Incidence, prevalence, and global burden of autism spectrum disorder from 1990 to 2019 across 204 countries

A mixed methods systematic review of assistance dogs for people with autism

OBJECTIVES

To critically examine and synthesise the available evidence regarding the impact of assistance dogs on individuals with autism.

STUDY DESIGN

Mixed methods systematic review with meta-analysis of quantitative data and meta-aggregation of qualitative data. Studies were eligible for inclusion if they included participants with autism and data describing the impact, effectiveness, or participant experience with an assistance dog or a companion dog.

DATA SOURCES

CENTRAL, Embase, MEDLINE, and PsycINFO.

DATA SYNTHESIS

Fourteen studies (one randomised controlled trial, three cohort, seven cross-sectional, and three single-arm studies) were included in the meta-analysis and 13 studies (eight cross-sectional, three longitudinal, and two case studies) were included in the meta-aggregation. There was some quantitative evidence that assistance dogs may be associated with benefit, but the pooled effect sizes are similar to those associated with companion dogs. The qualitative data suggested that parents perceived a broad range of benefits of assistance dogs but may be unprepared for the challenges associated with owning an assistance dog.

CONCLUSION

There is a lack of compelling evidence to suggest that assistance dogs confer unique benefits for individuals with autism. The evidence base is limited and of poor quality thus the potential benefits identified need to be interpreted with caution. Interpreting the quantitative and qualitative studies together, the findings indicate many potential benefits of assistance dogs for people with autism could be achieved by a companion dog.

Consanguinity as a Risk Factor for Autism

PURPOSE

Genetic and environmental risk factors associated with Autism Spectrum Disorders (ASD) continue to be a focus of research worldwide. Consanguinity, the cultural practice of marrying within a family, is common in cultures and societies of the Middle East, North Africa and parts of Asia. Consanguinity has been investigated as a risk factor for ASD in a limited number of studies, with mixed results. We employed registry and survey data from Qatar to evaluate the role of consanguinity as a risk factor for ASD.

METHODS

Data were sourced from a national registry and a population-based survey of autism recently conducted in Qatar. We selected a sample of 891 children (mean age: 8.3 years) with (N = 361) or without (N = 530) ASD. Data on consanguinity and covariates were collected through questionnaires and interviews.

RESULTS

The prevalence of consanguinity in the overall sample was 41.2% with no significant difference between cases and controls (42.1% vs 41.3%; p = .836). In adjusted multiple logistic regression analyses, consanguinity was not associated with risk of ASD (aOR = 1.065; 95% CI: .751-1.509; NS).

CONCLUSION

Parental consanguinity was not associated with autism risk in our study. Replication in other populations with high rates of consanguineous unions is recommended.

Multi-level treatment outcome evaluation in adolescents with autism spectrum disorder

BACKGROUND

Aberrant resting state electroencephalography (rsEEG) is a well-established indicator of psychopathological brain activity in clinical disorders. In Autism Spectrum Disorder (ASD), a substantial body of research reports reduced Alpha activity in the electrocortical resting state of affected individuals. However, effective interventions based on neurophysiological patterns and objective biological markers of treatment outcome remain scarce.

METHODS

In this randomized controlled trial, the primary objective was to examine rsEEG changes in adolescents with ASD following 24 sessions of slow cortical potential neurofeedback training (n = 21) compared to a treatment-as-usual control group (n = 20). A repeated-measures analysis of variance was used to assess group differences over time. Additionally, Pearson correlation analyses were conducted to exploratorily investigate associations between rsEEG measures and clinical psychopathology and affective well-being, as assessed via parental and self-report questionnaires at baseline and post-intervention.

RESULTS

Analyses revealed significant differences in the development of rsEEG between the intervention groups: while Alpha activity increased in the experimental neurofeedback group, it decreased in the control group, demonstrating an opposite trend. Exploratory analyses showed that Delta activity decreased in both groups, with a more pronounced decrease in the experimental group. Correlational analyses revealed significant associations between subjective-psychological and electrocortical levels: lower alpha power at baseline was related to greater severity of ASD symptoms, while both lower alpha and higher delta power were associated with greater negative affect at baseline. Increases in alpha power after NF-training were linked with enhanced positive affect, whereas reductions in delta power corresponded to decreases in negative affect.

CONCLUSIONS

This study provides insights into changes in resting-state neural activity before and after clinical interventions alongside clinical-psychological assessment, overcoming single-level assessments and emphasizing the need for multi-level outcome measures for a more comprehensive treatment evaluation.

CLINICAL TRIAL REGISTRATION

DRKS00012339.

Sensitivity and Specificity of Developmental Surveillance and Autism Screening in an Australian Multicultural Cohort: The Watch Me Grow Study

To examine accuracy of two-tiered surveillance to detect developmental disability and autism in a multicultural birth cohort; a subset of the Watch Me Grow Study. Surveillance tools were used at or soon after 18 months of age, including the Parents' Evaluation of Developmental Status (PEDS), the Ages and Stages Questionnaire (ASQ-3), and the revised Modified Checklist for Autism in Toddlers (M-CHAT-R/F). Children with and without identified concerns were assessed between 18 and 23 months using the Mullen Scales of Early Learning (MSEL) and the Autism Diagnostic Observation Schedule-2 (ADOS-2). Sensitivity and specificity of the surveillance tools used in isolation and in combination in this cohort ranged from 51 to 87% (n = 165). Some children (n = 21) who were not identified with high likelihood of difficulties were later assessed as having probable developmental disability. Adding the M-CHAT-R/F did not significantly improve autism likelihood identification in comparison with tiered developmental surveillance. There was highly variable sensitivity and specificity of combined tools for tiered developmental surveillance in this cohort. There remains a need in Australia to improve methods of, and engagement in, developmental screening and surveillance that includes detection of concerns in community and primary healthcare settings.

AI-driven report-generation tools in mental healthcare: A review of commercial tools

Artificial intelligence (AI) systems are increasingly being integrated in clinical care, including for AI-powered note-writing. We aimed to develop and apply a scale for assessing mental health electronic health records (EHRs) that use large language models (LLMs) for note-writing, focusing on their features, security, and ethics. The assessment involved analyzing product information and directly querying vendors about their systems. On their websites, the majority of vendors provided comprehensive information on data protection, privacy measures, multi-platform availability, patient access features, software update history, and Meaningful Use compliance. Most products clearly indicated the LLM's capabilities in creating customized reports or functioning as a co-pilot. However, critical information was often absent, including details on LLM training methodologies, the specific LLM used, bias correction techniques, and methods for evaluating the evidence base. The lack of transparency regarding LLM specifics and bias mitigation strategies raises concerns about the ethical implementation and reliability of these systems in clinical practice. While LLM-enhanced EHRs show promise in alleviating the documentation burden for mental health professionals, there is a pressing need for greater transparency and standardization in reporting LLM-related information. We propose recommendations for the future development and implementation of these systems to ensure they meet the highest standards of security, ethics, and clinical care.

Age-period-cohort analysis of autism spectrum disorders-related prevalence and DALYs: based on the Global Burden Of Disease Study 2021

Background

The Sustainable Development Goals (SDGs) call for systematic monitoring to optimize child development outcomes. As a developmental disorder affecting children and adults, Autism Spectrum Disorder (ASD) not only impacts individual social functioning but also places a burden on families and society. A detailed analysis of the latest global burden data on ASD can assist stakeholders in formulating support policies and interventions, thereby helping to meet the health needs of ASD.

Methods

We used data from the Global Burden of Disease Study 2021 (GBD 2021), compiled by the Institute for Health Metrics and Evaluation (IHME). Data were obtained through the Global Health Data Exchange (GHDx) and covered 204 countries and territories from 1990 to 2019. Variables included ASD-related prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates, and the sociodemographic index (SDI).

Results

Exposure to autism spectrum disorders contributed to 61823540 prevalence and 11544038 DALYs globally in 2021. Males and younger adults were high-risk populations. Higher socio-demographic index (SDI) regions were high-risk areas. The disease burden varied considerably across the GBD regions and the countries. From 1990 to 2021, the number of cases increased. The predicted results showed that the disease burden for both genders would still increase from 2022 to 2046. Countries or regions with a higher SDI have greater burden improvement potential.

