1. Alabed ST, Shacker M, Riestra DB, Riestra JM, Hussain NU. Mental health treatment access among U.S. children according to ASD and ADHD diagnostic status. PCN Rep;2026 (Dec);5(4):e70435.

AIM: To compare mental health treatment receipt and difficulty obtaining treatment among U.S. children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) diagnostic status. METHODS: We pooled 2023-2024 National Survey of Children’s Health data for children aged 3-17 years who received or needed mental health treatment (N = 15,952). Children were classified as neither ASD nor ADHD, ADHD only, ASD only, or ASD + ADHD. The reference group included children without diagnosed ASD/ADHD who nevertheless received or needed treatment. The primary outcome was substantial difficulty obtaining treatment. Survey-weighted models adjusted for sociodemographic factors; same-sample sensitivity analyses additionally adjusted for individual clinical conditions and chronic functional limitation. RESULTS: Substantial difficulty was reported for 22.2%, 23.2%, 28.3%, and 28.2% of the neither, ADHD-only, ASD-only, and ASD + ADHD groups, respectively. ASD + ADHD was associated with higher adjusted odds of difficulty than neither condition (aOR 1.38, 95% CI 1.07-1.78; Bonferroni-adjusted P = 0.04) but not ASD only (aOR 1.10, 95% CI 0.75-1.59). In the same complete-case sample (n = 15,037), the ASD + ADHD estimate was 1.37 (95% CI 1.06-1.78) with sociodemographic adjustment and 0.79 (95% CI 0.59-1.05) after additional adjustment for the individual clinical conditions and chronic functional limitation. Chronic functional limitation was associated with difficulty (aOR 1.89, 95% CI 1.54-2.31). CONCLUSION: Differences in difficulty obtaining mental health treatment by ASD/ADHD diagnostic status were attenuated after accounting for measured clinical characteristics and chronic functional limitation. This underscores the importance of considering functional and psychiatric complexity when interpreting access differences across diagnostic groups. Evaluating access should include both treatment receipt and caregiver-reported difficulty obtaining treatment.

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2. Andersen AD, Møller ME, Frandsen MS, Andersen SD, Sørensen SS, Naylor SJ, Adjorlu A. Sensory Overstimulation: A Virtual Reality Simulation to Foster Empathy Towards Autistic Youth. Stud Health Technol Inform;2026 (Oct 28);341:479-486.

This paper investigates whether a Virtual Reality (VR) simulation of sensory overstimulation in a classroom can increase empathy and understanding toward individuals with Autism Spectrum Disorder (ASD) among students aged 13-15 in Danish elementary schools. The project followed an iterative design process in which an initial prototype was refined through user testing and interviews with autistic adults and a special-needs teacher. The resulting simulation combined auditory overstimulation, environmental distractions, a listening-based classroom task, and hyperfocus mechanics intended to represent selected aspects of Sensory Over-Responsivity (SOR) in school settings. A mixed-methods A/B evaluation compared the VR simulation with a sound-based condition that communicated the same classroom scenario through narration. Fifty-nine participants took part in the evaluation. Broader dispositional empathy showed little change, but target-specific measures indicated short-term increases in empathic concern and personal distress immediately after the intervention. Interview findings suggested that participants gained a stronger understanding of ASD-related classroom challenges, particularly difficulty focusing under layered sensory input. The results suggest that immersive VR may be a useful medium for communicating sensory challenges in classroom environments, while longer-term empathy effects remain uncertain.

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3. Arevalo I, Izuno-Garcia AK. Artificial Intelligence in Autism Assessment: A Conceptual Framework for Multimodal Artificial Intelligence Integration. Assessment;2026 (Oct 29):10731911261496704.

Artificial intelligence (AI) may be increasingly positioned to strengthen autism spectrum disorder (ASD) assessment by improving scalability, consistency, and workflow efficiency across settings that serve children. Traditional diagnostic tools such as the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) require extensive clinician preparation and are difficult to implement in many contexts, which contributes to delays and uneven access. This article provides a detailed review of how AI methods can be embedded within existing evaluation procedures. Computer vision, speech analysis, natural language processing, predictive modeling, and multimodal fusion techniques are examined as tools that can support observation, interviewing, scoring, and documentation. A central contribution is a conceptual framework organized around structured signal extraction, interpretable and modular models, and strong safeguards that guide responsible use. Key challenges include bias, variation in data quality, and appropriate alignment with clinical judgment. The article offers a foundation for clinicians and researchers seeking to integrate AI within ASD assessment workflows.

