ABSTRACT

The potential etiological and diagnostic values of the gut microbiota in children with neurodevelopmental disorders are encouraging but controversial. In particular, the composition and characteristics of the gut microbiota in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) remain largely unidentified. Herein, we analyzed stool samples from 113 participants with a clinical diagnosis of ASD, 43 with ADHD, 8 with both ASD and ADHD, and 120 healthy controls between 2 and 11 years of age using 16S rRNA sequencing. We observed that clinical diagnosis, age, comorbidities, food sensitivities, and antibiotic use significantly affected the gut microbiota. The enriched genera in the control group were relatively common and dominant human gut bacteria, such as Bacteroides, Faecalibacterium, and Roseburia. The genera present in children with neurodevelopmental disorders showed greater heterogeneity, and the abundance of Bifidobacterium was consistently increased. We found 4899 deregulated microbial metabolic functions and revealed the formation of a divergent genus-level network in patients. This analysis demonstrated that the gut microbial signatures efficiently discriminated patients from healthy participants in both the discovery (area under the curve [AUC]: 0.95–0.98) and validation (AUC: 0.69–0.74) sets. Importantly, although ASD and ADHD share several gut microbial characteristics, specific bacteria that contribute to the disease pathogenesis may have different metabolic functions.

ABSTRACT

In an effort to reduce the “waitlist crisis,” researchers have developed training programs to educate community-based clinicians in best-practice autism diagnostic assessments. This systematic review aims to synthesize the effectiveness and implementation outcomes of such trainings. The following databases were searched from inception until August 2023: PubMed, Web of Science, APA PsycINFO, CINAHL, ERIC, and a select number from Google Scholar. Ten studies were included in the present review because they met the following criteria: development and/or evaluation of a training for practicing community-based clinicians to diagnose autism, published full-text in English, and original research. Risk of bias was assessed through an adapted NIH quality assessment tool. Only seven distinct training programs in autism diagnosis for practicing community-based clinicians were identified. Trainings demonstrated preliminary efficacy in the improvement of clinician knowledge, self-efficacy, practice behavior, and diagnostic accuracy. Many of the trainings had a reported positive impact on the community and were feasible to participate in; however, systems-level factors (e.g., time and reimbursement) remain as barriers to community-based diagnosis. Findings from the present review position clinician training as a promising strategy to increase families' timely access to an autism diagnosis. More research on training models is needed due to both the limited number of trainings and the limited reported effectiveness and implementation outcomes. Future implementation studies are also needed to reduce systems-level barriers and to aid in the determination of what trainings best fit the needs of different contexts.

ABSTRACT

The aim of this study was to investigate differences in mu-wave modulation in individuals diagnosed with autism spectrum disorder (ASD) without intellectual disabilities compared to a group of neurotypical controls (NT). Thirty autistic individuals and 30 NT underwent an EEG recording while watching short videos depicting goal-oriented action filmed from a fixed position, zooming in on the scene, and approaching the scene by means of a steadycam. Then, participants underwent a rating task to evaluate their subjective viewing experience. We found that steadycam videos elicited enhanced event-related desynchronization (ERD), suggestive of enhanced neural activity, in the NT group, and a reduced ERD in the autistic group, compared to the other filming conditions. Autistic participants also showed difficulties in returning to baseline mu-power levels after watching videos filmed from a fixed position. Finally, NT reported feeling more comfortable watching videos with movement, whereas autistic participants did not exhibit differences between conditions. We speculated that static, less naturalistic stimuli might impose higher and prolonged cognitive demands on autistic individuals. Understanding these differences might help develop tailored interventions to support perceptual, cognitive, and social processes of autistic people.

ABSTRACT

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.

