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

Autism spectrum disorder: difficulties in diagnosis and microRNA biomarkers

We performed a PubMed search for microRNAs in autism spectrum disorder that could serve as diagnostic biomarkers in patients and selected 17 articles published from January 2008 to December 2023, of which 4 studies were performed with whole blood, 4 with blood plasma, 5 with blood serum, 1 with serum neural cell adhesion molecule L1-captured extracellular vesicles, 1 with blood cells, and 2 with peripheral blood mononuclear cells. Most of the studies involved children and the study cohorts were largely males. Many of the studies had performed microRNA sequencing or quantitative polymerase chain reaction assays to measure microRNA expression. Only five studies had used real-time polymerase chain reaction assay to validate microRNA expression in autism spectrum disorder subjects compared to controls. The microRNAs that were validated in these studies may be considered as potential candidate biomarkers for autism spectrum disorder and include miR-500a-5p, -197-5p, -424-5p, -664a-3p, -365a-3p, -619-5p, -664a-3p, -3135a, -328-3p, and -500a-5p in blood plasma and miR-151a-3p, -181b-5p, -320a, -328, -433, -489, -572, -663a, -101-3p, -106b-5p, -19b-3p, -195-5p, and -130a-3p in blood serum of children, and miR-15b-5p and -6126 in whole blood of adults. Several important limitations were identified in the studies reviewed, and need to be taken into account in future studies. Further studies are warranted with children and adults having different levels of autism spectrum disorder severity and consideration should be given to using animal models of autism spectrum disorder to investigate the effects of suppressing or overexpressing specific microRNAs as a novel therapy.

Altered monocyte subpopulations and their association with autism spectrum disorder risk in children

OBJECTIVE

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in social communication, restricted interests, and repetitive behaviors. Emerging evidence suggests a link between immune dysregulation and ASD. This study investigates alterations in monocyte subpopulations and cytokine production in children with ASD and their potential associations with ASD risk and severity.

METHODS

Initially, the immune status of peripheral blood mononuclear cells was assessed in cohort-I of 96 typically developing (TD) children and 92 children diagnosed with ASD using flow cytometry. Subsequently, the secretion of cytokines IL-6 and IL-10 by monocytes was evaluated following stimulation with a leukocyte activation mixture and intracellular protein staining technique in cohort-II.

RESULTS

Children with ASD exhibited significantly higher levels of total monocytes, classical monocytes (CD14hi/CD16-), and non-classical monocytes (CD14low/CD16+) compared to TD children (p < 0.001). Elevated levels of classical monocytes (β: 0.395; 95 %CI: 0.260-0.530; p < 0.001) and non-classical monocytes (β: 0.629; 95 %CI: 0.516-0.742; p < 0.001) were significantly associated with ASD after adjusting for age, sex and body mass index. Furthermore, increased production of IL-6 by monocytes was observed in children with ASD (p = 0.001). Logistic regression analysis revealed that classical monocytes (OR: 1.104; 95 %CI: 1.062-1.147; p < 0.001), non-classical monocytes (OR: 2.913; 95 %CI: 2.130-3.986; p < 0.001) and IL-6 production by monocytes (OR: 1.306; 95 %CI: 1.096-1.557; p = 0.003) are risk factors for ASD. Spearman correlation analysis revealed a negative correlation between classical monocyte levels and adaptive behavior developmental quotient (DQ) (r = - 0.377; p = 0.001), fine motor DQ (r = - 0.329; p = 0.003) and personal-social DQ (r = - 0.247; p = 0.029) in children with ASD.

CONCLUSION

Elevated classical and non-classical monocytes are potential risk factors for ASD and may influence neurodevelopmental outcomes. Further research is needed to elucidate the precise mechanisms and therapeutic implications.

Factors Associated with Confirmed and Unconfirmed Autism Spectrum Disorder Diagnosis in Children Volunteering for Research

PURPOSE

Diagnostic accuracy of autism spectrum disorder (ASD) is crucial to track and characterize ASD, as well as to guide appropriate interventions at the individual level. However, under-diagnosis, over-diagnosis, and misdiagnosis of ASD are still prevalent.

METHODS

We describe 232 children (MAge = 10.71 years; 19% female) with community-based diagnoses of ASD referred for research participation. Extensive assessment procedures were employed to confirm ASD diagnosis before study inclusion. The sample was subsequently divided into two groups with either confirmed ASD diagnoses (ASD+) or unconfirmed/inaccurate diagnoses (ASD-). Clinical characteristics differentiating the groups were further analyzed.

RESULTS

47% of children with community-based ASD diagnoses did not meet ASD criteria by expert consensus. ASD + and ASD- groups did not differ in age, gender, ethnicity, or racial make-up. The ASD + group was more likely to have a history of early language delays compared to the ASD- group; however, no group differences in current functional language use were reported by caregivers. The ASD + group scored significantly higher on ADI-R scores and on the ADOS-2 algorithm composite scores and calibrated severity scores (CSSs). The ASD- group attained higher estimated IQ scores and higher rates of psychiatric disorders, including anxiety disorder, disruptive behavior, and mood disorder diagnoses. Broadly, caregiver questionnaires (SRS-2, CCC-2) did not differentiate groups.

CONCLUSION

Increased reported psychiatric disorders in the ASD- group suggests psychiatric complexity may contribute to community misdiagnosis and possible overdiagnosis of ASD. Clinician-mediated tools (ADI-R, ADOS-2) differentiated ASD + versus ASD- groups, whereas caregiver-reported questionnaires did not.

Relationship Between Antipsychotic Use and Cholesterol Levels in a Retrospective Chart Review of an Adult Autism Clinic Patient Population

Individuals with autism spectrum disorder (ASD) experience a high prevalence of metabolic and gastrointestinal (GI) comorbidities. Antipsychotics are commonly prescribed for adults with ASD. Our study investigated the effect of antipsychotic medication on metabolic and GI comorbidities, as well as effects across age, in an adult ASD population. We retrospectively analyzed 279 charts from patients with ASD, ages 16-62 (mean = 27.97, SD = 8.89, 18.3% female). Data abstracted included demographic information, medications taken, GI and metabolic comorbidities, and recent values for body mass index (BMI), triglycerides, and total cholesterol. Participants were separated into two groups based on antipsychotic use. Between-group differences were calculated for the prevalence of GI comorbidities and mean values for BMI, triglycerides, and total cholesterol. Lastly, binary correlations were calculated for age and total cholesterol as well as triglycerides, and age and BMI. No significant difference was found between the prevalence of GI comorbidities for the two groups. For metabolic factors, no significant difference was found in the mean BMI, triglycerides, or total cholesterol. Binary correlation analysis also revealed no significant correlation between age and BMI or triglycerides for patients in either group. A significant correlation was found between age and total cholesterol for patients both taking and not taking antipsychotics. Despite approximately one in three patients in this study taking an antipsychotic medication, no significant differences in GI or metabolic comorbidities were found. However, cholesterol increased with age regardless of the presence or absence of antipsychotics. Future research is needed to better understand the long-term effects of antipsychotics on adults with ASD and metabolic monitoring in those not on antipsychotics.

A Meta-Analysis of the Effects of Gut Microbiota-Based Interventions on Gastrointestinal and Behavioral Symptoms in Children With Autism Spectrum Disorder

CONTEXT

Despite an increasing body of research showing gut microbiota-based interventions can improve gastrointestinal (GI) symptoms and behavioral symptoms in both humans and animals, there are still disagreements about its impact on autism spectrum disorder (ASD) in children.

OBJECTIVE

The goal of this systematic review and meta-analysis was to fully investigate the effects of gut microbiota-based interventions (eg, fecal microbiota transplantation, probiotics, prebiotics) on GI and behavioral symptoms in children with ASD.

DATA SOURCES

The PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, and Scopus databases were searched from inception to August 25, 2024.

DATA EXTRACTION

Data were extracted by 2 reviewers independently, and discrepancies in authors' judgments were resolved by discussion or consulting a third author.

DATA ANALYSIS

The scale score of GI and behavioral symptoms before and after the intervention was extracted from included trials to evaluate the therapeutic effects of gut microbiota-based therapy in children with autism.

RESULTS

A total of 5722 records were identified, of which 13 included in narrative synthesis and 8 studies included a meta-analysis. The nonsignificant overall effect size of gut microbiota-based intervention on GI symptoms (standardized mean difference [SMD] = -0.34 [95% CI, -0.76 to 0.07]; P = .11) and behavioral symptoms (SMD = -0.18 [95% CI, -0.37 to 0.02]; P = .08) was observed. Nevertheless, we observed a significant effect size on behavioral symptoms in the subgroup of the intervention duration (SMD = -0.26 [95% CI, -0.49 to -0.03]; P = .02).

CONCLUSIONS

In children with autism, the proof supporting the validity of gut microbiota-based intervention on GI and behavioral symptoms should be interpreted cautiously. More randomized controlled trials with rigorous methodological quality are required to precisely confirm the curative benefits of gut microbiota-based interventions on GI and behavioral symptoms in children with autism.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42024583213.

Effects of Pharmacological Treatment on Telomere Length and the Expression of Telomerase/Shelterin-Related Genes in Rat Models of Autism

Telomeres are increasingly recognized for their potential role in the etiology of autism spectrum disorder (ASD) due to their involvement in cellular aging and telomerase-shelterin function. Although shorter telomeres have been observed in individuals with ASD, studies linking telomere dynamics in blood cells and brain regions remain limited. Using the valproic acid (VPA, 500 mg/kg) rodent model, this study aimed to assess the impact of three drugs commonly used in ASD treatment (amitriptyline, risperidone, and nooclerin) on telomere length and the expression of telomerase/shelterin-related genes (Dkc1, Gar1, Pot1a, Pot1b, Tep1, Terc, Terf2ip, Tert, Tinf2, Tnks, Tpp1, Trf1, and Trf2) in blood cells, the prefrontal cortex, and hippocampus of VPA-exposed Wistar rats. Telomere length and gene expression were measured using quantitative PCR. Risperidone treatment in VPA males resulted in telomere elongation and increased expression of Tnks in blood cell and Trf1, Trf2 genes in prefrontal cortex. Nooclerin treatment also showed beneficial effects on telomere length of blood cell in males, alongside increased Trf1 expression. Long telomeres in male blood cells were associated with reduced anxiety, while a positive correlation was found between Tpp1 expression and stereotypical behavior in both male and female VPA rats. These findings suggest that nooclerin and risperidone influence telomere length and gene expression related to the telomere-telomerase complex in a sex-dependent manner, offering insights into the neurobiological mechanisms underlying ASD.

