Autism severity and its relationship to disability

A cross-sectional study of public knowledge and stigma towards autism spectrum disorder in Lebanon

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that requires public understanding to foster acceptance and reduce stigma. This study aimed to evaluate ASD knowledge and stigma among the Lebanese population and the factors influencing them. An online cross-sectional study was conducted between February and July 2022 among Lebanese adults. Participants completed a self-administered structured questionnaire that comprised a sociodemographic section and two validated scales serving the study's purpose (The Autism Stigma and Knowledge Questionnaire (ASK-Q) and The Autism Social Distance Scale). A total of 949 participants filled out the questionnaire. More than half of them had adequate knowledge of autism diagnosis and symptoms (57.9%), while only 6.6% and 9.6% showed adequate knowledge of its etiology and treatment, respectively. Additionally, 83.4% of the participants did not endorse stigma toward autism. The multivariate analysis taking the knowledge total score and subscales as the dependent variables showed that declaring prior knowledge of autism was significantly associated with better knowledge (Beta = 1.38) and higher stigma (Beta = 0.26). Furthermore, a higher knowledge score (Beta = - 0.06) and a declared prior knowledge of autism (Beta = - 0.62) were significantly associated with lower autism social distance. These findings highlight the need for targeted awareness campaigns to address knowledge gaps and further reduce stigma in Lebanon.

Trajectories of autism symptom severity for boys and girls across childhood

Girls, more than boys, experience a decrease in the severity of autism symptoms during childhood. It is unclear, however, which specific autistic behaviors change more for girls than for boys. Trajectories of autism symptoms were evaluated using the Autism Diagnostic Observation Schedule-calibrated severity scores (ADOS-CSS). Change in the specific behavioral characteristics of autism was assessed by studying individual ADOS items for 183 children (55 girls) from age 3-to-11 years. Girls decreased in total autism symptom severity (ADOS-CSS) and restricted/repetitive behavior severity (RRB-CSS) across childhood, while boys remained stable in both. Girls showed decreasing-severity trajectories for seven ADOS items and an increasing-trajectory for one item. Boys showed decreasing-severity trajectories for six items and increasing-severity trajectories for three items. Girls with higher ADOS-CSS at age 3 were more likely to decrease in total symptom severity than other girls. Girls in our study mostly improved or remained stable in autism symptom severity and its specific behaviors during childhood, especially behaviors related to being socially engaged and responsive. Boys' symptom change was variable over time and included both improvement and worsening, especially in social behaviors that are key to interaction. Girls with high early severity levels can potentially decrease substantially in severity during childhood.Lay AbstractThe severity of overall autism symptoms tend to decrease more in autistic girls than in autistic boys during childhood, but we do not know which specific behaviors drive this difference. We studied how specific behaviors characteristic of autism change for girls and boys across childhood. We found that girls mostly improve or remain stable in the severity level of their autism symptoms and its specific behaviors during childhood. They improved mostly in behaviors related to being socially engaged and responsive to others. Furthermore, we found that it is possible for girls with high early autism symptoms to show major improvement during childhood. Boys improved in some specific behaviors but worsened in others. Boys worsened in some behaviors that are key to engaging in social interactions.

Autistic People's Perspectives on Functioning Labels and Associated Reasons, and Community Connectedness

PURPOSE

Functioning labels have been used in relation to autistic people and differentiating between support needs. The main purpose of our study was to identify perspectives regarding language about being autistic. In regard to themselves and functioning. Furthermore, we investigated the influential factor of community connectedness on use of language acceptability and functioning labels.

METHODS

516 autistic respondents completed our survey. We asked about demographic characteristics, how respondents would like autistic people to be termed in the survey, and their acceptability (person with autism, Aspergers, disorder, conditions, living with autism, autistic). We also asked about respondents? Autistic Community Connectedness, acknowledging the implicit nature of language and identity (Stets & Serpe in New directions in identity theory and research, Oxford University Press, 2016). The main focus of our survey was whether or not to use functioning labels, and the supporting rationale.

RESULTS

97% of respondents stated that they find the term 'autistic' acceptable. Respondents who did see merit in using functioning labels to describe autistic people also reported not necessarily using them about themselves. Community membership was found to impact the participants' language preferences to describe the support needs of autistic people, including the use of functioning labels.

CONCLUSION

The proposed best option for language preferences is not to find consensus but instead, opt for the optimal choice that people find the least offensive or disagreeable. This means using identity-first language and not using functioning labels.

Sex-Differential Trajectories of Domain-Specific Associations Between Autistic Traits and Co-Occurring Emotional-Behavioral Concerns in Autistic Children

Assessing autistic traits alongside co-occurring emotional/behavioral concerns (EBCs) is challenging due to their overlap in clinical presentations, which can vary by age and sex. This study aimed to investigate domain-specific associations between autistic traits and EBCs-including anxiety, affective, attention-deficit/hyperactivity, and oppositional-defiant problems-across childhood in autistic boys and girls. We prospectively followed 389 children (84% male) diagnosed with autism at ages 2-5 years, using the Social Responsiveness Scale (SRS) and Child Behavior Checklist (CBCL) across eight timepoints until age 12. Moderated nonlinear factor analysis was used to identify and adjust for measurement non-invariance of SRS items by age, sex, and EBCs. The adjusted scores were then used for sex-moderated time-varying modeling of associations between autistic traits and EBCs. Several SRS items in the domains of social-interaction difficulties and repetitive mannerisms showed significant intercept bias by age and level of co-occurring anxiety and ADHD (effect size r > 0.20). In autistic boys, strong associations were observed between social-communication difficulties and EBCs around ages 7-9, which tended to diminish in late childhood. In contrast, autistic girls showed stable or intensifying associations, particularly with anxiety, into late childhood. Results revealed significant associations between autistic traits and EBCs after addressing item-level measurement biases. The varying associations over time highlight the importance of continuous monitoring to promptly address autistic children's sex-differential mental health needs. These findings emphasize the benefits of refining behavioral constructs and adopting a nuanced developmental approach to identify critical periods of symptom coupling/decoupling for informing evaluation and service provision.

Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism With Intellectual Disability: An Observational Study

Catatonia is a highly morbid psychomotor and affective disorder, which can affect autistic individuals with and without intellectual disability. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments in autistic individuals has not been described. We conducted a prospective observational cohort study of patients with autism and co-morbid catatonia who received outpatient care in a specialized outpatient clinic from July 1, 2021 to May 31, 2024. Data investigating pharmacologic interventions, and clinical measures including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical Global Impression-Improvement (CGI-I) were collected. Forty-five autistic patients with co-morbid catatonia were treated during the study period. The mean age was 15.6 (SD = 7.9) years [Mdn = 16.0, range 6.0-31.0]. Forty-one patients (91.1%) met criteria for autism with co-occurring intellectual disability. All patients received pharmacotherapy. Forty-four (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD = 15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than one medication class for treatment. Sixteen (35.6%) patients received electroconvulsive therapy. Fourteen patients (31.1%) attempted to taper off benzodiazepines after achieving clinical improvement during the study period; of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9 (17.8%) discontinued the taper due to a return of catatonic symptoms. Statistically significant improvement was observed across all clinical domains except the KCS. However, the majority remained at least partially symptomatic over the study period. Three patients (6.7%) died over the study period. Despite clinical improvements while receiving the gold standard for psychopharmacologic management of catatonia, chronic symptoms remained for the majority of catatonia patients over the study period, and few were able to taper and discontinue benzodiazepine treatment. Notably, the open label design of this study is a limiting factor when interpreting the results.

Utilizing network analysis to identify core items of quality of life for children with autism spectrum disorder

The purpose of this study was to develop and validate an ultra-short scale called the Quality of Life for Children with Autism Spectrum Disorder 3 (QOLASD-C3) from the full 16-item QOLASD-C scale. We first used network analysis to identify three core items to be retained on the QOLASD-C3 scale. Second, we used Cronbach's alpha and Pearson Product Moment correlations to determine the reliability and validity of the scale. Third, an optimal cut-off score of 6 was identified for the using receiver operating characteristic curve analysis. Finally, we used logistic regression to examine the similarities in the classification status based on demographic characteristics between the quality of life (QOL) status using the QOLASD-C and the QOLASD-C3 scales. Results were similar across the two versions and suggested variations in QOL status based on race/ethnicity, autism spectrum disorder (ASD) severity, and parents' socio-economic status. Implications for research and practice are discussed.

Examining the Prevalence, Characteristics, and Potential Links Between Skin Disorders and Autism Spectrum Disorder (ASD)

Background: Increasing evidence indicates that skin disorders may contribute to an increased risk of autism spectrum disorder (ASD). They can affect the quality of life, and they have an impact on social isolation, behavioral problems, cognitive scores, and some subscales of ASD. Methods: This study was an online questionnaire-based, observational, and cross-sectional study conducted during the period from August 2022 through January 2023 to examine dermatological manifestations among ASD individuals compared to controls. Descriptive and non-parametric tests were used for data analysis. Results: A total of 363 individuals with skin diseases were interviewed during the study period. In total, 189 (52.1%) of participants were autistic and 174 (47.9%) were controls. Asthma, anxiety, depression, and autoimmune disease were persistent in the ASD group compared to the controls (p < 0.001). The results also show that skin, food, and respiratory allergies were statistically significantly associated with ASD (50%, 22.2%, 14.8%, respectively) compared to the controls (26.4%, 10.3%, 7.5%, respectively) (p < 0.05). The most prevalent disease in the controls was eczema (15.5%), followed by dry skin (14.9%) and acne (10.3%). These diseases showed a statistically significant association with ASD compared to the controls (p < 0.0001). Conclusions: Our findings indicate that atopic disorders and comorbidities, including eczema, asthma, and allergies, are significantly associated with ASD. A large population-based study is warranted to clarify the prevalence of skin disorders among individuals with ASD, coupled with the study of the association between skin disorders and comorbidities to determine the relationship precisely.

Effects of Using Prompts During Parent-Child Shared Reading on the Language Development of Mildly Autistic Children

The use of literal prompts (LPs) and inferential prompts (IPs) in shared book reading (SBR) facilitates children's use of language and promotes their thinking and understanding about the stories discussed and beyond. Furthermore, SBR provides a platform for mildly autistic children to have multiple rounds of communication with educators. This study investigated the contribution of LPs and IPs on the language development and affective factors of language learning in mildly autistic children. This study included 187 mildly autistic Chinese children who were stratified by random sampling and assigned into three groups (LP, IP and control). The mildly autistic children's language skills were tested immediately before and after the 12-week SBR intervention. Their parents were also included in this study. The results indicated that using prompts had positive effects on the mildly autistic children's language skills and on the affective factors central to language development. Moreover, LPs were beneficial in fostering mildly autistic children's affective factor development, whilst IPs fostered their Chinese word reading and listening comprehension skills. These findings indicated the benefits of using prompts during parent-child SBR, along with the extent to which prompts contribute to different language skills and affective factors central to language development in mildly autistic children.

MCBERT: A multi-modal framework for the diagnosis of autism spectrum disorder

Within the domain of neurodevelopmental disorders, autism spectrum disorder (ASD) emerges as a distinctive neurological condition characterized by multifaceted challenges. The delayed identification of ASD poses a considerable hurdle in effectively managing its impact and mitigating its severity. Addressing these complexities requires a nuanced understanding of data modalities and the underlying patterns. Existing studies have focused on a single data modality for ASD diagnosis. Recently, there has been a significant shift towards multimodal architectures with deep learning strategies due to their ability to handle and incorporate complex data modalities. In this paper, we developed a novel multimodal ASD diagnosis architecture, referred to as Multi-Head CNN with BERT (MCBERT), which integrates bidirectional encoder representations from transformers (BERT) for meta-features and a multi-head convolutional neural network (MCNN) for the brain image modality. The MCNN incorporates two attention mechanisms to capture spatial (SAC) and channel (CAC) features. The outputs of BERT and MCNN are then fused and processed through a classification module to generate the final diagnosis. We employed the ABIDE-I dataset, a multimodal dataset, and conducted a leave-one-site-out classification to assess the model's effectiveness comprehensively. Experimental simulations demonstrate that the proposed architecture achieves a high accuracy of 93.4 %. Furthermore, the exploration of functional MRI data may provide a deeper understanding of the underlying characteristics of ASD.

