Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018

Therapeutic Efficacy of a Synthetic Brain-Targeted H2S Donor Cross-Linked Nanomicelle in Autism Spectrum Disorder Rats through Aerobic Glycolysis

Autism spectrum disorder (ASD) is characterized by cognitive inflexibility and social deficits, with a notably limited range of brain-targeted medications, particularly in the field of nanomedicine. Herein, we introduce the brain-targeted H2S donor cross-linked nanomicelle, named mannose-PEG600-lipoic acid (Man-LA). Man-LA demonstrates enhanced stability and precise brain delivery by interacting with glucose transporter 1 (GLUT1) in astrocytes, facilitating a gradual release of H2S that is modulated by glutathione (GSH). In vivo, studies suggest that Man-LA alleviates symptoms of ASD, correlating with increased expression of aerobic glycolysis enzymes, elevated lactate production, and higher H2S levels, while preventing damage to hippocampal neurons. In vitro, Man-LA tightly binds to aldehyde dehydrogenase family 3 member B1 (Aldh3b1) in astrocytes, upregulating its expression. This interaction promotes aerobic glycolysis and enhances lactate production. These findings suggest a connection between ASD deficits and the dysregulation of astrocytic aerobic glycolysis, underscoring the role of H2S. Identifying the Aldh3b1 gene within aerobic glycolysis pathways provides a promising target for ASD treatment.

A multimodal neural signature of face processing in autism within the fusiform gyrus

Atypical face processing is commonly reported in autism. Its neural correlates have been explored extensively across single neuroimaging modalities within key regions of the face processing network, such as the fusiform gyrus (FFG). Nonetheless, it is poorly understood how variation in brain anatomy and function jointly impacts face processing and social functioning. Here we leveraged a large multimodal sample to study the cross-modal signature of face processing within the FFG across four imaging modalities (structural magnetic resonance imaging (MRI), resting-state functional magnetic resonance imaging, task-functional magnetic resonance imaging and electroencephalography) in 204 autistic and nonautistic individuals aged 7-30 years (case-control design). We combined two methodological innovations-normative modeling and linked independent component analysis-to integrate individual-level deviations across modalities and assessed how multimodal components differentiated groups and informed social functioning in autism. Groups differed significantly in a multimodal component driven by bilateral resting-state functional MRI, bilateral structure, right task-functional MRI and left electroencephalography loadings in face-selective and retinotopic FFG. Multimodal components outperformed unimodal ones in differentiating groups. In autistic individuals, multimodal components were associated with cognitive and clinical features linked to social, but not nonsocial, functioning. These findings underscore the importance of elucidating multimodal neural associations of social functioning in autism, offering potential for the identification of mechanistic and prognostic biomarkers.

Unraveling Copper Imbalance in Autism Spectrum Disorder: Mechanistic Insights from the Valproic Acid Mouse Model

Abnormal copper (Cu) levels are often closely associated with neurological disorders including neurodevelopmental conditions, such as autism spectrum disorder (ASD). However, the mechanisms underlying the disruption of Cu homeostasis in critical organs, such as the brain, remain unclear. In this study, we elucidated the molecular mechanisms of Cu imbalance in the brain of a valproic acid (VPA) mouse model along with the changes in specific metabolites. Significant alterations occurred in proteins associated with primary Cu-related metabolism in specific regions of the brain (prefrontal cortex, amygdala, cerebellum, and hippocampus), resulting in a direct elevation of Cu ions within the brain tissues (control: 5.05 ± 0.61 μg/g vs model: 6.28 ± 0.81 μg/g, p = 0.015). Furthermore, the brain metabolic profiles revealed significant upregulation of lipids, particularly phospholipid metabolites. Typical neurotransmitters, for example, dopamine (DA) (p < 0.0001) and serotonin (5-HT) (p = 0.02) were upregulated in amygdala. Other small metabolites like glutathione (GSH) (p = 0.0004) also exhibited notable variation in brain. The potential impact of Cu toxicity on the signaling pathways of key metabolites was then evaluated, providing new insights into the role of Cu in metabolism of neurotransmitters in the brain. Our finding sheds molecular aberrations associated with essential element metabolism in the brain, providing new elemental perspectives for understanding the pathogenic mechanisms underlying ASD.

Apps and Digital Resources for Child Neurodevelopment, Mental Health, and Well-Being: Review, Evaluation, and Reflection on Current Resources

BACKGROUND

An increase in the prevalence of neurodevelopmental conditions worldwide, alongside resource constraints within clinical services, has led to increased interest in health information technologies, such as apps and digital resources. Digital tools are often viewed as a solution to bridge this divide and to increase supports for families. There is, however, a paucity of research that has evaluated digital health tools, their potential benefits for child neurodevelopment and associated concerns (eg, mental health, well-being), and their benefit for families.

OBJECTIVE

This study conducted the first review of existing mobile apps and digital resources targeted at supporting the needs of children with developmental concerns or neurodevelopmental conditions.

METHODS

We identified 3435 separate resources, of which 112 (43 apps and 69 digital resources) met the criteria. These resources were categorized according to their purpose or target and were then reviewed based on their engagement, information quality, and evidence base using the Adapted Mobile App Rating Scale.

RESULTS

The most common condition of concern targeted by apps and digital resources was autism (19/112, 17% resources), with retrieved resources focusing on supporting challenging behaviors, promoting speech, language, and social development, and providing options for alternative and assistive communication. Other common areas of concern targeted by apps and digital resources included language and communication (16/112, 14.3%) and attention-deficit/hyperactivity disorder (11/112, 9.8%). Results showed that reviewed resources were engaging, with high levels of accessibility and functionality. Resources had various functions, including developmental or behavioral tasks targeted at children, assistive communication support, scheduling support, journaling, and advice, activities, and strategies for parents. The information quality of resources, such as credibility of source and evidence base was, however, mostly low. Apps and digital resources with good credibility and an existing evidence base were largely developed in partnership with research, health, or government institutions, and were rated significantly higher on overall quality compared with apps and digital resources not developed in partnership with such institutions (apps; t41=-4.35, P<.001; digital resources; t67=-4.95, P<.001).

CONCLUSIONS

The lack of evidence base across resources means that it is extremely difficult to provide recommendations to families with respect to apps or digital resources that may support their needs. Frameworks for the development of new tools are discussed, highlighting the novel approaches required to demonstrate the efficacy of tools for improving outcomes for children and families. Such a framework requires collaboration with multiple stakeholders (software developers, researchers, regulatory bodies, clinicians, children, and families) and engagement across multiple levels of expertise (app development, implementation, and dissemination within services, policy, and clinical regulations), to harness the potential of digital health for improving outcomes and promoting support in child neurodevelopment, which at this juncture remains largely underdeveloped.

Influenza A virus during pregnancy disrupts maternal intestinal immunity and fetal cortical development in a dose- and time-dependent manner

Epidemiological studies link exposure to viral infection during pregnancy, including influenza A virus (IAV) infection, with increased incidence of neurodevelopmental disorders (NDDs) in offspring. Models of maternal immune activation (MIA) using viral mimetics demonstrate that activation of maternal intestinal T helper 17 (TH17) cells, which produce effector cytokine interleukin (IL)-17, leads to aberrant fetal brain development, such as neocortical malformations. Fetal microglia and border-associated macrophages (BAMs) also serve as potential cellular mediators of MIA-induced cortical abnormalities. However, neither the inflammation-induced TH17 cell pathway nor fetal brain-resident macrophages have been thoroughly examined in models of live viral infection during pregnancy. Here, we inoculated pregnant mice with two infectious doses of IAV and evaluated peak innate and adaptive immune responses in the dam and fetus. While respiratory IAV infection led to dose-dependent maternal colonic shortening and microbial dysregulation, there was no elevation in intestinal TH17 cells nor IL-17. Systemically, IAV resulted in consistent dose- and time-dependent increases in IL-6 and IFN-γ. Fetal cortical abnormalities and global changes in fetal brain transcripts were observable in the high-but not the moderate-dose IAV group. Profiling of fetal microglia and BAMs revealed dose- and time-dependent differences in the numbers of meningeal but not choroid plexus BAMs, while microglial numbers and proliferative capacity of Iba1+ cells remained constant. Fetal brain-resident macrophages increased phagocytic CD68 expression, also in a dose- and time-dependent fashion. Taken together, our findings indicate that certain features of MIA are conserved between mimetic and live virus models, while others are not. Overall, we provide consistent evidence of an infection severity threshold for downstream maternal inflammation and fetal cortical abnormalities, which recapitulates a key feature of the epidemiological data and further underscores the importance of using live pathogens in NDD modeling to better evaluate the complete immune response and to improve translation to the clinic.

Profiles and Longitudinal Growth Trajectories of Teacher-Rated Academic Skills and Enablers in Autistic Children and Adolescents

In non-autistic children, academic skills are associated with academic enablers (motivation, engagement, study/interpersonal skills), but few studies have explored these in autistic children. This study identified profiles of academic skills and enablers in autistic students and explored the trajectory of each profile over time. Teachers completed the Academic Competences Evaluation Scales for autistic children in primary and secondary educational settings annually for 5 years. Latent profile analysis identified six profiles in the primary/younger cohort and seven in the secondary/older cohort. Whilst some profiles showed relative stability across skills and enablers, others profiles were more variable. The profiles remained stable and significantly different from each other over time, with no profile × time interactions identified. Autistic children may show variability across their academic skills and enablers. This highlights the importance of understanding each individual student and their profile of strengths and challenges when planning supports.

