Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation

The association between NLGN4 gene variants and the incidence of autism spectrum disorders in Guilan, Iran

Autism Spectrum Disorder (ASD) is a developmental disorder characterized by impaired social interaction, communication skills, and repetitive behaviours. This study aimed to investigate the association between variants of the Neuroligin-4 (NLGN4) gene (rs1882260 and rs3810688) and the incidence of ASD in North of Iran in the ASD group (n = 60) and control group (n = 60). DNA was isolated from whole blood, saliva, or hair samples. The targeted variants were genotyped using the Amplification Refractory Mutation System-Polymerase Chain Reaction (ARMS-PCR) technique. Genetic analyses were conducted using SNPAlyze ver. 8.1. Results revealed a significant difference of rs3810688 polymorphism in the NLGN4 gene in both genotypic and allelic frequency distributions between the ASD and control groups (P < 0.05). The GG genotype of rs3810688 polymorphism exhibited a significant association with an elevated risk of ASD in contrast to the CC genotype, as revealed under the co-dominant model (OR=4.2; 95 %CI, 1.25-14.05; P = 0.019). The study illustrated the possible role of rs3810688 polymorphism of NLGN4 in increasing the incidence of ASD among newborns in Guilan province. Also, the G-C haplotype was found to be a protective variant against ASD.

Impact of ASD and ADHD on pediatric asthma exacerbations: a retrospective analysis of the Nationwide Inpatient Sample 2005-2020

BACKGROUND

To explore the impact of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) on in-hospital outcomes in children hospitalized for asthma exacerbations.

METHODS

This retrospective study utilized data from the Nationwide Inpatient Sample (NIS) database between 2005 and 2020. We included children aged 5 to 19 years admitted for asthma exacerbations. Children were categorized into four groups: those with ASD only, ADHD only, both ASD and ADHD, and neither condition. Propensity score matching was used to balance baseline characteristics.

RESULTS

A total of 155,893 children hospitalized for asthma were identified, with 2,443 patients remaining after propensity score matching. Children with both ASD and ADHD had the highest total hospital costs, followed by those with ASD alone. Children with both ASD and ADHD had significantly increased risks of overall complications (aOR = 1.69, 95% CI: 1.27-2.26), including epilepsy (aOR = 3.56, 95% CI: 1.61-7.87), pneumonia (aOR = 2.00, 95% CI: 1.33-3.03), and constipation (aOR = 4.22, 95% CI: 1.58-11.26), compared to those without either condition. Children with ASD alone also had elevated risks for epilepsy (aOR = 3.79, 95% CI: 1.79-8.03) and constipation (aOR = 4.33, 95% CI: 1.78-10.54).

CONCLUSION

In the US children hospitalized for asthma exacerbations, those with both ASD and ADHD, or ASD alone, face significantly greater costs and higher risks of specific complications, particularly epilepsy, pneumonia, and constipation. The findings suggest a compounded impact of these neurodevelopmental conditions on asthma children, emphasizing the need for specialized care to manage these patients effectively and reduce the risks.

Gut-immune-brain interactions during neurodevelopment: from a brain-centric to a multisystem perspective

BACKGROUND

Neurodevelopmental disorders (NDDs) and epileptic syndromes are complex neurological conditions linked by shared abnormal neurobiological processes. Existing therapies mostly target symptoms, rather than addressing the underlying causes of the disease, leaving a burden of unmet clinical needs.

MAIN BODY

Emerging evidence suggests a significant role for the gut microbiota and associated immune responses in influencing brain development and function, changing the paradigm of a brain-centric origin of NDDs. This review discusses the pivotal interactions within the gut-immune-brain axis, highlighting how microbial dysbiosis and immune signaling contribute to neurological pathologies. We also explore the potential of microbial management and immunomodulation as novel therapeutic avenues, emphasizing the need for a shift towards addressing the root causes of these disorders rather than just their symptoms.

CONCLUSIONS

This integrated perspective offers new insights into the biological underpinnings of NDDs and epilepsy, proposing innovative biomarkers and therapeutic strategies.

Feeding Behaviors in Infants and Toddlers Later Diagnosed with Autism Spectrum Disorder: A Systematic Review

Children with autism spectrum disorder (ASD) are five times more likely to have feeding difficulties than neurotypical peers, although the majority of evidence describes feeding difficulty in children age 2 years and older. The purpose of this study is to systematically review the literature on feeding characteristics of children age 0-24 months who were later diagnosed with ASD with an emphasis on the measurement tools used to assess these feeding behaviors. We conducted a systematic review of the literature using PRISMA guidelines. Using selected keywords, a search was conducted using PubMed, PsycINFO, and CINAHL databases for relevant articles to identify feeding characteristics in infants and toddlers (age 0-24 months) later diagnosed with ASD. Sixteen studies were selected for this review by two independent reviewers. Among the selected studies, feeding difficulties were reported in all infant oral feeding modalities (breastfeeding, bottle feeding, and complementary feeding) by infants later diagnosed with ASD. However, the evidence was conflicting among studies regarding feeding characteristics, such as sucking differences while breastfeeding, use of the spoon with feedings, and preference of solid food texture, that presented in infants later diagnosed with ASD. A lack of consistent measurement of feeding behaviors in infants later diagnosed with ASD contributes to the difficulty in comparison across studies. Future research should focus on developing targeted, validated instruments for measuring feeding difficulty in this population with emphasis on breastfeeding and bottle feeding difficulty.

Comparison of Procedural Sedation Outcomes in Children With and Without Autism Spectrum Disorder

OBJECTIVE

Children with autism spectrum disorder (ASD) often have comorbidities predisposing them to higher risk for sedation-related adverse events (AEs). Our objective was to compare sedation-related AEs in children with and without ASD.

PATIENTS AND METHODS

We conducted a multicenter study of children aged 3-18 years with and without ASD who underwent sedation outside the operating room from May 1, 2022, to April 30, 2023, using the Pediatric Sedation Research Consortium database. The primary exposure was ASD diagnosis. We compared AEs in children with and without ASD after matching for age, sex, procedure, and American Society of Anesthesiologists classification.

RESULTS

Of 64 708 children analyzed, 4421 (6.8%) had an ASD diagnosis. A higher proportion of children with ASD were male (75.4% vs 54.7%), obese (6.0% vs 2.9%), and had a comorbid condition (93.5% vs 40.3%). Matched analysis showed no significant difference in critical AEs (odds ratio [OR], 0.63; 95% CI, 0.23-1.49). However, children with ASD had greater odds of high risk (OR, 1.52; 95% CI, 1.26-1.83) and low-risk AEs (OR, 1.39; 95% CI, 1.25-1.55) compared with children without ASD. Specifically, children with ASD had greater odds of hypoxia (OR, 1.31; 95% CI, 1.10-1.56) and complete (OR, 1.89; 95% CI, 1.27-2.81) or partial (OR, 1.43; 95% CI, 1.25-1.63) airway obstruction.

CONCLUSIONS

Children with ASD are at a higher risk for sedation-related airway AEs and significant respiratory interventions, although the incidence of critical AEs was low.

Effects of low concentration of fluoride exposure during fetal on behavior and neurotransmitters in adult mice

Fluoride (F) naturally occurs in water in China and India, and in excess, can cause skeletal fluorosis and mottled teeth. Chronic exposure to F during gestation can affect the development of the brain, reducing intelligence quotient and inducing autism spectrum disorder-like behavior. In the present study, it was aimed to clarify the effects of chronic exposure to low concentrations of F in utero on brain function. The behavior was assessed, the levels of brain neurotransmitters were measured in mice and their relationships were analyzed. ICR mice consumed water containing sodium fluoride (F concentrations: 0, 15, or 30 ppm) from 3 weeks of age until the weaning of their pups (F1). The pups then consumed water containing the same concentration of F as their parents from weaning. At 8-weeks old, the F1 mice underwent behavioral testing using the Y-maze, elevated plus maze, Barnes maze (BM) and open-field test (OFT). At 10 weeks of age, they were euthanized, their brains were collected, and the levels of neurotransmitters were measured. Grooming events in the OFT were more frequent in F-exposed groups than in the control group, indicating that F exposure causes anxiety-like behavior. In the BM, the time taken to reach the escape box and the number of errors were higher during the training and test, suggesting spatial memory impairment. Cerebellar glutamate (Glu) concentrations were significantly lower in the F-exposed groups than in the control group. Low Glu concentration was associated with greater grooming frequency in the OFT, lower mean speed and more errors in the BM, and a delay in reaching the escape box. In the F-exposed groups, the midbrain noradrenaline concentrations were significantly lower and the number of errors in the BM was larger than in controls. Thus, F-exposed mice showed poorer spatial memory and differences in the levels of neurotransmitter, suggesting that F is an environmental contributor to disease.

