1. Ábalos Z, Vicente A. Norms of Conversation: Autistic and Neurotypical Judgments of Conversational Coherence. J Autism Dev Disord. 2026.

PURPOSE: Challenges in conversational topic management have been widely reported in autistic individuals, sometimes leading to negative social judgments. Such challenges could stem from differences in conversational norms implicitly endorsed across neurotypes. This study investigated whether autistic and neurotypical adults differ in their judgments of conversational coherence, specifically regarding different types of topic shifts. METHODS: We collected data from 49 Spanish-speaking autistic adults aged 18-53 years (M = 31.2, SD = 8.7) without intellectual disability, and compared their judgments with those of 96 neurotypical adults from a previous study (age: M = 35.5, SD = 9.9). Participants read anonymized transcripts of child-adult conversations and were asked to rate the naturalness of the child’s utterance (containing either a topic shift or a contingent response) using a seven-point Likert scale. The materials were identical to those used in a previous study with neurotypical adults. RESULTS: Autistic and neurotypical adults shared a similar implicit understanding of conversational coherence. Both groups evaluated different types of topic shifts in broadly comparable ways, with those judged as less natural by neurotypical adults also receiving lower naturalness ratings from autistic adults. In addition, contingent responses which maintained the previous topic were consistently rated as more natural than topic shifts. CONCLUSION: These findings suggest that autistic and neurotypical individuals do not differ in their implicit understanding of conversational coherence. Differences in conversational behavior are therefore unlikely to arise from different norms of conversation, at least insofar as topic management is concerned.

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2. Andonotopo W, Bachnas MA, Dewantiningrum J, Pramono MBA, Sanjaya INH, Darmawan E, Akbar MIA, Aldiansyah D, Yeni CM, Bernolian N, Andanaputra WEK, Sulistyowati S, Stanojevic M, Kurjak A. The intrauterine microbiome-neurodevelopment axis: decoding the prenatal microbial imprint on lifelong mental health. J Perinat Med. 2026; 54(6): 944-61.

INTRODUCTION: The traditional view of a sterile intrauterine environment has been challenged by sequencing studies detecting low-biomass microbial DNA in placenta, amniotic fluid, and fetal tissues. These findings suggest that maternal microbiota-derived signals may contribute to fetal brain development and influence long-term neuropsychiatric outcomes. CONTENT: This narrative review synthesizes evidence from over 90 preclinical and clinical studies examining maternal microbiota-fetal brain interactions. Maternal immune activation – characterized by elevated cytokines such as interleukin (IL)-6 and IL-17A – has been shown in mouse models to disrupt cortical layering and synaptic organization, while human cohort studies involving more than 250,000 pregnancies link maternal inflammatory markers to increased autism spectrum disorder (ASD) risk. Microbial metabolites, including short-chain fatty acids (butyrate, acetate, propionate), bile acids, and tryptophan derivatives, regulate microglial maturation, blood-brain barrier integrity, and hippocampal neurogenesis. Epigenetic mechanisms – DNA methylation, histone acetylation, and chromatin remodeling – have been observed in placenta and cord blood from pregnancies affected by obesity or dysbiosis. Large-scale epidemiological studies also associate prenatal infection and antibiotic exposure with higher rates of ASD and attention-deficit/hyperactivity disorder (ADHD). SUMMARY: Collectively, the evidence indicates that maternal microbiota influence fetal brain development through converging immune, metabolic, epigenetic, and hormonal pathways. Strong mechanistic insights come from animal models, whereas human data remain largely observational, limiting causal interpretation. OUTLOOK: Recognizing the maternal microbiome as a modifiable prenatal factor highlights opportunities for prevention. Early translational approaches – including maternal microbiota profiling, dietary optimization, and probiotic supplementation – are under investigation, but require rigorous clinical validation before integration into prenatal care.

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3. Capal JK, Ritter DM, Horn PS, Currans K, Kent B, Pearson DA, Mansour R, O’Kelley SE, Sahin M, Bebin EM, Rajaraman R, Porter BE, Northrup H, Krueger DA. From Infancy to Early School Age: Longitudinal Developmental Outcomes and Autism Diagnostic Stability in Tuberous Sclerosis Complex. Pediatr Neurol. 2026; 183: 1-9.

BACKGROUND: Tuberous sclerosis complex (TSC) is associated with intellectual disability (ID), autism spectrum disorder (ASD), and TSC-associated neuropsychiatric disorders. Early prospective studies have characterized neurodevelopmental outcomes in infants and toddlers with TSC. Leveraging longitudinal data from the TSC Autism Center of Excellence Research Network and the Rare Diseases Clinical Research Network, we examined longer-term developmental trajectories and ASD diagnostic stability in a cohort of children with TSC. METHODS: Participants were originally enrolled in TSC Autism Center of Excellence Research Network and followed through 36 months and then subsequently enrolled in Rare Diseases Clinical Research Network for continued follow-up. Longitudinal neurodevelopmental assessments were performed. Analyses focused on participants’ most recent assessment to accommodate study overlap and missing data. Outcomes were compared by ASD status, sex, and adaptive functioning. RESULTS: Thirty-two participants with TSC (50% female; mean age 4.5 years) were included. Cognitive and adaptive functioning scores were generally in the delayed range and remained relatively stable over time. At the most recent visit, 48% met criteria for ASD, with ASD diagnosis remaining stable in most participants. Lower adaptive functioning was significantly associated with ASD diagnosis (P = 0.016) and greater social and behavioral impairment. Females demonstrated significantly higher levels of social impairment on the Social Responsiveness Scale, Second Edition compared to males, even after adjusting for ASD diagnosis. CONCLUSIONS: Early cognitive and adaptive assessments in children with TSC inform later neurodevelopmental outcomes. While ASD diagnosis is largely stable over time, subtle social impairments may be under-recognized. Routine, longitudinal screening for TSC-associated neuropsychiatric disorders symptoms is essential to support timely identification and intervention in TSC.

