The global prevalence of autism spectrum disorder: A three-level meta-analysis

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.

"The System Sweeps it Under the Rug": Educational Staff's Perspectives on Romantic Relationships Among Autistic Adolescents

Article 23 of the Convention on the Rights of Persons with Disabilities (CRPD) calls to recognize the right of people with disabilities to have romantic relationships, marry and raise children. However, to date, research has mainly focused on this issue in relation to people with physical or intellectual disabilities. Less is known about romantic relationships among autistic adolescents and how others in their immediate environment, such as educational staff, perceive and refer to this issue. To address this gap, the present study aimed to understand and describe the perspectives of educational staff on the romantic relationships of autistic adolescents, including their views regarding the right and capability of adolescents to form and maintain such relationships, and the education system's role in providing relevant knowledge and skills. A descriptive phenomenological qualitative approach was applied. Face-to-face interviews were conducted with 20 educational staff members from special education schools in Israel. Four main themes emerged from the thematic analysis of the interviews: (1) Stigmatic attitudes regarding the ability of autistic adolescents to develop romantic relationships; (2) Preventive sexual education as a priority; (3) Behavioral implications of educational neglect; and (4) Recommended practices. The findings highlight the need for macro- and micro-level change by developing an adapted curriculum that views romantic relationships as positive and constructive and eliminating stigmatic perceptions among educational staff. Another recommendation is to provide educational staff with emotional and practical preparation for addressing the issue of romantic relationships in class.

Demographic, ecological and social predictors of quality of life among parents of autistic children: A multi-centre cross-sectional study

Parents experience lower quality of life due to the psychological, financial and social challenges of caring for an autistic child. This study aims to identify the independent demographic and social predictors of parents' quality of life, to allocate support to parents who truly need it. Al-Subtain Academy and Baghdad's National Center for Autism recruited 248 parents in a cross-sectional study from 3 January to 13 September 2024. Demographics, quality of life and social support were assessed using a structured self-administered questionnaire. Multiple linear regression models were significant for all domains except role functioning (p = 0.258). The explained variance ranged from 50.8% for health perception to 19.5% for physical functioning. Mothers reported lower health perception and physical functioning than fathers (p = 0.015, p < 0.001). Parents with chronic condition also reported lower health perception, mental health, social functioning and higher pain scores (p-values: <0.001, 0.029, 0.023, 0.014). In addition, parents of female children and those with comorbidities reported lower mental health (p-values: 0.018, 0.004). Marital satisfaction was positively associated with all domains except pain (negative association) and physical/role functioning (no association). In conclusion, mothers, younger parents, parents with chronic conditions or female children, or whose children have comorbidities should be prioritised during interventions that promote family functioning and social support.Lay AbstractParents can face emotional and social challenges when taking care of autistic children, which can lower their quality of life. These challenges do not affect all parents in the same way. That is why we need to find out which parents are having more trouble, so that we can give more support to those who need it the most. Our goal was to identify which background and social factors are linked to lower quality of life in parents of autistic children. First, we found that parents of autistic children have lower mental and social well-being than physical quality of life. We argued that the type of challenges faced by parents might be the cause. We also detected lower quality of life among mothers, younger parents, parents with long-term conditions or autistic daughters, or whose children have other conditions besides autism. Finally, we found that marital satisfaction was the most important element in social support. Marital satisfaction is linked to a better quality of life in all areas except being able to do normal daily tasks and physical activities.

Feasibility, safety, and efficacy of high-dose intermittent theta burst stimulation in children with autism spectrum disorder: study protocol for a pilot randomized sham-controlled trial

Background

Autism spectrum disorders (ASD) are common neurodevelopmental disorders, mainly caused by disrupted excitation/inhibition balance and synaptic plasticity. Intermittent theta burst stimulation (iTBS) is a variant of excitatory repetitive transcranial magnetic stimulation, inducing long-term potentiation-like plasticity. In recent years, there has been a growing interest in high-dose iTBS as a therapeutic tool for psychiatric disorders. We aim to preliminarily investigate the feasibility, safety, and efficacy of high-dose iTBS in children with autism spectrum disorder (ASD).

Methods

A randomized controlled pilot trial with a 4-week intervention will be conducted. Forty children with ASD will be randomized into either the intervention or control group. The intervention group will receive 5400-pulse iTBS per day, while the control group will receive sham iTBS. Feasibility will be evaluated through recruitment, intervention adherence, and assessment completion. Safety will be assessed by comparing the rates of drop-outs attributed to adverse events and the rates of serious adverse events The efficacy outcomes include the Autism Behavior Checklist, Social Responsiveness Scale, 2nd Edition, Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist and Repetitive Behavior Scale-Revised. Resting-state electroencephalogram and functional near-infrared spectroscopy will be employed to quantify alterations in functional brain connectivity and cerebral haemodynamics. Salivary levels of oxytocin, growth hormone, insulin-like growth factor 1, and insulin-like growth factor binding protein 3 are measured to reflect the biochemical response to iTBS. These indicators will be assessed at baseline and at the end of the intervention.

Discussion

This trial will evaluate the feasibility, safety, and efficacy of high-dose iTBS treatment in children with ASD. The proposed study will provide pilot data to inform the feasibility and design of larger sample-size trials.

Clinical trial registration

http://www.chictr.org.cn, identifier ChiCTR2400089757.

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.

The Psychometric Properties of Autism Mental Status Examination (AMSE) in Turkish Sample

Autism Spectrum Disorder (ASD) is a prevalent neurodevelopmental disorder, and early diagnosis plays a pivotal role in prognosis and management. This study aims to examine the psychometric properties of the Autism Mental Status Exam (AMSE), a tool that shows great promise in terms of clinical utility, within the Turkish population. This study conducted in a cohort of 307 Turkish children aged 17 to 120 months with suspected ASD. Participants underwent a multidisciplinary assessment based on DSM-5 criteria for diagnosis and were categorized into ASD and non-ASD groups. Subsequently, the research team conducted blinded administrations of the AMSE and Childhood Autism Rating Scale (CARS). Additionally, a subset of 61 children underwent retesting for AMSE and CARS after three weeks for temporal stability. The results revealed an optimal cut-off score of 4 for AMSE, yielding sensitivity and specificity rates of 84% and 97%, respectively. Internal consistency, indicated by a Cronbach's alpha of 0.80, was very good. The test-retest reliability, assessed using the Intraclass Correlation Coefficient (ICC), was excellent (ICC = 0.959). The inter-rater reliability also showed excellent agreement (ICC = 0.997). Furthermore, a significant correlation was observed between the AMSE and CARS scores (r = 0.94, p < 0.001). Notably, the AMSE scores were significantly different between the ASD and non-ASD groups (p < 0.001) with a large effect size (Cohen's d = 1.40). The findings of this study underscore the utility of AMSE as a valid and reliable tool for Turkish children with robust psychometric properties.

Experiences of racism and racial disparities in health care among children and youth with autism and their caregivers: a systematic review

PURPOSE

Although the health benefits of early diagnosis and therapeutic approaches for children and youth with autism spectrum disorder (ASD), racial disparities persist. This systematic review explored the experiences of racism and racial disparities in health care among children and youth with ASD and their caregivers.

METHODS

We conducted a systematic review, drawing on six international databases. Two reviewers screened titles, abstracts, and full texts. Thirty-seven studies met our inclusion criteria and we applied a narrative synthesis to develop themes.

