Wiley: Autism Research: Table of Contents

Conceptualizing Functioning Levels of Theory of Mind Ability and Performance in Preschool to School‐Aged Autistic and Neurotypical Children

Mon, 08 Jun 2026 22:39:10 -0700

ABSTRACT

Autistic children often show reduced theory of mind (ToM). However, existing ToM measures neither sufficiently distinguish ToM ability from performance nor interpret both scores effectively, limiting their interpretability and clinical utility. To resolve these limitations, we characterized the measurement-based functioning levels and correspondence between ToM ability and performance among preschool to school-aged children. Data from 288 autistic and 168 neurotypical children were analyzed using a multidimensional Rasch model. The functioning levels and correspondence were established using expected responses across statistically distinguishable ToM levels. The results revealed three levels of ToM ability—Early (failure on all items), Basic (success on desire-based emotion), and Advanced (success on all items)—and five levels of ToM performance: Pre-ToM (understanding needs and wants), Emerging (simple emotion recognition), Transition (first-order false belief), Premature (contextual understanding), and Mature (pragmatic understanding). Importantly, while ToM performance tended to improve with ToM ability, only 20% of the items were comparable with neurotypical children. In conclusion, our findings highlight a critical gap in autistic children and provide the first empirically derived functioning framework linking ToM ability and performance. Beyond theoretical contribution, this study offers a practical pathway toward valid assessments and tailored interventions that target children's specific social-cognitive needs.

Lower Striatal and Cortical Calretinin Interneuron Density Associated With Altered Social Behavior in Cntnap2 Knockout Mice

Sat, 06 Jun 2026 02:09:33 -0700

ABSTRACT

Variants in the CNTNAP2 gene, encoding the cell adhesion molecule CASPR2, have been identified as genetic risk factors for autism spectrum disorder (ASD). However, the mechanisms through which CNTNAP2 dysfunction alters circuit function remain unknown. Interneurons, as key regulators of excitatory–inhibitory balance, represent a candidate source of vulnerability. In this study, we quantified calretinin-positive (CR+) and parvalbumin-positive (PV+) interneuron density in the caudoputamen (CP) and somatosensory cortex (SSC) of Cntnap2 knockout (KO) and wild-type (WT) mice and assessed their relationship with social behavior. Cntnap2 KO mice exhibited significantly lower CR+ interneuron density in both brain regions, whereas no significant difference was observed in the PV+ density. Cntnap2 KO females showed altered behavior in the social novelty preference test compared to WT females. Cntnap2 KO animals also displayed elevated “moving away” responses, a social withdrawal phenotype. Correlation analyses revealed that within the KO group, higher striatal CR+ density was associated with a greater frequency and duration of “moving away.” CR+ density in the SSC did not correlate with this behavioral phenotype. The results suggest that striatal CR+ interneurons may modulate the persistence and intensity of social withdrawal behavior. In conclusion, our findings reveal region-specific alterations in CR+ interneuron density in Cntnap2 KO mice and uncover a previously unrecognized link between Cntnap2 function, striatal interneuron organization and social withdrawal behavior. The results highlight CR+ interneurons as potential contributors to altered basal ganglia function in ASD and underscore the need for circuit-level analyses of genetically defined risk models.

Linking Brain Morphometry to Psychometric Measures and Energy‐Metabolic Biomarkers in Adults With Autism Spectrum Disorder

Fri, 05 Jun 2026 00:30:29 -0700

ABSTRACT

Autism spectrum disorder (ASD) is associated with differences in neurodevelopment and altered metabolism, yet the interplay between brain morphometry, mitochondrial and energy metabolism biomarkers, and autistic traits in adults remains poorly understood. This study investigates the link between brain structure, psychometric measures, and both central and peripheral metabolic biomarkers in adults with ASD. We studied 145 adults, including 74 with ASD and 71 control participants (CON) using high-resolution 3-Tesla MRI to assess cortical thickness, subcortical and global brain volumes. Central energy metabolism was indexed by the posterior-cingulate lactate + threonine (Lac⁺) peak quantified with proton-MRS. We examined associations between biomarkers of mitochondrial function and energy metabolism (including lactate, pyruvate, creatine kinase, and multiple acylcarnitines). Psychometric evaluations included measures of ASD and attention-deficit/hyperactivity disorder (ADHD) symptom severity, as well as other psychiatric comorbidities. Between-group differences and correlations were assessed using robust statistics, controlling for age, sex, image quality, and total intracranial volume. Adults with ASD showed significantly larger bilateral caudate volumes compared to CON. Within the ASD group, higher ADHD symptom severity in childhood correlated with reduced cortical thickness in multiple frontal and temporal regions. Among metabolic markers, acylcarnitine C5:1 was positively associated with right insular cortex thickness, while C18:1-OH and C18:2 levels correlated positively with caudate volume. Caudate nucleus volume is associated not only with an ASD diagnosis but also with specific peripheral energy-metabolism blood markers, such as specific acylcarnitines. Alterations in cortical thickness were also correlated with acylcarnitine levels and, to a greater extent, with co-occurring ADHD symptoms. While alterations in cortical thickness and basal ganglia structure have been previously described in ASD and comorbid ADHD, the linkage between mitochondrial and energy metabolism biomarkers with neuroanatomical alterations in ASD is, to our knowledge, a novel observation that warrants further investigation.

Limited Discrepancy Between Cognitive Ability and Daily Living Skills in Autism: A Longitudinal Study From Ages 2–25

Elaine B. Clarke, Catherine Lord, Vanessa H. Bal — Tue, 02 Jun 2026 00:06:16 -0700

ABSTRACT

Many autistic individuals with average or higher cognitive abilities (also referred to as intelligence quotient; IQ) exhibit weaker than expected daily living skills (DLS). However, existing evidence is primarily cross-sectional. This study examined: (1) how IQ-DLS discrepancies develop from early childhood through early adulthood, (2) whether childhood factors (e.g., autism features, non-verbal IQ) predict these developmental pathways, and (3) how IQ-DLS discrepancy trajectories relate to adult experiences (e.g., employment, well-being, relationships). Analyses included 92 individuals from the Longitudinal Study of Autism with average or better IQ and repeated assessments of IQ and DLS from ages 2–25 years. Developmental patterns in IQ-DLS discrepancy scores were identified using group-based trajectory modeling. Two trajectory groups were identified: IQ = DLS (commensurate cognitive and daily living skills) and IQ > DLS (weaker DLS than expected for IQ). Most participants had commensurate IQ and DLS across development. When discrepancies emerged, they did so gradually, becoming apparent by mid-childhood. White participants were more likely to be in the IQ > DLS group; participant race was the only early childhood predictor of group membership. IQ-DLS discrepancy trajectories were not significantly associated with adult experiences. In contrast to existing literature, this study suggests autistic individuals with average or higher IQ may not always have persistent deficits in DLS relative to cognitive ability. When discrepancies occurred in this sample, they developed over time rather than being present from early childhood. These findings challenge deterministic assumptions about adaptive function in autism and highlight the importance of sustained opportunities to learn and practice DLS across development.

Artificial Intelligence Methods in Early Detection of Autism Spectrum Disorder: A DSM‐5 Criterion‐Based Systematic Review

Mohamed Ali Zoromba, Heba Emad El‐Gazar — Mon, 01 Jun 2026 23:17:06 -0700

ABSTRACT

Can Artificial Intelligence (AI) revolutionize early detection of Autism Spectrum Disorder (ASD) by offering a more objective alternative to the subjective behavioral assessments? This systematic review evaluates AI-based methods for early ASD detection in children, assessing the distribution, performance, and DSM-5 alignment of AI techniques, and the methodological quality of existing studies. Following PRISMA guidelines, seven databases (PubMed, Web of Science, Scopus, IEEE Xplore, PsycNET, CINAHL, and Cochrane Library) were searched from January 2015 to March 2025; no backward or forward citation tracking was conducted. Studies were included if they focused on pediatric populations (ages 0–18) with clinically diagnosed ASD, employed AI detection/classification methods, utilized observable behavioral data, and reported diagnostic performance metrics. Studies using exclusively neurobiological data, adult populations, non-English publications, or lacking clear diagnostic reference standards were excluded. Two reviewers independently screened 1018 records; 43 met inclusion criteria. Methodological quality was assessed using QUADAS-2, adapted for machine learning considerations. Classical Machine Learning (34%), Deep Learning (34%), and Hybrid approaches (32%) were equally prevalent. Convolutional Neural Networks and Support Vector Machines dominated for unstructured and structured data, respectively. Most studies (74%) targeted both DSM-5 Criteria A and B; 23% focused solely on Criterion A. Direct DSM-5 alignment correlated with higher accuracy (median ~95%); overall accuracy ranged from 68.18% to 100%. Methodological concerns included 57% unclear patient selection and 43% unclear index test risk. AI demonstrates transformative potential for early ASD detection, particularly for social communication deficits. Gaps in Criterion B coverage, geographic skew toward high-income settings, and methodological inconsistencies limit clinical applicability. Future work should prioritize standardized protocols, multimodal integration, and diverse external validation.

Trial Registration: PROSPERO registration ID: CRD420250656126

Beyond the Outburst: Charting a New Frontier for Understanding and Treating Irritability in Autistic Adults

Hsiang‐Yuan Lin, Arthur N. Westover, Amy S. F. Lutz, Manish K. Jha — Mon, 01 Jun 2026 03:21:41 -0700

ABSTRACT

Irritability is a prevalent and impairing feature associated with autism, yet remains poorly understood, particularly in adults. Drawing heavily on insights translated from pediatric and transdiagnostic literatures, we propose that irritability in autistic individuals often reflects a psychophysiological stress or threat response, rooted in a vulnerable neurobiology (e.g., sensory sensitivities, intolerance of uncertainty), but may also stem from intrinsic neurobiological dysregulation independent of environmental triggers. The current treatment paradigm for autistic adults, largely extrapolated from pediatric antipsychotic trials, leaves these adults critically underserved due to a lack of evidence-based treatments, clinical trials, or validated tools to measure their internal experience. This viewpoint deconstructs irritability, differentiating its affective nature from aggression, and highlights heterogeneity across the lifespan and support needs. We critique the limitations of current assessment methods and recommend a shift toward a multi-modal strategy integrating self-report (when feasible) with objective, physiologically-informed tools (e.g., wearable biosensors) and nuanced observer reports. We argue that the field is poised for neuroscience-informed treatment innovation—including novel pharmacological agents and adapted psychosocial interventions—but is hampered by a lack of rigorous clinical trials in adults. Finally, we call for mechanistically driven trials to address the large unmet burden of inadequately treated irritability, ultimately improving the quality of life for autistic adults and their families/caregivers.