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4. El Mezouar C, Dali-Sahi M, Bourak I, Mekkioui Z, Amraoui N, Harek Y, Benguella Benmansour M, Berrahoui S, Dib J, Dennouni-Medjati N. Prenatal, Perinatal, and Familial Risk Factors in the Differential Diagnosis Between Autism Spectrum Disorder and Phenylketonuria: A Retrospective Case-Control Study in the Absence of Neonatal Screening. J Child Neurol. 2026: 8830738261467843.

BackgroundAutism spectrum disorder (ASD) and phenylketonuria (PKU) share overlapping neurodevelopmental features. In regions lacking systematic neonatal screening, the differential diagnosis remains a major clinical challenge.ObjectiveTo identify specific prenatal, perinatal, and familial factors that distinguish children with ASD from those with PKU, and to characterize the clinical profile of ASD compared with typically developing (TD) children.MethodsA retrospective case-control study was conducted including 117 children (34 ASD, 12 PKU, and 71 TD). Data were extracted from medical records and standardized parental questionnaires. Multivariate logistic regression was used to identify independent predictors for each condition.ResultsFamilial factors were highly discriminative: consanguinity was significantly more frequent in PKU than in ASD (85.7% vs 23.5%; P = .001). Regarding prenatal/perinatal factors, advanced paternal age at conception was a significant marker for ASD compared with PKU (42.3 ± 8.08 vs 33.0 ± 5.37 years; P = .015). Neonatal complications were present in 20.6% of ASD cases but absent in the PKU group. Multivariate analysis identified consanguinity (odds ratio [OR] = 12.68) and intellectual disability (OR = 11.89) as independent predictors of PKU. Compared with TD children, ASD cases were associated with higher rates of macrosomia, prematurity, and maternal bleeding. The strongest clinical predictors for ASD were sleep disorders (OR = 32.59) and intellectual disability (OR = 20.87).ConclusionsPrenatal, perinatal, and familial markers specifically consanguinity and paternal age are vital for differentiating ASD from undiagnosed PKU in the absence of neonatal screening. In consanguineous populations, these factors should guide clinicians toward metabolic screening to avoid diagnostic uncertainty.

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5. Forouzandeh Shahraki Z, Noori A, Amini-Khoei H, Yazdanpanahi N, Fatemi M. Trigonelline attenuates valproic acid-induced autism-like behaviours in rats: histopathological changes of the hippocampus, modulation of gene expressions related to neuroinflammation and blood-brain barrier permeability. World J Biol Psychiatry. 2026: 1-17.

BACKGROUND: Autism spectrum disorders (ASD) is a neurodevelopmental disorder. Neuroinflammation and bloodbrain barrier (BBB) dysfunction have role in the pathophysiology of ASD. Trigonelline (TRI) exerted neuroprotective effects. We aimed to investigate TRI’s effects on autistic phenotype, gene expression of tight junction proteins associated with BBB integrity, neuroinflammation and histopathological changes in the hippocampus in valproic acid (VPA) – induced autism in rats. METHODS: Pregnant Wistar rats received single subcutaneous injection of VPA (600mg/kg) on day 12 of gestation. Animals were treated with normal saline or TRI for one week. Repetitive behaviours, anxiety-like behaviour, memory function, and social interactions were assessed. The thickness and dark neurons of the CA1 and CA3 regions of hippocampus were examined. The inflammatory genes, including Tlr4, Tnf-α, and Il-1β, along with claudins (Cldn -3, Cldn-5, and Cldn-12), were measured in the hippocampus. RESULTS: TRI significantly attenuated autistic behaviors. TRI reduced the expression of inflammatory markers and modulated the expression of claudins. TRI increased the thickness and decreased the number of dark neurons in the CA1 and CA3 regions. CONCLUSIONS: TRI reduced autistic behaviours probably through attenuation of neuroinflammation, preservation of the hippocampus, and modulation of gene expressions of tight junction proteins associated with the BBB permeability.

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6. Goel A, Thabrew H, Wouldes T, Xie Z. Systematic Review of the Efficacy of Parent-Mediated Interventions in Reducing Problem Behaviours Shown by Autistic Adolescents. J Autism Dev Disord. 2026.

PURPOSE: Problem behaviours exacerbate the challenges associated with the core characteristics of autism during adolescence. Parenting interventions have demonstrated efficacy in addressing such behavioural challenges in younger autistic individuals, however, their evidence for autistic adolescents is sparse, particularly in low-income settings. METHODS: This systematic review narratively synthesised studies outlining parenting interventions targeting problem behaviours in autistic adolescents. RESULTS: Seven studies were included with three providing comparable quantitatively data for their efficacy in improving problem behaviours. Five out of seven studies reported positive evidence on reducing problem behaviours. Characteristics including fewer sessions, instructional mode of intervention delivery and use of behavioural management skills were most commonly shared among statistically significant studies. Parenting interventions had a positive effect on adaptive behaviours for children, and improved parent wellbeing and knowledge. The overall satisfaction with interventions was high, however, only one study was conducted in a lower- and middle-income country. CONCLUSION: The findings underscore the encouraging evidence in an understudied area. The results emphasise the need to conduct further research for autistic adolescents and highlight potential parent-mediated interventions carry, given their acceptability and logistically scalable nature.

