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Autism spectrum disorder (ASD) is an etiologically heterogeneous neurodevelopmental condition that eludes a single explanation or cure. Epidemiological studies reveal risk factors, relevant comorbidities, and behavioral correlates to reach a better understanding of ASD. To contribute such data from an understudied ASD population, this paper presents epidemiological data from a Turkish sample of individuals with ASD (n = 911, 748 boys (82.1%) and 163 girls (17.9%) between 1 and 18 years of age). Average age at diagnosis was 31.06 +/- 11.88 months, and the male-to-female ratio was 4.6:1. Three in 4 individuals with ASD had obsessive behaviors, and 1 in 4 had allergic conditions, inappropriate sexual behaviors, self-harming behaviors, and harmful behaviors towards others. One in 3 received a dietary treatment for at least 3 months; almost half received vitamin supplements; the majority (70%) did not experience constipation; and 2 in 3 were picky eaters. This paper presents data on the age of diagnosis, gender ratios, accompanying behaviors, and dietary interventions in Turkish individuals with ASD, which are topics of current research interest about ASD. Such data from non-Western populations may supplement epidemiological knowledge gained from Western populations to help reach a more comprehensive understanding of this condition with many unknowns. WOS:000658616700001 Q4

Objectives:Autism spectrum disorder is a neurodevelopmental conditiona that manifests with impairments in social interactions and communication and repetitive behaviors and restricted interests. It is known that autism spectrum disorder is accompanied by medical comorbidities, and as the number of accompanying comorbidities increase, the intensity of aberrant behaviors also increases in individuals with autism spectrum disorder. Yet, how subgroups of aberrant behaviors relate to physical complaints with unknown primary etiology in autism spectrum disorder has not yet been investigated. Understanding and solving these physical problems can improve the quality of life of individuals with autism spectrum disorder, as interventions should not only address core autism spectrum disorder symptoms but also all physical complaints affecting an individual’s life. Additionally, an examination of such a relation may help better understand the underlying mechanisms of autism spectrum disorder.Materials and Methods:In this study, in 64 individuals with autism spectrum disorder (11 girls) aged between 6 and 18 years, the relationship between the physical complaints subcategory of Child Behavior Checklist and the severity of autism spectrum disorderaccording to Childhood Autism Rating Scale was examined. Additionally, the relationship between physical complaints and the subgroups of the Aberrant Behavior Checklist was evaluated.Results:A significant positive correlation was found between physical symptoms and autism spectrum disorder severity. Among the five factors of this checklist (irritability, agitation, crying; lethargy, social withdrawal; stereotypic behavior; hyperactivity, non-compliance; inappropriate speech), only hyperactivity/non-compliance and inappropriate speech correlated with physical complaints. This relationship was independent of sociodemographic factors such as child age, parental age, and parental education.Conclusion:These findings indicate that children with autism spectrum disorder who exhibit extreme mobility and disobedience are at risk of physical discomfort. In addition to psychiatric and psychologic examinations, a comprehensive and holistic approach should be adopted for individuals with autism spectrum disorder, especially for those individuals experiencing physical problems.

