences in the first year of life. Despite the prevalence of gross motor impairments in these populations and the need for early clinical monitoring, there is little conclusive evidence of the onset of motor differences between these groups, specific patterns of delay, and how these might relate to a future ASD diagnosis. In this study, we used a detailed gross motor infant assessment, the Alberta Infant Motor Scale (AIMS), to assess motor trajectories in the first year of life in EL-AutSib, EL-TSC, and a comparison group with low-likelihood of autism (LL). METHODS: Participants included 51 EL-AutSib, 26 LL, and 16 EL-TSC infants who were assessed on motor ability at 3, 6, 9, and 12 months of age using the AIMS. EL-AutSib participants were further categorized into autism (ASD) or no autism (nASD) groups based on clinical best estimate at 24 or 36 months of age. AIMS total scores were analyzed using a linear mixed-model to assess differences in motor development between groups over time. RESULTS: EL-AutSib-ASD, EL-AutSib-nASD, and LL groups exhibited comparable growth in motor ability over 3-12 months of age. Though non-significant, LL participants on average had the highest AIMS total scores across timepoints, followed by EL-AutSib-nASD and EL-AutSib-ASD, respectively. EL-TSC participants scored significantly lower on the AIMS compared to the EL-AutSib-ASD group (ß=-7.92, p<0.001), with slower growth over time (ß=-0.80, p=0.04). DISCUSSION: These findings identify distinct motor trajectories between two populations with an elevated genetic likelihood of developing ASD. EL-AutSibs displayed converging motor trajectories with the LL group irrespective of ASD outcomes, suggesting that motor milestones, even when examined more granularly, may not capture the full range of motor differences in EL-AutSibs. However, the AIMS captured early and persistent motor delays in EL-TSC infants, highlighting the clinical utility of this measure for populations with more significant developmental delays.

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31. Zhang T, Wang X, Li P, Zhang J, Sun W, Zhang Z, Zhuo Y, Guo W, Chen Y. Early gut microbial and metabolic dysregulation with subclinical cardiac alterations in a nonhuman primate model of Rett syndrome. Imeta. 2026; 5(3): e70137.

Longitudinal multi-omics profiling of a nonhuman primate Rett syndrome (RTT) model reveals early systemic alterations. RTT monkeys exhibited postnatal growth retardation, intestinal structural abnormalities, and low-grade systemic inflammation. Gut microbiome analysis showed delayed microbial maturation and age-discordant dysbiosis, including altered Firmicutes/Bacteroidetes ratios and persistent community restructuring. Fecal metabolomics revealed reduced short-chain fatty acids (SCFAs), disrupted microbe-metabolite networks, and broad alterations in lipid, amino acid, and energy metabolism. Electrocardiogram (ECG) identified prolonged corrected QT interval (QTc) and subclinical cardiac electrophysiological changes. Integrated multi-omics analyses indicate that RTT involves early, coordinated dysregulation across gut microbial, metabolic, immune, and peripheral physiological systems, supporting its characterization as a systemic disorder from the early postnatal stage.

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