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

Nutritional Approaches in Autism Spectrum Disorder: A Scoping Review

PURPOSE OF REVIEW

This review was conducted to discuss the etiology of autism in the light of current information, to draw attention to the fact that defects in different biological mechanisms cause autism, and to examine the effectiveness of dietary interventions and supplements in relieving ASD symptoms.

RECENT FINDINGS

Autism spectrum disorder (ASD) is an extremely heterogeneous condition characterized by delays in reciprocal social interaction and communication skills, stereotyped behaviors, and a narrowed range of interests and limited activities. Comorbid conditions such as cognitive impairment, epilepsy, psychiatric diseases, and behavioral symptoms such as impaired social communication, repetitive behaviors, lack of interest in the environment, nutritional disorders, gastrointestinal diseases and abnormal (dysbiotic) states, sleep disorders, and dysmorphism are frequently encountered in individuals with ASD. Although nutrition is one of the environmental factors affecting ASD, it can also be effective in alleviating the behavioral and gastrointestinal symptoms of ASD. Various dietary models (GFCF diet, low glycemic index diet, ketogenic diet, specific carbohydrate diet, Mediterranean diet, GAPS, Feingold, Candida body ecology, allergy elimination diets, etc.) and supplements (vitamin D, polyunsaturated fatty acids, probiotics and prebiotics, phytochemicals) can be used to alleviate symptoms in individuals with ASD. The effectiveness and reliability of dietary interventions in individuals with ASD are a matter of significant debate, and the evidence for these practices is limited. Furthermore, there is no consensus on establishing an ideal nutritional model for individuals with ASD.

Prenatal Exposure To Valproic Acid Induces Increased Autism-Like Behaviors and Impairment of Learning and Memory Functions in Rat Offspring by Upregulating ADAM10 Expression

Autism spectrum disorder (ASD) involves a complex neurodevelopmental pathogenesis. A disintegrin and metalloproteinase 10 (ADAM10) plays a crucial role in embryonic brain development and neural network stability. This study aimed to investigate the influence of ADAM10 on excitation/inhibition (E/I) balance, autism-like behaviors, and learning and memory dysfunction in rats prenatally exposed to valproic acid (VPA) and determine potential intervention strategies. The VPA-exposed group exhibited increased levels of ADAM10 and secreted amyloid precursor protein-α (sAPPα). Moreover, overexpression of glutamate decarboxylase 1 and N-methyl-D-aspartate receptors was observed. High-performance liquid chromatography-mass spectrometry revealed elevated levels of glutamate, glutamine, and γ-aminobutyric acid, as well as an E/I imbalance in the VPA group. Additionally, narrower synaptic clefts as well as increased postsynaptic density and synaptic vesicles were observed. Remarkably, intraperitoneal administration of ADAM10 inhibitor during the critical period of synaptic development significantly improved ASD-like behavior and learning and memory function in VPA-exposed rats. This intervention effectively reduced abnormally high sAPPα levels in the prefrontal cortex and corrected abnormal E/I balance. Thus, inhibiting ADAM10 overexpression may improve the E/I imbalance, alleviate core symptoms of ASD, and improve learning and memory dysfunction. The use of ADAM10 inhibitor represents a potential therapeutic strategy for treating ASD patients with intellectual disabilities.

A mixed methods systematic review of assistance dogs for people with autism

OBJECTIVES

To critically examine and synthesise the available evidence regarding the impact of assistance dogs on individuals with autism.

STUDY DESIGN

Mixed methods systematic review with meta-analysis of quantitative data and meta-aggregation of qualitative data. Studies were eligible for inclusion if they included participants with autism and data describing the impact, effectiveness, or participant experience with an assistance dog or a companion dog.

DATA SOURCES

CENTRAL, Embase, MEDLINE, and PsycINFO.

DATA SYNTHESIS

Fourteen studies (one randomised controlled trial, three cohort, seven cross-sectional, and three single-arm studies) were included in the meta-analysis and 13 studies (eight cross-sectional, three longitudinal, and two case studies) were included in the meta-aggregation. There was some quantitative evidence that assistance dogs may be associated with benefit, but the pooled effect sizes are similar to those associated with companion dogs. The qualitative data suggested that parents perceived a broad range of benefits of assistance dogs but may be unprepared for the challenges associated with owning an assistance dog.

CONCLUSION

There is a lack of compelling evidence to suggest that assistance dogs confer unique benefits for individuals with autism. The evidence base is limited and of poor quality thus the potential benefits identified need to be interpreted with caution. Interpreting the quantitative and qualitative studies together, the findings indicate many potential benefits of assistance dogs for people with autism could be achieved by a companion dog.

Enhanced detection of autism spectrum disorder through neuroimaging data using stack classifier ensembled with modified VGG-19

BackgroundAutism spectrum disorder (ASD) is a neurodevelopmental disease marked by a variety of repetitive behaviors and social communication difficulties.PurposeTo develop a generalizable machine learning (ML) classifier that can accurately and effectively predict ASD in children.Material and MethodsThis paper makes use of neuroimaging data from the Autism Brain Imaging Data Exchange (ABIDE I and II) datasets through a combination of structural and functional magnetic resonance imaging data. Several ML models, such as Support Vector Machines (SVM), CatBoost, random forest (RF), and stack classifiers, were tested to demonstrate which model performs the best in ASD classification when used alongside a deep convolutional neural network.ResultsResults showed that stack classifier performed the best among the models, with the highest accuracy of 81.68%, sensitivity of 85.08%, and specificity of 79.13% for ABIDE I, and 81.34%, 83.61%, and 82.21% for ABIDE II, showing its superior ability to identify complex patterns in neuroimaging data. SVM performed poorly across all metrics, showing its limitations in dealing with high-dimensional neuroimaging data.ConclusionThe results show that the application of ML models, especially ensemble approaches like stack classifier, holds significant promise in improving the accuracy with which ASD is detected using neuroimaging and thus shows their potential for use in clinical applications and early intervention strategies.

Identification of immune cells and circulating inflammatory factors associated with neurodevelopmental disorders by bidirectional Mendelian randomization and mediation analysis

The roles of various immune cells and circulating inflammatory factors in neurodevelopmental disorders (NDDs) remain controversial. Therefore we employed a two-sample and bidirectional Mendelian randomization and mediation method to explore the causal relationships between immune cells, circulating inflammatory factors, and NDDs. All data were originated from Genome-Wide Association Study (GWAS) datasets. We found a significant positive causal relationship between 13 immune cells and autism spectrum disorder (ASD), including six CD8+ T cells, one CD3+ T cell, two CD20+ B cells, one CD38+  B cell, and two plasmacytoid DC. 9 inflammatory factors showed significant causal relationships with ASD: interleukins-7 (IL-7), interleukins-2 (IL-2), Interleukin-2 receptor subunit beta levels( IL-2β) and interleukins-18 receptor 1 levels (IL-18-R1) were negatively associated. In contrast, five inflammatory factors were positively associated, such as tumor necrosis factor-α (TNF-α). 14 immune cells exhibited significant causal relationships with attention deficit hyperactivity disorder (ADHD). CD3 on naive CD8br and CD4 on activated Treg were positively associated, while four CD27-expressing B cells were positively associated with ASD. Four CD40-expressing monocytes were negatively associated with ADHD. 7 inflammatory factors had significant causal relationships with ADHD: Fibroblast Growth Factor 23 levels (FGF-23), CD40L receptor levels, Glial Cell Line-Derived Neurotrophic Factor levels (GDNF), TNF-α were more important among these. Mediation analysis identified 12 mediating relationships, with three showing strong evidence: Natural killer cell receptor 2B4 levels (19.9%), FGF-23 (11%), and Eotaxin levels (- 5.95%). Strong causal relationships existed between immune cells, circulating inflammatory factors, and NDDs. Inflammatory factors mediated the pathways between immune cells and NDDs.

The Association and Mediators Between Sleep Problems in Autistic Children and Parenting Stress

Purpose

To investigate the association among sleep problems in autistic children, emotional symptom in autistic children and parenting stress.

Methods

This study recruited a total of 292 children with autism in two special education schools in Hunan province, China. The average age of the autistic children in this study was 6.5 ± 2.8 years. Sleep problems in autistic and parenting stress were measured by Youth Self-Rating Insomnia Scale (YSIS), Sleep Disturbance Scale for Children (SDSC), and The Parenting Stress Index-Short Form (PSI-SF-15). The main analysis included latent profile analysis, multivariate logistic regression analysis, and mediation analysis.