Background: Sensory problems are a core symptom of autism spectrum disorder (ASD) and tailoring the interventions according to sensory profiles yields better prognosis. Objective: This study profiled the sensory symptoms of children with ASD and their sociodemographic and behavioral correlates. Material and Methods: The sample included 911 Turkish children with ASD (748 male and 163 female) aged between 1-18 years. The study was conducted as an internet survey. Results: Almost all children had a sensory problem in at least one sensory domain. The parents stated that almost half of the children received sensory integration therapy (SIT) and that 3 out of 4 of these children benefited from this method. The rate of receiving SIT for their children with ASD was higher in children of mothers and fathers who had higher education levels. Two out of 3 parents reported that their children have hyperactivity, sleep problems, and food selectivity. Obsessive behaviors were 2 times higher in children with ASD who took non-food objects in their mouths, and almost 7 times more common in children who watched rotating objects. The rates of spinning around themselves, taking nonfood objects in their mouths, and hyperactivity were significantly higher in children who experienced sleep-related problems. Conclusion: This study documents the sensory problems of Turkish children with ASD and how they relate with other behavioral domains, which can be useful for determining the most appropriate therapeutic approaches., Amaç: Duyusal sorunlar, otizm spektrum bozukluğu (OSB)’na sıklıkla eşlik etmektedir. OSB’ye yönelik müdahaleleri bireylerin duyusal profillerine göre adapte etmek daha iyi bir prognoz sağlayabilir. Bu çalışma, OSB’li çocukların duyusal semptomlarını ve bu semptomların onların sosyodemografik ve davranışsal özellikleri ile ilişkilerini incelemiştir. Gereç ve Yöntem: Örnekleme, 1-18 yaşları arasındaki 911 Türk OSB’li (748 erkek ve 163 kız) çocuk dahil edilmiştir. Çalışma, bir internet araştırması olarak gerçekleştirilmiştir. Bulgular: Dahil edilen çocukların neredeyse tamamının en az bir duyusal alanda problem yaşadığı, ebeveynleri tarafından bildirilmiştir. Ebeveynlerin yarısı, çocuklarının duyusal bütünleme terapisi (DBT) aldığını ve alan çocukların 4’te 3’ünün bu yöntemden yararlandığını belirtmiştir. DBT alma oranının, yüksek eğitim düzeyine sahip annelerin ve babaların çocuklarında daha yüksek olduğu görülmüştür. Her 3 ebeveynden 2’si çocuklarında hiperaktivite, uyku sorunu ve gıda seçiciliği durumlarının görüldüğünü bildirmiştir. Ayrıca, obsesif davranışların, ağızlarında yiyecek olmayan cisimleri alan OSB’li çocuklarda 2 kat, dönen cisimleri izleyen çocuklarda ise yaklaşık 7 kat daha fazla görüldüğü belirlenmiştir. Uykuya bağlı problemler yaşayan çocuklarda, kendi etrafında dönme, ağızlarında yiyecek olmayan nesneler alma ve hiperaktivite oranları anlamlı derecede yüksek bulunmuştur. Sonuç: Bu çalışma, OSB’li Türk çocuklarının duyusal sorunlarını ve bu sorunların diğer davranışsal alanlarla ilişkilerini göstermektedir. Böylece, OSB’li bireyler için en uygun terapötik yaklaşımlara yönlendirmelerini sağlamakta fayda sağlayabileceği düşünülmektedir..

Recently, the need for a mental health technology revolution during COVID-19 was noted (1). These authors suggested that interventions should be targeted toward vulnerable groups and adapted to their individual needs (1), and we have expanded this concept here. One vulnerable group that will benefit from such a technology revolution and targeted interventions comprises individuals with Autism Spectrum Disorder (ASD). We discuss how technology can be leveraged to address the specific challenges experienced by these individuals and their families during the pandemic.

Individuals with autism spectrum disorder (ASD) have difficulties in social interactions. The cognitive domains that support these interactions include perceptual decision-making, timing, and error-monitoring, which enable one to appropriately understand and react to the other individual in communicative settings. This study constitutes a comprehensive exploration of decision-making and interval timing in ASD as well as the first investigation of error-monitoring abilities of individuals with ASD regarding their performance in the corresponding domains. We found that children with ASD fared similar to typically developing (TD) children in their first-order task performance in two-alternative forced choice perceptual decision-making and temporal reproduction tasks as well as the secondary tasks (signal detection and free finger tapping tasks). Yet, they had a deficit in error-monitoring in both tasks where their accuracy did not predict their confidence ratings, which was the case for the TD group. The difference between ASD and TD groups was limited to error-monitoring performance. This study attests to a circumscribed impairment in error-monitoring in individuals with ASD, which may partially underlie their social interaction problems. This difficulty in cognitively evaluating one's own performance may also relate to theory of mind deficits reported for individuals with ASD, where they struggle in understanding the mental states and intentions of others. This novel finding holds the potential to inform effective interventions for individuals with ASD that can target this error-monitoring ability to have broad-ranging effects in multiple domains involved in communication and social interaction. Autism Res 2019, 12: 239-248 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Decision-making, timing, and error-monitoring are three of many abilities that underlie smooth social interactions. To date, these domains have been only investigated separately, but given their interactive role in social interactions that are impaired in ASD, we conducted the first study to investigate them together. Children with ASD were as successful as typically developing children in their task performances, but unlike them, were unaware of their errors in both decision-making and timing tasks. This deficit that is limited to error-monitoring can contribute to unraveling the unique cognitive signature of ASD and to formulating interventions with positive implications in multiple domains.