RESULTS

Four themes were identified: (1) experiences and aspects of racism and racial disparities (i.e., language and cultural barriers, poor quality health care interactions, stereotypes and discrimination, family and community stigma, and indirect barriers); (2) racial disparities in health care (i.e., screening and referral, diagnosis, health care services, and care coordination and medication); (3) facilitators to accessing health care services; and (4) recommendations from caregivers.

CONCLUSIONS

This review highlights the extensive racial disparities experienced by children with autism. More research is needed to explore youth's perspectives on racism in addition to exploring potential interventions to address racial disparities and improve health equity for youth with ASD.

The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis

OBJECTIVE

Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by extensive avoidance and/or restriction of food. Existing research demonstrates that ARFID is over-represented in Autistic populations and vice-versa, with both groups exhibiting shared characteristics. This meta-analysis investigated the co-occurrence between ARFID and autism via determination of autism prevalence in ARFID populations, and ARFID prevalence in Autistic groups.

METHOD

This review systematically identified literature evaluating those with ARFID and Autistic individuals. Literature was searched for using SCOPUS, MEDLINE, and Web of Science. Selected publications included Autistic individuals and those with ARFID who either received a formal diagnosis of autism and/or ARFID or met clinical threshold cut-off scores on validated autism and/or ARFID questionnaires. Prevalence was reported in proportion-based values alongside 95% confidence intervals (CIs).

RESULTS

This meta-analysis identified 21 studies (kARFID = 18 papers; kAutism = 3 papers) comprising of n = 7442 participants (nARFID = 1708; nAutism = 5734). Prevalence of autism diagnoses was 16.27% in those with ARFID (95% CI = 8.64%-28.53%), and ARFID prevalence in Autistic groups was 11.41% (95% CI = 2.89%-35.76%). Gender and ethnicity served as significant sources of heterogeneity in ARFID papers. There was insufficient data to provide comparator values or prevalence across study population and distinct underpinning drivers of ARFID.

DISCUSSION

Meta-analytic findings highlight significant rates of co-occurrence between autism and ARFID, suggesting that in clinical settings, it may be beneficial to consider screening Autistic individuals for ARFID and vice-versa. Future research should further investigate co-occurrence across ARFID profiles, gender, and ethnicity.

A western dietary pattern during pregnancy is associated with neurodevelopmental disorders in childhood and adolescence

Despite the high prevalence of neurodevelopmental disorders, the influence of maternal diet during pregnancy on child neurodevelopment remains understudied. Here we show that a western dietary pattern during pregnancy is associated with child neurodevelopmental disorders. We analyse self-reported maternal dietary patterns at 24 weeks of pregnancy and clinically evaluated neurodevelopmental disorders at 10 years of age in the COPSAC2010 cohort (n = 508). We find significant associations with attention-deficit hyperactivity disorder (ADHD) and autism diagnoses. We validate the ADHD findings in three large, independent mother-child cohorts (n = 59,725, n = 656 and n = 348) through self-reported dietary modelling, maternal blood metabolomics and foetal blood metabolomics. Metabolome analyses identify 15 mediating metabolites in pregnancy that improve ADHD prediction. Longitudinal blood metabolome analyses, incorporating five time points per cohort in two independent cohorts, reveal that associations between western dietary pattern metabolite scores and neurodevelopmental outcomes are consistently significant in early-mid-pregnancy. These findings highlight the potential for targeted prenatal dietary interventions to prevent neurodevelopmental disorders and emphasise the importance of early intervention.

Metal Dyshomeostasis as a Driver of Gut Pathology in Autism Spectrum Disorders

Despite being classified as neurodevelopmental disorders, in recent years, there has been a growing interest in the association between autism spectrum disorders (ASDs) and gut pathology. This comprehensive and systematic review explores a potential mechanism underlying gut pathology in ASDs, including alterations in gut microbiota, intestinal permeability, immune dysregulation, and gastrointestinal (GI) symptoms. Specifically, it delves into the role of toxic and essential metals and their interplay, affecting the development and function of the GI tract. The review also discusses the potential implications of this gut pathology in the development and management of ASDs. Studies have shown that heavy metal exposure, whether through environmental sources or dietary intake, can disrupt the delicate balance of trace elements in the gut. This disruption can adversely affect zinc homeostasis, potentially exacerbating gut pathology in individuals with ASDs. The impaired zinc absorption resulting from heavy metal exposure may contribute to the immune dysregulation, oxidative stress, and inflammation observed in the gut of individuals with ASDs. By shedding light on the multifaceted nature of gut pathology, including the impact of metal dyshomeostasis as a non-genetic factor in ASD, this review underscores the significance of the gut-brain axis in the etiology and management of ASDs.

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.

Research trends of inflammation in autism spectrum disorders: a bibliometric analysis

Background

Inflammation has been recognized as a significant factor in the pathophysiology of autism spectrum disorders (ASD), which have garnered increasing scholarly attention over the past few decades. This study aims to explore research trends related to inflammation and ASD through bibliometric analysis.

Method

A comprehensive literature search was conducted in the Web of Science Core Collection (WoSCC) on August 28, 2024. This study was restricted to literature published in English. The bibliometric analysis utilized VOSviewer, CiteSpace, and the R package "bibliometrix" to visualize collaborations, keyword co-occurrences, and emerging research trends.

Results

A total of 1,752 articles addressing inflammation and ASD were published, demonstrating a consistent upward trend in research output. The United States emerged as the country with the highest volume of publications. Saleh A. Bakheet was identified as the most prolific authors, significantly contributing to the literature with 54 publications. The University of California System was recognized as the most productive institution in this area of study. The journal of Brain Behavior and Immunity was noted as a prominent venue for publication in this field, exhibiting high citation metrics that reflect its considerable influence. The keyword "children" was the most frequently occurring term, with other significant terms including "oxidative stress" and "brain." The keyword burst analysis revealed notable periods of increased research focus on topics such as "inflammatory bowel disease," "cytokine production," "neurodevelopmental disorders," and "microbiota."

Conclusion

This bibliometric analysis highlights the growing scholarly attention devoted to the relationship between inflammation and ASD. Significant contributions and emerging trends emphasize the pivotal role of neuroinflammation in ASD, indicating a necessity for further exploration in this domain.

Examining the Relationship Between Parental Broader Autism Phenotype Traits, Offspring Autism, and Parental Mental Health

Broader Autism Phenotype (BAP) traits may be present in parents of children on the autism spectrum. However, the prevalence and impact of these traits on parental mental health is poorly understood. We explore BAP traits and its relationship to mental health in 228 fathers and 261 mothers from a sample of 266 scholars from the EPINED study (Spain) grouped as follows: non-autism (N = 122), autism traits (N = 93: 38 subthreshold autism and 55 autism symptoms) and autism (N = 51). BAP rates were higher in fathers (36.9%) than in mothers (26.1%). Moreover, BAP was significantly more frequent in fathers of autistic children (52.3%) than in fathers of children without autistic traits (28.0%), with no differences between autistic conditions groups. Mothers of autistic children exhibited higher psychological distress (36.0%) than mothers of comparison group (19.2%). Fathers with BAP obtained significantly higher scores in emotional problems than fathers without BAP. Multivariate analyses showed that, fathers' emotional problems were associated with their BAP traits, whereas in mothers they were associated with having a child with autism as well as the child's emotional dysregulation. Identifying BAP in parents of autistic conditions children can help professionals to provide specific strategies for improving the well-being of children and parents.