Results

The prevalence for sleep disturbance and insomnia symptoms in autistic children were 38.7% and 13.0%, respectively. Parenting stress was divided into three groups: low-risk group (81 participants, 28%), middle-risk group (134 participants, 46%), and high-risk group (77 participants, 26%). Sleep problems (insomnia and sleep disturbance) and emotional symptoms (anxiety and depression) in children with autism were risk factors for parental stress. Depressive symptom in autistic children was significant in mediating the relationship between insomnia symptoms and parenting stress.

Conclusion

There is a significant effect of sleep problems in autistic children, as these sleep issues can substantially increase parental stress, with depressive symptoms in autistic children serving as a positive mediator.

A cross-sectional study of public knowledge and stigma towards autism spectrum disorder in Lebanon

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that requires public understanding to foster acceptance and reduce stigma. This study aimed to evaluate ASD knowledge and stigma among the Lebanese population and the factors influencing them. An online cross-sectional study was conducted between February and July 2022 among Lebanese adults. Participants completed a self-administered structured questionnaire that comprised a sociodemographic section and two validated scales serving the study's purpose (The Autism Stigma and Knowledge Questionnaire (ASK-Q) and The Autism Social Distance Scale). A total of 949 participants filled out the questionnaire. More than half of them had adequate knowledge of autism diagnosis and symptoms (57.9%), while only 6.6% and 9.6% showed adequate knowledge of its etiology and treatment, respectively. Additionally, 83.4% of the participants did not endorse stigma toward autism. The multivariate analysis taking the knowledge total score and subscales as the dependent variables showed that declaring prior knowledge of autism was significantly associated with better knowledge (Beta = 1.38) and higher stigma (Beta = 0.26). Furthermore, a higher knowledge score (Beta = - 0.06) and a declared prior knowledge of autism (Beta = - 0.62) were significantly associated with lower autism social distance. These findings highlight the need for targeted awareness campaigns to address knowledge gaps and further reduce stigma in Lebanon.

A cross-sectional survey on French psychiatrists' knowledge and perceptions of dissociative identity disorder

OBJECTIVE

The aim of this study was to determine French psychiatrists' level of general knowledge about dissociative identity disorder and to evaluate their perceptions of this condition.

METHODS

In this study, French psychiatrists were invited by e-mail to answer an online survey. The questionnaire asked about their general knowledge and perceptions of dissociative identity disorder.

RESULTS

We received 924 answers including 582 complete questionnaires. The survey revealed that almost two-thirds (60.8%) of psychiatrists working in France had never received any training on dissociative disorders and 62% had never managed patients suffering from dissociative identity disorder. Only 19.5% of them claimed to believe unreservedly in the existence of the diagnosis of dissociative identity disorder. The psychiatrists' confidence in diagnosing or treating dissociative identity disorder was low (mean confidence in diagnosis: 3.32 out of 10 (SD 1.89), mean confidence in treatment: 3.1 out of 10 (SD 1.68)). Fifty percent believed that dissociative identity disorder is an entity created by cinema, medias or social networks. Seventy-seven point seven percent thought that confusion with borderline personality disorder is possible, and 41.3% with schizophrenia.

CONCLUSION

In France, there is a lack of training and knowledge about dissociative identity disorder, as well as persistent skepticism about the validity of the diagnosis. Specific training seems essential for a better understanding of dissociative identity disorder.

Microbiome's effect on white matter in autism

Autism spectrum disorder (ASD) is characterized by deficits in social communication and restricted, repetitive behavioral patterns. Although other physiological presentations in individuals with ASD are heterogeneous, neuroimaging studies have consistently revealed a developmental pattern of initial white matter hypermyelination followed by reduced myelination compared with typically developing peers. Multiple studies have demonstrated that core ASD symptoms, including impairments in social skills, language acquisition, learning capabilities, motor performance, and sensory processing, correlate significantly with white matter dysregulation measured through diffusion tensor imaging (DTI). Longitudinal studies have shown that decreased gut microbiome diversity, particularly reductions in beneficial bacteria such as Bifidobacterium and Lactobacillus, correlates with symptom severity. Emerging mechanistic evidence suggests bidirectional relationships between microbiome composition and white matter development, both directly through metabolites like short-chain fatty acids (SCFAs) that regulate oligodendrocyte function and subsequent myelination, and indirectly through modulation of neuroinflammatory pathways. By integrating molecular-level gut physiology findings with macro-level brain imaging data, we may identify novel therapeutic approaches targeting the gut-brain axis in ASD management.

The canonical correlation between executive function and social skills in children with autism spectrum disorder and potential pathways to physical fitness

Research on the relationship between core and comorbid features in children with Autism Spectrum Disorder (ASD), particularly executive function, remains limited. Additionally, the role of physical fitness in supporting ASD children's growth and development appears critical. This study investigates the relationship between executive function, social skills, and physical health in children with ASD. A total of 428 male participants were enrolled, including 117 diagnosed with ASD (mean age: 10.25 ± 1.481 years) and 311 with typical development (mean age: 9.56 ± 1.261 years). The results showed that children with ASD had significantly lower executive function and social interaction abilities than those with typical development (P < 0.05). A strong correlation was found between executive function and social skills (first canonical correlation coefficient: 0.641, P < 0.001), with 20.4% of the variation in social abilities explained by executive function. Specifically, emotional control, working memory, social perception, social cognition, and autistic behaviors influenced ASD children's development. While balance did not correlate significantly with physical fitness (P > 0.05), muscle strength showed a stronger effect (r = -0.485 to -0.535, P < 0.05). Improving physical fitness may help alleviate deficits in executive function and social skills. These findings provide early insights into the relationship between executive function and social skills in ASD, emphasizing the potential role of physical activity.

Preschool and primary school teachers' attitude towards inclusive education for students with autism spectrum disorders in Ethiopian public schools: multicenter cross-sectional study

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder primarily impacting social communication and behavior. The prevalence of ASD has been rapidly increasing, leading to a corresponding rise in the number of children with ASD attending mainstream schools. Preschool and primary school teachers have a vital role in identifying and supporting these children. However, the extent of teachers' Attitudes towards including children with ASD in their classrooms remains uncertain.

OBJECTIVE

The aim of this study was to evaluate the attitude towards including children with autism spectrum disorders in their classrooms, and the associated factors among preschool and primary school teachers in public schools in Addis Ababa.

METHODS AND MATERIALS

Data from preschool and primary school teachers were collected using a self-administered questionnaire between September 2023 and December 2023. The collected data were analyzed utilizing SPSS version 27. Descriptive statistics and thematic analysis were employed to summarize the findings, while bivariate binary logistic regression was utilized to examine associations between variables.

RESULTS

The study findings revealed that from a total sample of 416 teachers, only 35.5% of teachers had adequate knowledge, and the mean attitude score was 3.4, indicating a slight positive inclination towards inclusive education. Furthermore, teachers who have previous experience with students with special needs are six times more likely to have a positive attitude towards inclusive education (AOR = 6, 95% CI = 1.05-40.7). Teachers with a positive attitude towards including students in regular classes were 72% more likely to have adequate knowledge (AOR = 0.28, 95% CI = 0.1-0.6). Teachers with a positive attitude towards including students in regular classes were 72% more likely to have adequate knowledge (AOR = 0.28, 95% CI = 0.1-0.6). Conversely, teachers who identify behavioral and emotional problems of autistic children as a challenge are 94% less likely to have a positive attitude towards inclusive education (AOR = 0.06, 95% CI = 0.05-0.7).

CONCLUSION AND RECOMMENDATION

The findings of this study indicate that teachers displayed a generally positive attitude towards ASD. This highlights the need for increased emphasis on educational interventions aimed at enhancing attitudes towards ASD further.

Arabic Language Autism Diagnostic Interview (ALADIN): A Validation Study

There is a gap in autism research from Low- and Middle-Income Countries (LMIC) where most children with autism live. This has contributed to a lack of culturally validated diagnostic instruments for autism and is a major barrier to early diagnosis, intervention, and research. The Arabic Language Autism Diagnostic Inventory (ALADIN) was developed based on the DSM-5 criteria and adapted to Arabic language and culture using primary source data. The aim of this study was to validate the Arabic Language Autism Diagnostic Inventory for the diagnostic evaluation of autism. A case-control study design was used to test the instrument for sensitivity and specificity for diagnosis of autism in children 2-5 years of age. Parents of 48 children with autism and 152 neurotypical children in Jordan completed the ALADIN. Demographic information from the participants in each group was summarized, and a Receiver Operating Curve (ROC) was fit to the data. A total score of 24 on the ALADIN had 77% sensitivity and 98% specificity for autism. The area under the curve (AUC) was 0.976, indicating strong performance in identifying children with autism. The ALADIN is the first instrument created specifically for Arab populations and is informed by cultural and linguistic data from the target population. Initial validation shows it has high diagnostic specificity for autism. Culturally informed instruments can improve access to early diagnosis and intervention and enhance autism research to improve care and outcomes in global populations.

