Epidemiology of Autism Spectrum Disorders: A Review of Worldwide Prevalence Estimates Since 2014

Mapping autism in Egypt: population-based insights into prevalence, risk determinants, and severity among children aged 1-12 years

BACKGROUND

The prevalence of autism spectrum disorder (ASD), a common developmental disorder, has surged in recent years. Accordingly, the identification and early management of possible risk factors can diminish ASD incidence.

AIM

To determine the prevalence and severity of idiopathic ASD in Egyptian children aged 12 months to 12 years, and to identify the epidemiological, sociodemographic, and environmental risk factors contributing to this disorder.

METHODS

This study comprised 41,640 children from the main eight geographic areas in Egypt. It was conducted through four phases: household screening, facility-based screening for high-risk children, diagnosis confirmation, and risk factor assessment.

RESULTS

The prevalence of ASD as confirmed by the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the Childhood Autism Rating Scale (CARS) was 1.1% (455 out of 41,640), with significant geographic variability. Urban areas had a significantly higher prevalence than rural areas. Children aged 3-6 years showed the highest prevalence at 1.5%. Boys were four times more affected than girls, with prevalence rates of 1.7% and 0.4%, respectively. Significant risk factors included: a history of convulsions (AOR = 4.7; 95% CI: 3.3-6.79), low birth weight (AOR = 2.08; 95% CI: 1.54-2.79), prolonged stays in neonatal intensive care unit (NICU) longer than two days (AOR = 1.91; 95% CI: 1.46-2.49) and maternal health problems during pregnancy (AOR = 1.66; 95% CI:1.36-1.95). Regarding severity, 45% of diagnosed children had moderate ASD, 39% had severe ASD, and 16% had mild ASD. Female gender and older age were significant predictors of greater ASD severity.

CONCLUSION

ASD prevalence in Egypt is comparable to other Middle Eastern countries. Policymakers should utilize these findings to design targeted public health interventions aimed at early detection, management, and prevention of ASD progression.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL TRIAL REGISTRATION

DRKS00012339.

A cross-cultural examination of bi-directional mentalising in autistic and non-autistic adults

BACKGROUND

So-called 'mismatch accounts' propose that, rather than arising from a socio-cognitive deficit present in autistic people, mentalising difficulties are the product of a mismatch in neurotype between interaction partners. Although this idea has grown in popularity over recent years, there is currently only limited empirical evidence to support mismatch theories. Moreover, the social model of disability such theories are grounded in demands a culturally situated view of social interaction, yet research on mentalising and/or autism is largely biased towards Western countries, with little knowledge on how successful mentalising is defined differently, and how tools to assess socio-cognitive ability compare, across cultures.

METHODS

Using a widely employed mentalising task-the animations task-, the current study investigated and compared the bi-directional mentalising performance of British and Japanese autistic and non-autistic adults and assessed observer-agent kinematic similarity as a potential dimension along which mismatches may occur between neurotypes. Participants were asked to depict various mental state- and action-based interactions by moving two triangles across a touch-screen device before viewing and interpreting stimuli generated by other participants.

RESULTS

In the UK sample, our results replicate a seminal prior study in showing poorer mentalising abilities in non-autistic adults for animations generated by the autistic group. Crucially, the same pattern did not emerge in the Japanese sample, where there were no mentalising differences between the two groups.

LIMITATIONS

Limitations of the current study include that efforts to match all samples within and across cultures in terms of IQ, gender, and age were not successful in all comparisons, but control analyses suggest this did not affect our results. Furthermore, any performance differences were found for both the mental state- and action-based conditions, mirroring prior work and raising questions about the domain-specificity of the employed task.

CONCLUSIONS

Our results add support for a paradigm shift in the autism literature, moving beyond deficit-based models and towards acknowledging the inherently relational nature of social interaction. We further discuss how our findings suggest limited cultural transferability of common socio-cognitive measures rather than superior mentalising abilities in Japanese autistic adults, underscoring the need for more cross-cultural research and the development of culturally sensitive scientific and diagnostic tools.

The Possible Role of Postnatal Biphasic Dysregulation of IGF-1 Tone in the Etiology of Idiopathic Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a pervasive condition of neurodevelopmental origin with an increasing burden on society. Idiopathic ASD is notorious for its heterogeneous behavioral manifestations, and despite substantial efforts, its etiopathology is still unclear. An increasing amount of data points to the causative role of critical developmental alterations in the first year of life, although the contribution of fetal, environmental, and genetic factors cannot be clearly distinguished. This review attempts to propose a narrative starting from neuropathological findings in ASD, involving insulin-like growth factor 1 (IGF-1) as a key modulator and demonstrates how the most consistent gestational risk factors of ASD-maternal insulin resistance and fetal growth insufficiency-converge at the perinatal dysregulation of offspring anabolism in the critical period of early development. A unifying hypothesis is derived, stating that the co-occurrence of these gestational conditions leads to postnatal biphasic dysregulation of IGF-1 tone in the offspring, leading first to insulin-dependent accelerated development, then to subsequent arrest of growth and brain maturation in ASD as an etiologic process. This hypothesis is tested for its explanation of various widely reported risk factors and observations of idiopathic ASD, including early postnatal growth abnormalities, the pervasive spectrum of symptoms, familial predisposition, and male susceptibility. Finally, further directions of research are outlined.

Gut microbiota mediated regulation of vitamin B homeostasis in autism spectrum disorders

The exact cause of autism spectrum disorder (ASD) is yet unknown, although possible causes include early childhood, foetal development, gestation, delivery mode, genetics, and environmental variables. Approximately 1% of children worldwide have ASD, and this percentage is rising. The immunological, endocrine, gut microbiota and brain-gut axis quality influence the intensity of ASD symptoms. Deficits in the composition and diversity of gut microbiota are common in children with ASD, accounting for 9-90% of these illnesses, including elevated inflammatory cytokines, inflammation, leaky gut syndrome, and pathological microflora growth. Dysbiosis can be made worse by eating issues that are prevalent in ASD. B vitamins, such as cobalamin and folate, which are essential methyl donors for DNA epigenetic changes, are usually produced by a healthy gut microbiota. 50% of people with ASD have a vitamin B deficit. This work summarises research on the impact of gut microbiota on DNA methylation and B vitamin synthesis in ASD, as well as etiological variables connected to dysbiosis. Probiotics, postbiotics, and vitamin B therapies in kids with ASD should be investigated in future studies.

E-coaching for parents of children with autism spectrum disorder: Protocol for a randomized controlled trial

Autism spectrum disorder (ASD) is a neurodevelopmental condition that significantly affects children's development, posing a significant challenge in pediatric healthcare. Early parent-mediated interventions (PMIs) aim to improve a child's social communication skills through joint engagement in daily activities. However, widespread access to this type of intervention is heavily limited due to implementation barriers and logistical challenges. The use of technology may offer promising alternatives to reach more families. This randomized controlled trial will assess the efficacy of an innovative e-coaching program designed to provide parents of young children with ASD with effective strategies via an online learning platform combined with personalized debriefings. It will compare e-coaching to standard Pediatric Autism Communication Therapy and to the absence of a PMI, with all three arms combined with community assistance as usual, in a cohort of 99 families with preschool children with ASD. The primary outcome will be the quality of parent-child interaction, measured through behavioral assessments and simultaneous dual gaze recording with head-mounted eye-tracking during semi-structured standardized play sessions. Secondary outcomes will include the child's developmental level and parental well-being. If validated, e-coaching could be disseminated to reach more families and have a positive impact on their quality of life.