Recent evidence implicates immune alterations and gut microbiota dysbiosis in at least some subpopulations of individuals with autism spectrum disorder (ASD). Immune and gut alterations in ASD have mostly been studied separately, and the reviews and theoretical models up to now have mainly considered the immune system as one of the routes for gut-brain communication. We take a different perspective and consider possible common mechanisms of action for the gut microbiota and inflammation on the neural basis of ASD. We propose these to be their effects on ASD-susceptibility genes, neurodevelopment, and intestinal and blood-brain barrier integrity. We then use these common mechanisms to offer pathways for potentially beneficial effects of early-life probiotics on the neural development in ASD. This new perspective yields a conceptual framework for creating effective preventions for mothers at risk of giving birth to children with ASD. Such a framework may also inform effective interventions targeting these common mechanisms of action, which may be shared in many ASD cases regardless of their different etiological profiles. Probiotics may be one example of such preventions and interventions. Finally, the common mechanisms offered by this perspective can be useful in the search of comprehensive theories that can account for the complete neurobiological and behavioral symptoms of ASD.

During disasters and pandemics, vulnerable populations such as patients with mental conditions are known to be overly influenced. Yet, not much is known about how the individuals with autism spectrum disorder (ASD), one of the most common neurodevelopmental conditions globally with a prevalence of 1%, are affected from health-related disasters, especially the current Covid-19 pandemic. Therefore, we conducted an investigation of how individuals with ASD responded to Covid-19 in terms of comprehension and adherence to implemented measures; changes in their behavioral problems; and how their caregivers' anxiety levels relate with these behavioral changes. Our sample consisted of 87 individuals with ASD (15 girls; ages ranged from 3-29, with an average of 13.96 +/- 6.1). The majority of our sample had problems understanding what Covid-19 is and the measures it requires. They also had challenges in implementing social distance and hygiene-related regulations of the pandemic. The majority stopped receiving special education during this period. We observed a Covid-19-related clinical presentation that resembled PTSD in individuals with ASD in terms of increased stereotypies, aggression, hypersensitivity, behavioral problems, and sleep and appetite alterations. All subscales of Aberrant Behavior Checklist (ABC) differed significantly between before and after the pandemic conditions. The number of hours the children slept significantly decreased from before to during Covid-19. The anxiety levels of caregivers were high and correlated with the current behavioral problem levels of their children, but not with the level of their behavioral problems before the pandemic. The difference in ABC total score and specifically the lethargy/social withdrawal subscale score predicted parents' anxiety score. Our results suggest that the Covid-19 period inflicts specific challenges to individuals with ASD and their caregivers, underlining the need for targeted, distance special education interventions and other support services for this population., NA

Amac: Otizm spektrum bozuklugu, dunya capinda yayginligi giderek artan fakat sebepleri hala tamamen bilinmeyen, norogelisimsel bir farkliliktir. Otizmli bireyler, sosyal beceri ve iletisim zorluklari yasarlar; tekrar eden ve kisitlayici ilgi alanlari ile davranislar gosterirler. Otizmin bilinen bir tedavisi veya otizmin butun unsurlarini aciklayabilen kapsamli bir model henuz yoktur. Yontem: Son yillarda bircok hastaligin rejeneratif tedavisinde oldukca yaygin olarak kullanilan kok hucrelerden, uyarilmis pluripotent kok hucre (UPKH), otizmin sebeplerinin daha iyi anlasilmasi icin umut vaat edicidir. Bulgular: UPKH’ler ile yurutulen otizm modellemeleri, otizme neden olan mekanizmalarin anlasilmasi, bozukluklarin duzeltilmesi ve kisiye ozel tedavilerin gelistirilmesi icin cesitli firsatlar sunmaktadir. Sonuc: Bu derleme, UPKH’lerin su ana kadar otizmdeki kullanim alanlarini, avantajlarini ve UPKH modellemeleri ile elde edilen bulgulari incelemektedir.