Conclusion

The global burden of ASD has shown a continuous upward trend, with some differences observed across gender, age groups, and SDI regions. In terms of gender, the burden of ASD among females may be underestimated. Regarding age groups, the aging process has highlighted the urgent need to address ASD in the elderly population. High-SDI regions should place greater emphasis on improving diagnostic methods and implementing precise interventions, while middle- and low-SDI regions should focus on raising public awareness and enhancing screening capabilities.

Augmented Reality and Learning-Cognitive Outcomes in Autism Spectrum Disorder: A Systematic Review

BACKGROUND/OBJECTIVES

Augmented reality (AR) has emerged as a promising educational tool for individuals with autism spectrum disorder (ASD), offering interactive and engaging learning experiences. While AR interventions have been widely explored in educational contexts, their specific impact on learning outcomes in individuals with ASD remains unclear. This systematic review aimed to explore preliminary indications of the efficacy of augmented reality (AR)-based interventions in improving cognitive and academic skills in children, adolescents, and adults with ASD.

METHODS

A comprehensive literature search identified studies published between 2014 and 2024 that assessed AR interventions targeting learning outcomes in individuals with ASD.

RESULTS

A total of 12 studies (9 were single-subject studies), comprising 123 participants, met the inclusion criteria. The findings revealed that AR interventions contributed to improvements in multiple learning domains, including language acquisition, reading comprehension, mathematics, science education, executive functioning, and attention. AR-based applications were particularly effective in enhancing engagement, motivation, and interactive learning, addressing challenges commonly faced by individuals with ASD.

CONCLUSIONS

Findings suggest that AR can be a valuable tool for improving learning outcomes in individuals with ASD, and it could contribute to the inclusion and functional development of students with special needs.

Oculomics approaches using retinal imaging to predict mental health disorders: a systematic review and meta-analysis

OBJECTIVE

This meta-analysis evaluated the diagnostic performance of oculomics approaches, including deep learning, machine learning, and logistic regression models, in detecting major mental disorders using retinal imaging.

METHODS

A systematic review identified 11 studies for inclusion. Study quality was assessed using the QUADAS-2 tool, revealing a high risk of bias, particularly in patient selection and index test design. Pooled sensitivity and specificity were estimated using random-effects models, and diagnostic performance was evaluated through a summary receiver operating characteristic curve.

RESULTS

The analysis included 13 diagnostic models across 11 studies, covering major depressive disorder, bipolar disorder, schizophrenia, obsessive-compulsive disorder, and autism spectrum disorder using color fundus photography, and optical coherence tomography (OCT), and OCT angiography. The pooled sensitivity was 0.89 (95% CI: 0.78-0.94), and specificity was 0.87 (95% CI: 0.74-0.95). The pooled area under the curve was 0.904, indicating high diagnostic accuracy. However, all studies exhibited a high risk of bias, primarily due to case-control study designs, lack of external validation, and selection bias in 77% of studies. Some models showed signs of overfitting, likely due to small sample sizes, insufficient validation, or dataset limitations. Additionally, no distinct retinal patterns specific to mental disorders were identified.

CONCLUSION

While oculomics demonstrates potential for detecting mental disorders through retinal imaging, significant methodological limitations, including high bias, overfitting risks, and the absence of disease-specific retinal biomarkers, limit its current clinical applicability. Future research should focus on large-scale, externally validated studies with prospective designs to establish reliable retinal markers for psychiatric diagnosis.

Unraveling the causal pathways of maternal smoking and breastfeeding in the development of neuropsychiatric disorders: A Mendelian randomization perspective

BACKGROUND

Maternal smoking around birth (MSAB) and early-life breastfeeding (BAB) represent critical factors that may exert enduring effects on neuropsychiatric health. Although previous research has examined these exposures separately, the combined impact of both on disorders such as ADHD, ASD, BD, MDD, ANX, and SCZ remains unclear. This study aims to evaluate the causal relationships between MSAB and BAB and the risk of developing these neuropsychiatric disorders through Mendelian randomization (MR) analysis.

METHODS

A two-sample MR analysis was conducted to investigate the potential causal effects of MSAB and BAB on a range of neuropsychiatric disorders. Genetic variants associated with MSAB and BAB were obtained from genome-wide association studies (GWAS), while summary data for neuropsychiatric disorders were gathered from large GWAS consortia. The primary MR analysis was conducted using the inverse-variance weighted (IVW) method, with additional sensitivity analyses performed to confirm the robustness of the findings. A False Discovery Rate (FDR) correction was applied to control for the issue of multiple comparisons and reduce the risk of Type I errors.

RESULTS

The IVW analysis indicated that there were significant associations between MSAB and an increased risk of the following conditions: The IVW analysis indicated significant associations between MSAB and an increased risk of ADHD (odds ratio [OR] = 5.36, 95 % confidence interval [CI] = 2.58-7.63, p-value for false discovery rate [PFDR] = 0.004) and major depressive disorder (MDD) (OR = 1.92, 95 % CI = 1.29-2.88, PFDR = 0. Furthermore, significant associations were observed between MSAB and an increased risk of bipolar disorder (BD) (OR = 6.33, 95 % CI = 1.56-8.73, PFDR = 0.020), anxiety disorders (ANX) (OR = 1.03, 95 % CI = 1.00-1.05, PFDR = 0.039), and attention deficit hyperactivity disorder (ADHD) (OR = 5.36, 95 % CI = 2.58-7.63, PFDR = 0.004). No significant associations were identified between MSAB and Autism Spectrum Disorder (ASD) or Schizophrenia (SCZ). In contrast, the results indicated that BAB was associated with a protective effect against ADHD (OR = 0.17, 95 % CI = 0.04-0.63, PFDR = 0.025), MDD (OR = 0.26, 95 % CI = 0.12-0.58, PFDR = 0.006), and ANX (OR = 0.96, 95 % CI = 0.49-0.99, PFDR = 0.030). No significant effects of BAB were observed for ASD, BD, or SCZ.

CONCLUSIONS

This study shows that maternal smoking around the time of birth increases the risk of attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), bipolar disorder (BD), and anxiety disorders (ANX). In contrast, breastfeeding during infancy offers protective benefits against ADHD, MDD, and ANX. These findings underscore the vital importance of maternal health behaviours during the perinatal and infant feeding periods. They also highlight the need for targeted public health interventions aimed at reducing the risk of neuropsychiatric disorders.

Environmental exposure to common pesticide induces synaptic deficit and social memory impairment driven by neurodevelopmental vulnerability of hippocampal parvalbumin interneurons

Environmental exposure to pesticides at levels deemed safe by regulatory agencies has been linked to increased risk for neurodevelopmental disorders. Yet, the mechanisms linking exposure to these disorders remain unclear. Here, we show that maternal exposure to the pesticide deltamethrin (DM) at the no observed adverse effect level (NOAEL) disrupts long-term potentiation (LTP) in the hippocampus of adult male offspring three months after exposure, a phenotype absent in female offspring. Clonazepam, a GABAa receptor agonist, rescued this deficit, indicating impaired hippocampal GABAergic signaling. Recordings from CA1 pyramidal neurons, complemented by MALDI mass spectrometry imaging, showed an imbalance in excitatory/inhibitory tone. Using a combination of parvalbumin (PV)-Cre transgenic mice and hippocampal injection of designer receptors exclusively activated by designer drugs (DREADDs), we show that developmental DM exposure reduces hippocampal PV interneuron intrinsic firing. DREADD activation rescued both PV interneuron firing and LTP deficits. Complementary behavioral experiments revealed a deficit in social memory, a behavior relevant to autism spectrum disorder (ASD) symptomatology, which was restored by DREADD activation. Overall, these results establish a novel mechanistic link between maternal exposure to DM at the NOAEL and known cellular, circuital, and behavioral vulnerabilities, indicating it is a potential driver in the exposome of ASD.

Latest clinical frontiers related to autism diagnostic strategies

The diagnosis of autism is currently based on the developmental history, direct observation of behavior, and reported symptoms, supplemented by rating scales/interviews/structured observational evaluations-which is influenced by the clinician's knowledge and experience-with no established diagnostic biomarkers. A growing body of research has been conducted over the past decades to improve diagnostic accuracy. Here, we provide an overview of the current diagnostic assessment process as well as of recent and ongoing developments to support diagnosis in terms of genetic evaluation, telemedicine, digital technologies, use of machine learning/artificial intelligence, and research on candidate diagnostic biomarkers. Genetic testing can meaningfully contribute to the assessment process, but caution is required when interpreting negative results, and more work is needed to strengthen the transferability of genetic information into clinical practice. Digital diagnostic and machine-learning-based analyses are emerging as promising approaches, but larger and more robust studies are needed. To date, there are no available diagnostic biomarkers. Moving forward, international collaborations may help develop multimodal datasets to identify biomarkers, ensure reproducibility, and support clinical translation.