Quality of life of primary caregivers of autistic children: Structural equation modeling

PURPOSE

Because autistic children may face difficulties living independently, considering their caregivers' quality of life (QoL) is crucial. However, few studies have examined the pathways through which the severity of autism spectrum disorder (ASD) affects caregivers. Based on the stress process model, this study examined a hypothesized model of how ASD severity affects caregivers' QoL, both directly and indirectly, through coping strategies, family functioning, and perceived social support.

DESIGN AND METHODS

This cross-sectional study included 392 caregivers of autistic children in Saudi Arabia. Structured interviews were conducted between April and July 2023. The data were collected from caregivers who visited the developmental and behavioral disorders clinic, daycare centers, and schools. Descriptive and correlational analyses were conducted to describe the study variables and their association with caregivers' QoL. Structural equation modeling was used to test the hypothesized model.

RESULTS

The results showed that the hypothesized model fit the data. Maladaptive coping strategies (β = -0.039, P < 0.05), family functioning (β = -0.110, P < 0.05), and perceived social support (β = -0.182, P < 0.05) partially mediated the association between ASD severity and caregivers' QoL.

CONCLUSION AND IMPLICATIONS

Our findings underscore the importance of tailoring interventions that focus on QoL for caregivers of autistic children, encouraging adaptive coping strategies, improving family functioning, and enhancing perceptions of social support.

HERVs Endophenotype in Autism Spectrum Disorder: Human Endogenous Retroviruses, Specific Immunoreactivity, and Disease Association in Different Family Members

Increasing evidence indicates that human endogenous retroviruses (HERVs) are important to human health and are an underexplored component of many diseases. Certain HERV families show unique expression patterns and immune responses in autism spectrum disorder (ASD) patients compared to healthy controls, suggesting their potential as biomarkers. Despite these interesting findings, the role of HERVs in ASD needs to be further investigated. In this review, we discuss recent advances in genetic research on ASD, with a particular emphasis on the implications of HERVs on neurodevelopment and future genomic initiatives aimed at discovering ASD-related genes through Artificial Intelligence. Given their pro-inflammatory and autoimmune characteristics, the existing literature suggests that HERVs may contribute to the onset or worsening of ASD in individuals with a genetic predisposition. Therefore, we propose that investigating their fundamental properties could not only improve existing therapies but also pave the way for new therapeutic strategies.

A Normative Model Representing Autistic Individuals Amidst Autism Spectrum Phenotypic Heterogeneity

BACKGROUND

Currently, there is a need for approaches to understand and manage the multidimensional autism spectrum and quantify its heterogeneity. The diagnosis is based on behaviors observed in two key dimensions, social communication and repetitive, restricted behaviors, alongside the identification of required support levels. However, it is now recognized that additional modifiers, such as language abilities, IQ, and comorbidities, are essential for a more comprehensive assessment of the complex clinical presentations and clinical trajectories in autistic individuals. Different approaches have been used to identify autism subgroups based on the genetic and clinical heterogeneity, recognizing the importance of autistic behaviors and the assessment of modifiers. While valuable, these methods are limited in their ability to evaluate a specific individual in relation to a normative reference sample of autistic individuals. A quantitative score based on axes of phenotypic variability could be useful to compare individuals, evaluate the homogeneity of subgroups, and follow trajectories of an individual or a specific group. Here we propose an approach by (i) combining measures of phenotype variability that contribute to clinical presentation and could impact different trajectories in autistic persons and (ii) using it with normative modeling to assess the clinical heterogeneity of a specific individual.

METHODS

Using phenotypic data available in a comprehensive reference sample, the Simons Simplex Collection (n = 2744 individuals), we performed principal component analysis (PCA) to find components of phenotypic variability. Features that contribute to clinical heterogeneity and could impact trajectories in autistic people were assessed by the Autism Diagnostic Interview-Revised (ADI-R), Vineland Adaptive Behavior Scales (VABS) and the Child Behavior Checklist (CBCL). Cognitive assessment was estimated by the Total Intelligence Quotient (IQ).

RESULTS

Three PCs embedded 72% of the normative sample variance. PCA-projected dimensions supported normative modeling where a multivariate normal distribution was used to calculate percentiles. A Multidimensional General Functionality Score (MGFS) to evaluate new prospective single subjects was developed based on percentiles.

CONCLUSIONS

Our approach proposes a basis for comparing individuals, or one individual at two or more times and evaluating homogeneity in phenotypic clinical presentation and possibly guides research sample selection for clinical trials.

Effectiveness of Equine-Assisted Activities and Therapies for Children with Autism Spectrum Disorder: An Update

BACKGROUND/OBJECTIVES

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition requiring personalised therapeutic approaches. This study evaluated the effectiveness of Equine-Assisted Activities and Therapies (EAATs) in 86 children with varying ASD severity levels (levels 1-3).

METHODS

Vineland Adaptive Behaviour Scales and the Parenting Stress Index were used. Between May 2022 and October 2023, participants completed 20 weekly sessions of 45 min each, tailored to their individual needs.