Atypical Predictive Processing Is Associated With Sensory Over‐Responsivity in Autism

Sat, 30 May 2026 07:15:29 -0700

ABSTRACT

Autism is characterized by sensory processing atypicalities including sensory over-responsivity (SOR), a heightened negative response to sensory stimuli. Although the neural mechanisms underlying SOR are not fully understood, SOR has been associated with sensory-limbic hyper-reactivity during sensory stimulation. Altered predictive processing may play a key role in atypical sensory processing but few studies have directly probed the relationship between SOR and prediction, particularly using aversive stimuli that bother autistic individuals in everyday life. Here, we examined whether visual cues signaling the onset of aversive sensory stimuli would either (a) reduce neural hyper-reactivity in autism by making stimuli less unexpected or (b) show limited effects in autism due to atypical predictive processing hindering the use of the cue to attenuate responses. Fifty-five autistic (ASD; 30 female, mean age 21.01 ± 3.49) and 28 typically developing (TD; 16 female, mean age 19.76 ± 3.00) adolescents and young adults underwent functional magnetic resonance imaging (fMRI) while they were exposed to mildly aversive auditory and tactile stimulation. Stimulus blocks were either presented with a visual cue representing the upcoming sensory stimulus (Predictable), or no cue (Unpredictable). Results showed sensory cortical hyper-reactivity in ASD compared to TD in the Unpredictable condition, but responses to Predictable stimuli were overall similar between groups. In addition, expected stimuli were associated with increased frontal activity in autism, suggesting that visual cues facilitated regulation of sensory responses. Notably, within the autism group, SOR was associated with increased responses to expected stimuli in relevant sensory cortices, suggesting that reduced expectancy suppression may be specifically related to SOR within ASD rather than being a general autistic trait.

Does Ongoing Task Load Influence Prospective Remembering in Autism Spectrum Disorders?

Daniela Nürnberg, Mareike Altgassen — Fri, 29 May 2026 12:50:25 -0700

ABSTRACT

Prospective memory (PM) refers to the cognitive ability to remember to carry out intended actions in the future. The present study investigated PM performance in autistic and non-autistic adults as well as the impact of the cognitive load of the ongoing task on PM performance. A total of 50 autistic individuals and 51 age- and non-verbal ability-matched non-autistic individuals completed an event-based PM task, which was embedded into an ongoing n-back task. The cognitive load of the n-back task was varied (2- vs. 3-back for low versus high cognitive load). Results showed that autistic participants did not differ from non-autistic participants in their PM performance. The cognitive load of the ongoing task had no impact on event-based PM performance in both groups. This is the first study to investigate the impact of ongoing task load on event-based PM performance in autistic adults. The results support the neurodiversity perspective of ASD as a highly heterogeneous population which is not necessarily characterized by reduced PM performance.

Content Analysis of Responses From an INSAR Special Interest Group (SIG): Indigenous Perspectives on Autism

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autism remains understudied and under-detected in Indigenous communities across the globe. This content analysis investigates key themes and future directions for Indigenous autism research, as discussed during a Special Interest Group at the 2025 International Society for Autism Research meeting in Seattle, United States. Discussions and perspectives were explored with shared knowledge from international participants who were service providers, Autistic self-advocates, academics, and other autism-related stakeholders. The emergent themes emphasized the need for autism research in Indigenous communities to utilize approaches that are decolonized, culturally informed, and strengths-based. The results highlighted the need for researchers to focus on building trust, fostering relationship-building, and encouraging collaborative research partnerships with communities, while addressing systemic limiting factors and integrating knowledge systems from Indigenous and Western models. There is also a desire for more Indigenous-led initiatives that allow non-Indigenous researchers to provide support. Overall, there is a clear interest in further Indigenous autism research initiatives, but further shifts are needed to ensure that efforts are community-led and strengths-based.

Why We Need to Study Assisted Methods to Teach Typing to Nonspeaking Autistic People

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

At least one third of autistic people have limited or no speech. Most nonspeaking autistic people are never provided alternatives that would enable the full range of expression that speech allows, significantly limiting their access to educational, social, and employment opportunities. In this commentary, we argue that assisted methods to teach nonspeaking autistic people to type—long dismissed because the assistant could influence the text they produce during training—warrant fresh study. Although these teaching methods developed in practice rather than research, the practice (including the range of support the assistant provides in the motor, sensory, and attentional domains) is aligned with contemporary research about nonspeaking autistic people's strengths and challenges. We suggest that past research showing that influence can occur during training has been over-interpreted to mean that influence always occurs and that nonspeaking autistic people instructed using assisted methods never learn to type independently. In fact, other research shows that influence does not always occur, and there are independent typers who attribute their skill to the range of assistance they received during training. We believe it is time to revisit assisted methods to teach typing in order to understand their potential, as well as their limits, including how successful learners became independent and for whom these methods would be a good match. These efforts have the potential to result in greater access to effective communication and better quality of life for more nonspeaking autistic people.

The 3‐Hit Metabolic Signaling Model for Autism Spectrum Disorder: A Summary

Robert K. Naviaux — Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autism spectrum disorder (ASD) is a highly heritable yet environmentally sensitive neurodevelopmental condition whose biological heterogeneity has resisted a unifying causal explanation for over 100 years. The 3-hit metabolic signaling model proposes that ASD arises from abnormal persistence of an evolutionarily conserved stress-response program—the cell danger response (CDR)—during critical windows of neurodevelopment. In this framework, ASD emerges from the sequential interaction of: (1) inherited genetic or epigenetic variants that sensitize mitochondrial metabolism, intracellular calcium handling, and purinergic signaling to environmental change; (2) early prenatal or postnatal activation of the CDR by infection, immune dysregulation, metabolic disturbance, or environmental toxicant exposure; and (3) prolonged or recurrent exposure to CDR-activating triggers for 3–6 months from the late 1st trimester to 18–36 months of age. The CDR is initiated by extracellular ATP (eATP)-associated purinergic signaling and mitochondrial changes that are resource- and energy-intensive. Persistent or recurrent activation of the CDR during the critical neurodevelopmental window is proposed to sensitize developing cells to eATP-related signaling, leading to false alarms and a mixture of chemical, immune, and neurosensory under- and over-responsivity. More frequent cycles of CDR activation and recovery are proposed to cause cellular competition for key bioenergetic, mitochondrial, and metabolic resources needed to support the normal trajectory of child development. Phenylketonuria (PKU) provides a proof-of-principle example. Untreated PKU historically caused intellectual disability and autistic features, while universal newborn screening and early treatment interrupt this sequence and prevent or decrease these outcomes despite strong genetic predisposition.

Assisted Communication Cannot Bypass Objective Research Investigation

Helen Tager‐Flusberg — Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

Inaccurate Claims in a Recent Commentary Supporting Facilitated Communication

Katharine Beals, Bronwyn Hemsley, Russell Lang, Howard Shane — Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

Empirical Validation Must Be a Precondition to Future Research in Facilitated Communication

Amy Lutz, Jill Escher, Alycia Halladay, Alison Singer — Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

Hope Is Not Enough: Assisted Typing Must Meet Scientific Standards

Connie Kasari — Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

Independent Typers Exist: A Reply to Letters on Why We Need to Study Assisted Methods to Teach Typing

Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

Why I Invited a Commentary on “Why We Need to Study Assisted Methods to Teach Typing to Nonspeaking Autistic People”

David G. Amaral — Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

Issue Information

Fri, 29 May 2026 00:00:00 -0700

Autism Research, Volume 19, Issue 5, May 2026.

The Role of Microbiota Metabolites Propionic Acid, p‐Cresol, and 4‐Ethylphenyl Sulfate in Autism Susceptibility: A Systematic Review

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

The etiopathogenesis of Autism Spectrum Disorder (ASD) encompasses complex interactions between genetic and environmental risk factors. The high prevalence of gastrointestinal disorders in autistic individuals has propelled a growing interest in the possible involvement of gut dysbiosis in ASD pathogenesis. Thousands of different bacterial strains are found in the human gut, which produce numerous metabolites that can enter the bloodstream and often pass the blood–brain barrier, potentially influencing neurodevelopment and brain function. This systematic review aims to provide a comprehensive outlook on the role of three metabolic compounds derived from gut bacteria, propionic acid (PPA), p-cresol, and 4-ethylphenyl sulfate (4-EPS), in modulating neuronal function and conferring susceptibility to ASD. To achieve this, we screened 411 records collected through a systematic search of current scientific literature in PubMed, Web of Science, and Scopus, ultimately reviewing a total of 90 records, which included data from ASD human cohorts as well as animal and cellular models of autism. Human studies provided compelling evidence of altered metabolic profiles in ASD individuals, especially for PPA and p-cresol, but also to a smaller extent, for 4-EPS. Furthermore, data obtained from the exposure of experimental models to each one of these three metabolic compounds identified several behavioral anomalies induced in treated animals and highlighted common neurobiological mechanisms. Overall, current literature supports the contribution of gut metabolites to ASD susceptibility and/or a significant modulatory role on the clinical expression of ASD, strongly encouraging further research in the field in order to improve autism diagnostics and management.

Compulsion Profile Differences Indicate Distinct Functional Mechanisms in Autistic and Non‐Autistic University Students

Gil Zukerman, Ester Ben–Itzchak — Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autistic individuals often exhibit high rates of obsessive-compulsive symptoms (OCS), yet traditional cognitive-behavioral therapy (CBT), especially exposure and response prevention (ERP), tends to be less effective for them. This may be due to differences in the function of compulsive behaviors: while OCD-related compulsions are typically ego-dystonic and aimed at reducing anxiety, autistic compulsions may be ego-syntonic, serving regulatory or sensory modulation purposes. This study investigated whether compulsions in autism are more aligned with regulation and sensory modulation than with anxiety reduction. Participants included 39 autistic university students, 25 non-autistic students with high OCS, and 25 non-autistic students with low OCS. A factor analysis of seven binary items from the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS-I) revealed two factors explaining 58% of the variance. The first factor showed high loadings for Repetition, Counting, and Hoarding compulsions, reflecting regulatory and sensory modulation processes. The second factor showed high loadings for checking and organizing compulsions that were previously associated with anxiety reduction. Chi-square analyses showed autistic students reported significantly more regulatory/sensory compulsions than low-OCS individuals. For anxiety-reduction compulsions, autistic students reported significantly fewer positive responses than both non-autistic groups. Trait and state anxiety correlated with OCS levels in non-autistic participants, but not in autistic individuals. These findings indicate that compulsions in autism may reflect distinct functional mechanisms compared to those in classical OCD. Specifically, the weaker association with anxiety or threat reduction suggests that ERP-based CBT, which targets anxiety-driven compulsions, may be less effective for autistic individuals. Broader implications for both diagnosis and therapeutic approaches are discussed.