Understanding the link between autism and self-harm from a forensic lens

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication difficulties, restricted interests, and repetitive behaviors. Individuals with ASD, particularly females, are at an increased risk of self-injurious behavior (SIB), which can sometimes be misinterpreted as signs of physical abuse. This case report describes a 17-year-old female with ASD and ADHD and limited verbal language skills who presented to the emergency room with multiple skin lesions resembling second-degree burns, raising concerns of child abuse. Initial assessments by the emergency and dermatology teams were inconclusive, and plastic surgeons suggested the lesions were burns. However, forensic specialists noted inconsistencies with burn patterns, including the absence of blisters and redness around newer lesions. A review of the patient's psychiatric records revealed a history of repetitive self-harm, specifically aggressive scratching. Additional history from the family confirmed that the injuries were self-inflicted. Distinguishing between self-harming injuries and physical abuse in patients with ASD can be challenging, especially since both can coexist. This necessitates thorough assessment and experienced forensic consultation to avoid misdiagnosis, which can lead to significant legal and emotional consequences. To conclude, accurate diagnosis of self-harm versus abuse in patients with autism requires detailed investigation, consideration of psychiatric history, and forensic expertise. Moreover, early and correct diagnosis is crucial to prevent misattributed allegations of abuse and facilitate appropriate medical and psychiatric care for individuals with ASD.

Four-Fold Increase of the Number of Children Diagnosed With Paediatric Feeding Disorder in Northern Sweden in 2012-2022

AIM

The aim of this study was to investigate the annual prevalence and characteristics of Paediatric Feeding Disorder (PFD) in Västerbotten county, Sweden, during the years 2012-2022.

METHODS

In this retrospective study, medical records of patients attending paediatric clinics with possible feeding problems were identified by applying pre-defined diagnostic and procedure codes. Diagnostic criteria of PFD were verified. Additional data including nutritional status and enteral feeding tube placement were retrieved.

RESULTS

Annual prevalence of PFD increased from 1.2 (95% CI, 0.9-1.5) per 1000 children in 2012 to 5.0 (95% CI, 4.4-5.6) per 1000 children in 2022. In 2022, the prevalence in children < 5 years of age was 10.2 (95% CI, 8.7-12.0) per 1000. Of those, 28% had thinness grades 2 or 3 (moderate or severe thinness), and 31% were fed via nasogastric tube or gastrostomy.

CONCLUSION

Prevalence of PFD has increased in the last decade, most notably for children under the age of five. High rates of malnutrition and enteral feeding in our study population indicate that we identified only the most severe cases of PFD. Given the rising prevalence of PFD, further research on the condition is of high priority.

Food and Nutrition in Autistic Adults: Knowledge Gaps and Future Perspectives

Proper nutrition is a critical component in supporting the overall health and development of individuals with autism spectrum disorder (ASD) who experience eating difficulties associated with their autistic traits. Evidence regarding the prevalence, origins, and consequences of eating issues related to ASD is largely derived from studies on autistic children, while information pertaining to adults remains scarce. It is therefore essential to critically review existing research focusing on autistic adults to draw robust conclusions and identify clear research gaps. A computer-aided search in PubMed, Science Direct, Scopus, and Web of Science databases spanning the years 2013-2024 using the search terms covering ASD/Autism, Adult, Nutrition/Nutritional Status, and Diet yielded 43 full-text articles. In our literature review, we explored three critical aspects of nutrition in adults with ASD: their food preferences and sensory processing patterns, studies on nutritional status, and whether dietary and nutritional interventions have improved their adherence to healthier diets. Autistic adults appear to select food based on sensory perceptions. This selection pattern can affect their nutritional status, with a tendency toward overweight and nutritional deficiencies. The most promising intervention strategies incorporate sensory adaptation and structured meal planning. Further research should apply rigorous methodologies that account for this population's specific characteristics.

The association between intolerance of uncertainty and psychological burden among caregivers of children with autism and the impact on their quality of life

Introduction

Caregivers of children with Autism Spectrum Disorder (ASD) often face significant stressors, including financial strain, social stigma, emotional exhaustion, and unpredictable daily routines. These challenges can severely impact their quality of life (QoL). This study aimed to examine the relationship between intolerance of uncertainty, caregiver burden, and QoL among caregivers of children with autism.

Methods

A cross-sectional study was conducted with 59 caregivers from six branches of the Obour Company for Human Development in Riyadh. Data were collected electronically using a sociodemographic data sheet, the Intolerance of Uncertainty Scale, the Zarit Burden Interview (short form), and the World Health Organization Quality of Life Scale (brief form).

Results

Findings revealed that two-thirds of caregivers experienced high to moderate levels of intolerance to uncertainty and a moderate burden, while 13.6% reported a high burden. Nearly 60% of participants reported low overall QoL, particularly in the psychological and social domains. A significant positive correlation was found between intolerance of uncertainty and caregiver burden. Additionally, significant negative associations were observed between QoL scores and both intolerance of uncertainty and caregiver burden, except in the environmental domain. Intolerance of uncertainty emerged as a significant inverse predictor of overall QoL.

Discussion

These results emphasize the psychological toll of caregiving for children with ASD. Interventions such as family- and community-based support programs and child behavioral training are essential to reduce caregiver burden and enhance QoL. Tailored services should be prioritized in clinical practice to support caregivers more effectively.

Insights into healthcare services for youth with autism spectrum disorder transitioning to adulthood: a focus on rural Atlantic Canada

Individuals with neurodevelopmental disabilities, such as autism spectrum disorder (ASD) often require unique healthcare services. As adolescents age out of the pediatric health system, accessing appropriate healthcare becomes more challenging during the transition to adulthood. This challenge is amplified for individuals with ASD living in rural areas where access to healthcare services is limited. The aim of this qualitative study was to explore the experiences of stakeholders, including individuals with ASD, parents of individuals with ASD, and service providers, during the transition to adulthood in rural communities. MethodsWe recruited 26 individuals including 16 youth, 6 parents and 4 service providers through convenience and snowball sampling methods from Canadian Atlantic provinces. Semi-structured interviews were conducted, focusing on barriers and challenges encountered during the transition.ResultsThematic analysis was employed to identify patterns and themes within the data. Three central themes emerged from the data including transport to and from care, limited resources, and continuity of care.ConclusionThe findings underscore the significant challenges faced by individuals with ASD and their families during the transition to adulthood in rural areas. By understanding and addressing these challenges, stakeholders can work towards implementing informed policies to ensure equitable access to healthcare services for individuals with ASD transitioning to adulthood in rural areas.

Movement Behaviors in Youth on the Autism Spectrum: The HUNT Study, Norway

Research consistently show that autistic youth are less physically active compared to their neurotypical peers. However, there is limited understanding of how gender influences physical activity (PA) patterns among neurodiverse youth compared to the general population. This study aims to examine 24-hour movement behaviors - PA, sedentary behavior (SB), and sleep duration - among autistic youth (n = 71) in Norway, in comparison to peers with Attention-Deficit/Hyperactivity Disorder (ADHD) (n = 411) and the general youth population (n = 3805). The data is from the Young-HUNT4 study, linked with diagnostic information from the Norwegian Patient Registry. Variables explored are objective accelerometer-measured PA, SB, and sleep duration, self-reported participation in organized and unorganized physical activities, and screen activities. Results confirms that autistic youth engage in lower levels of moderate-to-vigorous PA, while demonstrating similar levels of light PA. They also spend more time sitting and comparable time sleeping. Autistic youth participate less in sport and were less likely to use commercial gyms. However, their participation in outdoor activities were similar to their peers. Regarding screen activities, autistic youth spent more time playing video games, while youth with ADHD were more engaged in social media. Among autistic youth, the only gender difference found was in video games. In conclusion, autistic youth are less physically active overall and spend significant time in SB. However, their comparable participation in light PA suggests opportunities for promoting further participation. Additionally, exergaming could offer a promising avenue to increase PA in this population.

