Autism spectrum disorders

Aesthetic processing in neurodiverse populations

Neurodiversity is a perspective on cognition which suggests a non-pathological view of individual cognitive differences. Aesthetics research on neurodivergent brains has generally been limited to neuropsychological cases. Although this research has been integral to establishing the neurological correlates of aesthetic experience, it is crucial to expand this paradigm to more psychologically complex disorders. We offer a review of research on aesthetic preference in neurodivergent brains beyond neuropsychological cases: across populations with psychotic disorder, anhedonia and depression, anxiety disorder, and autism. We identify stable patterns of aesthetic bias in these populations, relate these biases to symptoms at perceptual, emotional, and evaluative levels of cognition, review relevant neurological correlates, and connect this evidence to current neuroaesthetics theory. Critically, we synthesize the reviewed evidence and discuss its relevance for three brain networks regularly implicated in aesthetic processing: the mesocorticolimbic reward circuit, frontolimbic connections, and the default mode network. Finally, we propose that broadening the subject populations for neuroaesthetics research to include neurodiverse populations is instrumental for yielding new insights into aesthetic processing in the brain.

Associations of maternal and paternal preconception and maternal pregnancy urinary phthalate biomarker and bisphenol A concentrations with offspring autistic behaviors: The PEACE study

BACKGROUND

Environmental chemical exposures in utero may play a role in autism development. While preconception risk factors for autism are increasingly being investigated, little is known about the influence of chemical exposures during the preconception period, particularly for paternal exposures.

METHODS

In 195 children from the Preconception Environmental exposures And Childhood health Effects (PEACE) cohort born to parents recruited from a fertility clinic in Boston, Massachusetts between 2004 and 2017, we quantified concentrations of 11 phthalate metabolites and bisphenol A (BPA) in urine samples collected from mothers and fathers before conception and mothers throughout pregnancy. When children were 6-15 years old, parents completed the Social Responsiveness Scale (SRS) questionnaire assessing autistic behaviors. We used linear mixed effect models to estimate covariate-adjusted associations of phthalate biomarker and BPA concentrations, separately for maternal preconception (n = 179), paternal preconception (n = 121), and maternal pregnancy (n = 177), with SRS T-scores, based on age and gender, in offspring. We used quantile g-computation models for mixture analyses and evaluated modification by selected dietary factors.

RESULTS

The mean SRS T-score was 47.7 (±7.4), lower than the normative mean of 50. In adjusted models for individual biomarkers or mixtures, few associations were observed and estimates were generally negative (e.g., lower SRS T-scores) and imprecise. We observed associations of higher mono-isobutyl phthalate (MiBP) concentrations measured in maternal preconception and paternal preconception periods with lower SRS T-scores (βmaternal_precon = -1.6, 95% CI -2.7; -0.4; βpaternal_precon = -2.9, 95% CI -4.6; -1.2) for each loge increase. In a subset of participants with maternal preconception nutrition information, we generally observed stronger inverse associations with higher folate and iron intake, particularly for folate intake and MiBP concentrations.

CONCLUSIONS

Urinary phthalate biomarker and BPA concentrations during preconception (maternal and paternal) and pregnancy (maternal) were not associated with adverse autistic behaviors in these children. Larger studies are needed to elucidate the observed associations, while considering interactions between maternal nutrition and chemical exposures.

Transcriptome Study in Sicilian Patients with Autism Spectrum Disorder

ASD is a complex condition primarily rooted in genetics, although influenced by environmental, prenatal, and perinatal risk factors, ultimately leading to genetic and epigenetic alterations. These mechanisms may manifest as inflammatory, oxidative stress, hypoxic, or ischemic damage. To elucidate potential variances in gene expression in ASD, a transcriptome analysis of peripheral blood mononuclear cells was conducted via RNA-seq on 12 ASD patients and 13 healthy controls, all of Sicilian ancestry to minimize environmental confounds. A total of 733 different statistically significant genes were identified between the two cohorts. Gene Set Enrichment Analysis (GSEA) and Gene Ontology (GO) terms were employed to explore the pathways influenced by differentially expressed mRNAs. GSEA revealed GO pathways strongly associated with ASD, namely the GO Biological Process term "Response to Oxygen-Containing Compound". Additionally, the GO Cellular Component pathway "Mitochondrion" stood out among other pathways, with differentially expressed genes predominantly affiliated with this specific pathway, implicating the involvement of different mitochondrial functions in ASD. Among the differentially expressed genes, FPR2 was particularly highlighted, belonging to three GO pathways. FPR2 can modulate pro-inflammatory responses, with its intracellular cascades triggering the activation of several kinases, thus suggesting its potential utility as a biomarker of pro-inflammatory processes in ASD.

Independent and combined effects of astaxanthin and omega-3 on behavioral deficits and molecular changes in a prenatal valproic acid model of autism in rats

Objectives: Autism is a devastating neurodevelopmental disorder and recent studies showed that omega-3 or astaxanthin might reduce autistic symptoms due to their anti-inflammatory properties. Therefore, we investigated the effects of omega-3 and astaxanthin on the VPA-induced autism model of rats.Material and Methods: Female Wistar albino pups (n = 40) were grouped as control, autistic, astaxanthin (2 mg/kg), omega-3 (200 mg/kg), and astaxanthin (2 mg/kg)+omega-3 (200 mg/kg). All groups except the control were prenatally exposed to VPA. Astaxanthin and omega-3 were orally administered from the postnatal day 41 to 68 and behavioral tests were performed between day 69 and 73. The rats were decapitated 24 h after the behavioral tests and hippocampal and prefrontal cytokines and 5-HT levels were analyzed by ELISA.Results: VPA rats have increased grooming behavior while decreased sociability (SI), social preference index (SPI), discrimination index (DI), and prepulse inhibition (PPI) compared to control. Additionally, IL-1β, IL-6, TNF-α, and IFN-γ levels increased while IL-10 and 5-HT levels decreased in both brain regions. Astaxanthin treatment raised SI, SPI, DI, PPI, and prefrontal IL-10 levels. It also raised 5-HT levels and decreased IL-6 levels in both brain regions. Omega-3 and astaxanthin + omega-3 increased the SI, SPI, DI, and PPI and decreased grooming behavior. Moreover, they increased IL-10 and 5-HT levels whereas decreased IL-1β, IL-6, TNF-α, IFN-γ levels in both brain regions.Conclusions: Our results showed that VPA administration mimicked the behavioral and molecular changes of autism in rats. Single and combined administration of astaxanthin and omega-3 improved the autistic-like behavioral and molecular changes in the VPA model of rats.

The role of Toll-like receptors in neuropsychiatric disorders: Immunopathology, treatment, and management

Neuropsychiatric disorders denote a broad range of illnesses involving neurology and psychiatry. These disorders include depressive disorders, anxiety, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, autism spectrum disorders, headaches, and epilepsy. In addition to their main neuropathology that lies in the central nervous system (CNS), lately, studies have highlighted the role of immunity and neuroinflammation in neuropsychiatric disorders. Toll-like receptors (TLRs) are innate receptors that act as a bridge between the innate and adaptive immune systems via adaptor proteins (e.g., MYD88) and downstream elements; TLRs are classified into 13 families that are involved in normal function and illnesses of the CNS. TLRs expression affects the course of neuropsychiatric disorders, and is influenced during their pharmacotherapy; For example, the expression of multiple TLRs is normalized during the major depressive disorder pharmacotherapy. Here, the role of TLRs in neuroimmunology, treatment, and management of neuropsychiatric disorders is discussed. We recommend longitudinal studies to comparatively assess the cell-type-specific expression of TLRs during treatment, illness progression, and remission. Also, further research should explore molecular insights into TLRs regulation and related pathways.

The Effectiveness of Sensory-Motor Integration Exercises on Social Skills and Motor Performance in Children with Autism

PURPOSE

The current study aims to investigate the effectiveness of sensory-motor integration exercises on social skills and motor performance in children with autism spectrum disorder (ASD).