Vocabulary of Autistic Preschool Children With Limited Language: Alignment With Early Word Inventories

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

There is a critical need to understand the early vocabulary of young children with autism who have limited language, defined in this study as producing fewer than 20 different spontaneous and functional spoken or augmented words, to better inform educational targets and vocabulary selection for spoken as well as augmentative and alternative communication (AAC) interventions, particularly given the lack of evaluation tools designed for children with limited language. The spontaneous words and gestures produced by 66 preschoolers with autism (ages 3.5–5) during a natural language sample are compared with words in two early vocabulary tools including the MacArthur Communicative Development Inventories (MCDI) and a list of core words compiled from research studies of early AAC vocabulary. Participants' expressive words and gestures were coded from the transcripts of 20-min natural language samples. Forty-nine children (74.24%) used spoken words, gestures, or a combination of both, with six children (9.09%) communicating using a speech-generating device (SGD). Spoken words were primarily used for commenting, while gestures, especially pointing, were used for requesting. Although more than half of the unique words expressed by the children during the natural language sample overlapped with those in the MCDI, only 32% of unique words expressed by the children overlapped with Laubscher's and Light's core word lists, suggesting that young children with autism who have limited language may use more fringe words related to their personal interests or experiences. The study's limitations as well as implications for vocabulary selection for AAC systems and intervention goals are discussed.

Adverse Childhood Experiences in Autistic and Neurotypical Girls

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Adverse childhood experiences (ACEs) are potentially traumatic, life-altering events that occur in childhood with long-term negative physical and/or mental health outcomes. Previous research, while limited and largely focused on males, suggests children with autism spectrum disorder (ASD) are at higher risk of experiencing ACEs than typically developing (TD) peers. The study aimed to enhance our understanding of ACEs by focusing on female participants comparing diagnostic (ASD, TD), developmental (age, puberty), and mental health (anxiety, depression) factors. Participants included 212 female children with ASD (N = 112) or TD (N = 100) between 6:0 to 12:11 years. Following diagnostic testing, the 10-item ACEs questionnaire was administered. Statistical analyses included Wilcoxon rank-sum tests, negative-binomial models, linear regression, and Spearman correlations. There was a significant group difference in the total number of ACEs such that autistic children had more parent-reported total adverse events (p = 0.024). There were no significant diagnosis by age or puberty stage interactions (p > 0.05). Depressive symptoms were significantly positively associated with autism diagnosis (p < 0.001, RESI = 0.574) and ACE total (p < 0.001, RESI = 0.282), indicating overall higher rates of depressive symptoms in autistic youth, and an increase in depressive symptoms for participants with at least one ACE. There were similar findings for anxiety. Results highlight that having autism along with ACEs may place youth at a higher risk of mental health conditions. Treatments developed to address the unique challenges of adverse events in autism may be warranted to prevent long-term sequelae and poor mental health outcomes.

Emotion Dysregulation Predicts Impairments in Peer Interaction and Adaptive Functioning in Autistic Kindergartners

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Emotion Dysregulation (ED) refers to difficulties in using adaptive strategies to modulate and express emotional arousal in socially appropriate ways. While ED contributes to developmental trajectories including peer engagement, academic achievement, and mental health in neurotypical children, its impact on autistic children is unclear. This study examines whether ED emerging during school transition can affect peer and adaptive functioning in autistic kindergartners. Participants included 64 autistic children at kindergarten-entry (M_age = 63.06 months) with the majority of children (n = 53) followed at kindergarten-exit. ED was measured based on the Child Behavioral Checklist-Dysregulation Profile (CBCL-DP scores and severity levels) and the CBCL-Emotion Dysregulation Index scores (CBCL-EDI). Children's peer engagement was examined with the Penn Interactive Peer Play Scale (PIPPS) and adaptive functioning with the Vineland Adaptive Behavior Scales, Third Edition (VABS-3). Hierarchical linear regressions were conducted to examine whether ED at kindergarten-entry predicts peer interaction and adaptive functioning concurrently and longitudinally at kindergarten-exit while controlling for age, gender, nonverbal IQ, and autism symptom severity. One-way ANOVAs were analyzed to compare significant mean differences in peer interactions and adaptive functioning domains across three CBCL-DP severity levels. Higher ED at kindergarten-entry was a strong predictor of impairments in peer and adaptive skills at both kindergarten-entry and -exit. Significant mean differences in peer interaction and adaptive social outcomes were found at both times across CBCL-DP severity levels categorized at kindergarten-entry. Targeted intervention for enhancing ED during the preschool years may optimally support peer engagement and adaptive functioning.

Bullying Trajectories From Childhood to Adolescence: The Relationship With Mental Health Outcomes for Autistic and Neurotypical Youth

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autistic youth are more likely to be involved in bullying, have poorer mental health, and experience friendships and social support differently compared to neurotypical youth. What remains unclear is whether the relationship between bullying and mental health is different for autistic and neurotypical youth and whether friendships and social support moderate this relationship. In this United Kingdom-based population-based study, we investigated the relationship between bullying involvement, victimization, and perpetration, from early childhood (age 5 years) through to mid-adolescence (age 14 years) with mental health outcomes in later adolescence (age 17 years) for autistic (n = 576) and neurotypical youth (n = 14,963). We used parent-, teacher-, and self-reports of bullying at ages 5, 7, 11, and 14 years to identify five bullying trajectory groups (uninvolved, adolescent victim, early childhood victim, early childhood bully, and bully-victims). Autistic youth were more likely than their neurotypical peers to be in one of the bullying trajectory groups compared to being in the uninvolved group. Specifically, 74% of autistic youth experienced bullying either as victims, bullies, or bully-victims between early childhood and adolescence compared to 38% of neurotypical youth. Both autistic and neurotypical youth who were involved in bullying, whether as a perpetrator or victim, experienced poorer subsequent mental health later in adolescence. Higher perceived social support buffered the effects of bullying involvement for neurotypical and, to a lesser extent, autistic youth. These findings highlight the need for further research focusing on possible targets for intervention to mitigate the possible impacts of bullying on subsequent mental health for autistic youth.

Optimizing Accuracy of Autism Diagnostic Observation Schedule‐2 in Very Young Children With Modifying the Effect of Global Developmental Delay

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

The current study investigated 1144 toddlers and preschoolers (ASD + GDD n = 592; ASD only n = 249; GDD only n = 89; no ASD or GDD n = 214) with the toddler module (38.6%), Module 1 (57.5%), and Module 2 (3.9%) as well as Mullen Scales of Early Learning. The calibrated severity score (CSS) was used to compare severity across modules. The study sample was stratified by GDD (Visual Reception Developmental Quotient < 75), and each stratum was investigated with descriptive statistics, ROC curves, and test statistics to identify the optimal cut-off CSS to differentiate ASD and non-ASD. ROC analysis indicated that the CSS scores showed excellent discrimination for ASD status for both the GDD (AUC = 0.86) and no GDD (AUC = 0.95) strata. In the no-GDD stratum, an ADOS-2 CSS of 5 was determined to be the optimal cut-off. In the GDD stratum, an ADOS-2 CSS of 6 was determined to be the optimal cutoff. While non-spectrum/little-to-no concern and autism/moderate-to-severe concern showed very high predictive accuracy for diagnostic outcomes, the autism spectrum/mild-to-moderate concern lacked clear diagnostic directionality, regardless of GDD status. This is the first study with a large sample of toddlers and preschoolers exploring optimal ADOS-2 CSS cut-off when stratified by GDD.

Language and Repetition Performance in Autism Spectrum Disorder Versus Developmental Language Disorder: Evidence From Turkish‐Speaking Children

Dilber Kaçar Kütükçü, Fenise Selin Karalı, Nilgün Çınar — Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent differences in social communication and interaction, as well as restricted and repetitive patterns of behavior, interests, or activities. Language difficulties are common in autism and can affect multiple domains, including phonology, morphology, syntax, semantics, and pragmatics. This study examined the language and repetition skills of Turkish-speaking autistic children (diagnosed with ASD), children with developmental language disorder (DLD), and typically developing (TD) peers. Ninety children aged 5–9 years participated: 30 autistic children, 30 children with DLD, and 30 TD children. Language abilities were assessed using the Turkish School Age Language Development Test (TODİL), the LITMUS Turkish Sentence Repetition Test (LITMUS-TR), and the Turkish Nonword Repetition Test (TAST). The TD group scored significantly higher than both clinical groups across all measures. In direct comparisons between the clinical groups, autistic children had lower scores than children with DLD on several morphosyntactic and lexical–semantic measures. After Bonferroni correction, only morpheme completion (TODİL BT) differed significantly between the groups; associated vocabulary (TODİL IS) and word description (TODİL SB) showed smaller differences that did not reach the Bonferroni-adjusted significance threshold. The two clinical groups showed similar performance on picture vocabulary (TODİL RS), sentence comprehension (TODİL CA), sentence repetition (TODİL CT; LITMUS-TR), and nonword repetition (TAST). The findings indicate specific areas of relative difficulty in morphosyntactic and lexical–semantic processing among autistic children in this sample, alongside broadly similar performance to children with DLD on other sentence-level and repetition measures. These results suggest the potential value of tailored, evidence-based interventions that consider autistic children's individual language profiles, while also taking into account broader cognitive and executive functioning needs.

Association Between Healthy Lifestyle Behaviors and Mental Health Symptoms in Children With Autism and ADHD: A Latent Profile Analysis

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Healthy lifestyle behaviors, including physical activity, screen time, sleep, and diet quality, are important determinants of mental health, yet little is known about how these behaviors cluster among children with neurodevelopmental disorders. This study identified lifestyle profiles in children with autism and ADHD and examined associations with internalizing, externalizing, and irritability symptoms. Parents of children with a diagnosis of autism and ADHD (n = 523, 7–12 years, 67% male) reported on lifestyle behaviors and mental health outcomes. Latent profile analysis supported a four-profile solution that balanced statistical fit, parsimony, and theoretical interpretability. Profile 1 (19%) was characterized by very high levels of physical activity, moderate sedentary screen time, relatively high sleep, and above average diet quality. Profile 2 (50%) represented a balanced lifestyle, with moderate activity and sedentary screen time, adequate sleep, and the highest diet quality. Profile 3 (20%) showed low activity, elevated sedentary screen time, adequate sleep, and poor diet quality, while Profile 4 (11%) was defined by extremely high sedentary screen time, low activity, adequate sleep, and poor diet. Children in less healthy profiles characterized by high screen time and poor diet quality reported significantly higher internalizing symptoms compared to the highly active group. However, externalizing symptoms were highest in the highly active profile, and irritability was lowest in the balanced profile relative to both high activity and high screen time groups. Findings suggest that while very high physical activity may protect against internalizing symptoms, a balanced lifestyle combining moderate activity, limited screen use, adequate sleep, and good diet quality may best mental health in children with autism and ADHD.