ABSTRACT

This study explored waiting times and the factors influencing them in child and adult populations undergoing assessment for autism, ADHD, and other neurodevelopmental differences. The analysis focused on a retrospective review of 408 cases with assessments completed between October 2021 and May 2022, conducted by 30 diagnosing teams in Scotland. Data included age, final diagnosis, demographics, medical and developmental history, contact frequency, and assessment service adherence to best-practice standards. Waiting times were calculated, and relationships were analyzed using linear regression. Median waiting times were 525 days (IQR 329–857) for children/adolescents and 252 days (IQR 106–611) for adults. Only 20% of children's and 47% of adult assessments met the proposed 252-day diagnostic time target. Autism and ADHD were the most common diagnoses. Receiving > 1 neurodevelopmental diagnosis on completion was uncommon. Demographic factors did not significantly affect waiting times. Children/adolescents with more complex developmental and medical histories experienced longer waits (100.3 weeks vs. 67.7 weeks; p < 0.001), while adults with similar histories had shorter waits (32.7 weeks vs. 57.4 weeks; p = 0.016). Adults with ADHD experienced longer waits than autistic adults (63.4 weeks vs. 38.6 weeks, p = 0.002). Adherence to best-practice quality standards was associated with shorter waits for children (β = 0.27, p = 0.002), but the relationship between standard adherence at different stages and for adults was less clear. More frequent appointments correlated with shorter adult waits (33.7 weeks vs. 59.2 weeks, p = 0.015). Gender distribution was balanced among adults, but children's services included more boys. The study highlights long waits and the need for improvement in processes.

ABSTRACT

To identify the neurocognitive mechanisms underpinning the social difficulties that characterize autism, we performed functional magnetic resonance imaging on pairs of autistic and non-autistic adults simultaneously whilst they interacted with one another on the iterated Ultimatum Game (iUG)—an interactive task that emulates the reciprocal characteristic of naturalistic interpersonal exchanges. Two age-matched sets of male–male dyads were investigated: 16 comprised an autistic Responder and a non-autistic Proposer, and 19 comprised non-autistic pairs of Responder and Proposer. Players' round-by-round behavior on the iUG was modeled as reciprocal choices, and dynamic functional connectivity (dFC) was measured to identify the neural mechanisms underpinning reciprocal behaviors. Behavioral expressions of reciprocity were significantly reduced in autistic compared with non-autistic Responders, yet no such differences were observed between the non-autistic Proposers in either set of dyads. Furthermore, we identified latent dFC states with temporal properties associated with reciprocity. Autistic interactants spent less time in brain states characterized by dynamic inter-network integration and segregation among the Default Mode Network and cognitive control networks, suggesting that their reduced expressions of social–emotional reciprocity reflect less efficient reconfigurations among brain networks supporting flexible cognition and behavior. These findings advance our mechanistic understanding of the social difficulties characterizing autism.

ABSTRACT

We assessed parent stress and competence outcomes from participation in a randomized controlled trial of a modular behavioral intervention (Modular Approach for Young Autistic Children; MAYAC) compared to a treatment-as-usual comprehensive behavioral intervention (CBI). Throughout their participation, parents of military families were included in their child's treatment (e.g., identifying goals, learning strategies to support their child) and reported on their feelings of stress using the Parenting Stress Index—4, Short Form (PSI-4), as well as their feelings of satisfaction and efficacy as a parent on the Parenting Sense of Competence (PSOC) scale. A linear mixed model evaluated the differences in stress and competence from baseline to each assessment period through follow-up. There were no significant differences between groups in stress or competence ratings; however, there were within-group changes in both treatment arms over the course of the trial. In both groups, parent stress decreased, and competence increased over time, continuing to suggest that behavioral analytic intervention for young children with autism can promote positive parent outcomes.

Trial Registration: ClinicalTrial.gov identifier: NCT04078061

ABSTRACT

Autism spectrum disorder (ASD) is a complex neuro developmental condition characterized by significant genetic and phenotypic variability, making diagnosis and treatment challenging. The heterogeneity of ASD-associated genetic variants and the absence of clear causal factors in many cases complicate personalized care. Traditional models, such as postmortem brain tissue and animal studies, have provided valuable insights but are limited in capturing the dynamic processes and human-specific aspects of ASD pathology. Recent advances in human induced pluripotent stem cell (iPSC) technology have transformed ASD research by enabling the generation of patient-derived neural cells in both two-dimensional cultures and three-dimensional brain organoid models. These models retain the donor's genetic background, allowing researchers to investigate disease-specific cellular and molecular mechanisms while identifying potential therapeutic targets tailored to individual patients. This commentary highlights how stem cell-based approaches are advancing our understanding of ASD and paving the way for more personalized diagnostic and therapeutic strategies.