RESULTS

Children with level 3 ASD demonstrated greater challenges in communication (level 1: 67.1 ± 29.0 vs. level 3: 30.0 ± 12.6; p < 0.001), daily living skills (81.0 ± 26.8 vs. 42.6 ± 18.1; p < 0.001), and socialisation (72.2 ± 23.2 vs. 37.3 ± 14.2; p < 0.001). Parental distress was higher in cases of greater ASD severity. Nevertheless, significant improvements were observed across the entire cohort in daily living skills (58.3 ± 25.5 vs. 67.8 ± 29.0; p = 0.023), with particularly notable outcomes in children with level 1 ASD (65.7 ± 26.9 vs. 81.0 ± 26.8; p = 0.010). While increases in socialisation were noted among children with level 1 ASD, these were not statistically significant (p = 0.073).

CONCLUSIONS

EAAT fosters improvements in daily living skills, particularly in children with level 1 ASD, and has a positive impact on socialisation. For children with more severe ASD, targeted interventions are required.

Developmental and Psychiatric Conditions Among 5-7 Year Old Children with Non-persistent and Persistent Autism

To describe the types and frequency of developmental and psychiatric conditions (DPCs) in early school-age children who were diagnosed with ASD as toddlers and to compare rates of DPCs in children whose ASD persists ("persistent ASD") versus those in whom it does not ("non-persistent ASD"). Children with a clinical ASD diagnosis at 12-36 months old underwent a research assessment at 5-7 years old. Research assessments included measures of ASD symptoms and cognitive and adaptive functioning. A research psychologist assigned an ASD diagnosis (yes or no) based on the child's current functioning. Information about DPCs was obtained from parent and/or research psychologist report. Intellectual disability was defined as cognitive standard score < 70. Of the 213 children diagnosed with ASD at initial clinical assessment, at the research assessment 134 (62.6%) had persistent ASD and 79 (37%) had non-persistent ASD. Overall, the most common DPCs were ADHD (n = 58; 27.2%); speech disorder (n = 46; 21.6%); and intellectual disability (n = 46; 21.6%). Of children with non-persistent ASD, 29.1% had ≥ 1 DPC, and 19% had ADHD. Children with persistent ASD were over 5 times more likely (OR = 5.72) to have an additional DPC, compared to those with non-persistent ASD. Children with non-persistent ASD may manifest several different DPCs, with an increased rate of ADHD compared to population norms. Children with persistent ASD have higher rates of DPCs than those with non-persistent ASD. Follow-up care for children diagnosed with ASD at a young age should include assessment for other DPCs.

Autism, intelligence, language, and adaptive behavior, disentangling a complex relationship

Introduction

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by a range of intellectual and language abilities. Its heterogeneity is acknowledged in modern diagnostics, complicating research and necessitating precision medicine and a multidimensional approach for individualized treatment and accurate assessment. Intellectual and language functioning influence adaptive skills and symptomatology. Thus, assessing adaptive functioning in a multidimensional and multi-informant manner is crucial, highlighting the importance of comprehensive evaluations. This study explores the interplay between autistic traits, demographic variables, IQ, adaptive functioning, and the applicability of ICD-11 classifications.

Methods

We analyzed data from the initial global evaluation of 60 diverse autistic children (aged 35 to 120 months; IQ range 16 to 118). Parent-reports using the Vineland Adaptive Behavior Scale (VABS-II) were compared with standardized assessments from the PsychoEducational Profile (PEP-3). Children's intellectual levels were assessed using Griffiths Scales of Child Development (Griffiths III) and the Autism Diagnostic Observation Schedule (ADOS-2) was used for autistic traits. They were further classified according to the ICD-11 diagnostic system, functional language, and intellectual functioning levels. Correlations among variables, group comparisons, and multivariate analyses were performed.

Results

The analysis indicates a linear effect of IQ on all adaptive scales and the impact of autistic traits on directly measured adaptive functioning. A factorial effect was observed due to changes concerning specific age, intellectual, and linguistic levels, which do not completely align with ICD-11 categorization. Additionally, a negative correlation between intelligence and measured autistic traits was found. Parental age, education level, and age at childbirth were also found to affect various adaptive scales.

Discussion

The study questions the ICD-11's proposed distinctions in IQ and language functioning for ASD, advocating for more refined categorization and developmental considerations. It underscores the intricate relationship between autistic traits, IQ, and communication skills, casting doubt on the precision of diagnostic tools across the spectrum. Parental reports and direct assessments are essential for comprehensive evaluation, with parental education and age influencing children's behaviors and skills. The study calls for a nuanced approach to ASD assessment, integrating various metrics and sources of information for a detailed phenotyping necessary for personalized interventions and biological research.

Heterogeneity and convergence across seven neuroimaging modalities: a review of the autism spectrum disorder literature

Background

A growing body of literature classifies autism spectrum disorder (ASD) as a heterogeneous, complex neurodevelopmental disorder that often is identified prior to three years of age. We aim to provide a narrative review of key structural and functional properties that differentiate the neuroimaging profile of autistic youth from their typically developing (TD) peers across different neuroimaging modalities.

Methods

Relevant studies were identified by searching for key terms in PubMed, with the most recent search conducted on September 1, 2023. Original research papers were included if they applied at least one of seven neuroimaging modalities (structural MRI, functional MRI, DTI, MRS, fNIRS, MEG, EEG) to compare autistic children or those with a family history of ASD to TD youth or those without ASD family history; included only participants <18 years; and were published from 2013 to 2023.

Results

In total, 172 papers were considered for qualitative synthesis. When comparing ASD to TD groups, structural MRI-based papers (n = 26) indicated larger subcortical gray matter volume in ASD groups. DTI-based papers (n = 14) reported higher mean and radial diffusivity in ASD participants. Functional MRI-based papers (n = 41) reported a substantial number of between-network functional connectivity findings in both directions. MRS-based papers (n = 19) demonstrated higher metabolite markers of excitatory neurotransmission and lower inhibitory markers in ASD groups. fNIRS-based papers (n = 20) reported lower oxygenated hemoglobin signals in ASD. Converging findings in MEG- (n = 20) and EEG-based (n = 32) papers indicated lower event-related potential and field amplitudes in ASD groups. Findings in the anterior cingulate cortex, insula, prefrontal cortex, amygdala, thalamus, cerebellum, corpus callosum, and default mode network appeared numerous times across modalities and provided opportunities for multimodal qualitative analysis.

