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Many young adults on the autism spectrum do not attain the recommended minimum weekly amount of moderate to vigorous physical activity (MVPA) to prevent significant health risks. Autism symptoms as well as environmental factors may play a key role in the physical activity (PA) behaviors of young adults on the autism spectrum. The socioecological model (SEM) has been previously used to identify determinants of PA among people within many disability categories. Aims: Explore the overall relationship between determinants of PA of MVPA among parents and their young adult child with ASD as well as MVPA determinants segmented by caregiver level of support. Methods: 336 parents of adult children with ASD completed the Determinants of Physical Activity and Eating Behaviors for Young Adults with ASD Scale. Results: Children's weekly time spent in MVPA was predicted by parent self-reported MVPA, exercise competency, video game use, social skills, and neighborhood qualities. Parent weekly time spent in MVPA was predicted by their child's weekly MVPA, parent exercise competency, parent discretionary time, available home exercise equipment, and parent attitude towards physical activity. Conclusion: These results support the administration of quality community-based motor development, motor skills, and exercise skills programs focused on increasing physical activity and parent's influential role in their children's weekly MVPA.

While there are multiple evidence-based practices (EBPs) available for students with autism, ongoing barriers to use in schools include limited access to training for educators and substantial provider modifications that limit fidelity. This suggests a need for further research to support data-informed adaptations and innovative methods for training and coaching teachers. In response to this need, the objectives of this protocol paper are to (1) describe the development of a data-informed adaptation process for an EBP, and (2) compare the effectiveness of two methods (online virtual and a combination of in-person and online virtual) for training teachers to use the adapted EBP. Outcome measures will include teacher implementation and sustainment of the EBP, teacher/coach relationship, and student outcomes.

Abstract Introduction Individuals on the autism spectrum (ASD) often experience poor mental health and coping strategies compared to their peers due to social exclusion and co-occurring conditions. Resiliency has been identified as a key factor in preventing adverse outcomes and promoting mental health. Therefore, it is important to determine what strategies can be used to build resiliency among autistic individuals. The current paper is one of the first studies that aims to collect information from autistic individuals and their caregivers on potential strategies to enhance resiliency. Methods We interviewed 18 participants from various provinces in Canada, comprising of 13 autistic individuals and 5 parents. We used thematic analysis to identify patterns in the data. Results Thematic analysis revealed three themes to indicate strategies that could be used to enhance resiliency, including: (a) self-reliant strategies, (b) using community-based facilities, and (c) contextual and individual characteristics. Conclusion Although the body of literature on resiliency is evolving, this paper provides a unique perspective as it is one of the few studies that considers the experiences of individuals on the spectrum. In addition, this study focuses on identifying and describing specific strategies that can be used to enhance resiliency and mental health, which consequently can help address the existing gaps in knowledge and practice.

Autistic people typically need methodical support as they explore and interact with their immediate surroundings and the objects associated with them, emphasising the importance of spatial knowledge and cognitive skills in improving and understanding their surroundings. The objective of this research paper is to present a conceptual and technical framework that could be of significant assistance in developing spatial ability and cognitive skills in autistic people. This framework is constructed based on aspects of autistic behaviour, spatial cognition, and technical aspects of haptic technology and virtual environments (VEs). The framework uses the Model, View, Controller (MVC) pattern as its structural foundation. This paper highlights the important elements required for scholars and designers to create and develop a haptic-based virtual environment (HBVE) for autistic people in order to improve spatial knowledge and cognitive skills. Furthermore, this research also aimed to create an HBVE application based on the proposed framework in order to assess its effectiveness. This research paper evaluates the proposed framework based on end-user perspectives. The findings indicate that the experimental study conducted with autistic people has demonstrated notable progress in enhancing spatial knowledge and cognitive abilities among this population. The experimental implementation of these findings supports the developed framework’s efficacy.

Sperber & Wilson (2005:468) see Pragmatics as is " the study of how contextual factors interact with linguistic meaning in the interpretation of utterances". Doctors often recognize patterns in people’s speech from their utterances. These patterns may affect the medical judgements. In general, this paper presents models for describing clinical contexts and illustrates them with analysis of medical interactions associated with developmental autism disorders. This paper attempts to examine Applied linguistic impairment through (The selected situations in the Season 1, Episode 2) of medical conversations in the TV series: "The Good Doctor" in which the main character is 'Dr. Murphy' who is an autistic resident doctor. The pragmatic impairment is spread in the world and there is difficult to identify exact nature of autism. This paper also endeavors to investigate the autism through its definition and scope to achieve the needs of the interactions between the interlocutors. Generally, interlocutor with autism is possibly to exhibit pragmatic troubles along with her/his interactions, but these troubles differ extremely from one person to another. (Cummings,2017:59). This paper also attempts to shed light the applied pragmatic strategies and devices that can be exploited in three stages: launching, maintaining, and terminating of clinical conversations in the case of autism.

Non-speaking autistic individuals grapple with the profound impact of the ‘double empathy problem’ in their daily interactions with speaking others. This study rethinks the communication challenges faced by non-speaking autistic individuals, challenging traditional approaches that predominantly focus on speech and complex communication devices (AAC). By spotlighting the natural phenomenon of “interactive stimming,” a powerful mode of communication among autistic individuals, this study advocates for a shift from a conventional emphasis on speech towards the foundational role of the body in autistic communication. Central to this exploration is the introduction of the Magical Musical Mat (MMM), an innovative interactive environment mapping interpersonal touch to musical sounds. Through a robust mixed-methods approach integrating video-based fieldwork and design-based research, this paper engages three non-speaking autistic children and their mothers in a 5-day empirical intervention. Results reveal significant transformations in parent–child interactions as both parents and children are acquainted with touch in a new environment. Children assert their autonomy, exploring at their own pace, and discovering sensory features of the environment. Notably, the introduction of sound prompts heightened awareness of the stims, leading to diversified and expressive stim movements. Foregrounding interpersonal touch eventually guides parents into their children’s sensory activities where parents attune to the stims of their children by joining in and facilitating their expressiveness, co-creating extended, evolving patterns of repetitive cycles. The collaborative stim cycles can be likened to free improvisation, where dynamical coherence between individuals occurs through a blend of stability and active flexibility. By shifting the focus from speech to co-created sensory experiences, this paper sheds light on the value of transformative multisensory environments, envisioning a world where varied modes of communication are valued and embraced.

Increased number of children with autism spectrum disorder (ASD) has also heightened interest in finding and providing appropriate interventions. Early intervention is implemented at the moment when deviations are noticed, without waiting for an official diagnosis. Parents are crucial participants in interventions carried out with children; therefore, this research considers interventions focused on training parents to work with children with ASD up to the age of six. For the purposes of this paper, we searched the following journals: Autism, Focus on Autism and Other Developmental Disabilities, and Research in Autism. The search was limited to editions from 2012 to 2022, and the following keywords were considered: parent training, early intervention, autism. References were searched manually. The initial search yielded a total of 992 articles. Twenty-four studies related to children up to six years old and involving parent training in early intervention were included in the analysis. Using a tool for assessing quantitative studies, the selected studies were evaluated, with each component assessed based on the information contained in the study as good, moderate, or weak. The overall rating for the paper can be strong, moderate, or weak. This paper highlights the importance of support to enhance parental competencies.

Increasing scientific productivity in autism research requires citation evaluations that may produce multiple benefits. One of the most recent citation evaluations is the delayed recognition of scientific productions, known as "Sleeping Beauties", which in this study referred to research articles that were neglected (rarely cited) in the first ten years of publication (ten-year sleep/sleep depth) but suddenly cited in later years (at least ten years later/ten years an opportunity to wake up). Based on the standard and comprehensive selection criteria, out of a total of 8864 papers found in WoS and Medline databases between 1946 and 2000, 197 SB papers were identified. In Scopus, 8550 papers were published between 1946 and 2000, and 232 papers were identified as SB. Gillberg (1983) received the highest SB score in all citation databases, and Vilensky et al. (1981) received the highest SB score among the most cited papers. The innovative nature of the SB papers and the special attention paid to autism in recent years were discussed and concluded as possible reasons for the findings.