ABSTRACT

Figurative language, including metaphors and similes, is a crucial component of communication; yet, it presents significant challenges for individuals with autism spectrum disorder (ASD). A critical gap in existing research is the impact of bilingualism on the ability of children with ASD to understand and produce non-literal speech. This study addresses this gap by examining the comprehension and production of metaphors and similes in monolingual and bilingual Greek-speaking children with high-functioning ASD. To the best of our knowledge, this is the first study to investigate these abilities in bilingual children with ASD. Thirty-three monolingual and 18 bilingual children participated in tasks designed to assess comprehension, production, and error patterns for metaphors and similes. The study has also investigated the roles of non-verbal intelligence, language skills (expressive vocabulary), and executive functions (working memory) in the children's performance in the metaphor and simile tasks. Results showed that the two groups did not differ in metaphor comprehension; however, bilingual autistic children with higher non-verbal intelligence appeared to have superior performance in metaphor comprehension compared to their bilingual peers with lower non-verbal intelligence. The bilingual autistic children outperformed their monolingual peers in metaphor production, likely due to their higher non-verbal intelligence ability, despite the fact that the bilingual group had lower expressive vocabulary scores than the monolingual children. Simile comprehension, on the other hand, favored monolingual children, while no significant group differences were observed in simile production. Regarding errors, both groups exhibited similar error patterns, with literal interpretations being the dominant error type across both groups, suggesting that pragmatic language difficulty is a hallmark feature in ASD. The findings challenge the misconception that bilingualism hinders language development in children with ASD and highlight its potential to provide benefits in the realm of non-literal language processing.

ABSTRACT

Gastrointestinal (GI) difficulties are common in children diagnosed with autism spectrum disorder (ASD). However, these difficulties can frequently remain unrecognized. Therefore, we aimed to translate a newly developed instrument, The Autism Spectrum Disorder Gastrointestinal and Related Behaviors Inventory in Children (ASD-GIRBI), to assess its reliability and to explore the frequency of various gastrointestinal difficulties and related behaviors, as well as to explore the association of GI difficulties with the measures of social functioning and emotional and behavioral difficulties in children with ASD. A total of 98 children and adolescents (aged 4–18 [M ^age = 10.67 ± 3.705], 82.7% male), previously diagnosed with ASD at the Institute of Mental Health in Belgrade, Serbia, took part in this research. Their parents filled out the following questionnaires: ASD-GIRBI (an assessment of gastrointestinal and related symptoms), Stanford Social Dimensions Scale (SSDS) (a measure of social functioning) and Strengths and Difficulties Questionnaire (SDQ) (a measure of emotional and behavioral problems). Our results indicate that the ASD-GIRBI is a reliable instrument for GI difficulties assessment (Cronbach's α = 0.841) with the total score successfully discriminating between the participants with and without a GI disorder diagnosis (p = 0.040). Any gastrointestinal symptom was present in 54.1% of the participants, most commonly flatulence, diarrhea, and constipation. The severity of gastrointestinal difficulties correlated to emotional problems (r = 0.261, p < 0.01), conduct problems (r = 0.219, p < 0.05), hyperactivity (r = 0.381, p < 0.01), peer problems (r = 0.266, p < 0.01), total difficulties (r = 0.454, p < 0.01) and total difficulties impact (r = 0.321, p < 0.01). Our data emphasize the potential importance of GI difficulties for various areas of functioning of individuals with ASD.

ABSTRACT

The Psychopathy Checklist Short Version (PCL:SV) is a brief measure of psychopathy. This study aimed to assess the reliability and validity of the PCL:SV with autistic adults detained in inpatient psychiatric care. Data were collected from 282 autistic adults at two time points separated by 12-months. Reliability and validity were investigated using omega, regression, receiver operating characteristic curves, and correlational analysis. PCL:SV Total, Factor 1, and Factor 2 had satisfactory to high reliability and construct validity. Higher PCL:SV scores were associated with poorer treatment progress, a longer length of stay, and previous criminal offending. Factor 1 was associated with a forensic history, detention under Part III of the Mental Health Act, and a personality disorder diagnosis, while Factor 2 was also associated with the absence of a forensic history, detention under Part II of the Mental Health Act, but not a personality disorder diagnosis. It was thought that Factor 2 most likely captured data associated with autism and/or intellectual disabilities (e.g., behaviors that challenge). Those with intellectual disabilities were less likely to have convictions, a history of violent offending, or a forensic history. They were also more likely to be detained under Part II of the Mental Health Act, and were more likely to have had a positive transfer 12-months later to a ward with lesser security. The PCL-SV correlated as expected with the HCR-20 and the START. This study provides preliminary evidence to support the use of the PCL:SV with autistic adults, including those with intellectual disabilities, within inpatient psychiatric hospitals.