Conclusions

Comparing across neuroimaging modalities, we found significant differences between the ASD and TD neuroimaging profile in addition to substantial heterogeneity. Inconsistent results are frequently seen within imaging modalities, comparable study populations and research designs. Still, converging patterns across imaging modalities support various existing theories on ASD.

Stratification of Gut Microbiota Profiling Based on Autism Neuropsychological Assessments

Autism spectrum disorder (ASD) is a neurodevelopmental disorder. Investigations of gut microbiota (GM) play an important role in deciphering disease severity and symptoms. Overall, we stratified 70 ASD patients by neuropsychological assessment, based on Calibrated Severity Scores (CSSs) of the Autism Diagnostic Observation Schedule-Second edition (ADOS-2), Child Behavior Checklist (CBCL) and intelligent quotient/developmental quotient (IQ/DQ) parameters. Hence, metataxonomy and PICRUSt-based KEGG predictions of fecal GM were assessed for each clinical subset. Here, 60% of ASD patients showed mild to moderate autism, while the remaining 40% showed severe symptoms; 23% showed no clinical symptoms, 21% had a risk of behavior problems and 56% had clinical symptoms based on the CBCL, which assesses internalizing problems; further, 52% had no clinical symptoms, 21% showed risk, and 26% had clinical symptoms classified by CBCL externalizing problems. Considering the total CBCL index, 34% showed no clinical symptoms, 13% showed risk, and 52% had clinical symptoms. Here, 70% of ASD patients showed cognitive impairment/developmental delay (CI/DD). The GM of ASDs with severe autism was characterized by an increase in Veillonella, a decrease in Monoglobus pectinilyticus and a higher microbial dysbiosis index (MDI) when compared to mild-moderate ASDs. Patients at risk for behavior problems and showing clinical symptoms were characterized by a GM with an increase of Clostridium, Eggerthella, Blautia, Intestinibacter, Coprococcus, Ruminococcus, Onthenecus and Bariatricus, respectively. Peptidoglycan biosynthesis and biofilm formation KEGGs characterized patients with clinical symptoms, while potential microbiota-activated PPAR-γ-signaling was seen in CI/DD patients. This evidence derived from GM profiling may be used to further improve ASD understanding, leasing to a better comprehension of the neurological phenotype.

Toward a functional classification for autism in adulthood

Autism spectrum disorder (ASD) is a heterogeneous condition that affects development and functioning from infancy through adulthood. Efforts to parse the heterogeneity of the autism spectrum through subgroups such as Asperger's and Profound Autism have been controversial, and have consistently struggled with issues of reliability, validity, and interpretability. Nonetheless, methods for successfully identifying clinically meaningful subgroups within autism are needed to ensure that research, interventions, and services address the range of needs experienced by autistic individuals. The purpose of this study was to generate and test whether a simple set of questions, organized in a flowchart, could be used in clinical practice and research to differentiate meaningful subgroups based on individuals' level of functioning. Once generated, subgroups could also be compared to the recently proposed administrative category of Profound Autism and to groupings based on standardized adaptive measures. Ninety-seven adults with autism or related neurodevelopmental disorders participating in a longstanding longitudinal study, or their caregivers if they could not answer for themselves, completed phone interviews when the participants were ~30 years old. Information from these phone interviews was used to generate vignettes summarizing characteristics and aspects of the daily lives of each participant (e.g., language level, vocational activities, and social relationships). Three expert clinicians then used these vignettes to classify each participant based on their level of support needs. Meaningfully distinct subgroups within the sample were identified which could be reliably distinguished from one another. Implications of such categorizations and future directions are discussed.

Feasibility and Preliminary Evaluation of Theory-Based Training Program on Daily Living Skills Among Children With Autism Spectrum Disorder: Findings From Rural Regions in Egypt

BACKGROUND

One of the most crucial objectives in the education and treatment of young children with autism spectrum disorder (ASD) is independence in daily living skills (DLS). Therefore, as a child with ASD condition grows, measures of everyday functioning including adaptive behaviors should be more regularly monitored and regulated.

AIM

The primary aim of this study was to evaluate the feasibility of a developed theory-based training program and its preliminary effectiveness on the acquisition of DLS among school-age children with ASD.

METHODS

A preliminary experimental research design (pre- and post-evaluation) was conducted from the beginning of May to the end of July 2023 on 31 children with ASD. The socio-economic status scale, Vineland Adaptive Behavior Scale, and Gilliam Autism Rating Scale were administered before and after a theory-based DLS training program.

RESULTS

There was a significant difference in the DLS and motor functioning before and after the implementation of the training program (p < .001 and p = .021, respectively). In addition, there was a significant difference in the total score of autistic severity before and after the implementation of the training program (p < .001).

CONCLUSION

The promising outcomes of the study indicate the need for further testing and expansion of this intervention. These findings contribute to the growing body of evidence highlighting the significance of DLS training program in the comprehensive treatment approach for children with ASD. Consequently, proposing DLS training programs as a cost-effective and efficient nursing intervention is warranted.

Longitudinal Symptom Burden and Pharmacologic Management of Catatonia in Autism with and without Profound Impairment: An Observational Study

Introduction

Catatonia is a highly morbid psychomotor and affective disorder which can affect autistic individuals with and without profound impairment. Catatonic symptoms are treatable with pharmacotherapy and electroconvulsive therapy, but the longitudinal effectiveness of these treatments has not been described.

Methods

We conducted a prospective observational cohort study of patients with autism and co-morbid catatonia who received outpatient care in a specialized outpatient clinic from July 1st, 2021 to May 31st, 2024. Data investigating pharmacologic interventions, and clinical measures including the Bush Francis Catatonia Rating Scale (BFCRS), Kanner Catatonia Severity Scale (KCS), Kanner Catatonia Examination (KCE), and Clinical Global Impression - Improvement (CGI-I) were collected.