Targeting S100A9 attenuates social dysfunction by modulating neuroinflammation and myelination in a mouse model of autism

Growing evidence supports a role for dysregulated neuroinflammation in autism. However, the underlying mechanisms of microglia-evoked neuroinflammation in the development of autistic phenotypes have not been elucidated. This study aimed to investigate the role and underlying mechanisms of microglial S100 calcium-binding protein A9 (S100A9) in autistic phenotypes. We utilized the BTBR T + tf/J (BTBR) mouse, a reliable preclinical model for autism that displays core behavioral features of autism as well as persistent immune dysregulation. A combination of behavioral, pharmacological, immunological, genetic, molecular, and transcriptomics approaches were used to uncover the potential role of S100A9 in autism. Significant overexpression of microglial S100A9 was observed in the hippocampus of BTBR mice. BTBR mice displayed decreased social communication and increased repetitive behaviors compared to C57BL/6 mice. Interestingly, the above social dysfunction was attenuated by a pharmacological inhibitor of S100A9, accompanied by a significant reduction in the activated microglia morphological phenotype, inflammatory receptors, and proinflammatory cytokines. Notably, S100A9 inhibition decreased c-Fos+ cells and promoted myelination in the cornu ammonis 3 of BTBR mice. Furthermore, the promyelinating compound administration ameliorated the autism-relevant behaviors in BTBR mice. Our findings indicate that microglia-derived S100A9 triggers the neuroinflammation cascade, myelination deficits, and social dysfunction. Targeting S100A9 could, therefore, be a promising therapeutic strategy for neuroinflammation-related neurodevelopmental disorders.

Accelerated Infant Brain Rhythm Maturation in Autism

Electroencephalography (EEG) captures characteristic oscillatory shifts in infant brain rhythms over the first year of life, offering unique insights into early functional brain development and potential markers for detecting neural differences associated with autism. This study used functional principal component analysis (FPCA) to derive dynamic markers of spectral maturation from task-free EEG recordings collected at 3, 6, 9, and 12 months from 87 infants, 51 of whom were at higher likelihood of developing autism due to an older sibling diagnosed with the condition. FPCA revealed three principal components explaining over 96% of the variance in infant power spectra, with power increases between 6 and 9 Hz (FPC1) representing the most significant age-related trend, accounting for more than 71% of the variance. Notably, this oscillatory change occurred at a faster rate in infants later diagnosed with autism, indicated by a steeper trajectory of FPC1 scores between 3 and 12 months (p < 0.001). Age-related spectral changes were consistent regardless of familial likelihood status, suggesting that differences in oscillatory timing are associated with autism outcomes rather than genetic predisposition. These findings indicate that while the typical sequence of oscillatory maturation is preserved in autism, the timing of these changes is altered, underscoring the critical role of timing in autism pathophysiology and the development of potential screening tools.

NEAT1 Promotes Valproic Acid-Induced Autism Spectrum Disorder by Recruiting YY1 to Regulate UBE3A Transcription

Evidence suggests that long non-coding RNAs (lncRNAs) play a significant role in autism. Herein, we explored the functional role and possible molecular mechanisms of NEAT1 in valproic acid (VPA)-induced autism spectrum disorder (ASD). A VPA-induced ASD rat model was constructed, and a series of behavioral tests were performed to examine motor coordination and learning-memory abilities. qRT-PCR and western blot assays were used to evaluate target gene expression levels. Loss-and-gain-of-function assays were conducted to explore the functional role of NEAT1 in ASD development. Furthermore, a combination of mechanistic experiments and bioinformatic tools was used to assess the relationship and regulatory role of the NEAT1-YY1-UBE3A axis in ASD cellular processes. Results showed that VPA exposure induced autism-like developmental delays and behavioral abnormalities in the VPA-induced ASD rat model. We found that NEAT1 was elevated in rat hippocampal tissues after VPA exposure. NEAT1 promoted VPA-induced autism-like behaviors and mitigated apoptosis, oxidative stress, and inflammation in VPA-induced ASD rats. Notably, NEAT1 knockdown improved autism-related behaviors and ameliorated hippocampal neuronal damage. Mechanistically, it was observed that NEAT1 recruited the transcription factor YY1 to regulate UBE3A expression. Additionally, in vitro experiments further confirmed that NEAT1 knockdown mitigated hippocampal neuronal damage, oxidative stress, and inflammation through the YY1/UBE3A axis. In conclusion, our study demonstrates that NEAT1 is highly expressed in ASD, and its inhibition prominently suppresses hippocampal neuronal injury and oxidative stress through the YY1/UBE3A axis, thereby alleviating ASD development. This provides a new direction for ASD-targeted therapy.

Treatment Fidelity and Outcome in CBT for Youth with Autism: The MEYA Fidelity Scale

OBJECTIVE

Assessing treatment fidelity in effectiveness research is critical to interpreting study findings. This paper details the development and initial psychometric evaluation of the Modular Evidence-Based Practices for Youth with Autism Fidelity Scale (MEYA-FS) designed to support the assessment of cognitive-behavioral treatments for youth with autism in effectiveness research.

METHOD

Recorded treatment sessions (N = 338) were randomly selected from 77 youth (M age = 9.65 years, SD = 1.87; 50.67% White; 85.33% male) who received the Schema, Emotion, and Behavior-Focused Therapy for Children (SEBASTIEN) (n = 51) or Coping Cat (n = 24) program.

RESULTS

The MEYA-FS Adherence items displayed acceptable interrater reliability, but more than half of the MEYA-FS Competence items did not. The magnitude and pattern of correlations supported the score validity of the MEYA-FS Adherence and Competence items and subscales. However, some corresponding Adherence and Competence items displayed significant overlap. Scores on each Adherence subscale distinguished between the SEBASTIEN and Coping Cat programs, providing support for discriminant validity. Finally, higher Adherence and Competence subscales predicted significant improvements in youth clinical outcomes (adjustment problems in the school setting, social-communication difficulties, restrictive/repetitive behaviors, and externalizing problems), providing initial evidence for predictive validity.

CONCLUSIONS

The psychometric properties of the MEYA-FS make it appropriate for supporting efforts to evaluate cognitive-behavioral interventions for youth with autism in effectiveness and implementation research.

Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system

LAY ABSTRACT

Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention-based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.

Characteristics of Young Children Associated with Diagnostic Utility of the Autism Diagnostic Observation Schedule: A DBPNet Study

OBJECTIVE

The aim of this study is to identify characteristics of children for whom a developmental-behavioral pediatrician's (DBP) diagnostic impressions of autism spectrum disorder (ASD) or non-ASD were changed by Autism Diagnostic Observation Schedule (ADOS) results.

METHOD

A prospective study of children 1½ to <6 years consecutively referred to 8 sites for possible ASD. Cognitive/developmental, language, and adaptive testing varied, as each site followed its usual clinical approach. DBPs documented diagnosis as ASD or non-ASD and their degree of diagnostic certainty (1-10) pre- and post-ADOS. Cases where DBP diagnostic impression did not change after ADOS administration ("Stable Group," n = 314) were compared with those for whom it did change ("Changed Group," n = 35), followed by matched random sample comparisons.

RESULTS

There were no significant differences in child characteristics (age, gender, race, ethnicity, insurance, caregiver education) between the Stable and Changed groups. DBPs' diagnostic certainty was significantly lower, both pre- and post-ADOS, in the Changed versus Stable group. Change was associated with milder symptoms of ASD and less impaired language. In an age- and gender-matched comparison, significant differences remained for diagnostic certainty and severity of social communication impairments. Cognitive scores were significantly higher in the Changed Group. Because of significantly higher caregiver education and a trend toward more privately insured children among the Changed Group, samples (n = 35 each) were then matched on those characteristics, revealing the same differences for diagnostic certainty, severity of ASD symptoms, and language skills.

CONCLUSION

Young children with milder ASD symptoms and less impaired language may benefit most from the administration of the ADOS.

Dynamical complexity of postural control system in autism spectrum disorder: a feasibility study of linear and non-linear measures in posturographic analysis of upright posture

BACKGROUND

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, characterized by impairments in social interaction and communication with restricted and repetitive behavior. Postural and motor disturbances occur more often in ASD, in comparison to typically developing subjects, affecting the quality of life. Linear and non-linear indexes derived from the trajectory of the center of pressure (COP) while subjects stand on force platforms are commonly used to assess postural stability. The aim of the present feasibility study was to investigate whether combining linear and non-linear parameters of the COP during stance in subjects with ASD, could provide insight on specific features of motor dysfunction possibly linked to ASD cognition and clinical characteristics.

METHODS

Twenty-two males, aged 10-15 years, including subjects with ASD and healthy controls (N = 11, respectively), were studied. They all had normal cognitive level and independent walking ability. A piezoelectric force platform was used to evaluate posture over three feet positions, with eyes open, closed and during visually-guided saccades. Linear (sway path, total area and root mean square) and non-linear parameters (fractal dimension and sample entropy) of the COP were measured to determine postural stability and the complexity and regularity of the COP signals. GLMM analyses were performed to assess COP parameter changes across experimental conditions and subject groups. Finally, Spearman correlations evaluated the significance of potential relationships between linear and non-linear measures as well as between non-linear parameters and clinical data in patients with ASD.