Shank3 mutation manifests in abnormal gastrointestinal morphology and function in mice

Background

Gastrointestinal (GI) comorbidities are common among those with Autism Spectrum Disorder (ASD), but their etiology is not well understood. This study aimed to characterize gastrointestinal morphology and function in Shank3B mutant mice, a common genetic model of ASD, to identify potential alterations to the GI tract that could underlie ASD-associated GI comorbidities.

Methods

GI and enteric nervous system morphology was characterized using Hematoxylin and Eosin staining and immunohistochemistry. GI permeability was measured using the FITC-Dextran paracellular permeability assay. Whole-GI tract motility time was measured in vivo using the carmine dye motility assay. Colonic contractions were characterized by tracking motility using an ex vivo motility assay.

Results

Homozygous knock-out (KO) Shank3B-/- mice exhibit significantly altered epithelial morphology and increased GI permeability. An increased myenteric plexus density and a higher number of HuC/D-expressing neurons in myenteric ganglia are observed in the colon of Shank3B-/- mice. These mice exhibit slowed whole-GI tract transit and reduced velocity and propagation length of colonic contractions. Compared to Shank3B-/- mice, heterozygous Shank3B+/- mice exhibit milder epithelial, neuronal, and functional alterations.

Conclusion

Shank3B-/- mice exhibit altered GI morphology and function, while Shank3B+/- mice exhibit a partial phenotype. These results indicate that Shank3, whose mutation is associated with ASD, is critical for function of the GI tract and its mutation may contribute to the etiology of GI comorbidities.

Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years - Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022

Problem/Condition

Autism spectrum disorder (ASD).

Period Covered

2022.

Description of System

The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2022, a total of 16 sites (located in Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas [two sites: Austin and Laredo], Utah, and Wisconsin) conducted surveillance for ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2022. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in a comprehensive developmental evaluation, 2) autism special education eligibility, or 3) an ASD International Classification of Diseases, Ninth Revision (ICD-9) code in the 299 range or International Classification of Diseases, Tenth Revision (ICD-10) code of F84.0, F84.3, F84.5, F84.8, or F84.9. Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had an evaluator's suspicion of ASD documented in a comprehensive developmental evaluation.

Results

Among children aged 8 years in 2022, ASD prevalence was 32.2 per 1,000 children (one in 31) across the 16 sites, ranging from 9.7 in Texas (Laredo) to 53.1 in California. The overall observed prevalence estimate was similar to estimates calculated using Bayesian hierarchical and random effects models. ASD was 3.4 times as prevalent among boys (49.2) than girls (14.3). Overall, ASD prevalence was lower among non-Hispanic White (White) children (27.7) than among Asian or Pacific Islander (A/PI) (38.2), American Indian or Alaska Native (AI/AN) (37.5), non-Hispanic Black or African American (Black) (36.6), Hispanic or Latino (Hispanic) (33.0), and multiracial children (31.9). No association was observed between ASD prevalence and neighborhood median household income (MHI) at 11 sites; higher ASD prevalence was associated with lower neighborhood MHI at five sites.Record abstraction was completed for 15 of the 16 sites for 8,613 children aged 8 years who met the ASD case definition. Of these 8,613 children, 68.4% had a documented diagnostic statement of ASD, 67.3% had a documented autism special education eligibility, and 68.9% had a documented ASD ICD-9 or ICD-10 code. All three elements of the ASD case definition were present for 34.6% of children aged 8 years with ASD.Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability. Intellectual disability was present among 52.8% of Black, 50.0% of AI/AN, 43.9% of A/PI, 38.8% of Hispanic, 32.7% of White, and 31.2% of multiracial children with ASD. The median age of earliest known ASD diagnosis was 47 months and ranged from 36 months in California to 69.5 months in Texas (Laredo).Cumulative incidence of ASD diagnosis or eligibility by age 48 months was higher among children born in 2018 (aged 4 years in 2022) than children born in 2014 (aged 8 years in 2022) at 13 of the 15 sites that were able to abstract records. Overall cumulative incidence of ASD diagnosis or eligibility by age 48 months was 1.7 times as high among those born in 2018 compared with those born in 2014 and ranged from 1.4 times as high in Arizona and Georgia to 3.1 times as high in Puerto Rico. Among children aged 4 years, for every 10 children meeting the case definition of ASD, one child met the definition of suspected ASD.Children with ASD who were born in 2018 had more evaluations and identification during ages 0-4 years than children with ASD who were born in 2014 during the 0-4 years age window, with an interruption in the pattern in early 2020 coinciding with onset of the COVID-19 pandemic.Overall, 66.5% of children aged 8 years with ASD had a documented autism test. Use of autism tests varied widely across sites: 24.7% (New Jersey) to 93.5% (Puerto Rico) of children aged 8 years with ASD had a documented autism test in their records. The most common tests documented for children aged 8 years were the Autism Diagnostic Observation Schedule, Autism Spectrum Rating Scales, Childhood Autism Rating Scale, Gilliam Autism Rating Scale, and Social Responsiveness Scale.

Interpretation

Prevalence of ASD among children aged 8 years was higher in 2022 than previous years. ASD prevalence was higher among A/PI, Black, and Hispanic children aged 8 years than White children aged 8 years, continuing a pattern first observed in 2020. A/PI, Black, and Hispanic children aged 8 years with ASD were also more likely than White or multiracial children with ASD to have a co-occurring intellectual disability. Identification by age 48 months was higher among children born in 2018 compared with children born in 2014, suggesting increased early identification consistent with historical patterns.

Public Health Action

Increased identification of autism, particularly among very young children and previously underidentified groups, underscores the increased demand and ongoing need for enhanced planning to provide equitable diagnostic, treatment, and support services for all children with ASD. The substantial variability in ASD identification across sites suggests opportunities to identify and implement successful strategies and practices in communities to ensure all children with ASD reach their potential.

Leveraging artificial intelligence for diagnosis of children autism through facial expressions

The global population contains a substantial number of individuals who experience autism spectrum disorder, thus requiring immediate identification to enable successful intervention approaches. The authors assess the detection of autism-related learning difficulties in children by evaluating deep learning models that use transfer learning methods along with fine-tuning methods. Using autism spectrum disorder (ASD) diagnosed child RGB images data, researchers evaluated six prevalent deep learning structures: DenseNet201, ResNet152, VGG16, VGG19, MobileNetV2, and EfficientNet-B0. ResNet152 reached the highest accuracy rate of 89% when functioning independently. This paper develops a hybrid deep-learning model by integrating ResNet152 with Vision Transformers (ViT) to achieve better classification performance. The ViT-ResNet152 model's convolutional and transformer processing elements worked together to improve the accuracy of the diagnosis to 91.33% and make it better at finding different cases of autism spectrum disorder (ASD).The research outcomes demonstrate that AI tools show promise for delivering highly precise and standardized methods to detect ASD at an early stage. Future research needs to include multiple data types as well as extend dataset variability while optimizing hybrid architecture systems to elevate diagnostic forecasting. The incorporation of artificial intelligence in ASD evaluation services holds promise to transform early therapy approaches, which leads to better results for autistic children all around the globe.

The effects of the DHACA method on expressive communication in children with autism spectrum disorder

PURPOSE

This study aimed to assess the contributions of the DHACA method to expressive communication development in children with autism spectrum disorder (ASD).

METHODS

This longitudinal case series study had a sample of 12 children with ASD, nonverbal or minimally verbal communication, and support level one or two. Data were collected by applying the ACOTEA-R Protocol by analyzing videos recorded during intervention sessions before and after using the DHACA. Participants underwent 20 individual speech-language-hearing sessions with the DHACA.

RESULTS

After the intervention with the ACOTEA-R, 10 of the 12 children improved their overall expressive communication skills. Concerning the communicative profile, initially, 10 children were nonverbal and 2 were minimally verbal. After the intervention, 7 evolved to a verbal pattern, whereas 5 remained nonverbal. The progress of the following communication skills stands out: use of sentences with four or more words, naming objects, social expressions, greeting people, and making comments. Moreover, 8 of the 12 participants advanced to the third skill in the DHACA, characterized by request with lexical and morphosyntactic expansion.

CONCLUSION

The children's speech and use of the communication book indicated progress in their expressive communication development after intervention with the DHACA.