Calcium-Binding Proteins in the Autistic Brain-Potential Links to Symptom Development

Autism spectrum disorder (ASD) is a complex challenge, influenced by genetic and environmental factors. This review focuses on the proteins calbindin (CB), calretinin (CR) and parvalbumin (PV) in the context of ASD, exploring their clinical correlations and providing a deeper understanding of the spectrum. In addition, we seek to understand the role of these proteins in GABAergic regulation and their implication in the pathophysiology of ASD. The studies reviewed revealed a significant decrease in PV+ interneurons in the prefrontal cortex of individuals with ASD compared with typical controls. This reduction is associated with local synaptic hyperconnectivity, characterized by an increase in the number of excitatory synapses and a reduction in inhibitory synapses. A correlation was also observed between the decrease in PV+ and the severity of the behavioural symptoms of ASD. The research highlights GABAergic imbalance as a crucial component in the neuropathology of ASD, highlighting the role of calcium-binding proteins, especially PV, in regulating neuronal excitability and modulating synaptic connectivity. These findings provide valuable insights for the development of new therapeutic strategies intended to modulate neuronal activity and improve the symptoms associated with ASD.

Challenges for neurodiverse children in acute medical hospitals and opportunities for the new National Children's Hospital to be 'neurodiversity-friendly'

Neurodiversity refers to the variation in human cognitive, sensory, and communication experiences and reframes deficits as differences. Rates and duration of hospitalisation in neurodiverse children are higher compared to their neurotypical peers. Despite increased admissions, paediatric medical hospitals are poorly equipped to adequately support their unique cognitive, sensory, behavioural, and communication needs, which can have negative impacts on the experiences of patients, families, and staff. The literature supports several innovative and inclusive strategies, which present exciting opportunities for Ireland's new National Children's Hospital (NCH) to become a 'neurodiversity-friendly paediatric hospital'.

The global prevalence of autism spectrum disorder in children: a systematic review and meta-analysis

BACKGROUND

The objective of this review was to analyze quantitative data on autism spectrum disorder (ASD) and to increase the accuracy of estimates of the prevalence of ASD.

METHODS

This review, which was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, included studies conducted from January 2008 to June 2024 on children aged 3 to 18 years that used standardized measurement tools and reported cut-off scores for ASD. The prevalence of ASD was the primary outcome analyzed in this review. The PubMed, Clinical Key, Scopus, Embase, CINAHL, and Web of Science databases were reviewed for relevant studies. The review protocol was registered with PROSPERO and followed the Cochrane collaboration guidelines.

RESULTS

A total of 66 studies reported on the prevalence of ASD, screening 21,313,061 children worldwide. Among these, 25 studies were conducted in Europe, 22 in Asia, and 13 in America. Additionally, 3 studies each were reported from Africa and Australia. According to a meta-analysis, 0.77% of children globally are diagnosed with ASD, with boys comprising 1.14% of this group. Notably, Australia showed the highest prevalence rate, with an effect size of 2.18, highlighting it as a critical area for public health focus.

CONCLUSION

ASD represents a significant global health burden. Early detection, increased awareness among parents, and prompt intervention are crucial for mitigating developmental problems in children later in life. It is essential for health policymakers to acknowledge the prevalence and growing trends of ASD in order to implement effective interventions.

Unraveling the Connections: Eating Issues, Microbiome, and Gastrointestinal Symptoms in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication, restricted interests, and repetitive behaviors. It is also associated with a high prevalence of eating disorders, gastrointestinal (GI) symptoms, and alterations in gut microbiota composition. One of the most pressing concerns is food selectivity. Various eating disorders, such as food neophobia, avoidant/restrictive food intake disorder (ARFID), specific dietary patterns, and poor-quality diets, are commonly observed in this population, often leading to nutrient deficiencies. Additionally, gastrointestinal problems in children with ASD are linked to imbalances in gut microbiota and immune system dysregulation. The aim of this narrative review is to identify previous associations between the gut-brain axis and gastrointestinal problems in ASD. We discuss the impact of the "microbiome-gut-brain axis", a bidirectional connection between gut microbiota and brain function, on the development and symptoms of ASD. In gastrointestinal problems associated with ASD, a 'vicious cycle' may play a significant role: ASD symptoms contribute to the prevalence of ARFID, which in turn leads to microbiota degradation, ultimately worsening ASD symptoms. Current data suggest a link between gastrointestinal problems in ASD and the microbiota, but the amount of evidence is limited. Further research is needed, targeting the correlation of a patient's microbiota status, dietary habits, and disease course.

Proximity-based solutions for optimizing autism spectrum disorder treatment: integrating clinical and process data for personalized care

Autism Spectrum Disorder (ASD) affects millions of individuals worldwide, presenting challenges in social communication, repetitive behaviors, and sensory processing. Despite its prevalence, diagnosis can be lengthy, and access to appropriate treatment varies greatly. This project utilizes the power of Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), to improve Autism Spectrum Disorder diagnosis and treatment. A central data hub, the Master Data Plan (MDP), will aggregate and analyze information from diverse sources, feeding AI algorithms that can identify risk factors for ASD, personalize treatment plans based on individual needs, and even predict potential relapses. Furthermore, the project incorporates a patient-facing chatbot to provide information and support. By integrating patient data, empowering individuals with ASD, and supporting healthcare professionals, this platform aims to transform care accessibility, personalize treatment approaches, and optimize the entire care journey. Rigorous data governance measures will ensure ethical and secure data management. This project will improve access to care, personalize treatments for better outcomes, shorten wait times, boost patient involvement, and raise ASD awareness, leading to better resource allocation. This project marks a transformative shift toward data-driven, patient-centred ASD care in Italy. This platform enhances treatment outcomes for individuals with ASD and provides a scalable model for integrating AI into mental health, establishing a new benchmark for personalized patient care. Through AI integration and collaborative efforts, it aims to redefine mental healthcare standards, enhancing the well-being for individuals with ASD.

EEG Abnormalities and Phenotypic Correlates in Preschoolers with Autism Spectrum Disorder: A Single-Center Study

Background: The literature suggests the existence of an association between autism spectrum disorders (ASDs) and subclinical electroencephalographic abnormalities (SEAs), which show a heterogeneous prevalence rate (12.5-60.7%) within the pediatric ASD population. The aim of this study was to investigate the EEG findings in a cohort of ASD preschoolers and their correlation with the phenotypic characteristics. Methods: We retrospectively reviewed data on 141 ASD preschoolers evaluated in a tertiary care university hospital over the period 2008-2018. All participants underwent at least one standard polygraphic electroencephalogram (EEG) and a clinical multidisciplinary assessment with standardized instruments. Results: 77 patients (55%) showed SEAs, which were mainly represented by epileptiform discharges (p < 0.00001), especially focal and multifocal (p = 0.010). Abnormal EEG (p = 0.035) and epileptiform discharges (p = 0.014) were associated with seizure onset and were predominant in sleep (p < 0.00001). Patients with abnormal tracing (p = 0.031) and slow abnormalities (p < 0.001) were significantly younger. ASD severity was not found to be correlated with EEG results, which showed a potential, albeit non-significant, association with some psychometric parameters. Very similar results were found when patients were divided according to sex. Conclusions: EEG abnormalities appear to correlate more with ASD internalizing, externalizing and emotional comorbidities, rather than with ASD core symptoms; larger samples are needed to further investigate this association.