METHODS

This is a quasi-experimental study with a pre-test-post-test design and with a control group. The statistical population of this research included all children with ASD aged 9-11 years old in Babolsar city in 2022, among whom 30 were selected through convenient sampling from the transplant center of Babolsar, and were randomly assigned into two experimental and control groups. Then, the experimental group received the treatment program in 12 sessions. The data collection instrument included Gresham and Elliott's social skills questionnaire (Gresham FM, Elliott SN (1993) Social skills intervention guide: systematic approaches to social skills training. Spec Serv Sch 8(1):137-158) and Ulrich's motor performance test (Ulrich B, Ulrich D (1985) The role of balancing ability in performance of fundamental motor skills in 3-, 4-, and 5-year-old children. Motor Dev: Curr Select Res 1:87-97). Data analysis was conducted using covariance analysis in SPSS21.

RESULTS

The multivariate covariance analysis test showed that there is a significant difference between the experimental and control groups in the variable of social skills and motor performance, respectively (P < 0.001).

CONCLUSION

According to the research findings, it can be concluded that sensory-motor integration exercises can be used as an appropriate intervention in promoting and improving social skills and motor performance of children with autism spectrum. Results of this study can be helpful for therapists and educators who deal with autistic children.

Examining the Impact of Group-Based Social Skills Intervention in Autistic Children Aged Eight to 15 Years

Introduction Autism spectrum disorder (ASD) is a neurological and developmental disorder, which poses challenges to social communication and behavior, particularly affecting social functioning. Individuals with ASD face significant social challenges, including difficulty understanding social cues and body language, limited ability to engage in reciprocal social interactions, and challenges with establishing empathy. A preference for routines and repetitive behaviors limits their ability to adapt to new or unexpected social situations. These problems tend to escalate during adolescence. These often cause distress to the individual as well as the caregivers. Group-based social skills interventions (GSSIs) are a widely used and effective modality for addressing core social impairments in children with autism. This study aims to assess the impact of GSSI on the broad age group of eight to 15 years, involving parents to enhance the transferability of children's social skills. Methods This was a single-arm interventional study where 30 verbal autistic children, aged eight to 15 years, with intelligence quotient (IQ) > 70 were enrolled after utilizing the Binet Kamat Test of Intelligence (BKT) to assess IQ and the Indian Scale for Assessment of Autism (ISAA) to grade severity of autism. The children received GSSI from interdisciplinary therapists for 12 sessions, on a weekly basis, lasting 90 minutes each for a period of three months. After each therapy session, parents received summaries of each session and were delegated reinforcing homework assignments to enable generalization and maintenance of the skills taught. Outcome measures were taken at three points in time by utilizing the Social Communication Questionnaire (SCQ) and the parent-rated Social Responsiveness Scale 2 (p-SRS-2): T1: pre-therapy at the time of enrolment; T2: immediately post-therapy at the end of three months of training; and T3: long-term follow-up, three months after the end of training. Results Mean SCQ scores were as follows: T1 = 21.87, T2 = 18.57, and T3 = 18.57 (p = 0.000). This progressive decline at T1, T2, and T3 indicated a decreasing trend in the severity of difficulties in the social communication domain. Mean p-SRS-2 scores were as follows: T1 = 73.00, T2 = 64.57, and T3 = 64.30 (p < 0.0001). This declining trend at T1, T2, and T3 suggested a statistically significant decrease in the severity of difficulties faced in various social aspects tested by the p-SRS-2, i.e., social awareness, social cognition, social communication, and social motivation, along with a reduction in restricted interests and repetitive behaviors (RRBs). Very strong correlation coefficients were obtained for SCQ scores (T1-T2 = 0.921, T1-T3 = 0.921, and T2-T3 = 1.000), as well as for p-SRS-2 scores (T1-T2 = 0.743, T1-T3 = 0.746, and T2-T3 = 0.989), which reinforced the statistical significance of the data. Conclusion GSSI is an effective parent-assisted intervention for adolescents with ASD, with effects lasting up to three months post-intervention.

Umbelliprenin via increase in the MECP2 and attenuation of oxidative stress mitigates the autistic-like behaviors in mouse model of maternal separation stress

Introduction: Autism spectrum disorder (ASD) is a complex neurodevelopmental condition. Maternal separation (MS) stress is an early-life stress factor associated with behaviors resembling Autism. Both MECP2 and oxidative stress are implicated in the pathophysiology of Autism. Umbelliprenin (UMB) is a coumarin compound with various pharmacological properties. Our study aimed to investigate the potential effects of UMB in mitigating autistic-like behaviors in a mouse model subjected to MS stress, focusing on probable alterations in MECP2 gene expression in the hippocampus. Methods: MS paradigm was performed, and mice were treated with saline or UMB. Behavioral tests consisting of the three-chamber test (evaluating social interaction), shuttle box (assessing passive avoidance memory), elevated plus-maze (measuring anxiety-like behaviors), and marble-burying test (evaluating repetitive behaviors) were conducted. Gene expression of MECP2 and measurements of total antioxidant capacity (TAC), nitrite level, and malondialdehyde (MDA) level were assessed in the hippocampus. Results: The findings demonstrated that MS-induced behaviors resembling Autism, accompanied by decreased MECP2 gene expression, elevated nitrite, MDA levels, and reduced TAC in the hippocampus. UMB mitigated these autistic-like behaviors induced by MS and attenuated the adverse effects of MS on oxidative stress and MECP2 gene expression in the hippocampus. Conclusion: In conclusion, UMB likely attenuated autistic-like behaviors caused by MS stress, probably, through the reduction of oxidative stress and an increase in MECP2 gene expression.

Children with Autism Spectrum Disorder and Abnormalities of Clinical EEG: A Qualitative Review

Over the last decade, the comorbidity between Autism Spectrum Disorder (ASD) and epilepsy has been widely demonstrated, and many hypotheses regarding the common neurobiological bases of these disorders have been put forward. A variable, but significant, prevalence of abnormalities on electroencephalogram (EEG) has been documented in non-epileptic children with ASD; therefore, several scientific studies have recently tried to demonstrate the role of these abnormalities as a possible biomarker of altered neural connectivity in ASD individuals. This narrative review intends to summarize the main findings of the recent scientific literature regarding abnormalities detected with standard EEG in children/adolescents with idiopathic ASD. Research using three different databases (PubMed, Scopus and Google Scholar) was conducted, resulting in the selection of 10 original articles. Despite an important lack of studies on preschoolers and a deep heterogeneity in results, some authors speculated on a possible association between EEG abnormalities and ASD characteristics, in particular, the severity of symptoms. Although this correlation needs to be more strongly elucidated, these findings may encourage future studies aimed at demonstrating the role of electrical brain abnormalities as an early biomarker of neural circuit alterations in ASD, highlighting the potential diagnostic, prognostic and therapeutic value of EEG in this field.

Culturally Adapted Dental Visual Aids Effect on Behavior Management during Dental Visits in Children with Autism Spectrum Disorder

AIM

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by unique behavioral patterns, treating children with ASD in the dental clinic has been a great challenge due to their behavior. This study aims to determine the effectiveness of culturally adapted dental visual aids in modifying behavior patterns during dental visits in children with ASD.

MATERIALS AND METHODS

A controlled, blinded, randomized, clinical trial, with 64 children diagnosed with ASD, were randomly divided into two groups. The study took place between January 2019 and January 2021. The experimental group was provided with culturally adapted dental visual aids created especially for this research and the control group was provided with universal dental visual aids. The children's behavior patterns were evaluated before and after using the dental visual aids. SPSS v.25 was used to process all the data.

RESULTS

Behavior patterns have modified significantly in the experimental group (p < 0.001) however, it was statistically insignificant in the control group (p = 0.077). In terms of behavioral patterns, the experimental group outperformed the control group significantly (p < 0.001).

CONCLUSION

The culturally adapted dental visual aids have shown effectiveness in modifying behavior patterns in children diagnosed with ASD during dental visits.