Annan Liu,1,2 Yiwen Lu,3 Chao Gong,1,2 Jiaxing Sun,1,2 Bobo Wang,1,2 Zhimei Jiang4 1College of Rehabilitation Medicine, Jiamusi University, Jiamusi, Heilongjiang Province, People’s Republic of China; 2Neurolab for Child Rehabilitation, Jiamusi University, Jiamusi, Heilongjiang Province, People’s Republic of China; 3The First Affiliated Hospital, Guangxi Medicine University, Nanning, Guangxi Province, People’s Republic of China; 4Jiamusi University, Jiamusi, Heilongjiang Province, People’s Republic of ChinaCorrespondence: Zhimei Jiang, Jiamusi University, Jiamusi, Heilongjiang Province, People’s Republic of China, Email mynard93@163.comBackground: In recent years, there has been a growing body of research suggesting that ASD and ADHD are two disorders that often co-exist. Despite the rapid development of research, little is known about their etiology, diagnostic markers, and interventions, which has led us to review and summarise the development of the field in the hope that this will provide an opportunity to look for future directions.Methods: A bibliometric approach was used to analyse papers in the field of ASD co-morbidities in ADHD on Web of Science from 1991– 2022, using CiteSpace and VOSview to map the country/institution, journal, author, co-citation, and keyword networks in the field and to visualise the results.Results: A total of 3284 papers were included, showing an increasing trend in terms of posting trends. Research on co-morbidities of ASD has proven to be mainly focused on universities. The USA (1662) published the most relevant literature in this area, followed by the UK (651) and Sweden (388). Lichtenstein P is the most published author (84), and research into the pathogenesis of ASD co-occurring ADHD and related clinical diagnostics is currently at the forefront of the field.Conclusion: This analysis identifies the most influential institutions and countries, cited journals, and authors in the field of ASD co-morbid ADHD research. The future direction of ASD co-occurring ADHD should be based on improving case identification, discovering the etiological and diagnostic markers of ASD and ADHD, and finding more effective clinical interventions.Keywords: autism, hyperactivity, bibliometrics, VOSviewer, CiteSpace, visualization analysis

Abstract Autism is a neurodevelopmental condition, behaviourally identified, which is generally characterised by social communication differences, and restrictive and repetitive patterns of behaviour and interests. It has long been claimed that it is more common in males. This observed preponderance of males in autistic populations has served as a focussing framework in all spheres of autism-related issues, from recognition and diagnosis through to theoretical models and research agendas. One related issue is the near total absence of females in key research areas. For example, this paper reports a review of over 120 brain-imaging studies of social brain processes in autism that reveals that nearly 70% only included male participants or minimal numbers (just one or two) of females. Authors of such studies very rarely report that their cohorts are virtually female-free and discuss their findings as though applicable to all autistic individuals. The absence of females can be linked to exclusionary consequences of autism diagnostic procedures, which have mainly been developed on male-only cohorts. There is clear evidence that disproportionately large numbers of females do not meet diagnostic criteria and are then excluded from ongoing autism research. Another issue is a long-standing assumption that the female autism phenotype is broadly equivalent to that of the male autism phenotype. Thus, models derived from male-based studies could be applicable to females. However, it is now emerging that certain patterns of social behaviour may be very different in females. This includes a specific type of social behaviour called camouflaging or masking, linked to attempts to disguise autistic characteristics. With respect to research in the field of sex/gender cognitive neuroscience, there is emerging evidence of female differences in patterns of connectivity and/or activation in the social brain that are at odds with those reported in previous, male-only studies. Decades of research have excluded or overlooked females on the autistic spectrum, resulting in the construction of inaccurate and misleading cognitive neuroscience models, and missed opportunities to explore the brain bases of this highly complex condition. A note of warning needs to be sounded about inferences drawn from past research, but if future research addresses this problem of male bias, then a deeper understanding of autism as a whole, as well as in previously overlooked females, will start to emerge.

Abstract Background Neurodevelopmental conditions such as intellectual disability (ID) and autism spectrum disorder (ASD) can stem from a broad array of inherited and de novo genetic differences, with marked physiological and behavioral impacts. We currently know little about the psychiatric phenotypes of rare genetic variants associated with ASD, despite heightened risk of psychiatric concerns in ASD more broadly. Understanding behavioral features of these variants can identify shared versus specific phenotypes across gene groups, facilitate mechanistic models, and provide prognostic insights to inform clinical practice. In this paper, we evaluate behavioral features within three gene groups associated with ID and ASD – ADNP, CHD8, and DYRK1A – with two aims: (1) characterize phenotypes across behavioral domains of anxiety, depression, ADHD, and challenging behavior; and (2) understand whether age and early developmental milestones are associated with later mental health outcomes. Methods Phenotypic data were obtained for youth with disruptive variants in ADNP, CHD8, or DYRK1A (N = 65, mean age = 8.7 years, 40% female) within a long-running, genetics-first study. Standardized caregiver-report measures of mental health features (anxiety, depression, attention-deficit/hyperactivity, oppositional behavior) and developmental history were extracted and analyzed for effects of gene group, age, and early developmental milestones on mental health features. Results Patterns of mental health features varied by group, with anxiety most prominent for CHD8, oppositional features overrepresented among ADNP, and attentional and depressive features most prominent for DYRK1A. For the full sample, age was positively associated with anxiety features, such that elevations in anxiety relative to same-age and same-sex peers may worsen with increasing age. Predictive utility of early developmental milestones was limited, with evidence of early language delays predicting greater difficulties across behavioral domains only for the CHD8 group. Conclusions Despite shared associations with autism and intellectual disability, disruptive variants in ADNP, CHD8, and DYRK1A may yield variable psychiatric phenotypes among children and adolescents. With replication in larger samples over time, efforts such as these may contribute to improved clinical care for affected children and adolescents, allow for earlier identification of emerging mental health difficulties, and promote early intervention to alleviate concerns and improve quality of life.

IntroductionThe current paper aimed to assess the feasibility of a modified intervention protocol named “Occupational Therapy using Zones of Regulation Concepts in an Equine Environment” (OT-ZOR Equine).MethodsA single arm A-B feasibility study was conducted, involving 14 autistic youth ages 6-13 years who first received 10-weeks of occupational therapy without horses (OT-ZOR Clinic) followed by 10-weeks of OT-ZOR Equine.ResultsAll participants completed the study and attended 95% of OT-ZOR Equine sessions. Occupational therapists maintained 91% fidelity to the OT-ZOR Equine intervention protocol and there were no serious adverse events. All participants’ caregivers and study occupational therapists rated being satisfied or very satisfied with the OT-ZOR Equine intervention. Youth demonstrated improved self-regulation following participation in the OT-ZOR Clinic and OT-ZOR Equine interventions. However, participants’ social functioning only improved after OT-ZOR Equine.DiscussionThis study demonstrated that OT-ZOR Equine is feasible to implement, acceptable to recipients and providers, and may offer additive benefits in social functioning compared to occupational therapy intervention without horses. The current study provides a foundation for future efficacy research aimed at quantifying additive benefits of integrating horses into occupational therapy for autistic youth.

This article explores the necessity of and requirements for developing a neurodiverse interpretation of the right to quality education for autistic children. While the debates have so far mostly focused on the questions of access and inclusivity of education, interrogations around the meaning of quality education for autistic children have also started to emerge. Focusing on the individual and identity aims of education, this paper examines the implications that a neurodiverse perspective would hold in developing a better understanding of the right to quality education for autistic children. It argues that to provide quality education to autistic children first and foremost requires respecting their identity, development, and cognitive, social, and communicative functioning, both at the individual and the collective levels.