Parenting Stress and Stressful Life Events Among Caregivers of Toddler Siblings of Autistic and Non‐Autistic Children

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

This study measured experiences of parenting stress and stressful life events in caregivers of families with a toddler who has either an autistic or non-autistic older sibling(s). Caregivers of toddlers (12–18 months old) with older autistic siblings (Sibs-autism; n = 58) and toddlers with older non-autistic siblings (Sibs-NA; n = 46) completed questionnaires assessing stress related to parenting their toddler and their exposure to stressful life events since their toddler's birth. We compared levels of parenting stress and stressful life events between caregivers of Sibs-autism and Sibs-NA and examined the association between these measures. Caregivers of Sibs-autism reported significantly higher levels of parenting stress and stressful life events relative to caregivers of Sibs-NA, with small to moderate effects. Parenting stress and stressful life events were moderately correlated. Across these groups of caregivers, parenting stress and stressful life events appear to be related, but partially distinct aspects of caregiver stress. These findings highlight the importance of assessing multiple aspects of stress to better understand how stress may influence both caregiver wellbeing and the development of children with autistic siblings.

Trajectories of Autism Symptoms and Overlapping Patterns in a Chinese Cohort From 18 to 36 Months

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Several studies have examined trajectories of autism symptoms in autistic children and their siblings. However, less is known about developmental patterns across different neurodevelopmental conditions, as well as the clinical characteristics and early predictors among children with distinct diagnoses but overlapping trajectories. This study investigated trajectories of autism symptoms [ADOS-2 Calibrated Severity Score; Total CSS, social affect (SA) CSS, and restricted and repetitive behaviors (RRB) CSS] and their overlap across symptom domains in a Chinese cohort of 163 children aged 18–36 months, including autism, broader autism phenotype (BAP), developmental delay (DD), and typical development (TD). Latent class growth modeling identified three trajectories for Total CSS and SA CSS, and two for RRB CSS. Cross-domain analyses revealed overlapping CSS trajectories between 51 autistic children (Overlap-Autism) and 36 children with BAP (Overlap-BAP). Clinical comparisons between these two groups revealed distinct temporal profiles in CSS and ADI-R scores. Hierarchical logistic regression analyses indicated that female sex was a protective factor for Overlap-Autism (OR = 0.20, p = 0.009) relative to the Overlap-BAP group, whereas higher SA CSS at 18 months independently predicted Overlap-Autism (OR = 1.61, p = 0.003). These findings highlight the challenges of early diagnostic differentiation among children with autism-related traits and underscore the importance of comprehensive and longitudinal assessment.

REM Sleep Abnormalities in Children With Autism Spectrum Disorder

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Sleep disturbances are common in children with autism spectrum disorder (ASD). However, the sleep pattern changes including rapid eye movement (REM) sleep for ASD in pediatric populations remain unknown. Using polysomnography (PSG) data from the National Children's Hospital (NCH) Sleep Databank, we identified 193 children with ASD and matched them with 193 Non-ASD controls. We found children with ASD showed reduced REM sleep proportion (17.8% ± 6.4% vs. 19.1% ± 7.0%; p = 0.049) and duration (71.5 [49.5–91.0] min vs. 81.5 [52.5–98.0] min; p = 0.036), prolonged REM latency (134.5 [94.0–181.5] min vs. 116.0 [82.0–157.0] min; p = 0.009), and increased 1st REM duration (13.0 [7.0–19.0] min vs. 10.5 [6.0–16.5] min; p = 0.024) compared with Non-ASD peers. They also showed higher 1st REM proportion (18.8 [11.0–31.3] vs. 15.7 [8.3–25.4]; p = 0.003), particularly in children aged 3–5 years and 6–8 years. Using these REM features, the XGBoost machine learning model was achieved to be the best predictive performance. SHAP analysis further showed that decreased REM sleep duration, increased 1st REM proportion or duration, and prolonged REM latency were discriminative features for children with ASD. These findings suggest that REM sleep abnormalities are common in young patients with ASD but its contribution to the disease's severity and/or development needs to be explored further.

Interval Timing Is Altered in Male Nrxn1+/− Mice: A Model of Autism Spectrum Disorder

Kyle M. Roddick, Elias B. Habib, Richard E. Brown, Fuat Balcı — Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autism spectrum disorder (ASD) is characterized by impaired social interactions and communication, and increased repetitive and stereotypical behavior. Neuroimaging shows functional abnormalities in brain areas involved in temporal processing in autistic individuals, and they also show deficits in interval timing. Neurexin (NRXN) mutations have been identified in a wide variety of neuropsychiatric disorders, including ASD, and Nrxn1^+/− mice possess a mutation that disrupts the α, β, and γ isoforms of Nrxn1, a gene involved in synapse structure. We investigated the interval timing abilities of the Nrxn1^+/− mouse model of ASD in the peak interval procedure using a 15-s target interval and compared their performance with that of Nrxn1^+/+ and Nrxn1^ΔS5/− rescue mice. Two-month-old male Nrxn1^+/+ (C57BL/6 J), Nrxn1^+/−, and Nrxn1^ΔS5/− mice were trained to obtain sucrose liquid rewards 15 s after the onset of a discriminative stimulus (discrete fixed-interval training), and their timing responses were tested in non-reinforced probe trials. Our analysis of responses across individual trials revealed that Nrxn1^+/− mice had earlier timing responses overall. This difference was manifested as earlier termination of responding in terms of the response curves. These findings are consistent with leftward shifts observed with experimental animal models of ASD. In conclusion, we believe these results indicate a bias in long-term memory in the Nrxn1^+/− mouse model of ASD and may capture the timing deficit observed in autistic individuals.

The E3 Ubiquitin Ligase UBE3B Regulates Synaptic Development and Cortical Network Activity

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired communication, abnormal social interactions, and restricted, repetitive behaviors. Pathogenic mutations in UBE3B result in neurodevelopmental disease, including intellectual disability, lack of speech, and ASD. UBE3B is an E3 ubiquitin ligase that tags substrate proteins with ubiquitin, marking them for proteasomal degradation. The ubiquitin-proteasome system (UPS) regulates several signaling pathways critical for neurodevelopment, including neurogenesis and synaptogenesis, and mutations in various UPS genes have been identified in ASD and related neurodevelopmental disorders. To investigate the function of UBE3B in the brain and how its disruption gives rise to neurodevelopmental abnormalities, we generated a central nervous system-specific conditional Ube3b knockout (cKO) mouse model and evaluated the resulting neurobehavioral phenotypes. We found that Ube3b cKO mice exhibit severe deficits in vocalization, social behavior, learning and memory, and motor skills. Assessment of in vivo neuronal phenotypes revealed defects in dendritic morphogenesis, reduced excitatory synapse density, diminished spontaneous cortical circuit activity, decreased AMPA receptor surface expression, and hyperexcitability of excitatory cortical neurons. Using quantitative proteomics, we profiled the proteome and ubiquitome of neural stem cells and identified 116 proteins that exhibited increased protein levels and reduced ubiquitination following loss of UBE3B. These proteins were highly enriched for ones involved in synaptic processes, and we confirmed interaction of UBE3B with several key synaptic proteins, including ATP1A1, DOCK7, NLGN2, and STX12. Collectively, our findings identify a role for UBE3B in regulating social, cognitive, and motor functions, and neuronal morphogenesis and activity by fine-tuning the synaptic proteome.

Auditory P100m and Language Difficulties in Children With ASD: Effects of Vowel‐Like Acoustic Structure

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

The P100/P100m component of auditory event-related potentials/fields is considered a potential biomarker of atypical arousal and language difficulties in children with ASD. When elicited by complex speech-like sounds with regular temporal or frequency structure, P100/P100m may be influenced by sustained negativity (SN), which can reduce its amplitude due to opposing current polarity and contribute to ASD-related differences. Using magnetoencephalography (MEG), we examined P100m responses to acoustic regularities in the left and right auditory cortices in 35 ASD and 39 TD boys (7–12 years). Stimuli included (1) temporally and spectrally regular sounds (periodic vowels), (2) temporally regular sounds (periodic non-vowels), (3) spectrally regular sounds (non-periodic vowels), as well as (4) non-regular control stimuli (non-periodic, non-vowels). P100m was estimated using distributed source localization. Both groups showed decreased P100m amplitude and latency with acoustic regularities, accompanied by proportional SN increases, suggesting P100m modulation primarily reflects early SN enhancement. No group differences were observed in P100m latency or amplitude, and their modulation by stimulus type was also normal in ASD, indicating spared processing of acoustic regularities in the P100m time range. However, P100m latencies variability was increased in boys with ASD, and their left P100m amplitudes to both non-regular and regular sounds were negatively associated with cumulative language and intellectual abilities. These findings suggest that while most children with ASD show typical P100m responses, individual variations in P100m amplitude may reflect neurodevelopmental differences in cortical maturation and/or sensory habituation processes that contribute to the heterogeneity of cognitive and language abilities in ASD.

Autism Spectrum Disorder Among Gender‐Diverse Children and Adolescents: A National Cohort Study

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Autism spectrum disorder (ASD) is more prevalent in transgender and gender-diverse (TGD) individuals than in the general population, yet the specific developmental pathways within and clinical outcomes of this intersection are insufficiently understood. This study examined how ASD and sex assigned at birth (SAAB) are associated with gender-related milestones, access to gender-affirming consultation and care (GACC), and psychiatric outcomes. We reviewed electronic medical records for 786 TGD children and adolescents (aged 4–19 years) presenting to a national referral clinic between 2013 and 2025. Demographic, developmental, and psychiatric variables were analyzed across four ASD-by-SAAB groups using generalized linear models and logistic regressions, with Bonferroni-adjusted post hoc comparisons (α = 0.0083). ASD was documented in 9.7% of the cohort, with referrals of autistic TGD patients increasing significantly over time. Autistic patients presented with a distinct profile, characterized by higher socioeconomic position (SEP), intellectual giftedness, non-binary gender identity, and an earlier stage of pubertal development at presentation. Crucially, while ages at gender-related milestones were largely comparable between neurotypes, autistic assigned female at birth (AFAB) adolescents were significantly less likely to initiate puberty suppression or gender-affirming hormones than their non-autistic peers. Furthermore, higher SEP was associated with earlier clinical presentation only for non-autistic youth. Autistic TGD patients exhibited a higher psychiatric burden, with an ASD diagnosis uniquely associated with elevated rates of anxiety, ADHD, and psychotropic medication use. These findings reveal a disparity between developmental synchrony and clinical access, underscoring the need for autism-informed protocols to support equitable gender-affirming care.