A short investigation of the effect of the selection of human brain atlases on the performance of ASD's classification models

This study investigated the impact of brain atlas selection on the classification accuracy of Autism Spectrum Disorder (ASD) models using functional Magnetic Resonance Imaging (fMRI) data. Brain atlases, such as AAL, CC200, Harvard-Oxford, and Yeo 7/17, are used to define regions of interest (ROIs) for fMRI analysis and play a crucial role in enabling researchers to study connectivity patterns and neural dynamics in ASD patients. Through a systematic review, we examined the performance of different atlases in various machine-learning and deep-learning frameworks for ASD classification. The results reveal that atlas selection significantly affects classification accuracy, with denser atlases, such as CC400, providing higher granularity, whereas coarser atlases such as AAL, offer computational efficiency. Furthermore, we discuss the dynamics of combining multiple atlases to enhance feature extraction and explore the implications of atlas selection across diverse datasets. Our findings emphasize the need for standardized approaches to atlas selection and highlight future research directions, including the integration of novel atlases, advanced data augmentation techniques, and end-to-end deep-learning models. This study provides valuable insights into optimizing fMRI-based ASD diagnosis and underscores the importance of interpreting atlas-specific features for an improved understanding of brain connectivity in ASD.

Supporting Families to 'Make the Most' of the Relationship Between Their Companion Dogs and Their Children with Autism Spectrum Condition: A Qualitative Exploration of the 'Family Dog Service'

Evidence suggests that assistance and therapy dogs can positively impact the mental and physical health of children with autism spectrum condition (ASC) and their families. However, these services are often costly and inaccessible. As an alternative, companion dogs (e.g., non-specialist-trained pet dogs) may offer similar benefits. To support families in selecting and training a dog to benefit the whole family, a charity named Dogs for Good has designed the Family Dog Service. This qualitative study aimed to explore the perceived impact of human-dog interactions and relationships for children with ASC and their families, and their perceptions of the Family Dog Service. Interviews were conducted with 16 parents of children with ASC who had engaged with the service within the last five years. Thematic analysis identified four main themes. These related to the positive impact of the companion dog on the child with ASC (e.g., enhanced focus and attention, reduction in loneliness, and reduced anxiety-based behaviours) and the parents (e.g., increased respite and wellbeing). However, parents also reported challenges of dog ownership (e.g., adjustment to routines and barriers associated with the development of the human-dog relationship). These challenges appeared to be mitigated by tailored guidance and support from the Family Dog Service. The findings indicate that companion dog ownership provided benefits to children with ASC and their families, similar to those reported for autism assistance dogs. While the findings do not suggest that companion dogs can replace the important role played by specialist trained assistance dogs, it is possible that reported benefits may occur due to the development of the human-dog relationship, facilitated by the support offered by the Family Dog Service. The service may provide a practical, valuable alternative in light of restrictions and challenges often associated with securing assistance dog placements.

Family Intensive Behavioral Intervention for Children with Autism Spectrum Disorder: A Half-Year Comparison-Controlled Study

Objective

Family intervention is a crucial component of treatment for children with autism spectrum disorder (ASD), yet the impact of parent-mediated family-intensive behavioral intervention on the language abilities of children with ASD has been barely studied. The purpose is to investigate the effectiveness of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)-based family-intensive behavioral intervention in enhancing the language abilities of children with ASD. This study provides insights to help ASD children better cope with daily life.

Methods

From September 2020 to September 2022, a total of 85 clinically diagnosed children with ASD and 30 age- and sex-matched children without ASD were recruited. Applied Behavior Analysis (ABA) and VB-MAPP were used for evaluating and determining individualized intervention programs for children with ASD. The intervention lasted 6 months.

Results

There were no significant differences in demographic characteristics between children with ASD and children without ASD (all p > 0.05), except for the mother's age. After the intervention, there was a significant increase in all VB-MAPP scores among children with ASD (all p < 0.001), compared with the baseline VB-MAPP total score and 16 domain scores. Tests of noninferiority showed that children with ASD at post-intervention were non-inferior to children without ASD in the Visual Perceptual Skills and Matching-to-Sample (VP/MTS) score (p = 0.001), play score (p = 0.034), reading score (p < 0.001), and writing score (p < 0.001).

Conclusions

Family-intensive behavioral intervention significantly improved the skills of children with ASD, as assessed by the VB-MAPP. These findings emphasize the importance of family intervention and provide further support for proposing a family intervention program for children with ASD that is suitable for China's national conditions.

Neonatal infection with Bordetella pertussis promotes autism-like phenotypes in mice

Autism spectrum disorder (ASD) has been linked with infections early in life. Here we demonstrate that the infection of neonatal mice with the respiratory pathogen Bordetella pertussis leads to neuroinflammation, neurodevelopmental defects, and ASD-like behaviors. Following the respiratory challenge of neonatal mice with B. pertussis, multiple atypical CNS findings were observed, including blood-brain barrier disruption, dissemination of live B. pertussis bacteria to the brain with the concomitant infiltration of inflammatory monocytes, neutrophils, and activated IL-17A- and IFN-γ-producing CD4 T cells. Microglia from infected mice were activated, with impaired phagocytic function, resulting in defective synaptic pruning and disrupted neuronal circuit formation. Impaired neurodevelopment in B. pertussis-infected post-natal mice was associated with ASD-like behavioral abnormalities in young adulthood. Our data indicate that infection with virulent B. pertussis during infancy increases the risk of autism-like behavior in young adult mice. A study into the potential role of B. pertussis in human ASD is warranted.

Comparison of the Clancy Autism Behavior Scale and Autism Behavior Checklist for Screening Autism Spectrum Disorder

PURPOSE

To make early detection of individuals with autism spectrum disorder (ASD), caregiver-report instruments remain an efficient and adaptable option for the preliminary assessment. This study aimed to compare the psychometric properties of the Clancy Autism Behavior Scale (CABS) and Autism Behavior Checklist (ABC) as screening tools for ASD by caregivers.

METHODS

The data were collected from 154 pairs of children and their parents, who sought medical attention for suspected autism at Peking University Sixth Hospital. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, Youden index, and area under the receiver operating characteristics curves (AUC) of the CABS and ABC were calculated and compared using recommended cut-off values from initial papers. The optimal cut-off values for CABS and ABC were determined according to the maximum Youden index.

RESULTS

The ABC performed better than the CABS in screening autistic persons. Specifically, the ABC demonstrated higher sensitivity than the CABS in identifying children with ASD, while the CABS exhibited superior specificity compared to the ABC. According to the maximum Youden index, the optimal cut-off value was determined to be 13 for CABS and 62 for ABC.

CONCLUSION

The ABC exhibits higher sensitivity and overall performance in screening individuals with ASD compared to the CABS. The ABC is more suitable as a screening tool for caregivers in both domestic and clinical settings, while the CABS may be utilized when evaluation time or medical resources are limited due to its shorter completion time and fewer items.

Using Instructions and Acoustic Feedback to Improve Staff Delivery of Behavior-Specific Praise in a Clinical Setting

Past research has shown the effectiveness of contingent acoustic feedback (CAF) in various human performance settings, but its impact on staff performance in clinical settings remains unclear. The current study replicated and extended Herron et al. (2018) by using vocal instructions and CAF to teach staff to use behavior-specific praise (BSP) to reinforce designated client behavior in a clinical setting. Results from a multiple-baseline-across-staff design revealed that this intervention increased the rate at which staff used BSP to reinforce designated client behavior. Paired sample t-tests showed a significant increase in the rate of BSP for each participant from baseline to the intervention phase, and participants maintained increased rates of BSP during probes conducted 1 to 3 weeks after the intervention was complete. Additionally, paired sample t-tests showed statistically significant increases in the rates of designated behavior for each client. Participants also rated the instructions and CAF procedure as more worthwhile, helpful, relevant, pleasant, and less disruptive than feedback methods typically used in their agency.