IntroductionAutism is characterized by social communication differences and repetitive behaviors, affecting 1%–2% of children. Irritability is a disabling condition affecting 19%–80% of autistic children. While extensive research has focused on interventions to reduce irritability symptoms, the underlying correlates remain poorly understood. To address this, we conducted a scoping review of the literature examining factors contributing to irritability in pediatric autistic populations.MethodsA literature search of Embase, MEDLINE, PubMed, PsycINFO, and Web of Science was conducted in addition to manually retrieved papers from Google Scholar. Studies underwent title and abstract screening by one reviewer and full-text screening by two reviewers; disagreements were resolved through deliberation. The remaining studies underwent data extraction. The review was conducted using the PRISMA-ScR checklist.ResultsThe search yielded 48 studies meeting the inclusion criteria. Correlates of irritability were categorized into eight themes: demographics/environmental, autism features, mental health, language, cognition, and function, neurobiological, physical health, physiological, and multidimensional factors. Findings revealed mixed associations with demographic factors, consistent positive associations with sensory differences and mental health symptoms, and varying associations with cognitive abilities and physical health factors. Neurobiological and physiological correlates were less explored.ConclusionThis review revealed a significant gap in understanding sociodemographic, phenotypic, and neurobiological and physiological correlates of irritability in autism. There was also a significant gap in understanding the multi-dimensional irritability correlates. Positive associations between irritability and sensory differences and mental health symptoms suggest potential avenues for investigation of non-medication interventions.

Individuals with autism (ASD) often face difficulty in executing graphic tasks. This can be related to how one uses a graphic tool (e.g., pen) and plans ahead the graphic execution. Use of graphic tool can be captured using attributes, e.g., pen-tip pressure, number of pen lifts, etc. One’s ability to plan a graphic execution can be quantified using the total duration of pen lifts (i.e., air time). Though pen-and-paper-based Trail Making Test-Part A (TMT-A) can estimate planning of graphic execution, yet it cannot capture other attributes, e.g., pen-tip pressure, pen lift, etc. This can be possible if TMT-A is administered on a pressure-sensitive tablet as seen from existing studies with typically developing (TD) individuals. However, quantification of such attributes using TMT-A administered on a pressure-sensitive tablet remains unexplored for individuals with ASD. In addition, such objective measures can help to understand variations in the use of graphic tool and ability to plan graphic execution even outside the TMT-A task, e.g., while drawing shapes which is important to the development of children’s graphic skills. Here, we conducted a study with 12 pairs of TD children and those with ASD who executed TMT-A (in Phase-I) and shape drawing (in Phase-II) on a pressure-sensitive tablet. Results of our study show differences in the use of graphic tool and planning ahead the graphic execution between two participant groups in both the Phases. Such insights can offer clinical inputs that can be helpful in designing individualized intervention paradigms for children facing difficulties in graphic execution.

This paper is related to aspects of supervision in music therapy, specifically focused on Argentine music therapists working in the context of autism. A supervision approach is described for music therapy in this context. Some reflections regarding the themes identified and worked on during the supervision process are presented. The reflections and guidelines are based on the author´s experience as a music therapist supervisor in this field. Acknowledgments I am very grateful to my colleagues from Argentina and Latin America for their trust in my contribution as a supervisor during the supervision process. Not only for their willing to improve their services and their professional role in this context, but for giving me the opportunity to grow and nurture myself as a professional and as a human being. Editor’s Note: The Article Editor thanks Alex Kratchman for their additional assistance with English-language editing. Resumen El presente escrito está relacionado con los aspectos de la supervisión en musicoterapia, específicamente focalizado en el trabajo clínico realizado por los/las musicoterapeutas argentinos/as actuando en el contexto del autismo. Se describirá un abordaje de supervisión en musicoterapia para este contexto. Se expondrán algunas reflexiones vinculadas a las temáticas identificadas y trabajadas con los/las musicoterapeutas durante el proceso de supervisión. Dichas reflexiones y lineamientos están basados en la experiencia de la autora, como supervisora de musicoterapeutas trabajando en este campo de aplicación. Agradecimientos Agradezco a los/las colegas de Argentina y Latinoamérica por su confianza en mi aporte durante el proceso de supervisión. No sólo por su búsqueda en mejorar sus servicios y su rol profesional en este contexto, sino por darme la oportunidad de crecer y nutrirme como profesional y como ser humano. Nota del editor: el editor del artículo agradece a Alex Kratchman su ayuda adicional con la redacción en inglés.

An increasing body of research suggests that bilingualism is possible and perhaps even advantageous for autistic individuals. However, several factors might influence parents’ decisions about raising their autistic child bilingually, including national language policies, educational contexts, advice received from key professionals, and the child’s individual strengths and needs. Accordingly, there is a clear imperative to understand how the views of different stakeholders converge and diverge when language decisions are made in the context of autism. This paper brings new insights by synthesising the findings of three qualitative studies that used interpretative phenomenological analysis (IPA) to explore the perspectives and experiences of bilingual autistic children (n = 11), parents (n = 16), and educational practitioners (n = 13) of bilingualism in autism in England and Wales. Despite wide variation between and within groups, a striking tension emerged between individuals’ beliefs about bilingualism in general, which were positive, and their experiences of bilingualism in autism specifically, which often foregrounded more monolingual approaches. This paper examines this tension, with a particular focus on stakeholders’ attitudes towards the feasibility of bilingualism, families’ language choices in the context of autism, and how notions of contextual linguistic diversity accentuated differences between England and Wales. We conclude by arguing that greater awareness of both bilingualism and neurodiversity in educational and clinical settings may improve the experiences of bilingual autistic children and, crucially, the language advice families receive.

The neurodiversity movement has introduced a new era for autism research. Yet, the neurodiversity paradigm and the autism clinic remain largely unconnected. With the present work, we aim to contribute to filling this lacuna by putting forward phenomenology as a foundation for developing neurodiversity-affirming clinical interventions for autism. In the first part of this paper, we highlight that autistic people face a severe mental health crisis. We argue that approaches focused on reducing autistic ‘symptoms’ are unlikely to solve the problem, as autistic mental health is positively correlated with autism acceptance and perceived quality of support provided, not necessarily with lack of ‘symptomatologic severity’. Therefore, the development and dissemination of neurodiversity-affirming clinical interventions is key for addressing the autism mental health crisis. However, therapists and researchers exploring such neurodiversity-affirming practices are faced with two significant challenges. First, they lack concrete methodological principles regarding the incorporation of neurodiversity into clinical work. Second, they need to find ways to acknowledge rightful calls to respect the ‘autistic self’ within the clinic, while also challenging certain beliefs and behaviors of autistic clients in a manner that is sine qua non for therapy, irrespective of neurotype. In the second part of the paper, we introduce phenomenological psychology as a potential resource for engaging with these challenges in neurodiversity-affirming approaches to psychotherapy. In this vein, we put forward specific directions for adapting cognitive behavioral and interpersonal psychotherapy for autism.

The sensitivity of children with autism to interior space elements differs from their healthy peers. Accordingly, there was a need to make a study on their sensitivity to internal elements, then study how to use that to enhance their skills. This paper aims to introduce different types of spatial design for children with autism and their sensitivity to interior elements and then use that to enhance their abilities through multi-sensory rooms. To achieve that aim several research methodologies were implemented starting with a literature review, and site visits to the rehabilitation centers, then a survey was conducted to measure the sensitivity of children with autism to interior space elements and how the elements of multi-sensory rooms enhance their abilities. The findings of this paper have enclosed that children with autism are more sensitive to light than any other element in the interior space, therefore, light is used to develop their skills in the multisensory room.

Variations of environmental parameters, like thermo-hygrometric, acoustic, visual and indoor air quality can influence the sensitivities of individuals on the spectrum. This paper presents research on this issue, studied by means of questionnaires administered to parents and professional caregivers taking care of people with Autism Spectrum Disorder (ASD).The study highlights that there are clear differences if the indirect evaluations are performed by parents or professional caregivers, in relation to the specific identification of stress sources. Additionally, acoustic domain is identified as the one causing the major stress, especially caused by strong noises and particular sounds such as voices, animal sounds and impacts, and its dependence on the severity of autism is evidenced. Furthermore, a lower impact of thermal, visual and IAQ factors is determined, with the exception of some specific stimuli like light contrast (glare), high illumination, particular light sources or stale air. Finally, this paper provides evidence of the influence of age, severity of autism and co-morbidities on perceived stress.