Virtual environments as a novel and promising approach in (neuro)diagnosis and (neuro)therapy: a perspective on the example of autism spectrum disorder

Over the last three decades, dynamically evolving research using novel technologies, including virtual environments (VEs), has presented promising solutions for neuroscience and neuropsychology. This article explores the known and potential benefits and drawbacks of employing modern technologies for diagnosing and treating developmental disorders, exemplified by autism spectrum disorder (ASD). ASD's complex nature is ideal for illustrating the advantages and disadvantages of the digital world. While VEs' possibilities remain under-explored, they offer enhanced diagnostics and treatment options for ASD, augmenting traditional approaches. Unlike real-world obstacles primarily rooted in social challenges and overwhelming environments, these novel technologies provide unique compensatory opportunities for ASD-related deficits. From our perspective in addition to other recent work, digital technologies should be adapted to suit the specific needs of individuals with ASD.

Healthcare professionals face ethical challenges in managing care for neurodevelopmental disorders: a qualitative study in Lebanon

OBJECTIVES

This study aimed to explore the ethical challenges faced by healthcare professionals (HCPs) in managing children and adolescents with neurodevelopmental disorders (NDDs) in Lebanon. The primary research question addressed how HCPs navigate ethical dilemmas related to patient autonomy, surrogate decision-making and communication in the context of severe cognitive impairments.

DESIGN

Qualitative, cross-sectional study using semi-structured interviews. Thematic analysis was applied to identify key ethical challenges in clinical practice.

SETTING

Participants recruited from a range of healthcare specialties, including paediatric neurology, general paediatrics and psychiatry, and registered with the Lebanese Order of Physicians.

PARTICIPANTS

Sixteen HCPs, including paediatric neurologists and psychiatrists, participated in the study. Participants were selected based on their experience in treating children and adolescents with NDDs. There were no exclusion criteria based on gender, ethnicity or years of experience.

INTERVENTIONS

No formal interventions were applied. Participants were interviewed about their experiences and ethical challenges in managing patients with NDD.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the identification of ethical dilemmas faced by HCPs in clinical decision-making with patients with NDD. Secondary outcomes included insights into the strategies employed by HCPs to balance patient autonomy with surrogate decision-making and the communication challenges they face with patients' families.

RESULTS

Thematic analysis revealed several key ethical challenges, including (1) balancing patient autonomy with the need for surrogate decision-making, (2) tailoring healthcare to individual cognitive abilities and (3) navigating the complexities of communication with patients and their families. Participants emphasised the importance of assessing decision-making capacity on a case-by-case basis. The study also highlighted the need for specialised, patient-centred approaches that respect autonomy while considering the practical limitations imposed by severe cognitive impairments.

CONCLUSIONS

This study provides critical insights into the ethical considerations faced by HCPs in managing children and adolescents with NDDs. Further research is needed to develop training programs for HCPs that address these ethical challenges and promote patient-centred decision-making.

Therapeutic Potential of Ocimum basilicum L. Extract in Alleviating Autistic-Like Behaviors Induced by Maternal Separation Stress in Mice: Role of Neuroinflammation and Oxidative Stress

A confluence of genetic, environmental, and epigenetic factors shapes autism spectrum disorder (ASD). Early-life stressors like MS play a contributing role in this multifaceted neurodevelopmental disorder. This research was to explore the efficacy of Ocimum basilicum L. (O.B.) extract in mitigating behaviors reminiscent of autism prompted by maternal separation (MS) stress in male mice, focusing on its impact on neuroinflammation and oxidative stress. MS mice were treated with O.B. extract at varying dosages (20, 40, and 60 mg/kg) from postnatal days (PND) 51-53 to PND 58-60. Behavioral experiments, including the Morris water maze, three-chamber test, shuttle box, and resident-intruder test, were conducted post-treatment. The method of maternal separation involved separating the pups from their mothers for 3 h daily, from PND 2 to PND 14. Molecular analysis of hippocampal tissue was performed to assess gene expression of Toll-like receptor 4 (TLR4), tumor necrosis factor-α (TNF-α), and interleukin-1β (IL-1β). Hippocampal and serum malondialdehyde (MDA) levels and total antioxidant capacity (TAC) were measured. O.B. extract administration resulted in the amelioration of autistic-like behaviors in MS mice, as evidenced by improved spatial and passive avoidance memories and social interactions, as well as reduced aggression in behavioral tests. O.B. extract attenuated oxidative stress and neuroinflammation, as indicated by decreased MDA and increased TAC levels, as well as downregulation of TLR4, TNF-α, and IL-1β expression in the hippocampus. O.B. extract may offer a novel therapeutic avenue for ASD, potentially mediated through its anti-inflammatory and antioxidant properties.

The Persian Version of the Emotion Regulation and Social Skills Questionnaire: Psychometric Properties for Young People with Autism Spectrum Disorders

PURPOSE

The aim of the current study was to examine the psychometric properties of the Emotion Regulation and Social Skills Questionnaire (ERSSQ) among young Farsi-speaking individuals with Autism Spectrum Disorder (ASD) in Iran.

METHODS

This cross-sectional study analyzed data from 108 children and teenagers (aged 7 to 14 years; mean age = 10.55 years, 91% male) with ASD, along with an equal number of neurotypical children, their families, and teachers. The assessment of the ERSSQ's psychometric properties included evaluations of reliability, content validity, and face validity. Cronbach's alpha coefficient was used to estimate the reliability of the ERSSQ-P and ERSSQ-T which were completed respectively by parents and teachers of children with autism spectrum disorders.

RESULTS

The results indicated that the Persian versions of the ERSSQ-P and ERSSQ-T questionnaires exhibited adequate face and content validity (CVI = 0.92 and 0.88, respectively). Additionally, both ERSSQ-P and ERSSQ-T demonstrated acceptable internal consistency, with Cronbach's alpha values of 0.95 and 0.70, respectively.

DISCUSSION

This study confirms the effectiveness and validity of the ERSSQ-P and ERSSQ-T, which can be utilized by specialists in the field of autism for clinical and research applications. These instruments offer a straightforward and cost-effective means of assessing emotion regulation and social skills among Farsi-speaking children and adolescents with ASD.

The Impact of Dog-Assisted Therapy Among Children and Adolescents with Autism Spectrum Disorder: A Systematic Review

BACKGROUND AND OBJECTIVES

Animal-assisted therapies have been utilized in various profiles to improve people's quality of life. This systematic review aims to assess the impact of dog-assisted therapies (DAT) on children and adolescents with Autism Spectrum Disorder (ASD). The benefits provided, the feasibility of implementation, and potential limitations are analysed.

METHODS

An exhaustive search was carried out in the following databases: Web of Science (WoS), Scopus, ERIC, PubMed, PubPsych, CINAHL, PsycInfo and Dialnet. The procedure was preregistered on PROSPERO.

RESULTS

This review included 19 scientific articles. Of these, 84% suggest that DAT has a positive impact on communication and social interaction during the development of children and adolescents diagnosed with ASD. The dog is often perceived as a communication facilitator that serves as a reinforcer, capturing the individual's attention. Emotional benefits have also been reported, including reducing stereotyped and self-harming behaviours. Additionally, an increase in smiling frequency and self-esteem levels was observed.