Transformer-based deep learning ensemble framework predicts autism spectrum disorder using health administrative and birth registry data

Early diagnosis and access to resources, support and therapy are critical for improving long-term outcomes for children with autism spectrum disorder (ASD). ASD is typically detected using a case-finding approach based on symptoms and family history, resulting in many delayed or missed diagnoses. While population-based screening would be ideal for early identification, available screening tools have limited accuracy. This study aims to determine whether machine learning models applied to health administrative and birth registry data can identify young children (aged 18 months to 5 years) who are at increased likelihood of developing ASD. We assembled the study cohort using individually linked maternal-newborn data from the Better Outcomes Registry and Network (BORN) Ontario database. The cohort included all live births in Ontario, Canada between April 1st, 2006, and March 31st, 2018, linked to datasets from Newborn Screening Ontario (NSO), Prenatal Screening Ontario (PSO), and Canadian Institute for Health Information (CIHI) (Discharge Abstract Database (DAD) and National Ambulatory Care Reporting System (NACRS)). The NSO and PSO datasets provided screening biomarker values and outcomes, while DAD and NACRS contained diagnosis codes and intervention codes for mothers and offspring. Extreme Gradient Boosting models and large-scale ensembled Transformer deep learning models were developed to predict ASD diagnosis between 18 and 60 months of age. Leveraging explainable artificial intelligence methods, we determined the impactful factors that contribute to increased likelihood of ASD at both an individual- and population-level. The final study cohort included 707,274 mother-offspring pairs, with 10,956 identified cases of ASD. The best-performing ensemble of Transformer models achieved an area under the receiver operating characteristic curve of 69.6% for predicting ASD diagnosis, a sensitivity of 70.9%, a specificity of 56.9%. We determine that our model can be used to identify an enriched pool of children with the greatest likelihood of developing ASD, demonstrating the feasibility of this approach.This study highlights the feasibility of employing machine learning models and routinely collected health data to systematically identify young children at high likelihood of developing ASD. Ensemble transformer models applied to health administrative and birth registry data offer a promising avenue for universal ASD screening. Such early detection enables targeted and formal assessment for timely diagnosis and early access to resources, support, or therapy.

Social vulnerability and the prevalence of autism spectrum disorder among 8-year-old children, Autism and Developmental Disabilities Monitoring Network, 2020

PURPOSE

The Autism and Developmental Disabilities Monitoring (ADDM) Network estimates the prevalence of autism spectrum disorder (ASD) throughout the United States. Reports through 2010 found higher prevalence in areas of higher socioeconomic status. Reports since 2018 indicate a pattern change. We used CDC's Social Vulnerability Index (SVI) to examine the association of ASD prevalence and social vulnerability in ADDM Network sites.

METHODS

Cases of ASD among 8-year-old children in 2020 were linked to SVI measures and population estimates. Tracts were categorized into tertiles (high, medium, and low) and prevalence, prevalence ratios (PRs), and 95 % confidence intervals (CIs) were calculated.

RESULTS

Among 5998 children with ASD, we saw higher ASD prevalence in areas with high versus low vulnerability overall (26.18 per 1000; PR=1.06 (1.00-1.13)) and in areas with more minority residents (28.28 per 1000; PR=1.29 (1.21-1.38)), less transportation (27.32 per 1000; PR=1.13 (1.06-1.20)), and greater disability (26.83 per 1000; PR=1.09 (1.02-1.17)). This pattern was observed among White children (PR=1.48 {1.36-1.60}) but reversed among Black (PR=0.61 {0.53-0.70}), Asian (PR=0.58 {0.46-0.73}), and Hispanic (PR=0.83 {0.72-0.95}) children.

CONCLUSIONS

Disparities in prevalence of ASD by neighborhood-level social vulnerability persist. Directing resources toward providing equitable access to healthcare and support services could help close this gap.

Autism disproportionality in racially and ethnically minoritized and girl students in schools

Special education services are crucial for enhancing outcomes and well-being among autistic students. Unfortunately, many racially and ethnically minoritized and girl autistic youth face challenges in timely and accurate identification. National-level data reveal autism prevalence rates differ across student gender, race, and ethnicity hindering access to services and appropriate education. As research focusing on autism disproportionality in schools is limited, we investigate autism identification disparities specific to racially and ethnically minoritized and girl students at the national and state levels in schools. State-level data from the 2019-2020 academic year were obtained from the United States Department of Education and analyzed to assess prevalence rate, relative risk, and systemic-level predictors of autism identification disparities. Girls were under-identified with autism in schools compared to their boy peers. The disproportionality risk of racially and ethnically minoritized students compared to White students had decreased in reference to prior reports, with the least improvement for Latine students. School locale proved significant in predicting the risk of autism identification for girl and Latine students. These findings can inform policy change, raise the collective consciousness, and encourage practitioners to seek out continued education regarding autism identification and girl students to reduce or eliminate these disparities.Lay abstractSpecial education services are important for helping autistic students succeed, but many racially and ethnically minoritized and girl students face difficulties in getting support because they are not identified appropriately in schools. This study looks at the identification of autism in racially and ethnically minoritized and girl students across schools in the United States during the 2019-2020 school year. We found that girls are less likely to be identified compared to boys, which means they might not get the help they need. The gap between racially and ethnically minoritized students and White students in autism identification has improved slightly, but Latinx students still face challenges. We also found that where students live (their locale) affects their chances of being identified, especially for girls and Latinx students. These findings show that there are disparities in school autism identification, and understanding them can help policymakers, educators, and communities make changes to ensure all autistic students get the support they need.

Initial study of verbal and nonverbal communication training through the collaborative operation of a humanoid robot for individuals with autism spectrum disorder

Individuals with autism spectrum disorder (ASD) experience difficulties in both verbal and nonverbal communication. Collaborative work allows them to use and develop their nonverbal communication abilities. Therefore, we developed a collaborative work training program for individuals with ASD. This study aimed to assess the feasibility of the proposed intervention for both verbal and nonverbal communication. A single humanoid robot was operated by two people, with each person operating different parts of the robot: one person moved the right half of the body while the other moved the left. The participants' roles were separated to promote verbal and nonverbal communication. Fourteen individuals (aged 18-27 years) participated in a training experiment that was conducted once a week for a maximum of seven sessions over two months. A comparison of the amount of communication between the first and last training sessions showed that both verbal and nonverbal communication increased (p=0.044 and p=0.024, respectively), indicating that the proposed training facilitated both verbal and nonverbal communication. Future studies are needed to establish evidence supporting the generalizability of the acquired skills to daily life activities by considering longitudinal designs.

Gender and Autism Program: A novel clinical service model for gender-diverse/transgender autistic youth and young adults

Objective: Situated in Children's National Hospital (CNH)'s Neuropsychology Division, the Gender and Autism Program (GAP) is the first clinical service dedicated to the needs of autistic gender-diverse/transgender youth. This study describes GAP clinical assessment profiles and presents a multi-perspective programmatic review of GAP evaluation services. Method: Seventy-five consecutive gender- and neuropsychologically-informed GAP evaluations were analyzed, including demographics, gender and autism characterization, and primary domains evaluated. Three program-based Delphi studies were conducted and identify: clinician priorities and challenges in providing care, program administrator lessons learned and ongoing barriers, and considerations adapting this model for a rural academic medical center. Results: Nearly two-thirds of referrals were transfeminine. Most youth had existing autism diagnoses; of those undiagnosed, three-quarters were found to be autistic. Five goals of evaluations were identified: Mental health was always assessed, and most evaluations also assessed gender-related needs in the context of autism neurodiversity. Neuropsychological characterization of strengths and challenges informed personalized accommodations to support youth gender-related self-advocacy. Clinicians emphasized frequent youth safety concerns. Administrators emphasized the need for specialized training for working with families. Components for adaptation of the GAP in a rural academic medical center were identified. Conclusions: Since its founding, the GAP has proven a sustainable neuropsychology-based service with consistent referral flow and insurance authorizations. Capturing staff perspectives through rigorous Delphi methods, and addressing the GAP's feasibility and replicability, this study provides a road map for replicating this service. We also highlight GAP training of specialist clinicians, fundamental to addressing the desperate shortage of providers in this field.

Prevalence, incidence, and characteristics of autism spectrum disorder among children in Beijing, China

The prevalence of autism spectrum disorder in the world has increased over the last decade, but the prevalence, incidence, and characteristics of autism spectrum disorder in China were not well understood. Using administrative data, we aimed to estimate the prevalence and incidence of autism spectrum disorder and describe the co-occurring conditions in preschoolers in Beijing, China. The study focused on 0- to 6-year-old children with registered residence in Beijing, using cohorts derived from the Beijing Municipal Health Big Data and Policy Research Center. We conducted a detailed analysis of autism spectrum disorder prevalence among the cohorts, comparing estimates across 2 to 3 years for the same birth cohort (4 years, 5 years). For the 6-year-old cohort, we obtained 1-year prevalence estimates in 2021. Annual incidence rate was also calculated. The prevalence in 6-year-old children in 2021 was 10.5 per 1000 (95% confidence interval = 9.7-10.9). The male-to-female prevalence ratio was 4.3. Between 40% and 43% of preschool children had at least one co-occurring condition. The incidence for children 6 years old and under was 0.11% in 2019 and increased to 0.18% in 2021. Both the prevalence and incidence rates in Beijing were comparable to those reported in developed countries.Lay abstractIt is the first study to explore the prevalence, incidence, and co-occurring conditions of autism spectrum disorder for the preschoolers in China. The prevalence and incidence of autism spectrum disorder has increased in recent decades. Autism spectrum disorder has become an important public concern worldwide. In this study, all hospital confirmed cases had an associated diagnosis (International Classification of Diseases, 10th revision (ICD-10) codes: F84.0, 84.5, F84.9). In total, 4457 children aged 4-6 years were identified as having autism spectrum disorder. In 2021, 1 in 95 children aged 6 years, 1 in 115 children aged 5 years, and 1 in 130 children aged 4 years were estimated to have autism spectrum disorder in Beijing. The incidence was 0.11% in 2019 and increased to 0.18% in 2021. There has been a great emphasis on the importance of early autism spectrum disorder diagnosis in large cities in China.

Correlates of physical activity, sedentary time, and cardiovascular disease risk factors in autistic adults without intellectual disabilities

BACKGROUND

Emerging evidence indicates that autistic adults without intellectual disabilities (ID) are at elevated risk of developing cardiovascular disease (CVD).

AIMS

This cross-sectional survey study aimed to assess the prevalence of physiological and mental health risk factors for CVD and examine how physical activity (PA) and sedentary time (ST) relate to CVD risk in autistic adults without ID.

METHODS

An online self-report survey addressing PA, ST, and CVD risk factors was delivered to 229 autistic adults without ID aged 18-55 years. Participants were recruited via direct contact with autism advocacy organizations in the U.S. and autism support groups on social media. Binary logistic regression analyses were used to explain the impact of PA and ST on CVD risk factors.