Gut microbial 'TNFα-sphingolipids-steroid hormones' axis in children with autism spectrum disorder: an insight from meta-omics analysis

BACKGROUND

Autism spectrum disorder (ASD) is a persistent neurodevelopmental disorder affecting brains of children. Mounting evidences support the associations between gut microbial dysbiosis and ASD, whereas detailed mechanisms are still obscure.

METHODS

Here we probed the potential roles of gut microbiome in ASD using fecal metagenomics and metabolomics.

RESULTS

Children with ASD were found to be associated with augmented serum cytokines milieu, especially TNFα. Metagenomic analysis generated 29 differential species and 18 dysregulated functional pathways such as Bifidobacterium bifidum, Segatella copri, and upregulated 'Sphingolipid metabolism' in children with ASD. Metabolomics revealed steroid hormone dysgenesis in children with ASD with lower abundances of metabolites such as estriol, estradiol and deoxycorticosterone. A three-way association analysis showed positive correlations between TNFα and microbial function potentials such as 'Bacterial toxins' and 'Lysosome', indicating the contribution of microbial dysbiosis to neuroinflammation. TNFα also correlated positively with 'Sphingolipid metabolism', which further showed negative correlations with metabolites estriol and deoxycorticosterone. Such results, in consistent with current findings, revealed the contribution of increased TNFα to upregulated sphingolipid metabolism, which further impaired steroid hormone biosynthesis.

CONCLUSION

Our study proposed the gut microbial 'TNFα-sphingolipids-steroid hormones' axis in children with ASD, which may provide new perspectives for developing gut microbiome-based treatments in the future.

Fecal Microbiota Transplantation in Children with Autism

Purpose

This research aimed to explore the clinical efficacy of fecal microbiota transplantation (FMT) in treating children with autism spectrum disorder (ASD).

Methods

In this single-arm prospective study, every participant received FMT therapy, followed by an 8-week follow-up. Children unable to swallow lyophilized capsules (Caps) received fecal solution through transendoscopic enteral tube (TET) or nasal jejunal tube (NJT) approaches. All participants underwent assessments of ASD core symptoms, gastrointestinal (GI) symptoms and sleep status initially, after treatment and during follow-up. The study outcomes included the changes in scores of the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), Gastrointestinal Symptoms Rating Scale (GSRS) and Sleep Disturbance Scale for Children (SDSC), as well as the adverse events (AEs).

Results

98 participants were involved, consisting of 80 males and 18 females, with a median age of 7 years. 73 children received the FMT in the form of Caps, while 13 patients underwent the procedure through TET and 12 patients via NJT. Improvements were observed in all outcome measures for Caps and NJT groups at both the post-treatment and 8-week follow-up evaluations. Adjusted between-group analyses at post-treatment and follow-up showed that Caps and NJT group had greater reduction in ABC, CARS and SRS scores compared with TET group, while NJT group had greater reduction in SDSC scores compared with Caps and TET group. The incidence of AEs was 8.2% in the Caps group, 23.1% in the TET group, and 8.3% in the NJT group, with no serious AEs reported.

Conclusion

FMT treatment can improve the core symptoms, GI symptoms and sleep disturbances in children with ASD. The upper GI tract routes, including Caps and NJT, may be more effective and safe compared to the lower GI tract route of TET.

Fecal Microbiota Transplantation: Indications, Methods, and Challenges

Over the past two decades, as the importance of gut microbiota to human health has become widely known, attempts have been made to treat diseases by correcting dysbiosis of gut microbiota through fecal microbiota transplantation (FMT). Apart from current knowledge of gut microbiota, FMT to treat disease has a long history, from the treatment of food poisoning in the fourth century to the treatment of Clostridioides difficile infections in the twentieth century. In 2013, FMT was recognized as a standard treatment for recurrent C. difficile because it consistently showed high efficacy. Though recurrent C. difficile is the only disease internationally recognized for FMT efficacy, FMT has been tested for other diseases and shown some promising preliminary results. Different FMT methods have been developed using various formulations and administration routes. Despite advances in FMT, some issues remain to be resolved, such as donor screening, manufacturing protocols, and unknown components in the fecal microbiota. In this review, we discuss the mechanisms, clinical indications, methods, and challenges of current FMT. We also discuss the development of alternative therapies to overcome the challenges of FMT.

Nigerian Hospital and Community Pharmacists' Knowledge, Awareness, and Perceptions of Autism Spectrum Disorders

Background

Pharmacists can play a role in enhancing treatment outcomes of autistic people, but they must possess sufficient knowledge and awareness of autism spectrum disorders (ASD). Current evidence is scant among Nigerian pharmacists. The objectives of this study were to: (1) Describe and compare Nigerian hospital and community pharmacists' ASD knowledge, awareness, and perceptions; (2) Determine if there is a significant correlation between ASD knowledge, awareness, and perceptions; (3) Determine if demographic and practice-related factors are significantly related to pharmacists' ASD awareness.

Method

Hospital and community pharmacists were administered a self-report survey to assess ASD knowledge and awareness, as well as confidence in caring for autistic people, and perceived benefits of ASD training and care. Data were collected from August to December 2021 and analyzed using inferential and descriptive statistics. Cronbach's alphas were used to assess reliability.

Results

Of respondents, (Total N = 383; N = 201 hospital pharmacists from various states) and N = 182 community pharmacists in Lagos state) community pharmacists had significantly higher mean knowledge than hospital pharmacists (58.10% ± 19.00% vs 53.20% ± 20.10%; P = .016). Overall mean awareness score was 2.90 ± 0.80, with no significant difference between community and hospital pharmacists (P = .096). Perception regarding ASD continuing education (CE) was strongly correlated with the perceived benefits of pharmacy services to autistic people in Nigeria (r = .69; P < .0001). Additionally, awareness was positively correlated with knowledge (r = .47, P < .0001) and perceived confidence in ASD medication counseling (r = .54, P < .0001). Multivariate analysis revealed that being a hospital pharmacist, having courses on ASD during pharmacy degree programs, undergoing ASD CE, and having <5 years of practice experience were significantly (P < 0.05) associated with higher ASD awareness.

Conclusion

Respondents had suboptimal knowledge and awareness of ASD. Including ASD in the pharmacy curriculum and providing CE programs may help improve pharmacists' ability to provide more optimal patient care services for autistic people.

Relationship between global warming and autism spectrum disorder from 1990 to 2019

BACKGROUND

Despite mounting evidence linking neurological diseases with climate change, the link between autism spectrum disorder (ASD) and global warming has yet to be explored.

AIMS

To examine the relationship between the incidence of ASD and global warming from 1990 to 2019 and estimate the trajectory of ASD incidence from 2020 to 2100 globally.

METHOD

We extracted meteorological data from TerraClimate between 1990 and 2019. To estimate the association between global ASD incidence and temperature variation, we adopted a two-stage analysis strategy using a generalised additive regression model. Additionally, we projected future ASD incidence under four representative shared socioeconomic pathways (SSPs: 126, 245, 370 and 585) by bootstrapping.

RESULTS

Between 1990 and 2019, the global mean incidence of ASD in children under 5 years old was 96.9 per 100 000. The incidence was higher in males (147.5) than in females (46.3). A 1.0 °C increase in the temperature variation was associated with a 3.0% increased risk of ASD incidence. The association was stronger in boys and children living in a low/low-middle sociodemographic index region, as well as in low-latitude areas. According to the SSP585 scenario, by 2100, the children living in regions between 10 and 20° latitude, particularly in Africa, will experience a 68.6% increase in ASD incidence if the association remains. However, the SSP126 scenario is expected to mitigate this increase, with a less than 10% increase in incidence across all latitudes.

CONCLUSIONS

Our study highlights the association between climate change and ASD incidence worldwide. Prospective studies are warranted to confirm the association.

Involvement of sphingosine-1-phosphate receptor 1 in pain insensitivity in a BTBR mouse model of autism spectrum disorder

BACKGROUND

Abnormal sensory perception, particularly pain insensitivity (PAI), is a typical symptom of autism spectrum disorder (ASD). Despite the role of myelin metabolism in the regulation of pain perception, the mechanisms underlying ASD-related PAI remain unclear.