Nurse participation in detecting signs of childhood autism in Primary Health Care

OBJECTIVES

to understand nurse participation in the process of early detection of warning signs of autism spectrum disorders (ASD) in childcare consultations.

METHODS

qualitative, exploratory research, conducted through semi-structured interviews conducted between August and November 2022 with 27 nurses from family clinics in the city of Rio de Janeiro. The IRaMuTeQ® software was used for data treatment. Interpretations and theorizing were guided by Hildegard Peplau's Theory of Interpersonal Relations.

RESULTS

lexical analysis pointed out thematic aspects related to the dynamics of development assessment, interpersonal relationship practices between nurses and family members as well as limits and interrelationships between healthcare professionals involved in early detection.

FINAL CONSIDERATIONS

childcare consultations are characterized as a unique resource for the early detection of warning signs of ASD. Nurses need to be recognized as strategic agents in the face of this demand, especially in caring for socioeconomically vulnerable families.

Impact of probiotic supplements on behavioural and gastrointestinal symptoms in children with autism spectrum disorder: A randomised controlled trial

OBJECTIVE

To investigate whether probiotic supplementation can improve behavioural and gastrointestinal (GI) symptoms in children with autism spectrum disorder (ASD) aged 2-9 years and further explore the correlation between these symptoms.

DESIGN

Single-blinded, randomised, placebo-controlled study.

SETTING

Five developmental paediatric outpatient clinics of 'Continua Kids'.

PATIENTS

Children aged 2-9 years diagnosed with ASD along with their caregivers.

INTERVENTIONS

Probiotic or placebo sachet reconstituted in 50 mL of lukewarm milk/water, taken two times per day for 3 months.

MAIN OUTCOME MEASURES

Change in behavioural (measured by Social Responsiveness Scale-2 (SRS-2) and Aberrant Behaviour Checklist-2 (ABC-2) tools) and GI (measured by GI Severity Index (GSI) score) symptoms after receiving intervention for 3 months.

RESULTS

A total of 180 children with ASD were enrolled in the study (probiotic group: 90 and placebo group: 90). All children completed the study. The probiotic group showed a significant reduction in behavioural symptom severity as measured by the SRS-2 tool (47.77% vs 23.33%; p=0.000) compared with the placebo. Probiotic-treated children demonstrated significant reductions in severe symptoms, including social withdrawal/lethargy (40%), stereotypic behaviour (37.77%), hyperactivity (34.44%) and inappropriate speech (32.22%) post-intervention (p=0.000). They also had marked improvements in constipation (p=0.003) and diarrhoea (p=0.043) compared with the placebo group. Both groups exhibited a statistically significant correlation between behavioural and GI symptoms.

CONCLUSIONS

Probiotic supplementation improved behavioural and GI symptoms in children with ASD with no adverse effects. Both symptoms were significantly correlated. However, these results need to be validated in a larger sample size.

TRIAL REGISTRATION NUMBER

CTRI/2021/11/038213.

Taste processing in autism spectrum disorder: A translational scoping review

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in social communication and restricted/repetitive behaviors, including sensory atypicalities. Taste processing is critical for assessing the sensory and hedonic properties of food; however, it remains understudied in ASD, which may limit our understanding of the disorder's links to selective eating and nutritional deficits. This scoping review on autistic gustatory functioning followed a predefined protocol. We conducted searches across four databases and identified 37 studies involving human participants, categorized into three methodologies: questionnaires, neuroimaging, and psychophysical tests. Additionally, eight studies on ASD animal models were included to offer cross-species insights. Questionnaire data generally indicate that individuals with ASD exhibit differences in taste reactivity compared to those without ASD. Neuroimaging studies suggest potential involvement of specific brain regions, including hippocampal volume and anterior superior temporal sulcus (aSTS) connectivity in atypical taste processing. Psychophysical assessments and animal studies further reveal variability in basic taste preferences, with individuals with ASD showing particular aversion to bitterness and showing either no difference or a decreased preference for sweetness compared to typically developing peers. This review also highlights research gaps regarding specific qualitative tastes such as saltiness, sourness, and umami in ASD, limiting a comprehensive understanding of ASD's chemosensory profile and emphasizing the need for further research in these areas.

Influence of self-esteem on health-related quality of life in children and adolescents with autism spectrum disorders

Aim

Autism spectrum disorder (ASD) is a neurodevelopmental condition that markedly impairs the physical, emotional, and social domains of health-related quality of life (HRQOL). Children with ASD typically report lower HRQOL than their neurotypical peers. This study investigated the impact of self-esteem and depressive symptoms on HRQOL in children with ASD and explored the discrepancies between parent-reported and self-reported HRQOL.

Methods

This study involved 94 participants, comprising 50 children with ASD and 44 typically developed. HRQOL was measured using the J-KIDSCREEN-52 (self-reported and parent-reported). Self-esteem, depressive symptoms, and social support were assessed using the Rosenberg Self-Esteem Scale, the Depression Self-Rating Scale for Children, and the Multidimensional Scale of Perceived Social Support, respectively. Discrepancies between parent-reported and self-reported HRQOL were examined. Multiple regression analyses were performed to determine the influence of depressive symptoms and self-esteem on HRQOL.

Results

Children with ASD showed markedly lower HRQOL than their neurotypical peers. Discrepancies between parent-reported and self-reported HRQOL revealed differing perspectives. Higher depressive symptoms were strongly correlated with poorer HRQOL. Conversely, higher self-esteem was linked to better HRQOL, notably in terms of self-perception. Social support also markedly influenced HRQOL.

Conclusion

This study underscores the necessity of addressing depressive symptoms, self-esteem, and social support as interventions to enhance HRQOL in children with ASD. The differences between parent-reported and self-reported HRQOL highlight the need to incorporate both views into clinical assessments for comprehensive and effective interventions. Future research should explore these dynamics longitudinally and across diverse populations to refine the intervention strategies.

The Future of Disentangling the Heterogeneity of Autism With Neuroimaging Studies

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition. Over the past decade, a considerable number of approaches have been developed to identify potential neuroimaging-based biomarkers of ASD that have uncovered specific neural mechanisms that underlie behaviors associated with ASD. However, the substantial heterogeneity among individuals who are diagnosed with ASD hinders the development of biomarkers. Disentangling the heterogeneity of ASD is pivotal to improving the quality of life for individuals with ASD by facilitating early diagnosis and individualized interventions for those who need support. In this review, we discuss recent advances in neuroimaging that have facilitated the characterization of the heterogeneity of this condition using 3 frameworks: neurosubtyping, dimensional models, and normative models. We also discuss the challenges, possible solutions, and clinical utility of these 3 frameworks. We argue that several factors need to be considered when parsing heterogeneity using neuroimaging, including co-occurring conditions, neurodevelopment, heredity and environment, and multisite and multimodal data. We close with a discussion of future directions for achieving a better understanding of the neural mechanisms that underlie neurodevelopmental heterogeneity and the future of precision medicine in ASD.

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

OBJECTIVE

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

METHOD

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

RESULTS

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

DISCUSSION

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

The Childhood Autism Rating Scale Second Edition (CARS2) and Its Applicability in an Iranian Sample

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

Improving neurodiversity awareness in school students: a scoping review protocol

OBJECTIVE

This scoping review aims to map and characterize existing programs present in mainstream schools internationally that are targeted at improving children's awareness about neurodiversity.

INTRODUCTION

Neurodiversity is a term used to describe human neurocognitive heterogeneity. Increased understanding and awareness about neurodiversity among school students has the potential to improve general student health and well-being. However, there is currently no standardized approach to raising children's awareness about neurodiversity in schools and the associated literature is diffuse.

INCLUSION CRITERIA

Literature will be included if it describes and/or evaluates programs designed to be delivered in mainstream schools aimed at increasing awareness of neurodiversity among students aged 5 to 18 years, regardless of geographical location. Published, unpublished, and gray literature from 2013 to the present will be considered.

METHODS

An academic literature search will be conducted across 5 databases: MEDLINE, CINAHL, PsycINFO, Embase, and ERIC. A gray literature search will also be performed across sources including ProQuest and Google Scholar, as well as targeted websites, expert opinion, and reference lists of relevant peer-reviewed literature. Articles will be selected based on eligibility criteria. Data extraction will be conducted independently by 2 extractors using a pre-determined form documenting study methods, population, interventions, and outcomes. Analysis and presentation of results will be reported according to the study objectives.