RESULTS

Higher ST was significantly associated with increased odds for high blood pressure, stroke, and mental health risk factors (depression, anxiety, bipolar, and obsessive-compulsive disorder; all p < 0.05). No significant associations were found between PA and CVD risk factors.

CONCLUSIONS

Excessive ST in autistic adults without ID is associated with an increased risk for certain CVD factors, particularly those related to poor mental health. Health interventions should focus on breaking up prolonged sitting as a CVD prevention strategy in this population.

HD-tDCS effects on social impairment in autism spectrum disorder with sensory processing abnormalities: a randomized controlled trial

This study examined the effects of high-definition transcranial direct current stimulation (HD-tDCS) on social impairment in children with autism spectrum disorder (ASD), focusing on those with and without sensory processing abnormalities. A randomized double-blind sham-controlled trial involved 72 children with ASD, divided into three groups based on sensory integration status. A post-hoc analysis of 51 children aged 4-8 years who received true HD-tDCS was conducted, categorizing them into hypo-tactile, hyper-tactile, and typical tactile sensitivity groups. Therapeutic efficacy was compared across these groups. (1) The randomized cntrolled Trial: The typical sensory integration group showed significant improvements in social awareness (t = 5.032, p < 0.000) and autistic mannerisms (t = 3.085, p = 0.004) compared to the sensory integration dysfunction group. (2)The result of the post-hoc analysis: The hypo-tactile and typical tactile sensitivity groups exhibited notable improvements in social awareness, cognition, communication, autistic mannerisms, and total SRS scores. In contrast, the hyper-tactile group only had a significant reduction in social communication (t = 2.385, p = 0.022) post-intervention. HD-tDCS effectively improved social impairment symptoms in children with ASD, particularly those with typical sensory integration and either typical or hypo-tactile responsiveness.

Discordant sibling analysis of autism risk associated with prenatal exposure to tailpipe and non-tailpipe particulate matter pollution

BACKGROUND

We previously assessed associations of prenatal exposure to fine particulate matter (PM2.5) tracers reflecting tailpipe (elemental carbon [EC] and organic carbon [OC]) and non-tailpipe emissions (copper [Cu], iron [Fe] and manganese [Mn]) with risk of autism spectrum disorder (ASD) in a large pregnancy cohort. To address genetic and family environment confounding, we conducted an ASD-discordant sibling study.

METHODS

Data included 4024 children (1837 with and 2187 siblings without ASD) born to 1801 unique mothers who had at least one child diagnosed with ASD by age 5, and one child without ASD. Prenatal exposures to total PM2.5, trace elements Cu, Fe, Mn, EC, and OC and dispersion-modeled near-roadway-air-pollution (NRAP) from freeway and non-freeway source were obtained using maternal addresses during pregnancy. Conditional logistic regression was used to assess ASD risk associated with exposures adjusting for covariates. Results were reported as odds ratio (OR, 95 % CI) per inter-quartile increment of each exposure.

RESULTS

In single-pollutant models, child ASD risk (OR; 95 % CI) was associated with gestational exposures to non-tailpipe source Cu (1.17; 1.03-1.33), Fe (1.26; 1.07-1.48), Mn (1.29; 1.11-1.50); but not likewise associated with tailpipe source EC (1.10; 0.92-1.32) and OC (1.10; 0.91-1.32). Total PM2.5 and non-freeway NRAP were both associated with ASD risk. Adjusting for total PM2.5 or NRAP attenuated the ASD associations with Cu, Fe, and Mn but they remained largely statistically significant. By trimester analysis showed the associations with Cu, Fe, and Mn were significant in the first two trimesters.

CONCLUSION

This ASD-discordant sibling study confirmed previously reported ASD risk associated with prenatal exposure to PM2.5, NRAP and non-tailpipe particulate trace-element Cu, Fe, and Mn, particularly in the first two trimesters, thus, increasing evidence of causality.

Women with polycystic ovary syndrome (PCOS): Likelihood of cooccurring neuropsychiatric conditions and the dual hit hypothesis

Polycystic Ovary Syndrome (PCOS) is the most common endocrine-metabolic disorder in women of reproductive age. Hyperandrogenism has been proposed as its main pathophysiological feature. PCOS is associated with co-occurring conditions, including psychiatric disorders such as anxiety, depression, and neurodevelopmental conditions such as autism. Exposure to hyperandrogenism during prenatal life and adolescence may explain this association. PCOS women exhibit hyperandrogenism during pregnancy, and up to 70% of their daughters will present a similar phenotype from puberty onwards. The 'dual hit hypothesis' proposes that stressors during prenatal life and adolescence can synergistically lead to co-occurring conditions in adulthood. PCOS has been recently proposed as an independent likelihood factor for the development of neuropsychiatric conditions. However, the specific mechanisms require further research to develop effective interventions. This review discusses how hyperandrogenism can affect neurodevelopment during two key periods of brain development, which may explain the long-term impact of PCOS on mental health.

Protocol for socioecological study of autism, suicide risk, and mental health care: Integrating machine learning and community consultation for suicide prevention

INTRODUCTION

Autistic people experience higher risk of suicidal ideation (SI) and suicide attempts (SA) compared to non-autistic people, yet there is limited understanding of complex, multilevel factors that drive this disparity. Further, determinants of mental health service receipt among this population are unknown. This study will identify socioecological factors associated with increased risk of SI and SA for autistic people and evaluate determinants of mental health care receipt.

METHODS

This study will link information for individuals aged 12-64 years in healthcare claims data (IBM® MarketScan® Research Database and CMS Medicaid) to publicly available databases containing community and policy factors, thereby creating a unique, multilevel dataset that includes health, demographic, community, and policy information. Machine learning data reduction methods will be applied to reduce the dimensionality prior to nested, multilevel empirical estimation. These techniques will allow for robust identification of clusters of socioecological factors associated with 1) risk of SI and SA and 2) receipt of mental health services (type, dose, delivery modality). Throughout, the research team will partner with an established group of autistic partners to promote community relevance, as well as receive input and guidance from a council of policy and practice advisors.

DISCUSSION

We hypothesize that nested individual (co-occurring conditions, age, sex), community (healthcare availability, social vulnerabilities), and policy factors (state mental health legislation, state Medicaid expansion) will be associated with heightened risk of SI and SA, and that receipt, dose, and delivery of mental health services will be associated with interdependent factors at all three levels. The approach will lead to identification of multilevel clusters of risk and factors that facilitate or impede mental health service delivery. The study team will then engage the community partners, and policy and practice advisors to inform development of recommendations to reduce risk and improve mental health for the autistic population.

Sleep Disorders and Constipation in Autistic Children and Youth: Who Receives Standard of Care Drug Treatments?

PURPOSE

The purpose of this retrospective cohort analysis was to investigate sex differences in receipt of standard of care sleep and constipation drug treatments among autistic children and youth with sleep disorder and constipation, respectively.

METHODS

We used the data from the OneFlorida + Data Trust to analyze healthcare claims for 19,877 autistic patients with sleep disorder and 32,355 patients with constipation, ages 1 to 22. We used logistic regression to examine sex differences in receiving sleep and constipation treatments, and a multivariate logistic regression model to further assess sex differences in ever receiving sleep and constipation treatments, adjusting for age, race, ethnicity, and urbanicity.

RESULTS

In our multivariate analysis, autistic girls with sleep disorder were 1.27 times more likely than boys to receive sleep treatment (p < 0.0001). Although autistic girls with constipation appeared to be 1.10 times more likely than boys to receive treatment, it was not significantly different after adjusting for demographic and socio-economic characteristics (p = 0.372). Older children were 1.09 times more likely than younger children to receive sleep treatment (p < 0.0001) and 1.07 times more likely to receive constipation treatment (p < 0.0001).

CONCLUSION

We did not find sex differences among autistic children for treatment of constipation, but autistic girls with sleep disorder were significantly more likely to have ever received treatment, which could indicate that girls experience more significant sleep disorders.

Physical-intellectual badminton teaching intervention for children with intellectual disabilities

Objective

To promote the healthy development of adolescents with intellectual disabilities, this study uses badminton to combine sports intervention with cognitive intervention to explore the content of sports teaching and cognitive intervention programs suitable for the learning of students with intellectual disabilities.

Methods

This research selected 26 mildly mentally disabled students in special education schools (age: 14.5 ± 0.8 years old), the subjects were randomly assigned to three groups by the digital randomization method, which badminton physical intelligence group (BSI), badminton group (BS) and control group (CON), with BSI conducting "physical intelligence" integration badminton intervention, and BS conducting badminton intervention, the intervention cycle was 12 weeks, with 3 teaching sessions per week, each session lasted for 40 min. The subjects' cognitive abilities and basic motor skills were analyzed.

Results

The results showed that BSI had highly significant differences in all cognitive ability test items (p < 0.01); BS had significant differences only in visual attention, visual memory, and motor imitation (p < 0.05). The results of incremental changes between groups before and after the intervention showed that BSI compared with CON had significant differences in all aspects except in object constancy (p < 0.05); BS compared with CON had higher incremental means than CON in visual attention, visual memory, and movement imitation, with significant differences (p < 0.05); BSI compared with BS had significant differences in all aspects except in object constancy and visual memory aspects, there is a significant difference (p < 0.05).

Conclusion

The "Body-Smart Integration" badminton intervention can improve the cognitive ability of students with intellectual disabilities in visual, auditory, imitation, concept learning, object permanence, etc., and the effect of improving the cognitive ability of students with intellectual disabilities is better than that of the badminton group and the control group.