METHODS

The pain-associated gene sphingosine-1-phosphate receptor 1 (S1PR1) was identified in ASD samples through bioinformatics analysis. Its expression in the dorsal root ganglion (DRG) tissues of BTBR ASD model mice was validated using RNA-seq, western blot, RT-qPCR, and immunofluorescence. Pain thresholds were assessed using the von Frey and Hargreaves tests. Patch-clamp techniques measured KCNQ/M channel activity and neuronal action potentials. The expression of S1PR1, KCNQ/M, mitogen-activated protein kinase (MAPK), and cyclic AMP/protein kinase A (cAMP/PKA) signaling proteins was analyzed before and after inhibiting the S1P-S1PR1-KCNQ/M pathway via western blot and RT-qPCR.

RESULTS

Through integrated transcriptomic analysis of ASD samples, we identified the upregulated gene S1PR1, which is associated with sphingolipid metabolism and linked to pain perception, and confirmed its role in the BTBR mouse model of ASD. This mechanism involves the regulation of KCNQ/M channels in DRG neurons. The enhanced activity of KCNQ/M channels and the decreased action potentials in small and medium DRG neurons were correlated with PAI in a BTBR mouse model of ASD. Inhibition of the S1P/S1PR1 pathway rescued baseline insensitivity to pain by suppressing KCNQ/M channels in DRG neurons, mediated through the MAPK and cAMP/PKA pathways. Investigating the modulation and underlying mechanisms of the non-opioid pathway involving S1PR1 will provide new insights into clinical targeted interventions for PAI in ASD.

CONCLUSIONS

S1PR1 may contribute to PAI in the PNS in ASD. The mechanism involves KCNQ/M channels and the MAPK and cAMP/PKA signaling pathways. Targeting S1PR1 in the PNS could offer novel therapeutic strategies for the intervention of pain dysesthesias in individuals with ASD.

Evaluating the impact of needs assessment models on autistic children's participation in the habilitation process: protocol for a prospective observational study

INTRODUCTION

The rising prevalence of autism spectrum disorder (ASD) among children poses significant challenges for healthcare services. Research has underscored the crucial role of children's involvement in their healthcare. However, due to the intricate nature of ASD, marked by communication and social interaction differences, healthcare providers face challenges in tailoring their services to accommodate these children. This project aims to explore the impact of two distinct needs assessment models on children's participation in the needs assessment process.

METHODS AND ANALYSIS

We will conduct a prospective observational study comparing responses from children subjected to two different needs assessment procedures: survey-based and meeting-based. Supplementary data will be collected from the children's parents/guardians and healthcare professionals. Data collection methods will include questionnaires, interviews and document analysis of individual habilitation plans. We aim to recruit 120 children aged 7-17 diagnosed with ASD but without intellectual disability, with 60 undergoing the survey-based needs assessment and 60 undergoing the meeting-based assessment. The primary outcome measure will be the perception of participation in the needs assessment procedure. Secondary outcomes will include the children's quality of life and mental health; the parents' knowledge of their child's strengths, abilities and special needs; and the parents' perception of the quality of collaboration with the healthcare team.

ETHICS AND DISSEMINATION

The study received ethics approval from the Swedish Ethical Review Authority on 4 March 2024 (reference number 2024-00227-01). All children and their caregivers will receive both verbal and written information about the study before being asked to provide written informed consent to participate. The findings will be disseminated through publication in peer-reviewed journals and presentation at conferences. Additionally, a popular science report summarising the data and its interpretation will be published.

TRIAL REGISTRATION NUMBER

NCT06381856.

Mobile App-Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial

BACKGROUND

In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members.

OBJECTIVE

We aimed to develop and evaluate the feasibility of a mobile app-assisted parent training program for reducing problem behaviors in children with ASD.

METHODS

This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app-assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app-assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior.

RESULTS

Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of -0.5 (95% CI -4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of -2.1 (95% CI -8.5 to 2.5). However, there was no significant difference in Clinical Global Impression-Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference -2, 95% CI -4 to 1). Caregivers' stress evaluated using the Korean Parenting Stress Index Fourth Edition-Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation.

CONCLUSIONS

The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices' accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD.

TRIAL REGISTRATION

CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112.

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.

Harnessing Virtual Reality: Improving Social Skills in Adults with Autism Spectrum Disorder

Background and Objectives: Autism Spectrum Disorder (ASD) involves challenges in social communication and daily functioning. Emerging research highlights that virtual reality (VR) interventions can significantly improve social skills in adults with ASD by providing immersive, controlled practice environments. This systematic review will assess the effectiveness of VR-based interventions for improving social skills in adults with ASD. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, and Embase databases without any search time range. This review was registered on Open OSF (n) P4SM5. Results: Recent studies show that VR interventions significantly enhance job interview skills, social abilities, and practical tasks in adults with ASD, with improvements in confidence, social understanding, and everyday skills. VR has been shown to be user-friendly and effective in providing immersive, adaptable training experiences. Conclusions: The review highlights VR's promising role in improving social skills, job interview abilities, and daily functioning in adults with ASD. It emphasizes the need for broader studies, standardized interventions, and exploration of VR's integration with other therapies to enhance long-term effectiveness and address comorbidities like anxiety and depression.

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.

Global burden and management of women with epilepsy in pregnancy: A modeling study

BACKGROUND

Most pregnant women with epilepsy do not receive proper medical care, which creates a special burden worldwide. We aimed to qualify this special global burden and assess the impact of different clinical management strategies to reduce it.

METHODS

The data used in this study were extracted from articles published between 2005 and 2022. We calculated the economic costs associated with major burdens experienced by pregnant women with epilepsy. We developed a microsimulation model to estimate the different effects of various interventions and their combinations as integrated strategies for pregnant women with epilepsy and related burden reduction. We also compared the regional differences in disease burden and interventions.

FINDINGS

The total economic burden for pregnant women with epilepsy is estimated to reach $1.8 billion globally annually, which is more than three times the burden for epilepsy alone. Folic acid supplementation is projected to be the most effective intervention, with a 9.1% reduction in major congenital malformations, a 14.9% reduction in autism spectrum disorder, and a 10.8% reduction in offspring-related economic burden globally annually. Integrated strategies are associated with a reduced economic burden of up to $37.7 million annually globally. Folic acid supplementation is the most effective intervention in high- and upper-middle-income countries, whereas changes in antiseizure medication prescriptions are more effective in lower-middle- and low-income countries.

CONCLUSION

This study highlights the huge burden for pregnant women with epilepsy and actions that must be taken to improve their quality of life.

FUNDING

This work was supported by the Sichuan Science and Technology Program (2023YFS0047).

Autism, youth suicide, and psychedelics: A review of the 21st century evidence

The concurrent rise in the prevalence of autism and youth suicide has drawn public health and professional attention. The renaissance of psychedelics in psychiatry occurred in the early 21st century and may suggest a hope for the therapeutic effect of psychedelics in autism and suicide. The psychedelics' molecular entities are the compounds that modulate the serotoninergic and glutamatergic systems, which play a crucial role in the pathomechanisms underlying autism and suicide. This systematic review comprehensively discussed the prevalence trends of autism and youth suicide globally and in Taiwan and discussed an association between autism and suicidality based on the 21st century clinical and preclinical literature. Furthermore, this review proposed a possible neurobiological connection between autism, suicide, and psychedelics. Finally, this review discussed the potential therapeutic applications of psychedelics in autism and youth suicide.

The role of isothiocyanate-rich plants and supplements in neuropsychiatric disorders: a review and update

Neuroinflammation in response to environmental stressors is an important common pathway in a number of neurological and psychiatric disorders. Responses to immune-mediated stress can lead to epigenetic changes and the development of neuropsychiatric disorders. Isothiocyanates (ITC) have shown promise in combating oxidative stress and inflammation in the nervous system as well as organ systems. While sulforaphane from broccoli is the most widely studied ITC for biomedical applications, ITC and their precursor glucosinolates are found in many species of cruciferous and other vegetables including moringa. In this review, we examine both clinical and pre-clinical studies of ITC on the amelioration of neuropsychiatric disorders (neurodevelopmental, neurodegenerative, and other) from 2018 to the present, including documentation of protocols for several ongoing clinical studies. During this time, there have been 16 clinical studies (9 randomized controlled trials), most of which reported on the effect of sulforaphane on autism spectrum disorder and schizophrenia. We also review over 80 preclinical studies examining ITC treatment of brain-related dysfunctions and disorders. The evidence to date reveals ITC have great potential for treating these conditions with minimal toxicity. The authors call for well-designed clinical trials to further the translation of these potent phytochemicals into therapeutic practice.