RESULTS

Compared to controls, subjects with ASD showed reduced postural stability and complexity, with higher regularity of COP trajectories, particularly in the most unstable feet positions, during visually-guided saccades and in the medial-lateral direction. Spearman correlations indicated that, in the patients' group, postural instability was associated with a decrease in the geometric complexity and an increase in the regularity of the COP trajectory. Moreover, the increase in regularity of the COP trajectory was associated to the severity of restricted and repetitive behavior.

CONCLUSIONS

The results of this study highlight the importance of combining linear and non-linear measures in evaluating postural control in patients with ASD, also with respect to the outcome of interventions on these patients targeting postural balance.

An Evaluation of a Jordanian Version of the Bruininks-Oseretsky Test of Motor Proficiency Second Edition Brief Form (BOT-2BF) for Use with Children with Autism Spectrum Disorder

In the current study, we tested a Jordanian version of the Bruininks-Oseretsky Test of Motor Proficiency - Second Edition, Brief Form (BOT2-BF) for use with children with autism. Study participants were a convenience sample of 140 children in Jordan, aged 4-8 years, including70 children with autism spectrum disorder (ASD) and 70 children without disabilities. The BOT 2-BF consists of 12 items divided into eight main areas: fine motor skills, fine motor integration, manual dexterity, bilateral coordination, balance, speed and agility, coordination of the upper extremities, and strength. We administered the Jordanian version of the scale individually to all the participants and found it to have acceptable construct validity, internal item consistency, internal sub-scale correlations, discriminant validity for our two groups, and factorial validity on confirmatory factor analysis. The scale also had acceptable split-half reliability. This study is the first Arabic adaptation of the BOT-2BF, and it is the first study to show utility of this instrument for children with ASD. We present further recommendations for research and practice.

Neuroprotective effect of PPAR gamma agonist in rat model of autism spectrum disorder: Role of Wnt/β-catenin pathway

BACKGROUND

The clinical manifestation of autism spectrum disorder (ASD) is linked to the disruption of fundamental neurodevelopmental pathways. Emerging evidences claim to have an upregulation of canonical Wnt/β-catenin pathway while downregulation of PPARγ pathway in ASD. This study aims to investigate the therapeutic potential of pioglitazone, a PPARγ agonist, in rat model of ASD. The study further explores the possible role of PPARγ and Wnt/β-catenin pathway and their interaction in ASD by using their modulators.

MATERIAL AND METHODS

Pregnant female Wistar rats received 600 mg/kg of valproic acid (VPA) to induce autistic symptoms in pups. Pioglitazone (10 mg/kg) was used to evaluate neurobehaviors, relative mRNA expression of inflammatory (IL-1β, IL-6, IL-10, TNF-α), apoptotic markers (Bcl-2, Bax, & Caspase-3) and histopathology (H&E, Nissl stain, Immunohistochemistry). Effect of pioglitazone was evaluated on Wnt pathway and 4 μg/kg dose of 6-BIO (Wnt modulator) was used to study the PPARγ pathway.

RESULTS

ASD model was established in pups as indicated by core autistic symptoms, increased neuroinflammation, apoptosis and histopathological neurodegeneration in cerebellum, hippocampus and amygdala. Pioglitazone significantly attenuated these alterations in VPA-exposed rats. The expression study results indicated an increase in key transcription factor, β-catenin in VPA-rats suggesting an upregulation of canonical Wnt pathway in them. Pioglitazone significantly downregulated the Wnt signaling by suppressing the expression of Wnt signaling-associated proteins. The inhibiting effect of Wnt pathway on PPARγ activity was indicated by downregulation of PPARγ-associated protein in VPA-exposed rats and those administered with 6-BIO.

CONCLUSION

In the present study, upregulation of canonical Wnt/β-catenin pathway was demonstrated in ASD rat model. Pioglitazone administration significantly ameliorated these symptoms potentially through its neuroprotective effect and its ability to downregulate the Wnt/β-catenin pathway. The antagonism between the PPARγ and Wnt pathway offers a promising therapeutic approach for addressing ASD.

Uncertainty Inspired Early Autism Spectrum Disorder Screening via Contrastive Image-viewing Paradigm

Eye-tracking technology is found effective in revealing the specific visual preference of Autism Spectrum Disorder (ASD) which can be characterized by high systemizing and low empathizing abilities. Early diagnosis is vital for ASD's subsequent treatment. However, existing eye-tracking-based methods suffer from long diagnostic times and low diagnostic accuracy due to the lack of awareness of gaze preference derived from individual differences. Moreover, there is only one publicly available eye-tracking dataset that employs a simple image free-viewing paradigm to collect the gaze patterns of ASD and typically developed (TD) subjects with an average age of 8 years, thus can not effectively support the early diagnosis for preschool children. To tackle the difficulties, in this paper, we first propose an Uncertainty-inspired ASD Screening Network (UASN) that dynamically estimates the contribution of each stimulus viewed by different subjects, and secondly, we design a contrastive image-viewing paradigm and further collect eye movement data from preschool children to reveal the visual behaviors of ASD children accordingly. Specifically, in UASN, we estimate the uncertainty of each stimulus and use it for more efficient model training and a more simplified personalized diagnosis procedure. Besides, by synthesizing two images with the opposite semantic representations and recruiting ASD and TD subjects aged 2-6, we construct a new CI4ASD dataset, which offers a novel contrastive image-viewing paradigm for better diagnosis of ASD in children. Comprehensive experiments are conducted and results have evidenced the effectiveness of the proposed UASN and eye-tracking paradigm.

Mapping the structure of biomarkers in autism spectrum disorder: a review of the most influential studies

BACKGROUND

Autism spectrum disorder is a distinctive developmental condition which is caused by an interaction between genetic vulnerability and environmental factors. Biomarkers play a crucial role in understanding disease characteristics for diagnosis, prognosis, and treatment. This study employs bibliometric analysis to identify and review the 100 top-cited articles' characteristics, current research hotspots and future directions of autism biomarkers.

METHODS

A comprehensive search of autism biomarkers studies was retrieved from the Web of Science Core Collection database with a combined keyword search strategy. A comprehensive analysis of the top 100 articles was conducted with CiteSpace, VOSviewer, and Excel, including citations, countries, authors, and keywords.

RESULTS

The top 100 cited studies were published between 1988 and 2021, with the United States led in productivity. Core biomarkers such as genetics, children, oxidative stress, and mitochondrial dysfunction are well-established. Potential trends for future research may include brain studies, metabolomics, and associations with other psychiatric disorders.

CONCLUSION

This pioneering bibliometric analysis provides a comprehensive compilation of the 100 most-cited studies on autism, which not only offers a valuable resource for doctors, and researchers but shedding insights into current shortcomings and future endeavors. Future research should prioritize the application of emerging technologies for biomarkers, longitudinal study of biomarkers, and specificity of autism biomarkers to advance the precision of ASD diagnosis and treatment.

Spontaneous theory of mind in autism: are anticipatory gaze and reaction time biases consistent?

Background

Individuals with autism spectrum disorder (ASD) exhibit persistent deficits in social interaction and communication in adulthood. Pioneering studies have suggested that these difficulties arise from a lack of immediate, spontaneous mentalizing (i.e., theory of mind: ToM), specifically, an ability to attribute false beliefs to others, which should be usually acquired during neurotypical development. However, this view has been challenged by recent reports of nonreplications of spontaneous mentalizing, even in neurotypical adults.

Objectives

We aimed to evaluate (1) whether measurements of spontaneous ToM in two representative paradigms, gaze bias in the anticipatory looking (AL) test and reaction time bias in the object detection (OD) test, are correlated in neurotypical adults and (2) whether these two measurements are altered in individuals with ASD.

Methods

We developed a novel hybridized spontaneous false belief test combining the AL and OD paradigms to enable within-subject comparison of different spontaneous ToM measurements.

Results

The results obtained with our hybridized test replicated the earlier positive evidence for spontaneous ToM in both AL and OD paradigms. Our results also revealed a correlation between the participants' spontaneous gaze bias in the AL paradigm and reaction time bias in the OD paradigm, indicating that the participants who had spontaneously anticipated other's false belief driven actions more quickly detected the object. We further found that spontaneous gaze and reaction time biases were altered in individuals with ASD. Finally, we ascertained those inclusions of these biases as diagnostic variables in a regression model improved the accuracy of diagnosing ASD. ASD diagnosis was best predicted by the model when variables obtained from both AL and OD methods were included in the model.

Conclusions/implications

Our hybridized paradigm not only replicated spontaneous gaze bias in early AL studies and reaction time bias in the OD paradigms, but indicated significant correlation between them, suggesting that different implicit tasks tap the same spontaneous ToM in neurotypical adults. Group differences of these indices between ASD and neurotypical adult groups indicated that our task could help diagnose ASD, which is essential for evaluating the social difficulties that individuals with ASD face in adulthood.