Contribution of autosomal rare and de novo variants to sex differences in autism

Autism is four times more prevalent in males than females. To study whether this reflects a difference in genetic predisposition attributed to autosomal rare variants, we evaluated sex differences in effect size of damaging protein-truncating and missense variants on autism predisposition in 47,061 autistic individuals using a liability model with differing thresholds. Given the sex differences in the rates of cognitive impairment among autistic individuals, we also compared effect sizes of rare variants between individuals with and without cognitive impairment or motor delay. Although these variants mediated different likelihoods of autism with versus without cognitive or motor difficulties, their effect sizes on the liability scale did not differ significantly by sex exome wide or in genes sex-differentially expressed in the cortex. De novo mutations were enriched in genes with male-biased expression in the adult cortex, but these genes did not show a significant sex difference on the liability scale, nor did the liability conferred by these genes differ significantly from other genes with similar loss-of-function intolerance and sex-averaged cortical expression. Exome-wide female bias in de novo protein-truncating mutation rates on the observed scale was driven by high-confidence and syndromic autism-predisposition genes. In summary, autosomal rare and damaging coding variants confer similar liability for autism in females and males.

Characterizing Federally Mandated Early Intervention for Children with Social Communication Delays: A Mixed-Methods Analysis

The most common way for children with social communication delays to receive intervention before age three in the United States is through Part C early intervention (EI). Part C was designed to take a multidisciplinary approach to address a range of developmental domains. The type of intervention delivered in Part C EI has rarely been examined through direct observation. Our team conducted a mixed-methods analysis to characterize EI sessions by 33 providers across four states. Specifically, we describe the quantity and quality of caregiver coaching based on provider report and researcher coding of EI session content. Eligible providers conducted weekly EI sessions with at least one child with social communication delays. Providers self-reported greater use of caregiver coaching relative to the video coding conducted by researchers. While there were similarities in session topics, presumed goals, and intervention strategies used across providers, differences were observed in session duration, session location, and caregiver engagement in session. This study begins to fill a substantial gap by illuminating the types of interventions children with social communication delays receive in federally mandated Part C. It also highlights the need for more specialized training and standardization in EI practices to ensure that children with social communication delays and their caregivers benefit from the most efficacious interventions during a critical time of increased brain plasticity.

Whole-genome sequencing analysis of Japanese autism spectrum disorder trios

AIM

Autism spectrum disorder (ASD) is a genetically and phenotypically heterogeneous neurodevelopmental disorder with a strong genetic basis. Conducting the first comprehensive whole-genome sequencing (WGS) analysis of Japanese ASD trios, this study aimed to elucidate the clinical significance of pathogenic variants and enhance the understanding of ASD pathogenesis.

METHODS

WGS was performed on 57 Japanese patients with ASD and their parents, investigating variants ranging from single-nucleotide variants to structural variants (SVs), short tandem repeats (STRs), mitochondrial variants, and polygenic risk score (PRS).

RESULTS

Potentially pathogenic variants that could explain observed phenotypes were identified in 18 patients (31.6%) overall and in 10 of 23 patients (43.5%) with comorbid intellectual developmental disorder (IDD). De novo variants in PTEN, CHD7, and HNRNPH2 were identified in patients referred for genetic counseling who exhibited previously reported phenotypes, including one patient with ASD who had profound IDD and macrocephaly with PTEN L320S. Analysis of the AlphaFold3 protein structure indicated potential inhibition of intramolecular interactions within PTEN. SV analysis identified deletions in ARHGAP11B and TMLHE. A pathogenic de novo mitochondrial variant was identified in a patient with ASD who had a history of encephalitis and cognitive decline. GO enrichment analysis of genes with nonsense variants and missense variants (Missense badness, PolyPhen-2, and Constraint >1) showed associations with regulation of growth and ATP-dependent chromatin remodeler activity. No reportable results were obtained in the analysis of STR and PRS.

CONCLUSION

Characterizing the comprehensive genetic architecture and phenotypes of ASD is a fundamental step towards unraveling its complex biology.

Pediatric Bipolar Disorder: Challenges in Diagnosis and Treatment

Despite an opportunity to prevent adult psychopathology associated with bipolar disorder through early diagnosis in children, there is insufficient information and awareness among healthcare providers about the unique features and treatment of mania and its comorbid conditions in children. Converging evidence from disparate sites describe a developmentally distinct presentation of bipolar disorder in youth that is highly morbid, persistent and responds to treatment with the mood stabilizer medications used in the treatment of adult bipolar disorder, such as divalproex sodium and carbamazepine. Some are additionally approved for use in pediatric populations including, for manic or mixed states, risperidone, aripiprazole, and asenapine for those aged 10-17 years and also including lithium and olanzapine for ages 13-17 years. Quetiapine is approved as monotherapy or as adjunct to lithium or divalproex sodium for manic states in those aged 10-17 years. Delayed or missed diagnosis, inappropriate treatment, worsening course, and treatment resistance unfortunately still occur. While an array of mood-stabilizing medications is available for treatment, such as second-generation antipsychotics, lithium, and anticonvulsants, these can be only partially effective and fraught with annoying and serious side effects. This article will review current practice in the diagnosis and treatment of pediatric bipolar disorder and its comorbid conditions, highlighting areas of need for future research.

The Validity and Reliability of the Turkish Version of the Autism Family Experience Questionnaire (AFEQ)

The aim of this study was to examine the reliability and validity of the Turkish version of the AFEQ for Turkish parents of children with ASD. The Turkish-translated version of the AFEQ was administered to 241 parents of children aged 2-12 years with ASD to examine the construct validity and internal consistencies. Parents completed the Autism Behavior Checklist (ABC), and Quality of Life in Autism Questionnaire Parent version, along with the AFEQ. The mean age of the children of 241 individuals in the study group was 7.63 ± 3.02 and 88.4% (n = 213) were male. Cronbach's alpha coefficient was 0.921 of the total variance. Cronbach alpha coefficients are 0.813 for the "Experience of being a parent" subscale, 0.768 for the "Family Life" subscale, 0.810 for the "Child Development, Understanding and Social Relationships" subscale, and 0.804 for the "Child Symptoms (Feelings and Behaviour)" subscale. In conclusion, the translated and culturally adapted AFEQ shows good reliability and validity to measure the priorities of autistic children and their families in Turkey. It can also be useful in monitoring the effectiveness of intervention programs and changes in the child.

Enhancing Diagnostic Follow-up and Care Coordination for Children with Autism in a Busy Resident Continuity Clinic: Leveraging the Electronic Health Record

PURPOSE

A high-quality primary care clinic should provide clear action points and important care coordination for a child receiving a new diagnosis of autism spectrum disorder (ASD). Unfortunately, a substantial proportion of caregivers report little-to-no post-diagnosis support from their home clinics and primary care providers often report lack of training and resources in providing these supports.

METHODS

We implemented an intervention package to investigate the impact on the frequency and quality of follow-up care for children with ASD in a busy, high-volume resident continuity clinic. The package consisted of a care coordination scheduling pathway and a standardized clinical template-embedded in the electronic health record (EHR)-that guided providers through best-practice recommendations and patient resources.

RESULTS

As a result of these interventions, 74% of patients had ASD-specific follow-up, a more than threefold increase from baseline with a majority of providers using the EHR-embedded template to guide their visit. Providers also indicated a high degree of usability for the system and that it aided them in following best-practice guidelines for ASD care.

CONCLUSION

Through explicit scheduling pathways and a novel EHR template, we saw a significant increase in ASD-specific follow-up visits and implementation of best practices for ASD care, demonstrating a new process for training and engaging primary care providers in clear action steps for post-diagnostic care without having to rely on tertiary referrals.

Autism screening and diagnostic outcomes among toddlers born preterm

AIM

To examine the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F), with follow-up screening and diagnostic outcomes for children born preterm. A secondary aim was to examine diagnostic evaluation attendance after screening to inform clinical practice.

METHOD

Using a cross-sectional design, 9725 toddlers (4951 males; 4774 females) whose gestational age was reported were screened at 15-month, 18-month, or 24-month well-child visits; screen-positive children were invited for an autism evaluation. Screening measure performance and diagnostic outcomes were evaluated according to preterm classification (Screening: nExtPreterm = 111; nVeryPreterm = 186; nModPreterm = 1122; nFullTerm = 8306; Evaluation: nExtPreterm = 27; nVeryPreterm = 21; nModPreterm = 86; nFullTerm = 301).

RESULTS

Screen-positive rates were highest for children born extremely preterm (51.35%) and lowest for children born at term (6.95%). Evaluation attendance for screen-positive cases did not differ according to preterm classification. Rates of autism diagnoses differed depending on preterm birth status: for children born extremely preterm, it was 16.05%; for children born very preterm, it was 2.00%; for children born moderately preterm, it was 2.89%; and for children born at term, it was 1.49%. M-CHAT-R/F sensitivity decreased with increasing gestational age, whereas specificity improved with increasing gestational age. Positive predictive value was highest for children born extremely preterm and children born at term. Negative predictive value was consistently strong across all groups. The likelihood ratio for positive screening increased with gestational age.

INTERPRETATION

The sensitivity and specificity of the M-CHAT-R/F are acceptable in toddlers born preterm. Autism screening-positive rates and prevalence increased with earlier preterm birth. Those born extremely preterm showed the greatest likelihood of an autism diagnosis; screening should not be delayed based on adjusted age.

The effect of modulation Piezo2 by IGF-1 on tactile hypersensitivity in BTBR model mice

AIMS

Autism spectrum disorder (ASD) is classified as a neurodevelopmental disorder. Individuals with ASD exhibit a higher incidence of tactile hypersensitivity. However, the underlying mechanisms remain unclear. The dorsal root ganglion (DRG) plays a crucial role in influencing tactile processing. This study aims to integrate RNA sequencing (RNA-seq) and molecular biology experiments to identify key molecules involved in tactile hypersensitivity in ASD, further investigate related mechanisms, and develop effective intervention strategy.