Targeted metabolomics in children with autism spectrum disorder with and without developmental regression

Early diagnosis and intervention in children with autism spectrum disorder (ASD) is crucial. At present, diagnosis of ASD is primarily based on subjective tools. Identifying metabolic biomarkers will aid in early diagnosis of ASD complementing the assessment tools. The study aimed to conduct targeted metabolomic analysis and determine the plasma metabolites that can discriminate children with ASD from typically developing children (TD), and to determine the utility of machine learning in classifying ASD children based on the metabotypes. This was a multi-centric, analytical, case-control study conducted between April 2021-April 2023. Fasting plasma samples were obtained from seventy ASD and fifty-eight TD children, aged 2 to 12 years. Samples were quantitively analysed for 52 targeted metabolites (13 amino acids, 37 acylcarnitines, adenosine and 2-deoxyadenosine levels) using tandem mass spectrometry. An in-depth statistical analysis was performed. A total of 26 metabolites (11 amino acids, 14 acyl carnitines and adenosine) were found to be significantly (p < 0.005) different between ASD and TD children. Adenosine and amino acid levels were significantly decreased in ASD children. Among acyl carnitines, short- and long-chain acyl carnitine levels were significantly decreased, while medium-chain acyl carnitine levels were significantly increased in ASD children. Octenoylcarnitine-C8:1 (Cut-off value- 0.025 mmol/L, AUC- 0.683) and adenosine (Cut-off value- 0.025 mmol/L, AUC- 0.673) were found to predict children with ASD at a sensitivity of 55.7% and 57.1%, specificity of 79.3% and 72.4% respectively. Based on the metabolites, machine learning models like Support Vector Machine (SVM) and Random Forest (RF) were able to discriminate ASD from TD children with the classification accuracy score being highest in RF (79.487%, AUC- 0.800). Significant abnormalities in plasma metabolites were observed leading to disturbances in the Krebs cycle, urea cycle and fatty acid oxidation, suggesting mitochondrial dysfunction that may possibly contribute in the pathobiology of ASD. Octenoylcarnitine-C8:1 and Adenosine may serve as potential metabolic biomarkers for ASD.

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.

Assessment of Essential and Toxic Element Levels in the Toenails of Children with Autism Spectrum Disorder

Autism spectrum disorder (ASD) has become a global public health concern, impacting the quality of life. The question of gene-environment interaction in the emergence of ASD remains a subject of ongoing debate, and exploring its pathophysiology is thoroughly related to metals as a risk factor. Therefore, this study aims to assess the levels of toxic (Al, Cd, Hg, and Pb) and essential (Cr, Mn, Fe, Ni, Cu, Zn, and Se) elements in toenail samples collected in children with ASD and neurotypical children, by ICP-MS. Parallelly, we will discuss the use of toenails as an exposure indicator. The study involved 208 children aged 3 to 14 from Marrakech, Morocco. One hundred two were diagnosed with ASD and 106 were neurotypical children. Significant statistical differences in the concentration of Cr, Mn, and Fe were documented between the two groups. Higher levels of Pb in toenails compared to reference values have been reported. No association was established between concentrations of elements and age. Spearman correlation coefficients revealed a significantly different pattern of mutual dependence for toxic and essential elements between the two groups. The strongest positive correlations were found in the neurotypical group (Fe-Mn (ρ = 0.750), and Se-Zn (ρ = 0.800)). These results provide additional, although inconclusive, evidence on the probable role of element disturbance in the pathogenesis of ASD. Further studies should be performed to explore other nutritional, cultural, sociodemographic, environmental, and methodological factors that may impact the levels of these elements in the nails and their possible correlation with the incidence of ASD.

Atypical Developmental Patterns of Sensorimotor-Related Networks in Autism Spectrum Disorder: A BrainAGE Study Based on Resting-State fMRI

Autism spectrum disorder (ASD) is a type of neurodevelopmental disorder characterized by atypical brain development. Previous whole-brain BrainAGE studies have unveiled the presence of accelerated or delayed brain function developmental patterns in individuals with ASD. However, it remains unclear whether these patterns manifest at a global level throughout the entire brain or are specific to certain functional sub-networks. The study included resting-state functional magnetic resonance imaging (fMRI) data from 127 individuals with ASD and 135 healthy controls (aged between 5 and 40 years). ALFF maps were measured for each participant. Then, sub-network-level BrainAGE analyses were conducted across 10 sub-networks using the Individual-weighted Multilayer Perceptron Network (ILWMLP) regression method. The BrainAGE analyses revealed atypical developmental trajectories in sensorimotor-related sub-networks, encompassing auditory, motor, and sensorimotor sub-networks. In individuals with ASD, delayed brain function development was observed in the auditory and sensorimotor networks, with a more pronounced delay observed in older individuals. Conversely, the motor network exhibited accelerated development in younger individuals but delayed development in older individuals. Our findings unveiled aberrant developmental patterns in sensorimotor-related sub-networks among individuals with ASD, exhibiting distinct atypical profiles across different sub-networks. These results might contribute to a deeper understanding of the deviant brain development observed in 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.

Percutaneous endoscopic gastrostomy helped to normalise feeding problems and gastrointestinal symptoms in Silver-Russell syndrome

AIM

This study evaluated feeding problems and gastrointestinal symptoms in children with Silver-Russell syndrome (SRS), which is a rare epigenetic disorder. It also compared the symptoms experienced during different feeding methods, including percutaneous endoscopic gastrostomy (PEG).

METHODS

The national expert team for children with SRS at Queen Silvia Children's Hospital, Gothenburg, studied 46 referrals (63% male) who were born with SRS in Sweden from 1984 to 2018. Patient data were extracted from the Paediatric National Growth Hormone Registry.

RESULTS

The medical records covered a median of 68% of the time of the patients' childhood, with a median follow-up of 9 years. Their symptoms were most prevalent during infancy and decreased when they were toddlers. Feeding problems and gastrointestinal symptoms were reported in 91% of the 46 patients, with vomiting in 57% and constipation in 46%. There were 19 children who relied on enteral feeding for their nutrition and 13 of those received PEG. Their body mass index (BMI) increased significantly 2 years after PEG started (p = 0.005).

CONCLUSION

Feeding problems and gastrointestinal symptoms were very common in children with SRS, but partly disappeared during childhood. Providing treatment, such as PEG, normalised the BMIs of children with SRS and reduced their symptoms.

Mapping associations of polygenic scores with autistic and ADHD traits in a single city region

BACKGROUND

The genetic and environmental aetiology of autistic and Attention Deficit Hyperactivity Disorder (ADHD) traits is known to vary spatially, but does this translate into variation in the association of specific common genetic variants?

METHODS

We mapped associations between polygenic scores for autism and ADHD and their respective traits in the Avon Longitudinal Study of Parents and Children (N = 4,255-6,165) across the area surrounding Bristol, UK, and compared them to maps of environments associated with the prevalence of autism and ADHD.

RESULTS

Our results suggest genetic associations vary spatially, with consistent patterns for autistic traits across polygenic scores constructed at different p-value thresholds. Patterns for ADHD traits were more variable across thresholds. We found that the spatial distributions often correlated with known environmental influences.

CONCLUSIONS

These findings shed light on the factors that contribute to the complex interplay between the environment and genetic influences in autistic and ADHD traits.

Robust Autism Spectrum Disorder-Related Spatial Covariance Gray Matter Pattern Revealed With a Large-Scale Multi-Center Dataset

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder and its underlying neuroanatomical mechanisms still remain unclear. The scaled subprofile model of principal component analysis (SSM-PCA) is a data-driven multivariate technique for capturing stable disease-related spatial covariance pattern. Here, SSM-PCA is innovatively applied to obtain robust ASD-related gray matter volume pattern associated with clinical symptoms. We utilized T1-weighted structural MRI images (sMRI) of 576 subjects (288 ASDs and 288 typically developing (TD) controls) aged 7-29 years from the Autism Brain Imaging Data Exchange II (ABIDE II) dataset. These images were analyzed with SSM-PCA to identify the ASD-related spatial covariance pattern. Subsequently, we investigated the relationship between the pattern and clinical symptoms and verified its robustness. Then, the applicability of the pattern under different age stages were further explored. The results revealed that the ASD-related pattern primarily involves the thalamus, putamen, parahippocampus, orbitofrontal cortex, and cerebellum. The expression of this pattern correlated with Social Response Scale and Social Communication Questionnaire scores. Moreover, the ASD-related pattern was robust for the ABIDE I dataset. Regarding the applicability of the pattern for different age stages, the effect sizes of its expression in ASD were medium in the children and adults, while small in adolescents. This study identified a robust ASD-related pattern based on gray matter volume that is associated with social deficits. Our findings provide new insights into the neuroanatomical mechanisms of ASD and may facilitate its future intervention.