Results

Forty-five patients were identified with 39 (86.7%) meeting criteria for profound autism. All patients received pharmacotherapy. 44 (97.8%) were treated with benzodiazepines with a mean maximal daily dose of 17.4 mg (SD=15.8) lorazepam equivalents. Thirty-five patients (77.8%) required more than one medication class for treatment. Fourteen patients (31.1%) attempted to taper off benzodiazepines during the study period; of these, 5 patients (11.1%) were successfully tapered off, and the remaining 9 (17.8%) discontinued the taper due to a return of catatonic symptoms. Statistically significant improvement was observed across all clinical domains except the KCS. However, the majority remained symptomatic over the study period.

Conclusions

Despite clinical improvements while receiving the gold standard for psychopharmacologic management of catatonia, chronic symptoms remained for the majority of catatonia patients over the study period, and few were able to taper and discontinue benzodiazepine treatment.

Harnessing the Gut Microbiome: To What Extent Can Pre-/Probiotics Alleviate Immune Activation in Autism Spectrum Disorder?

Children diagnosed with autism spectrum disorder (ASD) are at an increased risk of experiencing gastrointestinal (GI) discomfort, which has been linked to dysfunctions in the microbiome-gut-brain axis. The bidirectional communication between gut and brain plays a crucial role in the overall health of individuals, and alterations in the gut microbiome can contribute to immune activation and gut-brain dysfunction in ASD. Despite the limited and controversial results of pre-/probiotic applications in ASD, this review comprehensively maps the association between ASD clinical symptoms and specific bacterial taxa and evaluates the efficacy of pre-/probiotics in modulating microbiota composition, reducing inflammatory biomarkers, alleviating difficulties in GI distress, sleep problems, core and other ASD-associated symptoms, as well as relieving parental concerns, separately, in individuals with ASD. Beyond simply targeting core ASD symptoms, this review highlights the potential of pre-/probiotic supplementations as a strategy to modulate gut homeostasis and immune response, and to delineate the potential mechanisms by which its direct or mediating effects can alleviate gut-brain dysfunction and poor nutritional status in ASD management. Further well-designed randomized controlled trials are needed to strengthen the existing evidence and establish optimal protocols for the use of pre-/probiotics in the context of ASD.

Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review

INTRODUCTION

Child and adolescent mental health is a global priority. In sub-Saharan Africa, despite the high burden, there is a gap in health services for children and adolescents with mental health disorders. To bridge this gap, healthcare workers require a good understanding of child and adolescent mental health, the right attitude, and practices geared to improving child and adolescent mental health. This scoping review examined the knowledge, attitudes, and practices related to child and adolescent mental health among sub-Saharan African healthcare workers.

METHODS

The search was restricted between January 2010, the year when the Mental Health Gap Action Programme guidelines were launched, and April 2024. The review followed the methodological framework proposed by Arksey and O'Malley for conducting scoping reviews. The databases searched included CINHAL, PubMed, Web of Science, PsycINFO, and grey literature databases. Additional articles were identified through cited references of the studies included. A data extraction template was used to retrieve relevant text. A narrative synthesis approach was adopted to explore the relationships within and between the included studies.

RESULTS

The literature search yielded 4658 studies. Among these, 817 were identified as duplicates, and 3740 were excluded after screening. Only twenty-one articles met the criteria for inclusion in the review. The findings showed that healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health.

CONCLUSION

It is crucial to build capacity and improve healthcare workers' practices, knowledge, and attitudes toward child and adolescent mental health in sub-Saharan Africa. This could lead to better access to mental health services for children and adolescents in the region.

Gender differences in predictors of quality of life for parents of children with Autism Spectrum disorder in Saudi Arabia

PURPOSE

Few researchers have examined gender differences in the quality of life (QoL) of parents of children with autism spectrum disorder (ASD) in diverse cultural contexts. The purpose of this study was to identify how ASD severity, affiliate stigma, perceived social support, family functioning, and coping strategies differentially predict the QoL of mothers and fathers of children with ASD in Saudi Arabia.

DESIGN AND METHODS

Based on a cross-sectional research design, data were gathered between April and July 2023 from a convenience sample of 376 parents (220 mothers and 156 fathers) of children with ASD in Saudi Arabia. Welch's t-test and regression were used to achieve the study purpose.

RESULTS

Mothers of children with ASD reported lower QoL, perceived social support, and family functioning than fathers. Mothers relied on emotion-focused coping strategies, whereas fathers used problem-focused coping strategies. Furthermore, affiliate stigma, perceived social support, and family functioning significantly predicted the QoL of mothers and fathers of children with ASD. However, the severity of ASD affected only the QoL of the mothers. Problem-focused coping significantly predicted fathers' QoL but not mothers' QoL.

CONCLUSIONS

The results highlight gender differences in the factors that predict the QoL of parents of children with ASD in Saudi Arabia.

PRACTICE IMPLICATIONS

Healthcare professionals should consider parents' gender when providing support and interventions to improve parental QoL.

Studies assessing domains pertaining to structural language in autism vary in reporting practices and approaches to assessment: A systematic review

LAY ABSTRACT

Under the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), language impairment can co-occur with autism. It is not yet clear how research defines, reports, and characterizes structural language abilities of autistic individuals eligible for school-based special education services (aged 3-21 years) in the United States. In the United States, students typically must be formally diagnosed to be eligible for services and supports. However, the quality of diagnosis is only as good as the research evidence on which diagnosis depends. To evaluate evidence quality, we examined how studies of school-aged autistic individuals report assessments of language ability. This systematic review included 57 studies using English language age-referenced assessments used to measure structural language. Findings showed many differences across studies in how language abilities were measured and reported. Also, none of the studies fully reported the variables relevant to characterizing language impairment. Outcomes were similar across versions of the Diagnostic and Statistical Manual of Mental Disorders. Findings indicate that researchers and clinicians should pay attention to reporting diagnostic and grouping criteria. Carefully interpreting research evidence is critical for ensuring that diagnostic criteria and supports are representative of and accessible to autistic individuals and relevant parties.