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7. Held LK, Goris J, Braem S. Balancing Cognitive Flexibility and Stability: The Role of Reward, Autism, and Transdiagnostic Traits. J Cogn. 2026; 9(1): 38.

In our daily lives, we often need to switch between states of cognitive flexibility and stability based on environmental demands. It has been suggested that people can learn to navigate this balance based on reinforcement, but that this may be impaired in autism or other transdiagnostic dimensions. Replicating previous work, we show that people (n = 412) voluntarily switch tasks more when previously rewarded more for performing well on task-switch trials. Interestingly, we also found that it was difficult to unlearn this shift in cognitive flexibility when the mapping between task-switching and reward suddenly reversed. People with an autism diagnosis or high autism traits were not slower or faster in learning these contingencies. However, our results suggested a generally smaller task-rule interference effect and larger switch costs in autism and high autism traits, in line with prevalent ideas that they show more cognitive stability at the cost of less flexibility. A similar pattern was found for a significantly correlated Compulsivity and intrusive thought not capitalised for consistency please and Alexithymia component extracted from a rotated principal component analysis, highlighting the need to consider co-occurring symptoms. Together, our findings show that people learn to vary task-switching behaviour as a function of reinforcement, which may be hard or slow to unlearn, as well as interindividual variations along the flexibility-stability trade-off that show a relation to autism.

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8. Kablan A, Bakır A, Taşdelen E, Dinçsoy Bir F, Kolkıran A, Ataseven Kulalı M, Atasoy E, Menderes D, Efe A, Kılıç M, Erdal İ. Phenotypic spectrum in patients with 16p11.2 deletion: a single tertiary centre experience in Türkiye. Turk J Pediatr. 2026; 68(3): 416-27.

BACKGROUND: The 16p11.2 deletion is one of the most frequent recurrent copy number variations associated with a broad neurodevelopmental and phenotypic spectrum. Despite its relatively well-characterized genomic region, clinical expressivity remains highly variable, posing challenges for diagnosis and management. METHODS: We conducted a retrospective single-centre study of 25 individuals with molecularly confirmed 16p11.2 deletions, including 13 males (52%), 12 females (48%), and 7 familial (28%). Both de novo and inherited cases were included. The main testing method was chromosomal microarray, although karyotyping and additional tests such as sequencing and trinucleotide repeat testing were also utilized. Comprehensive clinical data were collected from medical records, including neurodevelopmental, neuropsychiatric, metabolic, skeletal, and systemic features. RESULTS: The majority of the cases had the typical ~600 kilobase deletion while two had distal ~220kb deletion. One patient was found to have a double genetic diagnosis. Developmental delay was almost universal in the probands, with expressive language significantly more impaired than receptive language abilities. Intellectual disability / learning difficulties and language problems were observed in 18/25 (72%) cases. Around half of the probands showed obesity and related hyperphagia. Autism spectrum disorder, attention deficit hyperactivity disorder, stereotypic movements, and aggressive behaviour were frequently reported. Epilepsy was present in thirteen patients (52%), with electroencephalographic abnormalities supporting generalized or focal epileptiform activity. Dysmorphic facial features and skeletal anomalies such as pes equinovarus, syndactyly, and scoliosis were variably present. Brain magnetic resonance imaging revealed abnormalities in several patients, including hypoplasia of the corpus callosum and intracranial hypertension. Additional systemic findings included hepatic steatosis, constipation, and ophthalmologic anomalies. Parental testing revealed asymptomatic or mildly affected carriers in multiple cases. CONCLUSION: Our findings emphasize the broad and heterogeneous clinical spectrum of 16p11.2 deletions in a Turkish cohort. Early recognition, multidisciplinary evaluation, and family-based genetic counselling are essential for timely diagnosis and optimal care of affected individuals.

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9. Kashida N, Yamamuro K, Matsuoka K, Mizui R, Ishida R, Takeda T, Tamakoshi H, Yoshihara T, Takahashi M, Yamauchi T, Toritsuka M, Iwata N, Makinodan M. Linking auditory brain responses to cortical microstructure and sensory behaviors in autism spectrum disorder: a preliminary study. Front Psychiatry. 2026; 17: 1688324.

INTRODUCTION: Atypical auditory processing is a core characteristic of autism spectrum disorder (ASD), potentially stemming from disrupted thalamocortical circuits and frontal modulation. This study investigated whether individual differences in cortical microstructure, as measured by neurite orientation dispersion and density imaging, are associated with auditory brainstem responses (ABR) and whether these ABR measures are associated with autism traits and atypical sensory processing. METHODS: We recruited 15 adults with ASD (9 males, 6 females; mean age 26.9 ± 6.7 years) and 12 typically developing controls (12 males; mean age 37.1 ± 8.0 years) and assessed microstructural properties in the thalamus, temporal cortex, and orbitofrontal cortex (OFC). Auditory processing was evaluated via ABR recorded under forward-masking conditions. RESULTS: In this preliminary, exploratory analysis, mediation models suggested that the amplitude of wave PVII mediated the association between the orientation dispersion index in the temporal cortex and autism traits, as measured by the Autism-Spectrum Quotient. Similarly, the ΔVI amplitude (peak-to-peak potential between NVI and PVI) mediated the relationship between the neurite density index in the OFC and atypical sensory behaviors, assessed using the Adolescent/Adult Sensory Profile. In the ASD group, reduced PVII amplitude was linked to difficulties in attention switching and imagination, while increased ΔVI amplitude was associated with sensory avoidance. DISCUSSION/CONCLUSION: Our preliminary and exploratory findings tentatively suggest that microstructural variability in the temporal cortex and OFC may relate to auditory neural responses and to sensory and cognitive features of ASD. However, given the small and demographically imbalanced sample, these results should be regarded as hypothesis-generating rather than confirmatory. These candidate brain-behavior pathways should be tested in larger, demographically matched cohorts before any mechanistic interpretation regarding sensory dysfunction in autism can be drawn.