REVIEW REGISTRATION

Open Science Framework https://osf.io/6b378.

Novel Procedures for Evaluating Autism Online in a Culturally Diverse Population of Children: Protocol for a Mixed Methods Pathway Development Study

BACKGROUND

Current autism assessment procedures are costly and resource-intensive. The COVID-19 pandemic accelerated the adoption of telemedicine, highlighting the benefits of innovative diagnostic tools. Telemedicine-based pathways could enhance accessibility and equity in autism diagnostics.

OBJECTIVE

The Children with Autism Technology Enabled Assessment (CHATA) project aims to develop and pilot an open-source autism diagnostic pathway for children up to 5 years old, delivered through telemedicine. The pathway is designed to be culturally and linguistically adaptable, increasing its applicability to diverse populations and integrating with existing National Health Service digital systems.

METHODS

Initial pathway development was informed by systematic evidence reviews, coproduction, and mixed methods usability. CHATA comprises 2 key elements: online self-completed standardized autism questionnaires and a structured online interview and observation by a trained clinician. Out of 60 families near the top of the local waiting list will be invited to participate in the pilot evaluation, assessed using both the CHATA and usual assessment pathways. Sensitivity and specificity will be calculated by comparing the diagnosis of autism through CHATA with usual care. Quantitative usability assessment will be gathered from all families using the System Usability Scale (where a mean above 68 indicates above-average usability). A subset of CHATA assessments will be reviewed for interrater reliability (measured by the Cohen κ for categorical data [diagnosis present or absent], with values indicating the level of agreement; eg, <0 indicating no agreement, 0.61-0.80 indicating substantial agreement). Qualitative data on acceptability, feasibility, and usability will be gathered from semistructured interviews with a subset of families and health care providers. We will recruit 60 families for the main pilot study (including the usability testing) and 10-15 participants for the qualitative substudy. Data will estimate CHATA's diagnostic accuracy, validity, reliability, usability, and acceptability. Patient and public involvement will be integral throughout. The study will take place in a socio-economically deprived, ethnically diverse inner-London Borough within a community-based child health National health service responsible for the Autism assessment of children and young people up to the age of 13 years.

RESULTS

Ethics approval was received in June 2023 (Research Ethics Committee reference 22/LO/0751; IRAS project ID 320499). Data collection commenced in April 2023 and completed in October 2024. Project end date is March 2025. As of November 2024, we had enrolled 57 participants to the pilot study and 12 to the qualitative substudy.

CONCLUSIONS

The CHATA project aims to establish a novel, culturally sensitive, equitable, and accurate online autism assessment pathway. By addressing geographical and linguistic barriers, this pathway seeks to reduce service costs, shorten waiting times, and promote equity in autism diagnosis. The procedures developed are expected to be generalized to other populations nationwide.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55741.

Efficacy and Safety of Propofol as a Sole Sedative for fMRI Sedation in Autism Spectrum Disorder Individuals with Low IQ

Autism spectrum disorder (ASD) is a group of complicated neurodevelopmental disorders. Functional magnetic resonance imaging (fMRI) can help to analyze the aberrant neurological functioning in ASD. However, due to their limited cognitive abilities, ASD individuals with low IQ may face challenges in cooperating during fMRI scanning. Consequently, sedation becomes necessary for them. To analyze and evaluate the sedative efficacy and safety of a single intravenous propofol sedation regimen for ASD individuals with low IQ undergoing fMRI examination. Seventy-seven ASD individuals with low IQ, aged 4 to 23 years, who underwent fMRI examination under propofol sedation, were included. Details of the sedation protocol, evaluation indices for effectiveness such as framewise displacement (FD) and temporal signal-to-noise ratio (tSNR), as well as safety assessment measures including pulse oxygen saturation (SPO2) and blood pressure were collected. Adverse events were also recorded. Data analysis was conducted upon completion of the study. Body movement was observed in 12 patients. The median and quartiles (25th percentile, 75th percentile) of FD was 0.065 (0.057, 0.086) mm, while the tSNR averaged at 89.6 ± 11.4. The image data from sixty-two cases (80.5%) were classified as high quality based on their tSNR surpassing 80. No serious adverse events, such as oxygen desaturation, hypotension, nausea, or vomiting, occurred that necessitated hospitalization. The exclusive propofol intravenous sedation protocol employed in this study demonstrates efficacy and safety for administering fMRI examinations to ASD individuals with low IQ, thereby warranting further investigation and validation towards its adoption in clinical practice.

[Pain assessment for children and adolescents with autism spectrum disorders (ASD): A systematic review]

OBJECTIVE

Pain in children and adolescents with autism spectrum disorders remains underdiagnosed due to their inherent communication difficulties. The goal of this review is to identify the most suitable methods for assessing pain in this population and for evaluating the specific perceptions of, or behavioural reactions to, pain whilst considering disorder severity and specifiers (with or without accompanying intellectual impairment, with or without accompanying language impairment).

METHOD

A systematic review and analysis of the international literature was conducted.

RESULTS

Fourteen studies were selected. No difference was found in pain-related behaviours based on the age or gender of children or adolescents with autism. Three studies showed pain-related behaviours in autism spectrum disorders to be similar to control groups. Other studies showed specific behavioural responses in autism spectrum disorders with a longer physiological and behavioural recovery time associated with an episode of acute pain in this population. Similarly, the three studies that focused on sensory perceptions of pain all showed differences in the autism spectrum disorders population compared to control groups. In hospital or daily life contexts, studies essentially showed idiosyncratic expressions, hypervigilance, motor agitation, negative emotional reactions, or vocalizations. Regarding the association of autism severity with hyposensitivity to pain, the results remain unclear even when language disorders or intellectual disabilities are also present (in conjunction with autism). The Non-Communicative Children Pain Checklist and its translation into French and Italian showed good internal validity and was used by almost half of the studies in hetero-assessment, mostly by parents. Studies recommend the inclusion of parents in the assessment in order to optimise the evaluation process. Similarly, analysis of parent/child/caregiver interviews from the studies highlights the importance of personalizing pain assessment of children and adolescents, taking into account subject-specific characteristics, pathology, and context.

CONCLUSION

An integrative and personalized approach to pain assessment appears to be the most appropriate for enhancing the understanding and detection of pain in individuals with autism spectrum disorders. This approach aligns well with a care setting where a nominated professional with a good expertise in autism is responsible for pain assessment. Given the complexity of identifying pain in individuals with autism, further qualitative studies, in conjunction with new pain exploration technologies, are considered necessary as well as a more extensive categorization of the population studies.

Family Intensive Behavioral Intervention for Children with Autism Spectrum Disorder: A Half-Year Comparison-Controlled Study

Objective

Family intervention is a crucial component of treatment for children with autism spectrum disorder (ASD), yet the impact of parent-mediated family-intensive behavioral intervention on the language abilities of children with ASD has been barely studied. The purpose is to investigate the effectiveness of the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)-based family-intensive behavioral intervention in enhancing the language abilities of children with ASD. This study provides insights to help ASD children better cope with daily life.

Methods

From September 2020 to September 2022, a total of 85 clinically diagnosed children with ASD and 30 age- and sex-matched children without ASD were recruited. Applied Behavior Analysis (ABA) and VB-MAPP were used for evaluating and determining individualized intervention programs for children with ASD. The intervention lasted 6 months.

Results

There were no significant differences in demographic characteristics between children with ASD and children without ASD (all p > 0.05), except for the mother's age. After the intervention, there was a significant increase in all VB-MAPP scores among children with ASD (all p < 0.001), compared with the baseline VB-MAPP total score and 16 domain scores. Tests of noninferiority showed that children with ASD at post-intervention were non-inferior to children without ASD in the Visual Perceptual Skills and Matching-to-Sample (VP/MTS) score (p = 0.001), play score (p = 0.034), reading score (p < 0.001), and writing score (p < 0.001).

Conclusions

Family-intensive behavioral intervention significantly improved the skills of children with ASD, as assessed by the VB-MAPP. These findings emphasize the importance of family intervention and provide further support for proposing a family intervention program for children with ASD that is suitable for China's national conditions.

Comparison of Gut Microbiota in Two Different Maternal Exposure Models of Autism Spectrum Disorder in Mice

Background

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with unknown etiology and unclear pathogenesis. Although construction of animal models of ASD using chemical exposure during pregnancy is a mature technique, the gut microbiota of these exposure models induced using different chemicals in mice have not been compared.