Personalizing AI tools for second language speaking: the role of gender and autistic traits

Introduction

It is important to consider individual differences in research on educational technology. This study investigates the interplay between autistic traits, gender, and the perception of artificial intelligence (AI) tools designed for second language (L2) speaking practice, contributing to a deeper understanding of inclusive educational technology.

Methods

A sample of 111 university students completed the Broad Autism Phenotype Questionnaire (BAPQ) to measure autistic traits (AU) and their sub-traits Aloof (AF), Rigid (RD), and Pragmatic Language (PL). Perceptions of AI tools were assessed across five dimensions: Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Attitude (AT), Behavioral Intention (BI), and Usage Behavior (UB). The study utilized correlation and regression analyses to examine relationships between these variables, while exploring gender-specific moderating effects.

Results

Key findings revealed no significant gender differences in autistic traits or overall perceptions of AI tools. Contrary to expectations, autistic traits were negatively correlated with perceptions of AI tools, suggesting that current AI designs may not adequately support individuals with pronounced autistic traits. Additionally, gender moderated some relationships, with males displaying stronger associations between autistic traits and both PEOU and UB.

Discussion

This research bridges critical gaps by linking neurodiversity and gender to technology acceptance, advancing the field's understanding of individual differences in AI-based language learning. It underscores the importance of designing personalized and adaptive educational tools that address diverse learner needs, promoting inclusivity and effectiveness in L2 practice.

Collaborative arts therapies as a supportive intervention for autism spectrum disorders: Bibliometric analysis, insights, and directions

Purpose

Arts therapies (ATs) for the treatment of autism spectrum disorders (ASD) has attracted widespread attention from scholars. However, resources, technical, and ethical issues still pose significant obstacles to current research. A collaborative design approach is needed to guide the intervention treatment process involving multiple stakeholders. Therefore, this study focuses on exploring the current status, development and potential value of the collaborative arts therapies (CATs), providing a comprehensive perspective for subsequent research.

Methods

The Web of Science, PubMed, ScienceDirect, and Cochrane Library were searched for publications up to August 30, 2023, related to the use of CATs for the treatment of ASD. CiteSpace was used to build a knowledge graph to achieve visual analysis of current research countries, institutions, journals, authors, and hot topics.

Results

A total of 845 articles met the inclusion criteria. In terms of quantity, the USA is the leading country which has the greatest influence in advancing the field. The University of Haifa is the most productive institution. Arteterapia Papeles De Arteterapia Y Educacion Artistica and Frontiers in Psychology occupy key publishing positions. The most central keywords were related to the quality of life of people with ASD. "family", "social robot" and "participation" are emerging topics in the research field. The positive impact of the combination of caregivers, technology and artistic media on enhancing connections between people with ASD and their everyday environment is the focus of current research.

Conclusions

Research on CATs as an adjunctive therapy for the treatment of ASD is evolving. Providing comprehensive rehabilitation and support intervention for patients with ASD is a key research direction. The research process requires more interdisciplinary resources and technical assistance. Collaboration will be the best way to improve the effectiveness of ATs.

A Serial Mediation Model of Resilience Among Caregivers of Children With Autism

IMPORTANCE

Resilience has been reported as a vital element against the high burden on caregivers of children with autism. However, the intricate mechanisms underlying the concurrent interplay of positive factors with resilience within this demographic group remain less understood.

OBJECTIVE

To construct a model to verify the sequential mediating influence of hope and gratitude in the relationship between perceived social support and resilience among caregivers of children with autism.

DESIGN

Cross-sectional study.

PARTICIPANTS

A total of 193 caregivers of children with autism in mainland China.

OUTCOMES AND MEASURES

Data were collected using the Herth Hope Index, C-GQ-6 Gratitude Questionnaire, Perceived Social Support Scale, and Resilience Questionnaire for Parents of Children With Special Needs. The hypothesized mediating model was tested with Process 4.0 (Model 6) for SPSS (Version 26.0).

RESULTS

The relationship of perceived social support and resilience was mediated by hope, gratitude, and the hope-gratitude sequence. Hope exhibited a stronger mediation effect, accounting for 26.23% of the total effect.

CONCLUSIONS AND RELEVANCE

The results indicated significant positive correlations between perceived social support, hope, gratitude, and resilience, with perceived social support strongly linked to the other three. This study has important implications for occupational therapy, suggesting strategies for resilience-focused interventions tailored to caregivers of children with autism.

PLAIN-LANGUAGE SUMMARY

Resilience is essential for caregivers of children with autism. Studies show that parents of children with autism report having fewer social supports, reduced quality of life, and heightened mental health challenges, including anxiety, depression, and hopelessness. This research highlights the connections between caregivers' perceived social support, hope, gratitude, and resilience. Addressing caregiver social supports and mental health can enhance caregiver well-being as well as children's participation in meaningful activities. The findings suggest practical implications and insights for occupational therapy practitioners to strengthen and foster caregiver resilience and well-being in the autism community.

tVNS alters inflammatory response in adult VPA-induced mouse model of autism: evidence for sexual dimorphism

Autism is a neurodevelopmental disorder with limited treatment alternatives and which incidence is increasing. Some research suggests that vagus nerve simulation might lead to the reduction of certain symptom. Therefore, we aimed to examine the effect of bilateral transcutaneous auricular vagus nerve stimulation (tVNS) on the inflammatory response in an adult valproic acid (VPA) induced mouse (C57BL6) model of autism for the first time. The autism model was induced by oral VPA administration (600 mg·kg-1) to C57BL/6 pregnant mice on E12.5 days. The study included three groups: the VPA Transcutaneous Auricular Stimulation Group (VPA + tVNS), the VPA Control Group (VPA + sham), and the Healthy Control Group (Control + sham). Each group included 16 mice (8 M/8 F). Our results show that serum IL-1β and IL-6 levels were significantly higher in male VPA-exposed mice than controls. However, IL-1β was significantly lower, and IL-6, TNF- α, and IL-22 were not different in female VPA-exposed mice compared to the control group. Brain NLRP3 levels were significantly higher in both sexes in the VPA autism model (P < 0.05). tVNS application increased brain NLRP3 levels in both sexes and reduced serum IL-1β levels in male mice. We conclude that cytokine dysregulation is associated with the VPA-induced adult autism model, and the inflammatory response is more pronounced in male mice. tVNS application altered the inflammatory response and increased brain NLPR3 levels in both sexes. Further studies are needed to understand the beneficial or detrimental role of the inflammatory response in autism and its sexual dimorphism.

Motor proficiency of persons with attention deficit hyperactivity disorder or autism spectrum disorder diagnosed in adulthood

PURPOSE

To compare (1) motor proficiency of persons diagnosed in adulthood with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) with normative values of motor proficiency, and (2) motor proficiency between persons with ADHD and those with ASD diagnosed in adulthood.

METHODS

A total of 153 adults (median age 32 years, 36% women) participated in this cross-sectional study. Fifty-three persons with predominately inattentive presentation (ADHD-I), 67 persons with combined presentation (ADHD-C), and 33 persons with ASD performed the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). One-sample binominal tests were used to compare motor proficiency against standardized norms of BOT-2 for young adults. One-way ANOVAs and Kruskal-Wallis tests were used to compare test outcomes between the groups.

RESULTS

The total sample showed significantly impaired motor proficiency in comparison to norms in all test domains (p < 0.001-0.006), except for fine motor skills. The ASD group showed significantly poorer body coordination compared with the ADHD-I and ADHD-C groups, with a moderate effect size (p = 0.003-0.02, η2 = 0.061).

CONCLUSIONS

Motor proficiency is impaired in most persons with ADHD or ASD diagnosed in adulthood, suggesting that motor assessment should be included in clinical examinations of adults with suspected neurodevelopment disorders.