ABSTRACT

Sensorimotor impairments are common in autism spectrum disorder (ASD) and evident in unaffected first-degree relatives, suggesting that they may serve as endophenotypes associated with inherited autism likelihood. We tested the familiality of sensorimotor impairments in autism across multiple motor behaviors and effector systems and in relation to parental broader autism phenotypic (BAP) characteristics. Fifty-seven autistic individuals (probands), 109 parents, and 89 neurotypical control participants completed tests of manual motor and oculomotor control. Sensorimotor tests varied in their involvement of rapid, feedforward control and sustained, sensory feedback control processes. Subgroup analyses compared families with at least one parent showing BAP traits (BAP+) and those in which neither parent showed BAP traits (BAP−). Results show that probands with BAP− parents (BAP− probands) showed atypical control of rapid oculomotor behaviors, while BAP+ probands showed impairments of sustained manual motor and oculomotor behaviors compared to controls. BAP− parents showed impaired rapid oculomotor and sustained manual motor abilities relative to BAP+ parents and controls. Rapid oculomotor behaviors were highly intercorrelated among probands and their biological parents. These findings indicate that rapid oculomotor behaviors are selectively impacted in BAP− probands and their parents and may reflect a familial likelihood for autism independent of parental autistic traits. In contrast, sustained sensorimotor behaviors were affected in BAP+ probands and BAP− parents, suggesting separate familial pathways associated with autism. Finally, atypical saccade dynamics may serve as strong endophenotypes for autism. These findings provide new evidence that rapid and sustained sensorimotor alterations represent strong but separate familial pathways of inherited likelihood for autism.

ABSTRACT

Previous research indicates that difficulties with expressing remorse may contribute to the longer sentences autistic individuals receive within the criminal justice system. These differences in remorse expression may stem from their reduced ability to perceive emotions in others. This study investigated the association between an individual's level of autistic traits and their remorse perception ability. We also examined the influence of Affective Theory of Mind (ToM), the ability to understand others' emotional experiences, in remorse perception. We thought that the more autistic traits with which a person presented, the poorer their ability to perceive remorse would be, with overall ToM and affective ToM serving as mediating factors. Forty-five autistic and 47 non-autistic individuals assessed a series of facial expressions to determine the perceived level of remorse in each face. Results revealed that neither the combination of autistic traits nor any individual trait was significantly correlated with remorse perception ability. Additionally, autistic traits did not indirectly impact the perception of remorse through either overall ToM or affective ToM. These findings imply that individuals with high autistic traits, regardless of their perspective-taking abilities, exhibit similar capacities for perceiving remorseful expressions to those with less autistic traits—at least when the stimuli are static. Future research should investigate the differences between autistic and non-autistic individuals in perceiving remorse through different modalities of emotional expression, including behavioral and verbal cues.

Autism Research, Volume 18, Issue 2, Page 231-235, February 2025.

ABSTRACT

Research and clinical work demonstrate that adults with intellectual and developmental disabilities (IDDs; including autistic adults and adults with other IDDs) struggle with key outcomes in adult life, including social relationships, employment, autonomy, and life satisfaction. However, few validated measures exist to measure these outcomes in adults with IDDs. The Relationships, Employment, Autonomy, and Life Satisfaction (REALS) Measures were created using methods developed by the Patient-Reported Outcomes Measurement Information System (PROMIS) to assess these outcomes. Large item pools were generated for the four domains, and, in field testing, 875 adults with IDDs (90% autistic; 18.4% with intellectual disability or a non-autism IDD) and 911 proxy reporters (caregivers; 79% autistic; 48.3% with intellectual disability or a non-autism IDD) completed 108 and 74 items, respectively, using response options capturing frequency, level of support needed, and satisfaction. The structure and item content of the REALS Measures were determined through an iterative process using both classical test theory and item response theory analyses. The final versions include 19 self-report and 14 proxy-report measures, with a range of 3 to 14 items each. The measures have excellent psychometric properties, high precision, and acceptable respondent burden. Thus, they are applicable for service provision, clinical, and research arenas for autistic adults and adults with other IDDs, though additional testing in IDD is warranted and evidence supporting self-report use in IDD is more limited.