Methods

To compare the effects of exposure to different chemicals during pregnancy on the composition of gut microbiota in offspring, we treated Institute of Cancer Research (ICR) mice with lipopolysaccharide (LPS) and valproic acid (VPA) during pregnancy to construct different offspring ASD mouse models. After successful model construction, the gut microbiota of these models were studied.

Results

After adjusting for the random effects of the litter, the two groups showed a significant reduction in social time (social deficits) and an increase in self-grooming behaviors (repetitive and stereotyped behaviors). Gut microbiota analysis revealed significant changes, mostly a decrease, in the abundance of four phyla, 52 genera, and 41 species in the two types of ASD models. Several different gut microbes could be related to the development of ASD.

Conclusions

Chemicals exposure during pregnancy induces ASD-related behavioral abnormalities in offspring mice. Importantly, exposure to different chemicals during pregnancy produces varying degrees of effects on gut microbiota composition in offspring ASD models. This finding can provide a reference for studies on the etiology and pathogenesis of ASD.

Effects of a Virtual Reality-Based Aggression Control Program on Children with Autism Spectrum Disorder: A Case Study

Background/Objectives: Aggression is a major challenge for children with autism spectrum disorder (ASD), their family members, friends, and teachers because it can pose a threat or harm not only to the children with ASD but also to others. This study is a case study aimed at verifying the effectiveness of a virtual reality-based aggression control program for children with ASD. Methods: The participants were two children (one was a 10-year-old boy and the other was a 6-year-old girl) who participated in the ACAA (Aggression Replacement Training for Children and Adolescents with ASD) Program for eight sessions over three weeks. Results: The frequency (C1: 48 → 3; C2: 32 → 3) and severity of aggressive behaviors in both participants decreased after the intervention compared to before. Additionally, overall problematic behaviors were also reduced after the intervention (C1: 85 → 70; C2: 87 → 64). Furthermore, both participants demonstrated a slight increase in their levels of adaptation (C1: 17 → 20; C2: 16 → 18). Conclusions: The effectiveness of the ACAA program has been demonstrated in reducing levels of aggression in children with ASD. Therefore, the ACAA program may contribute to helping aggressive children with ASD live in harmony with others in society and promote independence.

The challenge of a late diagnosis of Autism Spectrum Disorder: co-occurring trajectories and camouflage tendencies. a case report of a young Autistic female with Avoidant Restrictive Food Intake Disorder

Introduction

Autistic individuals may show several psychiatric co-occurrences, including Feeding and Eating Disorders (FEDs). Avoidant and Restrictive Food Intake Disorder (ARFID) consists of avoidance or restriction in food intake, leading to significant weight loss, nutritional deficiencies, and marked interference with psychosocial functioning. Both Autism Spectrum Disorder (ASD) and ARFID are characterized by the two main features of cognitive rigidity and sensory sensitivity, which may complicate differential diagnosis. There is a notable lack of information on the manifestation of ASD-ARFID co-occurrence, as well as tailored assessment tools and practice, and therapeutic approaches.

Case description

This report provides a detailed description of L., a young girl with a late diagnosis of ASD who also developed unspecific depressive mood disorder and ARFID in co-occurrence. After the diagnosis of ASD, L. underwent multiple evaluations to address emerging psychiatric co-occurrences and symptom exacerbation, and in order to develop the most effective integrated treatment.

Conclusion

The case of L. expands the knowledge on the phenotype of Autistic females and exemplifies how delayed diagnosis may exacerbate functioning differences and increase the camouflage phenomenon. Additionally, it underscores the importance of improving tailored evaluation, combined treatment plans, with both cognitive-behavioral therapy and drugs, and monitoring the evolving patterns of Autistic manifestations and associated psychiatric co-occurrences.

Telomere Length and Oxidative Damage in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

BACKGROUND

Autism spectrum disorder (ASD) has been reported to confer an increased risk of natural premature death. Telomere erosion caused by oxidative stress is a common consequence in age-related diseases. However, whether telomere length (TL) and oxidative indicators are significantly changed in ASD patients compared with controls remains controversial. The aim of this study was to determine the associations of ASD with TL and oxidative indicators by performing a meta-analysis of all published evidence.

METHODS

The PubMed and Embase databases were searched for articles published up to April, 2024. The effect size was expressed as standardized mean difference (SMD) and 95% confidence interval (CI) via Stata 15.0 software.

RESULTS

Thirty-nine studies were included. Pooled results showed that compared with controls, children and adolescents with ASD were associated with significantly shorter TL (SMD = -0.48; 95% CI = -0.66- -0.29; p < 0.001; particularly in males), lower total antioxidant capacity (TAC: SMD = -1.15; 95% CI = -2.01- -0.30; p = 0.008), and higher oxidative DNA (8-hydroxy-2'-deoxyguanosine, 8-OHdG: SMD = 0.63; 95% CI = 0.03-1.23; p = 0.039), lipid (hexanolyl-lysine, HEL: SMD = 0.37; 95% CI = 0.13-0.62; p = 0.003), and protein (3-nitrotyrosine, 3-NT: SMD = 0.86; 95% CI = 0.21-1.51; p = 0.01; dityrosine, DT: SMD = 0.66; 95% CI = 0.521-0.80; p < 0.01) damage. There were no significant differences between ASD and controls in 8-isoprostane and oxidative stress index after publication bias correction, and in N-formylkynurenine during overall meta-analysis.

CONCLUSIONS

TL, 8-OHdG, TAC, HEL, 3-NT, and DT represent potential biomarkers for prediction of ASD in children and adolescents.

The association between preterm delivery and autism spectrum disorder in childhood: A retrospective cohort study

BACKGROUND

Prematurity complications are a leading cause of mortality and morbidity in offspring, including adverse neurodevelopmental outcomes. The association between preterm birth (PTB) and autism spectrum disorder (ASD) remains debated.

OBJECTIVE

To investigate the association between PTB and ASD diagnosis during childhood.

METHODS

This cohort study analyzed data from community clinics and a tertiary hospital, encompassing deliveries from 2005 to 2017. ASD incidence was compared across gestational age categories: extremely preterm (<28 weeks), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term (≥37 weeks). Additional comparisons were made between all preterm (<37 weeks) and term deliveries (≥37 weeks). Cumulative ASD incidence was assessed using Kaplan-Meier survival curves and a Cox proportional hazards model adjusted for potential confounders.

RESULTS

Among 114 975 pregnancies, 0.3% delivered at <28 weeks, 0.6% at 28-32 weeks, and 6% at 32-37 weeks, with 6.9% preterm deliveries overall. Univariable analysis revealed a significant association between PTB and ASD (1.6% for <28 weeks vs 0.3% for 28-32 weeks vs 0.8% for 32-37 weeks vs 0.7% for term, P = 0.036). Crude ASD incidence was 0.8% (odds ratio [OR] 1.21, 95% confidence interval [CI] 0.93-1.56, P = 0.15). However, adjusted results showed no significant association: adjusted hazard ratio = 0.74 (95% CI 0.24-2.34, P = 0.61) for <28 weeks, 0.99 (95% CI 0.24-3.99, P = 0.98) for 28-32 weeks, and 1.07 (95% CI 0.81-1.43, P = 0.63) for 32-37 weeks. Kaplan-Meier analysis showed similar cumulative ASD incidence across groups (P = 0.855).

CONCLUSION

This retrospective cohort study found no significant association between PTB and childhood ASD diagnosis.

Mapping neuro-disabilities and their dimensions among under 5 years of age children in the southern agricultural corridor of Tanzania: a preliminary baseline survey

Background

Neuro-disabilities involve impairments of the nervous system, affecting brain development and functioning. Due to limited scientific data on neuro-disabilities in Tanzania, this study examines maternal characteristics in high-risk areas, such as the Southern Agricultural Growth Corridor (SAGCOT).

Methods

This cross-sectional study sampled 286 children aged 0-5 years and their mothers in the SAGCOT region. Each mother selected the youngest child within the specified age range. Multi-stage sampling was used to choose clusters and areas for the study. The Malawi Developmental Assessment Tool (M-DAT) was used to assess the children's developmental levels. Descriptive analysis determined distribution patterns, while multivariate analyses were performed to identify significant factors. Modified Poisson regression with robust standard errors estimated prevalence ratios (PRs) and their 95% confidence intervals (CIs).