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4. Bertollo JR, Baczewski L, Behar H, Black ER, Anderson T, Sharp K, Lopez A, Neuman CC, Verbalis A, Pugliese CE, Kenworthy L. Self- and parent-reported executive function and self-determination in autistic teens: domain-specific relationships and cross-rater considerations. J Neurodev Disord;2026 (Aug 3);18(1)

BACKGROUND: Self-determination, or the degree to which an individual perceives they have « causal agency » over their life plans, is an important predictor of quality of life, employment, and education for autistic people. However, little research has explored predictors of self-determination in autism. Limited research links executive function (EF) to self-determination, but tends to focus on EF globally and fails to address specific EF subdomains. Report of cross-rater links between EF and self-determination (e.g., parent-report EF and self-report self-determination) is also missing. As such, the current study evaluates the relation between real-world EF subdomains and self-determination, both within and between raters. METHODS: 226 autistic teens ages 14-22 years (M = 16.17; 73% male, 75% white, 89% non-Hispanic) and their parent/caregiver completed rating scales about the teens’ EF and self-determination at enrollment for one of two EF intervention studies. Through a series of linear regressions, the relationship between EF subscales on the BRIEF-2 and Self-Determination capacity and opportunity at home (on the AIR Self-Determination Scale) were evaluated within each rater (self or parent). Exploratory analyses repeated these models across rater. RESULTS: Within self-report, greater EF challenges with flexibility and planning predicted lower capacity for self-determination. Within parent-report, relationships with self-determination capacity were generalized across EF subdomains (e.g., self-monitoring, flexibility, initiation, working memory, planning/organizing). EF subdomains such as flexibility, planning, working memory, and emotion regulation demonstrated cross-rater relationships with self-determination. Skills such as organization of materials and inhibition appeared to be uniquely important for understanding opportunities provided for teens to be self-determined at home. CONCLUSIONS: The current study replicates and extends prior findings linking EF to self-determination in autism, by highlighting possible EF subdomains that relate to self-determination capacity and opportunity, and demonstrating that some of these relations are robust enough to be seen across teen and parent raters. Findings suggest that supporting specific EF skills such as flexibility, planning, initiation, inhibition, and emotional control may be important for facilitating self-determination. Findings also underscore the importance of providing opportunities for teens to play a central role in developing and executing plans toward their goals. CLINICAL TRIAL REGISTRATION: #NCT05131659, #NCT05017779.

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5. Blanchard A, DiGuiseppi C, Ing C, Russell MT, Li G. Unintentional suffocation emergencies associated with autism and common Co-occurring diagnoses. Inj Epidemiol;2026 (Oct 30);13(Suppl 1)

BACKGROUND: People with autism are at heightened risk of specific injuries and injury-related death. As autism prevalence rises, epidemiologic data describing specific injuries, such as suffocation, across the lifespan are essential for prevention efforts. We describe the risk of unintentional suffocation-related events associated with autism and common co-occurring diagnoses among people treated in United States (US) emergency departments (EDs). METHODS: Using a repeated cross-sectional study design, we analyzed data from the 2016-2021 Nationwide Emergency Department Sample (NEDS), the largest US all-payer ED visit claims database. Using ICD-10-CM codes, children ≥ 1 year and adults diagnosed with autism, intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and Alzheimer’s disease and related dementia (ADRD) were identified and evaluated. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of unintentional suffocation-related ED visits in persons with and without autism, ID, ADHD, and ADRD. Each model was adjusted for the other conditions, age, sex, urbanicity, and payor. RESULTS: The 2016-2021 NEDS recorded a weighted total of 803,777,608 ED visits; of these, 1,012,210 (0.13%) were related to unintentional suffocation. Unintentional suffocation accounted for 0.35% of ED visits in patients with autism, 0.67% of ED visits in patients with a diagnosis of ID, 0.07% of ED visits in patients with a diagnosis of ADHD, and 0.34% of ED visits in patients with a diagnosis of ADRD. The odds of unintentional suffocation were increased 75% for patients with autism (aOR = 1.75; 95% CI: 1.65, 1.86), 556% for patients with ID (aOR = 6.56; 95% CI: 6.2, 6.94), 44% for patients with ADHD (aOR = 1.44; 95% CI: 1.35, 1.53), and 106% for patients with ADRD (aOR = 2.06; 95% CI: 2.01, 2.12). Across the lifespan, unintentional suffocation accounted for a larger proportion of ED visits among autistic than non-autistic patients. CONCLUSION: Children and adults with autism have a significantly increased odds of unintentional suffocation requiring emergency care. ID, ADHD, and ADRD, diagnoses that often co-occur with autism, also have increased odds of unintentional suffocation, with intellectual disability conferring the greatest risk.

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6. Cobbaert L. Beyond appearances: understanding autistic behaviours through context, function and lived experience in eating disorder care. J Eat Disord;2026 (Oct 28);14(1)

Passarini et al. review restricted and repetitive behaviours in autism and eating disorders (EDs), proposing possible roles in the onset and persistence of an eating disorder (ED) and discussing implications for assessment. This commentary examines specific interpretations of their findings. Describing autistic routines as « rigid » without establishing their function may conflate behaviours that sustain restriction with those that make eating possible. Stimming and masking research complicates inferences from changes in visible behaviour. Predominantly cross-sectional findings cannot determine whether such behaviours predispose to EDs or maintain them. The review acknowledges this limitation and calls for longitudinal research. Its recommendation to assess autism after the acute ED phase also risks delaying recognition of support needs and appropriate accommodations. Research on ED care illustrates the potential consequences of unmet needs and how concerns about treatment may be dismissed rather than investigated. I argue for interpretations grounded in behavioural function and context, cautious causal reasoning, attention to treatment-related harm, and meaningful involvement of autistic people and those with lived experience of EDs in developing clinical recommendations.