An Exploratory Study on the Suicidal Behaviours of People With Intellectual Disability or Autism: Examining Their Understanding of Suicide and Death, and the Perceptions of Their Direct Support Staff

BACKGROUND

Individuals with intellectual disability or autism exhibit suicidal behaviours at an equal or greater rate than the general population, yet little is known about associated risk factors. This study explores suicidality in these populations, focusing on their understanding of suicide and death and perceptions of their direct support staff regarding their suicidality.

METHOD

Semi-structured interviews from 23 suicidal and non-suicidal participants and their support staff were analysed qualitatively to extract common themes and compare between groups.

RESULTS

A breadth of suicidal behaviours was documented. Generally, suicidal participants demonstrated a more elaborate understanding of suicide and death than non-suicidal participants. While staff often acknowledged never having discussed the topic with their client, most assumed they understood death accurately.

CONCLUSION

Results suggest interactions between conceptions of death and suicidal behaviour and a need for discussion around death and suicide in clinical settings. Implications for future research and clinical practice are discussed.

Characteristics and outcomes of the screening program of autism spectrum disorder in Primary Healthcare Centers in Bahrain

BACKGROUND

Autism spectrum disorder (ASD) is a chronic neurodevelopmental condition that requires early diagnosis and intervention for the improvement of the patient's skills and functioning. Several guidelines, therefore, recommend the screening of all children for ASD. This study determined the outcomes of ASD screening program in Primary Healthcare Centers (PHCs) in Bahrain.

MATERIALS AND METHODS

A cross-sectional study was conducted in 12 of the 27 PHCs in Bahrain. The Modified Checklist for Autism in Toddlers-Revised (MCHAT-R) was completed for children who attended the selected centers. Findings from the checklists and the outcome of positive screening cases were recorded. MCHAT-R scores of <3 were indicative of a low risk for ASD. Children with moderate and high MCHAT-R risk were referred for psychiatric assessment. SPSS version 25.0 was used for data analysis; mean and standard deviation were calculated for continuous variables, and categorical variables presented as frequency and percentage. Chi-square test or Fisher's exact test, as appropriate, used to test for statistical significance.

RESULTS

A total of 3729 MCHAT-R checklists of children with a mean age of 2 years were included. Most children were Bahraini (78.0%), half of whom were males (51.3%). While most of the children (98.8%) had a low-risk MCHAT-R score, 1.2% had a moderate-high risk MCHAT score (12.33/1000). Of the cohort, 19 cases (0.51%) had ASD, 5.10/1000 children. Nearly two-thirds of children with confirmed ASD were males ( 63.2%), and one-third were females (36.8%). In addition, 14 cases (41.2%) of those who had moderate-high MCHAT refused to follow the subsequent diagnostic protocol.

CONCLUSION

This study revealed a low prevalence of positive MCHAT-R screening and confirmed ASD cases. The vast majority of children who were positive on screening had a confirmed diagnosis of ASD. Some cases with positive MCHAT results failed to follow up for diagnosis. Therefore, improving parental and community awareness regarding ASD is important for a better outcome.

The Predictability of Stress Coping Strategies and Psychological Capital on the Psychological Well-Being of Autistic Spectrum Children's Mothers in the Kingdom of Saudi Arabia

There is an increasing number of studies concerned with the study of children with autism spectrum disorder (ASD). At the same time, there is a lack of interest in studies on their families, especially on mothers who represent the first breadwinner for a child who suffers from a deficit in social communication with others, reflected in their well-being (PWB). This study aimed to reveal the possibility of predicting the PWB of autistic spectrum children's mothers through the variables of coping strategies and psychological capital (PsyCap). The study used a predictive, descriptive research method to reveal the ability of the variables-coping strategies (problem-solving, avoidance, support, re-evaluation, remorse) and PsyCap (self-efficacy, optimism, hope, and resilience)-in predicting the PWB of autistic spectrum children's mothers. The study sample consisted of (248) mothers, to whom coping strategies, PsyCap, and PWB measures were applied. The results showed that there were statistically significant differences between working and housewife mothers of autistic spectrum children in solving problems (t = 3.162, p < 0.002), avoidance (t = 1.973, p < 0.05), positive coping (t = 2.307, p < 0.022), self-efficacy (t = 3.667, p < 0.000), resilience (t = 3.338, p < 0.001), PsyCap (t = 2.866, p < 0.005), and PWB (t = 2.549, p < 0.011). Meanwhile, there were no statistically significant differences in social support, problem reassessment, remorse, negative coping, optimism, and hope. Also, there were no statistically significant differences due to the number of children in coping strategies, PsyCap, and PWB. The results also showed that there were statistically significant differences at the level of significance (0.05) between mothers whose age was less than 40 years and those 40 years and older in solving problems (t = 2.093, p < 0.037) in favor of mothers of the age group 40 years and older (M = 22.00, SD = 1.22), and avoidance (t = 1.987, p < 0.048) in favor of mothers under 40 years of age (M = 6.228, SD = 0.464). However, there were no statistically significant differences in social support, problem reassessment, remorse, positive coping, negative coping, self-efficacy, optimism, hope, resilience, the total degree of PsyCap, and well-being due to the variable of the mother's age. The regression analysis results showed that optimism and problem-solving contributed to (39.90%) of the total change in PWB for mothers of children with autism spectrum. The study's findings indicate the need to develop the ability of autistic spectrum children's mothers to solve problems and their PsyCap, which is represented in self-efficacy, optimism, hope, and resilience, to enhance their PWB, which may have a positive impact on their autistic spectrum child.

Autism diagnoses in school-age children in southern Trøndelag 2016-2019

Background

We have previously reported a significantly higher prevalence of autism spectrum disorders in southern Trøndelag among preschool children with mothers from a different national background than Norway. In this study, we wanted to investigate whether, in the same period and in the same geographic area, there was also an excess prevalence among school-age children. Additionally, we wanted to identify psychiatric and developmental comorbidities.

Material and method

We carried out a retrospective review of the medical records of children between 10 and 16 years of age who had been diagnosed with autism in the period 2016-19.

Results

Out of a sample of 125 children, 18 had mothers with a different national background. This gave an incidence rate of 0.18 %, against 0.12 % for children with mothers born in Norway (relative risk 1.5; 95 % confidence interval 0.87 to 2.50, p = 0.11). A total of 74 children had been diagnosed with at least one other developmental disorder or psychiatric condition, most commonly ADHD, before they received the autism diagnosis. In four children, the autism spectrum disorder was accompanied by an intellectual disability.

Interpretation

Maternal national background appears to be a less significant factor among school-age children than among preschool children who receive an autism spectrum diagnosis, and age at the time of diagnosis should be specified in studies on autism in children and adolescents. Psychiatric comorbidity and other accompanying developmental disorders may suggest shared aetiological factors or increased vulnerability in cases of undiagnosed autism in children.

Autism Prevalence Information And Diagnosis Processes In Cyprus, Greece And Malta

The current paper follows the thematic review 'Autism spectrum disorders without borders: prevalence and diagnosis across the globe' aiming to highlight and familiarize readers with the challenges and heterogeneity related to the prevalence, and diagnostic processes of Autism Spectrum Disorders (ASD) from a cross-cultural and diverse geopolitical framework with a focus on Cyprus, Malta, and Greece. The study's goal was twofold: (a) to document the prevalence and diagnostic processes in the aforementioned geographical areas and (b) to highlight similarities and differences in the prevalence and diagnostic process in ASD. The findings revealed similarities across all countries regarding the diagnostic tools implemented in ASD assessment tools and clinical observations. Some differences were observed in documenting prevalence rates due to methodological heterogeneity in the documentation procedures. Although preliminary, the current findings underscore the importance of research-driven investigations that can lead to larger-scale programs necessary for establishing policy-making and stakeholders' involvement.