CLINICAL SIGNIFICANCE

By evaluating the impact of culturally adapted visual aids on behavior management, the study can enhance the accessibility and effectiveness of dental care for this vulnerable population, ultimately promoting better oral health outcomes and reducing potential trauma associated with dental visits for children with ASD. How to cite this article: Aljubour AA, AbdElBaki M, El Meligy O, et al. Culturally Adapted Dental Visual Aids Effect on Behavior Management during Dental Visits in Children with Autism Spectrum Disorder. J Contemp Dent Pract 2024;25(1):20-28.

Exploring the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination

INTRODUCTION

Autism is a neuro-developmental condition which affects the social-emotional skills, behaviour, language, communication skills and flexibility of thoughts of an individual and their sensory processing. This can result in Autistic service users finding it difficult to navigate current healthcare provision and cope with the unpredictable environment. This paper explores the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination.

METHODS

A cross sectional, mixed methods approach was adopted and the initial phase consisting of an online survey for parents to complete is the subject of this paper. The quantitative data was analysed using descriptive statistics and cross comparison between questions was also completed. Thematic analysis was taken to analyse the data from the two open questions at the end of the survey.

RESULTS

The online survey results are presented in this paper under four key themes; waiting times and environment, forms of communication, lack of understanding of staff regarding Autism and preparation for the X-ray examination.

CONCLUSION

The overall rating of the parents' experience whilst in the X-ray/diagnostic imaging department was positive, however there are several areas which received low scores which need further attention. These were waiting areas, waiting times, staff development and patient preparation.

IMPLICATIONS FOR PRACTICE

The development of more inclusive waiting areas is needed, more effective lines of communication between staff to expedite the patient journey where possible, staff development of both radiographers and also support staff and the review of design of more accessible and inclusive patient information.

Pre-autism: What a paediatrician should know about early diagnosis of autism‎

Autism, also known as an autism spectrum disorder, is a complex neurodevelopmental disorder usually diagnosed in the first three years of a child's life. A range of symptoms characterizes it and can be diagnosed at any age, including adolescence and adulthood. However, early diagnosis is crucial for effective management, prognosis, and care. Unfortunately, there are no established fetal, prenatal, or newborn screening programs for autism, making early detection difficult. This review aims to shed light on the early detection of autism prenatally, natally, and early in life, during a stage we call as "pre-autism" when typical symptoms are not yet apparent. Some fetal, neonatal, and infant biomarkers may predict an increased risk of autism in the coming baby. By developing a biomarker array, we can create an objective diagnostic tool to diagnose and rank the severity of autism for each patient. These biomarkers could be genetic, immunological, hormonal, metabolic, amino acids, acute phase reactants, neonatal brainstem function biophysical activity, behavioral profile, body measurements, or radiological markers. However, every biomarker has its accuracy and limitations. Several factors can make early detection of autism a real challenge. To improve early detection, we need to overcome various challenges, such as raising community awareness of early signs of autism, improving access to diagnostic tools, reducing the stigma attached to the diagnosis of autism, and addressing various culturally sensitive concepts related to the disorder.

Altered dynamic network interactions in children with ASD during face recognition revealed by time-varying EEG networks

Although the electrophysiological event-related potential in face processing (e.g. N170) is widely accepted as a face-sensitivity biomarker that is deficient in children with autism spectrum disorders, the time-varying brain networks during face recognition are still awaiting further investigation. To explore the social deficits in autism spectrum disorder, especially the time-varying brain networks during face recognition, the current study analyzed the N170, cortical activity, and time-varying networks under 3 tasks (face-upright, face-inverted, and house-upright) in autism spectrum disorder and typically developing children. The results revealed a smaller N170 amplitude in autism spectrum disorder compared with typically developing, along with decreased cortical activity mainly in occipitotemporal areas. Concerning the time-varying networks, the atypically stronger information flow and brain network connections across frontal, parietal, and temporal regions in autism spectrum disorder were reported, which reveals greater effort was exerted by autism spectrum disorder to obtain comparable performance to the typically developing children, although the amplitude of N170 was still smaller than that of the typically developing children. Different brain activation states and interaction patterns of brain regions during face processing were discovered between autism spectrum disorder and typically developing. These findings shed light on the face-processing mechanisms in children with autism spectrum disorder and provide new insight for understanding the social dysfunction of autism spectrum disorder.

Predicting Problematic Behavior in Autism Spectrum Disorder Using Medical History and Environmental Data

Autism spectrum disorder (ASD), characterized by social, communication, and behavioral abnormalities, affects 1 in 36 children according to the CDC. Several co-occurring conditions are often associated with ASD, including sleep and immune disorders and gastrointestinal (GI) problems. ASD is also associated with sensory sensitivities. Some individuals with ASD exhibit episodes of challenging behaviors that can endanger themselves or others, including aggression and self-injurious behavior (SIB). In this work, we explored the use of artificial intelligence models to predict behavior episodes based on past data of co-occurring conditions and environmental factors for 80 individuals in a residential setting. We found that our models predict occurrences of behavior and non-behavior with accuracies as high as 90% for some individuals, and that environmental, as well as gastrointestinal, factors are notable predictors across the population examined. While more work is needed to examine the underlying connections between the factors and the behaviors, having reasonably accurate predictions for behaviors has the potential to improve the quality of life of some individuals with ASD.

Associations between motor competence and physical activity levels of children with intellectual disabilities and/or autism spectrum disorder: Movement matters

Motor competence is important for lifelong physical activity (PA). The current study aimed to examine associations between PA and motor competence. In total, 43 children aged 7-12 years with intellectual disabilities and/or autism spectrum disorder completed anthropometric measures, the Bruininks-Oseretsky Test of Motor Proficiency-2, and wore a wrist accelerometer to capture total PA, moderate-to-vigorous PA (MVPA), average acceleration, and intensity gradient. No significant associations were found between PA outcomes and motor competence. Motor competence performance was commonly 'below average' or 'average'. The weakest subtests were upper limb coordination and strength. The strongest subtest was running speed and agility. Total weekly MVPA was 336.1 ± 150.3 min, higher than UK recommendations of 120-180 per week for disabled children and young people. Larger scale studies are needed to better understand the relationship between PA and motor competence. Future research should also consider the influence of environmental factors on PA in this group.

Evaluation of visual pedagogy teaching method for improving oral hygiene practice in children with Autism: An interventional study

BACKGROUND

Evaluation of visual pedagogy teaching method for improving oral hygiene practice in children with Autism: An interventional study: Visual pedagogy is a relatively newer approach to improve dental care in autistic children. The present study aimed to evaluate visual pedagogy in the practice of oral hygiene in autistic children.

MATERIALS AND METHODS

This interventional and prospective study was conducted in the Department of Paediatric and Preventive Dentistry. Required approval was obtained from Institutional Ethical Board. Written informed consent was obtained from parents/caregivers. The age range was 5-12 years which included 100 participants (40 males and 60 females). Improvement of oral hygiene was evaluated by recording the tooth brushing technique and ability to follow instructions as presented in the educational video shown on smartphones with Wi-Fi/mobile data. Inclusion criteria: (1) Accessibility and (2) Age range between 5 to 12 years. Exclusion criteria: (1) Non-cooperative children, (2) Children receiving medicines that influence oral health, and (3) Inability to follow-ups. Fones technique was used for brushing teeth in video recording demonstrating it in simple structured steps. Statistical analysis was performed using Chi-square and Independent t tests.

RESULTS

Statistically significant improvement was observed in oral hygiene (plaque index) after training patients with visual pedagogy.

CONCLUSION

In the present study, the use of visual pedagogy showed improvement in the oral hygiene scores of autistic children.

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder (ASD) is a group of heterogeneous, multi-factorial, neurodevelopmental disorders resulting from genetic and environmental factors interplay. Infection is a significant trigger of autism, especially during the critical developmental period. There is a strong interplay between the viral infection as a trigger and a result of ASD. We aim to highlight the mutual relationship between autism and viruses. We performed a thorough literature review and included 158 research in this review. Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism, especially for specific viral infections such as Rubella, Cytomegalovirus, Herpes Simplex virus, Varicella Zoster Virus, Influenza virus, Zika virus, and severe acute respiratory syndrome coronavirus 2. Viral infection directly infects the brain, triggers immune activation, induces epigenetic changes, and raises the risks of having a child with autism. At the same time, there is some evidence of increased risk of infection, including viral infections in children with autism, due to lots of factors. There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism. In addition, children with autism are at increased risk of infection, including viruses. Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism. Immune modulation of children with autism should be considered to reduce the risk of infection.