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7. Dong H, Zhang Y, Yu X, Du L, Jia F. Longitudinal relationship between sleep and emotional/behavioral problems in autism spectrum disorders: a cross-lagged panel analysis. Eur J Pediatr;2026 (Oct 30);185(11)

Sleep, emotional, and behavioral problems are common comorbidities associated with autism spectrum disorder (ASD). Current longitudinal research on the temporal links between sleep problems and emotional-behavioral problems shows inconsistent results among preschool children with ASD. Hence, this longitudinal study aimed to examine the temporal associations between emotional-behavioral and sleep problems among preschool children with ASD across two time points. Among 124 enrolled preschool children with ASD, 70 completed follow-up and constituted the final analytic sample (mean age 36.7 ± 10.2 months at T1). They were evaluated for developmental quotient using the Griffiths Development Scales-Chinese version (GDS-C), ASD symptoms using Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS), emotional and behavioral problems using the Child Behavior Checklist (CBCL), and sleep problems using the Children’s Sleep Habits Questionnaire (CSHQ) at time 1 (T1). The evaluations were replicated at a follow-up appointment 18 months after T1 (time 2; T2). The cross-lagged panel model (CLPM) was employed to examine the potential relationship between CBCL and CSHQ scores in the children. The total CBCL score at T1 could predict the CSHQ at T2 (β = 0.348, t = 3.105, p = 0.002), whereas the CSHQ at T1 could not predict the CBCL at T2 (β = 0.117, t = 1.083, p = 0.279). Findings remained robust across five sensitivity subsets after excluding subgroups with distinct rehabilitation exposure, younger age, higher development quotients, girls, or mild ASD symptoms. CONCLUSION: Emotional-behavioral problems predict sleep problems 18 months later in preschool ASD children. Screening of these symptoms during follow-up supports early sleep-risk monitoring. WHAT IS KNOWN: • Sleep, emotional, and behavioral problems are common comorbidities associated with ASD. • Thus, researching their temporal correlation over time is necessary. WHAT IS NEW: • Emotional and behavioral problems indicate a positive temporal correlation at T1, which was also evident for sleep problems at T2, in children with ASD. • Emotional and behavioral problems in preschool children with ASD can forecast sleep problems that develop 18 months later, providing guidance for clinical decision-making.

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8. Hickey Townsend P, Jones L, Tolosa A, Massa N, Simon NA, Mylonas D, Neumeyer AM, Manoach DS. Measuring Sleep at Home in Adolescents With Autism Using EEG Headbands: Protocol for a Remote Study. JMIR Res Protoc;2026 (Oct 30);15:e105941.

BACKGROUND: Sleep disturbances are prevalent in autism spectrum disorders (ASDs) and worsen daytime functioning, yet their neural bases remain poorly understood. This may reflect the challenges of laboratory-based polysomnography for individuals with ASD, including sensory sensitivities and difficulty adapting to changes in routine. The advent of wearable electroencephalography (EEG) devices allows for remote data collection in the home and facilitates large-scale sleep studies. OBJECTIVE: The aim of this study is to test the hypothesis that thalamocortical circuit dysfunction contributes to poor sleep in ASD by characterizing sleep oscillations that rely on this circuitry. To achieve this goal, we monitored sleep in the home using wearable EEG headbands in adolescents with ASD, including those who are profoundly affected, and their typically developing peers. When necessary, we used a desensitization protocol to gradually acclimate participants to wearing the headband overnight to promote the inclusion of individuals with sensory sensitivities and high support needs. METHODS: Participants and their families completed assessments and questionnaires and received remote training to use a wearable EEG headband. Those needing time to acclimate followed a personalized 2-week desensitization protocol with a practice headband. Sleep was monitored at home for 3 consecutive nights, the first of which was for adaptation to the headband. Sleep data quality was checked daily, and remote technical support was provided as needed. Using sleep rhythms as physiological biomarkers of thalamocortical circuit function, we will test the hypothesis that abnormal circuit function in ASD is related to worse sleep quality. RESULTS: This study was funded by the Simons Foundation Autism Research Initiative (SFARI) and approved by the Mass General Brigham Institutional Review Board in November 2021. Data were collected between July 2023 and November 2025. A total of 146 participants (ASD: n=77; typically developing [TD]: n=65; profound autism: n=4) completed the study and produced at least 1 night of usable sleep data. Data analysis is underway, and the results will be submitted for publication in November 2026. CONCLUSIONS: At-home sleep monitoring enables large samples that are needed to characterize the neural underpinnings of sleep disturbances across the autism spectrum. The personalized desensitization protocol promotes inclusion by accommodating individuals often excluded from research due to sensory or behavioral challenges. These methods are adaptable for other conditions and research goals beyond ASD, such as longitudinal studies across development or characterizing sleep in other neurodevelopmental disorders. Desensitization protocols may also increase the tolerability of diagnostic laboratory-based sleep studies and other medical procedures, improving both patient experience and quality of care.