Exploring the landscape of adult autism research in psychology: a bibliometric and network analysis

The global prevalence of autism spectrum disorder (ASD) is increasing. ASD manifests with persistent social communication and interaction challenges, limited interests, and repetitive behaviors. As the scientific literature on ASD in adults varies greatly, mapping the recent global research becomes valuable for enhancing comprehension of this subject. This study aims to map recent global scientific publications on ASD in adults. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, bibliometrics, and network analyses, we assessed 850 articles indexed in the Web of Science Core Collection between 2013 and 2022 assigned to the research area of psychology. Findings indicate an annual average growth of 11.69%. Key keywords include Emotion, Anxiety, and Depression, with Anxiety, Depression, and Mental Health as central nodes in the network. Rehabilitation, Behavioral Sciences, and Psychiatry frequently co-occur, and Psychology, Psychiatry, and 'Neurosciences and Neurology' are central nodes in the network of research areas. The United States of America and the United Kingdom lead in publications, with the United Kingdom being the most central country in the network. King's College London and the University of California are the main research organizations, with King's College London as the central node in the network. The American Psychiatric Association's DSM-5-TR was the most cited reference in the period. This comprehensive analysis contributes to understanding the landscape of ASD research in adults, providing insights for future research and fostering collaborations.

The Face of Autism in Israel

This article seeks to offer a comprehensive perspective on autism in Israel, aligning with global reports. It aims to serve as a foundational resource for policymakers in developing relevant support and point to unmet needs. The data was drawn from publications by Israeli government authorities and academic publications. In 2022, the prevalence of child and adolescent autism in Israel was approximately 1.13%, with a male-to-female ratio of 4:1, and an annual increase of 23%, particularly among young children. In Israel, the diagnosis of autism follows the DSM-5 guidelines and is conducted by a physician and a psychologist specializing in autism. Typically, diagnosis is at age 2. The autism intervention approaches prevalent in Israel are consistent with those that are globally accepted. Children with autism are entitled to special education services adapted to their needs and developmental levels. The legally established package of services for children with autism includes sessions with occupational therapists, speech-language pathologists (SLPs), physical therapists, psychologists, and social workers. Children and adults with autism are eligible for disability allowance along with support regarding residence, educational programs, and employment opportunities. Nonetheless, underdiagnosis and low accessibility to services are common in minority populations and rural areas. Furthermore, in recent years, services for autistic individuals have declined. This decline, particularly considering the ongoing rise in the prevalence of autism, pose significant challenges for Israeli government authorities in ensuring that autistic persons receive appropriate support.

Low-frequency RTMS attenuates social impairment in the VPA-induced mouse model

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social interactions and repetitive behaviors. Despite its prevalence, effective treatments remain elusive. Recent studies have highlighted the importance of the balance between GABAergic and glutamatergic neuronal synaptic functions in ASD development. Repetitive transcranial magnetic stimulation (RTMS) is a painless and effective treatment allowed for use in depression and obsessive-compulsive disorder. However, its efficacy in treating autism is still under investigation. Low-frequency RTMS (LF-RTMS), which shows promise in reducing autism-like behaviors, is considered to regulate synaptic function.

OBJECTIVE

We observed and recorded the behaviors of mice to assess the impact of RTMS on their social interactions and repetitive activities. Subsequently, we examined GABAergic and glutamatergic neuronal markers along with synaptic marker proteins to understand the underlying changes associated with these behaviors.

METHODS

To evaluate behaviors associated with autism spectrum disorder (ASD), several behavioral tests were conducted, focusing on sociability, repetitive behaviors, locomotion, anxiety, and depression. Additionally, Western blot and immunofluorescence staining were employed to investigate the activity of GABAergic and glutamatergic neurons in the hippocampus, aiming to understand the synaptic mechanisms underlying these behaviors.

RESULTS

LF-RTMS treatment effectively relieved the social disability and normalized synaptic function in the hippocampus of ASD mice model induced by valproate (VPA). Importantly, this treatment did not lead to any adverse effects on repetitive behavior, locomotion, anxiety, or depression.

CONCLUSION

LF-RTMS attenuated social disability without affecting repetitive behavior, locomotion, anxiety, or depression. Changes in the expression of GABAergic and glutamatergic neuronal synaptic proteins in the hippocampus were also observed.

Maternal high-fat or low-protein diets promote autism-related behavior and altered social behavior within groups in offspring male mice

Maternal malnutrition has been associated with neurodevelopmental deficits and long-term implications on the offspring's health and behavior. Here, we investigated the effects of maternal low-protein diet (LPD) or obesity-inducing maternal high-fat diet (HFD) on dyadic social interactions, group organization and autism-related behaviors in mice. We found that maternal HFD induced an autism-related behavioral phenotype in the male offspring, including a robust decrease in sociability, increased aggression, cognitive rigidity and repetitive behaviors. Maternal LPD led to a milder yet significant effect on autism-related symptoms, with no effects on olfactory-mediated social behavior. Under naturalistic conditions in a group setting, this manifested in altered behavioral repertoires, increased magnitude in dominance relations, and reduced interactions with novel social stimuli in the HFD male offspring, but not in the LPD offspring. Finally, we found HFD-induced transcriptomic changes in the olfactory bulbs of the male offspring. Together, our findings show that maternal malnutrition induces long-lasting effects on aggression and autism-related behaviors in male offspring, and potential impairments in brain regions processing chemosensory signals.

Prevalence of Autism in Scandinavian Countries (Denmark, Norway, Sweden), and Nordic Countries (Finland, Iceland, the Faroe Islands, and Greenland)

Aim

This study aims to identify and describe prevalence rates for ASD in the Scandinavian countries (Denmark, Norway, Sweden), as well as the Nordic countries (Finland, Iceland, the Faroe Islands, and Greenland).

Methods

A systematic review was conducted following PRISMA (2009) guidelines and based on the two databases: APA PsycINFO and MEDLINE (PubMed).

Results

A total of 13 studies were included in the analyses. It was not possible to identify ASD prevalence studies for Greenland. However, for the remaining countries descriptive increases in ASD prevalence figures were observed. Increases were evident both in relation to age and birth cohort. Studies varied regarding which age group and cohort prevalence figures were reported. The most reported age group was the 7-12-year-olds. In this group, recent prevalence figures for Denmark ranged from 0.26% to 1.47%, in Norway 0.6%, in Sweden 0.23-0.68%, in Finland 0.22-0.86%, and in Iceland 2.40-3.13%. Iceland stood out in terms of higher prevalence figures compared to the other Scandinavian and Nordic countries. Two studies from the Faroe Islands reported ASD prevalence rates between 0.50% and 0.94% for 7-24-year-olds. These studies were based on nationwide figures, but not from national or official registers.

Discussion and conclusion

This study documented increasing prevalence of ASD in Scandinavian and Nordic countries. Several explanations of aspects that may contribute to the increases were discussed, eg, heightened awareness of ASD and earlier diagnosis. The importance of considering differences in data sources was discussed, with an emphasis on the importance of using national registries when available as this source is the most reliable and valid. The absence of prevalence figures for Greenland may be attributed to structural as well as cultural aspects, eg, two parallel systems assessing ASD, cultural taboos as well as lack of awareness of ASD. Suggestions or how to gain knowledge on ASD prevalence in Greenland is presented.

Effect of Parental Severe Mental Disorders on the Timing of Autism Diagnosis: A Family Linkage Study

The mean diagnosis age of autism was about 5 years in Taiwan. Whether the delayed diagnosis of autism (≥ 6 years) was associated with parental severe mental disorders remained unknown. The parents of 22,859 autistic individuals and 228,590 age- and sex-matched nonautistic individuals were assessed for the presence of severe mental disorders (schizophrenia, bipolar disorder, major depressive disorder, alcohol use disorder, and substance use disorder). The timing of autism diagnosis was classified into three age categories: < 6 years, 6-11 years, and ≥ 12 years. Logistic regression models were used to examine associations between parental severe mental disorders and these age categories of autism diagnosis. Parental schizophrenia and substance use disorders were associated with the delayed diagnosis of autism, both diagnosis at ≥ 12 years (odds ratio [OR]: 2.14; 1.57) and at 6-11 years (1.87; 1.38). Parental bipolar disorder and major depressive disorder were also associated with the delayed diagnosis of autism, especially diagnosis at 6-11 years (OR 1.98; 1.86). Our findings underscore the need for clinicians to monitor the neurodevelopmental conditions of offspring born to parents with severe mental disorders during the early stages of their life.