Results

The study included 286 mother-child pairs from four clusters: Ihemi, Kilombero, Ludewa, and Mbarali. The children's median age was 24 months, with the majority aged between 13 and 48 months. Boys constituted a slight majority (59.4%). The majority of mothers were married (72.4%), had primary education (56.6%), and were engaged in non-farming occupations (56.3%). Neurodevelopmental assessments revealed that 11.2% of children were fully developed, while 88.8% exhibited development delays. Adjusted prevalence ratios (aPR) with 95% confidence intervals identified significant associations between developmental domains and demographic variables such as age, gender, marital status, and maternal occupation.

Conclusion

The study highlights a high prevalence of neuro-disability among children in Tanzania's southern corridor, revealing disparities across regions and the impact of factors such as gender and marital status. Targeted interventions are essential to address these developmental challenges effectively and promote optimal child development and wellbeing.

Exploring the potential of the ketogenic diet in autism spectrum disorder: metabolic, genetic, and therapeutic insights

Current treatment approaches for Autism spectrum disorder (ASD) primarily focus on symptom management rather than addressing underlying dysfunctions. The ketogenic diet (KD), a high-fat, low-carbohydrate diet inducing nutritional ketosis, has shown promise in treating epilepsy and may offer therapeutic benefits for ASD by modulating metabolic and neuroprotective pathways. This review examined the potential impact of KD on underlying mechanisms in ASD. While evidence from human studies on underlying mechanisms is limited, animal research has shown a large overlap of mechanisms modulated by KD and dysfunctions in ASD. As such, targeting multiple disrupted pathways at once, KD presents a potential multifaceted treatment approach for ASD. However, more evidence from human studies is needed on the effectiveness of KD in the modulation of underlying dysfunctions in ASD. Additionally, precision medicine approaches could help identify individuals who would benefit most from the intervention, potentially extending its use to other psychiatric conditions with similar metabolic patterns. Consequently, KD interventions might show the potential to induce a drastic paradigm shift in understanding and treating ASD.

Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms

BACKGROUND

The prevalence of autism spectrum disorder (ASD) has surged, with an estimated 1 in 36 eight-year-olds in the United States meeting criteria for ASD in 2020. Autistic individuals face elevated rates of co-occurring medical, psychiatric, and behavioral conditions compared to non-autistic individuals. The rising ASD-patient demand is increasingly outpacing the capacity of ASD-specialty clinics, resulting in urgent need for autism-competent providers in general practice settings. This work aims to empower healthcare providers, especially primary care providers (PCPs), with guidelines for the recognition and safe pharmacologic management of common co-occurring psychiatric and behavioral conditions in ASD.

METHODS

Lurie Center for Autism medical providers, who have extensive experience in ASD care, delineated approaches for recognition and pharmacological treatment of sleep disturbances, attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and irritability tailored to ASD patients. Pharmacological guidelines were iteratively refined until consensus was reached. Treatment differences relative to standard of care (SOC) of non-autistic individuals are noted. Key literature and clinical trial results were reviewed to supplement clinical experience.

RESULTS

The pharmacological treatment pathways reflect how appropriate medication options for ASD patients can depend on many factors unique to the patient and can differ from established non-autistic SOC. Key takeaways include: For sleep disturbances in ASD, initial strategies align with non-autistic SOC, emphasizing sleep hygiene and melatonin use. First-line recommendations for treating ADHD, anxiety, and depression in ASD differ from non-autistic SOC; α2-adrenergic agonists are more suitable than stimulants for some ASD-ADHD patients, buspirone and mirtazapine are preferred to selective serotonin reuptake inhibitors (SSRIs) for anxiety, and duloxetine, mirtazapine, bupropion, and vortioxetine are recommended ahead of SSRIs for depression. Addressing irritability in ASD requires interdisciplinary evaluation of contributing factors, and guanfacine, risperidone, or aripiprazole may be appropriate, depending on severity.

CONCLUSIONS

Recognition and treatment of co-occurring psychiatric and behavioral conditions in autistic patients must account for differences in clinical presentation and medication effectiveness and tolerability. Drawing on evidence-based clinical insights, these guidelines seek to support PCPs in making informed decisions when prescribing medications for ASD patients with co-occurring psychiatric and behavioral conditions, ultimately enhancing access to timely, comprehensive care for all individuals with ASD.

Oxytocin in autism: Rethinking treatment and research through a neurodivergent perspective

This perspective piece addresses critical challenges in oxytocin-based interventions for autism, drawing on neurodivergent perspectives to highlight key issues in research relevance and inclusivity. Although oxytocin has been posited to modulate social and routinized behaviors in autistic individuals, empirical findings on its efficacy remain inconsistent. We argue that these behavioral targets may reflect neurotypical biases, often disregarding autistic individuals' perspectives, thereby limiting intervention acceptability and efficacy. Past research has frequently excluded marginalized autistic populations, including individuals with intellectual disabilities or gender-diverse identities, exacerbating generalizability issues. This piece advocates for a reorientation of research objectives in autism, proposing a shift from modifying core autistic behaviors towards enhancing quality of life through participatory research. By integrating autistic perspectives into study design and outcome selection, researchers move away from deficit-oriented frameworks and instead prioritize socially valid outcomes, such as reducing anxiety and improving adaptive functioning. Further, the perspective piece critiques the reliance on animal models, which often lack translational validity due to autism's complex social and communicative dimensions. In closing, we underscore the importance of inclusive, reproducible autism research practices that align with the lived experiences and priorities of autistic individuals. Embracing participatory research, alongside rigorous methodological adjustments, can foster advancements that effectively support the well-being of the autistic community.

A Compound Nutritional Supplement Relieving the Core Symptoms of Autism Rats

Autism, with a global morbidity of approximately 0.6% annually, significantly burdens on families and society. A predominant characteristic among autistic children is intestinal dysfunction, generating nutrient absorption issues. This often causes vitamin and mineral deficiencies, which significantly impacts neurological development. To address this, we have developed a comprehensive nutritional supplement containing compound vitamins, minerals, and gut bacteria. The aim of this study is to investigate the behavioral effects of this supplement on autism rats. The supplement formulated in this study encompasses compound vitamins, minerals, and intestinal bacteria. The autism offspring model (VPA model) was established through intraperitoneal injection of sodium valproate into pregnant rats. Behavioral assessments, gastrointestinal microbiota analysis, and brain development evaluations were conducted to assess the effects of the supplement on VPA offspring rats. A nutritional supplement enriched with vitamins (VB6, VB12, VC, VD, folic acid), minerals (calcium, magnesium), and bifidobacteria was prepared. Open field experiments demonstrated a 3-mo supplementation intervention effectively alleviated anxiety symptoms and enhanced curiosity levels in VPA offspring. The bead embedding experiment revealed the supplementation significantly improved stereotypical behaviors in VPA offspring. The nesting experiment showed a 3-mo supplementation intervention effectively enhanced cognitive abilities in VPA offspring rats. The three-box social experiment demonstrated the supplementation improved social novelty and tendency in VPA offspring. Analysis of gastrointestinal microbiota revealed the supplementation modulated the gut microbiome, promoting better nutrient absorption and overall health. Our findings suggest the comprehensive nutritional supplement, containing compound vitamins, minerals, and gut bacteria, effectively alleviates core symptoms of autism in rats. This study provides valuable insights into the potency of nutritional interventions in improving the quality of life for autistic individuals. Future research is warranted to further explore the mechanisms underlying these observed benefits and to assess the long-term effects of this supplement in larger clinical trials.

Global prevalence of depression in caregivers of children with autism: A systematic review and meta-analysis

PROBLEM

Depression is reported as the most common disorder among caregivers, especially for caregivers of children with autism. However, limited systematic reviews have investigated the prevalence of depressive symptoms among these caregivers. This systematic review and meta-analysis aim to synthesize the prevalence of global depressive symptoms among caregivers of children with autism and identify associated factors.

ELIGIBILITY CRITERIA

Articles were limited to English language and reported on the prevalence of depressive symptoms among formal or informal caregivers, aged 18 or older, of children with ASD, with no publication year restrictions.

SAMPLE

A total of 40 included studies involving 13,853 caregivers of children with autism were included.

RESULTS

Meta-analysis of 40 included studies involving 13,853 caregivers of children with autism showed a pooled prevalence estimate of 45 % (95 % CI: 39.0-51.0). Depressive symptoms were most prevalent in European studies, with a rate of 54 % (N: 980), closely followed by the Eastern Mediterranean region at 53 % (N:1071). The South-East Asia and Western Pacific region exhibited a prevalence of 40 % (N: 5719), while the Americas reported a rate of 38 % (N: 6083).

CONCLUSION

This review presents compelling evidence of a high global prevalence rate of 45 % for depressive symptoms among caregivers of children with ASD.