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9. Hollingdale J, Bang-Andersen T, Woodhouse E. Sensory profiles for young males and females with ADHD and autistic characteristics. Child Neuropsychol;2026 (Oct 30):1-14.

Young people with ADHD frequently experience sensory differences. However, little is known about sensory differences between young males and females with ADHD and the extent to which frequently co-occurring autistic characteristics affect this. The aim of this paper was to determine whether perceptions of sensory problems differ between parents/caregivers and teachers, whether young males and females with ADHD experience different sensory profiles to one another and whether autistic characteristics affect these sensory experiences. The study included 78 young people (age range 5 to 17; M age=10.60, SD = 2.92), including 48 males (age range 5 to 17; M = 10.65, 2.96) and 30 females (age range 6 to 17; M = 10.53, SD = 2.90) who were diagnosed with ADHD at a private UK assessment clinic. Paired samples t-tests identified that parents/caregivers and teachers differed in their perceptions of sensory differences. Parents/caregivers reported more differences related to sensory systems compared with teachers. A MANCOVA did not identify a statistically significant difference in sensory profiles between males and females with ADHD after controlling for age. However, the sample size may not have been large enough to detect real sex differences, if they exist. Finally, regression analyses were conducted to determine whether autistic characteristics affected the sensory experiences of young people with ADHD. Autistic characteristics were consistently associated with increased sensory differences in parent report, but not teacher report, while age showed a consistent effect across both informants. This study provides new insights into the sensory experiences of young males and females with ADHD and different perspectives of parents and teachers.

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10. Hyseni F, Martinis J, Shehu E, Damiani M, Blanck P. Exploratory study of a supported decision-making intervention for adults with intellectual and developmental disabilities. J Intellect Disabil;2026 (Oct 30):17446295261501603.

Supported decision-making (SDM) is a legally recognized, person-centered approach that enables people with and without disabilities to make their own decisions with support from others. This study evaluated an 8-week virtual SDM pilot program for adults with intellectual and developmental disabilities using a pre-post design and introduced a facilitator guide adaptable to multiple settings. Pilot participants showed improvements in setting goals, making and expressing decisions, and seeking support when needed, along with overall gains across various SDM-related indicators. Findings suggest the intervention is feasible across diverse disabilities and support needs, with particularly strong benefits for individuals under guardianship. Future research should test the model with larger, more diverse samples and longer follow-up, as well as expand SDM training for providers, staff, and individuals to support broader model adoption.

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11. Khodadoust E, Zarafshan H, Nouri M, Majmaa A, Khaleghi A, Zamani F, Seyfi M, Shahrbaf MA, Samimi S, Sadri B, Mahmoodi SM, Abdi N, Ghasemi A, Ashrafi MR, Zarrabi M, Vosough M, Mohammadi MR. Three repeated intrathecal injections of allogenic umbilical cord-derived mesenchymal stromal cells in autism spectrum disorder: a Phase I clinical trial. Stem Cell Res Ther;2026 (Jul 30);17(1)

BACKGROUND: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition of etiology, characterized by deficits in social communication and restricted, repetitive behaviors. Despite its growing prevalence, no treatment has yet demonstrated consistent efficacy across the full spectrum of ASD phenotypes. This Phase I, open-label study investigates the safety and feasibility of three repeated intrathecal injections of allogeneic Umbilical Cord Tissue-Derived Mesenchymal Stromal Cells (UC-MSCs) in children diagnosed with ASD. METHODS: Five children (aged 3-7) with ASD, confirmed by Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-5) criteria and on stable behavioral and pharmacologic regimens for at least two months, received three intrathecal (IT) injections of 20 × 10⁶ UC-MSCs at one-month intervals. Safety was monitored over six months based on Common Terminology Criteria for Adverse Events (CTCAE). Preliminary behavioral assessments, including the Childhood Autism Rating Scale (CARS), Autism Treatment Evaluation Checklist (ATEC), and the Behavior Problem Inventory (BPI-S), were conducted at the baseline, one-, two-, four-, and six-month follow-ups. Cerebrospinal fluid (CSF) cytokine profiles were measured prior to each injection. Electroencephalography (EEG) and Diffusion Tensor Imaging (DTI) were performed at baseline and the final follow-up. RESULTS: The treatment was safe and well-tolerated with no serious adverse events (SAEs). All participants experienced at least one mild to moderate, transient adverse event (AEs), most commonly fever (5/5) and nausea (4/5). Exploratory behavioral improvements were observed in CARS in all children, while two participants moved from the mild-to-moderate to the non-autistic ranges, and three shifted from the severe to the mild-to-moderate range. Other measures also improved, though the persistence of these improvements was varied. CSF cytokines showed consistent reduction, particularly in TNF-[Formula: see text] and IL-6 levels across participants, confirming the immunomodulatory impact of UC-MSC administration. The EEG findings revealed that the spectral pattern shifted toward a more typical profile in one participant after treatment. CONCLUSIONS: This Phase I study showed that three repeated IT injections of UC-MSCs are safe and well-tolerated in children with ASD. Preliminary behavioral and biomarker improvements warrant further study in larger controlled trials. TRIAL REGISTRATION: Trial Registration ID: IRCT20200217046526N3.