CONCLUSIONS

These findings highlight the potential of DAT as a component of socio-educational intervention for children and adolescents diagnosed with ASD. However, further research is necessary due to the limited sample sizes in the studies reviewed.

Unveiling autism spectrum disorder in South East Asia through a public health Lens

Autism spectrum disorder (ASD) is a multifaceted developmental condition characterized by persistent challenges in social communication, restricted interests, and repetitive behaviors. Though there is no cure, early and intensive interventions can significantly improve the quality of life for those affected. The aim of this paper is to examine the complexities of autism spectrum disorder (ASD) from a public health perspective in South East Asian region, highlighting the global rise in prevalence and the compounded challenges posed by the COVID-19 pandemic. The rise in ASD prevalence from 4 to 5 cases per 10,000 children in the 1980s to 11.3 per 1,000 children in 2012 highlights the need for effective interventions. The pandemic exacerbated behavioral issues, anxiety, and screen time-related health problems, underscoring the importance of adjusting strategies for early identification and support. Diagnostic tools like the Modified Checklist for Autism in Toddlers (M-CHAT) and the Social Communication Questionnaire (SCQ) play a critical role in community-based screening. Effective prevention strategies include primary measures such as public awareness campaigns and genetic counseling, secondary measures focusing on early identification and intervention, and tertiary measures involving ongoing support and therapy. Addressing implementation challenges, particularly in low-income countries, requires enhanced public awareness, training of community health workers, and integration of ASD services into primary healthcare systems. Future research should aim to develop and evaluate scalable, culturally relevant interventions and explore the impact of environmental factors on ASD. Comprehensive strategies at the community level, combined with robust public health policies, are crucial for improving outcomes for individuals with ASD and their families.

Epigenetic underpinnings of the autistic mind: Histone modifications and prefrontal excitation/inhibition imbalance

Autism spectrum disorder (ASD) is complex neurobehavioral condition influenced by several cellular and molecular mechanisms that are often concerned with synaptogenesis and synaptic activity. Based on the excitation/inhibition (E/I) imbalance theory, ASD could be the result of disruption in excitatory and inhibitory synaptic transmission across the brain. The prefrontal cortex (PFC) is the chief regulator of executive function and can be affected by altered neuronal excitation and inhibition in the course of ASD. The molecular mechanisms involved in E/I imbalance are subject to epigenetic regulation. In ASD, altered enrichment and spreading of histone H3 and H4 modifications such as the activation-linked H3K4me2/3, H3K9ac, and H3K27ac, and repression-linked H3K9me2, H3K27me3, and H4K20me2 in the PFC result in dysregulation of molecules mediating synaptic excitation (ARC, EGR1, mGluR2, mGluR3, GluN2A, and GluN2B) and synaptic inhibition (BSN, EphA7, SLC6A1). Histone modifications are a dynamic component of the epigenetic regulatory elements with a pronounced effect on patterns of gene expression with regards to any biological process. The excitation/inhibition imbalance associated with ASD is based on the excitatory and inhibitory synaptic activity in different regions of the brain, including the PFC, the ultimate outcome of which is highly influenced by transcriptional activity of relevant genes.

Dental Adaptation Strategies for Children with Autism Spectrum Disorder-A Systematic Review of Randomized Trials

Background: Children with Autism Spectrum Disorder (ASD) often struggle with dental care due to sensory sensitivities and behavioral issues, increasing their risk for oral health problems. Adaptation strategies such as visual aids, video modeling, and sensory-adapted environments aim to improve their dental experiences. Methods: A systematic review of randomized controlled trials (RCTs) was conducted according to PRISMA 2020 guidelines using the PubMed, Scopus, Embase, and Cochrane databases. Of the 1072 records screened, nine RCTs were included in the analysis. Studies included children with ASD under 18 years and compared dental adaptation techniques with traditional care. The risk of bias and study quality were assessed. The quality of evidence for the results was determined using the GRADE tool. Results: Nine RCTs with sample sizes ranging from 25 to 138 participants showed significant improvements in oral hygiene, reduced anxiety, and increased cooperation. Video modeling and sensory-adapted environments were particularly effective in lowering distress during dental visits. Conclusions: Dental adaptation strategies, especially video modeling and sensory-adapted environments, effectively improve oral health outcomes and reduce anxiety in children with ASD. More research is needed to explore the long-term effects and include children with severe ASD.

Effect of the social environment on olfaction and social skills in wild-type and a mouse model of autism

Autism spectrum disorders (ASD) are complex, polygenic and heterogenous neurodevelopmental conditions. The severity of autism-associated variants is influenced by environmental factors, particularly social experiences during the critical neurodevelopmental period. While early behavioral interventions have shown efficacy in some children with autism, pharmacological support for core features - impairments in social interaction and communication, and stereotyped or restricted behaviors - is currently lacking. In this study, we examined how the social environment influences both wild-type (WT) and Shank3 knockout (KO) mice, a model reflecting core autism-like traits. Our findings revealed that chronic social isolation enhanced social interaction and olfactory neuron responses in WT animals. Furthermore, it restored impairments in social novelty preference and olfactory function, as well as self-grooming in Shank3 KO mice. Conversely, an enriched social environment heightened social interest toward novel conspecifics in WT mice, but elicited the opposite effect in Shank3 KO mice. Notably, Shank3 KO mice displayed distinct social responses when exposed to WT or Shank3 KO mice. These results offer novel insights that could favor the implementation of behavioral interventions and inclusive classroom programs for children with ASD.

Assessment of Knowledge and Attitude of General Practitioners Regarding Autism and Associated Factors at Gondar University Hospital, Gondar, Ethiopia

Background: The neurodevelopmental conditions known as autism spectrum disorders (ASDs) start in early childhood and last the entirety of a person's life. They are characterized by distorted social interaction, difficulties communicating, and repetitive, stereotypical behavior. Objective: This study sought to evaluate general practitioners (GPs)' attitudes and knowledge of ASDs and related factors at Gondar University Hospital. Methods: An institutional-based cross-sectional study design was used. Using a convenience-sample method, three-hundred sixty individuals were chosen for this study. Data were collected using a self-administered questionnaire. The GPs who took part in this survey were characterized by descriptive statistics. The relationship between the dependent variables (knowledge and attitude) and the sociodemographic characteristics was examined using an independent two-sample t-test and Pearson correlation analysis. The Statistical Package for the Social Sciences Version 25 was used for all data analyses. Results: In this study, the GPs had an average age of 31.82 years, with an average of 18 years since graduation and 16 years of practice. Participants' average overall knowledge and attitude scores on autism were 15.83 (SD = 3.27) and 29.54 (SD = 3.21), respectively, both falling within the moderate range. Using an independent t-test, we found a significant difference (p < 0.001) between the attitudes of male and female GPs regarding autism. The study also identified weakly significant correlations between GPs' age and their attitudes toward autism (r = 0.271⁣∗∗, p < 0.001) and between years of practice and attitudes (r = 0.105⁣∗, p=0.046). However, no significant correlations emerged between GPs' knowledge and their age, years since graduation, or years of practice (r = 0.069, p=0.194; r = 0.069, p=0.193; and r = -0.053, p=0.312, respectively). In addition, we observed a weakly significant association (r = 0.004⁣∗∗, p < 0.001) between GPs' knowledge and their attitudes about autism. Conclusion: Based on their total scores, the participants had a moderate level of knowledge and attitudes toward autism. There was a favorable correlation found between the study subjects' attitudes regarding autism and their age, as well as their practice year. Furthermore, a clear correlation was observed between GPs' attitudes and their understanding of autism.