Trace amine-associated receptor 1 (TAAR1): an emerging therapeutic target for neurodegenerative, neurodevelopmental, and neurotraumatic disorders

Trace amines are physiologically active amines present in all organisms. They are structurally identical to traditional monoamines and are rapidly metabolized by monoamine oxidases. The mammalian neurological system generates these molecules at rates equivalent to traditional monoamines, but because of their short half-life, they are only observable in trace quantities. Their receptors are G protein-coupled receptors present in both the CNS and peripheral locations, with trace amine-associated receptor 1 (TAAR1) being the most researched. TAAR1's capacity to regulate glutamatergic and monoaminergic neurotransmission has made it a viable therapeutic target for neuropsychiatric illnesses. Although the TAAR1 role in schizophrenia and other neuropsychiatric disorders is well established, its role in the pathology of neurodegenerative and neurotraumatic disorders recently got attention. This review discusses the role of TAAR1 in neurodegenerative, neurodevelopment, and neurotraumatic disorders and explores its potential to be a novel therapeutic target in these disorders.

Nutritional Approaches in Autism Spectrum Disorder: A Scoping Review

PURPOSE OF REVIEW

This review was conducted to discuss the etiology of autism in the light of current information, to draw attention to the fact that defects in different biological mechanisms cause autism, and to examine the effectiveness of dietary interventions and supplements in relieving ASD symptoms.

RECENT FINDINGS

Autism spectrum disorder (ASD) is an extremely heterogeneous condition characterized by delays in reciprocal social interaction and communication skills, stereotyped behaviors, and a narrowed range of interests and limited activities. Comorbid conditions such as cognitive impairment, epilepsy, psychiatric diseases, and behavioral symptoms such as impaired social communication, repetitive behaviors, lack of interest in the environment, nutritional disorders, gastrointestinal diseases and abnormal (dysbiotic) states, sleep disorders, and dysmorphism are frequently encountered in individuals with ASD. Although nutrition is one of the environmental factors affecting ASD, it can also be effective in alleviating the behavioral and gastrointestinal symptoms of ASD. Various dietary models (GFCF diet, low glycemic index diet, ketogenic diet, specific carbohydrate diet, Mediterranean diet, GAPS, Feingold, Candida body ecology, allergy elimination diets, etc.) and supplements (vitamin D, polyunsaturated fatty acids, probiotics and prebiotics, phytochemicals) can be used to alleviate symptoms in individuals with ASD. The effectiveness and reliability of dietary interventions in individuals with ASD are a matter of significant debate, and the evidence for these practices is limited. Furthermore, there is no consensus on establishing an ideal nutritional model for individuals with ASD.

Limitations of genomics to predict and treat autism: a disorder born in the womb

Brain development involves the sequential expression of vulnerable biological processes including cell proliferation, programmed cell death, neuronal migration, synapse and functional unit formation. All these processes involve gene and activity-dependent events that can be distorted by many extrinsic and intrinsic environmental factors, including stress, microbiota, inflammatory signals, hormonal signals and epigenetic factors, hence leading to disorders born in the womb that are manifested later in autism spectrum disorders (ASDs) and other neurodevelopmental disorders. Predicting and treating such disorders call for a conceptual framework that includes all aspects of developmental biology. Here, taking the high incidence of ASDs as an example, we first discuss the intrinsic limitations of the genetic approach, notably the widely used twin studies and SNPs. We then review the long list of in utero events that can deviate developmental sequences, leading to persistent aberrant activity generated by immature misplaced and misconnected neuronal ensembles that are the direct cause of ASD. In a clinical perspective, we suggest analysing non-genetic maternity data to enable an early prediction of babies who will develop ASD years later, thereby facilitating early psycho-educative techniques. Subsequently, agents capable of selectively silencing malformed immature networks offer promising therapeutic perspectives. In summary, understanding developmental processes is critical to predicting, understanding and treating ASD, as well as most other disorders that arise in the womb.

Accelerating autism spectrum disorder care: A rapid review of data science applications in diagnosis and intervention

Integrating data science techniques, including machine learning, natural language processing, and big data analytics, has revolutionized the diagnosis and intervention landscape for Autism Spectrum Disorder (ASD). This rapid review examines these approaches' current applications, benefits, limitations, and ethical considerations while identifying key research gaps and future directions. Data-driven methodologies offer significant advantages, such as enhanced diagnostic accuracy, personalized interventions, and increased accessibility, particularly in resource-limited settings. However, challenges like data quality, algorithmic bias, and interpretability hinder widespread implementation. Additionally, ethical concerns regarding privacy, consent, and equity necessitate careful navigation. Despite these advancements, substantial research gaps remain, including the lack of diverse datasets, limited longitudinal studies, and insufficient generalizability across populations. Future studies must prioritize addressing these gaps by fostering collaboration, ensuring ethical transparency, and developing inclusive, scalable solutions to improve patient outcomes. This review underscores the transformative potential of data science in accelerating ASD care while emphasizing the need for continued innovation and responsible application.

Transcripts derived from AmnSINE1 repetitive sequences are depleted in the cortex of autism spectrum disorder patients

Aims

Autism spectrum disorder (ASD) is a brain developmental disability with a not-fully clarified etiogenesis. Current ASD research largely focuses on coding regions of the genome, but up to date much less is known about the contribution of non-coding elements to ASD risk. The non-coding genome is largely made of DNA repetitive sequences (RS). Although RS were considered slightly more than "junk DNA", today RS have a recognized role in almost every aspect of human biology, especially in developing human brain. Our aim was to test if RS transcription may play a role in ASD.

Methods

Global RS transcription was firstly investigated in postmortem dorsolateral prefrontal cortex of 13 ASD patients and 39 matched controls. Results were validated in independent datasets.

Results

AmnSINE1 was the only RS significantly downregulated in ASD specimens. The role of AmnSINE1 in ASD has been investigated at multiple levels, showing that the 1,416 genes containing AmnSINE1 are associated with nervous system development and autism susceptibility. This has been confirmed in a different experimental setting, such as in organoid models of the human cerebral cortex, harboring different ASD causative mutations. AmnSINE1 related genes are transcriptionally co-regulated and are involved not only in brain formation but can specifically be involved in ASD development. Looking for a possible direct role of AmnSINE1 non-coding transcripts in ASD, we report that AmnSINE1 transcripts may alter the miRNA regulatory landscape for genes involved in neurogenesis.

Conclusion

Our findings provide preliminary evidence supporting a role for AmnSINE1 in ASD development.

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

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

Machine learning of clinical phenotypes facilitates autism screening and identifies novel subgroups with distinct transcriptomic profiles

Autism spectrum disorder (ASD) presents significant challenges in diagnosis and intervention due to its diverse clinical manifestations and underlying biological complexity. This study explored machine learning approaches to enhance ASD screening accuracy and identify meaningful subtypes using clinical assessments from AGRE database integrated with molecular data from GSE15402. Analysis of ADI-R scores from a large cohort of 2794 individuals demonstrated that deep learning models could achieve exceptional screening accuracy of 95.23% (CI 94.32-95.99%). Notably, comparable performance was maintained using a streamlined set of just 27 ADI-R sub-items, suggesting potential for more efficient diagnostic tools. Clustering analyses revealed three distinct subgroups identifiable through both clinical symptoms and gene expression patterns. When ASD were grouped based on clinical features, stronger associations emerged between symptoms and underlying molecular profiles compared to grouping based on gene expression alone. These findings suggest that starting with detailed clinical observations may be more effective for identifying biologically meaningful ASD subtypes than beginning with molecular data. This integrated approach combining clinical and molecular data through machine learning offers promising directions for developing more precise screening methods and personalized intervention strategies for individuals with ASD.