Labor Epidural Analgesia and Autism Spectrum Disorder in Offspring: A Population‐Based Case–Control Study

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

While the immediate benefits of labor epidural analgesia (LEA) are well established, recent studies have raised concerns about possible associations with autism spectrum disorder (ASD). Therefore, we examined the association between LEA and ASD in offspring. We analyzed data from mother–child dyads enrolled in the Study to Explore Early Development (2007–2020), a US multisite case–control study. Receipt of LEA during childbirth and other covariate information was ascertained from a combination of maternal self-report, medical record abstraction, and the birth certificate. ASD classification was determined by trained psychologists using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. We used logistic regression to estimate the odds ratio (OR) for the association between LEA and ASD in offspring. Models were adjusted for demographic and pregnancy factors. Sensitivity analyses restricted to term deliveries, singleton pregnancies, and vaginal births were conducted. Our sample included 2039 ASD cases and 3171 controls. The prevalence of LEA use was similar among cases and controls (66% and 67%, respectively). The crude OR for the association between LEA and ASD was 0.97 (95% CI: 0.85, 1.10), and the adjusted OR was 1.02 (95% CI: 0.89, 1.17). Findings from sensitivity analyses were generally consistent with the primary results. Subtle associations emerged when the analysis was restricted to vaginal deliveries; however, they attenuated after additional adjustment for fetal distress, induced or augmented labor, and prolonged labor. Our findings do not support an association between LEA and ASD in offspring.

Language Abilities Associated With Household Income and Parental Education Level in Autistic Children During Early Childhood

Fri, 29 May 2026 00:00:00 -0700

ABSTRACT

Socioeconomic factors, such as poverty, can significantly impact developmental outcomes. While well-studied in neurotypical children, limited research exists on the impact of these factors on autistic children's development, especially in early childhood. We examined the relationships between two socioeconomic factors, household income and parental education, with cognitive and behavioral profiles in a sample of 308 autistic children aged 2–3.5 years. We found that higher household income and parental education level were significantly associated with higher language abilities and lower externalizing behaviors. Moreover, autistic children from families with below-average income had lower language abilities compared to those from families with average or above-average income. The effects of household income and parental education level remained significant even after controlling for one another. Our findings suggest that lower parental education level and household income, particularly among families from the lowest economic backgrounds, significantly impact language abilities in young autistic children and may contribute to the development of externalizing behaviors, a pattern similar to that observed in non-autistic children. Given that early language abilities are predictive of adulthood outcomes in autism, these findings underscore the importance of supporting socioeconomic stability in the first two to three years of life for autistic children and providing appropriate early interventions to promote language development.

The Effectiveness of Acceptance and Commitment Therapy Group Intervention (Navigator ACT) for Parents of Children With Neurodevelopmental Disabilities: A Randomized Controlled Trial

T. Holmberg Bergman, P. Lappalainen, A. Ghaderi, T. Hirvikoski — Tue, 26 May 2026 05:36:10 -0700

ABSTRACT

High levels of parental stress and psychological inflexibility are common among caregivers raising children with neurodevelopmental disabilities. Navigator ACT is a group-based treatment developed to increase psychological flexibility and reduce the impact of stress among parents of children with various disabilities (e.g., autism spectrum disorder, ADHD, intellectual disability, acquired brain injury). This two-arm randomized controlled trial (n = 137) was conducted in Sweden within outpatient disability services setting, and pre-registered in the clinical trials register. To compare conditions, stressed and distressed parents were randomly assigned to either the ACT group (n = 70) or treatment-as-usual (TAU, n = 67). In the ACT group, 83.3% completed the full course of treatment. Mixed-model linear regression analyses indicated that ACT was significantly more effective than TAU in reducing self-reported psychological inflexibility (p < 0.002, d = 0.84) and parenting stress (p < 0.001, d = 0.38). These improvements were maintained at four-month follow-up. Parents in the ACT group also reported significantly greater improvements in their children's prosocial behaviors (p < 0.05, d = 0.46). However, no significant group differences were observed in levels of parental depression, anxiety, mindfulness, or child's difficulties. ACT group treatment demonstrated promising outcomes in reducing psychological inflexibility and parenting stress in a mixed group of parents of children with different neurodevelopmental disabilities, suggesting that parent support interventions do not need to be specific to the child's diagnosis.

Informational and Normative Influence on Conformity in Autism

Akiko Kobayashi, Takuya Makino, Yuka Mizuno, Hirotaka Kosaka, Keise Izuma — Mon, 25 May 2026 20:26:21 -0700

ABSTRACT

This preregistered study examined whether adults with autism spectrum disorder (ASD) show reduced social conformity and whether any such reduction depends on the type of social influence. Social conformity—the tendency to adjust one's judgments to align with those of others—is typically driven by normative (acceptance-seeking) and informational (accuracy-seeking) motives. Thirty adults with ASD and 30 matched neurotypical (NT) adults completed two tasks: a preference rating task indexing normative influence, and a dot-counting task indexing informational influence with monetary rewards. Contrary to our predictions, adults with ASD conformed as much as NT adults in the preference rating task but showed significantly reduced conformity in the dot-counting task. Exploratory analyses indicated that this reduction was driven by a distinct subgroup of nine adults with ASD who never revised their initial estimates despite informative social cues, resulting in poorer accuracy and lower rewards. When this subgroup was excluded, group differences in conformity were no longer evident. These findings suggest that, overall, adults with ASD are as susceptible as NT adults to normative influence but less responsive to informational influence, highlighting the importance of distinguishing between types of social influence and considering individual differences when characterizing social behavior in ASD.

Staged Audiovisual Speech Integration and Altered Early‐Stage Audiovisual Processing in Autistic Children: An EEG Investigation

Fri, 22 May 2026 22:56:23 -0700

ABSTRACT

Autistic children exhibit difficulties in audiovisual speech integration, which are associated with their social communication challenges. The neural mechanism underlying audiovisual speech integration difficulties in autism remains unclear. We recruited 19 neurotypical (NT) children and 29 autistic children. We recorded their behavioral responses and Electroencephalography (EEG) signals to audiovisual congruent syllables, and incongruent syllables that could evoke audiovisual speech integration (i.e., McGurk effect). For the EEG analysis, we further classified autistic children into the autistic McGurk group and the autistic non-McGurk group based on their strength of audiovisual speech integration. Behaviorally, we found reduced audiovisual speech integration in autistic children. At the neural level, we found that: (1) NT children showed an early stage audiovisual processing (indexed by the N1 amplitude), which was altered in two autistic groups; (2) all three groups exhibited a successful audiovisual incongruence detection (i.e., phonological Mismatch Negativity, pMMN); (3) NT and autistic McGurk groups could successfully resolve the audiovisual incongruence (indexed by the restoration of pMMN), but the autistic non-McGurk group could not (indexed by the sustained negative amplitude). Furthermore, we found a distinct temporal decoding pattern between non-McGurk and congruent trials across groups: both NT and autistic McGurk groups exhibited early EEG decoding, whereas the autistic non-McGurk group demonstrated successful decoding during late processing stages. Audiovisual speech integration entails a three-stage process in NT children: early audiovisual processing, audiovisual incongruence detection, and audiovisual incongruence resolution. The altered early-stage processing was possibly the neural mechanism underlying the reduced audiovisual speech integration in autistic children.

Neural Correlates for Anticipating and Observing Goal‐Directed Actions in Autism

Manon A. Krol, Tereza Skodova, Tjeerd Jellema — Fri, 22 May 2026 21:00:14 -0700

ABSTRACT

We investigated possible atypicalities in activation of cortical motor-related circuits in young adults with Autism Spectrum Conditions (ASC) and typical-development (TD) when observing others' actions. Activation of these circuits is reflected by suppression of power in EEG-Mu oscillations (8-13 Hz). Despite strong indications for functional distinctions between the upper (10.5-13 Hz) and lower (8–10.5 Hz) Mu-subbands, their separation remained unchartered territory in ASC research. Recordings were made from central, sensorimotor and occipital areas, while goal-directed actions that varied in the extent of both social interaction and biological motion were presented in video-clips. Anticipatory Mu suppression in response to upcoming actions was found exclusively at the sensorimotor site, in both groups. That is, during the presentation of a color signal embedded in the videos, which indicated whether or not an action would ensue, significantly more Mu-suppression occurred when the signal indicated an upcoming action. No such anticipatory activity occurred at central and occipital sites. During action observation, both groups showed significantly larger Mu suppressions in (i) the lower compared to the upper Mu band, and at (ii) sensorimotor compared to occipital and central sites. Extent of social interaction and biological motion of the actions did not significantly affect responses in either group. The groups did not differ significantly from each other in either band, condition or hemisphere. At the sensorimotor site, there was an overall tendency—though no significant evidence—for less desynchronisation to observed actions, and for more synchronization to no-action events (still image), in ASC compared to TD.

Examining the Validity and Reliability of Evaluation in Ayres Sensory Integration Data Collected With Autistic Children: A Rasch Analysis

Patricia Grady‐Dominguez, Anita C. Bundy, Zoe Mailloux, Roseann C. Schaaf — Wed, 20 May 2026 23:20:54 -0700

ABSTRACT

Performance-based assessments of sensory function provide essential insights into sensory integration challenges in autistic children and provide objective, standardized measurement data that can be used to tailor targeted interventions. We sought to evaluate the validity and reliability of data collected using the Evaluation in Ayres Sensory Integration (EASI) for assessing sensory and motor functions in autistic children. We used the Rasch Measurement Model to evaluate data collected with 146 autistic children aged 3–12 years (United States: n = 24, Australia: n = 115, Brazil: n = 7). We analyzed 19 performance-based tests assessing sensory perception, praxis, and motor functions. Rasch analyses examined item fit, unidimensionality, item targeting, and internal reliability. Seventeen of 19 analyzed EASI tests demonstrated strong construct validity, with adequate item-fit and unidimensionality. Fourteen tests met reliability thresholds (person separation reliability ≥ 0.70), while five tests exhibited lower person separation reliability. Some tests showed poor item targeting, potentially limiting their precision for children with stronger sensorimotor abilities. Most EASI tests demonstrate strong validity and reliability for assessing sensory integration in autistic children. Clinicians can use tests meeting reliability thresholds with confidence; tests with lower reliability can provide useful information but should be corroborated with other clinical data. Findings for PF should be considered preliminary given limited sample size. In general, this initial validation of EASI advances the evaluation of sensory integration for autistic children.