The use of data independent acquisition based proteomic analysis and machine learning to reveal potential biomarkers for autism spectrum disorder

Autism spectrum disorder (ASD) is a complex neurological developmental disorder in children, and is associated with social isolation and restricted interests. The etiology of this disorder is still unknown. There is neither any confirmed laboratory test nor any effective therapeutic strategy to diagnose or cure it. We performed data independent acquisition (DIA) and multiple reaction monitoring (MRM) analysis of plasma from children with ASD and controls. The result showed that 45 differentially expressed proteins (DEPs) were identified between autistic subjects and controls. Among these, only one DEP was down-regulated in ASD; other DEPs were up-regulated in ASD children's plasma. These proteins are found associated with complement and coagulation cascades, vitamin digestion and absorption, cholesterol metabolism, platelet degranulation, selenium micronutrient network, extracellular matrix organization and inflammatory pathway, which have been reported to be related to ASD. After MRM verification, five key proteins in complement pathway (PLG, SERPINC1, and A2M) and inflammatory pathway (CD5L, ATRN, SERPINC1, and A2M) were confirmed to be significantly up-regulated in ASD group. Through the screening of machine learning model and MRM verification, we found that two proteins (biotinidase and carbonic anhydrase 1) can be used as early diagnostic markers of ASD (AUC = 0.8, p = 0.0001). SIGNIFICANCE: ASD is the fastest growing neurodevelopmental disorder in the world and has become a major public health problem worldwide. Its prevalence has been steadily increasing, with a global prevalence rate of 1%. Early diagnosis and intervention can achieve better prognosis. In this study, data independent acquisition (DIA) and multiple reaction monitoring (MRM) analysis was applied to analyze the plasma proteome of ASD patients (31 (±5) months old), and 378 proteins were quantified. 45 differentially expressed proteins (DEPs) were identified between the ASD group and the control group. They mainly were associated with platelet degranulation, ECM proteoglycar, complement and coagulation cascades, selenium micronutrient network, regulation of insulin-like growth factor (IGF) transport and uptake by insulin-like growth factor binding proteins (IGFBPs), cholesterol metabolism, vitamin metabolism, and inflammatory pathway. Through the integrated machine learning methods and the MRM verification of independent samples, it is considered that biotinidase and carbon anhydrase 1 have the potential to become biomarkers for the early diagnosis of ASD. These results complement proteomics database of the ASD patients, broaden our understanding of ASD, and provide a panel of biomarkers for the early diagnosis of ASD.

Epidemiological Study of Autism Spectrum Disorders in Greece for 2021: Nationwide Prevalence in 2–17-Year-Old Children and Regional Disparities

This study estimated the crude prevalence of autism spectrum disorders (ASD) in Greece in 2021. A retrospective study was conducted for 2021 using data provided for research purposes for the first time by the Greek National Health Service Organization for Healthcare Services Provision (EOPYY) related to the ICD-10 diagnosis codes F84.0–F84.9 (ASD). Treatments were categorized by gender, age, and location. Statistical analysis was performed using the open-source software R. In total, 15,706 children aged 2–17 years were registered with ASD: 12,380 boys and 3326 girls. In total, 6,117,910 therapies were prescribed: 4,844,173 for boys and 1,273,737 for girls. Boys are estimated to be diagnosed 3.5 times more often than girls. On average, approximately 390 treatments are prescribed per person per year for both sexes. The annual prevalence is estimated at 0.94%, ranging from 0.42% to 1.44% depending on geographic region. Our findings provide evidence-based data for the planning of policies regarding health, education, and employment for people with ASD. The number of children and treatments makes ASD a public health concern to support children and their families and ensure equal participation in all aspects of society.

Self-forgiveness, Guilt, Shame, and Parental Stress among Parents of Children with Autism Spectrum Disorder

A mixed-method approach was used to explore and compare self-forgiveness, guilt, shame, and parental stress in parents of children with autism spectrum disorder (ASD) and parents of neurotypical (NT) children. The data were obtained by the Heartland Forgiveness Scale (Thompson et al., 2005), Guilt and Shame Experience Scale (Maliňáková et al., 2019), Parental Stress Scale (Berry & Jones, 1995) and by open-ended questions. The research sample consisted of 143 parents of children with ASD and 135 parents of NT children from Slovakia. The regression analysis confirmed that guilt, shame, and self-forgiveness explained 23% of the variance in parental stress, while the only significant negative predictor was self-forgiveness. Furthermore, shame mediated the pathway between self-forgiveness and parental stress in parents of children with ASD. Parents of children with ASD experience more shame than parents of NT children. The qualitative analysis obtained a more comprehensive understanding of both groups. Parents of children with ASD mostly experienced shame in regard to their child's inappropriate behavior or it being misunderstood by society, while parents of NT children mostly did not feel ashamed of their parenting. Acceptance, social support, religious beliefs, and love from the child were the most often mentioned factors helping self-forgiveness in parents of children with ASD. We highlight the importance of self-forgiveness as a potential coping mechanism for parental stress and suggest focusing on negative aspects of shame in parents of children with ASD.

Gingival swelling as a first sign of clinical presentation of ligneous periodontitis in a patient with autism spectrum disorder

BACKGROUND

Ligneous periodontitis is a rare periodontal condition characterized by pseudomembranous enlargement of gingiva with marked impairment in fibrinolysis. The term ligneous is defined as made of, consisting of, or resembling wood; woody. Few cases of ligneous disease have been described in the literature.

CASE DESCRIPTION

The authors describe the case of a 32-year-old woman with autism spectrum disorder who had multiple, ulcerated, erythematous, nodular enlargements of the maxillary and mandibular anterior gingiva. Histopathologic examination revealed extensive fibrinous deposits in the submucosa. The patient's laboratory test results showed plasminogen activity of less than 5%. The patient received a final diagnosis of ligneous periodontitis on the basis of histopathologic features and laboratory findings. Recurrence was not noted until 3 months after excision.

PRACTICAL IMPLICATIONS

Autism spectrum disorders can be associated with ligneous diseases. Because ligneous disease is a lifelong systemic disease affecting multiple systems, early diagnosis is essential to prevent infections and additional periodontal destruction.

Features and effects of computer-based games on cognitive impairments in children with autism spectrum disorder: an evidence-based systematic literature review

INTRODUCTION

Children with Autism Spectrum Disorder (ASD) have different cognitive and intelligence profiles than typical developing individuals. Some of these children need cognitive rehabilitation. This study's main purpose is to provide a systematic review about applying computerized cognitive games for autistic children and to determine the effectiveness of such interventions.

MATERIAL AND METHODS

A thorough search of the ISI Web of Science, Medline (through PubMed), Scopus, IEEE Xplore, and APA PsycInfo databases was performed for articles published from inception to May 17, 2022.

RESULTS

Of 1746 papers, 28 studies were found to be eligible in this systematic review. Fifteen studies (53.57%) compared a Control Group (CG) with Experimental Groups (EGs), while 13 papers (46.42%) evaluated only the impact of the applied intervention in an experimental group. Major domains of cognitive functions are divided into five main categories: 1. Executive functions, 2. Social cognition/emotions, 3. Attention/concentration, 4. Learning and memory, and 5. Language. In 42.85% (12 studies) of the screened papers, social cognition and emotions were assessed after cognitive rehabilitation. The highest rate of effects reported by studies were related to social cognition enhancement. Of the total number of included studies, 17 studies reported a positive effect at all scales, of which nine were quasi-experimental, and seven were fully experimental.

CONCLUSION

Using suitable computerized game-based solutions could enhance cognition indexes in autistic children. Hence, further investigation is needed to determine the real effectiveness of these novel technologies.