Autism Spectrum Disorder and Epilepsy: Pathogenetic Mechanisms and Therapeutic Implications

The co-occurrence of autism spectrum disorder (ASD) and epilepsy is a complex neurological condition that presents significant challenges for both patients and clinicians. ASD is a group of complex developmental disorders characterized by the following: (1) Social communication difficulties: challenges in understanding and responding to social cues, initiating and maintaining conversations, and developing and maintaining relationships. (2) Repetitive behaviors: engaging in repetitive actions, such as hand-flapping, rocking, or lining up objects. (3) Restricted interests: focusing intensely on specific topics or activities, often to the exclusion of other interests. (4) Sensory sensitivities: over- or under-sensitivity to sensory input, such as sounds, touch, tastes, smells, or sights. These challenges can significantly impact individuals' daily lives and require specialized support and interventions. Early diagnosis and intervention can significantly improve the quality of life for individuals with ASD and their families. Epilepsy is a chronic brain disorder characterized by recurrent unprovoked (≥2) seizures that occur >24 h apart. Single seizures are not considered epileptic seizures. Epilepsy is often idiopathic, but various brain disorders, such as malformations, strokes, and tumors, can cause symptomatic epilepsy. While these two conditions were once considered distinct, growing evidence suggests a substantial overlap in their underlying neurobiology. The prevalence of epilepsy in individuals with ASD is significantly higher than in the general population. This review will explore the epidemiology of this comorbidity, delve into the potential mechanisms linking ASD and epilepsy, and discuss the implications for diagnosis, treatment, and management.

Sociocultural and perinatal health factors associated with Autism spectrum disorder (ASD) in children

While previous research has examined perinatal factors in the context of Autism Spectrum Disorder (ASD), studies focusing on sociocultural factors is limited. We conducted a cross-sectional analysis utilizing data from the Australian Autism Biobank (AAB), which encompasses autistic children aged 2-17, their siblings, parents, and unrelated controls. Employing multivariable regression analyses, we aimed to identify factors associated with ASD across various domains, spanning health and lifestyle, perinatal, and postnatal contexts. Importantly, our analyses were adjusted for critical sociodemographic covariates. Advanced maternal age, male sex at birth, and identifying as from culturally and linguistically diverse (CALD) background, were found to be associated with risk of ASD. Pre-existing chronic health conditions in both parents and paternal medication use before conception were also associated with ASD risk in children. Associations with complications during pregnancy, caesarean delivery, and maternal medication use during pregnancy were also found. Postnatal factors of interest included the presence of health conditions (e.g., epilepsy), infections in early-life (e.g., respiratory infections), and atypical development in the first six months of life (e.g., hypotonia). These insights can guide closer monitoring and support for those with pre-existing vulnerabilities especially in terms of certain perinatal and sociocultural characteristics.

Detecting Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Using Multimodal Time-Frequency Analysis with Machine Learning Using the Electroretinogram from Two Flash Strengths

PURPOSE

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are conditions that similarly alter cognitive functioning ability and challenge the social interaction, attention, and communication skills of affected individuals. Yet these are distinct neurological conditions that can exhibit diverse characteristics which require different management strategies. It is desirable to develop tools to assist with early distinction so that appropriate early interventions and support may be tailored to an individual's specific requirements. The current diagnostic procedures for ASD and ADHD require a multidisciplinary approach and can be lengthy. This study investigated the potential of electroretinogram (ERG), an eye test measuring retinal responses to light, for rapid screening of ASD and ADHD.

METHODS

Previous studies identified differences in ERG amplitude between ASD and ADHD, but this study explored time-frequency analysis (TFS) to capture dynamic changes in the signal. ERG data from 286 subjects (146 control, 94 ASD, 46 ADHD) was analyzed using two TFS techniques.

RESULTS

Key features were selected, and machine learning models were trained to classify individuals based on their ERG response. The best model achieved 70% overall accuracy in distinguishing control, ASD, and ADHD groups.

CONCLUSION

The ERG to the stronger flash strength provided better separation and the high frequency dynamics (80-300 Hz) were more informative features than lower frequency components. To further improve classification a greater number of different flash strengths may be required along with a discrimination comparison to participants who meet both ASD and ADHD classifications and carry both diagnoses.

Gut microbiota, vitamin A deficiency and autism spectrum disorder: an interconnected trio - a systematic review

Accumulating evidence proves that children with autism have gastrointestinal problems. However, a significant difference in gut microbiota (GM) exists between autistic and non-autistic children. These changes in the GM may stem from several factors. Recently, researchers focused on nutritional factors, especially vitamin deficiency. Thus, our systematic review investigates the connections among autism, GM alterations, and vitamin A deficiency (VAD), by analyzing studies sourced from PubMed and Embase databases spanning from 2010 to 2022. Adhering to PRISMA guidelines, we meticulously selected 19 pertinent studies that established links between autism and GM changes or between autism and VAD. Our findings uniformly point to significant alterations in the GM of individuals with autism, indicating these changes as promising biomarkers for the disorder. Despite the consistent association of GM alterations with autism, our analysis revealed no notable differences in GM composition between individuals with autism and those experiencing VAD. This suggests that VAD, especially when encountered early in life, might play a role in the onset of autism. Furthermore, our review underscores a distinct correlation between reduced levels of retinoic acid in children with autism, a disparity that could relate to the severity of autism symptoms. The implications of our findings are twofold: they not only reinforce the significance of GM alterations as potential diagnostic markers but also spotlight the critical need for further research into nutritional interventions. Specifically, vitamin A supplementation emerges as a promising avenue for alleviating autism symptoms, warranting deeper investigation into its therapeutic potential.

Health disparities persist for adults with developmental disabilities: NHIS insights, 1999-2018

This study assesses changes in self-reported health and healthcare status among adults with intellectual and developmental disabilities (I/DD) over the past 20 years, utilizing data from the National Health Interview Survey. We conducted a cross-sectional analysis of 601 464 adults 18 and older, categorized by disability status: no functional limitations, developmental disabilities, intellectual disabilities, and other functional limitations. We aimed to identify trends in health status, healthcare access, affordability, and utilization from 1999 to 2018, comparing outcomes across disability groups. Results indicate adults with intellectual disabilities reported poorer health compared to those without functional limitations, particularly in the most recent period (2014-2018). Adults with developmental disabilities exhibited increased odds of poor health during 2009-2013 compared to 1999-2003, but no significant differences occurred between other periods. Additionally, poverty rates for adults with I/DD were higher, with a substantial proportion of adults with intellectual disabilities living in poverty compared to those without functional limitations, indicating persistent disparities without significant trend improvements. Despite advancements in healthcare access and affordability, self-reported health outcomes for adults with I/DD have not improved, highlighting the need for policies to enhance care quality. Future research should focus on effective healthcare practices and provider training to address these persistent disparities.

Gut microbes: Therapeutic Target for neuropsychiatric disorders

Neuropsychiatric diseases encompass a range of mental and neurological disorders that have a significant and far-reaching effect on an individual's quality of life. These conditions affect not only the mental status but also the physical well-being of individuals, which leads to weakened immune systems and other diseases. Emerging research underscores a significant connection between the gut microbiome and neuropsychiatric diseases, suggesting that microbial communities within the gastrointestinal tract may influence brain function and mental health. Gut dysbiosis is caused by various factors, including stress, diet, inappropriate usage of antibiotics, infections, and so on, all of which can disrupt numerous pathways, resulting in abnormal neurotransmitter signaling, inflammation, and impaired brain function. Similarly, various neuropsychiatric diseases can disrupt the specific microbiome in the gut, leading to gut dysbiosis, often impairing memory and cognitive function. The growing evidence supporting the role of gut dysbiosis in neuropsychiatric disorders has opened up new avenues for therapeutic interventions. Modulating the gut microbiome through strategies such as probiotics, prebiotics, or fecal microbiota transplantation has shown promising results in various studies of neuropsychiatric disorders. However, further research is needed to fully elucidate the mechanisms involved in gut dysbiosis-associated brain changes to develop effective and personalized treatment strategies for neuropsychiatric diseases.