Vicarious Perception of Touch in ASD: The Role of Empathy and Touch Experiences

Mon, 18 May 2026 03:06:13 -0700

ABSTRACT

C-Tactile (CT) targeted affective touch plays a central role in social cognition and emotional development. In autism, atypical sensory processing, particularly in response to tactile stimulation, has frequently been reported. Autistic individuals have been shown to exhibit altered perception and reduced hedonic evaluation of affective touch, as well as increased defensive responses. Despite these differences in direct touch, the perception of vicarious social touch or its connection to social and emotional constructs remains poorly explored. Vicarious touch is theoretically relevant because it recruits social-cognitive and affective mechanisms beyond primary somatosensory processing; however, most prior studies have focused on neural correlates in neurotypical adults, with limited behavioral investigation and scarce evidence in autistic populations. The present study evaluated how autistic and non-autistic adolescents and young adults perceive vicarious social touch. Participants observed videos depicting touch delivered at three different speeds (static, CT-optimal, and fast) and across five skin locations (back, upper arm, ventral forearm, dorsal forearm, and palm). Participants provided subjective ratings of how pleasant they believed the touch was for the person in the video (numeric rating scale (NRS) Other/pleasantness) and how much they would like to be touched in the same way (NRS Self/willingness). We also examined associations with empathy and touch-related attitudes. Results showed no group differences in the pleasantness and willingness ratings. However, a significant three-way interaction between speed, skin location, and group emerged for the NRS Self. Across both groups, ratings indicated that speed and skin location modulated ratings, with CT-optimal stroking and touch in the back rated as most pleasant. For NRS Self, male participants reported higher pleasantness than females, across groups. Pleasantness and willingness ratings were positively correlated with attitudes toward touch from friends and family and toward self-care, but not with other touch-related attitudes or empathy scores, across groups. Finally, autistic individuals reported significantly lower empathy and less positive touch-related experiences than non-autistic participants. Overall, these findings suggest that global vicarious touch perception may be relatively preserved in autistic adolescents and young adults, while individual differences in empathy and touch-related experiences may contribute to broader variability in social touch processing.

Auditory Sensitivity in Autism: A Systematic Review of Mismatch Negativity and Mismatch Field Responses

Sun, 17 May 2026 23:09:48 -0700

ABSTRACT

Auditory mismatch responses—mismatch negativity (MMN) and mismatch fields (MMF)—are well established electrophysiological markers of automatic auditory discrimination supported by short-term sensory memory. These responses, typically elicited using passive oddball paradigms, are increasingly used to investigate sensory and language processing in autism. This systematic review synthesizes findings from 55 studies comparing MMN and MMF responses in autistic and typically developing (TD) individuals across childhood, adolescence, and adulthood. Using the Synthesis Without Meta-analysis (SWiM) framework, we identified consistent evidence for smaller MMN amplitudes and reduced MMF power in autistic children and adolescents relative to TD peers, particularly in response to frequency, duration, and speech-based deviants. Studies also frequently reported longer mismatch latencies in autistic participants and associated these delays with language difficulties and heightened auditory sensitivity. Although some studies reported age-related convergence in MMN and MMF measures between autistic and TD groups in later childhood or adolescence, greater right-hemisphere lateralization in autistic individuals emerged as a consistent finding across both speech and non-speech paradigms, suggesting differences in hemispheric weighting for auditory processing of linguistic and non-linguistic cues. To explain interindividual and developmental variability in mismatch responses, we propose a precision-weighted predictive coding account, in which divergent assignment of confidence to sensory prediction errors may contribute to autism-related differences. While study quality was generally fair, methodological heterogeneity, underrepresentation of females, and limited cross-cultural sampling constrain generalizability. Future research should prioritize longitudinal, sex-stratified, and culturally diverse designs, using standardized protocols and collaborative data practices. MMN and MMF responses hold promise as non-invasive translational biomarkers of early-stage sensory prediction and neurodevelopmental variation in autism.

ShopAutiPlan: Validating a Serious Game for Assessing Executive Planning in Autism

Sun, 17 May 2026 22:59:43 -0700

ABSTRACT

Children with autism spectrum disorder (ASD) frequently experience difficulties in executive functions, particularly planning and goal-directed behavior, yet traditional assessments such as the Tower of London and Zoo Map offer limited ecological validity and do not capture how planning challenges manifest in everyday contexts. This study introduces and validates ShopAutiPlan, a supermarket-based serious game designed to assess planning skills through naturalistic, multistep tasks. A total of 57 children aged 7–10 years (27 ASD and 30 neurotypical), matched on age and IQ, completed both the game and conventional EF assessments, including the BRIEF-2 and two BADS-C subtests (Zoo Map and Key Search). ShopAutiPlan automatically recorded behavioral indicators related to task completion and efficiency. Group comparisons revealed that neurotypical children outperformed those with ASD across all standardized measures, and autistic participants exhibited reduced in-game efficiency—demonstrated by longer completion times, greater distances traveled, and more pauses—despite achieving similar item completion. Significant correlations between game-derived metrics and traditional planning tests provided strong evidence of convergent validity. Overall, findings demonstrate that ShopAutiPlan is a valid, ecologically grounded, and engaging tool for assessing executive planning in children with ASD, complementing and extending conventional neuropsychological approaches.

Untangling Sex and Gender Differences in Impression Management and Associated Autism Features in French Autistic Adults

Thu, 14 May 2026 00:00:00 -0700

ABSTRACT

Some autistic individuals camouflage their behavioral differences, a phenomenon that overlaps with general impression management (IM). Few studies have examined IM in autistic people, particularly outside English-speaking countries. This study delineated the shared facets of camouflaging and IM, and used this conceptual clarification to address two knowledge gaps: (1) the respective roles of assigned-sex, gender identity, and gender role expression in explaining IM facet differences, and (2) how these facets relate to autism features across life stages. French autistic adults (N = 291) completed self-report measures of camouflaging, concern for appropriateness, self-monitoring, and gender role expression. The Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule Second Edition (ADOS-2) measured childhood and adulthood autism features, respectively. Joint exploratory factor analysis extracted latent facets of camouflaging and IM measures. Hierarchical and elastic-net regressions examined how IM facets were associated with assigned-sex, gender identity, and gender role expression. Multiple regressions tested whether IM facets moderated the relationship between childhood and adulthood autism profiles. The results highlighted the multi-faceted nature of IM (as inclusive of camouflaging) and unveiled nuances beyond previously documented sex/gender differences in autistic camouflaging. We found two IM facets: “intentional use” (purposeful IM use) and “self-efficacy” (self-perceived IM capability). IM intentional use was greater in autistic women and gender-diverse adults than men. Greater IM self-efficacy was most strongly associated with higher communion traits (i.e., qualities of being caring and cooperative). In autistic assigned-males, greater IM self-efficacy was linked with lower adulthood autistic social communication features. The findings confer new insights into sex-related, gender-related, and potential developmental links between IM and autism profiles.

Change Trajectories During Parent–Child Interaction Therapy for Autistic Children and Their Caregivers

Wed, 13 May 2026 22:45:05 -0700

ABSTRACT

Disruptive behaviors (non-compliance, aggression) are common in autistic children. Parent–Child Interaction Therapy (PCIT) is a caregiver-mediated intervention utilizing in vivo caregiver coaching that reduces disruptive behaviors and has been shown to be effective for young autistic children. This study sought to identify child and caregiver factors that relate to session-level progress among autistic children and their caregivers. Participants included 98 autistic children aged 2–8 years (91% male) who received PCIT in a university-affiliated clinic. Session-level change was examined using iterative multilevel modeling to examine change in child disruptive behaviors, as measured on the Eyberg Child Behavior Inventory (ECBI), caregiver positive attending skills (Do-skills), and caregiver negative statements (Avoid-skills). Optimal fitting trajectories revealed quadratic change in ECBI scores, Do-skills, and Avoid-skills. The effectiveness of PCIT did not differ based on participants' level of autistic traits or caregiver demographics. Improvements in child disruptive behavior were associated with child adaptability and parenting stress pre-treatment; higher adaptability and lower stress were related to faster declines in child disruptive behavior. Caregivers exhibited slower rates of change in Do-skills when they had lower rates of homework completion, and when their child had lower social responsiveness, and challenges with adaptability and externalizing problems. These findings may help clinicians tailor what factors to emphasize and monitor over the course of PCIT.

Disparities in Physical Activity and Sport Participation Among Transition‐Age Youth With Autism and Intellectual Disability

Daniel E. Lidstone — Wed, 13 May 2026 03:59:18 -0700

ABSTRACT

Physical activity is critical for health, yet many adolescents do not engage in regular activity. Youth with autism spectrum disorder (ASD) and intellectual disability (ID) may be at heightened risk due to motor, sensory, and social barriers, but less is known about complete disengagement. Using nationally representative data from the 2021–2023 National Survey of Children's Health, this study examined disparities in (1) any weekly physical activity and (2) participation in organized sport among transition-age youth (14–17 years) with ASD only, ID only, or ASD + ID, compared with youth without ASD or ID. Survey-weighted multiple logistic regression models estimated adjusted odds ratios (aORs) for each outcome, controlling for sex, race, household poverty ratio, metropolitan residence, and age. Compared to youth without ASD or ID, all diagnostic groups had significantly lower odds of engaging in any weekly physical activity (ASD only: aOR = 0.32, 95% CI: 0.24–0.44; ID only: aOR = 0.49, 95% CI: 0.31–0.76; ASD + ID: aOR = 0.51, 95% CI: 0.30–0.88; all p ≤ 0.02) and organized sport (ASD only: aOR = 0.20, 95% CI: 0.15–0.27; ID only: aOR = 0.31, 95% CI: 0.19–0.51; ASD + ID: aOR = 0.24, 95% CI: 0.14–0.41; all p < 0.001). Across both models and diagnostic groups, female sex, lower household income, and increased age were associated with lower physical activity and sport participation (all p ≤ 0.02), whereas non-metropolitan residence was associated with higher odds of sport participation-only (p = 0.005). These findings identify substantial disengagement among youth with ASD and/or ID and highlight the need for accessible, adapted physical activity and sport opportunities during adolescence to reduce risk of long-term inactivity.