RNA epitranscriptomics dysregulation: A major determinant for significantly increased risk of ASD pathogenesis

Autism spectrum disorders (ASDs) are perhaps the most severe, intractable and challenging child psychiatric disorders. They are complex, pervasive and highly heterogeneous and depend on multifactorial neurodevelopmental conditions. Although the pathogenesis of autism remains unclear, it revolves around altered neurodevelopmental patterns and their implications for brain function, although these cannot be specifically linked to symptoms. While these affect neuronal migration and connectivity, little is known about the processes that lead to the disruption of specific laminar excitatory and inhibitory cortical circuits, a key feature of ASD. It is evident that ASD has multiple underlying causes and this multigenic condition has been considered to also dependent on epigenetic effects, although the exact nature of the factors that could be involved remains unclear. However, besides the possibility for differential epigenetic markings directly affecting the relative expression levels of individual genes or groups of genes, there are at least three mRNA epitranscriptomic mechanisms, which function cooperatively and could, in association with both genotypes and environmental conditions, alter spatiotemporal proteins expression patterns during brain development, at both quantitative and qualitative levels, in a tissue-specific, and context-dependent manner. As we have already postulated, sudden changes in environmental conditions, such as those conferred by maternal inflammation/immune activation, influence RNA epitranscriptomic mechanisms, with the combination of these processes altering fetal brain development. Herein, we explore the postulate whereby, in ASD pathogenesis, RNA epitranscriptomics might take precedence over epigenetic modifications. RNA epitranscriptomics affects real-time differential expression of receptor and channel proteins isoforms, playing a prominent role in central nervous system (CNS) development and functions, but also RNAi which, in turn, impact the spatiotemporal expression of receptors, channels and regulatory proteins irrespective of isoforms. Slight dysregulations in few early components of brain development, could, depending upon their extent, snowball into a huge variety of pathological cerebral alterations a few years after birth. This may very well explain the enormous genetic, neuropathological and symptomatic heterogeneities that are systematically associated with ASD and psychiatric disorders at large.

The Clinical Implications of the Academic Performance of the Siblings of Individuals With Autism Spectrum Disorder

We all know that autism spectrum disorder (ASD) can affect academic performance. Many children with autism face different challenges at school. However, less attention is paid to the siblings of autistic children, who are at a high risk of ASD or the broad autism phenotype (BAP). Recent data also shows that many siblings of ASD children suffer from neurodevelopmental disorders, mental health problems as well as poor academic performance. This review will look at the possible etiologies of the poor school performance of autistic children's siblings, with an emphasis on the challenges they face. We will also highlight the clinical implications of these findings, and the possible solutions that can help this vulnerable group.

Saudi Expert Consensus-Based Autism Spectrum Disorder Statement: From Screening to Management

Background: There is a large gap between the needs of individuals diagnosed with autism spectrum disorder (ASD) and the currently available services in Saudi Arabia. Services are often difficult to access, inconsistent in quality, incomplete, unsatisfactory, and costly. As such, there is a national need for expert consensus on the appropriate standards for the assessment and management of children on the autism spectrum. Methodology: A guideline development group (GDC) was formed by professionals representing all related specialties and institutions involved in the management of individuals on the autism spectrum in Saudi Arabia. They met on a regular basis over 21 months. The guideline development process consisted of five steps starting from reviewing existing guidelines and ending with discussing and writing this manuscript. A formal voting process was utilized and recommendations were discussed until a consensus was reached. Results: There was consensus on the following: A specialized diagnostic assessment needs to be carried out by an experienced multidisciplinary team for children referred to assess for ASD. They should be assessed for medical etiology, their behavioral history carefully reviewed, and symptoms directly observed. Longitudinal assessments are encouraged to reflect the effects of symptoms on the individual’s ability to function while with their family, among peers, and in school settings. An additional formal assessment of language, cognitive, and adaptive abilities as well as sensory status is essential to complete the diagnostic process. Interventions should be individualized, developmentally appropriate, and intensive, with performance data relevant to intervention goals to evaluate and adjust interventions. Target symptoms must be identified to address and develop monitoring systems to track change. Conclusion: ASD is a complex condition with widely varying clinical manifestations, thus requiring evaluation and intervention by a range of professionals working in coordination. Behavioral and environmental interventions are the key to optimal outcomes, in conjunction with medications when indicated for specific symptoms. Parental involvement in interventions is vital to sustaining therapeutic gains.

Mitochondrial Impairment: A Common Motif in Neuropsychiatric Presentation? The Link to the Tryptophan-Kynurenine Metabolic System

Nearly half a century has passed since the discovery of cytoplasmic inheritance of human chloramphenicol resistance. The inheritance was then revealed to take place maternally by mitochondrial DNA (mtDNA). Later, a number of mutations in mtDNA were identified as a cause of severe inheritable metabolic diseases with neurological manifestation, and the impairment of mitochondrial functions has been probed in the pathogenesis of a wide range of illnesses including neurodegenerative diseases. Recently, a growing number of preclinical studies have revealed that animal behaviors are influenced by the impairment of mitochondrial functions and possibly by the loss of mitochondrial stress resilience. Indeed, as high as 54% of patients with one of the most common primary mitochondrial diseases, mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome, present psychiatric symptoms including cognitive impairment, mood disorder, anxiety, and psychosis. Mitochondria are multifunctional organelles which produce cellular energy and play a major role in other cellular functions including homeostasis, cellular signaling, and gene expression, among others. Mitochondrial functions are observed to be compromised and to become less resilient under continuous stress. Meanwhile, stress and inflammation have been linked to the activation of the tryptophan (Trp)-kynurenine (KYN) metabolic system, which observably contributes to the development of pathological conditions including neurological and psychiatric disorders. This review discusses the functions of mitochondria and the Trp-KYN system, the interaction of the Trp-KYN system with mitochondria, and the current understanding of the involvement of mitochondria and the Trp-KYN system in preclinical and clinical studies of major neurological and psychiatric diseases.

Autism-like symptoms by exposure to air pollution and valproic acid-induced in male rats

Exposure to air pollution during prenatal or neonatal periods is associated with autism spectrum disorder (ASD) according to epidemiology studies. Furthermore, prenatal exposure to valproic acid (VPA) has also been found to be associated with an increased prevalence of ASD. To assess the association between simultaneous exposure to VPA and air pollutants, seven exposure groups of rats were included in current study (PM2.5 and gaseous pollutants exposed - high dose of VPA (PGE-high); PM2.5 and gaseous pollutants exposed - low dose of VPA (PGE-low); gaseous pollutants only exposed - high dose of VPA (GE-high); gaseous pollutants only exposed - low dose of VPA (GE-low); clean air exposed - high dose of VPA (CAE-high); clean air exposed - low dose of VPA (CAE-low) and clean air exposed (CAE)). The pollution-exposed rats were exposed to air pollutants from embryonic day (E0) to postnatal day 42 (PND42). In all the induced groups, decreased oxidative stress biomarkers, decreased oxytocin receptor (OXTR) levels, and increased the expression of interleukin 6 (IL-6), interleukin 1β (IL-1β), and tumor necrosis factor alpha (TNF-α) were found. The volumes of the cerebellum, hippocampus, striatum, and prefrontal decreased in all induced groups in comparison to CAE. Additionally, increased numerical density of glial cells and decreased of numerical density of neurons were found in all induced groups. Results show that simultaneous exposure to air pollution and VPA can cause ASD-related behavioral deficits and air pollution reinforced the mechanism of inducing ASD ̉s in VPA-induced rat model of autism.

Social Virtual Reality: Neurodivergence and Inclusivity in the Metaverse

Whereas traditional teaching environments encourage lively and engaged interaction and reward extrovert qualities, introverts, and others with symptoms that make social engagement difficult, such as autism spectrum disorder (ASD), are often disadvantaged. This population is often more engaged in quieter, low-key learning environments and often does not speak up and answer questions in traditional lecture-style classes. These individuals are often passed over in school and later in their careers for not speaking up and are assumed to not be as competent as their gregarious and outgoing colleagues. With the rise of the metaverse and democratization of virtual reality (VR) technology, post-secondary education is especially poised to capitalize on the immersive learning environments social VR provides and prepare students for the future of work, where virtual collaboration will be key. This study seeks to reconsider the role of VR and the metaverse for introverts and those with ASD. The metaverse has the potential to continue the social and workplace changes already accelerated by the pandemic and open new avenues for communication and collaboration for a more inclusive audience and tomorrow.