Emerging autism and Fragile X syndrome treatments

The limitations of current symptom-focused treatments drive the urgent need for effective therapies for autism and Fragile X syndrome (FXS). Currently, no approved pharmacological interventions target the core symptoms of these disorders. Advances in understanding the underlying biology of autism and FXS make this an important time to explore novel options. Indeed, several treatments have recently been tested in clinical trials, with promising results in treating core symptoms of autism and FXS. We focus on emerging interventions, such as gut microbiome therapies, anti-inflammatory approaches, bumetanide, phosphodiesterase 4D inhibitors, and endocannabinoid modulators. We also discuss factors, such as disorder heterogeneity, which may have contributed to poor efficacy in previously failed late-phase trials and impact recent trials, emphasizing the need for personalized treatment approaches.

Revealing the Multivariate Associations Between Autistic Traits and Principal Functional Connectome

Autism Spectrum Disorder (ASD) is a multifaceted neurodevelopmental condition characterized by a spectrum of behavioral and cognitive traits. As the characteristics of ASD are highly heterogeneous across individuals, a dimensional approach that overcomes the limitation of the categorical approach is preferred to reveal the symptomatology of ASD. Previous neuroimaging studies demonstrated strong links between large-scale brain networks and autism phenotypes. However, the existing studies have primarily focused on univariate association analysis, which limits our understanding of autism connectopathy. Using resting-state functional magnetic resonance imaging data from 309 participants (168 individuals with ASD and 141 typically developing controls) across a discovery dataset and two independent validation datasets, we identified multivariate associations between high-dimensional neuroimaging features and diverse phenotypic measures (20 or 7 measures). We generated low-dimensional representations of functional connectivity (i.e., gradients) and assessed their multivariate associations with autism-related phenotypes of social, behavioral, and cognitive problems using sparse canonical correlation analysis (SCCA). We selected three functional gradients that represented the cortical axes of the sensory-transmodal, motor-visual, and multiple demand-rests of the brain. The SCCA revealed multivariate associations between gradients and phenotypic measures, which were noted as linked dimensions. We identified three linked dimensions: the links between (1) the first gradient and social impairment, (2) the second and internalizing/externalizing problems, and (3) the third and metacognitive problems. Our findings were partially replicated in two independent validation datasets, indicating robustness. Multivariate association analysis linking high-dimensional neuroimaging and phenotypic features may offer promising avenues for establishing a dimensional approach to autism diagnosis.

Chemogenetic induction of CA1 hyperexcitability triggers indistinguishable autistic traits in asymptomatic mice differing in Ambra1 expression and sex

Among the genomic alterations identified as risk factors in mice models of autism spectrum disorders (ASD), heterozygous deletion of Ambra1 (Activating Molecule in Beclin1-Regulated Autophagy) triggers an ASD phenotype associated with hippocampal hyperexcitability exclusively in the female sex although Ambra1 protein is comparably expressed in the hippocampus of symptomatic females and asymptomatic males. Given the intricate relationship between Ambra1 deficiency and sex in the etiology of ASD, we took advantage of asymptomatic mice including Ambra1+/- males and wild-type (Wt) mice of both sexes to investigate whether their non-pathogenic variations in Ambra1 levels could underlie a differential susceptibility to exhibit ASD-like traits in response to experimental elevation of hippocampal excitability. Here we report that selective activation of inhibitory DREADD in CA1 parvalbumin-positive interneurons (PV-IN) reduces GABAergic currents onto pyramidal neurons (PN), causes social and attentional deficits, and augments the proportion of immature/thin spines in CA1 PN dendrites to the same extent in Ambra1+/- males and Wt mice of both sexes. Our findings show that the substantial hippocampal variations in pro-autophagic Ambra1 gene product shown by asymptomatic mice differing in mutation and/or sex do not underlie a differential reactivity to chemogenetic induction of idiopathic ASD.

Behavioural disorders and sleep problems in Sanfilippo syndrome: overlaps with some other conditions and importance indications

Sanfilippo syndrome (MPS III) is one of the types of mucopolysaccharidoses (MPS), a group of inherited metabolic diseases in which the accumulation of glycosaminoglycans (GAGs) results from deficiency of different lysosomal enzymes. The hallmarks of MPS III are relatively minor somatic abnormalities with severe and progressive central nervous system (CNS) symptoms. An analysis of the literature showed that the biggest problems for carers of people with MPS III are behavioural disorders and sleep disorders. Despite extensive discussions on improving the quality of life of patients, little attention was paid to the families/carers of patients. The families/carers are providing appropriate medical and palliative care to the patient every day due to their loss of mobility, self-care skills, tube feeding, airway clearance and other supports continue to have an adverse effect on the quality of life of families/carers. However, a literature review of possible solutions showed that effective methods (both pharmacological and non-pharmacological) exist. The needs of carers of MPS III patients should receive as much attention as the search for new treatments. There are many options for dealing with such problems. The key issue is to identify the source of the problem and choose the most effective therapy. Alleviating behavioural disorders, pain complaints and sleep problems will have a positive impact not only on the quality of life of carers/families, but also on the patients themselves.

Modulation of autism-associated serotonin transporters by palmitoylation: Insights into the molecular pathogenesis and targeted therapies for autism spectrum disorder

Background

Autism spectrum disorder (ASD) is a developmental disorder of the nervous system characterized by a deficiency in interpersonal communication skills, a pathologic tendency for repetitive behaviors, and highly restrictive interests. The spectrum is a gradient-based construct used to categorize the widely varying degrees of ASD phenotypes, and has been linked to a genetic etiology in 25% of cases. Prior studies have revealed that 30% of ASD patients exhibit hyperserotonemia, or elevated whole blood serotonin, implicating the serotonergic system in the pathogenesis of ASD. Likewise, escitalopram, a selective-serotonin reuptake inhibitor (SSRI), has been demonstrated to improve aberrant behavior and irritability in ASD patients, potentially by modulating abnormal brain activation. Prior studies have uncovered proband patients with rare mutations in the human serotonin transporter (hSERT) that manifest enhanced surface expression and transport capacity, suggesting that abnormal enhancement of hSERT function may be involved in the pathogenesis of ASD.

Methods

HEK-293 cells stably expressing WT, C109A, I425L, F465L, L550V, or K605N hSERT were subject to analysis for palmitoylation via Acyl-Biotin Exchange followed with hSERT immunoblotting. F465L functional enhancement was confirmed by surface analysis via biotinylation and saturation analysis via 5HT transport. F465L palmitoylation, surface expression and transport capacity were then assessed following treatment with 2-bromopalmitate or escitalopram.

Results

Here, we reveal that palmitoylation is enhanced in the ASD hSERT F465L and L550V coding variants, and confirm prior reports of enhanced kinetic activity and surface expression of F465L. Subsequently, treatment of F465L with the irreversible palmitoyl acyl-transferase inhibitor, 2-bromopalmitate (2BP), or escitalopram, rectified enhanced F465L palmitoylation, surface expression, and transport capacity to basal WT levels.

Limitations

Tests assessing L550V for surface expression, transport capacity, and reactivity to inhibition of palmitoylation was not assessed. In addition, further characterization is necessary for internalization rates, degradative mechanisms, the impact of cysteine-mediated substitutions, and other SSRIs on these processes.

Conclusions

Overall, our results implicate disordered hSERT palmitoylation in the pathogenesis of serotonergic ASD subtypes, with basal recovery of these processes following escitalopram providing insight into its molecular utility as an ASD therapeutic.

The Increasing Prevalence of Autism Spectrum Disorder in the U.S. and Its Implications for Pediatric Micronutrient Status: A Narrative Review of Case Reports and Series

INTRODUCTION

Micronutrient deficiencies are considered uncommon in the United States. However, children with autism spectrum disorder (ASD) are at higher risk due to food selectivity and restrictive eating patterns. The prevalence of ASD in the U.S. has quadrupled over the past two decades, amplifying the need to address nutritional gaps in this population.

OBJECTIVE

This narrative review examines the prevalence and clinical impact of underreported micronutrient deficiencies beyond vitamin C in children with ASD using case reports and series.

METHODS

Case reports and case series reporting micronutrient deficiencies in children with ASD published from 2014 to 2025 were identified through PubMed and ScienceDirect using search terms "autism and deficiency" and "autism and vitamin A, K, magnesium, iron deficiency". Eligible cases included children aged 2-18 years with ASD and laboratory-confirmed micronutrient deficiencies.