Evaluation of an interprofessional collaborative practice training module for the management of children with autism spectrum disorder

Background

Protocols instituted for behavioral treatment and skills training programs for the management of autism spectrum disorder (ASD) suffer from lack of collaborative approaches. The tenets of interprofessional collaborative practice (IPCP) focus on preparing a panel of health care professionals (HCPs) from different professions who can work together to enable the common goal of ensuring that children with ASD can participate in society. This study was designed to pilot this approach through an IPCP training module on ASD for care providers from multiple professions.

Methods

An interventional study with pre-post analysis began with formation of the interprofessional (IP) team, who developed an IPCP module, addressing the knowledge and skills needed for the collaborative management of neurodevelopmental issues of children with ASD. This module was delivered through an online training workshop using various teaching learning methods to the participants from seven different health professions after obtaining informed consent. Perceptions of interprofessional collaboration and competencies of IPCP were assessed using standard IP tools and reflective summaries and analyzed through a mixed-methods approach.

Results

A total of 42 HCPs from seven professions, including speech and hearing, occupational therapy, clinical psychology, physiotherapy, pediatrics, nursing, and pedodontics, participated in the study. Pre-post analysis of PINCOM-Q and Dow-IPEC data and thematic analysis revealed a significant difference in the perceptions of interprofessional collaboration and competencies' levels of IPCP.

Conclusion

This study suggests that use of IPCP principles in the training of professionals working with ASD is a promising and feasible option to develop more competent health professionals. The training enhanced the abilities of professionals to work in field of ASD as conveyed by the participants. They also expressed confidence in the knowledge of IP core competencies after the completion of the module.

The epithelial barrier theory and its associated diseases

The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation.

Association between prenatal air pollutant exposure and autism spectrum disorders in young children: A matched case-control study in Canada

The direction and magnitude of association between maternal exposure to ambient air pollutants across gestational windows and offspring risk of autism spectrum disorders (ASD) remains unclear. We sought to evaluate the time-varying effects of prenatal air pollutant exposure on ASD. We conducted a matched case-control study of singleton term children born in Ontario, Canada from 1-Apr-2012 to 31-Dec-2016. Provincial birth registry data were linked with applied behavioural analysis services and ambient air pollutant datasets to ascertain prenatal exposure to nitrogen dioxide (NO2), ground-level ozone (O3), fine particulate matter (PM2.5), and ASD diagnoses. Covariate balance between cases and controls was established using coarsened exact matching. Conditional logistic regression was used to assess the association between prenatal air pollutant exposure and ASD. Distributed lag non-linear models (DLNM) were used to examine the effects of single-pollutant exposure by prenatal week. Sensitivity analyses were conducted to assess the impact of exposure period on the observed findings. The final sample included 1589 ASD cases and 7563 controls. Compared to controls, cases were more likely to be born to mothers living in urban areas, delivered by Caesarean section, and assigned male sex at birth. NO2 was a consistent and significant contributor to ASD risk after accounting for co-exposure to O3, PM2.5 and covariates. The odds ratio per interquartile range increase was 2.1 (95%CI 1.8-2.3) pre-conception, 2.2 (2.0-2.5) for the 1st trimester, 2.2 (1.9-2.5) for the 2nd trimester, and 2.1 (1.9-2.4) for the 3rd trimester. In contrast, findings for O3 and PM2.5 with ASD were inconsistent. Findings from DLNM and sensitivity analyses were similar. Exposure to NO2 before and during pregnancy was significantly associated with ASD in offspring. The relationship between prenatal O3 and PM2.5 exposure and ASD remains unclear. Further investigation into the combined effects of multi-pollutant exposure on child neurodevelopment is warranted.

Challenges of Alternative Teaching-Learning Faced by Indian Parents of People with Autism Spectrum Disorder During Pandemic Emergency

The COVID-19 pandemic stretched between 2020 and 2021 and witnessed impactful changes in the education system inclusive of the special education sector. The special education sector selected online teaching-learning to continue the studies of their students with the help of the parents. The study aimed to find out the challenges faced by parents of people with autism enrolled in special schools who attended online classes along with their children and supported their teaching-learning. The mixed method study (sequential explanatory design) opted for quantitative phases followed by a qualitative phase for further in-depth exploration of the focus area. The quantitative phase consists of 100 participant parents and the qualitative phase consists of 15 participant parents recruited from phase one of the study through purposive sampling based on the inclusion and exclusion criteria. The data were collected via web forms and online interviews were recorded. The univariate analysis was used for the quantitative phase whereas thematic analysis was used for the qualitative phase. The parents had to manage office work, childcare, assisting in online classes, handling the psychological and behavioral issues of the child. Even challenges like learning new technology, managing additional expenses and personal stress were reported. The enormous efforts of the parents helped to overcome many of the challenges and achieve positive learning outcomes. Nevertheless, some recommendations like arrangement of parental workshops, increase in tech education and occasional hybrid mode of learning is suggested.

Assessing visual motor performance in autistic children based on Kinect and fNIRS: A case study

In recent years, the incidence rate of children with autism has shown a significant upward trend. Rehabilitation training is an important part of recovery or improvement in autism children. However, during autism rehabilitation training, the methods that can visually reflect and objectively evaluate its effects are seldom considered. Therefore, this study aimed to objectively evaluate the rehabilitation impact of visual-motor skills training in children with autism via quantitative measures. In this study, vision sensors and functional near-infrared spectroscopy were used to monitor and analyze visual motor training task of 20 autism children. These children were divided into high- and low-score groups according to the autism behavior checklist (ABC). Results showed significant differences between the high- and low-score groups in the brain regions of the left and right temporal lobe, right motor cortex, and left occipital lobe; the difference in functional connectivity was greatest when the left hand was moving at the green light (p < 0.05). The differences in speed, acceleration, and angle between the high- and low-score groups were mainly reflected in left-hand movement. Moreover, analysis of multimodal data showed that visual motor training had a positive effect on brain activation and functional connectivity, and increasing the frequency of left-hand training and using more green light were beneficial to the improvement of brain function. These findings can be used as basis to help optimize rehabilitation programs and improve rehabilitation effectiveness.

Validation of the autism behavior checklist in Egyptian children with autism spectrum disorder

This study was designed to validate the Arabic version of the Autism Behavior Checklist (ABC) for the Egyptian population. A total of 500 mothers of children aged 4-14 years, of whom 150 had a diagnosis of ASD, 100 with intellectual disability, and 250 typically developing children completed the ABC. The factor analysis showed that 48 of 57 ABC items yielded a five-dimensional factor structure. The ABC-Arabic version indicated acceptable internal consistency (α = 0.85) and test - retest reliability (0.82). Also, the ABC exhibited good concurrent validity and discriminative validity. A cutoff score of 58 obtained a sensitivity of 94.7% and a specificity of 92.14% for detecting children with ASD. Our findings support the use of the ABC as a valid screening measure for ASD cases, and it may promote the use of the ABC for clinical and research purposes among Arabic-speaking communities.

Acquisition Time for Resting-State HbO/Hb Coupling Measured by Functional Near-Infrared Spectroscopy in Assessing Autism

Functional near-infrared spectroscopy was used to record spontaneous hemodynamic fluctuations form the bilateral temporal lobes in 25 children with autism spectrum disorder (ASD) and 22 typically developing (TD) children. The coupling between oxygenated hemoglobin (HbO) and deoxygenated hemoglobin (Hb) was calculated by Pearson correlation coefficient, showing significant difference between ASD and TD, thus the coupling could be a characteristic feature for ASD. To evaluate the discrimination ability of the feature obtained in different acquisition times, the receiver operating characteristic curve (ROC) was constructed and the area under curve (AUC) was calculated. The results showed AUC > 0.8 when the time duration was longer than 1.5 min, but longer than 4 min, AUC value (~0.87) hardly varied, implying the maximal discrimination ability reached. This study demonstrated the coupling could be one of characteristic features for ASD even acquired in a short measurement time.