Impact of Human Milk Oligosaccharides and Probiotics on Gut Microbiome and Mood in Autism: A Case Report

Recent evidence has highlighted the role of the gut-brain axis in the progression of autism spectrum disorder (ASD), with significant changes in the gut microbiome of individuals with this condition. This report investigates the effects of probiotics and human milk oligosaccharide (HMO) supplements on the gut microbiome, inflammatory cytokine profile, and clinical outcomes in an ASD adolescent with chronic gastrointestinal dysfunction and cognitive impairment. Following treatment, we observed a decrease in proinflammatory cytokines' concentration alongside Sutterella relative abundance, a bacterium reported to be linked with gastrointestinal diseases. Also, we reported a notable increase in mood stability. The study aims to evaluate the use of gut microbiome-based therapy in selected ASD patients, highlighting its potential to improve related clinical symptoms.

Protocol for a systematic review evaluating psychometric properties and gender-related measurement (non)invariance of self-report assessment tools for autism in adults

BACKGROUND

Given the recent evidence on gender differences in the presentation of autism, there is an increasing concern that current tools for autism do not adequately capture traits more often found in women. If tools for autism measure autistic traits differently based on gender alone, their validity may be compromised as they may not be measuring the same construct across genders. Measurement invariance investigations of autism measures can help assess the validity of autism constructs for different genders. The aim of this systematic review is to identify and critically appraise the psychometric properties of all self-report tools for autism in adults that meet two criteria: (a) they have been published since or included in the NICE (2014) recommendations, and (b) they have undergone gender-related measurement invariance investigations as part of their validation process.

METHODS

A search of electronic databases will be conducted from 2014 until the present using MEDLINE, Embase, and PsycINFO using predefined search terms to identify eligible studies. The search for grey literature will include sources such as OpenGrey, APA PsycEXTRA, and Scopus. Two reviewers will independently screen titles, abstracts, and full texts for eligibility. The references of included studies will be searched for additional records. The methodological quality of the studies will be evaluated using the COSMIN Risk of Bias checklist, while psychometric quality of findings will be assessed based on criteria for good measurement properties and ConPsy checklist. The quality of the total body of evidence will be appraised using the approach outlined in the modified GRADE guidelines.

DISCUSSION

This systematic review will be among the first to assess the psychometric properties and gender-related measurement invariance of self-reported measures for autism in adults that were published since (or included in) NICE (2014) guidelines. The review will provide recommendations for the most suitable tool to assess for autism without gender bias. If no such measure is found, it will identify existing tools with promising psychometric properties that require further testing, or suggest developing a new measure.

SYSTEMATIC REVIEW REGISTRATION

The protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO). The registration number is CRD42023429350.

Molecular profiling of the hippocampus of children with autism spectrum disorder

Several lines of evidence point to a key role of the hippocampus in Autism Spectrum Disorders (ASD). Altered hippocampal volume and deficits in memory for person and emotion related stimuli have been reported, along with enhanced ability for declarative memories. Mouse models have demonstrated a critical role of the hippocampus in social memory dysfunction, associated with ASD, together with decreased synaptic plasticity. Chondroitin sulfate proteoglycans (CSPGs), a family of extracellular matrix molecules, represent a potential key link between neurodevelopment, synaptic plasticity, and immune system signaling. There is a lack of information regarding the molecular pathology of the hippocampus in ASD. We conducted RNAseq profiling on postmortem human brain samples containing the hippocampus from male children with ASD (n = 7) and normal male children (3-14 yrs old), (n = 6) from the NIH NeuroBioBank. Gene expression profiling analysis implicated molecular pathways involved in extracellular matrix organization, neurodevelopment, synaptic regulation, and immune system signaling. qRT-PCR and Western blotting were used to confirm several of the top markers identified. The CSPG protein BCAN was examined with multiplex immunofluorescence to analyze cell-type specific expression of BCAN and astrocyte morphology. We observed decreased expression of synaptic proteins PSD95 (p < 0.02) and SYN1 (p < 0.02), increased expression of the extracellular matrix (ECM) protease MMP9 (p < 0.03), and decreased expression of MEF2C (p < 0.03). We also observed increased BCAN expression with astrocytes in children with ASD, together with altered astrocyte morphology. Our results point to alterations in immune system signaling, glia cell differentiation, and synaptic signaling in the hippocampus of children with ASD, together with alterations in extracellular matrix molecules. Furthermore, our results demonstrate altered expression of genes implicated in genetic studies of ASD including SYN1 and MEF2C.

Autism spectrum disorder (ASD) and sexual offending: A systematic review

The relationship between autism spectrum disorder (ASD) and sexual offending (SO) is an overlooked issue, both in clinical practice and in research. Based on a pre-specified protocol (PROSPERO: CRD42024501598), we systematically searched Pubmed and Scopus, between January 1st, 1994 and January 12th, 2024, for articles related to SO in ASD. Study quality was assessed with study design-specific tools (Study Quality Assessment Tools, NHLBI, NIH). We found 19 relevant publications (five cross-sectional studies, two case-control studies, and 12 case reports). Seven of the studies were deemed of "good" quality, the rest as "fair". Included studies addressed three key aspects: 1) psychopathological characteristics of individuals with ASD that increase the risk of committing SO; 2) intervention strategies for individuals with ASD and SO; 3) involvement of individuals with ASD and SO in the justice system. Overall, while there is an increasing interest in this topic, more rigorous study designs, including randomised controlled trials, are needed to inform clinical practice and healthcare and social policies.

Randomizing Human Brain Function Representation for Brain Disease Diagnosis

Resting-state fMRI (rs-fMRI) is an effective tool for quantifying functional connectivity (FC), which plays a crucial role in exploring various brain diseases. Due to the high dimensionality of fMRI data, FC is typically computed based on the region of interest (ROI), whose parcellation relies on a pre-defined atlas. However, utilizing the brain atlas poses several challenges including 1) subjective selection bias in choosing from various brain atlases, 2) parcellation of each subject's brain with the same atlas yet disregarding individual specificity; 3) lack of interaction between brain region parcellation and downstream ROI-based FC analysis. To address these limitations, we propose a novel randomizing strategy for generating brain function representation to facilitate neural disease diagnosis. Specifically, we randomly sample brain patches, thus avoiding ROI parcellations of the brain atlas. Then, we introduce a new brain function representation framework for the sampled patches. Each patch has its function description by referring to anchor patches, as well as the position description. Furthermore, we design an adaptive-selection-assisted Transformer network to optimize and integrate the function representations of all sampled patches within each brain for neural disease diagnosis. To validate our framework, we conduct extensive evaluations on three datasets, and the experimental results establish the effectiveness and generality of our proposed method, offering a promising avenue for advancing neural disease diagnosis beyond the confines of traditional atlas-based methods. Our code is available at https://github.com/mjliu2020/RandomFR.

Temporal and spatial trend analysis of all-cause depression burden based on Global Burden of Disease (GBD) 2019 study

Depression has been reported as one of the most prevalent psychiatric illnesses globally. This study aimed to obtain information on the global burden of depression and its associated spatiotemporal variation, by exploring the correlation between the global burden of depression and the social development index (SDI) and associated risk factors. Using data from the Global Burden of Disease study from 1990 to 2019, we described the prevalence and burden of disease in 204 countries across 21 regions, including sex and age differences and the relationship between the global disease burden and SDI. The age-standardized rate and estimated annual percentage change were used to assess the global burden of depression. Individuals with documented depression globally ranged from 182,183,358 in 1990 to 290,185,742 in 2019, representing an increase of 0.59%. More patients experienced major depressive disorder than dysthymia. The incidence and disability-adjusted life years of depression were the highest in the 60-64 age group and much higher in females than in males, with this trend occurring across all ages. The age-standardized incidence and adjusted life-years-disability rates varied with different SDI levels. Relevant risk factors for depression were identified. National governments must support research to improve prevention and treatment interventions.

Prevalence of autism spectrum disorder in mainland china over the past 6 years: a systematic review and meta-analysis

BACKGROUND

Coupled with its rising prevalence, Autism spectrum disorder (ASD) has become a globally recognized public health concern. Nevertheless, large-scale, multicenter studies that analyze the epidemiology of ASD in China are relatively scarce.