RESULTS

A total of 44 cases from 27 articles were analyzed. Frequently reported deficiencies were vitamin D (25.0%), vitamin A (24.8%), B-vitamins (18.0%), calcium (10.8%), and iron (9.6%). Less common deficiencies included iodine, zinc, vitamin E, etc. Diseases such as xerophthalmia, rickets, pellagra, and goiter were reported. Co-occurring deficiencies were present in 70% of cases, and all cases reported food selectivity, with deficiencies occurring despite normal growth parameters in some children.

CONCLUSIONS

Based on cases reviewed, children with ASD are at high risk for micronutrient deficiencies, despite meeting normal growth parameters. Further research is needed to develop a standardized nutrition assessment, but combining anthropometric, biochemical, and dietary assessments can aid in early intervention and prevent complications.

The Insulin-like Growth Factor Family as a Potential Peripheral Biomarker in Psychiatric Disorders: A Systematic Review

Psychiatric disorders (PDs), including schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), autism spectrum disorder (ASD), among other disorders, represent a significant global health burden. Despite advancements in understanding their biological mechanisms, there is still no reliable objective and reliable biomarker; therefore, diagnosis remains largely reliant on subjective clinical assessments. Peripheral biomarkers in plasma or serum are interesting due to their accessibility, low cost, and potential to reflect central nervous system processes. Among these, the insulin-like growth factor (IGF) family, IGF-1, IGF-2, and IGF-binding proteins (IGFBPs), has gained attention for its roles in neuroplasticity, cognition, and neuroprotection, as well as for their capability to cross the blood-brain barrier. This review evaluates the evidence for IGF family alterations in PDs, with special focus on SZ, MDD, and BD, while also addressing other PDs covering almost 40 years of history. In SZ patients, IGF-1 alterations have been linked to metabolic dysregulation, treatment response, and hypothalamic-pituitary-adrenal axis dysfunction. In MDD patients, IGF-1 appears to compensate for impaired neurogenesis, although findings are inconsistent. Emerging studies on IGF-2 and IGFBPs suggest potential roles across PDs. While promising, heterogeneity among studies and methodological limitations highlights the need for further research to validate IGFs as reliable psychiatric biomarkers.

Real world evidence for altered communication patterns in individuals with autism spectrum disorder

Adults with autism spectrum disorder (ASD) may compensate for their social difficulties by resorting to more sequential forms of communication. Here, we study communication preferences in individuals with ASD and neurotypical controls by monitoring smartphone-based communication for verbal, written, and mixed app categories over a period of four months. We find ASD participants to prefer written over verbal communication, underscoring the importance of considering these preferences to facilitate social integration.

Caregiving for autistic children in Nigeria: experiences and challenges

BACKGROUND

Raising autistic children poses a daunting task for their caregivers. Providing care may take a toll on caregivers' physical, psychological, social, and financial wellbeing. This study explored the experience of the responsibility of care among caregivers of autistic children in Nigeria and informed targeted psychosocial support interventions.

METHODS

This phenomenology qualitative study was conducted among 103 caregivers in Cross River, Nigeria. The PREPARE tool was used for the data collection. Data were analyzed using the inductive and deductive approaches qualitatively, using NVivo software.

RESULTS

Stigma and misunderstanding of autism, emotional impact and acceptance, transportation and accessibility, lack of support networks, and balancing responsibilities and care responsibilities with personal commitments were the major challenges reported by our participants. These factors contributed to emotional strain, underscoring the complexities associated with caregiving experiences.

CONCLUSION

Given the significant responsibilities of caregivers, targeted intervention must be taken to properly enlighten Nigerian societies on autistic people, and the need for acceptance. Key stakeholders must provide suitable healthcare facilities and resources for autistic people. Also, social support groups would help establish a sense of belonging and support.

Using the Community Resilience Model and Project ECHO to Build Resiliency in Direct Support Professionals: Protocol for a Longitudinal Survey

BACKGROUND

Individuals with intellectual disabilities or autism spectrum disorder (ID/A) sometimes require supportive services from direct support professionals (DSPs). The supportive care provided to individuals with ID/A by DSPs can vary from assistance with daily living activities to navigating society. The COVID-19 pandemic not only exacerbated poor outcomes for individuals with ID/A but also for DSPs, who report experiencing burnout in the aftermath of the pandemic. DSPs are critical to providing much-needed support to individuals with ID/A.

OBJECTIVE

The goal of this study is to evaluate the impact of the community resilience model on DSP burnout and neurodivergent client outcomes using the Project ECHO (Extension for Community Healthcare Outcomes) telementoring platform as a dissemination tool.

METHODS

This protocol leverages community resilience theory and telementoring through the Project ECHO model to foster resilience in DSPs and their neurodiverse client population. ECHO participants' resilience behaviors will be evaluated via surveys including the Connor Davison Resilience Scale and the WHO-5 Well-Being Index. These surveys will be administered preprogram, at the end of the 8-week ECHO program, and 90 days after the ECHO program's completion. Pre-post relationships will be assessed using generalized estimating equations. The main outcomes will be self-reported changes in knowledge, self-efficacy, and resilience.

RESULTS

All ECHO program cohorts and follow-up data collection have concluded, with 131 survey participants. The project team is currently analyzing and interpreting the data. We anticipate having all data analyzed and interpreted by February 2025.

CONCLUSIONS

DSPs provide critical services to individuals with ID/A. By providing skills in resiliency via the ECHO model, participants will be able to apply resiliency to their own professional lives while fostering resilience within their neurodiverse client base, leading to increased positive outcomes for both groups.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59913.

Impact of probiotic supplements on behavioural and gastrointestinal symptoms in children with autism spectrum disorder: A randomised controlled trial

OBJECTIVE

To investigate whether probiotic supplementation can improve behavioural and gastrointestinal (GI) symptoms in children with autism spectrum disorder (ASD) aged 2-9 years and further explore the correlation between these symptoms.

DESIGN

Single-blinded, randomised, placebo-controlled study.

SETTING

Five developmental paediatric outpatient clinics of 'Continua Kids'.

PATIENTS

Children aged 2-9 years diagnosed with ASD along with their caregivers.

INTERVENTIONS

Probiotic or placebo sachet reconstituted in 50 mL of lukewarm milk/water, taken two times per day for 3 months.

MAIN OUTCOME MEASURES

Change in behavioural (measured by Social Responsiveness Scale-2 (SRS-2) and Aberrant Behaviour Checklist-2 (ABC-2) tools) and GI (measured by GI Severity Index (GSI) score) symptoms after receiving intervention for 3 months.

RESULTS

A total of 180 children with ASD were enrolled in the study (probiotic group: 90 and placebo group: 90). All children completed the study. The probiotic group showed a significant reduction in behavioural symptom severity as measured by the SRS-2 tool (47.77% vs 23.33%; p=0.000) compared with the placebo. Probiotic-treated children demonstrated significant reductions in severe symptoms, including social withdrawal/lethargy (40%), stereotypic behaviour (37.77%), hyperactivity (34.44%) and inappropriate speech (32.22%) post-intervention (p=0.000). They also had marked improvements in constipation (p=0.003) and diarrhoea (p=0.043) compared with the placebo group. Both groups exhibited a statistically significant correlation between behavioural and GI symptoms.

CONCLUSIONS

Probiotic supplementation improved behavioural and GI symptoms in children with ASD with no adverse effects. Both symptoms were significantly correlated. However, these results need to be validated in a larger sample size.

TRIAL REGISTRATION NUMBER

CTRI/2021/11/038213.

The Role of Artificial Intelligence for Early Diagnostic Tools of Autism Spectrum Disorder: A Systematic Review

Objective: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by challenges in social communication and repetitive behaviors. This systematic review examines the application of artificial intelligence (AI) in diagnosing ASD, focusing on pediatric populations aged 0-18 years. Materials and methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Inclusion criteria encompassed studies applying AI techniques for ASD diagnosis, primarily evaluated using metriclike accuracy. Non-English articles and studies not focusing on diagnostic applications were excluded. The literature search covered PubMed, ScienceDirect, CENTRAL, ProQuest, Web of Science, and Google Scholar up to November 9, 2024. Bias assessment was performed using the Joanna Briggs Institute checklist for critical appraisal. Results: The review included 25 studies. These studies explored AI-driven approaches that demonstrated high accuracy in classifying ASD using various data modalities, including visual (facial, home videos, eye-tracking), motor function, behavioral, microbiome, genetic, and neuroimaging data. Key findings highlight the efficacy of AI in analyzing complex datasets, identifying subtle ASD markers, and potentially enabling earlier intervention. The studies showed improved diagnostic accuracy, reduced assessment time, and enhanced predictive capabilities. Conclusion: The integration of AI technologies in ASD diagnosis presents a promising frontier for enhancing diagnostic accuracy, efficiency, and early detection. While these tools can increase accessibility to ASD screening in underserved areas, challenges related to data quality, privacy, ethics, and clinical integration remain. Future research should focus on applying diverse AI techniques to large populations for comparative analysis to develop more robust diagnostic models.