An Analysis of the Time Required for the Diagnosis of ASD and the Factors Influencing Its Duration in a Sample of the Pediatric Population from Poland

Background/Objectives: Early diagnosis of autism spectrum disorder (ASD) is a very important factor for improving the quality of life of people on the spectrum, but it still remains a major problem in Europe, especially concerning girls. In this study, we tried to answer the question of what factors affect the age of diagnosis in Poland. Additionally, we tried to establish the time between the first visit to the mental health center (MHC) and the diagnosis in this population, and what factors affect its length. Methods: 77 children were randomly recruited among the patients who came to local MHC at the Child and Family Health Centre in Sosnowiec. All participants were tested using the ADOS-2 protocol. In addition, the study used the TAS-20 test and BDI. Results: The mean age of the first enrollment in the MHC was 9.09 years for girls and 6.42 for the boys. The time needed to obtain a diagnosis from the first visit was consecutively 2.90 years and 4.29 years, but the difference was not statistically significant (p > 0.05). Obtaining a different psychiatric diagnosis did not affect the average time to diagnosis and the age of diagnosis. Conclusions: The results of the study indicate that the diagnosis of ASD is still a significant problem both in Poland and in the world. Obtaining an accurate diagnosis requires significant time, and it frequently involves consulting multiple specialists. The diagnostic process should be flexible, and the specialist should always take into account the axial symptoms but remain aware that the "overdiagnosis" of ASD can also have harmful consequences for the child.

The Experiences of Motor Skill Development in Children with Autism Spectrum Disorder (ASD) Reflected through Parental Responses

Background/Objectives: Understanding movement development in children with autism spectrum disorder (ASD) is critical for creating effective intervention strategies. This study aims to explore parental perspectives on the movement development of children with ASD, focusing on identifying common challenges and successful strategies. The objective is to analyze the experiences of parents to highlight the most effective approaches to support motor, communication, and social skills development in these children. Methods: Using a qualitative approach, we conducted in-depth interviews with parents of children with ASD. The data were analyzed using open and selective coding to identify key themes related to movement development challenges and strategies. The analysis included cross-referencing with the existing literature to support parental insights. Results: This study identified several key themes, including communication barriers, social interaction difficulties, and the importance of personalized movement programs. Parents reported significant challenges in understanding and addressing their children's movement needs, particularly in group settings. However, activities such as water programs, music and dance, and animal-assisted therapies were found to be highly engaging. Motivation was a critical factor, with rewards and active parental involvement enhancing participation. Conclusions: This study highlights the crucial role of a supportive environment, including professional guidance and family support, in the success of movement development programs.

Targeting the circadian modulation: novel therapeutic approaches in the management of ASD

Circadian dysfunction is prevalent in neurodevelopmental disorders, particularly in autism spectrum disorder (ASD). A plethora of empirical studies demonstrate a strong correlation between ASD and circadian disruption, suggesting that modulation of circadian rhythms and the clocks could yield satisfactory advancements. Research indicates that circadian dysfunction associated with abnormal neurodevelopmental phenotypes in ASD individuals, potentially contribute to synapse plasticity disruption. Therefore, targeting circadian rhythms may emerge as a key therapeutic approach. In this study, we did a brief review of the mammalian circadian clock, and the correlation between the circadian mechanism and the pathology of ASD at multiple levels. In addition, we highlight that circadian is the target or modulator to participate in the therapeutic approaches in the management of ASD, such as phototherapy, melatonin, modulating circadian components, natural compounds, and chronotherapies. A deep understanding of the circadian clock's regulatory role in the neurodevelopmental phenotypes in ASD may inspire novel strategies for improving ASD treatment.

Associations between antagonistic SNPs for neuropsychiatric disorders and human brain structure

A previously published genome-wide association study (GWAS) meta-analysis across eight neuropsychiatric disorders identified antagonistic single-nucleotide polymorphisms (SNPs) at eleven genomic loci where the same allele was protective against one neuropsychiatric disorder and increased the risk for another. Until now, these antagonistic SNPs have not been further investigated regarding their link to brain structural phenotypes. Here, we explored their associations with cortical surface area and cortical thickness (in 34 brain regions and one global measure each) as well as the volumes of eight subcortical structures using summary statistics of large-scale GWAS of brain structural phenotypes. We assessed if significantly associated brain structural phenotypes were previously reported to be associated with major neuropsychiatric disorders in large-scale case-control imaging studies by the ENIGMA consortium. We further characterized the effects of the antagonistic SNPs on gene expression in brain tissue and their association with additional cognitive and behavioral phenotypes, and performed an exploratory voxel-based whole-brain analysis in the FOR2107 study (n = 754 patients with major depressive disorder and n = 847 controls). We found that eight antagonistic SNPs were significantly associated with brain structural phenotypes in regions such as anterior parts of the cingulate cortex, the insula, and the superior temporal gyrus. Case-control differences in implicated brain structural phenotypes have previously been reported for bipolar disorder, major depressive disorder, and schizophrenia. In addition, antagonistic SNPs were associated with gene expression changes in brain tissue and linked to several cognitive-behavioral traits. In our exploratory whole-brain analysis, we observed significant associations of gray matter volume in the left superior temporal pole and left superior parietal region with the variants rs301805 and rs1933802, respectively. Our results suggest that multiple antagonistic SNPs for neuropsychiatric disorders are linked to brain structural phenotypes. However, to further elucidate these findings, future case-control genomic imaging studies are required.

Oral health status of children with autism spectrum disorder in KSA: A systematic review and meta-analysis

Background

Individuals with autism spectrum disorder (ASD) often face challenges in maintaining good oral health, because of factors including sensory sensitivities, communication difficulties, and microbial imbalances in the oral cavity. Despite growing awareness of ASD, both in Kingdom of Saudi Arabia (KSA) and globally, no systematic review has comprehensively assessed the effects of ASD on oral health status in KSA.

Objective

This study was aimed at assessing whether the oral health of individuals with ASD in KSA might differ from that of neurotypical individuals, on the basis of a systematic review framework.

Materials and methods

According to the Participants, Exposure, Comparison, and Outcome (PICO) framework, a systematic search of electronic databases was conducted, and screening was independently performed by two reviewers. Conflicts were resolved through discussion. Data on study characteristics and oral health findings were independently extracted by the two reviewers. The risk of bias was assessed with the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

Results

Of 763 initially identified articles, 14 met the inclusion criteria. These studies indicated that children with ASD have a higher prevalence of dental caries, greater gingival inflammation, and a greater risk of dental trauma than their neurotypical peers. Parents of children with ASD showed elevated concern regarding their children's oral health.

Conclusion

Training dental professionals to manage patients with ASD is essential. Further research with larger sample sizes and rigorous methods is necessary to enhance understanding of the relationship between ASD and oral health outcomes in KSA.

Demographic and autism characteristics as predictors of age of autism diagnosis of individuals with autism in Paraguay

LAY ABSTRACT

Autism is a lifelong condition characterized by repetitive behaviors and social communication differences. The reported cases of autism increased globally in the past years. Detecting autism early and providing appropriate supports promptly are crucial for better outcomes. Yet, little research focuses on what factors interplay in the diagnostic process of autistic children in Paraguay. We gathered data from 176 caregivers of autistic children under 18 years in Paraguay. Through a detailed analysis, we found that child's age, child's age at the caregiver's first concerns about their development, and the child's verbal skills are key in predicting the age of autism diagnosis in Paraguay. Educating caregivers and professionals about autism and social communication development can help identify autism early and provide timely support.

Groups and Subgroups in Autism Spectrum Disorder (ASD) Considering an Advanced Integrative Model (AIM)

BACKGROUND

Autism spectrum disorder (ASD) is related to social communication difficulties, repetitive behaviors, and highly restricted interests beginning early in life. Currently, ASD is more diagnosed than in the past, and new models are needed. The Advanced Integrative Model (AIM) is a new model in which genes and concomitant medical problems to diagnosis (CMPD) and the impact of their rigorous and adequate treatment are considered.

METHODS

The role of a dynamic encephalopathy from which the individual response, susceptibilities in the brain and outside the brain, gut barrier and brain-blood-barrier permeabilities, and the plastic nature of the brain is proposed as a tool for diagnosis. The concomitant medical problems (CMP) are those at and outside the brain. The individual response to treatments of CMP is analyzed.