Does a high threshold of sensory responsiveness affect the development of pretend play in children on the autism spectrum?

BACKGROUND

Among the current avenues of research into the origins and development of the autism spectrum, those concerning atypical levels of sensory responsiveness are gaining increasing relevance. Researchers note the relationship of sensory responsiveness in children on the autism spectrum to their motor, cognitive and social development. Current research reports combines the responsiveness to sensory stimuli also with the development of pretend play. Aim of this study was to verify the relationship between the level of development of pretend play and the level of sensory responsiveness in children on the autism spectrum.

METHODS

A study was conducted in a group of 63 children with a diagnosis of autism spectrum aged from 3 years and 7 months to 9 years and 3 months using: Pretend Play subscale from the Theory of Mind Mechanism Scale and Sensory Experiences Questionnaire version 2.1.

RESULTS

The results revealed that elevated sensory hyporesponsiveness predicted low pretend play skills in the group of participating children.

CONCLUSION

The study verified the contribution of the level of sensory hyporesponsiveness to explaining the atypical development of pretend play in children on the autism spectrum.

Changes in the severity of autism symptom domains are related to mental health challenges during middle childhood

LAY ABSTRACT

For many autistic children, the severity of their autism symptoms changes during middle childhood. We studied whether these changes are associated with the emergence of other mental health challenges such as anxiety and attention-deficit hyperactivity disorder. Children who had increased social-communication challenges had more anxiety and attention-deficit hyperactivity disorder symptoms and disruptive behavior problems than other children. Children who decreased their restricted and repetitive behaviors, on the contrary, had more anxiety. We discuss why these changes in autism symptoms may lead to increases in other mental health concerns.

Profound Autism: An Imperative Diagnosis

Profound autism refers to a subset of individuals with autism spectrum disorder who have an intellectual disability with an intelligence quotient less than 50 and minimal-to-no language and require 24-hour supervision and assistance with activities of daily living. The general pediatrician will invariably work with autistic children across the spectrum and will likely encounter youth with profound autism. Awareness of profound autism as a real entity describing autistic children with concomitant intellectual disability and language impairment who require 24-hour care is the first step in developing a solid pediatric home for these youth.

Brain functional connectivity alterations of Wernicke's area in individuals with autism spectrum conditions in multi-frequency bands: A mega-analysis

Characterized by severe deficits in communication, most individuals with autism spectrum conditions (ASC) experience significant language dysfunctions, thereby impacting their overall quality of life. Wernicke's area, a classical and traditional brain region associated with language processing, plays a substantial role in the manifestation of language impairments. The current study carried out a mega-analysis to attain a comprehensive understanding of the neural mechanisms underpinning ASC, particularly in the context of language processing. The study employed the Autism Brain Image Data Exchange (ABIDE) dataset, which encompasses data from 443 typically developing (TD) individuals and 362 individuals with ASC. The objective was to detect abnormal functional connectivity (FC) between Wernicke's area and other language-related functional regions, and identify frequency-specific altered FC using Wernicke's area as the seed region in ASC. The findings revealed that increased FC in individuals with ASC has frequency-specific characteristics. Further, in the conventional frequency band (0.01-0.08 Hz), individuals with ASC exhibited increased FC between Wernicke's area and the right thalamus compared with TD individuals. In the slow-5 frequency band (0.01-0.027 Hz), increased FC values were observed in the left cerebellum Crus II and the right lenticular nucleus, pallidum. These results provide novel insights into the potential neural mechanisms underlying communication deficits in ASC from the perspective of language impairments.

Diagnosing autism severity associated with physical fitness and gray matter volume in children with autism spectrum disorder: Explainable machine learning method

PURPOSE

This study aimed to investigate the relationship between physical fitness, gray matter volume (GMV), and autism severity in children with autism spectrum disorder (ASD). Besides, we sought to diagnose autism severity associated with physical fitness and GMV using machine learning methods.

METHODS

Ninety children diagnosed with ASD underwent physical fitness tests, magnetic resonance imaging scans, and autism severity assessments. Diagnosis models were established using extreme gradient boosting (XGB), random forest (RF), support vector machine (SVM), and decision tree (DT) algorithms. Hyperparameters were optimized through the grid search cross-validation method. The shapley additive explanation (SHAP) method was employed to explain the diagnosis results.

RESULTS

Our study revealed associations between muscular strength in physical fitness and GMV in specific brain regions (left paracentral lobule, bilateral thalamus, left inferior temporal gyrus, and cerebellar vermis I-II) with autism severity in children with ASD. The accuracy (95 % confidence interval) of the XGB, RF, SVM, and DT models were 77.9 % (77.3, 78.6 %), 72.4 % (71.7, 73.2 %), 71.9 % (71.1, 72.6 %), and 66.9 % (66.2, 67.7 %), respectively. SHAP analysis revealed that muscular strength and thalamic GMV significantly influenced the decision-making process of the XGB model.

CONCLUSION

Machine learning methods can effectively diagnose autism severity associated with physical fitness and GMV in children with ASD. In this respect, the XGB model demonstrated excellent performance across various indicators, suggesting its potential for diagnosing autism severity.