Understanding the Association Between Neighborhood Resources and Trauma-Informed Care Among Providers Who Serve Autistic Youth

A growing body of literature suggests that youth with autism spectrum disorders (ASD), herein, autistic youth, face an increased risk of being exposed to adverse childhood experiences (ACEs). However, trauma-informed approaches to care among autistic youth remain limited. In a large cross-sectional survey of ASD providers (N = 670) recruited from five U.S. locations, we examined the association between neighborhood resources using the Child Opportunity Index (i.e., educational, health/environmental, and social/economic opportunities) and the frequency at which providers engaged in trauma-informed care (i.e., inquire about, screen for, treat, and provide referrals for trauma diagnosis and treatment) and the types of adverse childhood experiences (ACEs) they screen for (i.e., maltreatment/neglect and household dysfunction). The latent model revealed that providers in neighborhoods with fewer resources engaged in more trauma-informed care and were more likely to screen for ACEs related to household dysfunction. Follow-up exploratory analyses indicated that providers in the lowest 20% of opportunity neighborhoods made the greatest efforts in trauma screening for maltreatment and household dysfunction, followed closely by those in the lowest 40%, compared to higher-opportunity areas. Sensitivity analyses, controlling for potential nesting effects, confirmed similar results. These findings may suggest a concerted effort to ensure that autistic youth in highly disadvantaged areas receive adequate trauma screening. However, lower screening rates in higher-resourced neighborhoods may mean trauma-exposed autistic youth in these areas are overlooked. Expanding provider training to emphasize trauma inquiry across all neighborhoods could help address this gap. Limitations, implications for policy and practice, and future directions are discussed.

Integrative approaches to m6A and m5C RNA modifications in autism spectrum disorder revealing potential causal variants

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that currently affects approximately 1-2% of the global population. Genome-wide studies have identified several loci associated with ASD; however, pinpointing causal variants remains elusive. Therefore, functional studies are essential to discover potential therapeutics for ASD. RNA modification plays a crucial role in the post-transcriptional regulation of mRNA, with m6A and m5C being the most prevalent internal modifications. Recent research indicates their involvement in the regulation of key genes associated with ASD. In this study, we conducted an integrative genomic analysis of ASD, incorporating m6A and m5C variants, followed by cis-eQTL, gene differential expression, and gene enrichment analyses to identify causal variants from a genome-wide study of ASD. We identified 20,708 common m6A-SNPs and 2,407 common m5C-SNPs. Among these, 647 m6A-SNPs exhibited cis-eQTL signals with a p-value < 0.05, while only 81 m5C-SNPs with a p-value < 0.05 showed cis-eQTL signals. Most of these were functional loss variants, with 38 variants representing the most significant common m6A/m5C-SNPs associated with key ASD-related genes. In the gene differential expression analysis, seven proximal genes corresponding to significant m6A/m5C-SNPs were differentially expressed in at least one of the three microarray gene expression profiles of ASD. Key differentially expressed genes corresponding to m6A/m5C cis-variants included KIAA1671 (rs5752063, rs12627825), INTS1 (rs67049052, rs10237910), VSIG10 (rs7965350), TJP2 (rs3812536), FAM167A (rs9693108), TMEM8A (rs1802752), and NUP43 (rs3924871, rs7818, rs9383844, rs9767113). Cell-specific cis-eQTL analysis for proximal gene identification, combined with gene expression datasets from single-cell RNA-seq analysis, would validate the causal relationship of gene regulation in brain-specific regions, and experimental validation in cell lines would achieve the goal of precision medicine.

Electroencephalographic aspects and phenotypic characteristics in children with autism

Autism is a severe neurodevelopmental disorder that affects many individuals around the world, with a constantly increasing prevalence. The association between autism and electroencephalographic (EEG) abnormalities in children suggests a worse evolution of clinical features. A retrospective study was conducted, including 101 children with autism who underwent clinical and neurological examination and wake electroencephalography. This study aimed to examine EEG abnormalities in children with autism, identify phenotypic characteristics associated with these abnormalities, asses their clinical relevance, and determine potential phenotypic correlations. The results showed that 10.89% of the patients in the study presented EEG abnormalities, similar to those of other studies that used wake EEG. Of these patients, 18.18% presented epileptic-type discharges, such as spike and wave complexes, and 81.81% presented non-epileptic-type abnormalities, such as bursts of slow waves, generalized or focal. Regarding the phenotypic profile of the patients with EEG abnormalities, 45.45% had a positive family history, 63.63% presented with dysmorphic features and 27.27% presented with gait disturbance. This study shows that some children with autism present multiple EEG abnormalities and diverse phenotypic traits in terms of personal and family history, dysmorphic features, and neurological examination. Identifying EEG abnormalities can improve clinical decisions with complex treatment and monitoring of co-occurring conditions like epilepsy. The use of accessible, effective, and noninvasive assessment tools, such as EEG recordings and neurological examinations in children with autism, can provide valuable support for improved case management.

Investigating the role of food pollutants in autism spectrum disorder: a comprehensive analysis of heavy metals, pesticides, and mycotoxins

Food pollutants, including heavy metals, pesticides, and mycotoxins, have been proposed as potential risk factors for autism spectrum disorder (ASD) during pregnancy and early childhood. This paper examines the impact of food pollutants on ASD risk. A systematic search through PubMed, Google Scholar, and Sciverse yielded studies from 1990 to present. Research indicates elevated levels of heavy metals in children with ASD, linking pesticides and toxins to brain development disruptions. Mycotoxins, specifically, show a correlation with ASD and can contaminate food, posing a threat to neurodevelopment. Strategies like choosing organic foods and reducing exposure to toxins may benefit individuals with ASD and those vulnerable to the disorder. Further research is essential to comprehend the food pollutant-ASD relationship and devise effective exposure reduction strategies.

The Assessment of Selenium, Aluminum, and Zinc in Children with Autism Spectrum Disorder

ASD is a complex condition defined by many causes, one of them being excessive concentrations of necessary and harmful chemicals in children. The serum, hair, and nails of children with ASD have lower levels of critical trace elements, according to studies. It is quite obvious that bio elements are involved in physiology and pathophysiology. Thus, this study examined trace element contents in serum samples from children with autism spectrum disorder (ASD), specifically zinc (Zn), aluminum (Al), and selenium (Se). The study also looked for links between trace element levels and autistic severity. The study included 47 children with autism spectrum disorder, and the Gilliam's Scale was used for severity. The study also included 53 healthy kids with age and gender-matched with those of ASD. For serum trace element analysis, graphite furnace atomic absorption spectrophotometry was used. The study found significant decreases in selenium and zinc concentration (OR, 5.25; CI, 1.96 ~ 14.08; p < 0.001) and increases in aluminum level (OR, 39.34; CI, 8.20 ~ 89.45; p < 0.001) in children with ASD compared to the control group. The area under the curve (AUC) values of 0.85 for Se, 0.98 for Al, and 0.7 for Zn showed high sensitivity and specificity for all parameters. Results indicate a strong positive connection between ASD and their levels of selenium (Se) and zinc (Zn) (β, 0.48; CI, 0.280 ~ 0.679; p < 0.001 and β, 0.31; CI, 0.10 ~ 0.52; p = 0.005). There is a negative correlation between ASD and aluminum (Al) (β 0.83; CI, 0.71 ~ 0.95; p < 0.001). This element may be a biomarker for autism in youngsters. High odds ratio (OR) values indicate trace element risk in autistic children.