Visual Search Performance in Children With ASD: A Combined Case‐Control and Longitudinal Study

Tue, 12 May 2026 23:09:12 -0700

ABSTRACT

Autism Spectrum Disorder (ASD) is associated with altered attentional function. This has been associated with enhanced visual search performance. Addressing a gap in the literature, we investigate the longitudinal development of visual search alongside ASD symptoms. Using eye-tracking, we studied performance in a single-feature visual search task with visual search accuracy and time to target. We investigated preschoolers with ASD (n = 60, age = 47 months) and a cohort of developmental age-matched typically developing (TD) children (n = 50, age = 35 months) at baseline and after approximately 3 years. We further explored associations of visual search performance with parent-reported ASD symptom domains. Both groups showed similar visual search accuracy and time to target at baseline. At the 3-year follow-up, the ASD group showed significantly lower visual search accuracy and shorter time to target than the TD group. Within the ASD cohort, higher accuracy and shorter time to target were associated with higher social communication impairments. The often-reported ASD advantage in visual search may not be as pronounced as assumed to differentiate between ASD and neurotypical development. It may also be dependent on the measure reported. More accurate and faster search may be associated with certain symptom severity profiles of ASD, supporting broad heterogeneity in the autism spectrum.

Exposure, Extinction, and Cognitive Appraisals in Autistic Adults With Social Anxiety: Evidence From a Structured Speech Exposure Task

Thu, 07 May 2026 01:59:28 -0700

ABSTRACT

Social anxiety (SA) is highly prevalent among autistic adults, yet little is known about how autistic people respond to common therapeutic strategies, such as exposure tasks. This study examined responses to a structured speech exposure task embedded within an 8-week modified cognitive–behavioral therapy (M-CBT) program. Thirty-two autistic adults with co-occurring SA completed pre- and post-task assessments of anxiety and related cognitive appraisals, including self-focused attention, perceived performance, appearance concerns, and threat appraisals. Participants reported appropriate engagement with the task, characterized by elevated anticipatory anxiety followed by reductions in anxiety during the speech. Responses were largely consistent with CBT models of social anxiety and with reports by those in a social anxiety disorder reference group. Participants overestimated anticipatory anxiety (predicted fear) relative to experienced peak fear during the task. Higher anxiety was associated with greater self-focused attention and stronger threat appraisals, although anxiety correlated positively with self-rated performance. Importantly, the extinction of fear during the speech task was associated with post-treatment response to CBT. Among participants classified as high-extinction, 59% showed clinically significant improvement on the Liebowitz Social Anxiety Scale, Self-Report (LSAS-SR), compared with 25% of those in the low-extinction group. A parallel pattern was observed in a social anxiety disorder comparison group, indicating that the extinction–outcome relationship was similar across autistic and non-autistic adults. This study provides evidence that autistic individuals report fear and anxiety responses in a manner largely consistent with CBT models and that extinction-based processes during exposure are meaningfully associated with treatment response. Further studies employing randomized controlled trials and objective measures of fear are now needed.

Psychological Impact of Autism Screening on Caregivers

Thu, 30 Apr 2026 21:50:44 -0700

ABSTRACT

Autism screening in childhood is common, yet little is known about its potential psychological impact on caregivers. The U.S. Preventive Services Task Force, an independent national panel of disease prevention experts, stated that this gap in knowledge limited their ability to endorse universal autism screening. This study examined the psychological impact of autism screening, using data from a large community-based sample (n = 1272) involving online caregiver-completed autism screeners at child age 6, 9, 12, 18, and 24 months. Caregivers completed the Participation Impact Questionnaire retrospectively (mean child age at completion 37.2 ± 4.8 months) to measure feelings about screening. A minority (34.7%) of the sample reported presence of ≥ 1 negative feeling; the most commonly endorsed was “worried”. Among this subset, negative feelings were of short duration (lasted for < 1 day in 56.9%), were mild in severity (86.4%), and did not affect functioning (85.3%). A majority (86.2%) also reported ≥ 1 positive feeling. Our findings address a critical evidence gap regarding potential harms of autism screening and support universal screening, given that psychological harms are not common and have low functional impact, as well as possible psychological benefits.

A Network Analysis of Alexithymia, Interoception, Empathy, Self‐Awareness and Psychopathological Symptoms in Young People With Autism Spectrum Disorder

Tue, 28 Apr 2026 19:29:58 -0700

ABSTRACT

Autism Spectrum Disorder (ASD) is associated with altered interoception, empathy, self-awareness, and alexithymia. However, limited research has been conducted to investigate the interrelationships of these constructs with psychopathological symptoms. A prior network analysis in college students examined the interrelationship of these constructs and demonstrated that cognitive empathy and alexithymia influenced interoception and autistic features. We aimed to examine the interrelationships of these constructs in people with clinical ASD using network analysis. We recruited 208 young people aged 15–25 with Autism Diagnostic Observation Schedule (ADOS-2) confirmed diagnosis of ASD and administered self-report measures for interoception, empathy, self-awareness, and alexithymia. We constructed a regularized partial correlation network. The results showed the alexithymia node of “difficulty-describing-feelings-to-others” (expected influence (EI) = 0.854), interoceptive awareness (strength = 1.273; EI = −0.084), depressive symptoms (EI = 0.537), and anxiety symptoms (EI = 0.652) were important nodes. Our findings suggested that alexithymia, depressive, and anxiety symptoms influenced empathy, self-awareness, and autistic features in people with ASD and supported the important role of interoception in the network.

Physical Fitness Profiles Among Children and Adolescents With ADHD and ASD: A Comparison With Typically Developing Peers

Sun, 26 Apr 2026 19:19:16 -0700

ABSTRACT

Children and adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) often present physical and motor challenges that may compromise health, yet direct comparisons between these neurodevelopmental conditions and typically developing (TD) peers remain limited. This study aimed to examine the physical fitness profiles of these three groups. A total of 1537 school-aged participants were recruited from mainstream educational settings. The assessment included selected tests from the EUROFIT battery and body mass index (BMI). Composite indices of physical fitness and motor coordination were computed using age- and sex-adjusted Z-scores. Both the ADHD (n = 80) and ASD (n = 36) groups showed significantly lower cardiorespiratory fitness, balance, and upper-body coordination compared with TD peers (n = 1413). Lower-body muscular strength was reduced only in the ASD group, which also performed worse than the ADHD group. Flexibility and BMI distributions did not differ significantly across groups. Plate Tapping and Flamingo Balance test indices were markedly lower in both clinical groups relative to TD peers. Children and adolescents with ADHD and ASD had lower physical fitness than TD peers. Direct comparisons between ADHD and ASD revealed generally similar profiles, except for lower muscular strength in ASD. These findings highlight the need for early screening and tailored interventions to support healthier developmental trajectories and enhance functional outcomes in neurodevelopmental populations.

Occurrence and Correlates of Suicidal Thoughts Among Young Autistic Users of a Mental Health App

Wed, 15 Apr 2026 07:01:26 -0700

ABSTRACT

Young autistic people experience disproportionately high rates of mental health challenges, yet little is known about factors associated with suicidality in this group. This study leveraged anonymous self-report data to identify correlates of suicidal thoughts among 365 young users (aged approximately 11–25 years) of a mental health app in the United Kingdom with an autism diagnosis or self-identifying as autistic. The presence of suicidal thoughts was assessed as a binary item. Binary logistic regression was used to explore correlates of suicidal thoughts across three domains: mental health-related symptoms, autism-related factors, and adverse life events/experiences. The final model included all significant correlates from domain-specific models alongside demographic factors. Suicidal thoughts were reported by 63% of participants, with similar rates across age groups. The final model accounted for nearly 50% of variability in the presence of suicidal thoughts (R ² _Nagelkerke = 0.48, p < 0.001). Self-harm and depression showed the strongest positive associations (odds ratio, OR and [95% confidence interval] = 6.41 [3.62, 11.35] and 4.58 [2.51, 8.35], respectively), followed by a history of physical abuse (OR = 3.01 [1.20, 7.56]) and a transgender/gender-diverse identity (OR = 2.13 [1.11, 4.10]). Personal use of the term “neurodiversity” was associated with a lower likelihood of suicidal thoughts (OR = 0.45 [0.24, 0.83]). These findings contribute to evidence of high rates of suicidal thoughts among young autistic people and associations with self-harm, depression, a history of abuse, and a gender minority identity. Self-identification with the term neurodiversity emerged as a potential protective factor, although this novel finding warrants further research. Overall, this study highlights the importance of access to autism-adapted mental health care, addressing trauma and identity-related stressors, and fostering belonging and connection as part of comprehensive suicide prevention strategies for autistic youth.

Exploring Biases in Autism Diagnostic Pathways

Ryan Woolhouse, Sarah L. Nicholson — Mon, 13 Apr 2026 02:16:59 -0700

ABSTRACT

Assessments for autism spectrum disorder are time-consuming and expensive, and demand has increased over recent decades. Despite improved diagnostic criteria and awareness of autism, there still appear to be disparities in diagnostic rates of autism across age, gender, and ethnicity. Research investigating biases in referrals to, and assessments conducted by, autism diagnostic services is limited, especially in adults, making it difficult to understand these disparities. This clinical service evaluation collected data on demographic characteristics of clients referred and accepted for autism assessments (N = 350) and fully assessed for autism (N = 269) by a London-based adult autism team. Demographic characteristics of clients referred to the service were compared to population prevalences using Census data to investigate potential biases in referring clinicians. Demographic characteristics of clients who received diagnoses of autism were compared to the service's average diagnostic rate to investigate potential biases in assessing clinicians. Participants referred and accepted for autism assessments were significantly more likely to be male, aged 18–34, and from White or “Other” ethnic backgrounds compared to local population prevalences. Of clients assessed, there were no significant differences in diagnostic rates of autism among demographic groups compared to the service's average diagnostic rate. Clinicians conducting autism assessments appeared to show no diagnostic bias. However, findings suggest there are still disparities in gender, ethnicity, and age of adults who were referred and accepted for autism assessments. Further research is needed to investigate causes of this access disparity to ensure people can access appropriate services and support.