MAIN METHODS

Using BTBR as the ASD model mouse and wild-type C57BL/6J as the control mouse, the differences in tactile sensitivity between them was compared. DRG were collected for RNA-seq analysis. Immunofluorescence and Enzyme-linked immunosorbent assay (ELISA) techniques were employed to validate the identified key molecules. And combined western blot to investigate the associated regulatory pathways.

KEY FINDINGS

BTBR mice exhibit tactile hypersensitivity, which are associated with the upregulation of IGF-1 in the DRG. IGF-1 regulates the expression of Piezo2 ion channels. Inhibition of the IGF-1/Piezo2 pathway can significantly alleviate tactile hypersensitivity and social deficits in BTBR mice. Additionally, gentle touch intervention has been shown to reduce the overexpression of IGF-1/Piezo2 in the DRG, thereby ameliorating ASD symptoms.

SIGNIFICANCE

The upregulation of the IGF-1/Piezo2 pathway in DRG may serve as a potential mechanism for tactile hypersensitivity observed in BTBR mice. Restoring the normalization of the IGF-1/Piezo2 is crucial for alleviating tactile hypersensitivity and synergistically rescues social deficits. Gentle touch intervention has the potential to ameliorate these behaviors through regulating IGF-1/Piezo2, positioning it as a promising strategy for ASD.

"I Want More People Like Y'all to be Willing to Listen to People Like Us": A Qualitative Study Exploring Barriers and Facilitators to Care With Autistic Women and Caregivers

Recent surveillance data indicate an estimated 1 in 36 children are diagnosed with autism spectrum disorder (ASD). More males than females are diagnosed with ASD and children of color are less likely to be identified with ASD than White children. Given the rising prevalence estimates and persistent gender and racial/ethnic differences in diagnostic rates, it is time that we seek to better understand ASD as it relates to culture, care, and lived experience from the perspective of those we serve. Utilizing qualitative methods, the current research study sought to understand the lived experiences of three autistic women and three women caregivers of autistic children as it relates to the identification, diagnostic, and service delivery processes. In-depth focus group research revealed five major themes ranging from feelings associated with the diagnosis, dissatisfaction with services, the perspective of culture within autism and the family, and how culture should be considered by service providers in treatment planning and implementation. These results are discussed in the context of future research, and implications for autism service providers are provided.

The Grief Experiences of Children with Developmental Disabilities: A Narrative Literature Review

BACKGROUND

Children with developmental disabilities have wide-ranging social, developmental, and communication challenges impacting their grieving process. This narrative review examined the literature relating to the grief experiences of children with developmental disabilities to identify implications for practice and areas for future research.

METHODS

The literature review was conducted using five databases, and a hand search of dissertations with original research, due to the sparse body of published works.

RESULTS

Nine works were included in the review, which were thematically synthesized into three categories: (1) Understanding of death concepts, (2) Social-emotional responses to loss, and (3) Disenfranchised grief.

CONCLUSIONS

Children with developmental disabilities are affected by loss, even if their comprehension of death concepts is impacted by their level of disability. They may experience challenges due to changes in routines and concrete thinking, and are at risk of disenfranchised grief. Future research is needed to inform developmentally appropriate grief interventions.

Goal Attainment Scaling and Quality of Life of Autistic Children Receiving Speech and Language Therapy in a Higher Educational Institution in the Philippines

Objectives

This study aimed to describe the demographic profile, intervention sessions, goal attainment scaling (GAS), and health-related quality of life (HRQOL) of autistic children receiving speech and language therapy (SLT) in a higher educational institution in the Philippines.

Methods

Deidentified data from 18 autistic children aged 4-16 years (mean=8.2; SD=2.9) who received SLT for two months were analyzed. Their demographic profile, intervention sessions, GAS scores, and generic HRQOL scores were documented.

Results

Most participants were school-age children (n=12; 66%) and were boys (n=14; 78%). After two months, the GAS scores of 11 participants (61%) increased by 1-2 points, whereas the scores of the remaining participants decreased (n=6; 33%) or did not change (n=1; 6%). Their mean generic HRQOL scores before and after SLT were 65.6 (SD=15.2) and 61.2 (SD=17.4), respectively.

Conclusions

While the GAS scores increased for most participants, their generic HRQOL scores did not show clinically significant changes after two months of SLT. This can be attributed to the few therapy sessions and short follow-up period. The findings highlight the need to provide long-term support to SLT services of autistic children in the Philippines to document more desirable quality of life outcomes.

Prevalence, Socio-Demographic Characteristics, and Co-Morbidities of Autism Spectrum Disorder in US Children: Insights from the 2020-2021 National Survey of Children's Health

BACKGROUND

The primary goal of our study is to assess the national US prevalence of autism spectrum disorder (ASD), along with its socio-demographic characteristics, severity, and co-occurring medical and psychiatric disorders, using data from the 2020-2021 National Survey of Children's Health (NSCH).

METHODS

We analyzed 2020-2021 NSCH data to estimate the prevalence of ever-diagnosed and current ASD among 79,182 children and adolescents (3-17 years). Univariate and multivariate regression models were used to examine associations between medical and psychiatric co-morbidities, socio-demographic factors, and ASD severity.

RESULTS

Adolescents (11-17 years) and males were more likely to have ASD, with males comprising 78.7% of the ASD group. The mean age of the sample was 10.1 ± 4.6 years, and 3.2% had an ASD diagnosis. Children from lower-income households and those with caregivers who completed only a high school education were more likely to have ASD. Nearly 96.4% of children with ASD had at least one co-morbid condition. The most common neuropsychiatric co-morbidities were developmental delay (64%), behavioral and conduct problems (57.8%), and anxiety disorder (45.7%), while the most common medical conditions were allergies (32.4%), genetic disorders (26.2%), and asthma (12.6%). Gender disparities in ASD presentation were evident that females with ASD were more likely to experience vision problems, cerebral palsy, epilepsy, depression, and intellectual disability but had lower odds of ADHD and anxiety problems. Greater ASD severity was linked to higher odds of intellectual disability (OR: 5.8, p < 0.001), developmental delay (OR: 5.0, p < 0.001), epilepsy, Down syndrome (OR: 3.4, p < 0.001), vision problems (OR: 2.5, p < 0.001), and genetic disorders (OR: 2.3, p < 0.001).

CONCLUSIONS

This study provides updated prevalence estimates of ASD and highlights the high burden of co-morbidities, emphasizing the need for comprehensive, multidisciplinary approaches in ASD management. Additionally, our findings emphasize gender differences in ASD presentation, which should be considered in future research and clinical practice to ensure more tailored diagnostic and intervention strategies.

Role of androgen receptors in sexually dimorphic phenotypes in UBE3A-dependent autism spectrum disorder

Autism spectrum disorders (ASDs) involve social, communication, and behavioral challenges. ASDs display a remarkable sex difference with a 4:1 male to female prevalence ratio; however, the underlying mechanism remains largely unknown. Using the UBE3A-overexpressing mouse model for ASD, we studied sexually dimorphic changes at behavioral, genetic, and molecular levels. We found that male mice with extra copies of Ube3A exhibited greater impairments in social communication, long-term memory, and pain sensitivity compared to females. UBE3A-mediated degradation reduced androgen receptor (AR) levels in both sexes but only male mice showed significant dysregulation in the expression of AR target genes. Importantly, restoring AR levels in the brain normalized levels of AR target genes, and rescued the deficits in social preference, grooming, and memory in male UBE3A-overexpressing mice, without affecting females. These findings reveal the critical role of AR signaling in sex-specific changes linked to UBE3A-dependent ASD.

Autonomic Disequilibrium at Rest in Autistic Children and Adults

Autism Spectrum Disorder (ASD) symptoms have been proposed to be linked to Autonomic Nervous System (ANS) atypical functioning, in particular sympathetic hyper-arousal and parasympathetic under-activation. The objective of this study was to characterize autonomic functioning at rest in autistic and neurotypical children and adults. To characterize several aspects of autonomic functioning, we recorded simultaneously pupil diameter, heart rate and electrodermal activity during 5 min of rest in 44 children (6-12 years old, 22 autistic) and 42 adults (19-52 years old, 21 autistic). Several parameters allowed to characterize tonic and phasic indices of sympathetic and parasympathetic systems at rest. Autistic children exhibited the expected pattern of parasympathetic under-activation at rest compared to their typically developing (TD) peers, and with a tendency for a higher phasic sympathetic activity. Adults exhibited a reverse autonomic pattern, with autistic individuals showing higher sympathetic tonus and lower sympathetic phasic activity than their TD peers. In conclusion, we observed an autonomic disequilibrium at rest both in autistic children and adults, but with opposite patterns that could reflect adaptive compensation mechanisms during maturation. This disequilibrium in autistic children would switch from excessive phasic components to excessive tonic components in adults, possibly subtended by an atypical locus coeruleus functioning.

Tooth brushing behavior and oral health care of people with early childhood autism in Germany

OBJECTIVES

Only a little is known about the tooth brushing behaviors and oral health care of people with early childhood autism (P-EA). To remedy this, a survey was carried out with P-EA of all ages.

MATERIALS AND METHODS

In summer 2021, an online survey questionnaire with 124 questions, addressed only at caregivers of P-EA, was sent to all members of the Bundesverband Autismus Deutschland e.V. Our present study evaluated the 20 survey questions related to dental self-care.

RESULTS

In total, 130 questionnaires were evaluated. The mean age of the P-EA was 22.7 years (min: 3y; max: 60y; SD ± 14.1y). Only 17.7% (n =23) of the P-EA were female, while 82.3%(n =107) were male. Overall, 54.6% (n = 71) of P-EA are always actively assisted in tooth brushing. Although 57.7% (n = 75) of P-EA brushed teeth twice daily, 39.2% brushed for one to two minutes (n = 51). P-EA younger than 18 years old selected toothpaste primarily for taste reasons (32.7%;n = 18). Only 9.3% (n = 7) of adult P-EA selected toothpaste because of the fluoride content. Manual toothbrushes were preferred by 40.8% (n = 53) of the P-EA, and electric toothbrushes by 34.6% (n = 45). Almost three quarters (71.5%;n = 93) did not use additional dental care implements. The same number (75.4%;n = 98) of P-EA had not practiced supervised brushing in a dental office.