METHODS

Literature searches were conducted in PubMed/Medline, Embase, the Cochrane Library, Wanfang Data Knowledge Service Platform, China Biology Medicine database (CBM), China Science and Technology Journal Database (CSTJ), and China National Knowledge Infrastructure (CNKI) to retrieve studies published before April 8, 2023, related to ASD prevalence among children aged 0 to 14 years in mainland China. Meta-analysis was conducted using RevMan 5.2 and Stata 14.0.

RESULTS

Twenty-one articles were included. The ASD prevalence among children in mainland China has been 0.7% (95% confidence interval(CI): 0.006-0.008) since 2017. The prevalence of ASD among boys was 1.0% (95% CI: 0.008-0.011), which was significantly higher than that among girls at 0.2% (95% CI: 0.002-0.003), with a statistically significant difference (OR = 3.198, 95% CI: 2.489-4.109, P = 0.000). Among the included studies, 18 reported an ASD prevalence of 0.8% (95% CI: 0.007-0.010), while 3 studies reported an autistic disorder (AD) prevalence of 0.7% (95% CI: 0.006-0.008). The prevalence of autism among urban children was 23.9% (95% CI: 0.149-0.328), and in rural areas, it was 0.7% (95% CI: 0.002-0.013), with no statistically significant difference (OR = 1.342, 95% CI: 0.258-6.975, P = 0.727). Regression analysis showed that factors such as region (P = 0.000), age (P = 0.000), study period (P = 0.000), sample size (P = 0.000), sampling method (P = 0.002), population source (P = 0.000), disease type (P = 0.000), quality score of the study (P = 0.000), and diagnostic criteria (P = 0.000) might have contributed to the heterogeneity in ASD prevalence.

CONCLUSION

The prevalence of ASD in China from 2017 to 2023 was 7/1000, showing an upward trend compared to that before 2017 (26.50/10,000). The male-to-female prevalence ratio was 5:1.The overall prevalence remained significantly lower than that reported in foreign countries.

Prevalence of Autism Spectrum Disorder Among Children and Adolescents in the United States from 2021 to 2022

PURPOSE

The prevalence of autism spectrum disorder (ASD) among children and adolescents seem to be high in countries around the world, and it's worth understanding the latest prevalence and trends of ASD in children and adolescents. The purpose of this study was to examine the latest prevalence and decade trend of ASD among individuals aged 3-17 years in the United States.

METHODS

A total of 13,198 individuals aged 3-17 years were included. Annual data were examined from the National Health Interview Survey (2021-2022). Weighted prevalence for each of the selected developmental disabilities were calculated.

RESULTS

This cross-sectional study estimated the weighted prevalence of autism spectrum disorder were 3.05, 3.79, and 3.42% among individuals aged 3-17 years in the US in 2021, 2022, and the 2-year overall, respectively. We also observed a decade-long upward trend even after adjusting for demographic characteristics (P for trend < .05).

CONCLUSION

The results of this study showed that the prevalence of ASD among children and adolescents aged 3-17 years in the United States remained high and has increased over the past decade. The further investigation is necessary to evaluate potential modifiable risk factors and causes of ASD.

Effects and microbiota changes following oral lyophilized fecal microbiota transplantation in children with autism spectrum disorder

Background and purpose

Autism spectrum disorder (ASD) is a group of heterogeneous neurodevelopmental disorders that is characterized by core features in social communication impairment and restricted, repetitive sensory-motor behaviors. This study aimed to further investigate the utilization of fecal microbiota transplantation (FMT) in children with ASD, both with and without gastrointestinal (GI) symptoms, evaluate the effect of FMT and analyze the alterations in bacterial and fungal composition within the gut microbiota.

Methods

A total of 38 children diagnosed with ASD participated in the study and underwent oral lyophilized FMT treatment. The dosage of the FMT treatment was determined based on a ratio of 1 g of donor stool per 1 kg of recipient body weight, with a frequency of once every 4 weeks for a total of 12 weeks. In addition, 30 healthy controls (HC) were included in the analysis. The clinical efficacy of FMT was evaluated, while the composition of fecal bacteria and fungi was determined using 16S rRNA and ITS gene sequencing methods.

Results

Median age of the 38 children with ASD was 7 years. Among these children, 84.2% (32 of 38) were boys and 81.6% (31 of 38) exhibited GI symptoms, with indigestion, constipation and diarrhea being the most common symptoms. Sample collections and assessments were conducted at baseline (week 0), post-treatment (week 12) and follow-up (week 20). At the end of the follow-up phase after FMT treatment, the autism behavior checklist (ABC) scores decreased by 23% from baseline, and there was a 10% reduction in scores on the childhood autism rating scale (CARS), a 6% reduction in scores on the social responsiveness scale (SRS) and a 10% reduction in scores on the sleep disturbance scale for children (SDSC). In addition, short-term adverse events observed included vomiting and fever in 2 participants, which were self-limiting and resolved within 24 h, and no long-term adverse events were observed. Although there was no significant difference in alpha and beta diversity in children with ASD before and after FMT therapy, the FMT treatment resulted in alterations in the relative abundances of various bacterial and fungal genera in the samples of ASD patients. Comparisons between children with ASD and healthy controls (HC) revealed statistically significant differences in microbial abundance before and after FMT. Blautia, Sellimonas, Saccharomycopsis and Cystobasidium were more abundant in children with ASD than in HC, while Dorea were less abundant. After FMT treatment, levels of Blautia, Sellimonas, Saccharomycopsis and Cystobasidium decreased, while levels of Dorea increased. Moreover, the increased abundances of Fusicatenibacter, Erysipelotrichaceae_UCG-003, Saccharomyces, Rhodotorula, Cutaneotrichosporon and Zygosaccharomyces were negatively correlated with the scores of ASD core symptoms.

Conclusions

Oral lyophilized FMT could improve GI and ASD related symptoms, as well as sleep disturbances, and alter the gut bacterial and fungal microbiota composition in children with ASD.

Clinical Trial Registration

Chinese Clinical Trial Registry, ChiCTR2200055943. Registered 28 January 2022, www.chictr.org.cn.

Language Preferences in the Dutch Autism Community: A Social Psychological Approach

This research examined the preference for identity-first language (IFL) versus person-first language (PFL) among 215 respondents (Mage = 30.24 years, SD = 9.92) from the Dutch autism community. We found that a stronger identification with the autism community and a later age of diagnosis predicted a stronger IFL preference and a weaker PFL preference. Both effects were mediated by the perceived consequences (justice to identity, prejudice reduction) of PFL. Participants' own explanations were in line with these statistical analyses but also provided nuance to the IFL-PFL debate. Our results are consistent with the Social Identity Approach (Reicher et al., 2010) and Identity Uncertainty Theory (Hogg, 2007) and demonstrate the value of a social psychological approach to study disability language preferences.

The burden of mental disorders in Asian countries, 1990-2019: an analysis for the global burden of disease study 2019

Mental disorders are the leading contributors to the globally nonfatal burden of disease. This study was aimed to estimate the burden of mental disorders in Asian countries. Based on GBD 2019, the prevalence and disability-adjusted life of years (DALYs) rates with 95% uncertainty intervals (UI) were estimated in Asian countries. Predictions for the future burden of 8 selected countries, ranks of the burden of mental disorders and correlations with Sociodemographic Index (SDI) were also estimated. During the past 3 decades, while the number of DALYs of mental disorders increased from 43.9 million (95% UI: 32.5-57.2) to 69.0 million (95% UI: 51.0-89.7), the age-standardized rates of DALYs of mental disorders remained largely consistent from 1452.2 (95% UI: 1080.16-1888.53) per 100,000 population in 1990 to 1434.82 (95% UI: 1065.02-1867.27) per 100,000 population in 2019, ranked as the eighth most significant disease burden in Asia in 2019. Depressive disorders (37.2%) were the leading contributors to the age-standardized DALY rates of mental disorders in Asia, followed by anxiety disorders (21.5%). The age-standardized DALY rates in females were higher than their male counterparts, both peaked at 30-34 years. The age-standardized DALY rates were predicted to remain stable, with the number of DALYs presented an upward trend in the future. There was no significant correlation between the burden of mental disorders and SDI. All mental disorders ranked higher in 2019, compared in 1990. To reduce this burden, urgent measures for prevention, treatment, and rehabilitation for mental disorders need to be taken by Asian governments.