Alterations in microbiota-metabolism-circRNA crosstalk in autism spectrum disorder-like behaviours caused by maternal exposure to glyphosate-based herbicides in mice

Epidemiological evidence indicates exposure to glyphosate-based herbicides (GBHs) increases the risk for autism spectrum disorder (ASD). The gut microbiota has been found to influence ASD behaviours through the microbiota-gut-brain axis. However, the underlying links between early life GBH exposure and ASD-like phenotypes through the microbiota-gut-brain axis remain unclear. Therefore, we exposed mice to low-dose GBH (0.10, 0.25, 0.50, and 1.00 %) and determined the effects on ASD-like behaviours. Furthermore, three kinds of omics (gut microbiomics, metabolomics, and transcriptomics) were conducted to investigate the effects of GBH exposure on gut microbiota, gut metabolites, and circular RNAs (circRNAs) in the prefrontal cortex (PFC) using a cross-generational mouse model. Behavioural analyses suggested social impairment and repetitive/stereotypic behaviours in the GBH-exposed offspring. Furthermore, maternal exposure to glyphosate significantly altered the ASD-associated gut microbiota of offspring, and ASD-associated gut metabolites were identified. Specifically, we found that alterations in the gut microenvironment may contribute to changes in gut permeability and the blood-brain barrier, which are related to changes in the levels of circRNAs in the PFC. Our results suggest a potential effect of circRNAs through the disruption of the gut-brain interaction, which is an important factor in the pathogenesis of ASD in offspring induced by maternal exposure to GBH.

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

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

Autistic-like social communication disorders and sensory profile in visually impaired children: Similarity and divergence with autism spectrum disorders

This study examined the sensory profile of three groups of children (those with visual impairment, typical development or autism spectrum disorder) aged 3 to 12. The principal aim was to find out whether the Sensory Profile (SP) of children with visual impairment was a good predictor of behaviors typical of ASD. The data was collected through a sensory profile filled out by parents of 37 visually impaired children, 30 with autism spectrum disorder (ASD) and 42 with typical development (TD). To assess the risk of ASD, the Social Communication Questionnaire (SCQ) was also administered. The results indicate that children with visual impairment are at increased risk of exhibiting signs of ASD, and that the sensory profile is a good predictor of risk of autistic signs in children with visual impairment. This study provides for the first time strong evidence for the need to systematically assess the sensory profile in children with visual impairment.

Breaking Down the Stigma: A Review of the Literature on the Relationships between Autism Spectrum Disorder and Criminal Behavior

Background: In recent years, there has been growing interest in the evaluation of autism spectrum disorder (ASD) and autistic traits in prison populations and offenders. Due to misleading headlines and highly publicized criminal cases, the belief that autistic individuals are more prone to commit crimes has spread among the general population, also leading to increasing research on this matter. Aims: In this context, this narrative review aimed to analyze the available scientific literature on the bi-directional link between ASD and criminal behaviors and to assess the key characteristics of eventual ASD offenders, including sociodemographic data, comorbidities, crime-related features, and interactions with the criminal justice system. Results: Our review highlighted that the available studies lack methodological rigor and present controversial results. Overall, the current state of research does not support any definitive correlation between ASD or autistic traits and the predisposition to engage in criminal conduct. Further studies are needed to confirm or reject this hypothesis.

The Autism Program Environment Rating Scale in Swedish Primary School: Cultural Adaptation and Content Validation

There is a recognized need to improve inclusive learning environments for autistic children in primary school settings in Sweden. This study aimed to translate, cross-culturally adapt, and assess the content validity of the Swedish primary school version of the Autism Program Environment Scale (APERS), originally developed to evaluate autism program quality in educational settings in the United States. Following the translation into Swedish and the first cultural adaptation of the APERS, a content panel group of 14 professionals rated its content validity. Four of the content panel members also participated in individual interviews that provided a qualitative evaluation of the instrument's content validity. Finally, the authors piloted the APERS in 10 Swedish primary school classrooms to assess its feasibility. The ratings and qualitative information from the content panel members indicated a substantial need for the Swedish APERS in primary school, resulting in the culturally adapted APERS-Primary-Sweden (SE). The instrument demonstrated a high level of cross-cultural content validity for assessing the quality of the learning environment for students with autism in Swedish primary school settings. The pilot testing of the instrument resulted in further cultural adaptations. In conclusion, APERS-Primary-SE is a comprehensive scale that can be used to assess the quality of primary school learning environments for children with autism in Sweden. Further research is needed to evaluate the adapted instrument's effectiveness in improving the learning environment in Swedish primary school classrooms.

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

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

Decoding the genetic landscape of autism: A comprehensive review

BACKGROUND

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by heterogeneous symptoms and genetic underpinnings. Recent advancements in genetic and epigenetic research have provided insights into the intricate mechanisms contributing to ASD, influencing both diagnosis and therapeutic strategies.

AIM

To explore the genetic architecture of ASD, elucidate mechanistic insights into genetic mutations, and examine gene-environment interactions.

METHODS

A comprehensive systematic review was conducted, integrating findings from studies on genetic variations, epigenetic mechanisms (such as DNA methylation and histone modifications), and emerging technologies [including Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)-Cas9 and single-cell RNA sequencing]. Relevant articles were identified through systematic searches of databases such as PubMed and Google Scholar.

RESULTS

Genetic studies have identified numerous risk genes and mutations associated with ASD, yet many cases remain unexplained by known factors, suggesting undiscovered genetic components. Mechanistic insights into how these genetic mutations impact neural development and brain connectivity are still evolving. Epigenetic modifications, particularly DNA methylation and non-coding RNAs, also play significant roles in ASD pathogenesis. Emerging technologies like CRISPR-Cas9 and advanced bioinformatics are advancing our understanding by enabling precise genetic editing and analysis of complex genomic data.

CONCLUSION

Continued research into the genetic and epigenetic underpinnings of ASD is crucial for developing personalized and effective treatments. Collaborative efforts integrating multidisciplinary expertise and international collaborations are essential to address the complexity of ASD and translate genetic discoveries into clinical practice. Addressing unresolved questions and ethical considerations surrounding genetic research will pave the way for improved diagnostic tools and targeted therapies, ultimately enhancing outcomes for individuals affected by ASD.

The Face of Autism in Israel

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

"We call it Bokoa jwa tlhaloganyo": Setswana parents' perspective on autism spectrum disorder

Introduction

There is a dearth of knowledge in South Africa about the incidence, prevalence, and effect of autism spectrum disorder (ASD). Consequently, national autism data is outdated, and World Health Organization (WHO) prevalence rates are being used.

Methods

This study focused on Ngaka Modiri Molema District to explore the cultural perspective of ASD in the Setswana culture from a parental or caregiver perspective, specifically those who attended the World Health Organization Caregiver Skills Training (WHO-CST) on ASD. This qualitative study used a phenomenological design and purposively sampled 6 out of 12 participants who wererecipients of WHO-CST. Semi-structured interviews, audio recordings, and field notes were used to collect data.