Animal Model of Autism Induced by Valproic Acid Combined with Maternal Deprivation: Sex-Specific Effects on Inflammation and Oxidative Stress

Autism spectrum disorder (ASD) etiology probably involves a complex interplay of both genetic and environmental risk factors, which includes pre- and perinatal exposure to environmental stressors. Thus, this study evaluated the effects of prenatal exposure to valproic acid (VPA) combined with maternal deprivation (MD) on behavior, oxidative stress parameters, and inflammatory state at a central and systemic level in male and female rats. Pregnant Wistar rats were exposed to VPA during gestation, and the offspring were submitted to MD. Offspring were tested for locomotor and social behavior; rats were euthanized, where the cerebellum, posterior cortex, prefrontal cortex, and peripheric blood were collected for oxidative stress and inflammatory analysis. It was observed that young rats (25-30 days old) exposed only to VPA presented a lower social approach when compared to the control group. VPA + MD rats did not present the same deficit. Female rats exposed to VPA + MD presented oxidative stress in all brain areas analyzed. Male rats in the VPA and VPA + MD groups presented oxidative stress only in the cerebellum. Regarding inflammatory parameters, male rats exposed only to MD exhibited an increase in pro-inflammatory cytokines in the blood and in the cortex total. The same was observed in females exposed only to VPA. Animals exposed to VPA + MD showed no alterations in the cytokines analyzed. In summary, gestational (VPA) and perinatal (MD) insults can affect molecular mechanisms such as oxidative stress and inflammation differently depending on the sex and brain area analyzed. Combined exposition to VPA and MD triggers oxidative stress especially in female brains without evoking an inflammatory response.

Understanding Sensory-Motor Disorders in Autism Spectrum Disorders by Extending Hebbian Theory: Formation of a Rigid-Autonomous Phase Sequence

Autism spectrum disorder is a neuropsychiatric disorder characterized by persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities. The symptoms invariably appear in early childhood and cause significant impairment in social, occupational, and other important functions. Various abnormalities in the genetic, neurological, and endocrine systems of patients with autism spectrum disorder have been reported as the etiology; however, no clear factor leading to the onset of the disease has been identified. Additionally, higher order cognitive dysfunctions, which are represented by a lack of theory of mind, sensorimotor disorders, and memory-related disorders (e.g., flashbacks), have been reported in recent years, but no theoretical framework has been proposed to explain these behavioral abnormalities. In this study, we extended Hebb's biopsychology theory to provide a theoretical framework that comprehensively explains the various behavioral abnormalities observed in autism spectrum disorder. Specifically, we propose that a wide range of symptoms in autism spectrum disorder may be caused by the formation of a rigid-autonomous phase sequence (RAPS) in the brain. Using the RAPS formation theory, we propose a biopsychological mechanism that could be a target for the treatment of autism spectrum disorders.

The Childhood Autism Rating Scale Second Edition (CARS2) and Its Applicability in an Iranian Sample

The present study aimed to evaluate the reliability and validity of the Childhood Autism Rating Scale: Second Edition (CARS2) in diagnosing individuals with autism in Iran. A mixed-method approach was used and 313 participants were recruited, with an age range of 2-32 years, for CARS2-Standard Form (ST) and 218 individuals aged 6-25 years for CARS2-High Functioning (HF). The participants were recruited from daycare centers, schools, and clinics with different developmental trajectories: autism, intellectual disabilities, and neurotypical development. All participants with autism and intellectual disabilities had been clinically diagnosed previously. In addition, the CARS2-Questionnaire of Parent Concerns (QPC) was used to gather qualitative data on 30 randomly selected parents and the perspectives of the 20 test administrators were also collected. The CARS2 had high internal consistency, inter-rater reliability, and test-retest reliability. Factor analyses revealed a one-factor structure for CARS2-ST and a three-factor structure for CARS2-HF. When adjustments were made to the cut-off points, the discriminant analyses indicated that CARS2 effectively differentiated between those with autism and typical development but less so with persons who had intellectual disabilities. The qualitative data analysis and the extracted themes suggest that the CARS2-QPC is a valid tool for collecting autism-related information from parents. Our findings suggest that the CARS2 is broadly a reliable and valid instrument for diagnosing autism spectrum in Iran in the absence of more extensive assessments.

Metformin efficacy and safety as an adjunctive treatment for irritability in children with autism spectrum disorder: A randomized, double-blind, placebo-controlled trial

BACKGROUND

Antidiabetic medications have shown efficacy in alleviating autism symptoms. However, there is a lack of clinical research on the impact of metformin on irritability associated with autism. This study aimed to assess the efficacy and safety of metformin as an adjuvant therapy with risperidone for managing irritability in children diagnosed with Autism Spectrum Disorder (ASD).

METHODS

This is a randomized, 10-week, double-blind, placebo-controlled trial conducted at the children's autism clinic of Roozbeh Hospital (Tehran, Iran) from March 2024 to May 2024. Participants were divided into two groups of risperidone plus metformin (500 mg per day) and risperidone plus placebo and were assessed at baseline, weeks 5 and 10 with the aberrant behavior checklist-community scale (ABC-C).

RESULTS

A total of 55 patients were included in the final analysis. Irritability (primary outcome measure) sharply decreased in the metformin compared to the placebo group (p = 0.008). Among the other four subscales of ABC-C, the hyperactivity/noncompliance score showed a significant drop during the baseline-to-week-5 period (p = 0.021). In addition, inappropriate speech subscales decreased significantly from baseline-to-week 5 in the metformin compared to the placebo group (p = 0.045). No other significant finding was observed among ABC-C scores for lethargy/social withdrawal or stereotypic behavior subscales.

CONCLUSION

Metformin demonstrated promising results in reducing irritability in ASD patients, which is in concordance with previous studies. However, further studies are required before any broad clinical recommendation.

Effectiveness of social skills training interventions for children with autism spectrum disorder: A systematic review and meta-analysis

OBJECTIVES

To evaluatethe effectiveness of social skills training (SST) interventions for children with autism spectrum disorder (ASD).

METHODS

A systematic review and meta-analysis were carried out to identify relevant studies published between 2000-2023. The study was conductedin accordance with the PRISMA guidelines. Studies were included if they met the following criteria: randomized controlled trials (RCTs) or quasi-RCTs, participants were children with ASD aged 3-18 years, SST interventions were delivered individually or in groups, and social skills were assessed using standardized measures. Effect sizes were calculated using Cohen's d, and meta-analyses were carried out using a random-effects model.

RESULTS

A total of 17 studies were included in the meta-analysis. The overall effect size for SST interventions was 0.28-0.60 (95% confidence interval: [0.23-0.41]), indicating a small to moderate effect. Social skills training interventions were effective in improving a range of social skills, including social communication, reciprocity, and joint attention.

CONCLUSION

Social skills training interventions demonstrate modest to moderate effectiveness in improving social skills in children with ASD, with outcomes varying depending on intervention type, participant characteristics, and implementation fidelity. While SST interventions offer potential benefits, they should be considered as one component of a broader, individualized treatment plan for children with ASD, rather than a standalone solution.PROSPERO No. ID: CRD42024578682.

Investigation of Electroencephalographic Aspects, Adaptive Features, and Clinical Phenotypes in a Group of Children with Autism-A Pilot Study

(1) Background: Autism, as an important global problem that affects many phenotypically different individuals, is associated with electroencephalographic (EEG) abnormalities and adaptability impairment. (2) Materials and Methods: In this retrospective study of a group of 101 autistic children, we aimed to evaluate the presence of EEG abnormalities, adaptive features, and clinical phenotypes via EEG, the Adaptive Behavior Assessment System II (ABAS II) scale, and neurological examination. (3) Results: Our results showed statistically significant associations between the level of adaptability obtained through the ABAS II scale and neurological deficit, specifically in terms of coordination impairment. There were also statistically significant differences between the level of adaptability and clinical phenotypes between autism type groups. (4) Conclusions: This study shows that children with autism are likely to exhibit neurological and adaptive abnormalities. Non-invasive assessment tools, such as EEG recordings, the ABAS II scale, and neurological examination offer valuable support for improved diagnosis and management.