Rapid effects of valproic acid on the fetal brain transcriptome: implications for brain development and autism

There is an increased incidence of autism among the children of women who take the anti-epileptic, mood-stabilizing drug, valproic acid (VPA) during pregnancy; moreover, exposure to VPA in utero causes autistic-like symptoms in rodents and non-human primates. Analysis of RNA-seq data obtained from E12.5 fetal mouse brains 3 hours after VPA administration to the pregnant dam revealed that VPA rapidly and significantly increased or decreased the expression of approximately 7,300 genes. No significant sex differences in VPA-induced gene expression were observed. Expression of 399 autism risk genes was significantly altered by VPA as was expression of 258 genes that have been reported to modulate fetal brain development but are not otherwise linked to autism. Expression of genes associated with intracellular signaling pathways, neurogenesis, and excitation-inhibition balance as well as synaptogenesis, neuronal fate determination, axon and dendritic development, neuroinflammation, circadian rhythms, and epigenetic modulation of gene expression was dysregulated by VPA. Notably, at least 40 genes that are known to regulate embryonic neurogenesis were dysregulated by VPA. The goal of this study was to identify mouse genes that are: (a) significantly up- or downregulated by VPA in the fetal brain and (b) associated with autism and/or known to play a role in embryonic neurodevelopmental processes, perturbation of which has the potential to alter brain connectivity and, consequently behavior, in the adult. The genes meeting these criteria provide potential targets for future hypothesis-driven studies to elucidate the proximal causes of errors in brain connectivity underlying neurodevelopmental disorders such as autism.

Evaluation of an interprofessional collaborative practice training module for the management of children with autism spectrum disorder

Background

Protocols instituted for behavioral treatment and skills training programs for the management of autism spectrum disorder (ASD) suffer from lack of collaborative approaches. The tenets of interprofessional collaborative practice (IPCP) focus on preparing a panel of health care professionals (HCPs) from different professions who can work together to enable the common goal of ensuring that children with ASD can participate in society. This study was designed to pilot this approach through an IPCP training module on ASD for care providers from multiple professions.

Methods

An interventional study with pre-post analysis began with formation of the interprofessional (IP) team, who developed an IPCP module, addressing the knowledge and skills needed for the collaborative management of neurodevelopmental issues of children with ASD. This module was delivered through an online training workshop using various teaching learning methods to the participants from seven different health professions after obtaining informed consent. Perceptions of interprofessional collaboration and competencies of IPCP were assessed using standard IP tools and reflective summaries and analyzed through a mixed-methods approach.

Results

A total of 42 HCPs from seven professions, including speech and hearing, occupational therapy, clinical psychology, physiotherapy, pediatrics, nursing, and pedodontics, participated in the study. Pre-post analysis of PINCOM-Q and Dow-IPEC data and thematic analysis revealed a significant difference in the perceptions of interprofessional collaboration and competencies' levels of IPCP.

Conclusion

This study suggests that use of IPCP principles in the training of professionals working with ASD is a promising and feasible option to develop more competent health professionals. The training enhanced the abilities of professionals to work in field of ASD as conveyed by the participants. They also expressed confidence in the knowledge of IP core competencies after the completion of the module.

Catatonia responsive to corticosteroids in a patient with an SCN2A variant

Variants in SCN2A are a known risk factor for developing autism spectrum disorder (ASD). Catatonia is a complex neuropsychiatric syndrome, which occurs at a higher rate in individuals with ASD. Catatonia has also been associated with COVID-19 infection, though the majority of these cases are associated with increased serum inflammatory markers. We present a case of a 15-year-old female with ASD and corticosteroid responsive stuporous catatonia to explore the relationship between SCN2A variants, ASD, COVID-19 exposure, and treatment refractory catatonia. Despite a lack of significantly elevated serum or CSF inflammatory markers, this patient showed significant improvement following initiation of corticosteroid therapy. This case presents a novel approach to the work-up and treatment of catatonia in individuals with SCN2A variants independent of elevated inflammatory markers.

Sex differences in clinically diagnosed psychiatric disorders over the lifespan: a nationwide register-based study in Sweden

Background

Limited studies exist on sex differences in incidence rates of psychiatric disorders across the lifespan. This study aims to analyze sex differences in the incidence rates of clinically diagnosed psychiatric disorders over the lifespan.

Methods

We conducted a nationwide register-based cohort study, including all individuals who were born in Sweden and lived in Sweden between 2003 and 2019, including 4,818,071 females and 4,837,829 males. We calculated sex- and age-specific standardized incidence rates for any and 10 major types of psychiatric disorders. Multivariable-adjusted incidence rate differences (IRDs) for diagnosed psychiatric disorders between females and males were estimated.

Findings

During a follow-up of 119,420,908 person-years, males showed a higher incidence rate of any diagnosed psychiatric disorder than females at age 5-9 (IRD = -8.93; 95% CI: -9.08 to -8.79; per 1000 person-years), whereas females showed a higher rate than males at age 15-19 (IRD = 9.33; 95% CI: 9.12-9.54) and onwards (except age 60-69). Specifically, among females, excess rates were apparent for depressive, anxiety, eating, stress-related and bipolar disorders at age 10-54, whereas among males, excess rates were pronounced for autism and attention deficit hyperactivity disorders before age 14, drug use disorders at age 15-54, and alcohol use disorders in adulthood. For schizophrenia, the male excess at age 15-49 shifted to female excess at age 60-79. The magnitude of IRDs were greater in recent years and individuals with lower socioeconomic status.

Interpretation

Knowledge about the lifespan and socioeconomic variations in the sex differences in rates of diagnosed psychiatric disorders may inform targeted screening/intervention strategies.

Funding

Vetenskapsrådet, FORTE, Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, and Icelandic Research Fund.

Pre-pandemic Executive Function Protects Against Pandemic Anxiety in Children with and Without Autism Spectrum Disorder

The COVID-19 pandemic may have exacerbated depression, anxiety, and executive function (EF) difficulties in children with autism spectrum disorder (ASD). EF skills have been positively associated with mental health outcomes. Here, we probed the psychosocial impacts of pandemic responses in children with and without ASD by relating pre-pandemic EF assessments with anxiety and depression symptoms several months into the pandemic. We found that pre-pandemic inhibition and shifting difficulties, measured by the Behavior Rating Inventory of Executive Function, predicted higher risk of anxiety symptoms. These findings are critical for promoting community recovery and maximizing clinical preparedness to support children at increased risk for adverse psychosocial outcomes.

"It Was Like the Final Piece in the Puzzle for Me": A Qualitative Study on the Experiences of Autistic Women Initially Diagnosed with Borderline Personality Disorder

Background

Women who self-harm and experience complex mental health difficulties are frequently diagnosed with borderline personality disorder (BPD), also known as emotionally unstable personality disorder. Emerging research suggests that self-harm may often be better explained through the lens of autism, and that greater consideration should be given to the clients' motivations for self-harm. How time alone is experienced may also be a differentiating factor. The objective of this study was to investigate individuals' perceptions of a change in diagnosis, experiences of self-harm, and fear of real or imagined abandonment, with the aim of improving the accuracy of initial diagnosis.

Method

Eight women, first diagnosed with BPD, then autism, and with a history of self-harm and multiple admissions to a psychiatric hospital, underwent a semistructured interview, which was recorded, transcribed, and analyzed using thematic analysis.

Results

Three main themes and 11 subthemes were identified. Theme one centers around participants' "Journey through the diagnostic and therapeutic jungle." Theme two is entitled "Self-harm as a developed and systematic way of coping." Theme three is entitled "Alone is not abandoned."

Conclusions

Better awareness and understanding of the subtle differences between BPD and autism are essential, as misdiagnosis leads to misinformed treatments, which are often contraindicative. Recognition of these specific, differentiating traits is most evident with a detailed neurodevelopmental history. This study suggests two potential factors for consideration in a neurodevelopmental history: first, the triggers and functions of self-harm, which often starts early in childhood, and second, limited awareness or absence of feelings of fear of abandonment alongside contentment with spending time alone.

Children With Chronic Health Conditions and Social Needs: Investigating Outcomes to Drive Health System Improvements

Children with chronic health conditions (CHCs) are a high-resource population, and further data are needed to identify associations between CHC diagnoses and social needs to optimize health outcomes. In this cross-sectional study of 19 779 pediatric patients screened for social needs in an urban health system, we used logistic regression to evaluate CHC diagnoses and social need. Our independent variables were CHC diagnoses. Our dependent variable was the presence of social need. In the study, 2247 of 11 071 (20%) children with CHCs identified need. Children with CHCs were more likely to have a social need than children without CHCs (adjusted odds ratio: 1.56; 95% confidence interval: 1.44-1.68). Children with autism/developmental delay were most likely to have a social need. Children with autism/developmental delay, anxiety/depression, and asthma were most likely to report specific social needs. Health systems should screen for these families' needs to improve health outcomes.

Patterns of Brain Maturation in Autism and Their Molecular Associations

Importance

In the neurotypical brain, regions develop in coordinated patterns, providing a fundamental scaffold for brain function and behavior. Whether altered patterns contribute to clinical profiles in neurodevelopmental conditions, including autism, remains unclear.

Objectives

To examine if, in autism, brain regions develop differently in relation to each other and how these differences are associated with molecular/genomic mechanisms and symptomatology.