Understanding the role of AMPA receptors in autism: insights from circuit and synapse dysfunction

Autism spectrum disorders represent a diverse etiological spectrum that converge on a syndrome characterized by discrepant deficits in developmental domains often highlighted by concerns in socialization, sensory integration, and autonomic functioning. Importantly, the incidence and prevalence of autism spectrum disorders have seen sharp increases since the syndrome was first described in the 1940s. The wide etiological spectrum and rising number of individuals being diagnosed with the condition lend urgency to capturing a more nuanced understanding of the pathogenic mechanisms underlying the autism spectrum disorders. The current review seeks to understand how the disruption of AMPA receptor (AMPAr)-mediated neurotransmission in the cerebro-cerebellar circuit, particularly in genetic autism related to SHANK3 or SYNGAP1 protein dysfunction function and autism associated with in utero exposure to the anti-seizure medications valproic acid and topiramate, may contribute to the disease presentation. Initially, a discussion contextualizing AMPAr signaling in the cerebro-cerebellar circuitry and microstructural circuit considerations is offered. Subsequently, a detailed review of the literature implicating mutations or deletions of SHANK3 and SYNGAP1 in disrupted AMPAr signaling reveals how bidirectional pathogenic modulation of this key circuit may contribute to autism. Finally, how pharmacological exposure may interact with this pathway, via increased risk of autism diagnosis with valproic acid and topiramate exposure and potential treatment of autism using AMPAr modulator perampanel, is discussed. Through the lens of the review, we will offer speculation on how neuromodulation may be used as a rational adjunct to therapy. Together, the present review seeks to synthesize the disparate considerations of circuit understanding, genetic etiology, and pharmacological modulation to understand the mechanistic interaction of this important and complex disorder.

Understanding profound autism: implications for stigma and supports

Introduction

Societal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families.

Methods

The current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults.

Results

The prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma.

Discussion

Future research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.

Mothers' satisfaction with emergency care when their child has an autism spectrum disorder

PURPOSE

This study aimed to examine factors identified by mothers as affecting their satisfaction with the care provided to their children in the Emergency Department (ED), among mothers of children with autistic spectrum disorder (ASD) in comparison to mothers of children without ASD.

DESIGN AND METHODS

In this correlational quantitative study, 128 Israeli mothers - 59 (46%) mothers of children with ASD and 69 (54%) of children without ASD - completed an online survey based on a Ministry of Health national survey of patient experience.

RESULTS

Mothers of children with ASD expressed lower satisfaction with the care provided. The difference was particularly evident concerning waiting times for examination of the child by nurses and physicians in the ED, whether the nurses were attentive and responsive to the mother's questions and concerns, whether the ED staff demonstrated coordination and cooperation with regard to medical care of the child, and whether work in the ED was conducted in an orderly and organized manner. The presence of communication difficulties in children predicted mothers' satisfaction with care.

CONCLUSIONS

These findings suggest that certain needs of mothers and/or their children with ASD do not receive an appropriate response in the ED.

PRACTICE IMPLICATIONS

It is important to raise the awareness of healthcare providers in EDs regarding the needs of children with ASD and their parents, especially children with communication difficulties. Strategies should be implemented to improve the experience of children with ASD and their parents in the ED.

Modified Meta Heuristic BAT with ML Classifiers for Detection of Autism Spectrum Disorder

ASD (autism spectrum disorder) is a complex developmental and neurological disorder that impacts the social life of the affected person by disturbing their capability for interaction and communication. As it is a behavioural disorder, early treatment will improve the quality of life of ASD patients. Traditional screening is carried out with behavioural assessment through trained physicians, which is expensive and time-consuming. To resolve the issue, several conventional methods strive to achieve an effective ASD identification system, but are limited by handling large data sets, accuracy, and speed. Therefore, the proposed identification system employed the MBA (modified bat) algorithm based on ANN (artificial neural networks), modified ANN (modified artificial neural networks), DT (decision tree), and KNN (k-nearest neighbours) for the classification of ASD in children and adolescents. A BA (bat algorithm) is utilised for the automatic zooming capability, which improves the system's efficacy by excellently finding the solutions in the identification system. Conversely, BA is effective in the identification, it still has certain drawbacks like speed, accuracy, and falls into local extremum. Therefore, the proposed identification system modifies the BA optimisation with random perturbation of trends and optimal orientation. The dataset utilised in the respective model is the Q-chat-10 dataset. This dataset contains data of four stages of age groups such as toddlers, children, adolescents, and adults. To analyse the quality of the dataset, dataset evaluation mechanism, such as the Chi-Squared Statistic and p-value, are used in the respective research. The evaluation signifies the relation of the dataset with respect to the proposed model. Further, the performance of the proposed detection system is examined with certain performance metrics to calculate its efficiency. The outcome revealed that the modified ANN classifier model attained an accuracy of 1.00, ensuring improved performance when compared with other state-of-the-art methods. Thus, the proposed model was intended to assist physicians and researchers in enhancing the diagnosis of ASD to improve the standard of life of ASD patients.

Prototypical autism: New diagnostic criteria and asymmetrical bifurcation model

The current "autism spectrum" DSM 5 diagnostic criteria and autism standardized diagnostic instruments promote considerable heterogeneity or clinical indecision and may be detrimental to the advancement of fundamental research on autism mechanisms. To increase clinical specificity and reorient research towards core autistic presentations, we propose new diagnostic criteria for prototypical autism during the age of 2- to 5-years. We include autism within other non-dominant, familiarly aggregated phenomena sharing asymmetrical developmental bifurcations, such as twin pregnancy, left handedness, and breech presentation/delivery. Following this model, nature, trajectory, and positive/negative signs structure of autism would result from the polarized problem of whether or not language and information is processed in a socially biased manner. Prototypical autism would follow a canonical developmental trajectory by which a gradual decline in social bias in the processing of incoming information, overtly beginning at the end of the first year, bifurcates into a prototypical autistic presentation in the second half of the second year of life. This bifurcation event is followed by a plateau, in which these atypicalities show maximal stringency and distinctiveness, and then ultimately, in most cases, by partial normalization. During the plateau period, the orientation towards, and processing of, information is considerably modified, with an absence of bias for social information, contrasting with a high level of interest in complex, unbiased information, independently of its social or non-social nature. Integrating autism into asymmetrical developmental bifurcations would explain the absence of deleterious neurological and genetic markers and the presence of familial transmission in canonical autistic presentations.