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12. Kim YS, Cho YJ, Choi Y, Leventhal B. Trends in Autism Spectrum Disorder Cumulative Incidence and Incidence Density: A Systematic Review. Biol Psychiatry;2026 (Oct 30)

BACKGROUND: Claims of an « autism epidemic » imply a true increase in ASD occurrence and changing underlying risk yet largely rely on rising prevalence estimates rather than incidence. Both measures are influenced by diagnostic practices, service access, documentation, and ascertainment; prevalence is additionally affected by service-related migration. Incidence studies follow a defined population previously not identified, to examine outcomes over a specified period and study area; incidence is more likely to capture temporal changes in underlying risk. We systematically reviewed autism incidence studies across differing methodological designs. METHODS: Following PRISMA 2020 guidelines, we identified population-based studies reporting ASD or Autistic Disorder incidence in individuals under 18 years. Studies were classified as Category A (birth-defined cohorts with definable risk periods) or Category B (dynamic population annual incidence density). Due to heterogeneity, incidence estimates were compared narratively. RESULTS: Twenty-seven studies met inclusion criteria (14 Category A; 13 Category B). While ASD incidence increased, patterns varied by incidence framework, diagnostic definition, risk period, and ascertainment comprehensiveness (population coverage and detection of undiagnosed cases). High-comprehensiveness birth cohort studies tended to show inconsistent patterns and lower male-to-female ratios, whereas studies with moderate or low comprehensiveness often showed consistent increases. Increases were stronger for broader ASD category. CONCLUSIONS: ASD incidence increased in dynamic, administratively defined study populations with moderate or low ascertainment comprehensiveness. In contrast, birth-defined cohorts with fixed risk periods and high ascertainment comprehensiveness showed inconsistent patterns. Overall, the available data do not provide compelling evidence of a true increase in ASD occurrence-an « autism epidemic. »

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13. Lee IO, Wolstencroft J, Housby H, van den Bree MBM, Chawner S, Hall J, Owen MJ, Skuse DH. Factors associated with the use of UK emergency services in children and young people with intellectual developmental disabilities. BMC Med;2026 (Oct 28);24(1)

BACKGROUND: Children and young people (CYP) with intellectual developmental disabilities (IDD) experience substantial health needs and higher healthcare utilisation compared with the general paediatric population. However, factors affecting the emergency healthcare use among children with IDD of genetic aetiology remain poorly understood. This study aimed to examine demographic, socioeconomic, behavioural, genetic, and clinical factors of emergency service use among CYP with IDD in England. METHODS: This retrospective cohort study used linked administrative healthcare data from Hospital Episode Statistics (HES) emergency service records obtained from National Health Service (NHS) England. Participants were CYP aged between 4 and 15.5 years with confirmed pathogenic genetic variants associated with IDD identified via NHS medical genetic clinics. The outcome was the yearly emergency service use rate, calculated as the total number of lifetime emergency visits divided by age (years). Independent variables included demographic and socioeconomic factors, genetic characteristics, region of residence, adaptive functioning, behavioural and emotional adjustment, prosocial behaviour, general health status, and system-specific medical conditions. Primary caregivers completed questionnaires and provided information regarding the child’s medical history and demographic information. RESULTS: The average emergency attendance rate in this cohort was 0.73 visits per annum, which was much higher than that among children in the same age range from the general population. Emergency services were used more by younger IDD children with poorer adaptive functioning, more externalising and less prosocial behaviour, as well as those with complex multisystem conditions. Frequent attendance was associated with high rates of medical comorbidities especially seizures and respiratory problems. Regional differences were found with relatively higher usage in London and the North East of England. Attendance rates were not influenced by sex, ethnicity, socioeconomic deprivation, genetic variant type or inheritance status. CONCLUSIONS: This novel study demonstrated emergency healthcare utilisation among CYP with IDD of known genetic aetiology in England was primarily associated with clinical complexity, functional impairment, and younger age rather than socioeconomic or genetic factors. Their vulnerability to multisystem morbidity as well as regional disparities highlight the need for improved coordinated care and targeted service planning to reduce emergency healthcare dependence among children with disabilities.

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14. Madhuri S, Merugula S, Sagiraju HK, Nandini SS, Sravani A. STWO_GDSNet: Supercell Thunderstorm Wind Optimization-Based Gated Dual-Stream Convolutional Neural Network for Autism Spectrum Disorder Detection. Int J Dev Neurosci;2026 (Nov);86(7)

Autism spectrum disorder (ASD) affects social interaction and behaviour in children. Current diagnostic methods largely depend on clinical observation and standardized assessments, which can be subjective, time-intensive and influenced by the experience of evaluator. Here, STWO_GDSNet is devised for detecting ASD. Firstly, input image is sent to image pre-preparation, where image is denoised by anisotropic diffusion Kuwahara filtering (ADKF), followed by N4 bias field correction. Next, based on functional connectivity, the pivotal region is extracted by STWO that combines supercell thunderstorm algorithm (STA) and leaf in wind optimization (LiWO). After that, multiscale triangle descriptor (MTD) is extracted in descriptor computation phase. Subsequently, the input autism data are pre-prepared by normalization and standardization. Next, analysis of variance (ANOVA) method conducts attribute pruning, and extracted features as well as the pruned data are passed to gated dual-stream convolutional neural network (GDSNet) for detecting ASD. Here, GDSNet is trained by STWO that incorporates STA and LiWO. The efficacy of STWO_GDSNet is examined by considering accuracy, sensitivity and specificity, which yield maximal values of 96.24%, 95.99% and 96.61%.