ABSTRACT

Parents of autistic children are at a higher risk for mental health problems, including anxiety, depression, and stress. Cognitive behavior therapy (CBT) that targets children's emotion regulation may have an indirect influence on parent outcomes, especially if they play a supporting role in their child's intervention. However, most CBT interventions have been carried out in highly controlled research settings and there are a few studies that examined parental outcomes after participating in autistic child-focused CBT within a community setting. The current study examined parent outcomes (i.e., mental health problems, mindful parenting, and parenting practices) following a community-based CBT program with concurrent parent involvement for autistic children, as well as associations between changes in parent and child outcomes (i.e., autism symptoms and emotion dysregulation). Participants included 77 parent–child dyads across seven community organizations in Ontario, Canada. Parents reported improved mindful parenting and positive parenting practices post-intervention, and no significant changes in their mental health. Multiple mediation analyses revealed that positive changes in parent outcomes (i.e., mindful parenting and parenting practices) were associated with positive changes in child emotion regulation. These positive changes in parenting practices mediated the relationship between mindful parenting and child emotion regulation. Results suggest that participating in community-based CBT is mutually beneficial for autistic children and their parents, particularly in improving parenting behaviors.

ABSTRACT

Central sensitivity syndromes (CSSs) are a group of health conditions thought to include an underlying sensitisation of the central nervous system. Evidence suggests autistic adults experience poorer physical health than the general population and are more likely to have a CSS. This study examined CSS diagnoses and symptoms in autistic and non-autistic adults, to determine whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, age or gender. Participants included 534 adults with clinical diagnoses of autism, CSS, both diagnoses or neither (i.e., comparison group), who were recruited through social media, support groups and institutional affiliations. Participants completed online self-report validated questionnaires, including the Autism Spectrum Quotient (AQ), Central Sensitization Inventory (CSI), Sensory Perception Quotient (SPQ), and the PHQ-9 and GAD-7. Autistic people without a diagnosed CSS reported significantly more CSS symptoms than the comparison group, with a mean score above the clinical cut-off. Non-autistic participants with a CSS had significantly more autistic traits than the comparison group. Autistic people with a CSS reported the most sensory sensitivity, with autism only and CSS only groups reporting similar levels of sensory sensitivity and all diagnostic groups reporting more sensory sensitivity than the comparison group. Sensory sensitivity, anxiety, autistic traits, age and gender were all significant predictors of CSS symptoms. The overlap in symptoms between autistic individuals and those with CSS suggests diagnostic overshadowing and possible under-diagnosis or misdiagnosis. Furthermore, these symptoms may exacerbate or mask one another. Notwithstanding potential limitations of representativeness and selection bias, increased awareness of the association between autistic traits and CSS symptoms is important for clinicians to improve diagnostic accuracy and treatment.

ABSTRACT

Although autism is a childhood-onset neurodevelopmental disorder, its features change across the life course due to a combination of individual and contextual influences. However, the influence of contextual factors on development during childhood and beyond is less frequently studied than individual factors such as genetic variants that increase autism risk, IQ, language, and autistic features. Potentially important contexts include the family environment and socioeconomic status, social networks, school, work, services, neighborhood characteristics, environmental events, and sociocultural factors. Here, we articulate the benefit of studying contextual factors, and we offer selected examples of published longitudinal autism studies that have focused on how individuals develop within context. Expanding the autism research agenda to include the broader context in which autism emerges and changes across the life course can enhance understanding of how contexts influence the heterogeneity of autism, support strengths and resilience, or amplify disabilities. We describe challenges and opportunities for future research on contextual influences and provide a list of digital resources that can be integrated into autism data sets. It is important to conceptualize contextual influences on autism development as main exposures, not only as descriptive variables or factors needing statistical control.

ABSTRACT

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

ABSTRACT

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