Results

The study found five main themes: understanding autism, indigenous perceptions of ASD, ways of interacting with children living with autism spectrum disorder, creating a friendly environment and symptoms of ASD.

Discussion

It was concluded that there is a lack of knowledge in Setswana culture about what ASD entails, and there are still some superstitious beliefs regarding ASD, resulting in late diagnoses. ASD studies with larger sample sizes, including medical professionals and policymakers, are recommended.

Aberrant Flexibility of Dynamic Brain Network in Patients with Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a collection of neurodevelopmental disorders whose pathobiology remains elusive. This study aimed to investigate the possible neural mechanisms underlying ASD using a dynamic brain network model and a relatively large-sample, multi-site dataset. Resting-state functional magnetic resonance imaging data were acquired from 208 ASD patients and 227 typical development (TD) controls, who were drawn from the multi-site Autism Brain Imaging Data Exchange (ABIDE) database. Brain network flexibilities were estimated and compared between the ASD and TD groups at both global and local levels, after adjusting for sex, age, head motion, and site effects. The results revealed significantly increased brain network flexibilities (indicating a decreased stability) at the global level, as well as at the local level within the default mode and sensorimotor areas in ASD patients than TD participants. Additionally, significant ASD-related decreases in flexibilities were also observed in several occipital regions at the nodal level. Most of these changes were significantly correlated with the Autism Diagnostic Observation Schedule (ADOS) total score in the entire sample. These results suggested that ASD is characterized by significant changes in temporal stabilities of the functional brain network, which can further strengthen our understanding of the pathobiology of ASD.

Validity of the Systemizer Profile Questionnaire: A New Tool to Identify Cognitive, Mentalizing, Sensory, Social, and Systemizing Abilities in Adults with Autism-Spectrum-Disorders With and Without Comorbid ADHD

PURPOSE

Systemizer Profile Questionnaire (SPQ), which has not been used before, investigates difficulties in mentalisation, sensory- and/or social sensitivity and social cognition (MSSSC) in subjects with Autism-Spectrum-Disorders (ASD) with and without Attention-Deficit-Hyperactivity-Disorder (ADHD). The aim of this study was to evaluate the reliability and validity of the SPQ domains, and to assess the predictive validity of the SPQ against the Ritvo Autism Asperger Diagnostic Scale (RAADS).

METHODS

Three-hundred-fifty-four study subjects with ICD-10 verified ASD confirmed by RAADS and 354 controls matched on age group and gender were recruited and evaluated systematically with SPQ, standardized questions about demographic and clinical data. Hypothesized SPQ subscales formed from 85 items were evaluated using confirmatory factor analysis (CFA). Resulting revised sub-scales were confirmed using item response theory (IRT) and the predictive validity of the SPQ scores was evaluated using RAADS scores above 64 as the standard.

RESULTS

Twenty-two of the original 85 items were removed, resulting in an instrument with 63 items across nine psychometrically valid domains. These domains had high sensitivity (range: 0.64 to 0.84), and high specificity (range: 0.73 to 0.90). Positive predictive values (range: 0.76 to 0.89) and negative predictive values (range: 0.69 to 0.90) were also high. For the total SPQ score the sensitivity was 0.95, the specificity was 0.87, the positive predictive value was 0.88 and the negative predictive value was 0.95.

CONCLUSION

SPQ domains are valid descriptions/profiles of MSSSC given that ASD is confirmed by RAADS, though irrelevant if not, as SPQ is not a diagnostic instrument.

Developing Knowledge of Autism in Majority World Countries: Examples of Bolivia and Paraguay

Bolivia and Paraguay are Majority World countries, which are defined as areas within which most of the world's population live, natural resources and landmass are located, but are often economically poor. Minority world countries, such as, the United States, have a smaller percentage of the world's population, but often a greater share of the world's wealth. Many Majority World countries, such as Bolivia and Paraguay, have not collected prevalence data on autism and assessments and interventions for persons are quite limited, if they are available at all. Persons with autism in Bolivia and Paraguay are at most underserved and the majority are unserved. This article reviews topological, demographic, and economic/political factors affecting the identification and provisions of services for autistic children and the current health and educational status for autistic persons in Bolivia and Paraguay. Descriptions of the efforts of outside consultants to assist parents and professional within those countries to gain information and develop assessment and intervention programs for autistic children are described. Attention is given to methodologies employed by United States consultants to ensure the implementation of culturally responsive practices. Consultants employed skilled dialogue when interviewing parents and professionals in Bolivia and Paraguay to understand their perspectives so as to guide content of trainings. The PRECEDE-PROCEED framework was employed to develop a culturally-responsive approach to assessment and intervention.

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

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

Knowledge, Attitude, and Perception towards Autism Spectrum Disorders among Parents in Sakaka, Al-Jouf Region, Saudi Arabia: A Cross-Sectional Study

Parents are an essential element of family intervention for all children, including those with autism spectrum disorders (ASDs). We can better understand and address parents' knowledge gaps about ASD through in-depth research and inquiry into parents' current level of understanding, attitude, and perception. We aimed to assess the knowledge, attitude, and perception of ASD and influencing factors towards ASD among a group of parents with and without a child diagnosed with ASD in Sakaka, Al-Jouf Region, Saudi Arabia. Using the cross-sectional study design, information from the parents was gathered using a pretested questionnaire that included validated scales for measuring knowledge, attitudes, and perceptions related to ASD. The required number of participants was selected using the convenience sampling method. We used Spearman's correlation test to determine the strength and direction of correlation between each domain. As a last step, we analyzed the influencing factors using binomial logistic regression. Among the 400 participants, 41.2% had high knowledge, 69.1% had a positive attitude, and 60.3% had a high perception of ASD. We found that knowledge was significantly higher among the parents with autistic individuals in the family (p = 038). The high and positive attitude was significantly greater among females (p = 0.010) and parents with high income (p = 0.007), and the perception was significantly associated with females (p = 0.037) and highly educated participants (p = 0.046). Furthermore, we found a positive correlation between knowledge, attitude, and perception. Overall, only less than half of the participants had a high knowledge of ASD. Hence, we recommend awareness-raising programs for the parents in this region. Furthermore, a prospective study involving parents from all provinces of Saudi Arabia is recommended.

The influence of exercise intensity on comorbid anxious behavior in psychiatric conditions

Many experts have extensively studied the potential of exercise as a treatment option for psychiatric conditions, including depression and autism spectrum disorder (ASD). Despite their core symptoms, these conditions exhibits comparable component traits, an anxiety. In this study, we explored the effect of exercise on behavioral abnormalities in psychiatric conditions, focusing on its intensity and emotional resilience. Shank3B knockout (KOSED) mice displaying self-injurious repetitive behavior and C57BL/6J mice, susceptible to stress as ASD and depression model, respectively, were subjected to moderate-intensity exercise (ME) for 2 weeks. ME mitigated the core symptoms (excessive grooming traits and behavioral despair) but did not exert a significant anxiolytic effect. Notably, exercise intensity has emerged as a critical determinant of its efficacy, as evidenced by a lower ventilation threshold and anxiolytic effect mediated by low-intensity exercise. The findings substantiate the notion that exercise is promising as a disease-modifying treatment, but intensity matters for emotional resilience.