Design, Setting, and Participants

This study was an analysis of one the largest deep-phenotyped, case-control, longitudinal (2 assessments separated by approximately 12-24 months) structural magnetic resonance imaging and cognitive-behavioral autism datasets (EU-AIMS Longitudinal European Autism Project [LEAP]; study dates, February 2014-November 2017) and an out-of-sample validation in the Brain Development Imaging Study (BrainMapASD) independent cohort. Analyses were performed during the 2022 to 2023 period. This multicenter study included autistic and neurotypical children, adolescents, and adults. Autistic participants were included if they had an existing autism diagnosis (DSM-IV/International Statistical Classification of Diseases and Related Health Problems, Tenth Revision or DSM-5 criteria). Autistic participants with co-occurring psychiatric conditions (except psychosis/bipolar disorder) and those taking regular medications were included.

Exposures

Neuroanatomy of neurotypical and autistic participants.

Main Outcomes and Measures

Intraindividual changes in surface area and cortical thickness over time, analyzed via surface-based morphometrics.

Results

A total of 386 individuals in the LEAP cohort (6-31 years at first visit; 214 autistic individuals, mean [SD] age, 17.3 [5.4] years; 154 male [72.0%] and 172 neurotypical individuals, mean [SD] age, 16.35 [5.7] years; 108 male [62.8%]) and 146 individuals in the BrainMapASD cohort (11-18 years at first visit; 49 autistic individuals, mean [SD] age, 14.31 [2.4] years; 42 male [85.7%] and 97 neurotypical individuals, mean [SD] age, 14.10 [2.5] years; 58 male [59.8%]). Maturational between-group differences in cortical thickness and surface area were established that were mostly driven by sensorimotor regions (eg, across features, absolute loadings for early visual cortex ranged from 0.07 to 0.11, whereas absolute loadings for dorsolateral prefrontal cortex ranged from 0.005 to 0.06). Neurodevelopmental differences were transcriptomically enriched for genes expressed in several cell types and during various neurodevelopmental stages, and autism candidate genes (eg, downregulated genes in autism, including those regulating synaptic transmission; enrichment odds ratio =3.7; P =2.6 × -10). A more neurotypical, less autismlike maturational profile was associated with fewer social difficulties and more typical sensory processing (false discovery rate P <.05; Pearson r ≥0.17). Results were replicated in the independently collected BrainMapASD cohort.

Conclusions and Relevance

Results of this case-control study suggest that the coordinated development of brain regions was altered in autism, involved a complex interplay of temporally sensitive molecular mechanisms, and may be associated with both lower-order (eg, sensory) and higher-order (eg, social) clinical features of autism. Thus, examining maturational patterns may provide an analytic framework to study the neurobiological origins of clinical profiles in neurodevelopmental/mental health conditions.

GABA and glutamate measurements in temporal cortex of autistic children

Autism spectrum disorder (ASD) is a neurodevelopmental disorder and presents with challenges in social communication. A hypothesized underlying contributing mechanism is the imbalance in excitation and inhibition (E/I), partly influenced by the levels of excitatory neurotransmitter glutamate (Glu) and inhibitory neurotransmitter γ-aminobutyric acid (GABA) in the brain. Although many have reported the levels of GABA and Glu in the brain, only a few reports address the temporal cortex and then only with a small sample of autistic children, and often only in one hemisphere. We used a macromolecular suppressed edited-magnetic resonance spectroscopy (MRS) sequence to study GABA and Glu (as potential key players influencing E/I) in a large sample of children with ASD in the right and left temporal cortices of children with (N = 56) and without (N = 30) ASD (7-18 years). As a group, children with ASD exhibited no differences in the left hemisphere (GABA and Glu Cohen's |d|: 0.24 and 0.03), but the right hemisphere showed higher GABA and lower Glu concentrations (GABA and Glu Cohen's |d|: 0.53 and 0.65) compared to neurotypicals. Furthermore, a negative association was found between the right hemisphere Glu levels of the ASD group and a clinical assessment tool (r = -0.361, p = 0.022), reflecting autism trait severity (social responsiveness scale). In conclusion, we highlight the chemical abnormalities in children with ASD through a cross-sectional measurement. Longitudinal studies are warranted to determine whether these chemical levels persist or resolve over development.

Parental experiences and perspectives of healthcare providers' genetic testing recommendations for their children diagnosed with autism spectrum disorder in the United States

Although genetic testing is recommended for all children diagnosed with autism spectrum disorder (ASD) in the United States, it remains unclear how many parents have received and followed these recommendations. This study aimed to assess parental experiences and perspectives of healthcare providers' genetic testing recommendations. A total of 1043 parents of children with ASD from Simons Foundation Powering Autism Research for Knowledge completed an online survey. Only about one-third of the parents (34.2%) reported that their children's providers had recommended genetic testing. Factors associated with whether parents received these recommendations included the type of healthcare providers diagnosing ASD, parents' knowledge of genetic testing, the age of their children's diagnosis, and the presence of certain co-occurring medical conditions in their children. Our study also revealed that most parents (76.9%) who received recommendations had pursued genetic testing for their children. Adherence to the recommendations was associated with the characteristics of the parents (i.e., age and employment status) and children (i.e., gender), and their trust in the information from providers. The findings highlight the critical role of healthcare providers in facilitating genetic testing among families of children with ASD. Healthcare providers are recommended to increase their competencies and practice in providing genetic testing recommendations for ASD, assist parents in navigating testing challenges, and support parents through the testing process.

Equine-assisted services for motor outcomes of autistic children: A systematic review

LAY ABSTRACT

Equine-assisted services use various aspects of horses, like their movement, warmth, and size, to enhance individuals' overall well-being. Many studies have underscored the positive impact of equine-assisted services on autistic children, affecting areas such as social interaction, communication, engagement, stereotypical behaviors, and motor functions. Given the growing recognition of motor functions as clinical specifiers in autism, it is imperative to specifically investigate how equine-assisted services influence these outcomes. To address this, we conducted a systematic review to synthesize existing literature on the effects of equine-assisted services on motor outcomes of autistic children. Our review encompassed study characteristics, features of equine-assisted service interventions, and major motor outcomes. We also evaluated the methodological quality of the equine-assisted service studies to offer insights for future research directions. Through thorough database searches and the use of the standardized procedure of conducting a systematic review (The Preferred Reporting Items for Systematic Reviews and Meta-analyses), 12 research studies were identified and included. These studies reported the effects of various equine-assisted service types (such as therapy, horsemanship, or learning) on motor outcomes of autistic children. Significant enhancements in coordination, strength, balance, posture, and overall motor skills indicate the effectiveness of equine-assisted services in improving motor outcomes of autistic children. Building on these findings, we provide recommendations for future research endeavors aimed at enhancing the reliability and validity of using equine-assisted services to improve motor outcomes of autistic children. This work contributes to a deeper understanding of how equine-assisted services can benefit this population and guides the development of more effective equine-assisted service interventions.

Taprenepag restores maternal-fetal interface homeostasis for the treatment of neurodevelopmental disorders

BACKGROUND AND PURPOSE

Neurodevelopmental disorders (NDDs) are characterized by abnormalities in brain development and neurobehaviors, including autism. The maternal-fetal interface (MFI) is a highly specialized tissue through which maternal factors affect fetal brain development. However, limited research exists on restoring and maintaining MFI homeostasis and its potential impact on NDDs. This study explores the role of placental indoleamine 2,3-dioxygenase (IDO-1) in MFI homeostasis and fetal brain development.

EXPERIMENTAL APPROACH

The maternal-fetal barrier was disrupted by sodium valproate (VPA) in pregnant mice, whose offspring show typical autism-like behaviors. Ultrastructural analysis and flow cytometric analysis were conducted to observe the morphological and immune system changes. Behavioral tests and immunofluorescence staining was used to investigate the ability and mechanism of taprenepag to alleviate the abnormal behaviors of VPA-exposed offspring and normalize the development of serotonergic neurons.

KEY RESULTS

In VPA-exposed pregnant mice, the downregulation of IDO-1 led to maternal immune overactivation and disruption of maternal-fetal barrier, resulting in excessive 5-HT synthesis in the placenta. This process disrupted the development of the serotonergic neuronal system in the offspring, resulting in impaired development of serotonergic neurons, thalamocortical axons, and NDDs in the progeny. However, a single injection of taprenepag at E13.5 ultimately upregulated placental IDO-1 through amplifying the positive feedback loop COX-2/PGE2/PTGER-2/IDO-1 and abolished these alterations.

CONCLUSION

Taprenepag improved autism-like behaviors in the offspring of VPA-exposed mice by addressing placental IDO-1 downregulation. This study highlights the potential of targeting IDO-1 to mitigate MFI disruption and NDD development.

Dysregulated metabolic pathways associated with air pollution exposure and the risk of autism: Evidence from epidemiological studies

Autism spectrum disorder (ASD) is a developmental disorder with symptoms that range from social and communication impairments to restricted interests and repetitive behavior and is the 4th most disabling condition for children aged 5-14. Risk factors of ASD are not fully understood. Environmental risk factors are believed to play a significant role in the ASD epidemic. Research focusing on air pollution exposure as an early-life risk factor of autism is growing, with numerous studies finding associations of traffic and industrial emissions with an increased risk of ASD. One of the possible mechanisms linking autism and air pollution exposure is metabolic dysfunction. However, there were no consensus about the key metabolic pathways and corresponding metabolite signatures in mothers and children that are altered by air pollution exposure and cause the ASD. Therefore, we performed a review of published papers examining the metabolomic signatures and metabolic pathways that are associated with either air pollution exposure or ASD risk in human studies. In conclusion, we found that dysregulated lipid, fatty acid, amino acid, neurotransmitter, and microbiome metabolisms are associated with both short-term and long-term air pollution exposure and the risk of ASD. These dysregulated metabolisms may provide insights into ASD etiology related to air pollution exposure, particularly during the perinatal period in which neurodevelopment is highly susceptible to damage from oxidative stress and inflammation.