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10. Kasirer A, Kammay M, Shnitzer-Meirovich S. Social Anxiety, Social Avoidance, Self-Esteem, and Loneliness: The Role of Class Type for Autistic Adolescents. J Autism Dev Disord. 2026.

OBJECTIVE: This study examined differences in social anxiety, social avoidance, loneliness, and self-esteem among autistic adolescents attending special education versus general classes, and whether class type moderated associations among these variables. METHOD: Participants included 137 autistic adolescents without intellectual disability from multiple mainstream schools in central Israel. They completed validated self-report questionnaires: Liebowitz Social Anxiety Scale, UCLA Loneliness Scale, and Rosenberg Self-Esteem Scale. RESULTS: Autistic adolescents in special education classes reported higher social anxiety, social avoidance, and loneliness than peers in general classes, while self-esteem did not differ. Class type moderated associations between social anxiety and loneliness, and between social avoidance and loneliness, with stronger associations in general classes. Self-esteem consistently served as a protective factor across both class types. CONCLUSIONS: Educational context relates to autistic adolescents’ social-emotional experiences, with stronger associations between social anxiety, avoidance, and loneliness in general versus special education classes. These findings provide a descriptive comparison of educational contexts, suggesting that observed differences may reflect variations in social exposure or pre-existing needs that influenced placement, rather than the effects of the placement itself. While self-esteem remains a consistent protective factor, these results highlight the need for supportive strategies that promote inclusion and wellbeing for autistic adolescents across all settings.

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11. Ke Y, He Q, Jiang W, Chen Y, Ke Y. Cortical surface-based descriptors for childhood autism classification using segmentation-guided cortical reconstruction from sMRI. Biomed Tech (Berl). 2026.

OBJECTIVES: Autism spectrum disorder (ASD) involves subtle and heterogeneous brain-structural differences that are not usually visible on routine structural magnetic resonance imaging (sMRI). This study investigated a segmentation-guided sMRI feature-classification framework for childhood ASD analysis. METHODS: Pediatric T1-weighted sMRI scans were obtained from the publicly available Autism Brain Imaging Data Exchange II (ABIDE-II) dataset. Preprocessing used the FMRIB Software Library (FSL) Brain Extraction Tool (BET), N4 bias-field correction, intensity normalization, and Advanced Normalization Tools (ANTs) registration. Gray matter, white matter, and cerebrospinal fluid (CSF) were segmented using FSL FAST, and cortical reconstruction/parcellation was performed using FreeSurfer recon-all. Extracted features included global structural summaries, regional cortical gray-matter volume, cortical surface area, cortical thickness, cortical-thickness variability, mean curvature, and folding index. Each participant was represented by a 414-dimensional numerical feature vector. Features were normalized, filtered, selected using minimum-redundancy maximum-relevance (mRMR) analysis, and classified using support vector machine, random forest, k-nearest neighbors, and multilayer perceptron models. RESULTS: The multilayer perceptron achieved 69.4 % accuracy, 67.9 % precision, 70.0 % sensitivity, 68.8 % specificity, 68.9 % F1-score, and 72.6 % area under the receiver operating characteristic curve (AUC). CONCLUSIONS: Extracted quantitative sMRI features supported ASD-versus-typical-control classification.

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12. Kozhemiako N, Gong NN, Purcell SM. The effect of sex on sleep neurophysiology in typical and altered neurodevelopment. Sleep Med. 2026; 147: 109153.

STUDY OBJECTIVES: Sleep electroencephalography (EEG) patterns exhibit complex variations influenced by multiple factors, including age and sex. While sex effects in sleep neurophysiology are well-described in adults, evidence in pediatric populations is limited, particularly in the context of neurodevelopmental disorders (NDDs). METHODS: Here, we analyzed a large pediatric clinical dataset to examine sex differences in whole-night sleep EEG among children without NDDs (N = 1523, 2.5-17.5 years) and those with autism spectrum disorder (ASD,N = 196), attention deficit hyperactivity disorder (ADHD,N = 523), and intellectual disabilities (IntDis,N = 167). We investigated sleep macro- and microarchitecture, including spectral power, density and morphology of spindles and slow oscillations, and their temporal coupling. RESULTS: Significant sex differences in the non-NDD sample were observed across features of sleep macroarchitecture, spectral power, sleep spindles, and slow oscillations, with the majority of findings replicated in an independent cohort. More specifically, non-NDD boys exhibited more fragmented sleep compared to girls, but this pattern was not observed among children with NDDs. In contrast, fast spindle density was lower in boys regardless of NDD diagnosis, which may contribute to males’ increased susceptibility to developing NDDs. No sex differences were observed in EEG-based brain age predictions. Medical record analysis revealed limited sex differences in the prevalence of sleep disorders. We found strong evidence of altered sleep EEG characteristics in boys and girls with IntDis. Several sleep EEG metrics showed nominal group-by-sex interactions with ASD and ADHD girls displaying more pronounced alterations, pointing to a varying degree of sleep disturbance. CONCLUSIONS: Our findings demonstrate that many sleep EEG features exhibit significant sex differences during childhood, but these differences may be distinct in NDD populations. The sex-specific sleep alterations in NDDs highlight the potential importance of considering sex in pediatric sleep research.