Abstract Background We evaluated the clinical and cost-effectiveness of manualised sensory integration therapy (SIT) for autistic children with sensory processing difficulties in a two-arm randomised controlled trial. Trial processes and contextual factors which may have affected intervention outcomes were explored within a nested process evaluation. This paper details the process evaluation methods and results. We also discuss implications for evaluation of individual level, tailored interventions in similar populations. Methods The process evaluation was conducted in line with Medical Research Council guidance. Recruitment, demographics, retention, adherence, and adverse effects are reported using descriptive statistics. Fidelity of intervention delivery is reported according to the intervention scoring manual. Qualitative interviews with therapists and carers were undertaken to explore the acceptability of the intervention and trial processes. Qualitative interviews with carers explored potential contamination. Results Recruitment, reach and retention within the trial met expected thresholds. One hundred thirty-eight children and carers were recruited (92% of those screened and 53.5% of those who expressed an interest) with 77.5% retained at 6 months and 69.9% at 12 months post-randomisation. The intervention was delivered with structural and process fidelity with the majority (78.3%) receiving a ‘sufficient dose’ of intervention. However, there was considerable individual variability in the receipt of sessions. Carers and therapists reported that trial processes were generally acceptable though logistical challenges such as appointment times, travel and COVID restrictions were frequent barriers to receiving the intervention. No adverse effects were reported. Conclusions The process evaluation was highly valuable in identifying contextual factors that could impact the effectiveness of this individualised intervention. Rigorous evaluations of interventions for autistic children are important, especially given the limitations such as limited sample sizes and short-term follow-up as faced by previous research. One of the challenges lies in the variability of outcomes considered important by caregivers, as each autistic child faces unique challenges. It is crucial to consider the role of parents or other caregivers in facilitating access to these interventions and how this may impact effectiveness. Trial registration This trial is registered as ISRCTN14716440. August 11, 2016.

The internet of medical things (IoMT) has become a pivotal aspect of IoT applications, playing a crucial role in cutting down healthcare expenses, enhancing access to clinical services, and refining operational efficiency within the healthcare domain. An early detection of neurological brain disorders continues to present a formidable challenge. In response, our research endeavors are directed towards the IoMT-based system used for the real-time diagnosis of neurological disorders. In this paper, IoMT-based real-time diagnosis model is developed for neurological brain disorders using systematic deep learning and electroencephalogram (EEG) signal (RT-NeuroDDSM). We first introduce the time domain, channel and spatial attention network (TCSNet) for feature extraction which extracts the high-level time series, channel and spatial features, respectively. TCSNet aims to learn more valuable features from the input data to achieve good classification results. Furthermore, in order to maximize features, we create the modified normative fish swarm (MNFS) feature selection algorithm. Next, the detection of various neurological brain problems, including neuro-typical, epilepsy, and autism spectrum disorder (ASD), is accomplished by applying the hinging hyperplane neural network (HHNN). To verify the performance, we used the publicly accessible EEG datasets from University of Bonn-Germany, CHB-MIT EEG repository, and King Abdulaziz University. The RT-NeuroDDSM has an overall classification accuracy of 99.956%, making it 5.471% more in efficiency compared to the existing state-of-the-art model.

Abstract Background Recent systematic reviews have indicated that cognitive behavioral therapy (CBT) is effective in reducing anxiety symptoms for autistic and non-autistic children. However, the vast majority of CBT research for autistic youth has been implemented within university settings and primarily by mental health providers. Schools hold great promise to equitably manage the mental health symptoms of autistic youth. Although preliminary research evaluating CBT within schools has been promising, CBT has not yet been compared to another readily available school mental health program. The goal of this protocol paper is to describe a multi-site study comparing two school-based interventions, Facing Your Fears-School Based (FYF-SB) and Zones of Regulation (ZOR) via a cluster randomized controlled type 1 hybrid effectiveness-implementation trial to determine which of the two interventions will best support autistic youth with anxiety in schools. Methods Up to 100 elementary and middle schools will be randomized into FYF-SB or ZOR. Once schools are randomized, a minimum of two interdisciplinary school providers at each school will be trained to deliver either FYF-SB or ZOR over the course of 12 weeks to groups of 2–5 autistic students ages 8–14 years. Over the course of two years, a total of 200 autistic students will receive either ZOR or FYF-SB. The primary outcome of this trial is child anxiety, as rated by masked evaluators and via caregiver- and student-report, which will be measured at baseline, post-treatment, and 6-month follow-up. Semi-structured interviews will also be conducted with a purposive sample of students, caregivers, and school providers to understand the acceptability, appropriateness, and feasibility of either ZOR or FYF-SB. Stakeholder engagement is a central component of this project via two stakeholder advisory boards that will directly inform and oversee the project. Discussion Results of this study will provide evidence about the relative impact of two school-based mental health interventions on outcomes reported as meaningful by caregivers and school providers. The additional focus on evaluating factors that support the implementation of FYF-SB and ZOR will allow future studies to test targeted implementation strategies that support mental health programming uptake and implementation within public schools. Trial registration This trial is registered with clinicaltrials.gov (NCT05863520).

Abstract Background Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed to manage anxiety in adults with an autism diagnosis. However, their effectiveness and adverse effect profile in the autistic population are not well known. This trial aims to determine the effectiveness and cost-effectiveness of the SSRI sertraline in reducing symptoms of anxiety and improving quality of life in adults with a diagnosis of autism compared with placebo and to quantify any adverse effects. Methods STRATA is a two-parallel group, multi-centre, pragmatic, double-blind, randomised placebo-controlled trial with allocation at the level of the individual. It will be delivered through recruiting sites with autism services in 4 regional centres in the United Kingdom (UK) and 1 in Australia. Adults with an autism diagnosis and a Generalised Anxiety Disorder Assessment (GAD-7) score ≥ 10 at screening will be randomised 1:1 to either 25 mg sertraline or placebo, with subsequent flexible dose titration up to 200 mg. The primary outcome is GAD-7 scores at 16 weeks post-randomisation. Secondary outcomes include adverse effects, proportionate change in GAD-7 scores including 50% reduction, social anxiety, obsessive-compulsive symptoms, panic attacks, repetitive behaviours, meltdowns, depressive symptoms, composite depression and anxiety, functioning and disability and quality of life. Carer burden will be assessed in a linked carer sub-study. Outcome data will be collected using online/paper methods via video call, face-to-face or telephone according to participant preference at 16, 24 and 52 weeks post-randomisation, with brief safety checks and data collection at 1–2, 4, 8, 12 and 36 weeks. An economic evaluation to study the cost-effectiveness of sertraline vs placebo and a QuinteT Recruitment Intervention (QRI) to optimise recruitment and informed consent are embedded within the trial. Qualitative interviews at various times during the study will explore experiences of participating and taking the trial medication. Discussion Results from this study should help autistic adults and their clinicians make evidence-based decisions on the use of sertraline for managing anxiety in this population. Trial registration ISRCTN, ISRCTN15984604 . Registered on 08 February 2021. EudraCT 2019-004312-66. ANZCTR ACTRN12621000801819. Registered on 07 April 2021.

Yangyang Wang,* Xianhao Huo,* Wenchao Li, Lifei Xiao, Mei Li, Chaofan Wang, Yangyang Sun, Tao Sun Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Tao Sun, Ningxia Key Laboratory of Cerebrocranial Disease, Ningxia Medical University, Yinchuan, People’s Republic of China, Email suntao_nxmu@163.comObjective: This study aimed to analyze research on epilepsy in autism and autism in epilepsy using VOSviewer and CiteSpace to identify research hotspots and future directions.Methods: We searched the Web of Science Core Collection (WoSCC) for relevant studies about epilepsy in autism and autism in epilepsy published from inception to 31 May 2022. VOSviewer and CiteSpace were used to analyze the authors, institutions, countries, publishing journals, reference co-citation patterns, keyword co-occurrence, keyword clustering, keywords with citation bursts, and other aspects to construct a knowledge atlas.Results: A total of 473 publications related to epilepsy/autism were retrieved. The number of publications about epilepsy/ASD has generally increased over time, with some fluctuations. The USA (202 papers) and University of California-Los Angeles (15 papers) were the leading country and institution, respectively, in this field. Frye, Richard E. was the most published author (9 papers). Notably, collaboration between institutions, countries, and authors does not appear to be active. Hot topics and research frontiers include intellectual disability and exploring the mechanism of epilepsy/ASD from a genetics perspective.Conclusion: This analysis identified the most influential publications, authors, journals, institutions, and countries in the field of epilepsy/ASD research. Using co-occurrence and evolution analyses, the status of the field was identified and future trends were predicted.Keywords: epilepsy, autism, bibliometrics, VOSviewer, CiteSpace, visualization analysis