IMPLICATIONS

To enhance nursing support for caregivers of children with ASD, specific interventions are needed. Nurses should integrate mental health screenings into regular check-ups, link caregivers to community resources, and receive specialized training. Promoting respite care and collaborating with stakeholders can further address caregiver stress and mental health stigma.

Parental Burnout in Israeli Parents of Children with ASD During Wartime: The Role of Child Behavior, Parental Emotion Regulation, Stress, and Social Support

During emergencies like wartime, parents of children with Autism Spectrum Disorder (ASD) face heightened challenges, potentially leading to Parental Burnout (PB). Wartime conditions can exacerbate children's behavioral difficulties, contributing to PB. Protective factors such as successful Emotional Regulation (ER) and perceived social support may mitigate PB. This study aims to compare child behavioral problems, parental ER difficulties, perceived social support, stress, and PB between parents of children with ASD and Typical Development (TD) during wartime. It also investigates how ER difficulties, perceived social support, and stress moderate the relationship between child behavioral problems and PB. The study included 213 Israeli parents: 101 parents of children diagnosed with ASD and 112 parents of TD children. Participants were recruited during the "Swords of Iron" War using purposive sampling via online platforms. Findings indicate that children with ASD exhibited higher levels of behavioral problems, and their parents experienced increased difficulties in ER, stress, and PB, alongside decreased perceived social support compared to parents of TD children. Moderation analysis revealed that ER difficulties, perceived social support, and stress moderated the direct association between child behavioral problems and PB specifically among parents of TD children. This study underscores the heightened vulnerability of parents with ASD-diagnosed children during wartime, emphasizing the importance of understanding how these circumstances impact parental well-being and available resources. Effective interventions should target enhancing ER, social support, and addressing parental stress, PB, and child behavioral issues, underscoring the need for prioritized services despite wartime challenges.

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

BACKGROUND AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Bruxism associated with short sleep duration in children with autism spectrum disorder: The Japan Environment and Children's Study

Bruxism, the involuntary activity of masticatory muscles, is common among individuals with autism spectrum disorders (ASD). Although bruxism is bidirectionally associated with sleep issues, whether an infant's sleep duration contributes to the development of bruxism remains unknown. In this study, a dataset (n = 83,720) obtained from the Japan Environment and Children's Study, a nationwide birth cohort study, was subjected to multiple imputations using logistic regression analysis with adjustments for several maternal and child-related variables. The aim of this study was to assess whether shorter sleep duration in the neonatal period additively affected the high prevalence of parent-reported bruxism (PRB) among children with ASD. The prevalences of ASD and PRB in the participants were 1.2% and 7.2%, respectively, and the odds ratio of the increased risk of PRB prevalence in individuals with ASD (95% confidence interval) was 1.59 (1.31-1.94) after covariate adjustments. Importantly, shorter sleep duration in the neonatal period (at one month of age) was significantly associated with an increased risk of PRB prevalence in individuals with ASD. The increased occurrence of bruxism, known to be highly prevalent among children with ASD, is associated with shorter sleep duration, particularly in the neonatal stage. Based on our results, a better understanding of the development of bruxism in individuals with ASD would provide valuable information for the prevention of oral diseases.

Enhancing ASD detection accuracy: a combined approach of machine learning and deep learning models with natural language processing

Purpose

The main aim of our study was to explore the utility of artificial intelligence (AI) in diagnosing autism spectrum disorder (ASD). The study primarily focused on using machine learning (ML) and deep learning (DL) models to detect ASD potential cases by analyzing text inputs, especially from social media platforms like Twitter. This is to overcome the ongoing challenges in ASD diagnosis, such as the requirement for specialized professionals and extensive resources. Timely identification, particularly in children, is essential to provide immediate intervention and support, thereby improving the quality of life for affected individuals.

Methods

We employed natural language processing (NLP) techniques along with ML models like decision trees, extreme gradient boosting (XGB), k-nearest neighbors algorithm (KNN), and DL models such as recurrent neural networks (RNN), long short-term memory (LSTM), bidirectional long short-term memory (Bi-LSTM), bidirectional encoder representations from transformers (BERT and BERTweet). We extracted a dataset of 404,627 tweets from Twitter users using the platform's API and classified them based on whether they were written by individuals claiming to have ASD (ASD users) or by those without ASD (non-ASD users). From this dataset, we used a subset of 90,000 tweets (45,000 from each classification group) for the training and testing of these models.

Results

The application of our AI models yielded promising results, with the predictive model reaching an accuracy of almost 88% when classifying texts that potentially originated from individuals with ASD.

Conclusion

Our research demonstrated the potential of using AI, particularly DL models, in enhancing the accuracy of ASD detection and diagnosis. This innovative approach signifies the critical role AI can play in advancing early diagnostic techniques, enabling better patient outcomes and underlining the importance of early identification of ASD, especially in children.

Autism Spectrum Disorder and Associated Factors in Children in Spain, 2017: Population-Based Cross-Sectional Study

OBJECTIVES

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with biological, multicausal and polygenic origins. The true prevalence of ASD has not been clearly established. The aim of this study was to estimate the prevalence of ASD in children aged 3 to 14 years in Spain and to analyze the factors associated with it.

METHODS

A cross-sectional observational study using data from the 2017 National Survey of Health in Minors in Spain. Primary outcome was the diagnosis of ASD, and sociodemographic, behavioral, health-related, the use of health services, household and medication use variables was analyzed. Multivariable logistic regression model with a correction for modelling rare events was fitted. Complex sampling was undertaken, using the survey elevation factor in the analysis.

RESULTS

A total of 4409 children were included, and there were 26 children with ASD, for a prevalence of 0.59%, representing 29,143 children with ASD. Factors significantly associated were male sex, having visited a psychologist, and/or a speech therapist in the past year, presenting probable problems with peers, antisocial behavior, taking antibiotics and taking other medications.

CONCLUSION

The findings of this study may be useful to inform health policies and develop strategic plans to identify and address the needs of children with ASD.

Relationships between Gut Microbiota and Autism Spectrum Disorders: Development and Treatment

Many studies have demonstrated the impact of intestinal microbiota on normal brain development. Moreover, the gut microbiota (GM) is impacted by multiple endogenous and environmental factors that may promote gut dysbiosis (GD). An increasing number of studies are investigating the possible role of the GD in the development of neurological and behavioral disorders. For autism spectrum disorders (ASD), specific intestinal bacterial signatures have been identified, knowing that gastrointestinal symptoms are frequently found in ASD. In this review, the peri and post-natal factors modulating the GM are described and the specific gut bacterial signature of ASD children is detailed. Through bidirectional communication between the GM and the brain, several mechanisms are involved in the development of ASD, such as cytokine-mediated neuroinflammation and decreased production of neuroprotective factors such as short-chain fatty acids by the GM. Imbalance of certain neurotransmitters such as serotonin or gamma-aminobutyric acid could also play a role in these gut-brain interactions. Some studies show that this GD in ASD is partly reversible by treatment with pre- and probiotics, or fecal microbiota transplantation with promising results. However, certain limitations have been raised, in particular concerning the short duration of treatment, the small sample sizes and the diversity of protocols. The development of standardized therapeutics acting on GD in large cohort could rescue the gastrointestinal symptoms and behavioral impairments, as well as patient management.

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

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

The associations between child behavioral problems, parents' emotional regulation difficulties, and parental burnout among Israeli parents of children with autism during wartime

Introduction

Parents of children with Autism Spectrum Disorder (ASD) face heightened challenges during crises like war, leading to parental burnout (PB). Wartime demands may exacerbate the children's behavioral difficulties, which associated with PB. Successful emotional regulation (ER) is considered a protective factor for PB. This study aimed to explore the associations between the child behavioral problems, parent's ER difficulties and PB among parents of children ASD during wartime.

Methods

92 parents completed demographic, Parental Burnout, Difficulties in Emotion Regulation, and Child Aberrant Behavior questionnaires. In addition, 18 parents of children with ASD aged 6-21 were semi-interviewed.

Results

During wartime, child behavioral problems and parents' ER difficulties were positively correlated with PB, contributing beyond background characteristics and other changes following the war. Parent ER difficulties serve as a mediation variable and did not function as a moderation variable between child behavioral problems and PB.

Discussion

This study emphasizes the increased vulnerability of parents of children with ASD during wartime, highlighting the need for a deeper understanding of how these circumstances affect parental risk and resources. Effective interventions should target emotional regulation and address child behavioral issues, necessitating prioritized support for affected families despite wartime challenges.