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13. Lloyd-White S, Borschmann R, Rorke A, Stark E, Combe G. Demographics and clinical outcomes of autistic children and adolescents receiving psychiatric in-patient care in the Thames Valley from 2019 to 2024: retrospective cohort study. BJPsych Open. 2026; 12(4): e195.

BACKGROUND: Many autistic adolescents receive in-patient psychiatric care from services that are ill-equipped to meet neurodivergent needs. However, the outcomes for autistic adolescents accessing in-patient care remain poorly understood. AIMS: To document the demographics and clinical outcomes of autistic adolescents referred to in-patient psychiatric services over a 5-year period and compare these with those of their allistic peers accessing the same services. METHOD: We conducted a retrospective cohort study involving all adolescents (aged 12-17 years inclusive) referred for in-patient psychiatric care through the Thames Valley Provider Collaborative between 1 April 2019 and 31 March 2024. Clinical characteristics and outcomes of referrals for autistic and allistic adolescents were collected and summarised from routine service data. Inferential statistics (including t-tests and chi-squared tests) were used to compare characteristics between the autistic and allistic groups. RESULTS: Autistic adolescents were more likely than their allistic peers to be referred in an emergency (24.6 v. 16.6%) and for risk management (53.7 v. 33.5%). Autistic adolescents without an eating disorder had longer average length of stay than their peers (146.1 v. 97.5 days) and were more likely to be discharged to more secure settings following admission (12.9 v. 7.7%). Emerging evidence from routine outcome measures suggests less positive progress during in-patient care and greater impairment among autistic adolescents at both admission and discharge. CONCLUSIONS: There are important differences in outcomes from psychiatric in-patient admissions between autistic and allistic adolescents. Greater work is needed to understand these differences and the factors influencing treatment success for autistic adolescents.

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14. Longhurst P, White LCJ, Swami V. The body appreciation Scale-2 for Autistic adults (BAS-2A): Psychometric properties in autistic gender diverse and transgender adults from four english-speaking, Western countries. Body Image. 2026; 58: 102154.

The Body Appreciation Scale-2A (BAS-2A) is a measure for capturing a core facet of positive body image in the adult Autistic population. Preliminary evidence suggests body appreciation may foster physical and psychological well-being among Autistic people who are also transgender or gender diverse (TGD); however, to date, the scale has not been validated within this group. To address this, we evaluated the factor structure and psychometric properties of the BAS-2A in Autistic TGD people. A total of 191 Autistic TGD people (aged 18-85 years) from Western countries (i.e., Australia, Canada, the United Kingdom, and the United States) completed the BAS-2A along with additional measures of physical well-being and eating disorder symptomatology. Confirmatory factor analysis supported a 12-item, unidimensional structure of the BAS-2A in the total sample. The BAS-2A also demonstrated excellent composite reliability. Evidence of convergent, concurrent, discriminant, and incremental validity was strong when using both observed and latent scores. Body appreciation was significantly associated with higher self-compassion, self-esteem, and quality of life, and lower eating disorder symptomatology. Overall, our results suggest that the BAS-2A is a valid and reliable measure for capturing body appreciation among Autistic TGD people. The present study offers a valuable contribution toward a better understanding of positive body image in the wider Autistic population.

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15. Pandian K, Manzoor HM, John SA, Benoy NA, Sunny B. Mapping occupational therapy interventions in caregiver skill training for children with neurodiversity: a scoping review protocol. BMJ Open. 2026; 16(7): e115920.

INTRODUCTION: Caregivers of children with neurodiversity, particularly autism spectrum disorder and attention deficit hyperactivity disorder, experience sustained occupational, emotional and participation-related challenges. Occupational therapy (OT) plays a crucial role in supporting caregivers through skill training that enhances daily routines, participation and family functioning. Although caregiver training programmes are described across multiple disciplines, the scope, nature and specific contribution of OT-related caregiver skill training interventions remain insufficiently synthesised, with fragmented terminology, heterogeneous theoretical foundations and inconsistent reporting. To date, there appears to be limited synthesis specifically mapping OT-related caregiver skill training programmes for caregivers of children with neurodiversity. OBJECTIVES: This scoping review aims to identify and map the range, characteristics and implementation features of OT-related caregiver skill-training programmes for caregivers of children with neurodiversity. Secondary objectives are to describe how these programmes are structured and to examine delivery characteristics, including mode, provider, setting, duration and contextual or cultural adaptations. METHODS AND ANALYSIS: This protocol follows the Joanna Briggs Institute methodological framework for scoping reviews and will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Review guidelines. Eligibility criteria are guided by the Population-Concept-Context framework. The review will include mixed-methods studies, intervention studies (randomised and non-randomised), feasibility studies and programme descriptions published in English from 2000 to 2025. Electronic searches will be conducted in PubMed, Embase, CINAHL, Scopus and Web of Science. The PubMed search strategy will undergo peer review in accordance with the PRESS 2015 guidelines. Study selection and data charting will be performed independently by multiple reviewers. Data will be synthesised descriptively and narratively, with results presented in tables, conceptual maps and an evidence gap map. ETHICS AND DISSEMINATION: Ethical approval is not required as this review uses publicly available data. Findings will be disseminated through publication in a peer-reviewed journal and presentations at relevant scientific and professional forums to inform clinical practice, policy development and future research in caregiver-focused OT interventions.