Autism in Taiwan and Thailand: Influences of Culture

The prevalence of autism is increasing worldwide. The majority of autism research and development of autism assessments and interventions has been conducted in Western cultures. The prevalence of autism is reportedly lower in Asian versus Western cultures, but this is likely due to lack of personnel and uniform criteria for diagnosing autism. This article describes how two Asian cultures, Taiwan and Thailand, are dealing with the increasing identification of autistic children. National universal healthcare in both Taiwan and Thailand provides a mechanism for assessment and diagnosis of young children, but a lack of a sufficient number of trained professionals limits the availability of intervention services. A focus of research in these cultures has been on parents' experiences and coping with the stigma and stress of having an autistic child. Cultural values associated with Confucianism and Buddhism influence attitudes toward persons with disability and how parents of autistic children experience and cope with stigma and stress. Both areas have national laws that provide a range of educational opportunities for autistic children, including inclusion into general education classrooms. Special education and general education teachers, however, have little specific training in autism. Speech and language services are rarely offered in public school programs. Available speech and language services are limited to consultation with teachers a few times a year. In general, parents of autistic children are supportive of inclusion programs, but teachers and parents of both autistic and typically developing children express concerns about the ability to implement such programs in ways that are beneficial to all children.

Exploring autism via the retina: Comparative insights in children with autism spectrum disorder and typical development

Autism spectrum disorder (ASD) is a widely recognized neurodevelopmental disorder, yet the identification of reliable imaging biomarkers for its early diagnosis remains a challenge. Considering the specific manifestations of ASD in the eyes and the interconnectivity between the brain and the eyes, this study investigates ASD through the lens of retinal analysis. We specifically examined differences in the macular region of the retina using optical coherence tomography (OCT)/optical coherence tomography angiography (OCTA) images between children diagnosed with ASD and those with typical development (TD). Our findings present potential novel characteristics of ASD: the thickness of the ellipsoid zone (EZ) with cone photoreceptors was significantly increased in ASD; the large-caliber arteriovenous of the inner retina was significantly reduced in ASD; these changes in the EZ and arteriovenous were more significant in the left eye than in the right eye. These observations of photoreceptor alterations, vascular function changes, and lateralization phenomena in ASD warrant further investigation, and we hope that this work can advance interdisciplinary understanding of ASD.

Gestational Fisetin Exerts Neuroprotection by Regulating Mitochondria-Directed Canonical Wnt Signaling, BBB Integrity, and Apoptosis in Prenatal VPA-Induced Rodent Model of Autism

Embryonic valproic acid (VPA) has been considered a potential risk factor for autism. Majority of studies indicated that targeting autism-associated alterations in VPA-induced autistic model could be promising in defining and designing therapeutics for autism. Numerous investigations in this field investigated the role of canonical Wnt signaling cascade in regulating the pathophysiology of autism. The impaired blood-brain barrier (BBB) permeability and mitochondrial dysfunction are some key implied features of the autistic brain. So, the current study was conducted to target canonical Wnt signaling pathway with a natural polyphenolic modulator cum antioxidant namely fisetin. A single dose of intraperitoneal VPA sodium salt (400 mg/kg) at gestational day 12.5 induced developmental delays, social behaviour impairments (tube dominance test), and anxiety-like behaviour (sucrose preference test) similar to autism. VPA induced mitochondrial damage and over-activated the canonical Wnt signaling which further increased the blood-brain barrier (BBB) disruption, apoptosis, and neuronal damage. Our findings revealed that oral administration of 10 mg/kg gestational fisetin (GD 13-till parturition) improved social and anxiety-like behaviour by modulating the ROS-regulated mitochondrial-canonical Wnt signaling. Moreover, fisetin controls BBB permeability, apoptosis, and neuronal damage in autism model proving its neuroprotective efficacy. Collectively, our findings revealed that fisetin-evoked modulation of the Wnt signaling cascade successfully relieved the associated symptoms of autism along with developmental delays in the model and indicates its potential as a bioceutical against autism.

A Western Dietary Pattern during Pregnancy is Associated with Neurodevelopmental Disorders in Childhood and Adolescence

Despite the high prevalence of neurodevelopmental disorders, there is a notable gap in clinical studies exploring the impact of maternal diet during pregnancy on child neurodevelopment. This observational clinical study examined the association between pregnancy dietary patterns and neurodevelopmental disorders, as well as their symptoms, in a prospective cohort of 10-year-old children (n=508). Data-driven dietary patterns were derived from self-reported food frequency questionnaires. A Western dietary pattern in pregnancy (per SD change) was significantly associated with attention-deficit / hyperactivity disorder (ADHD) (OR 1.66 [1.21 - 2.27], p=0.002) and autism diagnosis (OR 2.22 [1.33 - 3.74], p=0.002) and associated symptoms (p<0.001). Findings for ADHD were validated in three large (n=59725, n=656, n=348), independent mother-child cohorts. Objective blood metabolome modelling at 24 weeks gestation identified 15 causally mediating metabolites which significantly improved ADHD prediction in external validation. Temporal analyses across five blood metabolome timepoints in two independent mother-child cohorts revealed that the association of Western dietary pattern metabolite scores with neurodevelopmental outcomes was consistently significant in early to mid-pregnancy, independent of later child timepoints. These findings underscore the importance of early intervention and provide robust evidence for targeted prenatal dietary interventions to prevent neurodevelopmental disorders in children.

A Discussion of Positive Behavior Support and Applied Behavior Analysis in the Context of Autism Spectrum Disorder in the UK and Ireland

This article addresses the relationship between applied behavior analysis (ABA) and the emergence of positive behavior support (PBS) in context of autism spectrum disorder (ASD) in the UK and Ireland. Two overarching issues that are salient in this discussion are professional training and certification. To date, there has been a lack of standardized training or statutory requirements to practice PBS despite proponents insisting that its practice should be grounded in behavior analytic principles. Furthermore, there is an undercurrent of anti-ABA bias fueled by misinterpretation and unsubstantiated anecdotal claims used to promote an alternative "value based" approach to managing behavior.

Gut-brain barrier dysfunction bridge autistic-like behavior in mouse model of maternal separation stress: A behavioral, histopathological, and molecular study

Autism spectrum disorder (ASD) is a fast-growing neurodevelopmental disorder throughout the world. Experiencing early life stresses (ELS) like maternal separation (MS) is associated with autistic-like behaviors. It has been proposed that disturbance in the gut-brain axis-mediated psychiatric disorders following MS. The role of disruption in the integrity of gut-brain barrier in ASD remains unclear. Addressing this knowledge gap, in this study we aimed to investigate role of the gut-brain barrier integrity in mediating autistic-like behaviors in mouse models of MS stress. To do this, mice neonates are separated daily from their mothers from postnatal day (PND) 2 to PND 14 for 3 hours. During PND58-60, behavioral tests related to autistic-like behaviors including three-chamber sociability, shuttle box, and resident-intruder tests were performed. Then, prefrontal cortex (PFC), hippocampus, and colon samples were dissected out for histopathological and molecular evaluations. Results showed that MS is associated with impaired sociability and social preference indexes, aggressive behaviors, and impaired passive avoidance memory. The gene expression of CLDN1 decreased in the colon, and the gene expression of CLDN5, CLDN12, and MMP9 increased in the PFC of the MS mice. MS is associated with decrease in the diameter of CA1 and CA3 areas of the hippocampus. In addition, MS led to histopathological changes in the colon. We concluded that, probably, disturbance in the gut-brain barrier integrities mediated the autistic-like behavior in MS stress in mice.