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15. Maes P, Tafolla M, Benrey N, Rosen N, Tager-Flusberg H, Lord C. Language Proficiency and Code Switching in English-Spanish Autistic Bilingual Speakers. J Speech Lang Hear Res;2026 (Oct 30):1-18.

PURPOSE: Evidence that bilingual exposure does not negatively affect language outcomes in autistic individuals has expanded over the past 15 years. However, research on bilingualism in autism has been limited to focusing on one language or each language separately, which does not capture natural bilingual dynamics such as code switching. This study examined how English-Spanish autistic speakers use their languages to communicate in semistructured settings. METHOD: Thirty English-Spanish autistic bilingual individuals (age range: 5.33-42.33 years) participated in two semistructured interactions with either a caregiver or a bilingual examiner. In each context, participants were instructed to speak either English or Spanish. Video recordings were transcribed and coded for code switching. Language proficiency in each language was measured using mean length of utterance in morphemes and number of different words. From the transcripts, we extracted rates of target language utterances (matching the instructed language), intersentential code switching (using the noncontextual language), and intrasentential code switching (mixing languages within an utterance). RESULTS: Participants were, on average, more proficient in English than in Spanish. Code switching occurred primarily when participants were instructed to speak Spanish, with English-dominant individuals and those who were less proficient in Spanish switching back to English more frequently. Code switching was also more frequent during interactions with a familiar caregiver than an unfamiliar examiner. CONCLUSIONS: The language of English-Spanish autistic individuals reflects expected patterns of bilingual use. They showed greater proficiency in their societal than in their heritage language and seemed to rely on code switching primarily to compensate for limited proficiency in their nondominant Spanish. These findings add to the growing body of evidence that bilingualism should not be viewed as detrimental in autism.

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16. Malik MA, Fatima T. Accelerometer-Based Step Counts May Be Confounded by Repetitive Motor Behaviors in Adults With Autism Spectrum Disorder. JMIR Res Protoc;2026 (Oct 30);15:e110988.

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17. Miraclin TA, Oommen SP, Cruz SD, Gunasekaran K, Inbaraj MJ, Verghese VP, Neeravi A, Varghese R, Ezekiel F, Thomas M, George L, Gupta N, Veeraraghavan B. Neurodevelopmental sequelae in paediatric pneumococcal meningitis: a call for strengthened surveillance and follow-up care. BMC Pediatr;2026 (Aug 1);26(1)

BACKGROUND: Pneumococcal meningitis remains a significant cause of morbidity and mortality in children, particularly in low- and middle-income countries. Despite widespread use of pneumococcal conjugate vaccines (PCVs), limited data exist from India on the long-term neurodevelopmental sequelae among survivors. This study aimed to characterise the clinical profile, microbiological features, and neurocognitive outcomes of children diagnosed with pneumococcal meningitis over a 15-year period at a tertiary care centre in South India. METHODS: This cross-sectional study included children admitted with microbiologically confirmed pneumococcal meningitis between January 2007 and January 2022. Clinical, laboratory, radiological, and microbiological data were retrieved retrospectively. Survivors were contacted for follow-up; consenting families underwent structured neurodevelopmental screening and in-person evaluations by a developmental paediatrician and psychologist. Outcomes were assessed using the Modified Rankin Scale (mRS) and domain-specific neuropsychological assessments. Statistical analyses were conducted using SPSS software. RESULTS: A total of 48 children were included, of whom 70.8% were male and under 12 months of age. The in-hospital case fatality rate was 10.4%, while 25.7% of children died post-discharge. At follow-up, only 57.2% achieved favourable functional outcomes (mRS 0-2), and 17.2% had moderate-to-severe disability (mRS 3-5). Long-term sequelae included learning difficulties (54.2%), behavioural disturbances (37.5%), intellectual disability (37.5%), hearing impairment (28.0%), and drug-refractory epilepsy (25.0%). Language impairments, sensorimotor delays, executive dysfunction, and cortical visual impairment were also observed. Serotype 14 was the most prevalent (20.8%), with 23 unique serotypes identified. Post-vaccine trends showed a decline in the prevalence of vaccine-protected serotypes, such as 6B and 23 F, and the emergence of 19 A and 7 F. Penicillin resistance was high (79.2%), including 14.6% with high-level resistance (≥ 1 µg/mL). Cefotaxime susceptibility remained favourable in 81.3% of isolates; however, increasing resistance is alarming. CONCLUSION: Pneumococcal meningitis in children is associated with substantial mortality and a high burden of long-term neurodevelopmental sequelae, particularly in low-resource settings. Survivors experience persistent deficits across cognitive, motor, sensory, and behavioural domains, warranting structured post-discharge neurodevelopmental follow-up. The evolving serotype landscape and antibiotic resistance patterns underscore the need for continuous surveillance and tailored vaccine strategies, with particular emphasis on PCV13. Public health efforts must integrate early rehabilitation and school-based support to optimise outcomes for children affected by this disease.