A Systems Biology Approach for Prioritizing ASD Genes in Large or Noisy Datasets

Autism spectrum disorder (ASD) is a complex multifactorial neurodevelopmental disorder. Despite extensive research involving genome-wide association studies, copy number variant (CNV) testing, and genome sequencing, the comprehensive genetic landscape remains incomplete. In this context, we developed a systems biology approach to prioritize genes associated with ASD and uncover potential new candidates. A Protein-Protein Interaction (PPI) network was generated from genes associated to ASD in a public database. Leveraging gene topological properties, particularly betweenness centrality, we prioritized genes and unveiled potential novel candidates (e.g., CDC5L, RYBP, and MEOX2). To test this approach, a list of genes within CNVs of unknown significance, identified through array comparative genomic hybridization analysis in 135 ASD patients, was mapped onto the PPI network. A prioritized gene list was obtained through ranking by betweenness centrality score. Intriguingly, by over-representation analysis, significant enrichments emerged in pathways not strictly linked to ASD, including ubiquitin-mediated proteolysis and cannabinoid receptor signaling, suggesting their potential perturbation in ASD. Our systems biology approach provides a promising strategy for identifying ASD risk genes, especially in large and noisy datasets, and contributes to a deeper understanding of the disorder's complex genetic basis.

Multimodal Morphometric Similarity Network Analysis of Autism Spectrum Disorder

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent difficulties in social interaction, communication, and repetitive behaviors. Neuroimaging studies have revealed structural and functional neural changes in individuals with ASD compared to healthy subjects. Objectives: This study aimed to investigate brain network structural connectivity in ASD using Morphometric Similarity Network (MSN) analysis. Methods: Data from the Autism Brain Imaging Data Exchange (ABIDE) were analyzed, comprising 597 individuals with ASD and 644 healthy controls. Structural connectivity was assessed using cortical morphometric features. Global and regional network indices, including the density index, node degree, node strength, and clustering coefficients, were evaluated. Results: Among the global network indices, when using a threshold value of 0.4, ASD patients compared to HCs showed a lower density (p = 0.041) and higher negative clustering (p = 0.0051) coefficients. For regional network indices, ASD patients showed a lower bilateral superior frontal cortices degree (left hemisphere: p = 0.014; right hemisphere: p = 0.0038) and strength (left: p = 0.017; right: p = 0.018). Additionally, they showed higher negative clustering coefficients in the bilateral superior frontal cortices (left, p = 0.0088; right, p = 0.0056) and bilateral pars orbitalis (left, p = 0.016; right, p = 0.0006), as well as lower positive clustering in the bilateral frontal pole (left, p = 0.03; right, p = 0.044). Conclusions: These findings highlight significant alterations in both global and regional brain network organization in ASD, which may contribute to the disorder's cognitive and behavioral manifestations. Future studies are needed to investigate the pathophysiological mechanisms underlying these structural connectivity changes, to inform the development of more targeted and individualized therapeutic interventions for individuals with ASD.

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.

"Out of sight out of mind": attentional characteristics in mothers who have children with autism

BACKGROUND

Families are faced with enormous challenges in caring for children with autism spectrum disorder (ASD) over a lifetime. As the main caregiver of children, mothers who have children with autism are in poor health compared to the mothers of typically developing (TD) children. Previous studies have revealed that the mental health of mothers has a direct impact on children. On the other hand, attention bias (AB) can be an important indicator of the mental status. Therefore, the characteristic of AB of mothers who have children with autism can be a window into the treatment of autism.

METHODS

In this study, 28 mothers who have children with autism and 31 mothers of typically developing children completed the modified dot-probe task to explore the attention bias.

RESULTS

We found that there was a significant difference of AB between mothers who have children with autism and mothers of typically developing children, which indicated that mothers who have children with autism tend to avoid negative emotional words.

CONCLUSIONS

The current study illuminates the attentional characteristics of mothers who have children with autism toward emotional words, which provides a new starting point for the intervention of mothers of children with autism.

Gangliosides and Cholesterol: Dual Regulators of Neuronal Membrane Framework in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with heterogeneous clinical presentation. Diagnosing ASD is complex, and the criteria for diagnosis, as well as the term ASD, have changed during the last decades. Diagnosis is made based on observation and accomplishment of specific diagnostic criteria, while a particular biomarker of ASD does not yet exist. However, studies universally report a disequilibrium in membrane lipid content, pointing to a unique neurolipid signature of ASD. This review sheds light on the possible role of cholesterol and gangliosides, complex membrane glycosphingolipids, in the development of ASD. In addition to maintaining membrane integrity, neuronal signaling, and synaptic plasticity, these lipids play a role in neurotransmitter release and calcium signaling. Evidence linking ASD to lipidome changes includes low cholesterol levels, unusual ganglioside levels, and unique metabolic profiles. ASD symptoms may be mitigated with therapeutic interventions targeting the lipid composition of membranes. However, restoring membrane equilibrium in the central nervous system remains a challenge. This review underscores the need for comprehensive research into lipid metabolism to uncover practical insights into ASD etiology and treatment as lipidomics emerges as a major area in ASD research.

A systematic review on the roles of remote diagnosis in telemedicine system: Coherent taxonomy, insights, recommendations, and open research directions for intelligent healthcare solutions

BACKGROUND

The term 'remote diagnosis' in telemedicine describes the procedure wherein medical practitioners diagnose patients remotely by using telecommunications technology. With this method, patients can obtain medical care without having to physically visit a hospital, which can be helpful for people who live in distant places or have restricted mobility. When people in the past had health issues, they were usually sent to the hospital, where they received clinical examinations, diagnoses, and treatment at the facility. Thus, hospitals were overcrowded because of the increase in the number of patients or in the death of some very ill patients given that the completion of medical operations required a significant amount of time.

OBJECTIVE

This research aims to provide a literature review study and an in-depth analysis to (1) investigate the procedure and roles of remote diagnosis in telemedicine; (2) review the technical tools and technologies used in remote diagnosis; (3) review the diseases diagnosed remotely in telemedicine; (4) compose a crossover taxonomy among diseases, technologies, and telemedicine; (5) present lists of input variables, vital signs, data and output decisions already applied in remote diagnosis; (6) Summarize the performance assessment measures utilized to assess and validate remote diagnosis models; and (7) identify and categorize open research issues while providing recommendations for future advancements in intelligent remote diagnosis within telemedicine systems.

METHODS

A systematic search was conducted using online libraries for articles published from 1 January 2016 to 13 September 2023 in IEEE, PubMed, Science Direct, Springer, and Web of Science. Notably, searches were limited to articles in the English language. The papers examine remote diagnosis in telemedicine, the technologies employed for this function, and the ramifications of diagnosing patients outside hospital settings. Each selected study was synthesized to furnish proof about the implementation of remote diagnostics in telemedicine.

RESULTS

A new crossover taxonomy between the most important diagnosed diseases and technologies used for this purpose and their relationship with telemedicine tiers is proposed. The functions executed at each tier are elucidated. Additionally, a compilation of diagnostic technologies is provided. Additionally, open research difficulties, advantages of remote diagnosis in telemedicine, and suggestions for future research prospects that require attention are systematically organized and presented.

CONCLUSIONS

This study reviews the role of remote diagnosis in telemedicine, with a focus on key technologies and current approaches. This study highlights research challenges, provides recommendations for future directions, and addresses research gaps and limitations to provide a clear vision of remote diagnosis in telemedicine. This study emphasizes the advantages of existing research and opens the possibility for new directions and smart healthcare solutions.

Molecular and clinical Insights into KMT2E-Related O'Donnell-Luria-Rodan syndrome in a novel patient cohort

O'Donnell-Luria-Rodan (ODLURO) syndrome is an autosomal dominant neurodevelopmental disorder mainly characterized by global development delay/intellectual disability, white matter abnormalities, and behavioral manifestations. It is caused by pathogenic variants in the KMT2E gene. Here we report seven new patients with loss-of-function KMT2E variants, six harboring frameshift/nonsense changes, and one with a 7q22.3 microdeletion encompassing the entire gene-locus. We further characterize both the clinical phenotype as well as its associated pathogenic variants' spectrum providing new information on sex-related phenotype distribution, according to the variant groups. We also highlight different epilepsy phenotype-genotype correlation with preferential association of generalized epilepsy and/or developmental and epileptic encephalopathy with missense pathogenic variants and focal epilepsy, childhood absence epilepsy and/or febrile seizures with pathogenic truncating variants and structural rearrangements. By a systematic review of the previously reported series, we also discuss previously unappreciated findings, including progressive macrocephaly, apraxia, and higher risk of bone fractures.