Association between prenatal air pollutant exposure and autism spectrum disorders in young children: A matched case-control study in Canada

The direction and magnitude of association between maternal exposure to ambient air pollutants across gestational windows and offspring risk of autism spectrum disorders (ASD) remains unclear. We sought to evaluate the time-varying effects of prenatal air pollutant exposure on ASD. We conducted a matched case-control study of singleton term children born in Ontario, Canada from 1-Apr-2012 to 31-Dec-2016. Provincial birth registry data were linked with applied behavioural analysis services and ambient air pollutant datasets to ascertain prenatal exposure to nitrogen dioxide (NO2), ground-level ozone (O3), fine particulate matter (PM2.5), and ASD diagnoses. Covariate balance between cases and controls was established using coarsened exact matching. Conditional logistic regression was used to assess the association between prenatal air pollutant exposure and ASD. Distributed lag non-linear models (DLNM) were used to examine the effects of single-pollutant exposure by prenatal week. Sensitivity analyses were conducted to assess the impact of exposure period on the observed findings. The final sample included 1589 ASD cases and 7563 controls. Compared to controls, cases were more likely to be born to mothers living in urban areas, delivered by Caesarean section, and assigned male sex at birth. NO2 was a consistent and significant contributor to ASD risk after accounting for co-exposure to O3, PM2.5 and covariates. The odds ratio per interquartile range increase was 2.1 (95%CI 1.8-2.3) pre-conception, 2.2 (2.0-2.5) for the 1st trimester, 2.2 (1.9-2.5) for the 2nd trimester, and 2.1 (1.9-2.4) for the 3rd trimester. In contrast, findings for O3 and PM2.5 with ASD were inconsistent. Findings from DLNM and sensitivity analyses were similar. Exposure to NO2 before and during pregnancy was significantly associated with ASD in offspring. The relationship between prenatal O3 and PM2.5 exposure and ASD remains unclear. Further investigation into the combined effects of multi-pollutant exposure on child neurodevelopment is warranted.

Cognitive, adaptive and daily life functioning in adults with 22q11.2 deletion syndrome

BACKGROUND

22q11.2 deletion syndrome (22q11.2DS) is associated with cognitive impairments and an increased risk of psychopathology. Most of the research has been conducted in children and adolescents, although the majority of affected individuals live well into adulthood. Hence, limited data are available on functional outcomes in adults.

AIMS

To provide more insight in cognitive and adaptive abilities, and daily life functioning (marital status, living situation and work situation) in adults with 22q11.2DS.

METHOD

This retrospective study included 250 Dutch-speaking adults (16-69 years) with 22q11.2DS from three sites in The Netherlands and Belgium. Data on full-scale IQ (FSIQ) scores (assessed with the Wechsler Adult Intelligence Scale), adaptive functioning (assessed with the Vineland Adaptive Behavior Scale II), and functional outcomes including marital status, living and work situation were systematically collected from clinical files. In addition, we examined predictors of adaptive functioning.

RESULTS

The majority of individuals in our adult sample demonstrated a low level of adaptive functioning (65%). In contrast to previous findings in children and adolescents, the majority functioned at an intellectual disability level (56%). Male sex, lower FSIQ and autism spectrum disorder were predictors of lower adaptive functioning (P = 0.016, P < 0.001 and P = 0.16, respectively).

CONCLUSIONS

These results suggest that low levels of cognitive and adaptive functioning are common in adults with 22q11.2DS. Future longitudinal and multicentre studies including older patients (>40 years) are needed to further investigate cognitive and adaptive trajectories and their interactions with physical and psychiatric comorbidities.

Intercontinental insights into autism spectrum disorder: a synthesis of environmental influences and DNA methylation

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by a broad range of symptoms. The etiology of ASD is thought to involve complex gene-environment interactions, which are crucial to understanding its various causes and symptoms. DNA methylation is an epigenetic mechanism that potentially links genetic predispositions to environmental factors in the development of ASD. This review provides a global perspective on ASD, focusing on how DNA methylation studies may reveal gene-environment interactions characteristic of specific geographical regions. It delves into the role of DNA methylation in influencing the causes and prevalence of ASD in regions where environmental influences vary significantly. We also address potential explanations for the high ASD prevalence in North America, considering lifestyle factors, environmental toxins, and diagnostic considerations. Asian and European studies offer insights into endocrine-disrupting compounds, persistent organic pollutants, maternal smoking, and their associations with DNA methylation alterations in ASD. In areas with limited data on DNA methylation and ASD, such as Africa, Oceania, and South America, we discuss prevalent environmental factors based on epidemiological studies. Additionally, the review integrates global and country-specific prevalence data from various studies, providing a comprehensive picture of the variables influencing ASD diagnoses over region and year of assessment. This prevalence data, coupled with regional environmental variables and DNA methylation studies, provides a perspective on the complexities of ASD research. Integrating global prevalence data, we underscore the need for a comprehensive global understanding of ASD's complex etiology. Expanded research into epigenetic mechanisms of ASD is needed, particularly in underrepresented populations and locations, to enhance biomarker development for diagnosis and intervention strategies for ASD that reflect the varied environmental and genetic landscapes worldwide.

Regional differences in autism and intellectual disability risk associated with cesarean section delivery

Prior epidemiological studies investigating the association between delivery mode (i.e., vaginal birth and cesarean section [C-section]) and autism spectrum disorder (ASD) and intellectual disability (ID) risk have reported mixed findings. This study examined ASD and ID risks associated with primary and repeat C-section within diverse US regions. During even years 2000-2016, 8-years-olds were identified with ASD and/or ID and matched to birth records [ASD only (N = 8566, 83.6% male), ASD + ID (N = 3445, 79.5% male), ID only (N = 6158, 60.8% male)] using the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network methodology. The comparison birth cohort (N = 1,456,914, 51.1% male) comprised all births recorded in the National Center for Health Statistics corresponding to birth years and counties in which surveillance occurred. C-section rates in the birth cohort demonstrated significant regional variation with lowest rates in the West. Overall models demonstrate increased odds of disability associated with primary and repeat C-section. Adjusted models, stratified by region, identified significant variability in disability likelihood associated with repeat C-section: increased odds occurred for all case groups in the Southeast, for ASD only and ID only in the Mid-Atlantic, and no case groups in the West. Regional variability in disability risk associated with repeat C-section coincides with differences in birth cohorts' C-section rates. This suggests increased likelihood of disability is not incurred by the procedure itself, but rather C-section serves as a proxy for exposures with regional variability that influence fetal development and C-section rates.

Intestinal Symptoms Among Children aged 2-7 Years with Autism Spectrum Disorder in 13 Cities of China

BACKGROUND

Autism spectrum disorder (ASD) is a multifactorial, pervasive, neurodevelopmental disorder, of which intestinal symptoms collectively represent one of the most common comorbidities.

METHODS

In this study, 1,222 children with ASD and 1,206 typically developing (TD) children aged 2-7 years were enrolled from 13 cities in China. Physical measurement and basic information questionnaires were conducted in ASD and TD children. The Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), and Autism Behavior Checklist (ABC) were used to evaluate the clinical symptoms of children with ASD. The six-item Gastrointestinal Severity Index (6-GSI) was used to evaluate the prevalence of intestinal symptoms in two groups.

RESULTS

The detection rates of constipation, stool odor, and total intestinal symptoms in ASD children were significantly higher than those in TD children (40.098% vs. 25.622%, 17.021% vs. 9.287%, and 53.601% vs. 41.294%, respectively). Autistic children presenting with intestinal comorbidity had significantly higher scores on the ABC, SRS, CARS, and multiple subscales than autistic children without intestinal symptoms, suggesting that intestinal comorbidity may exacerbates the core symptoms of ASD children.

CONCLUSION

Intestinal dysfunction was significantly more common in autistic than in TD children. This dysfunction may aggravate the core symptoms of children with ASD.

The diagnostic yield of genetic and metabolic investigations in syndromic and nonsyndromic patients with autism spectrum disorder, global developmental delay, or intellectual disability from a dedicated neurodevelopmental disorders genetics clinic

First-tier genetic investigations for patients with neurodevelopmental disorders (NDDs) may include chromosomal microarray, Fragile X testing, and screening for inherited metabolic diseases, but most remain undiagnosed upon completion of testing. Here, we report the diagnostic yields of genetic testing for 537 patients with at least one of autism spectrum disorder, global developmental delay, and/or intellectual disability. Patients were assessed in a single neurodevelopmental genetics clinic, and each underwent a standardized history and physical examination. Each patient was characterized as syndromic or nonsyndromic based on clinical features. Our results demonstrate that multigene sequencing (with an NDD gene panel or exome) had a higher diagnostic yield (8%; 95% confidence interval [CI]: 5%, 13%) than chromosomal microarray and Fragile X testing combined (4%; 95% CI: 3%, 7%). Biochemical screening for inherited metabolic diseases had a diagnostic yield of zero. The diagnostic yield of genetic testing was significantly higher for syndromic patients than for nonsyndromic patients (odds ratio [OR] 3.09; 95% CI: 1.46, 6.83) and higher for female patients than for male (OR 3.21; 95% CI: 1.52, 6.82). These results add to the growing evidence supporting a comprehensive genetic evaluation that includes both copy number analysis and sequencing of known NDD genes for patients with NDDs.