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16. Revathy J, M K, Yogarayan S, Balusamy B. NeuroCon-AutismNet: a privacy-preserving multimodal framework toward autism screening via diffusion-regularized EEG biomarkers and empathy-aware multilingual dialogue. Front Psychiatry. 2026; 17: 1803720.

INTRODUCTION: Autism Spectrum Disorder (ASD) screening requires multimodal biomarkers to capture the heterogeneous neurological and behavioral phenotypes. Current screening approaches remain siloed across EEG analysis and conversational assessment, limiting integrated diagnostic architecture. Privacy-preserving machine learning frameworks for mental health screening are underdeveloped, particularly for multilingual deployment contexts. This paper presents NeuroCon-AutismNet, a candidate multimodal architecture integrating diffusion-regularized EEG synthesis, multilingual conversational screening, and formal differential privacy as architectural proof-of-concept. No diagnostic discrimination capability is claimed; all validation is scoped to synthetic evaluation. METHODS: NeuroCon-AutismNet comprises four modules: (1) Temporal Diffusion Biomarker Generator (TDBG), a latent diffusion model over VAE-encoded 19-channel EEG; (2) Multilingual Affective Dialogue Screening Network (MADSN), a fine-tuned GPT-2-small module deployed in English, Spanish, and Hindi; (3) Neuro-Linguistic Fusion Transformer (NLFT), enforcing positional alignment as a design prior rather than learned cross-modal association; and (4) Adaptive Mixture-of-Experts Layer (AMEL-X) for entropy-regularized multimodal fusion. Formal (ε, δ)-differential privacy (ε = 1.0, δ = 1e-5) is verified via DP-SGD RDP composition (σ = 1.2, q = 0.0914, T = 550 steps, verified ε = 0.97). Privacy verification establishes architectural readiness for future real-data deployment; no real patient records are present in the training set. RESULTS AND DISCUSSION: Within closed synthetic evaluation, held-out diagnostic AUC is 0.503 (95% CI: 0.487-0.519, DeLong p = 0.67), statistically indistinguishable from chance and the central limitation of this study. Two partial external benchmarks are provided. Spectral comparison against three independently published real ASD EEG studies yields Pearson r = 0.87 across five frequency bands; delta and alpha directions are reproduced, but theta and gamma reproduce poorly with large amplitude errors (delta MAE 14.79%, alpha MAE 11.57%). Expert evaluation of MADSN outputs by 50 annotators under single-blind protocol yields 90% empathy satisfaction and Cohen’s κ = 0.82, reflecting text quality rather than clinical screening validity. The null diagnostic AUC and synthetic-only evaluation prevent any current screening or clinical-utility claims. Real-data EEG validation, clinician-caregiver interaction studies for MADSN, and DP-protected training on real patient records are prerequisites for future clinical deployment.

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17. Rodríguez-Vera D, Soriano-Ursúa MA, Pinto-Almazán R, Arciniega-Martínez IM, Reséndiz-Albor AA, Vergara-Castañeda A, Valadez-Vega C, Morales-González Á, Madrigal-Santillán EO, García-Machorro J, Ibañez-Cervantes G, Morales-González JA. Berberine as a modulator in autism: Insights into mechanisms of action and therapeutic potential. J Integr Med. 2026.

Autism spectrum disorder (ASD) is a broad neurodevelopmental disorder characterized by impairments in social communication and limited, repetitive patterns of behavior and interests. It is frequently associated with comorbidities, including gastrointestinal dysfunction, and immune and oxidative disturbances. Recent discoveries have revealed that nutritional therapies designed to target certain pathophysiological processes may serve as adjunctive treatments. Berberine is a natural isoquinoline alkaloid isolated from various medicinal herbs. It possesses anti-inflammatory and antioxidant activities and has demonstrated neuroprotective effects in preclinical models. Recent preclinical studies have shown that berberine may help modulate key pathways implicated in ASD, such as gut microbiota-brain axis, neuroinflammatory cascades, mitochondrial dysfunction and oxidative stress responses. Berberine can restore intestinal barrier integrity, suppress microglial activation, balance neurotransmitter systems, and regulate key signaling pathways including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and nuclear factor erythroid 2-related factor 2 (Nrf2), which is considered a plausible basis for investigating it as an adjunctive strategy for ASD-associated biological pathways. Moreover, the impact of berberine on the composition of gut microbiota may be associated with behavioral modulation and immune homeostasis. This review explores the mechanistic basis of berberine activity in ASD. Existing preclinical evidence and indirect clinical data suggest that berberine can be regarded as an adjunct intervention and a biological therapeutic approach targeting ASD-related biological pathways. However, current evidence remains preliminary and needs to be further validated in subsequent clinical studies. Please cite this article as: Rodríguez-Vera D, Soriano-Ursúa MA, Pinto-Almazán R, Arciniega-Martínez IM, Reséndiz-Albor AA, Vergara-Castañeda A, Valadez-Vega C, Morales-González Á, Madrigal-Santillán EO, García-Machorro J, Ibañez-Cervantes G, Morales-González JA. Berberine as a modulator in autism: Insights into mechanisms of action and therapeutic potential. J Integr Med. 2026; Epub ahead of print.