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18. Nunez-Gaunaurd A, Tovin MM, Hale M, Li T, Bhat A. Authors’ Reply: Accelerometer-Based Step Counts May Be Confounded by Repetitive Motor Behaviors in Adults With Autism Spectrum Disorder. JMIR Res Protoc;2026 (Oct 30);15:e113321.

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19. O’Donoghue M, Storni C, Carvalho ACG, Healy S, Grufferty L, Killeen C, Downey M, Shaw-Kelly R, Nguyen H, Shahzad N, McGarry T, Galvin R. Making Space: A Participatory Approach to Designing Inclusive Outdoor Activity Spaces. Stud Health Technol Inform;2026 (Oct 28);341:222-229.

This paper presents the ARISE project, a participatory initiative developing design requirements for an inclusive outdoor recreation and activity space in Limerick, Ireland. Through community engaged methods – including focus groups, interviews, observations, and interdisciplinary workshops – we collaborated with autistic young people and adults, people with disabilities, older adults, carers, and professionals to identify barriers and opportunities within public outdoor environments. Six core design priorities are identified: flexible design, accessible information, physical access, activity spaces, safe environments, and inclusive amenities. These findings demonstrate how Universal Design principles, when shaped through meaningful co design with excluded communities, can inform outdoor spaces that promote wellbeing, autonomy, and social connection. The resulting guidelines will support the development of the ARISE site as a model for inclusive outdoor recreation and exercise.

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20. Orellana Banegas L, Urbina R, Flores Antúnez YII, Mejia JA. Delayed Recognition of Autism Spectrum Disorder and Off-Label Lurasidone After Intolerance to Risperidone and Aripiprazole in a Latin American Child: A Case Report. Cureus;2026 (Sep);18(9):e117158.

Autism spectrum disorder (ASD) can be difficult to recognize when co-occurring psychiatric symptoms are more clinically prominent, which may delay diagnosis. We report the case of a nine-year-old Latin American boy whose ASD and obsessive-compulsive disorder (OCD) were not diagnosed until approximately 27 months after initial presentation with irritability, mood lability, anxiety, and, subsequently, hallucinatory experiences; these symptoms were initially managed as primary psychiatric conditions. During this interval, fluoxetine was discontinued due to symptom worsening, sertraline produced only partial benefit, and both Food and Drug Administration (FDA)-approved agents for irritability associated with autistic disorder were discontinued because of adverse effects: risperidone due to significant weight gain and aripiprazole due to nausea, vomiting, and dizziness. A detailed neurodevelopmental reassessment subsequently identified longstanding social communication difficulties, rigid routines, sensory sensitivities, and restricted interests, supporting diagnoses of ASD and OCD. Low-dose lurasidone (20 mg nightly) was initiated off-label alongside continued sertraline. Over the following year, the patient demonstrated sustained improvement in irritability, aggression, self-injurious behavior, anxiety, and sleep disturbance. Hallucinatory experiences resolved within approximately three months and did not recur, with no significant adverse effects observed. This case illustrates how more prominent psychiatric symptoms can mask ASD and describes the individualized use of off-label lurasidone after intolerance to approved agents. However, the temporal association with clinical improvement does not establish causality, and findings from a single case cannot demonstrate efficacy.

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21. Sato T, Saito K, Oyu T, Yamaguchi K, Osawa M, Shiko Y, Kawasaki Y, Kurisaki T, Tsuda S, Kajihara T, Nagashima M. Paroxetine-induced transient apoptosis with delayed neurogenesis triggers brain-preferential regeneration in developing zebrafish. PLoS One;2026;21(10):e0345903.

Autism spectrum disorder (ASD) is a neurodevelopmental condition caused by a combination of genetic and environmental factors. Its cardinal symptoms include impaired social behavior involving the amygdala. Maternal use of antidepressants such as paroxetine during early pregnancy increases the risk of ASD in offspring. However, the underlying pathogenic mechanisms remain poorly understood. Herein, we demonstrate that early exposure of zebrafish embryos to paroxetine delays neurogenesis in the optic tectum and telencephalon, including a region corresponding to the mammalian amygdala. Paroxetine-treated embryos exhibit growth restriction characterized by small heads and short-body lengths resulting from transient apoptosis. This phenotype resembles the early-onset fetal growth restriction (FGR) associated with ASD. Interestingly, we observed regeneration of delayed neurogenesis in the reduced brain following paroxetine withdrawal. This regenerative process was accompanied by extended retinotectal projections, suggesting brain-preferential regeneration. Finally, we examined the social behavior of paroxetine-treated fish. Taken together, our findings suggest a biological mechanism linking early paroxetine exposure, a risk factor for ASD, to its pathogenesis.