Background: The COVID-19 pandemic caused unprecedented changes to the lives of many. The aim of this paper was to understand how the COVID-19 pandemic impacted behavioral inflexibility (BI) and anxiety among autistic children and how autistic children and their families have adapted to COVID-19-related routine changes. Methods: This sequential mixed-method study included two phases. During the first phase, parents of autistic children (N = 48) completed an online survey consisting of the Behavioral Inflexibility Scale (BIS) and the Parent-Rated Anxiety Scale – Autism Spectrum Disorder (PRAS-ASD). During the second phase, a subset of parents (parents of adolescents, N = 11) was invited to participate in a virtual focus-group. Results: The parents reported a wide range of BI during the pandemic (BIS M = 2.03, SD = 1.02, range = 0.21 – 3.86). Child BI was a significant predictor of anxiety (t[40] = 5.56, p < .0001). From the focus groups, 155 codes were organized into four themes, two of which are discussed in this paper: child client factors that have changed during the pandemic and changes to family routines. Conclusions: In this preliminary study, the parents identified problematic BI and anxiety among their autistic children. The outcomes of this small-scale study indicate that some of the changes to routines brought about by the pandemic may be helpful for autistic children after the pandemic restrictions have ended. We provide a unique perspective on how to leverage occupational changes that resulted from the COVID-19 pandemic to aid autistics during non-pandemic times.

Abstract: Background: Various health-related benefits of physical activity (PA) in children and adolescents have been reported, with suggestions that PA could effectively address certain deficits found in autism spectrum disorder (ASD). However, there remains insufficient engagement in PA among individuals with ASD, and barriers to accessing PA persist. Objective: This study aims to review PA interventions (types, frequencies, and durations) in ASD over the last five years and discuss their effects. Methods: Searches were conducted in the PubMed database from October to December 2022 using Mesh Terms: “adolescent” OR “children” AND “sport” OR “physical activity” AND “mental health” AND/OR “autism.” Results were critically appraised using PEDro and Cochrane’s ROB-2, categorized into five stages to assess potential bias. Results: A total of ten papers were included and appraised, examining various types of PA. Primary benefits observed in children and adolescents included the development of social skills, reduction of autistic traits, regulation of emotions, and management of behaviour and cognition. Conclusions: Evidence indicates that PA can effectively address some neuropsychological deficits in ASD. Additionally, managing and protecting against metabolic conditions through PA can significantly enhance overall health.

Early detection and diagnosis of Autism Spectrum Disorder (ASD) can significantly improve the quality of life for affected individuals. Identifying ASD based on brain functional connectivity (FC) poses a challenge due to the high heterogeneity of subjects’ fMRI data in different sites. Meanwhile, deep learning algorithms show efficacy in ASD identification but lack interpretability. In this paper, a novel approach for ASD recognition is proposed based on graph attention networks. Specifically, we treat the region of interest (ROI) of the subjects as node, conduct wavelet decomposition of the BOLD signal in each ROI, extract wavelet features, and utilize them along with the mean and variance of the BOLD signal as node features, and the optimized FC matrix as the adjacency matrix, respectively. We then employ the self-attention mechanism to capture long-range dependencies among features. To enhance interpretability, the node-selection pooling layers are designed to determine the importance of ROI for prediction. The proposed framework are applied to fMRI data of children (younger than 12 years old) from the Autism Brain Imaging Data Exchange datasets. Promising results demonstrate superior performance compared to recent similar studies. The obtained ROI detection results exhibit high correspondence with previous studies and offer good interpretability.

Emerging research in the UK suggests a disproportionate number of autistic adults experience homelessness. This paper reinterprets findings from a narrative study on autism and homelessness through the lens of Critical Disability Studies (CDS). Ten autistic participants who had experienced homelessness took part in narrative interviews focussing on their life history. Throughout their lives, participants experienced repeated social and economic exclusion, which ultimately led to homelessness. This paper uses CDS to examine how normative social expectations may increase risk of homelessness for autistic people. It also considers how some participants renegotiated their autistic identities and became self-advocates. Using dis/human theory, it is argued that the autism label provides a framework from which to challenge social exclusion. To reduce risk of homelessness for autistic adults, structural changes are required that reposition accepted forms of personhood.

الملخص: أهداف البحث: توضح هذه المقالة عملية تطوير وحدة تعليمية بين المهنيين في اضطراب طيف التوحد والتي تدمج الكفاءات المهنية وتطبيقاتها بين طلاب مهن الرعاية الصحية المختارين. طريقة البحث: اعتمدت الورقة ''طريقة البحث والتطوير لبحوث التعليم'' من قبل ''بورغ وجال'' كأساس للدراسة. كانت الأساليب المستخدمة هي المقابلات شبه المنظمة ومناقشة مجموعة التركيز واستبانة تقييم الاحتياجات. النتائج: تم التحقق من صحة دليل المقابلة (0.92) ودليل مناقشة المجموعة (0.98) واستبيان تقييم الاحتياجات بمؤشرات الصلاحية (1.00). تم اختبار استبانة تقييم الاحتياجات من أجل الموثوقية. تم إعداد وحدة التعليم بين المهنيين وأدوات التقييم لتقييم فعاليتها على أساس النتائج. كانت مؤشرات الصلاحية للوحدة ومقاطع فيديو المحاكاة (0.98) وسيناريوهات الحالة (0.97) وأدوات التقييم (1.00) واختبار تقييم الكفاءة بين المهنيين (0.98) واختبار تقييم الكفاءة بين المهنيين - قائمة مراجعة المراقبة (1.00). كانت درجات الموثوقية في اختبار تقييم الكفاءة بين المهنيين (0.87) واختبار تقييم الكفاءة بين المهنيين - قائمة مراجعة الملاحظة (0.90). الاستنتاجات: ستساعد هذه الوحدة في التعليمية توفير البيانات والمعلومات الضرورية لأولئك الباحثين الذين يقومون بتدخلات تعليمية مماثلة تركز على كفاءات التعليم بين المهنيين والممارسة التعاونية ، وتحديداً من هذه المنطقة. Abstract: Objective: This article describes the process of developing an interprofessional education (IPE) module in autism spectrum disorder, which incorporates the interprofessional competencies and their applications among selected healthcare professional students. Method: The paper adapted the “Research and Development method for education research” by Borg and Gall as a basis for the study. The methods used were semi-structured interviews, focus group discussion, and a needs assessment questionnaire. Results: An interview guide, group discussion guide, and needs assessment questionnaire were validated with validity indices of 0.92, 0.98, and 1.00, respectively. A needs assessment questionnaire was tested for reliability (r = 0.96). The IPE module and evaluation tools to evaluate its effectiveness were prepared on the basis of the findings. Validity indices for module, simulation videos, case scenarios and the evaluation tools, Interprofessional Competency Assessment Test (IPCAT) and IPCAT-Observation Checklist (IPCAT-OC), were 0.98, 0.97, 1.00, 0.98, and 1.00, respectively. Reliability scores for IPCAT and IPCAT-OC were 0.87 and 0.90, respectively. Conclusion: This module will assist in providing data and necessary information for those researchers who undertake similar educational interventions that focus on the competencies of IPE and collaborative practice, specifically from this region.