Autism spectrum disorder-like behavior induced in rat offspring by perinatal exposure to di-(2-ethylhexyl) phthalate

Autism spectrum disorders (ASD), also known as childhood autism, is a common neurological developmental disorder. Although it is generally believed that genetic factors are a primary cause for ASD development, more and more studies show that an increasing number of ASD diagnoses are related to environmental exposure. Epidemiological studies indicated that perinatal exposure to endocrine disruptors might cause neurodevelopmental disorders in children. Di-(2-ethylhexyl) phthalate (DEHP) is widely used as a plasticizer in many products. To explore the neurodevelopmental effect induced by perinatal exposure to DEHP on rat offspring, and the potential mechanisms, female Wistar rats were exposed to 1, 10, and 100 mg/kg/day DEHP during pregnancy and lactation, while valproic acid (VPA) was used as a positive control. The behavior tests showed that rat pups exposed to VPA and 100 mg/kg/day DEHP were not good as those from the control group in both their socialability and social novelty. Expression of mTOR pathway-related components increased while the number of autophagosomes decreased in the brain tissue of the rat offspring exposed to 100 mg/kg/day DEHP. In addition, perinatal exposure to DEHP at all dosages decreased the level of autophagy proteins LC3II and Beclin1 in the brain tissue of rat pups. Our results indicated that perinatal DEHP exposure would induce ASD-like behavioral changes in rat offspring, which might be mediated by activation of the mTOR signaling pathway, and inhibition of autophagy in the brain.

The Quantitative Case-by-Case Analyses of the Socio-Emotional Outcomes of Children with ASD in Robot-Assisted Autism Therapy

With its focus on robot-assisted autism therapy, this paper presents case-by-case analyses of socio-emotional outcomes of 34 children aged 3–12 years old, with different cases of Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). We grouped children by the following characteristics: ASD alone (n = 22), ASD+ADHD (n = 12), verbal (n = 11), non-verbal (n = 23), low-functioning autism (n = 24), and high-functioning autism (n = 10). This paper provides a series of separate quantitative analyses across the first and last sessions, adaptive and non-adaptive sessions, and parent and no-parent sessions, to present child experiences with the NAO robot, during play-based activities. The results suggest that robots are able to interact with children in social ways and influence their social behaviors over time. Each child with ASD is a unique case and needs an individualized approach to practice and learn social skills with the robot. We, finally, present specific child–robot intricacies that affect how children engage and learn over time as well as across different sessions.

Autistic-like social deficits in hippocampal MeCP2 knockdown rat models are rescued by ketamine

Autism or autism spectrum disorder (ASD) is a behavioral syndrome characterized by persistent deficits in social interaction, and repetitive patterns of behavior, interests, or activities. The gene encoding Methyl-CpG binding protein 2 (MeCP2) is one of a few exceptional genes of established causal effect in ASD. Although genetically engineered mice studies may shed light on how MeCP2 loss affects synaptic activity patterns across the whole brain, such studies are not considered practical in ASD patients due to the overall level of impairment, and are technically challenging in mice. For the first time, we show that hippo-campal MeCP2 knockdown produces behavioral abnormalities associated with autism-like traits in rats, providing a new strategy to investigate the efficacy of therapeutics in ASD. Ketamine, an N-Methyl-D-aspartate (NMDA) blocker, has been proposed as a possible treatment for autism. Using the MeCP2 knockdown rats in conjunction with a rat model of valproic acid (VPA)-induced ASD, we examined gene expression and ASD behaviors upon ketamine treatment. We report that the core symptoms of autism in MeCP2 knockdown rats with social impairment recovered dramatically following a single treatment with ketamine.

Effectiveness of psychological techniques in dental management for children with autism spectrum disorder: a systematic literature review

BACKGROUND

A rise in the reported numbers of children with Autism Spectrum Disorder (ASD) highlights the need for dental practitioners to be more familiar with the treatment approaches for these special needs children to ensure comfortable, well-accepted and efficient management while in dental office.

AIM

This paper aimed to acquire a deeper understanding of some of the innovative and best approaches to managing children with ASD in dental settings.

DESIGN

A systematic literature search was performed in PubMed, Scopus, Web of Science, Cochrane databases, and grey literature based on the PRISMA 2020 statement, using main keywords such as: 'management', 'dental', 'children', and 'Autism Spectrum Disorder'. Original full-text papers including randomised controlled trials (RCT) and all other designs of non-randomised controlled studies (NRS) reporting relevant intervention studies in English were included without any publication time limit. The quality of the evidence found eligible for the review were then assessed using the ROB-2 and ROBINS-I tools. Subsequently, the details of management interventions and impact of treatment approaches were compared and discussed.

RESULTS

Out of the 204 articles found, 109 unrelated articles were excluded during the initial screening. The full papers of remaining 28 were retrieved and only 15 (7%) articles were eligible to be reviewed; eight RCTs with 'some concerns' and 'high risk' categories particularly concerning their randomisation design, and seven NSRs with 'serious' to 'critical' bias largely due to confounding factors.

CONCLUSION

Our review found inconclusive evidence on the strength of recent psychological and non-pharmacological approaches used to manage children with ASD in dental settings. Small sample size and lack of a control group in certain studies affected the strength of evidence and credibility of the findings. Nevertheless, this review shared informative details on some innovative approaches for better understanding of the management of children with ASD for dental professionals.

Effect of Culturally Adapted Dental Visual Aids on Oral Hygiene Status during Dental Visits in Children with Autism Spectrum Disorder: A Randomized Clinical Trial

Autism spectrum disorder (ASD) prevalence has escalated in the last few decades; it is common to have children with ASD seek dental treatment. Their unique behavior patterns prevent them from attending a regular dental setting and receiving proper oral hygiene instructions (OHI); therefore, culturally adapted dental visual aids are necessary to teach them proper OHI. The aim of this study was to assess the effectiveness of culturally adapted dental visual aids in improving oral hygiene (OH) status in children with ASD. A blinded, randomized, controlled clinical trial with sixty-four children with ASD were randomly divided into two groups according to the type of dental visual aids given to them. The experimental group received culturally adapted dental visual aids developed specifically for the study, and the control group received regular dental visual aids. OH status was assessed before and after using the dental visual aids, and data were processed using SPSS version 25.0. OH status improved significantly in both groups after using the dental visual aids (p < 0.001, p < 0.001), respectively. The experimental group showed significant improvement in comparison to the control group in OH status (p = 0.030). Both dental visual aids showed effectiveness in improving OH status in children with ASD.

Burnout, Depression, and Anxiety Levels among Healthcare Workers Serving Children with Autism Spectrum Disorder

Burnout in healthcare workers (HCWs) is defined as a state of emotional, physical, and mental exhaustion that results from unmanaged, excessive, and long-term workplace stressors. This study aims to assess the prevalence of burnout and the levels of anxiety and depression among HCWs who primarily work with children who have autism spectrum disorder (ASD). A quantitative cross-sectional survey was conducted utilizing the Arabic version of the Maslach Burnout Inventory (MBI), Areas of Worklife Survey (AWS), Patient Health Questionnaire for Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire for Depression (PHQ-9). Among the 381 participants working in autism centers, the majority were young Saudi females (326) working full-time as specialists in the private sector with less than five years of experience. The HCWs' overall mean scores on the three Maslach Burnout Inventory (MBI) subscales: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) were 62%, 23.7%, and 76.5%, respectively. A total of 51.4% of HCWs reported moderate to high anxiety levels on GAD-7, and 47.8% showed moderate to very high levels of depression on PHQ-9. The mean perceived EE converged significantly but negatively on their overall mean perceived satisfaction with AWS (p-value < 0.001), demonstrating that greater emotional fatigue predicts less satisfaction with their work. The PA scores correlated significantly and positively with their overall mean satisfaction with their AWS score (p-value < 0.001). Considering sociodemographic variables, HCWs aged between 20-29 years have significantly lower mean PA scores than HCWs aged thirty and older (p = 0.007). Also, male HCWs perceived significantly higher work-related DP than females. More research is required to determine the nature of variables that contribute to burnout, depression, and anxiety in HCWs helping children with ASD.