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18. Sabbah S, Namoura SM, Yacoub H, Yacoub Z, Yacoub R. Sensory feeding problems, pica-related behaviors, and sleep habits among children with autism spectrum disorder in palestine: a parent-reported cross-sectional study. Front Pediatr. 2026; 14: 1899150.

BACKGROUND: Autism Spectrum Disorder (ASD) is commonly associated with feeding difficulties and sleep disturbances, yet their co-occurrence remains understudied in Arab and Palestinian contexts. Pica and broader pica-related sensory feeding behaviors are among the most clinically significant feeding problems in children with ASD, carrying serious health risks. This study examined the level of parent-reported sensory feeding problems, pica-related behaviors, and sleep habit disturbances in children with ASD attending care centers in the West Bank, Palestine, and explored their association. METHODS: A cross-sectional descriptive-correlational survey was conducted. A convenience sample of 105 parents of children with ASD was recruited from care centers in the West Bank during August 2025. Two instruments were used: a 20-item literature-informed Sensory Feeding/Pica-Related Behaviors Scale developed for this study, and a 21-item Sleep Habits Scale adapted from the Arabic scale developed and validated by Al-Merdasi. The feeding scale underwent expert content review and pilot testing, while internal consistency was assessed for both instruments in the present sample. The feeding scale was designed to describe caregiver-reported sensory feeding difficulties and pica-related behaviors rather than to establish a DSM-5-TR or ICD-11 diagnosis of pica. All sleep items were coded so that higher scores indicated greater sleep disturbance; sleep adequacy items were reverse-scored. Data were analyzed using descriptive statistics, independent-samples t-tests, one-way ANOVA with LSD post-hoc tests, and Pearson correlation in SPSS. Effect sizes were reported as Cohen’s d for t-tests and partial η² for ANOVA. RESULTS: Sensory feeding problems and Pica-related behaviors scores were at a moderate level overall (M = 1.946, SD = 0.307; relative weight 64.9%). Sleep habit disturbances were also moderate (M = 3.123, SD = 0.551; 62.5%), with sleep anxiety ranking highest (M = 3.507). No significant differences in Sensory feeding and pica-related behavior scores were found by any demographic variable. For sleep habits, significant differences were found by child age (F = 10.038, p = 0.001, η² = 0.164), with younger children appearing to score higher, though the oldest age group was small (n = 7) and the finding should be interpreted cautiously. Significant differences were also found by child sex (t = 2.195, p = 0.030, d = 0.43), with higher sleep disturbance scores among females. A significant positive moderate correlation was found between pica-related problem scores and sleep disturbance scores (r = 0.463, p < 0.001). CONCLUSIONS: This parent-reported cross-sectional study found moderate levels of sensory feeding problems, pica-related behaviors, and sleep disturbances among children with ASD in the West Bank, Palestine, and a significant positive association between them. Because the study used convenience sampling and researcher-developed instruments with preliminary validation only, findings should be interpreted as preliminary and should not be taken as estimates of clinically diagnosed pica or sleep disturbances. They highlight the importance of integrating screening for pica-like behaviors and sleep problems within ASD services, and support the need for future longitudinal studies incorporating clinical diagnosis, gastrointestinal assessment, nutritional biomarkers, and validated measures.

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19. Vale P, Cerqueira ECS, Melo DV, Dezoti AP, Mazza VA, Carvalho RC, Carvalho ESS. Advanced nursing practice for caring for mothers of children with autism spectrum disorder in the CACTO program. Rev Lat Am Enfermagem. 2026; 34: e4882.

OBJECTIVE: to describe the competencies of advanced nursing practice for the care of mothers participating in CACTO: a unitary care program for mothers of children with autism spectrum disorder and/or disability. METHODS: qualitative study based on the Unitary Caring Science, conducted with 39 mothers of children with autism spectrum disorder. Data were collected from medical records, field diaries, meeting minutes, and CACTO’s social media profile. Deductive, reflective thematic analysis was used for data analysis. RESULTS: the results revealed a broadening of the scope of competencies that can be performed by nurses in primary health care, for example: understanding health needs, creating new ways of caring, recognizing ethical dilemmas, establishing collaborative relationships, valuing the social role of mothers, suggesting care with recommended scientific evidence, conducting scientific research, and acting autonomously. CONCLUSION: the competencies of nurses working at CACTO are distributed across seven dimensions, namely: care management, ethics, interprofessional collaboration, health promotion and risk prevention, evidence-based nursing, research, and leadership.

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20. Wang T, Wang P, Tang Y, Tian Y, Li D. Nonlinear dose-response relationship between exercise intervention and executive function in children with autism spectrum disorder: A systematic review and multilevel meta-analysis. Res Dev Disabil. 2026; 176: 105349.