Susanne Clinch,1 Stacie Hudgens,2 Elizabeth Gibbons,3 Tom Willgoss,1 Janice Smith,4 Ela Polek,5 Claire Burbridge3 1Patient Centered Outcomes Research, Roche Products Ltd, Welwyn Garden City, Hertfordshire, UK; 2Quantitative Sciences, Clinical Outcomes Solutions, LLC, Tucson, AZ, USA; 3Clinical Outcome Assessments, Clinical Outcomes Solutions Ltd, Folkestone, Kent, UK; 4Global Development, Roche Products Ltd, Welwyn Garden City, Hertfordshire, UK; 5Quantitative Sciences, Clinical Outcomes Solutions Ltd, Folkestone, Kent, UKCorrespondence: Susanne Clinch, Patient Centered Outcomes Research, Roche Products Ltd, 6 Falcon Way, Shire Park, Welwyn Garden City, Hertfordshire, AL71TW, UK, Email susanne.clinch@roche.comPurpose: The VinelandTM Adaptive Behavior Scale is often used in autism spectrum disorder (ASD) trials. The Adaptive Behavior Composite Score (VABS-ABC) is the standardized overall score (the average of the Socialization, Communication and Daily Living skills domains), and the standardized 2-Domain Composite Score (VABS-2DC) is a novel outcome measure (average of the Socialization and Communication domains). A within-person meaningful change threshold (MCT) has not been established for the VABS-2DC. This paper presents a quantitative and qualitative interpretation of what constitutes a meaningful change in these scores to individuals with ASD without Intellectual Disability (ID; IQ≥ 70) and their families, as reported by their study partners (SPs).Participants and Methods: Data were obtained from the aV1ation clinical trial in children and adolescents with ASD and associated exit interviews. The intent-to-treat (ITT) clinical trial population included 308 individuals with autism (85.4% male; average age: 12.4 years [standard deviation (SD)=2.97]); 124 in the child cohort (aged 5 to 12 years; average age: 9.4 years [SD=1.86]), and 184 in the adolescent cohort (aged 13 to 17 years; average age: 14.5 years [SD=1.39]). Study partners of 86 trial participants were included in the Exit Interview Population (EIP): participants represented were 83.7% male, average age: 12.3 years [SD=2.98]). Anchor and distribution-based methods were used to estimate within-person change to support a responder definition, to aid interpretation of the clinical trial data; qualitative data were used to contextualize the meaning of changes observed.Results: A within-person MCT range of 4 to 8 points was proposed for both VABS-ABC and VABS-2DC, which was associated with at least a 1-point improvement on 4 different anchors. Evidence for this within-person MCT was further supported by qualitative data, which suggested any change was considered meaningful to the individual with ASD, as reported by their SP, no matter what the magnitude.Conclusion: A change in standardized score of 4 to 8 points constitutes a within-person MCT on both VABS-ABC and novel VABS-2DC in those with ASD and no ID. A change of this, or more, was reported by the SPs in this trial to be meaningful and highly impactful upon the individuals with ASD and their family.Keywords: Autism, VinelandTM-II, meaningful change threshold, QOL, MCID

The benefits of puppetry for children in therapeutic and educational contexts are well established, with puppets shown to have improved children’s learning, their relationships with adults and other children, and their self-confidence and communication. Adding to this research is an emerging body of evidence that shows the many benefits of puppets for autistic children both as a form of early intervention and as a teaching strategy in the early years of schooling. This paper examines the qualitative literature that describes the value of puppets for autistic teenagers and young people to see how the object of puppets may maintain relevance for older students in secondary school and as they transition out of school and how puppets can enhance the already established advantages seen in younger children. An online search was conducted of peer-reviewed journals through the university library, followed by an additional search using the same keywords on Google Scholar. The review highlighted the possibilities of puppetry for many educational purposes and the wellbeing of autistic adolescents and young people. Also found were a significant gap in the research and the need for further studies that apply puppetry to this diverse population.

Many researchers now believe that autism heterogeneity is likely to include many disorders, but most research is based on samples defined by the DSM-5 Autism Spectrum Disorder (ASD) criteria. However, individuals diagnosed with autism have complex and varied biological causes for their symptoms. Therefore, autism is not a unitary biological entity. And although autism is significantly different from typical development, autism is not a unitary clinical disorder because diagnosed individuals vary in symptom patterns, comorbidities, biomarkers, and gene variants. The DSM-5 ASD criteria were designed to reduce heterogeneity, and there have been many other efforts to reduce autism heterogeneity including using more stringent clinical criteria, dividing autism into low and high functioning groups, creating subgroups, and by studying larger samples. However, to date these efforts have not been successful. Heterogeneity is extensive and remains unexplained, and no autism pathophysiology has been discovered. Most importantly, heterogeneity has hindered the explanatory power of the autism diagnosis to discover drug regimens and effective behavioral treatments. The paper proposes that possible transdiagnostic endophenotypes may reduce autism heterogeneity. Searching for transdiagnostic endophenotypes requires exploring autism symptoms outside of the framework of the DSM-5 autism diagnosis. This paper proposes that researchers relax diagnostic criteria to increase the range of phenotypes to support the search for transdiagnostic endophenotypes. The paper proposes possible candidates for transdiagnostic endophenotypes. These candidates are taken from DSM-5 ASD criteria, from concepts that have resulted from researched theories, and from symptoms that are the result of subtyping. The paper then sketches a possible basis for a future transdiagnostic endophenotypes screening tool that includes symptoms of autism and other neurodevelopmental disorders.

BackgroundEducation should be inclusive, nurturing each individual’s potential, talents, and creativity. However, criticisms have emerged regarding support for autistic learners, particularly in addressing disproportionately high absence levels within this group. The demand for accessible, person-centered, neuro-affirming approaches is evident. This paper provides a program description of a structured absence support framework, developed and implemented during and following the Covid-19 pandemic. We detail creation, content, and implementation.MethodsWe collaborated with stakeholders, reviewed literature and drew on existing theoretical frameworks to understand absence in autistic learners, and produced draft guidance detailing practical approaches and strategies for supporting their return to school. The final resource was disseminated nationally and made freely available online with a supporting program of work around inclusive practices.ResultsThe resource is rooted in neuro-affirming perspectives, rejecting reward-based systems and deficit models of autism. It includes key messages, case studies and a planning framework. It aims to cultivate inclusive practices with an autism-informed lens. The principles promoted include recognizing the child’s 24-hour presentation, parental partnership, prioritizing environmental modifications, and providing predictable, desirable and meaningful experiences at school. Feedback to date has been positive in terms of feasibility, face validity, and utility.ConclusionThis novel, freely available resource provides a concise, practical framework for addressing absence in autistic learners by cultivating a more inclusive, equitable, and supportive educational system in which autistic individuals can thrive.

Differences between autistic and nonautistic people are often framed as deficits. This research considers whether some of these differences might actually be strengths. In particular, autistic people tend to be less sensitive to their social environment than nonautistic people who are easily influenced by the judgments, opinions, beliefs and actions of others. Because autistic people are less susceptible to social influence, as employees they are more likely to take action when they witness an operational inefficiency or an ethical problem in the organization. By reporting problems, autistic employees may contribute to the introduction of innovations and improvements in organizational processes and effectiveness that result in superior performance. This paper considers whether and the extent to which these differences between autistic and nonautistic employees are moderated by “moral disengagement,” a set of interrelated cognitive mechanisms that allow people to make unethical decisions by deactivating moral self-regulatory processes. While previous research has shown that moral disengagement is related to unethical decisions, there is no research on whether and the extent to which autistic people are vulnerable to moral disengagement. Thirty-three autistic employees and 34 nonautistic employees completed an on-line survey to determine whether differences between autistic and nonautistic employees with regards to (1) likelihood they would voice concerns about organizational dysfunctions, and (2) degree to which they were influenced by the presence of others when deciding to intervene, are moderated by individual differences in moral disengagement. As predicted, autistic participants scored lower on moral disengagement than nonautistic participants. In terms of the moderating effects of moral disengagement, the results are mixed. Although moral disengagement reduced intervention likelihood, there was not a difference between autistic and nonautistic employees in the degree to which intervention likelihood was changed by an individual’s level of moral disengagement. However, there was a difference between autistic and nonautistic employees in the extent to which acknowledging the influence of others was affected by moral disengagement. These findings suggest that autistic adults are not just more likely to intervene when they witness dysfunction or misconduct in an organizational context; they are also less likely to engage in unethical behavior in general due to lower levels of moral disengagement. The reduced susceptibility to the bystander effect evidenced by autistic adults in the workplace may be accounted for, in part, by their lower levels of moral disengagement compared with nonautistic adults.