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22. Shi S, Baranova A, Cao H, Zhang F. Causal associations between gut microbiota and autism spectrum disorder and attention-deficit/hyperactivity disorder: a two-sample mendelian randomization study. Front Genet;2026;17:1972696.

BACKGROUND: The gut microbiota have been implicated in the development of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). However, the precise causal relationships between the gut microbiota and ASD or ADHD remain unclear. METHODS: We investigated potential causal associations between gut microbiota and two neurodevelopmental mental disorders (ASD and ADHD) via Mendelian randomization (MR) analyses. We used genome-wide association study (GWAS) summary datasets, including data from the MiBioGen consortium (N = 18,340), the Dutch Microbiome Project (N = 8,208), an ASD GWAS (N = 46,350), and an ADHD GWAS (N = 292,548). RESULTS: Our MR analysis identified 16 gut bacterial taxa associated with ASD. Seven taxa were associated with an increased risk (OR 1.03-1.10), while nine were associated with a decreased risk (OR 0.89-0.96). Conversely, 28 gut bacterial taxa were causally linked to ADHD: 16 were associated with an increased risk (OR 1.02-1.04), and 12 were associated with a decreased risk (OR 0.95-0.98). Both ASD and ADHD were causally influenced by the family « Clostridiales noname, » but with opposite effects. CONCLUSION: Our MR analysis revealed causal effects of specific gut microbiota on ASD and ADHD, suggesting that certain gut microbes may play a role in the development and treatment of these disorders, as well as in their differential diagnosis.

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23. Trew S, Russell DH, Lawson WB. How Have Non-speaking and Minimally Verbal Autistic Children Been Included as Direct Participants in Qualitative Research? A Scoping Review of Methods. Child Psychiatry Hum Dev;2026 (Oct 30)

Non-speaking and minimally verbal autistic children are rarely included as direct sources of qualitative data. This scoping review followed the Arksey and O’Malley framework and PRISMA-ScR. We searched eight databases and grey literature, screened 2,092 records and included 11 studies (2012-2025) involving non-speaking or minimally verbal autistic children aged 5-18. We used thematic synthesis to identify six themes. Most studies used video observation, and analysis varied. Studies took two positions on how the child’s communication system related to the method. Theoretical frameworks guided how children took part. Consent and assent were reported in different ways. Studies differed in the time and relationship-building they described. Five studies treated refusal and resistance as communication. The evidence base is small, and the studies are not fully independent. Studies that treat children’s own communication as data show that direct participation is possible.

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24. Watts B, Chawner S, Burchell G, Fox JRE. A systematic review of qualitative research of eating disorders in autistic adults: convergent and divergent experiences. Front Psychiatry;2026;17:1953234.

INTRODUCTION: Autism and eating disorders frequently co-occur, yet relatively little is known about how autistic adults experience eating disorders. METHODS: This systematic review synthesised qualitative evidence to explore the lived experiences of autistic adults with an eating disorder and inform autism-informed clinical practice. A systematic search identified 13 eligible studies, which were appraised using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist and synthesised using thematic synthesis. RESULTS: Findings were organised into three themes: eating disorder experiences cannot be understood independently of autistic ways of processing the world; recovery is enabled through developing self-understanding and integrating autism into personal identity; and recovery is facilitated when support aligns with autistic needs rather than neurotypical assumptions. Autistic characteristics, particularly sensory sensitivities, interoceptive differences, and a preference for predictability, fundamentally shaped the development, maintenance, and recovery of eating disorders. Sensory-driven food restriction was frequently experienced independently of body image concerns, highlighting potential conceptual overlap with Avoidant/Restrictive Food Intake Disorder (ARFID). DISCUSSION: Autistic adults described eating disorders as inseparable from their autistic experience, indicating the need for a paradigm shift from conceptualising autism and eating disorders as co-occurring conditions towards a model rooted in lived phenomenological experience. Clinical assessment, formulation, and intervention should adopt autism-informed, individualised approaches that recognise sensory processing and interoceptive differences, while future research should examine these mechanisms across a broader range of eating disorder diagnoses. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261375735.

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25. Zaidman-Zait A. Letter to the Editor: Beyond bridge nodes: conceptual and methodological considerations for autism-anxiety network models: A response to Sahin (2026). Child Adolesc Ment Health;2026 (Oct 30)

This Response addresses a Letter to the Editor by Sahin (Child and Adolescent Mental Health, 2026) concerning our network analysis of autism characteristics and anxiety symptoms in autistic children and youth (Child and Adolescent Mental Health, 2025, 30, 327). In his Letter, Sahin proposes three extensions for future research: examining whether Theory of Mind mediates the association between social communication and anxiety, modeling intolerance of uncertainty and arousal dysregulation as potential bridge mechanisms, and estimating comparable network models using autistic youths’ self-report data. In this Response, I argue that although each extension warrants further examination, it also raises conceptual and methodological issues that require closer consideration. Moreover, I emphasize that examining potentially modifiable mechanisms underlying autism-anxiety co-occurrence will require future research to move beyond descriptions of cross-sectional network topology and adopt study designs and network models better suited to examining temporal and mechanistic processes.

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