OBJECTIVE: This study aims to examine the effects of exercise interventions on executive function in children with ASD and to investigate the dose-response relationship between exercise dosage and intervention effects. METHODS: We searched databases including PubMed, Web of Science, Embase, and the Cochrane Library to identify studies evaluating the effects of exercise interventions on executive function in children with ASD. Effect sizes were calculated using Hedges’ g. Using the metafor package in R, we constructed a three-level random-effects model to account for inter-effect dependencies and conducted a multilevel meta-analysis. Furthermore, we employed a TPS model to assess the dose-response relationship between exercise interventions and executive function, and to identify the effects of potential moderating variables on executive function. RESULTS: This review included 21 studies from six countries, involving 742 participants aged 3-15 years. Three-level meta-analysis showed that exercise interventions significantly improved executive function in children with ASD (Hedges’ g = 0.64, 95% CI [0.39, 0.88]), including inhibitory control (Hedges’ g = 0.59, 95% CI [0.34, 0.84]), working memory (Hedges’ g = 0.56, 95% CI [0.26, 0.87]), and cognitive flexibility (Hedges’ g = 0.75, 95% CI [0.50, 1.00]). The TPS model suggested potential dose-response patterns, with the highest predicted effect near the upper boundary of the observed data. Age-moderated intervention effects. Given the low certainty of evidence, findings should be interpreted cautiously. CONCLUSIONS: Exercise interventions can significantly improve executive function in children with ASD, and there is a significant dose-response relationship between exercise and executive function.

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21. Yan J, Kuang C, Liang X, Sun X, Chen F. Prosodic marking of contrastive focus in Mandarin-speaking children with autism spectrum disorder. Front Psychol. 2026; 17: 1898035.

INTRODUCTION: Prosodic focus marking plays a central role in conveying information structure, yet little is known about how Mandarin-speaking children with autism spectrum disorder (ASD) use acoustic cues to signal contrastive focus in a tonal language. METHODS: Prosodic focus marking plays a central role in conveying information structure, yet little is known about how Mandarin-speaking children with autism spectrum disorder (ASD) use acoustic cues to signal contrastive focus in a tonal language. This study examined pitch, duration, and intensity in sentence-initial and sentence-final focus produced by 20 Mandarin-speaking children with ASD and 20 age- and sex-matched typically developing (TD) peers. Using picture-based prompts, children produced simple subject-verb-object sentences, and acoustic measures of focus words (sentence-initial subject and sentence-final object) and post-focus verbs were analyzed with linear mixed-effects models. RESULTS: Children with ASD showed significantly higher pitch than TD children in sentence-final focus, with no group difference in sentence-initial focus. Duration ratio was significantly reduced only with high-tone verbs. Intensity ratio was lower in sentence-initial focus, but higher in sentence-final focus with high-tone verbs. In the post-focus region, children with ASD exhibited higher pitch than TD children for both high- and low-tone verbs, but showed larger duration ratio and lower intensity ratio only for low-tone verbs. DISCUSSION: These findings suggest that children with ASD are not globally impaired in focus marking, but show patterns that vary with focus position and tonal context.

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22. Yu B, He XN, Zhang XH, Lei G, Song XY, Wu JL, Li DX, Cheng SN, Zhang Y, Lv JM. Prefrontal activation and connectivity during verbal fluency in autism Spectrum disorder: an fNIRS study. Front Hum Neurosci. 2026; 20: 1810519.

OBJECTIVE: The neural mechanisms behind varying cognitive ability in children with Autism Spectrum Disorder (ASD) remain unclear. This study compared cortical activation and brain connectivity across ASD subgroups stratified by Full-Scale Intelligence Quotient (FSIQ). METHODS: Sixty-four children with ASD were divided into two groups based on their FSIQ scores: Group 1 (n = 30, FSIQ ≥ 70) and Group 2 (n = 34, FSIQ < 70). Using a 19-channel functional near-infrared spectroscopy (fNIRS) system, we assessed cortical activation and functional connectivity in both groups during a Verbal Fluency Task (VFT) by monitoring changes in oxyhemoglobin (Oxy-Hb) concentration. Inter-group differences in brain activation and connectivity were compared, and correlations between cortical activation levels and clinical indices (FSIQ, verbal production) were examined. RESULTS: Compared to Group 2, Group 1 showed significantly stronger cortical activation in channels 1 and 2 [corresponding to the inferior frontal gyrus (IFG)] (U = 212.000, Z = -4.009, FDR-corrected p < 0.001; U = 160.000, Z = -4.709, FDR-corrected p < 0.001). Global functional connectivity was also greater in Group 1 (mean = 0.586, SD = 0.521) relative to Group 2 (mean = 0.413, SD = 0.521) (permutation statistic = 4.82, FDR-corrected p < 0.001). Moreover, Oxy-Hb changes in channels 1 (r(s)  = 0.304, p < 0.05), 2 (r(s)  = 0.405, p < 0.01), and 10 (r(s)  = 0.253, p < 0.05) were positively correlated with FSIQ scores. Activation in channels 1 (r(s)  = 0.529, p < 0.001), 2 (r(s)  = 0.569, p < 0.001) and 10 (r(s)  = 0.290, p < 0.05) were also significantly correlated with verbal production. CONCLUSION: Our findings provide neurofunctional evidence for the association between cognitive resource capacity and verbal-executive processing in ASD. ASD children with lower FSIQ exhibited lower prefrontal activation and lower functional connectivity during the VFT, particularly within the IFG, frontopolar cortex (FPC), and dorsolateral prefrontal cortex (DLPFC). These results underscore the utility of fNIRS in delineating distinct neurocognitive profiles within ASD and highlight the IFG as a key region where neural activity correlates with both cognitive ability and language output, offering a potential target for mechanism-based intervention strategies.

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