IntroductionAutism is a global health priority with an urgent need for evidence-based, resource-efficient, scalable supports that are feasible for implementation in low- and middle-income countries (LMICs). Initiating supports in the toddler years has potential to significantly impact child and family outcomes. The current paper describes the feasibility and outcomes associated with a Canadian-developed caregiver-mediated intervention for toddlers (the Social ABCs), delivered through a clinical service in Goa, India.MethodsClinical staff at the Sethu Centre for Child Development and Family Guidance in Goa, India, were trained by the Canadian program development team and delivered the program to families seen through their clinic. Using a retrospective chart review, we gathered information about participating families and used a pre-post design to examine change over time.ResultsSixty-four families were enrolled (toddler mean age = 28.5 months; range: 19–35), of whom 55 (85.94%) completed the program. Video-coded data revealed that parents learned the strategies (implementation fidelity increased from M = 45.42% to 76.77%, p

Recent advances in genetic and epigenetic research have underscored the significance of 5-hydroxymethylcytosine (5hmC) in neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and intellectual disability (ID), revealing its potential as both a biomarker for early detection and a target for novel therapeutic strategies. This review article provides a comprehensive analysis of the role of 5hmC in NDDs by examining both animal models and human studies. By examining mouse models, studies have demonstrated that prenatal environmental challenges, such as maternal infection and food allergies, lead to significant epigenetic alterations in 5hmC levels, which were associated with NDDs in offspring, impacting social behavior, cognitive abilities and increasing ASD-like symptoms. In human studies, researchers have linked alterations in 5hmC levels NDDs through studies in individuals with ASD, fragile X syndrome, TET3 deficiency and ID, specifically identifying significant epigenetic modifications in genes such as GAD1, RELN, FMR1 and EN-2, suggesting that dysregulation of 5hmC played a critical role in the pathogenesis of these disorders and highlighted the potential for targeted therapeutic interventions. Moreover, we explore the implications of these findings for the development of epigenetic therapies aimed at modulating 5hmC levels. The review concludes with a discussion on future directions for research in this field, such as machine learning, emphasizing the need for further studies to elucidate the complex mechanisms underlying NDDs and to translate these findings into clinical practice. This paper not only advances our understanding of the epigenetic landscape of NDDs but also opens up new avenues for diagnosis and treatment, offering hope for individuals affected by these conditions.

BackgroundSocial ABCs is a caregiver-mediated Naturalistic Developmental Behavioral Intervention for toddlers with confirmed/suspected Autism Spectrum Disorder (ASD), with evidence in controlled research settings. Information is lacking on implementation in community settings. We reported on the treatment effectiveness of this program within a community setting, and the current paper describes the implementation phase of this work. Distinguishing between treatment and implementation effectiveness is critical for transporting interventions from laboratory to community.ObjectivesDescribe the implementation of Social ABCs through a large public autism service, supported by a research-community partnership.MethodsWe describe this project through the Exploration, Preparation, Implementation, Sustainment (EPIS) framework as it focuses on implementation of evidence-based practices in publicly funded services. We apply this framework to the reporting stage. This project took place in the context of a 3-year government-funded pilot at a hospital-based publicly funded autism service. Participants: Program developers; Autism Service team; toddlers with suspected/confirmed ASD aged 14–34 months (M = 25.18 months) and their caregivers. Training/supervision: Provided by program developers at tapering intensity. Evaluation: Caregivers completed the Caregiver Diary and satisfaction surveys. We explored training processes, intervention uptake, acceptability, adaptations to fit community context, appropriateness, perceived impact, and facilitators/barriers.ResultsSix coaches were trained to fidelity, and three of these were further trained as Site Trainers. 183 clinically referred families enrolled and 89.4% completed the 12-week program. Caregivers reported increases in adherence and competence, high satisfaction and perceived benefits for their children. Coaches reported high satisfaction. Toddlers were appropriately identified to receive the intervention. Referral processes improved, including decreased referral age, and increased family readiness for diagnostic assessment and subsequent services.ConclusionsSocial ABCs was successfully implemented in a community service through a research-community partnership. The program was feasible, acceptable, and appropriate within a community context. Drivers of success included funding, institutional support, shared decision-making, adaptations to fit context, leadership support, perceived positive impact, and commitment to evaluation.

Radical transformation of Ireland’s special education system has occurred over the past three decades. National and international policy and legislative drivers for a more inclusive approach to education have resulted in greater levels of mainstreaming, with one exception. Provision for autistic children is increasingly provided through special classes: discrete classes attached to mainstream schools. This paper presents findings from a qualitative exploration of the benefits and challenges attributed to autism class provision in mainstream primary schools in Ireland, from the perspective of teachers and school principals. The findings reveal a role for autism special class teachers that is multi-faceted, rewarding, challenging, and directly related to the extent to which the special class is systematically included with whole school policy and practice. The significance of leadership and collaboration in promoting inclusive approaches to autism class provision features strongly in the findings and influences schools’ willingness to establish special classes. Micro-exclusion emerged as a theme and is linked to school culture and ethos. Findings contribute unique perspectives of school personnel, and recommendations create awareness of the benefits and challenges associated with autism special class provision and inform future innovation at a time when inclusive policy agendas and practices relating to autism provision arguably contradict each other.

Purpose – The aim of this paper is to share the details of a multidisciplinary approach, which includes occupational therapy, and to review the factors that should be considered in the evaluation and treatment of children with autism spectrum disorders (ASD) who are excessively selective in their food choices. Issues in this area are complex and often related to several complementary domains (medical, nutritional, psychosocial, sensorimotor, etc.). However, feeding disorders are frequently assessed and treated from a single discipline and important issues are missed or confounded. Design/methodology/approach – A team of experienced clinicians in the field of paediatric feeding disorders gathered the knowledge and experience they acquired from working with individuals with ASD as well as with individuals with other neurodevelopmental diagnosis. A review of current literature in paediatric feeding disorders was used to document and explicate the multifactorial nature of feeding disorders in children with ASD and justify the need for a multidisciplinary approach to issues in this area. Findings – Feeding disorders in children with ASD are linked to multiple sensory, motor, behavioural, nutritional and gastrointestinal comorbidities. A multidisciplinary approach is needed and increasingly recommended. However, multidisciplinary teams, specialised in the care of children with ASD and feeding issues, continue to be difficult to locate and access for families. The authors sought to highlight the signs of feeding problems in children with ASD from different domains and share a model of a multidisciplinary approach that can lead to more successful interventions. Originality/value – The detailed description of the domains linked to feeding issues and the clinical descriptions provided throughout the paper create a roadmap for other clinicians aiming to set up similar teams.

Purpose: An increasing number of scholarly publications on autism spectrum disorder (ASD) have urged researcher interest in this topic; however, there is still a lack of quantitative analysis. Therefore, this study aims to cover the knowledge gap between the amount of literature published on ASD research on architectural and designers' perspectives compared to the medical and psychological fields. The study has analyzed global research output on ASD from a designer's perspective to recognize this gap related to designing the physical environment. Methodology: The bibliometric method was employed to analyze the published literature from 1992–to 2021. 812 papers were downloaded from the Web of Science for analysis based on annual growth of literature, prolific authors, authorship pattern, organizations, countries, international collaboration, and subject development by keywords and thematic map analyses. Various bibliometric and scientometric software was used to analyze the data, namely Bibexcel, Biblioshiny, and VOS viewer. Results: The812 research papers were published in 405 sources. 2019 appeared as a productive year (NP=101), and 2014 received the highest number of citations (TC=6634). Researchers preferred to publish as journal articles (NP=538; TC=24922). The University of Toronto, Canada, was identified as a productive institution with 42 publications and 5358 citations. The USA was the leading producing country with 433 publications, and most of the researchers published in the journal "Scientific Reports" (NP=16). The word autism (NP=257) and architecture (NP=165) were more frequently used keywords. Conclusion: The study identified a massive gap in the development of literature in ASD for architecture design and built environment perspective, the most important and trending keywords are missing, and the analyses also showed a lack of subject development. The authors have suggested areas and keywords for further research to fulfill the gap in the future.