Aquatic Therapy in Children and Adolescents with Disabilities: A Scoping Review

Globally, around 1 in 10 children aged 0-17 years have moderate-to-severe disabilities. The aquatic environment provides hydrostatic and hydrodynamic characteristics that make exercise and therapy feasible for children and adolescents with disabilities. The objective of this scoping review is to understand the extent and type of evidence in relation to the use of aquatic therapy in children and adolescents with disabilities. The eligibility criteria were as follows: participants-children and/or adolescents with disabilities aged from 6 to 18 years old; concept-aquatic therapy interventions; context-any available setting. The databases searched included MEDLINE, CINAHL, EMBASE, PsycINFO, AMED, Eric, Scopus, Web of Science, Epistemonikos, and one register, Cochrane Central Register of Controlled Trials. In total, 52 reports met the inclusion criteria. Most of the studies included children/adolescents with autism spectrum disorder (ASD; 46.7%)-442 participants in 21 studies in total. The majority of interventions were based on aquatic exercise (35%). Most often, interventions were conducted for 8 weeks, with 2 sessions a week lasting 60 min. The most common type of intervention for children and adolescents with ASD and Down syndrome was swimming. Participants with attention deficit hyperactivity disorder, neuromuscular disorders, and cerebral palsy were more often treated with aquatic exercises. This scoping review could guide practitioners, clinicians, and researchers on what type, setting, and content of aquatic therapy interventions, including exercise types, intervention duration, number of sessions, frequency, facility, and provider, are used with children and adolescents with disabilities.

Development of personalized profiles of students with autism spectrum disorder for interactive interventions with robots to enhance language and social skills

The inclusion of students with autism spectrum disorder (ASD) in mainstream education (primary and secondary, in the range of 4-5 to 8-10 years old) is a complex task that has long challenged both educators and health professionals. However, the correct use of digital technologies such as personalization settings and interaction with robots has clearly shown how these new technologies can benefit ASD students. However, it is essential to characterize the profile, problems, and needs of each student, since it is not possible to generalize an accessible approach for all users. The work presented shows the creation and validation, through pilot tests, of an instrument that outlines the main needs of a student with ASD, based on behavioral variables. In a later phase, instructional sequences will be designed and adapted through digital tablets and interaction with a robot to improve specific aspects identified in the initial profile. The results demonstrate the method's ability to assess and prioritize profiles satisfactorily which helps create a design adjusted to each student. The first pilot tests have been well received by ASD students, who have shown increased interest in the contents and methods used in this approach. Motivation levels and engagement have also increased, and social interactions with their peers have improved.

Nigerian Hospital and Community Pharmacists' Knowledge, Awareness, and Perceptions of Autism Spectrum Disorders

Background

Pharmacists can play a role in enhancing treatment outcomes of autistic people, but they must possess sufficient knowledge and awareness of autism spectrum disorders (ASD). Current evidence is scant among Nigerian pharmacists. The objectives of this study were to: (1) Describe and compare Nigerian hospital and community pharmacists' ASD knowledge, awareness, and perceptions; (2) Determine if there is a significant correlation between ASD knowledge, awareness, and perceptions; (3) Determine if demographic and practice-related factors are significantly related to pharmacists' ASD awareness.

Method

Hospital and community pharmacists were administered a self-report survey to assess ASD knowledge and awareness, as well as confidence in caring for autistic people, and perceived benefits of ASD training and care. Data were collected from August to December 2021 and analyzed using inferential and descriptive statistics. Cronbach's alphas were used to assess reliability.

Results

Of respondents, (Total N = 383; N = 201 hospital pharmacists from various states) and N = 182 community pharmacists in Lagos state) community pharmacists had significantly higher mean knowledge than hospital pharmacists (58.10% ± 19.00% vs 53.20% ± 20.10%; P = .016). Overall mean awareness score was 2.90 ± 0.80, with no significant difference between community and hospital pharmacists (P = .096). Perception regarding ASD continuing education (CE) was strongly correlated with the perceived benefits of pharmacy services to autistic people in Nigeria (r = .69; P < .0001). Additionally, awareness was positively correlated with knowledge (r = .47, P < .0001) and perceived confidence in ASD medication counseling (r = .54, P < .0001). Multivariate analysis revealed that being a hospital pharmacist, having courses on ASD during pharmacy degree programs, undergoing ASD CE, and having <5 years of practice experience were significantly (P < 0.05) associated with higher ASD awareness.

Conclusion

Respondents had suboptimal knowledge and awareness of ASD. Including ASD in the pharmacy curriculum and providing CE programs may help improve pharmacists' ability to provide more optimal patient care services for autistic people.

Amelioration of propionic acid-induced autism-like behaviors in rats by fenofibrate: A focus on reduction of brain galectin-3 levels

INTRODUCTION

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social interactions and repetitive behaviors. This study examines the effects of fenofibrate on a propionic acid (PPA)-induced rat model of ASD, focusing on behavioral changes, inflammatory markers, and histological findings.

MATERIALS AND METHODS

Thirty male Wistar rats were divided into three groups: a control group, a group receiving PPA and saline, and a group treated with PPA and fenofibrate for 15 days. Behavioral assessments, including the three-chamber sociability test, open-field test, and passive avoidance learning, were conducted. Biochemical analyses measured TNF-α, NGF, IL-17, IL-2, and galectin-3 levels in brain tissues. Histological evaluations focused on Purkinje neuron counts in the cerebellum and neuronal changes in the CA1 and CA3 regions of the hippocampus, along with glial fibrillary acidic protein (GFAP) levels.

RESULTS

Fenofibrate treatment significantly improved behavioral outcomes, reducing autism-like behaviors compared to the PPA/saline group. Biochemically, the PPA/saline group showed elevated levels of malondialdehyde, TNF-α, IL-2, IL-17, and galectin-3, which were reduced following fenofibrate treatment. Histologically, the PPA/saline group exhibited fewer, dysmorphic Purkinje neurons and increased glial activity in the CA1 region, both of which were ameliorated by fenofibrate treatment.

CONCLUSION

Fenofibrate shows promise in mitigating autism-like behaviors in a rat model of ASD, likely due to its antioxidative and neuroprotective properties, which contribute to preserving neuronal integrity and reducing inflammation.

Evaluation of the Efficacy of a Full-Spectrum Low-THC Cannabis Plant Extract Using In Vitro Models of Inflammation and Excitotoxicity

Evidence has accumulated that Cannabis-derived compounds have the potential to treat neuroinflammatory changes present in neurodevelopmental conditions such as autism spectrum disorder. However, research is needed on the specific brain health benefits of strains of whole Cannabis extract that are ready for commercial production. Here, we explore the anti-inflammatory and neuroprotective effects of NTI-164, a genetically unique high-cannabidiol (CBD), low-Δ9-tetrahydrocannabinol extract, and also CBD alone on BV-2 microglia and SHSY-5Y neurons. Inflammation-induced up-regulation of microglial inflammatory markers was significantly attenuated by NTI-164, but not by CBD. NTI-164 promoted undifferentiated neuron proliferation and differentiated neuron survival under excitotoxic conditions. These effects suggest the potential for NTI-164 as a treatment for neuropathologies.

Intercontinental insights into autism spectrum disorder: a synthesis of environmental influences and DNA methylation

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder characterized by a broad range of symptoms. The etiology of ASD is thought to involve complex gene-environment interactions, which are crucial to understanding its various causes and symptoms. DNA methylation is an epigenetic mechanism that potentially links genetic predispositions to environmental factors in the development of ASD. This review provides a global perspective on ASD, focusing on how DNA methylation studies may reveal gene-environment interactions characteristic of specific geographical regions. It delves into the role of DNA methylation in influencing the causes and prevalence of ASD in regions where environmental influences vary significantly. We also address potential explanations for the high ASD prevalence in North America, considering lifestyle factors, environmental toxins, and diagnostic considerations. Asian and European studies offer insights into endocrine-disrupting compounds, persistent organic pollutants, maternal smoking, and their associations with DNA methylation alterations in ASD. In areas with limited data on DNA methylation and ASD, such as Africa, Oceania, and South America, we discuss prevalent environmental factors based on epidemiological studies. Additionally, the review integrates global and country-specific prevalence data from various studies, providing a comprehensive picture of the variables influencing ASD diagnoses over region and year of assessment. This prevalence data, coupled with regional environmental variables and DNA methylation studies, provides a perspective on the complexities of ASD research. Integrating global prevalence data, we underscore the need for a comprehensive global understanding of ASD's complex etiology. Expanded research into epigenetic mechanisms of ASD is needed, particularly in underrepresented populations and locations, to enhance biomarker development for diagnosis and intervention strategies for ASD that reflect the varied environmental and genetic landscapes worldwide.

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

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