CONCLUSIONS/CLINICAL RELEVANCE

Active support in dental self-care is crucial for a majority of the P-EA in Germany, regardless of their age. Professional support needs to be fundamentally improved. Clinical concepts for practical instruction in dental hygiene should be developed for P-EA.

Examining Virtual Reality Interventions for Social Skills in Children with Autism Spectrum Disorder: A Systematic Review

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is characterized by limitations in social communication and interaction, self-repetitive behaviors, and the presence of limited interests. The prevalence of ASD, which typically emerges in the first years of life, is increasing at an alarming rate due to multiple factors, including the broadening of diagnostic criteria, heightened public awareness, and more frequent diagnoses among women and adults. Over the years, experts have invested considerable time and effort in developing educational scenarios for children with ASD. However, they have faced challenges replicating certain scenarios-such as emergencies, crowded public transportation, or restaurant environments-because recreating these exact conditions in real-world settings is difficult or cost-prohibitive. This has consequently compelled experts to seek out supplementary intervention methods that are more suitable and accessible. Virtual reality (VR), which has the capacity to integrate the physical and virtual realms, represents one such alternative intervention method. In this study, a systematic review of studies employing VR technology in social skills interventions for individuals with ASD was conducted, and 31 studies were included. The findings indicate the potential benefits of VR applications focusing on the social skills of individuals with ASD. Additionally, this research elucidates the limitations of the studies and offers suggestions for future research.

Altered Monocyte Populations and Activation Marker Expression in Children with Autism and Co-Occurring Gastrointestinal Symptoms

Autism spectrum disorder (ASD) is an early-onset neurodevelopmental condition that now impacts 1 in 36 children in the United States and is characterized by deficits in social communication, repetitive behaviors, and restricted interests. Children with ASD also frequently experience co-morbidities including anxiety and ADHD, and up to 80% experience gastrointestinal (GI) symptoms such as constipation, diarrhea, and/or abdominal pain. Systemic immune activation and dysregulation, including increased pro-inflammatory cytokines, are frequently observed in ASD. Evidence has shown that the innate immune system may be impacted in ASD, as altered monocyte gene expression profiles and cytokine responses to pattern recognition ligands have been observed compared to typically developing (TD) children. In humans, circulating monocytes are often categorized into three subpopulations-classical, transitional (or "intermediate"), and nonclassical monocytes, which can vary in functions, including archetypal inflammatory and/or reparative functions, as well as their effector locations. The potential for monocytes to contribute to immune dysregulation in ASD and its comorbidities has so far not been extensively studied. This study aims to determine whether these monocyte subsets differ in frequency in children with ASD and if the presence of GI symptoms alters subset distribution, as has been seen for T cell subsets. Whole blood from ASD children with (ASD+GI+) and without gastrointestinal symptoms (ASD+GI-) and their TD counterparts was collected from children enrolled in the Childhood Autism Risk from Genetics and Environment (CHARGE) study. Peripheral blood mononuclear cells were isolated and stained for commonly used subset identifiers CD14 and CD16 as well as activation state markers CCR2, HLA-DR, PD-1, and PD-L1 for flow cytometry analysis. We identified changes in monocyte subpopulations and their expression of surface markers in children with ASD compared to TD children. These differences in ASD appear to be dependent on the presence or absence of GI symptoms. We found that the ASD+GI+ group have a different monocyte composition, evident in their classical, transitional, and nonclassical populations, compared to the ASD+GI- and TD groups. Both the ASD+GI+ and ASD+GI- groups exhibited greater frequencies of classical monocytes compared to the TD group. However, the ASD+GI+ group demonstrated lower frequencies of transitional and nonclassical monocytes than their ASD+GI- and TD counterparts. CCR2+ classical monocyte frequencies were highest in the ASD+GI- group. HLA-DR+ classical, transitional, and nonclassical monocytes were statistically comparable between groups, however, HLA-DR- nonclassical monocyte frequencies were lower in both ASD groups compared to TD. The frequency of classical monocytes displaying exhaustion markers PD-1 and PD-L1 were increased in the ASD+GI+ group compared to ASD+GI- and TD, suggesting potentially impaired ability for clearance of foreign pathogens or debris, typically associated with worsened inflammation. Taken together, the findings of differential proportions of the monocyte subpopulations and altered surface markers may explain some of the characteristics of immune dysregulation, such as in the gastrointestinal tract, observed in ASD.

Recognition of autism in subcortical brain volumetric images using autoencoding-based region selection method and Siamese Convolutional Neural Network

BACKGROUND

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects social interactions and behavior. Accurate and early diagnosis of ASD is still challenging even with the improvements in neuroimaging technology and machine learning algorithms. It's challenging because of the wide range of symptoms, delayed appearance of symptoms, and the subjective nature of diagnosis. In this study, the aim is to enhance ASD recognition by focusing on brain subcortical regions, which are critical for understanding ASD pathology.

METHODOLOGY

First, subcortical structures were extracted from a collection of brain MRI datasets using sophisticated processing steps. Next, a 3D autoencoder was trained on these 3D images to help identify brain regions related to ASD. Two distinct feature selection methods were then applied to the features extracted from the encoder. The highest-ranked features were iteratively selected and increased to reconstruct a specific percentage of the brain that represents the most relevant parts for ASD. Finally, a Siamese Convolutional Neural Network (SCNN) was employed as the classifier model.

RESULTS

The 3D autoencoder stage helped in identifying and reconstructing the significant subcortical regions related to ASD. Based on the studied dataset, high agreement in regions like the Putamen and Pallidum indicated the critical nature of these structures in distinguishing Autism from controls cases. Subsequently, applying SCNN on these selected subcortical regions yielded promising results. For example, using the classifier on the output regions identified by the Mutual Information (MI) features selection method achieved the highest accuracy of 0.66.

CONCLUSIONS

This study shows that using a two-stage model involving autoencoder and SCNN can notably improve the classification of ASD from brain MRI volumetric images. Applying an iterative feature extraction approach allowed to achieve a more accurate identification of ASD-related brain areas. This two-stage approach not only improved classification performance but also enhanced the interpretability of the neuroimaging data.

Revolutionizing pediatric neurology care: telemedicine advancements and regulatory impact in the Northeast of Brazil

BACKGROUND

 Telemedicine, a patient-centered approach that leverages technology, has emerged as a cost-effective solution to provide comprehensive medical services for acute and chronic conditions.

OBJECTIVE

 We aim to document the experiences of pediatric neurologists using teleconsultations within the TeleNortheast program, a specialized medical assistance initiative in the Northeast of Brazil.

METHODS

 A retrospective analysis of teleconsultations was conducted from January to October 2023. Data from 546 teleconsultations, involving 506 pediatric patients, were extracted from medical records. Consultations were conducted between pediatric neurologists in São Paulo and primary care professionals in Sergipe. The analysis included patients' demographics, diagnoses, and outcomes.

RESULTS

 Of the 506 teleconsultation patients seen, 89% continued treatment within their primary care settings without needing in-person referrals. Discharge was observed in 9.5% of cases, and only 1.4% required specialized in-person care. The most frequent diagnosis was autism spectrum disorder (19.1%), followed by epilepsy (7.1%), attention-deficit/hyperactivity disorder (6.7%), and intellectual disability (5.9%). A cost-saving analysis indicated that teleconsultations avoided significant transportation costs, which could reach up to R$ 21 thousand for travel and feeding expenses.

CONCLUSION

 The results highlight the effectiveness of teleconsultations in improving access to pediatric neurological care in underserved regions, reducing the need for in-person counseling, with the potential to provide significant cost savings for the public health system. The TeleNortheast program demonstrates the potential of this approach to bridge healthcare gaps, particularly in regions with limited access to specialized care.

Understanding autistic youths' menstrual product preferences and caregivers' product choices

LAY ABSTRACT

There is little research exploring the menstrual product preferences of autistic youth, especially those who recently started their period. Study authors surveyed caregivers' choice of menstrual products for their autistic children. They provided popular menstrual materials to autistic youth to try, then asked them which product(s) they preferred, did not try, and why they did not try it. Caregivers selected sensory impact as the most important feature they consider when choosing a menstrual product for their child, and youth participants preferred to use period underwear. Therefore, autistic youth may benefit from purchasing and using period underwear, and caregivers, clinicians, and companies should consider the impact of menstrual product features, like sensory sensitivities, on young autistic menstruators and how best to support them.

Sex-specific effects of prenatal bisphenol A exposure on transcriptome-interactome profiles of autism candidate genes in neural stem cells from offspring hippocampus

Bisphenol A (BPA), an endocrine-disrupting chemical, is increasingly linked to the pathogenesis of autism spectrum disorder (ASD). This study investigates the effects of prenatal BPA exposure on neural stem cells (NSCs) from the hippocampi of rat offspring, a brain region critical for neurodevelopment and implicated in ASD. Pregnant rats were administered with BPA or vehicle control once daily via oral gavage from gestational day 1 until parturition. NSCs were isolated from the offspring's hippocampi on postnatal day 1, and RNA sequencing was performed to examine transcriptomic alterations. Differentially expressed genes (DEGs) were identified through RNA-seq and further analyzed using Ingenuity Pathway Analysis (IPA) to explore disrupted pathways. In addition, in vitro proliferation assays were conducted, utilizing immunofluorescence staining for Sox2, a stem cell marker, and BrdU to quantify proliferating NSCs. Our results revealed that prenatal BPA exposure induced sex-specific alterations in NSC gene expression, with ASD-related genes such as Atp1a3, Nefl, and Grin1 being particularly dysregulated in male offspring. Moreover, sex-specific changes in NSC proliferation were observed. The study underscores BPA's potential as an environmental risk factor for ASD, emphasizing the need for further research into its role in sex-specific neurodevelopmental effects.