Gastrointestinal manifestations and their relation to faecal calprotectin in children with autism

Introduction

A common comorbidity in autism spectrum disorder (ASD) children is gastrointestinal problems, and a possible link between active gastrointestinal inflammation and autism has been suggested. Faecal calprotectin (FC) is a non-invasive marker for of gastrointestinal inflammation.

Aim

To study the level of FC as a marker of bowel inflammation in children with ASD and its possible relation to gastrointestinal manifestations.

Material and methods

Calprotectin levels were assessed in stool samples of 40 ASD children. Autism severity was assessed by the Childhood Autism Rating Scale (CARS). Severity of gastrointestinal symptoms was assessed using a modified version of the 6-Item Gastrointestinal Severity Index (6-GSI) questionnaire. A control group of 40 healthy children matched for age and sex with the cases was also included to compare their levels of FC.

Results

Gastrointestinal symptoms were present in 82.5% of children with autism; the most reported offensive stool odour (70%) and the least diarrhoea (17.5%), and a high 6-GSI score was observed in 35% of ASD children. FC levels were elevated in 35% of the cases and in 25% of the control group. The mean levels of FC of cases were significantly elevated compared to levels of controls. FC levels positively correlated with severity of gastrointestinal symptoms (6-GSI) in autistic patients. There was positive correlation between CARS and 6-GSI.

Conclusions

Gastrointestinal manifestations are a common comorbidity in autistic patients. ASD patients have significantly higher FC levels than healthy controls. FC levels are strongly correlated with the severity of gastrointestinal manifestations in ASD children. So, gastrointestinal manifestations among autistic patients could be caused by gastrointestinal inflammation.

Zebrafish Modeling of Autism Spectrum Disorders, Current Status and Future Prospective

Autism spectrum disorder (ASD) refers to a complicated range of childhood neurodevelopmental disorders which can occur via genetic or non-genetic factors. Clinically, ASD is associated with problems in relationships, social interactions, and behaviors that pose many challenges for children with ASD and their families. Due to the complexity, heterogeneity, and association of symptoms with some neuropsychiatric disorders such as ADHD, anxiety, and sleep disorders, clinical trials have not yielded reliable results and there still remain challenges in drug discovery and development pipeline for ASD patients. One of the main steps in promoting lead compounds to the suitable drug for commercialization is preclinical animal testing, in which the efficacy and toxicity of candidate drugs are examined in vivo. In recent years, zebrafish have been able to attract the attention of many researchers in the field of neurological disorders such as ASD due to their outstanding features. The presence of orthologous genes for ASD modeling, the anatomical similarities of parts of the brain, and similar neurotransmitter systems between zebrafish and humans are some of the main reasons why scientists draw attention to zebrafish as a prominent animal model in preclinical studies to discover highly effective treatment approaches for the ASD through genetic and non-genetic modeling methods.

Oxidative Stress in Autism Spectrum Disorder-Current Progress of Mechanisms and Biomarkers

Autism spectrum disorder (ASD) is a type of neurodevelopmental disorder that has been diagnosed in an increasing number of children around the world. Existing data suggest that early diagnosis and intervention can improve ASD outcomes. However, the causes of ASD remain complex and unclear, and there are currently no clinical biomarkers for autism spectrum disorder. More mechanisms and biomarkers of autism have been found with the development of advanced technology such as mass spectrometry. Many recent studies have found a link between ASD and elevated oxidative stress, which may play a role in its development. ASD is caused by oxidative stress in several ways, including protein post-translational changes (e.g., carbonylation), abnormal metabolism (e.g., lipid peroxidation), and toxic buildup [e.g., reactive oxygen species (ROS)]. To detect elevated oxidative stress in ASD, various biomarkers have been developed and employed. This article summarizes recent studies about the mechanisms and biomarkers of oxidative stress. Potential biomarkers identified in this study could be used for early diagnosis and evaluation of ASD intervention, as well as to inform and target ASD pharmacological or nutritional treatment interventions.

Commercial microbiota test revealed differences in the composition of intestinal microorganisms between children with autism spectrum disorders and neurotypical peers

The early-life modifications of intestinal microbiota may impact children's subsequent emotional and cognitive development. Studies show that some bacteria species in gut microbiota, and the lack of others, may play a key role in autism spectrum disorders (ASD) development. Fecal samples were obtained from three groups of children: 16 healthy, 24 with allergies (ALG), and 33 with ASD (probiotics and non-probiotics users). The analysis was carried out according to the KyberKompakt Pro protocol. We observed a significantly higher level of Klebsiella spp. in the healthy children from the non-probiotics group, considering three groups. In the same group, Bifidobacterium spp. the level was lower in ASD compared to neurotypical individuals. In healthy children who did not use probiotics, strong positive correlations were observed in E. coli and Enterococcus spp. and Bacteroides and Klebsiella spp., and a negative correlation for Akkermansia muciniphila with both Klebsiella spp. and Bacteroides spp. In the ASD group who take probiotics, a strongly negative correlation was observed in Lactobacillus spp., and both Faecalibacterium prausnitzii and Akkermansia muciniphila levels. In the ALG group, the strongest, negative correlation was found between Enterococcus spp. and Lactobacillus spp. as in Akkermansia muciniphila and Bifidobacterium spp. The simple commercial test revealed minor differences in the composition of intestinal microorganisms between children with autism spectrum disorders and neurotypical peers.

Millennium Nutrient N,N-Dimethylglycine (DMG) and its Effectiveness in Autism Spectrum Disorders

Autism is a neurodevelopmental disorder belonging to the autism spectrum disorder (ASD). In ASDs, the individuals show substantial impairments in social communication, repetitive behaviours, and sensory behaviours deficits in the early stages of their life. Globally, the prevalence of autism is estimated to be less than 1%, especially in high-income countries. In recent decades, there has been a drastic increase in the incidence of ASD, which has put ASD into the category of epidemics. Presently, two US Food and Drug Administration-approved drugs, aripiprazole and risperidone are used to treat symptoms of agitation and irritability in autistic children. However, to date, no medication has been found to treat the core symptoms of ASD. The adverse side effects of conventional medicine and limited treatment options have led families and parents of autistic children to turn to complementary and alternative medicine (CAM) treatments, which are perceived as relatively safe compared to conventional medicine. Recently, N,N-dimethylglycine (DMG), a dietary supplement, has emerged as a useful supplement to improve the mental and physical state of children with ASD. The current review discusses ASD, the prevalence of ASD, CAM approach and efficacy of CAM treatment in children with ASD. Moreover, it highlights the chemistry, pharmacological effect, and clinical studies of DMG, highlighting its potential for improving the lifestyle of children with ASD.

Levels of happiness and depression in parents of children with autism spectrum disorder in Poland

There are numerous factors that determine the sense of happiness and level of depression in caregivers of children with autism spectrum disorder (ASD). The aim of this paper is to evaluate happiness and depression in/among families with an ASD child and compare with families with neurotypical children. The study included 182 participants. The participants answered questions for two questionnaires: Beck Depression Inventory and Oxford Happiness Questionnaire. The outcome of the study identified significant differences for sense of happiness and level of depression among the parents of children with ASD compared with the parents of neurotypical children. It was shown that parents of children with ASD reported a lower sense of happiness and a higher level of depression compared to the parents of neurotypical children. They also showed a significantly higher level of depression relative to the decreased level of happiness. Moreover, parents who have a university education degree and a child with ASD showed a higher sense of happiness and a lower level of depression than parents who had a secondary education degree, in the studied groups.