One of the most challenging problems when diagnosing autism spectrum disorder (ASD) is the need for long sets of data. Collecting data during such long periods is challenging, particularly when dealing with children. This challenge motivates the investigation of possible classifiers of ASD that do not need such long data sets. In this paper, we use eye-tracking data sets covering only 5 s and introduce one metric able to distinguish between ASD and typically developed (TD) gaze patterns based on such short time-series and compare it with two benchmarks, one using the traditional eye-tracking metrics and one state-of-the-art AI classifier. Although the data can only track possible disorders in visual attention and our approach is not a substitute to medical diagnosis, we find that our newly introduced metric can achieve an accuracy of 93% in classifying eye gaze trajectories from children with ASD surpassing both benchmarks while needing fewer data. The classification accuracy of our method, using a 5 s data series, performs better than the standard metrics in eye-tracking and is at the level of the best AI benchmarks, even when these are trained with longer time series. We also discuss the advantages and limitations of our method in comparison with the state of the art: besides needing a low amount of data, this method is a simple, understandable, and straightforward criterion to apply, which often contrasts with “black box” AI methods.

This theoretical paper addresses the issue of epistemic injustice with particular reference to autism. Injustice is epistemic when harm is performed without adequate reason and is caused by or related to access to knowledge production and processing, e.g., concerning racial or ethnic minorities or patients. The paper argues that both mental health service users and providers can be subject to epistemic injustice. Cognitive diagnostic errors often appear when complex decisions are made in a limited timeframe. In those situations, the socially dominant ways of thinking about mental disorders and half-automated and operationalized diagnostic paradigms imprint on experts’ decision-making processes. Recently, analyses have focused on how power operates in the service user–provider relationship. It was observed that cognitive injustice inflicts on patients through the lack of consideration of their first-person perspectives, denial of epistemic authority, and even epistemic subject status, among others. This paper shifts focus toward health professionals as rarely considered objects of epistemic injustice. Epistemic injustice affects mental health providers by harming their access to and use of knowledge in their professional activities, thus affecting the reliability of their diagnostic assessments.

The assumption that autistic individuals do not have the theory of mind – the social-cognitive ability to understand other people by attributing mental states to them – has been widespread in the psychological literature. However, the empirical evidence from the original research and its replications failed to prove and support autistic mind-blindness. Yet, it is still present in literature on autism spectrum. Meanwhile, convincing research, that has been conducted among autistic researchers and their allies, is often overlooked by non-autistic specialists. This paper focuses on how autistic autism researchers have been influencing their field of study and how academy can benefit from their work.

We are now at a transition point in autism conceptualisation, science, and clinical practise, where phenomenology could play a key role. This paper takes a broad view of the history of phenomenological perspectives on the autism concept and how this has evolved over time, including contemporaneous theory and methods. Early inquiry from a clinical perspective within the tradition of classical continental phenomenology, linked closely to the consideration of schizophrenia, is contrasted with emerging observations of child development and a period in the second half of the twentieth century of scientific inquiry into a behavioural autistic phenotype where there was little or no phenomenological aspect; a phenotype that has determined the recent scientific and clinical conceptualisation of autism within current nosology. We then mark a more recent reawakening of interdisciplinary interest in subjective experience and phenomenological inquiry, which itself coincides with the increasing prominence and salience of the neurodiversity movement, autistic advocacy, and critical autism studies. We review this emerging phenomenological work alongside a contemporaneous clinical phenomenology perspective and representations of autistic experience from within the extensive literature (including life writing) from autistic people themselves; all perspectives that we argue need now be brought into juxtaposition and dialogue as the field moves forward. We argue from this for a future which could build on such accounts at a greater scale, working toward a more co-constructed, systematic, representative, and empirical autistic phenomenology, which would include citizen and participatory science approaches. Success in this would not only mean that autistic experience and subjectivity would be re-integrated back into a shared understanding of the autism concept, but we also argue that there could be the eventual goal of an enhanced descriptive nosology, in which key subjective and phenomenological experiences, discriminating for autism, could be identified alongside current behavioural and developmental descriptors. Such progress could have major benefits, including increased mutual empathy and common language between professionals and the autistic community, the provision of crucial new foci for research through aspects of autistic experience previously neglected, and potential new supportive innovations for healthcare and education. We outline a programme and methodological considerations to this end.

Autism spectrum disorder (ASD) is diagnosed based on socio-communicative difficulties, which are believed to result from deficits in mentalizing, mainly evidenced by alterations in recognizing and responding to the mental states of others. In recent years, efforts have been made to develop mentalization-based treatment (MBT) models for this population. These models focus on enhancing individuals’ ability to understand and reflect on their own mental states, as well as those of others. However, MBT approaches for people with ASD are limited by their existing theoretical background, which lacks a strong foundation grounded in neuroscience-based evidence properly integrated with attachment, and mentalizing. These are crucial aspects for understanding psychological processes in autism, and as such, they play a pivotal role in shaping the development of tailored and effective therapeutic strategies for this specific population. In this paper we review evidence related to the neurobiological, interpersonal, and psychological dimensions of autism and their implications for mentalizing processes. We also review previous mentalization-based frameworks on the psychosis continuum to provide a comprehensive understanding of attachment, neurobiology, and mentalization domains in therapeutic approaches for autism. After presenting a synthesis of the literature, we offer a set of clinical strategies for the work with children with autism. Finally, we provide recommendations to advance the field towards more robust models that can serve as a basis for evidence-based therapeutic strategies.

Sustainable Development Goal 4 from the United Nations 2030 Agenda, focus on ensuring inclusive and equitable quality education and promoting lifelong learning opportunities for all. Inclusive education is a key component of sustainable development goal 4, and assistive technology is a critical factor in achieving it. In this context, this paper introduces the development of an immersive virtual reality system with conversational skills for inclusive learning processes. The idea of this work is to provide an assistive technology to motivate, educate, and train students with disabilities in a more inclusive way. In order to improve the user experience, the system was developed to work in a CAVE-like immersive environment using Natural Language Processing through a Semantic Embodied Conversational Agent. This work highlights that assistive technology can promote educational, psychological, and social benefits for students with disabilities. The use of assistive technology can enable academic engagement and social participation and be transformative from a psychological perspective. A case study was conducted on children with autism, which showed encouraging results of the system as an assistive technology for teaching and learning.

There is strong evidence for the existence of a high comorbidity between autism and psychosis with percentages reaching up to 34. 8% and several significant implications for treatment and prognosis of these patients. However, the identification of comorbid psychosis in patients with Autism Spectrum Disorder represents a complex challenge from a psychopathological point of view, in particular in patients with greater deficits in verbal communication. Intercepting the onset of a psychotic breakdown in autism may be very difficult, both disorders in fact occur along a phenotypic continuum of clinical severity and in many cases, psychotic symptoms are present in an attenuated form. In this paper, we reviewed the available scientific literature about comorbidity between psychosis and autism, focusing our attention on four specific dimensions: delusions, hallucinations, negative symptoms, and clinical course. The aim of this paper is to provide clinical tools to identify these psychotic phenomena in autistic patients, even when they occur in their attenuated form.

Many children in Bangladesh have ASD. The rate of Autism Spectrum Disorder (ASD) is increasing in Bangladesh and other countries, day by day. Autistic children find it difficult to talk and express themselves regarding what they want or not. Also, some autistic children are not comfortable dealing with the outside world. For example, they do not feel comfortable in social settings or in any program. There are some schools and organizations where many kind-hearted people are trying to help those autistic children in many ways. We all know that there is no cure for autism. But it can be reduced. After good treatment, an autistic child can recover. To help the treatment process, we have developed an interactive app that will help them to cope with social events and places, as well as help them with verbal tasks. We have developed a model to access the severity of an autistic child and help the child to improve communication. This paper presents our interactive app and also provides a concise comparison of it with existing apps to support children with ASD.

Background and Objectives: There is a paucity of research studies, especially from the low- and middle-income countries, on gender-specific clinical profiles of autism and whether this lack of information is a barrier for early diagnosis among females. The present paper examined the gender differences in the timing of identification of autism among children. Methods: The case records diagnosed children with autism spectrum disorder with no documented intellectual disability (IQ 0.05). There was a significant difference in the timing of the identification of autism by gender and females were found to be identified at significantly older ages relative to males (t = 2.13, P = 0.034). Conclusions: There is an imperative need to develop more gender-sensitive diagnostic tools incorporating the sex-specific differences in clinical presentation to improve the assessment of autism in girls.