Caregiver report of infant behavior associated with autism likelihood in first year of life

BACKGROUND

Identification of prodromal indicators of autism in infancy has the potential to identify behaviors relevant to early autism screening.

METHODS

We report on data from a prospective general population birth cohort with maternal reported measures at 9 and 12 months: the Survey of Well-Being of Young Children (SWYC; general developmental surveillance) and the First Year Inventory-Lite v3.1b (FYI-Lite; autism specific parent report research tool). Mothers completed the surveys and the Broad Autism Phenotype Questionnaire (BAPQ), a self-report measure of subclinical features of autism.

RESULTS

In this sample of 332 infants (168 males), maternal-reported infant developmental milestones and behavioral indicators of difficult temperament, poor adaptability, and sleep problems at 9 months (SWYC) and maternal self-reported subclinical autism characteristics (BAPQ) were correlated with maternal-reported autism-related behaviors on the FYI-Lite at 12 months. Regression models revealed significant unique associations between infant temperament, developmental milestones, and FYI-Lite scores while controlling for significant effects of maternal BAPQ scores and education.

CONCLUSIONS

Maternal report of infant temperament and developmental milestones at 9 months were associated with maternal-report early indicators of autism likelihood at 12 months in a general birth cohort. Follow up of this cohort is needed to determine associations with formal diagnostic outcomes.

IMPACT

Identifying scalable measures of infant behaviors in general and specific to autism may help identify targets of intervention for infants in the first year of life. This study aims to contribute to improved first-year surveillance by assessing potential early autism indicators in a prospective general birth cohort, whereas other observational studies utilize enriched risk cohorts (e.g., infant siblings of autistic children). Preliminary findings of this cohort revealed that a maternal report of 9-month temperament significantly predicted higher scores on a maternal report 12-month autism screener and indicated the importance of considering maternal self-reported subclinical autism characteristics when interpreting parent report screeners.

Alterations of triple network dynamic connectivity and repetitive behaviors after mini-basketball training program in children with autism spectrum disorder

Physical exercise has been demonstrated to effectively mitigate repetitive behaviors in children with autism spectrum disorder (ASD), but the underlying dynamic brain network mechanisms are poorly understood. The triple network model consists of three brain networks that jointly regulate cognitive and emotional processes and is considered to be the core network underlying the aberrant manifestations of ASD. This study investigated whether a mini-basketball training program (MBTP) could alter repetitive behaviors and the dynamic connectivity of the triple network. 28 male children with ASD were scanned twice with resting-state functional MRI and assessed for repetitive behaviors using the repetitive behavior scale (RBS-R). 15 children in the exercise group participated in a 12-week MBTP, while 13 in the control group maintained their regular routines. The feature of Dynamic independent component analysis (dyn-ICA) is its ability to capture the rate of change in connectivity between brain regions. In this study, it was specifically employed to examine the triple network dynamic connectivity in both groups. Compared to the control group, the exercise group exhibited distinct dynamic connectivity patterns in two networks: Network 1 involved cross-network dynamic connectivity changes within the triple network, and Network 2 pertained to dynamic connectivity alterations within the default mode network. Furthermore, a reduction in the RBS-R Total score was observed in the exercise group, reflecting improvements in self-injurious behavior and restricted behavior. Correlation analysis revealed that the amelioration of repetitive behaviors was associated with enhanced dynamic connectivity in parts of the triple network. These findings suggest that MBTP can improve repetitive behaviors in ASD children and is linked to changes in triple network dynamic connectivity.

Exploring Narrative Ability in Greek-Speaking Children with High-Functioning ASD: Associations with Memory and Attention

Background/Objectives: Narration is a sensitive tool for the assessment of language in children with high-functioning autism spectrum disorder (HF-ASD) since mild language deficits beyond the sentential level are not always noticeable through the administration of standardized language tests targeting the lexical or sentential level. This study investigated the narrative ability of monolingual Greek-speaking HF-ASD children in comparison to that of their typically developing (TD) peers and explored the associations between narrative variables, ADHD symptomatology, and memory skills in the participants on the autistic spectrum. Methods: The participants were 39 children aged 7 to 12 years, 19 with HF-ASD and 20 age-matched, vocabulary-matched, and cognitively matched TD peers. Results: The two groups were similar in most microstructural and macrostructural variables but differed significantly in syntactic complexity (p = 0.024; d = 0.754) and subordination (p < 0.001; d = -1.576) indices, implying that the HF-ASD group presented syntactic delay in comparison to their TD peers. The HF-ASD participants showed significantly higher heterogeneity in the amount of information generated for the story's main character (p = 0.004; d = -0.093) in comparison to their TD peers. Significant associations were observed between verbal and visual memory, complex syntactic structures, and Theory of Mind-related internal state terms. ADHD symptomatology was negatively correlated with the generation of simple and coordinated clauses. Finally, complex syntax and delayed vSTM were correlated with retelling total scores, indicating that language ability and verbal memory compensate for narrative competence in HF-ASD children. Conclusions: The findings highlight the impact that language skills, memory ability, and ADHD symptomatology have on narrative competence in children with HF-ASD, as well as the importance of narrative use for assessing the language skills in populations with mild language impairment.

The effectiveness of music therapy in improving behavioral symptoms among children with autism spectrum disorders: a systematic review and meta-analysis

Objectives

This comprehensive review and meta-analysis aimed to thoroughly identify the effectiveness of music therapy (MT) in improving behavioral symptoms in children with autism spectrum disorders (ASD) by analyzing the data from all relevant randomized controlled trials (RCTs) related to this field.

Methods

From inception until September 18, 2024, PubMed, Web of Science, the Cochrane Library, SinoMed, and Embase were searched. Two reviewers extracted the data separately, and any controversies between the authors' assessments were resolved by conversation or speaking with another author. The behavioral symptoms scale score before and after the intervention was taken from the included trials and used to reflect the therapeutic effect of music therapy in children with autism.

Results

2607 records across all retrieved databases were discovered, thirteen of which were included in a meta-analysis with 1160 participants. According to the meta-analysis, children with autism showed a substantial improvement in their behavior symptoms when receiving music treatment (standardized mean difference [SMD] = -0.66, 95% confidence interval [CI]: -0.93 to -0.39, p < 0.001). With I 2 = 78% and P < 0.001, we did discover a medium level of heterogeneity among the included studies.

Conclusions

MT has a positive impact on improving behavioral symptoms in children with autism. However, given the significant heterogeneity and limitations in this study, RCTs with rigorous methodological quality are still required to confirm the curative benefits of MT in autistic children precisely.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024597939.

Analysis of Disparities in Diagnosis of Autism Spectrum Disorder in the Military Health System Pediatrics Population

There have been disparities reported in prevalence of autism by gender, race, and socioeconomic status with older ages of diagnosis in non-White and in female children. Possible disparities in the ages of autism diagnosis are not well-established within the Military Health System (MHS) pediatric population, where we hypothesized less disparities given universal Tricare coverage for active-duty military families and theoretically equal access to the military treatment facility (MTF). We conducted retrospective cross-sectional analysis using deidentified database repository records from the MHS. We collected and analyzed demographic data on children covered by Tricare and newly diagnosed with autism within an MTF (N = 31,355) or outside of the MTF (5,579 respectively). Within the MTF, we identified younger ages of autism diagnosis in non-White children less than 18 years old (p < 2.2e-16), without significant differences in ages of diagnosis by race in children less than 6 years of age. There were no statistically significant differences in ages of diagnosis between males and females. Outside the MTF, we identified younger ages of autism diagnosis in males versus females with statistically significant difference in average ages of autism diagnosis between males and females less than the age of 18 years (p = 4.4e-08). This difference was not seen in children less than 6 years of age. Racial data was not available for diagnosis outside the MTF. The age of autism diagnosis in the military pediatric population within the MTF did not reflect historical disparities seen in non-White and in female children.

Study protocol for a hybrid type 3 effectiveness-implementation trial of a team-based implementation strategy to support educators' use of a social engagement intervention

BACKGROUND

Remaking Recess (RR) is a school-based evidence-based peer social engagement intervention for autistic students. RR involves direct training and coaching with educators; however, educators face several barriers to implementation at both the individual- and organizational-levels. This protocol paper describes a multi-site study that will test whether an educator-level implementation strategy, coaching, with or without a school-level implementation strategy, school-based teams, will maximize educators' use (fidelity and sustainment) of RR for autistic students and their peers who are socially-isolated, rejected, or peripheral and may need additional support during recess.

METHODS

This study will employ a hybrid type-3 effectiveness-implementation trial. Fifty-five elementary schools will be recruited as well as 121 educators (e.g., classroom assistants, aides), 55 general and special educator teachers, and 83-138 other school personnel (e.g., administrators). Additionally, at least 118 autistic students and allistic or non-autistic classmates will be recruited as RR recipients. Participants will complete baseline assessments at the beginning of the year, and all schools will be provided RR training. Schools will be randomized to coaching with or without school-based teams. This study will measure RR fidelity (primary outcome), RR sustainment, as well as peer engagement, social network inclusion, and social skills (secondary outcomes). It is expected that coaching with school-based teams will improve both RR fidelity and social network inclusion, while coaching with and without school-based teams will result in improved peer engagement and social skills.

DISCUSSION

Previous research has documented barriers to RR implementation at both the individual- (provider) and organization-level (school). Using multi-level implementation strategies such as coaching with school-based teams may address these barriers and support RR implementation in schools. Findings from this study may guide future efforts to scale up tailored implementation strategies for use in public school districts, with the ultimate goal of increasing intervention access and improving student outcomes.

TRIAL REGISTRATION

Name of the Registry: clinicaltrials.gov.

TRIAL REGISTRATION

Clinical Trials ID: NCT06559267 . Date of Registration: August 15, 2024. Prospectively registered.