Changing teacher willingness to teach inclusive classes is critical in achieving optimal outcomes for students with autism spectrum disorder (ASD). The present study investigated the mechanisms underlying the effects of a teacher training in special education strategies for students with ASD on mainstream school teachers' behavioral intentions toward inclusive education. Specifically, the role of attitudes and autism self-efficacy were explored as mediators in this process. The sample comprised 763 mainstream school teachers from eleven cities in Northeastern Turkey who participated in an intensive training that included special education strategies for students with ASD, evidence-based special education applications, and inclusive education practices. Statistical mediation analyses revealed that the training increased teachers' willingness to teach inclusive classes and intention to implement special education techniques in the regular education classroom through increasing their autism self-efficacy. However, though attitudes toward inclusive education was a significant predictor of both willingness to teach inclusive classes and intent to use special education techniques, the training did not improve attitudes. Based on these findings, additional strategies or components to change attitudes toward inclusive education were recommended to be integrated into the teacher training programs on special education strategies for inclusive education.

We propose an unprecedented intervention for individuals with autism spectrum disorder (ASD) and their parents: the social living complex. Unlike existing social skills interventions, peer-mediated interventions here are not limited to the school/experiment duration and setting. Whereas other supported living services house adults with ASD only, here children with ASD and their families live and interact with typically developing (TD) individuals. Another novelty is support groups for parents of children with ASD, who report feeling higher levels of stress than parents of TD children and children with other disabilities, feeling isolated, and not receiving social support. This complex will enable the practice and generalization of schooled skills in the lives of children with ASD and foster an accepting, autism-friendly community.

Autism spectrum disorder (ASD) is a neurodevelopmental condition manifesting with impaired social interaction and communication, and restricted and repetitive behaviors and interests. In this perspective Journal article, a more comprehensive approach than the gut-brain axis, hereby termed the "gut-immune-endocrine-brain" axis, is taken, based on which a personalized treatment plan for ASD is presented. ASD has no known etiology or cure, making desperate parents willing to try any treatment that worked for an individual with ASD, without much regard for its effectiveness, safety or side effects. This has been the case for restrictive dietary interventions as gluten-free/casein-free and ketogenic diets and recently, probiotics have emerged as the new such fad. One of the concerns about these dietary and probiotic treatments is their non-specificity: they may not be effective for all individuals with ASD, not all probiotic strains may have the beneficial qualities advertised indiscriminately for probiotics, and strains conferring benefits in one condition may not be probiotic in another. Not all children with ASD show immune reactivity to dietary proteins in wheat and milk, and wheat and milk may not be the only dietary elements to which reactivity is exhibited, where dietary aquaporins that resemble human aquaporins may elicit antibody reactivity in genetically susceptible individuals, which may include individuals with ASD. These observations are utilized to formulate a three-step plan to create effective, targeted, personalized treatments with as few side effects as possible, enabled by a systems approach connecting the various findings for dietary, immune, and neuroautoimmune reactivity in individuals with ASD., NA

We conducted the first study on Turkish children with autism and tablet computers, with a web-based iPad application designed especially for them. We performed a pilot study on three Turkish boys of different ages with autism to observe their reactions to the tablet application and its effectiveness in teaching the sequencing skill, which is part of their educational curriculum. Our application had a testing session with no prompts or rewards and a teaching session with prompts, rewards, and demonstration of correct responses. First, our participants played the testing session to determine their baseline sequencing abilities. Next, they played the teaching session. Finally, they played the testing session again to see if they were now able to sequence the cards on their own. Through this application, the 11-year-old boy's sequencing skills improved without external help, via only the prompts and reinforcements of the iPad application. The application was not enough to teach sequencing to the 4-year-old, who required external help, and it was too simple for the 15-year-old, who did not use any prompts and quickly became bored. Based on our findings, we discuss how to improve similar sequencing applications and offer suggestions for designing iPad applications for individuals with autism.