Role of microbes in the pathogenesis of neuropsychiatric disorders

Microbes inhabit different anatomical sites of the human body including oral cavity, gut, and skin. A growing literature highlights how microbiome variation is associated with human health and disease. There is strong evidence of bidirectional communication between gut and brain mediated by neurotransmitters and microbial metabolites. Here, we review the potential involvement of microbes residing in the gut and in other body sites in the pathogenesis of eight neuropsychiatric disorders, discussing findings from animal and human studies. The data reported provide a comprehensive overview of the current state of the microbiome research in neuropsychiatry, including hypotheses about the mechanisms underlying the associations reported and the translational potential of probiotics and prebiotics.

PM2.5 as a potential risk factor for autism spectrum disorder: Its possible link to neuroinflammation, oxidative stress and changes in gene expression

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by behavioral deficits including impairments in social communication, social interaction, and repetitive behaviors. Because the etiology of ASD is still largely unknown, there is no cure for ASD thus far. Although it has been established that genetic components play a vital role in ASD development, the influence of epigenetic regulation induced by environmental factors could also contribute to ASD susceptibility. Accumulated evidence has suggested that exposure to atmospheric particulate matter (PM) in polluted air could affect neurodevelopment, thus possibly leading to ASD. Particles with a size of 2.5 μm (PM_2.5) or less have been shown to have negative effects on human health, and could be linked to ASD symptoms in children. This review summarizes evidence from clinical and animal studies to demonstrate the possible linkage between PM_2.5 exposure and the incidence of ASD in children. An attempt was made to explore the possible mechanisms of this linkage, including changes of gene expression, oxidative stress and neuroinflammation induced by PM_2.5 exposure.

Investigating autism associated genes in C. elegans reveals candidates with a role in social behaviour

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by a triad of behavioural impairments and includes disruption in social behaviour. ASD has a clear genetic underpinning and hundreds of genes are implicated in its aetiology. However, how single penetrant genes disrupt activity of neural circuits which lead to affected behaviours is only beginning to be understood and less is known about how low penetrant genes interact to disrupt emergent behaviours. Investigations are well served by experimental approaches that allow tractable investigation of the underpinning genetic basis of circuits that control behaviours that operate in the biological domains that are neuro-atypical in autism. The model organism C. elegans provides an experimental platform to investigate the effect of genetic mutations on behavioural outputs including those that impact social biology. Here we use progeny-derived social cues that modulate C. elegans food leaving to assay genetic determinants of social behaviour. We used the SAFRI Gene database to identify C. elegans orthologues of human ASD associated genes. We identified a number of mutants that displayed selective deficits in response to progeny. The genetic determinants of this complex social behaviour highlight the important contribution of synaptopathy and implicates genes within cell signalling, epigenetics and phospholipid metabolism functional domains. The approach overlaps with a growing number of studies that investigate potential molecular determinants of autism in C. elegans. However, our use of a complex, sensory integrative, emergent behaviour provides routes to enrich new or underexplored biology with the identification of novel candidate genes with a definable role in social behaviour.

Autism medical comorbidities

Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.

Autism medical comorbidities

Medical comorbidities are more common in children with autism spectrum disorders (ASD) than in the general population. Some genetic disorders are more common in children with ASD such as Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex. Children with autism are also more prone to a variety of neurological disorders, including epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. Besides, sleep disorders are a significant problem in individuals with autism, occurring in about 80% of them. Gastrointestinal (GI) disorders are significantly more common in children with ASD; they occur in 46% to 84% of them. The most common GI problems observed in children with ASD are chronic constipation, chronic diarrhoea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. Several categories of inborn-errors of metabolism have been observed in some patients with autism including mitochondrial disorders, disorders of creatine metabolism, selected amino acid disorders, disorders of folate or B12 metabolism, and selected lysosomal storage disorders. A significant proportion of children with ASD have evidence of persistent neuroinflammation, altered inflammatory responses, and immune abnormalities. Anti-brain antibodies may play an important pathoplastic mechanism in autism. Allergic disorders are significantly more common in individuals with ASD from all age groups. They influence the development and severity of symptoms. They could cause problematic behaviours in at least a significant subset of affected children. Therefore, it is important to consider the child with autism as a whole and not overlook possible symptoms as part of autism. The physician should rule out the presence of a medical condition before moving on to other interventions or therapies. Children who enjoy good health have a better chance of learning. This can apply to all children including those with autism.

A review of resting-state fMRI and its use to examine psychiatric disorders

Resting-state fMRI (rs-fMRI) has emerged as an alternative method to study brain function in human and animal models. In humans, it has been widely used to study psychiatric disorders including schizophrenia, bipolar disorder, autism spectrum disorders, and attention deficit hyperactivity disorders. In this review, rs-fMRI and its advantages over task based fMRI, its currently used analysis methods, and its application in psychiatric disorders using different analysis methods are discussed. Finally, several limitations and challenges of rs-fMRI applications are also discussed.

The Frontal Aslant Tract: A Systematic Review for Neurosurgical Applications

The frontal aslant tract (FAT) is a recently identified white matter tract connecting the supplementary motor complex and lateral superior frontal gyrus to the inferior frontal gyrus. Advancements in neuroimaging and refinements to anatomical dissection techniques of the human brain white matter contributed to the recent description of the FAT anatomical and functional connectivity and its role in the pathogenesis of several neurological, psychiatric, and neurosurgical disorders. Through the application of diffusion tractography and intraoperative electrical brain stimulation, the FAT was shown to have a role in speech and language functions (verbal fluency, initiation and inhibition of speech, sentence production, and lexical decision), working memory, visual–motor activities, orofacial movements, social community tasks, attention, and music processing. Microstructural alterations of the FAT have also been associated with neurological disorders, such as primary progressive aphasia, post-stroke aphasia, stuttering, Foix–Chavany–Marie syndrome, social communication deficit in autism spectrum disorders, and attention–deficit hyperactivity disorder. We provide a systematic review of the current literature about the FAT anatomical connectivity and functional roles. Specifically, the aim of the present study relies on providing an overview for practical neurosurgical applications for the pre-operative, intra-operative, and post-operative assessment of patients with brain tumors located around and within the FAT. Moreover, some useful tests are suggested for the neurosurgical evaluation of FAT integrity to plan a safer surgery and to reduce post-operative deficits.

The Effect of a Combined Gluten- and Casein-Free Diet on Children and Adolescents with Autism Spectrum Disorders: A Systematic Review and Meta-Analysis

There has been a growing interest in the gastrointestinal system and its significance for autism spectrum disorder (ASD), including the significance of adopting a gluten-free and casein-free (GFCF) diet. The objective was to investigate beneficial and safety of a GFCF diet among children with a diagnosis of ASD. We performed a systematic literature search in Medline, Embase, Cinahl, and the Cochrane Library up to January 2020 for existing systematic reviews and individual randomized controlled trials (RCTs). Studies were included if they investigated a GFCF diet compared to a regular diet in children aged 3 to 17 years diagnosed with ASD, with or without comorbidities. The quality of the identified existing reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR). The risk of bias in RCTs was assessed using the Cochrane Risk of Bias Tool, and overall quality of evidence was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). We identified six relevant RCTs, which included 143 participants. The results from a random effect model showed no effect of a GFCF diet on clinician-reported autism core symptoms (standardized mean difference (SMD) -0.31 (95% Cl. -0.89, 0.27)), parent-reported functional level (mean difference (MD) 0.61 (95% Cl -5.92, 7.14)) or behavioral difficulties (MD 0.80 (95% Cl -6.56, 10.16)). On the contrary, a GFCF diet might trigger gastrointestinal adverse effects (relative risk (RR) 2.33 (95% Cl 0.69, 7.90)). The quality of evidence ranged from low to very low due to serious risk of bias, serious risk of inconsistency, and serious risk of imprecision. Clinical implications of the present findings may be careful consideration of introducing a GFCF diet to children with ASD. However, the limitations of the current literature hinder the possibility of drawing any solid conclusion, and more high-quality RCTs are needed. The protocol is registered at the Danish Health Authority website.