Investigation of RhoA, ROCK1, and ROCK2 Gene Expressions in Autism Spectrum Disorders

OBJECTIVE

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that emerges in early childhood and is characterized by difficulties in social communication, repetitive behaviors, and restricted interests. The Ras homolog (Rho)/Rho-kinase signaling pathway plays a critical role in maintaining synaptic structure and function, as it regulates the actin cytoskeleton. This study aims to investigate the expression of the Ras homolog (Rho) family member A (RhoA), Rho-kinase 1 (ROCK1), and Rho-kinase 2 (ROCK2) genes within this pathway in relation to ASD.

METHODS

The study included 82 individuals diagnosed with ASD from the Adıyaman Training and Research Hospital's Department of Child and Adolescent Psychiatry and 82 healthy individuals without a family history of ASD, matched for gender and age. RNA isolation and complementary DNA (cDNA) extraction for RhoA, ROCK1, and ROCK2 genes were performed from blood samples of the patient and control groups. The RhoA, ROCK1, and ROCK2 gene expression levels were analyzed by real-time polymerase chain reaction (PCR) using the comparative CT (ΔΔCT) method.

RESULTS

Of the 82 individuals in the ASD group, 54 (65.9%) were male, and 28 (34.1%) were female, with a mean age of 7.74 ± 4.35 years. ASD is more common in males (p < 0.001). RhoA gene expression level is lower in patients with ASD (p < 0.001).

CONCLUSION

The Rho/Rho-kinase signaling pathway genes, including RhoA, ROCK1, and ROCK2, play roles in the neurodevelopmental processes. The lower expression level of RhoA in the ASD group may suggest that these genes could serve as potential biomarkers for the disorder. Further research is needed to explore these genetic markers' roles and their potential as therapeutic targets in ASD treatment.

Neurodevelopmental changes in Drosophila melanogaster are restored by treatment with lutein-loaded nanoparticles: Positive modulation of neurochemical and behavioral parameters

Neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are characterized by persistent changes in communication and social interaction, as well as restricted and stereotyped patterns of behavior. The complex etiology of these disorders possibly combines the effects of multiple genes and environmental factors. Hence, exposure to insecticides such as imidacloprid (IMI) has been used to replicate the changes observed in these disorders. Lutein is known for its anti-inflammatory and antioxidant properties and is associated with neuroprotective effects. Therefore, the aim of this study was to evaluate the protective effect of lutein-loaded nanoparticles, along with their mechanisms of action, on Drosophila melanogaster offspring exposed to IMI-induced damage. To simulate the neurodevelopmental disorder model, flies were exposed to a diet containing IMI for 7 days. Posteriorly, their offspring were exposed to a diet containing lutein-loaded nanoparticles for a period of 24 h, and male and female flies were subjected to behavioral and biochemical evaluations. Treatment with lutein-loaded nanoparticles reversed the parameters of hyperactivity, aggressiveness, social interaction, repetitive movements, and anxiety in the offspring of flies exposed to IMI. It also protected markers of oxidative stress and cell viability, in addition to preventing the reduction of Nrf2 and Shank3 immunoreactivity. These results demonstrate that the damage induced by exposure to IMI was restored through treatment with lutein-loaded nanoparticles, elucidating lutein's mechanisms of action as a therapeutic agent, which, after further studies, can become a co-adjuvant in the treatment of neurodevelopmental disorders, such as ASD and ADHD.

Pairing tones with vagus nerve stimulation improves brain stem responses to speech in the valproic acid model of autism

Receptive language deficits and aberrant auditory processing are often observed in individuals with autism spectrum disorders (ASD). Symptoms associated with ASD are observed in rodents prenatally exposed to valproic acid (VPA), including deficits in speech sound discrimination ability. These perceptual difficulties are accompanied by changes in neural activity patterns. In both cortical and subcortical levels of the auditory pathway, VPA-exposed rats have impaired responses to speech sounds. Developing a method to improve these neural deficits throughout the auditory pathway is necessary. The purpose of this study was to investigate the ability of vagus nerve stimulation (VNS) paired with sounds to restore degraded inferior colliculus (IC) responses in VPA-exposed rats. VNS paired with the speech sound "dad" was presented to a group of VPA-exposed rats 300 times per day for 20 days. Another group of VPA-exposed rats were presented with VNS paired with multiple tone frequencies for 20 days. The IC responses were recorded from 19 saline-exposed control rats and 18 VPA-exposed with no VNS, 8 VNS-speech paired VPA-exposed, and 7 VNS-tone paired VPA-exposed female and male rats. Pairing VNS with tones increased the IC response strength to speech sounds by 44% compared to VPA-exposed rats alone. Contrarily, VNS-speech pairing significantly decreased the IC response to speech compared with VPA-exposed rats by 5%. The present research indicates that pairing VNS with tones improved sound processing in rats exposed to VPA and suggests that auditory processing can be improved through targeted plasticity.NEW & NOTEWORTHY Pairing vagus nerve stimulation (VNS) with sounds has improved auditory processing in the auditory cortex of normal-hearing rats and autism models of rats. This study tests the ability of VNS-sound pairing to restore auditory processing in the inferior colliculus (IC) of valproic acid (VPA)-exposed rats. Pairing VNS with tones significantly reversed the degraded sound processing in the IC in VPA-exposed rats. The findings provide evidence that auditory processing in autism rat models can be improved through VNS.

Measurement invariance of the PROMIS emotional distress and subjective well-being domains among autistic and General Population adolescents

PURPOSE

Quality of life (QoL) is identified as a clinical and research priority by the autistic community. Researchers have the responsibility to ensure that instruments used to measure QoL do so reliably and accurately among autistic participants.

METHODS

Our study evaluated measurement invariance of Emotional Distress (Depression, Anxiety, Anger, Psychological Stress) and Subjective Well-Being (Life Satisfaction, Positive Affect, and Meaning & Purpose) scales of the Patient-Reported Outcomes Measurement Information System (PROMIS) among groups of autistic (N=140, n per scale=132-140) and general population (N=1,224, n per scale=406-411) teenagers (14-17 years). These scales were included in the PROMIS Autism Battery-Lifespan, which uses PROMIS scales to measure QoL domains most relevant for autistic people.

RESULTS

Multi-group confirmatory factor analyses using permutation tests demonstrated that Depression and Positive Affect scales exhibited scalar invariance between groups, indicating that scores can be meaningfully compared across autistic and general population teens. Anger and Psychological Stress scales demonstrated metric invariance between groups, indicating that these scales measure the same latent trait in both groups, but group comparisons are not supported.

CONCLUSION

We provide guidance as to how these scales can be used in psychometrically supported ways to capture constructs relevant for understanding QoL among autistic teens.

Psychometric Properties of the Chinese Version of the Psy-Flex Among Parents of Children with Autism Spectrum Disorder

This research aimed to translate the original English version of the Psy-Flex, a scale of psychological flexibility, into Chinese and to test its psychometric properties among parents of children with autism spectrum disorder (ASD). Two phases were conducted: (1) translation from English to Chinese (Psy-Flex-C), followed by a semantic equivalence evaluation between two versions, a pre-test, and an evaluation of the Psy-Flex-C in terms of face validity with 20 parents of autistic children, and content validity of the Psy-Flex-C with eight experts. (2) A cross-sectional study with 248 parents of autistic children was conducted for validation, and a subgroup of 50 participants was randomly selected to assess the test-retest reliability at a 2-week interval. The Psy-Flex-C showed satisfactory semantic equivalence with the original version and demonstrated adequate internal consistency (Cronbach's α = 0.84) and test-retest stability (weighted kappa statistic = 0.88). Concurrent validity was supported by a moderate correlation between the Psy-Flex-C and the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (Pearson's r = 0.54, p < 0.01). The Psy-Flex-C showed a significant mean score difference between parents with high and low parenting stress (t = 5.43, p < 0.001). Similar to the original scale, confirmatory factor analysis showed the best fitting one-factor structure of the Psy-Flex-C (X2/df = 1.62, p = 0.13, RMSEA = 0.05, GFI = 0.99, CFI = 0.99, TLI = 0.98, SRMR = 0.023). The Psy-Flex-C can be a reliable and valid instrument to self-report psychological flexibility in parents of children with ASD. Future research is recommended to test the Psy-Flex-C using diverse samples from different cultures and contexts to enhance its generalizability.

Visual Working Memory in Adolescents with Autism Spectrum Disorder

Previous research suggests that individuals with autism spectrum disorder (ASD) may experience working memory (WM) problems, but the nature of the underlying disruption remains unknown. A recent study (Bodner et al. 2019) found that young adults with ASD experienced intact WM capacity but disruptions in their ability to efficiently filter and allocate attention. The goal of the present study was to extend this work and evaluate potential disruptions in WM capacity and attentional allocation ability in adolescents with ASD. A sample of 38 adolescents with ASD and 39 adolescents without ASD aged 11-15 years completed a computerized WM task. In brief, participants were shown visual arrays consisting of four or six colored stimuli (circles and squares). After a short delay, memory for one of the stimuli was probed. Importantly, participants were informed beforehand that one of the shapes (e.g., circles) was more likely to be probed compared to the other shape (e.g., squares) - thus making it strategically beneficial to focus primarily on the high frequency shapes. The ASD group demonstrated overall lower WM capacity compared to the non-ASD group. However, no group differences were seen in attentional allocation. There was also no evidence of sex-related differences in WM performance in adolescents with ASD. Taken together with previous findings, the current results suggest that adolescents with ASD show disruptions in WM capacity that are resolved by adulthood. Future longitudinal research is needed to further disentangle the component processes of WM and the developmental trajectories of these components.