RESULTS

The AIM allows for classification into 3 main groups and 24 subgroups.

CONCLUSIONS

The groups and subgroups in ASD are obtained taking into account CMPD treatments and individual response.

The complex interplay between autism spectrum disorder and gut microbiota in children: A comprehensive review

Autism spectrum disorder (ASD) is characterized by defects in social communication and interaction along with restricted interests and/or repetitive behavior. Children with ASD often also experience gastrointestinal (GI) problems in fact incidence of GI problems in ASD is estimated up to 80 percent. Intestinal microbiota, which is a collection of trillions of microorganisms both beneficial and potentially harmful bacteria living inside the gut, has been considered one of the key elements of gut disorders. The goal of this review is to explore potential link between gut microbiota and ASD in children, based on the recently available data. This review discusses recent advances in this rapidly expanding area of neurodevelopmental disorders, which focuses on what is known about the changes in composition of gut bacteria in children with ASD, exploration of possible mechanisms via which gut microbiota might influence the brain and thus lead to appearance of ASD symptoms, as well as potential treatments that involve modulation of gut flora to improve symptoms in children with ASD, i.e., probiotics, postbiotics or changes in the diet. Of course, it's important to keep in mind inherent difficulties in proving of existence of causal relationships between gut bacteria and ASD. There are significant gaps in understanding of the mechanism of gut-brain axis and the mechanisms that underlie ASD. Standardized approaches for research in this area are needed. This review would provide an overview of this exciting emerging field of research.

AOP-based framework for predicting the joint action mode of di-(2-ethylhexyl) phthalate and bisphenol A co-exposure on autism spectrum disorder

Autism spectrum disorder (ASD), also known as autism, is a common, highly hereditary and heterogeneous neurodevelopmental disorder. The global prevalence of ASD among children continues to rise significantly, which is partially attributed to environmental pollution. It has been reported that pre- or post-natal exposure to di-(2-ethylhexyl) phthalate (DEHP) or bisphenol A (BPA), two prevalent environmental endocrine disruptors, increases the risk of ASD in offspring. Yet, the joint action mode linking DEHP and BPA with ASD is incompletely understood. This study aims to unravel the joint action mode of DEHP and BPA co-exposure on the development of ASD. An adverse outcome pathway (AOP) framework was employed to integrate data from multiple public database and construct chemical-gene-phenotype-disease networks (CGPDN) for DEHP- and BPA-related ASD. Topological analysis and comprehensive literature exploration of the CGPDN were performed to build the AOP. By analysis of shared key events (KEs) or phenotypes within the AOP or the CGPDN, we uncovered two AOPs, decreased N-methyl-D-aspartate receptor (NMDAR) and estrogen antagonism that were likely linked to ASD, both with moderate confidence. Our analysis further predicted that the joint action mode of DEHP and BPA related ASD was possibly an additive or synergistic action. Thus, we propose that the co-exposure to BPA and DEHP perhaps additively or synergistically increases the risk of ASD.

Critical period of exposure to mercury and the diagnostic of autism spectrum disorder: A systematic review

Autism spectrum disorder (ASD) is characterized by repetitive behaviors and deficits in social interaction. Its etiology is not completely clear, but both genetic and environmental factors contribute to and influence its development and course. The increased number of autism cases in recent years has been strongly associated with increased exposure to heavy metals. Mercury (Hg) has gained prominence in the scientific literature as a result of its presence as an urban pollutant and well-described neurotoxicity. This review assessed the relationship between Hg exposure in the pre- and post-natal period and ASD. The systematic review identified observational clinical studies and pre-clinical trials in journals indexed in the PubMed, Embase, ProQuest, and LILACS databases. The aim of this study was to investigate the association between exposure to Hg and ASD and to define the critical period of exposure. A total of 57 articles were selected for this review, with 35 articles (61.40%) identifying a positive association between ASD and Hg, while 22 articles (38.60%) did not find the same outcome. The biological samples most used to analyze Hg body burdens were hair (36.84%) and blood (36.84%). Most case-control studies found an increase in Hg levels in individuals with ASD who were exposed to a polluted environment in the post-natal period. Taken together, the studies suggest that these patients have a deficient detoxification system, and this could worsen the symptoms of the disorder. However, new studies addressing the influence of Hg on the post-natal nervous system and its relationship with ASD should be carried out.

The contribution of environmental pollutants to the risk of autism and other neurodevelopmental disorders: A systematic review of case-control studies

Exposure to environmental pollutants, such as metals, pesticides, and air pollutants during early life, is a risk factor for neurodevelopmental disorders (NDDs), including Autism Spectrum Disorder (ASD). Our systematic review aimed to select and summarize more recent case-control studies that examined the association between prenatal and early postnatal exposure to environmental pollutants and NDDs. We searched five databases (Web of Science, PubMed, Embase, Scopus, Ovid), screened 2261 records, and included 24 eligible case-control studies. Meta-analyses were conducted on subgroups of at least three studies that shared both the outcome and the exposure. A noteworthy discovery from this literature review is the existence of non-linear or non-monotonic dose-response relationships between the exposure to certain metals and the risk of ASD. The meta-analysis revealed a significant association between exposure to particular matter (PM)10 during the first year of life and the risk of ASD. Overall, studies included in our systematic review indicate that exposure to several pollutants within the first three years of life was significantly associated with the risk of NDDs.

Prenatal Diabetes and Obesity: Implications for Autism Spectrum Disorders in Offspring - A Comprehensive Review

Fetal brain development is an important determinant of neuropsychological performance in children. Any alterations in the intrauterine environment at different stages of pregnancy, such as maternal metabolic disorders, can lead to the development of chronic conditions in the offspring. Therefore, maternal diabetes, especially gestational diabetes mellitus, is an important factor in the development of pathological changes, such as miscarriage, fetal macrosomia, or neurodevelopmental disorders. During pregnancy, the hyperglycemic intrauterine environment adversely affects fetal brain development. A growing body of scientific research indicates that prenatal environmental factors, by affecting fetal brain development, can contribute to the appearance of autism spectrum disorders. According to the latest estimates from the International Diabetes Federation (2021), approximately 21.1 million live births worldwide (16.7%) have been affected by some form of hyperglycemia during pregnancy. The condition is more prevalent in low- and middle-income countries, where access to obstetric care is limited. The following factors have been identified as potential risk factors for gestational diabetes: advanced maternal age, overweight and obesity, family history of diabetes, and any form of diabetes. The purpose of this review is to summarize recent studies evaluating the effect of prenatal and maternal risk factors such as maternal pre-pregnancy diabetes, gestational diabetes, and obesity on the risk of developing autism spectrum disorder in offspring.

Decomposition of phenotypic heterogeneity in autism reveals distinct and coherent genetic programs

Unraveling the phenotypic and genetic complexity of autism is extremely challenging yet critical for understanding the biology, inheritance, trajectory, and clinical manifestations of the many forms of the condition. Here, we leveraged broad phenotypic data from a large cohort with matched genetics to characterize classes of autism and their patterns of core, associated, and co-occurring traits, ultimately demonstrating that phenotypic patterns are associated with distinct genetic and molecular programs. We used a generative mixture modeling approach to identify robust, clinically-relevant classes of autism which we validate and replicate in a large independent cohort. We link the phenotypic findings to distinct patterns of de novo and inherited variation which emerge from the deconvolution of these genetic signals, and demonstrate that class-specific common variant scores strongly align with clinical outcomes. We further provide insights into the distinct biological pathways and processes disrupted by the sets of mutations in each class. Remarkably, we discover class-specific differences in the developmental timing of genes that are dysregulated, and these temporal patterns correspond to clinical milestone and outcome differences between the classes. These analyses embrace the phenotypic complexity of children with autism, unraveling genetic and molecular programs underlying their heterogeneity and suggesting specific biological dysregulation patterns and mechanistic hypotheses.