Unraveling the relative abundance of psychobiotic bacteria in children with Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by social deficits. Accumulated evidence has shown a link between alterations in the composition of gut microbiota and both neurobehavioural and gastrointestinal symptoms in children with ASD which are related to the genera Lactobacillus and Bifidobacterium. These genera have been recently categorized as "psychobiotics". Moreover, this study aimed to compare the relative abundance of psychobiotics (L. plantarum, L. reuteri, and B. longum) to the total gut microbiome in typically developing (TD) children and those with ASD in order to correlate the distribution of psychobiotic with the severity and sensory impairments in autism. The ASD children were assessed using the Childhood Autism Rating Scale (CARS), while sensory impairments were evaluated using the Short Sensory Profile (SSP). Furthermore, the gut microbiome was analyzed using the quantitative real-time PCR. The study revealed a statistically significant increase in the relative abundance of L. reuteri and L. plantarum in the TD group in comparison to ASD children. Regarding the SSP total score of ASD children, a statistically significant negative correlation was found between both Lactobacillus and L. plantarum with the under-responsive subscale. For the Autism Treatment Evaluation Checklist (ATEC) score, B. longum and Lactobacillus showed a significant positive correlation with Health/Physical/Behaviour.

The role of multiple birth and birth complications in the association between assisted reproductive technology conception and autism diagnosis

In recent decades, the use of assisted reproductive technology (ART) has increased rapidly. To assess the relationship between ART and autism diagnosis, we linked California birth records from 2000 through 2016 with contemporaneous records from the National ART Surveillance System (NASS) and autism caseload records from California's Department of Developmental Services from 2000 through November 2019. All 95 149 birth records that were successfully linked to a NASS record, indicating an ART birth, were matched 1:1 using propensity scores to non-ART births. We calculated the hazard risk ratio for autism diagnosis and the proportions of the relationship between ART conception and autism diagnosis mediated by multiple birth pregnancy and related birth complications. The hazard risk ratio for autism diagnosis following ART compared with non-ART conception is 1.26 (95% CI, 1.17-1.35). Multiple birth, preterm birth, and cesarean delivery jointly mediate 77.9% of the relationship between ART conception and autism diagnosis. Thus, increased use of single embryo transfer in the United States to reduce multiple births and related birth complications may be a strategy to address the risk of autism diagnosis among ART-conceived children.

Occupational Therapy Outcome Measures in Preschool Children With Autism Spectrum Disorders: A Scoping Review

With the rising prevalence of autism spectrum disorder (ASD), early assessment of preschool children is vital for occupational therapists. This scoping review aimed to provide detailed information about outcome measures used in occupational therapy interventions in preschool children with ASD and map the focus of the outcome measures based on the International Classification of Functioning, Disability, and Health (ICF) components. A thorough search from 2000 to 2022 was conducted that employed ICF linking rules to categorize the outcome measures. Seventy-four outcome measures were identified. They predominantly targeted body function and activity/participation, with less emphasis on environmental factors, and none assessed body structure. The most common measures were Vineland Adaptive Behavior Scale (VABS-2), Canadian Occupational Performance Measure (COPM), and Parenting Stress Index-Short Form (PSI-SF). This study offers a diverse array of outcome measures and underscores the potential of the ICF framework in enhancing evaluations, particularly concerning broader environmental components as one of the primary facilitating/hindering factors in the participation of children with ASD.

Maternal Prenatal Cannabis Use and Child Autism Spectrum Disorder

IMPORTANCE

Despite an increase in maternal prenatal cannabis use and associations with adverse neonatal outcomes, research on child neurodevelopmental outcomes is limited.

OBJECTIVE

To evaluate the association between maternal cannabis use in early pregnancy and child autism spectrum disorder (ASD).

DESIGN, SETTING, and PARTICIPANTS

This population-based retrospective birth cohort study included children born between 2011 and 2019 to pregnant Kaiser Permanente Northern California members screened for prenatal cannabis use during pregnancy. Statistical analysis was conducted February 2023 to March 2024.

EXPOSURES

Maternal prenatal cannabis use was assessed at entrance to prenatal care (approximately 8- to 10-weeks' gestation) via self-report and/or positive urine toxicology test. Use frequency was assessed.

Main Outcomes and Measures

Child ASD was defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes ascertained from the electronic health record. Associations between maternal prenatal cannabis use and child ASD were modeled using Cox proportional hazards regression adjusted for maternal sociodemographic, other substance use and disorders, prenatal care initiation, comorbidities, and clustering among maternal siblings.

RESULTS

The study cohort included 178 948 singleton pregnancies among 146 296 unique pregnant individuals, including 48 880 (27.3%) Asian or Pacific Islander, 42 799 (23.9%) Hispanic, 9742 (5.4%) non-Hispanic Black, and 70 733 (39.5%) non-Hispanic White pregnancies. The median (IQR) maternal age at pregnancy onset was 31 (6) years; 8486 (4.7%) screened positive for cannabis use, 7054 (3.9%) via urine toxicology testing and 3662 (2.0%) by self-report. In the total study population, the frequency of self-reported use was monthly or less for 2003 pregnancies (1.1%), weekly for 918 pregnancies (0.5%), daily for 741 pregnancies (0.4%), and unknown for 4824 pregnancies (2.7%). ASD was diagnosed in 3.6% of children. After adjustment for maternal characteristics, maternal prenatal cannabis use was not associated with child ASD (hazard ratio [HR], 1.05; 95% CI, 0.84-1.32). When self-reported frequency of use was assessed, no statistically significant associations were observed after confounder adjustment. No sex-specific associations were documented (males: HR, 1.01; 95% CI, 0.77-1.32; and females: HR, 1.19; 95% CI, 0.77-1.85).

CONCLUSIONS and Relevance

In this cohort study, maternal cannabis use assessed in early pregnancy was not associated with child ASD. Additional studies are needed to evaluate different patterns of use throughout pregnancy. Given the known adverse neonatal health effects of maternal prenatal cannabis use, clinicians should follow national guidelines and advise against use.

Relative Efficacy of Self-directed and Therapist-assisted Telehealth Models of a Parent-mediated Intervention for Autism: Examining Effects on Parent Intervention Fidelity, Well-being, and Program Engagement

PURPOSE

Although there is growing interest in telehealth to deliver parent-mediated intervention for autistic children, empirical evaluations are limited, and little is known regarding the relative benefits of self-directed and therapist-assisted telehealth interventions. This study examined the effect of self-directed and therapist-assisted ImPACT Online on parent learning and well-being, moderators of treatment, and predictors of program engagement.

METHOD

Sixty-four young autistic children and their primary caregiver participated. Children were matched on age and developmental quotient and randomly assigned to a therapist-assisted, self-directed, or resource support control group. Participants were assessed at intake, after 6 months (post), and at a 3-month follow-up.

RESULTS

There was a significant treatment effect for parent learning for the therapist-assisted but not self-directed program; when analysis was limited to parents who completed the program, treatment effects were observed for both groups. There were no treatment effects for parent self-efficacy or parenting stress; however, there was an effect on parents' perception of their child's positive impact. Parenting stress did not moderate the effect of group on parent outcomes. Parent age, program satisfaction, and therapist assistance were all significant predictors of parent program engagement.

CONCLUSION

This study supports the efficacy of therapist-assisted telehealth parent-mediated intervention for teaching parents intervention strategies to support their child's social communication and improving their perceptions of their child's positive impact, and suggests that self-directed programs may be beneficial for parents who fully engage with the program.

Autism Prevalence and the Intersectionality of Assigned Sex at Birth, Race, and Ethnicity on Age of Diagnosis

PURPOSE

An official autism diagnosis is required to access timely intervention and is associated with better long-term wellbeing and mental health. Certain demographic characteristics, such as being female or a racially or ethnically minoritized youth, have been associated with significant diagnostic lag. However, it remains unclear how assigned sex, race, and ethnicity interact with each other in predicting the prevalence and age of autism diagnosis.

METHODS

To examine the interactions between assigned sex, race, and ethnicity, we used data from the National Survey of Children's Health (NSCH; 2016 > 2021).

RESULTS

One in 38 children had an autism diagnosis and 3.8 males were diagnosed per 1 female. Hierarchical linear regressions yielded diagnostic delays in some females, particularly those who were non-Hispanic white, Black, and Asian. Ethnic and racial minority children had significantly earlier diagnoses than white and non-Hispanic children when not accounting for sex.

CONCLUSION

This study demonstrates slight increases in reported autism prevalence, a diagnostic lag in some autistic females that was strongly associated with ethnicity, and earlier diagnoses in racial and ethnic minority youth, a finding that may be explained by factors associated with phenotypic differences. This study has important implications for the diagnosis of minority autistic youth, particularly females and females who are non-Hispanic, who may experience a greater propensity for diagnostic delays.