Associations Between Comorbidities, Developmental Status, and Disease Severity in Children With Autism Spectrum Disorder: A Multicenter Cross‐Sectional Study in China

Mon, 13 Apr 2026 00:26:00 -0700

ABSTRACT

Children with autism spectrum disorder (ASD) frequently present with co-occurring conditions that can influence autism symptom severity and complicate clinical management. However, studies with clinician-confirmed diagnoses in non-Western populations remain limited. In this multicenter cross-sectional study, 1279 children aged 3–14 years with DSM-5-confirmed ASD were recruited from eight medical centers in China. Autism symptom severity was assessed using the Childhood Autism Rating Scale (CARS). Comorbidities were identified through clinical evaluation and specialized assessments, and developmental status was measured using the Gesell Developmental Schedule (GDS) and Wechsler Intelligence Scales. Associations with CARS scores were analyzed using generalized linear regression. Of participants, 96.6% had at least one comorbidity and 71.2% had multiple comorbidities. Common conditions were intellectual developmental disorders (IDD) (87.3%), food selectivity (45.3%), insomnia disorder (16.9%), developmental regression (15.6%), and behavioral problems (14.6%). Patterns differed by sex and age: gastrointestinal problem and sleep-related interventions were more common in girls, whereas food selectivity was more common in boys. Older children showed higher rates of tic disorders, asthma, epilepsy, and offensive language, although these findings should be interpreted cautiously because the subgroup aged ≥ 6 years was small. In adjusted analyses, IDD, food selectivity, pica, insomnia disorder, and developmental regression were associated with higher CARS scores, whereas higher GDS and Wechsler scores were associated with lower CARS scores. In this Chinese cohort, comorbidities were prevalent and showed distinct sex- and age-related patterns. Several comorbidities were associated with greater autism symptom severity, underscoring the importance of comprehensive developmental and medical assessment in ASD care.

Visual Exploration and Construction Strategies Underlying Performance in the Block Design Task in Autism

Alizee Diu, Anais Gaume, Magali Batty, Lucie Bouvet — Mon, 13 Apr 2026 00:00:00 -0700

ABSTRACT

Visuospatial reasoning in autism is often linked to superior performance on tasks such as the Block Design Task (BDT). While different strategies have been described in the general population, no study has examined how these strategies relate to performance in autistic individuals, even though the task is widely used to characterize their visuospatial profile. To address this gap, the present study examined not only overall scores but also the underlying strategies used by autistic (ASD) and neurotypical (TD) adults during the BDT. Forty-one participants (ASD = 18; TD = 23) completed the standard BDT while eye-tracking and behavioral data captured both visual exploration and construction strategies. Globally, structured strategies—both in visual exploration and construction—were found to be the most effective, as they were associated with higher success rates and faster completion times, consistent with previous findings. At the group level, our results revealed that autistic participants employed these analytic strategies more frequently than neurotypical individuals, along with a stronger alignment between visual and construction approaches. The consistent use of these strategies in the autistic group may help explain the enhanced visuospatial performance observed in our study after controlling for manual dexterity and reported in earlier studies. These findings emphasize the importance of looking beyond traditional performance measures such as accuracy and completion time, highlighting that cognitive strategies are key to understanding visuospatial reasoning.

Event‐ and Time‐Based Prospective Memory and Time Perception in Autistic Adults With and Without Intellectual Disabilities

Daniela Nürnberg, Mareike Altgassen — Thu, 09 Apr 2026 23:30:44 -0700

ABSTRACT

The aim of this study was to examine time perception (i.e., the sense of the duration, order and passage of time) and event- and time-based prospective memory (PM; i.e., the ability to recall an intention to perform an action in the future) in adults across the wider autism spectrum including those with intellectual disabilities. Sixty-four adults, aged 18–65 years, took part in the study (32 autistic, 32 neurotypical controls). Participants were tested using computerized event- and time-based PM tasks and two different time perception tasks (naturalistic vs. comprehensive consisting of time estimation, time production and time reproduction). Results showed no differences between the groups in both PM tasks after controlling for verbal abilities. Moreover, both groups displayed comparable performance in event- versus time-based PM tasks. Autistic participants showed difficulties in time perception in comparison to neurotypical controls in the naturalistic, but not in the comprehensive time perception task. In both groups better performance in time perception was linked to better event- and time-based PM performance. Given the high relevance of PM in everyday life, further research is needed to support autistic individuals in their day-to-day lives. This is one of the first studies investigating PM in autistic adults, including those with intellectual disabilities, a part of the spectrum that is often overlooked.

Reframing Body Representations in Autistic Individuals: A Systematic Review

Thu, 09 Apr 2026 03:41:50 -0700

ABSTRACT

Body representations (BR) are multidimensional constructs that shape everyday functioning, autonomy, and quality of life. They include body schema (BS): the action-oriented representation of the body that supports movement and sensorimotor regulation, and body image (BI): the conscious perceptual, affective, and cognitive experience of the body. In autism, alterations in BR have been linked to sensory processing, motor coordination, social interaction, self-perception, and identity, yet the overall structure of these components remains unclear. This systematic review aimed to define a conceptual framework for BR in autism, identify the domains most consistently reported as different from non-autistic comparison groups, and synthesize current evidence on assessment approaches and clinical implications. Following PRISMA guidelines, we reviewed 54 studies published between 2000 and 2025, comprising 2982 participants. The findings showed a marked predominance of research on BS (81% of studies), particularly sensorimotor dimensions such as interoception (9 studies), proprioception (4 studies), and multisensory integration (3 studies). By contrast, BI was substantially less investigated, despite emerging evidence linking it to body dissatisfaction, body dysmorphic concerns, and identity-related difficulties. Across studies, BR differences were most often described in relation to bodily awareness, movement regulation, emotional processing, and self-referential perception. The review also highlighted major methodological limitations, including heterogeneity of constructs and an overreliance on self-report tools. Overall, BR emerges as a clinically relevant but still underdeveloped domain in autism research, underscoring the need for more comprehensive, developmentally sensitive, and multimodal assessment approaches.

Testing the Auditory Steady‐State Response (ASSR) to 40‐Hz and 27‐Hz Click Trains in Children With Autism Spectrum Disorder and First‐Degree Biological Relatives: An Electroencephalographic (EEG) Study

Tue, 07 Apr 2026 02:01:55 -0700

ABSTRACT

Altered auditory processing likely contributes to core social and attentional impairments in autism spectrum disorder (ASD). The auditory steady-state response (ASSR), a neural measure of auditory processing and cortical excitatory-inhibitory balance, has yielded mixed results in ASD. This study uses electroencephalography (EEG) to evaluate ASSR in ASD and unaffected siblings to clarify neural mechanisms underlying auditory deficits in autism. High-density 70-channel EEG was recorded in children (8–12 years, IQ > 80) with ASD (n = 53), typically developing (TD) peers (n = 35), and unaffected biological siblings (n = 26) during 500-ms binaural click trains (27- and 40-Hz) in an active oddball task. The ASSR was evaluated using data from frontocentral sensors, where the grand averaged response was greatest. No group differences were observed in frequency-following responses (FFR) to 27- or 40-Hz stimuli, although higher 40-Hz power and ITPC were associated with older age and better behavioral performance in ASD. The broad-band response from 180 to 250 ms was reduced in ASD for both stimulation frequencies—particularly in the low-frequency (< 8 Hz) range—and significantly correlated with IQ and age. Siblings showed intermediate broad-band responses. While FFRs appeared intact in ASD, we observed reduced broad-band response in the transition period to the steady state FFR, which was specific to low (< 8-Hz) frequencies. Intermediate responses in first-degree relatives suggest that this is related to genetic vulnerability for ASD and highlights its clinical relevance. These findings suggest intact sensory processing in ASD alongside possible top-down auditory feedback deficits, which may serve as a heritable neurophysiological marker.

Autistic Children With Speech Onset Delay Show Reversed Bias in Spectral Versus Temporal Auditory Processing

Luodi Yu, Shuyu Xie, Li Wang, Laurent Mottron — Tue, 07 Apr 2026 02:00:01 -0700

ABSTRACT

A recent “hierarchical” reinterpretation of the neurological basis of autism suggests that in autism with early language delay, perceptual processing may be favored over the integration of transmodal information. This model is largely based on neuroimaging findings relating to visual processing, but predicts a corresponding reorganization in the auditory modality. The present study provides the first direct psychophysical evidence of a reversed auditory processing bias in children with prototypical autism, characterized by impaired temporal resolution and enhanced spectral sensitivity. Using two matched psychoacoustic paradigms—temporal gap detection and low-frequency frequency modulation (FM) detection—we assessed auditory thresholds in 21 autistic and 23 typically developing (TD) children. Compared to TD peers, autistic children exhibited significantly higher temporal thresholds and significantly lower spectral thresholds, yielding a markedly elevated Auditory Bias Index (ABI) that quantifies a preference for spectral over temporal cues. In the group of autistic children investigated here, enhanced spectral resolution correlated positively with receptive language and nonverbal IQ, whereas temporal resolution was associated with age-related gains and language outcomes. These findings support the hypothesis of an atypical sensory-perceptual hierarchy in autism with speech onset delay and early behavioral atypicalities, with potential implications for alternative, nonsocial pathways to language acquisition.

A Systematic Review on Computer Vision in Play‐Based Research and Interventions for Autistic Children

Tue, 07 Apr 2026 01:43:27 -0700

ABSTRACT

Play holds a prominent role in Autism Research and practice, serving not only as a medium for assessment, providing insights into developmental progress and diagnostic indicators, but also as a foundational element in targeted interventions designed to support specific skills, education, and therapeutic outcomes. Additionally, free, unstructured play offers autistic children vital opportunities for self-expression, exploration, and emotional regulation. Recent advancements in computer vision techniques have significantly expanded the possibilities in Autism Research by capturing nuanced motor behaviors and facilitating interactive environments tailored to enhance social engagement and responsiveness. This paper investigates the application of computer vision techniques within diverse play contexts involving autistic children. A systematic literature review was conducted across six major databases, identifying 39 studies published between January 2014 and January 2026 that met the inclusion criteria. The collected data included the type of computer vision techniques used, participant demographics, and purpose of play and its environment. Most of the included studies used structured play scenarios, employing methods such as facial expression recognition, eye tracking, and pose estimation to objectively assess social communication, emotion recognition, and motor coordination in autistic children. Some studies positioned their approach as targeted interventions, while others utilized play-based tasks for early screening and diagnostic insights. The findings highlight the usefulness of computer vision in enhancing child-centered play and autism-related assessments. However, small sample sizes, methodological inconsistencies, and limited real-world applicability remain significant constraints. Future research should focus on inclusive designs, larger and more diverse participant samples, and longitudinal studies to validate the long-term effectiveness of these systems. By addressing these limitations, computer vision–enhanced play could become a crucial component of both personalized interventions and diagnostic frameworks for autistic individuals.

Unlocking the Potential of Habitual Napping to Moderate the Association Between Sleep Disturbances and Behavioral Problems Among Autistic and Typically Developing Children

Yiqing Zhong, Dagmara Dimitriou — Fri, 03 Apr 2026 18:30:28 -0700

ABSTRACT

Sleep disturbances are highly prevalent in autistic children and closely linked to behavioral difficulties, yet the role of napping in this relationship remains poorly understood, particularly in cultural contexts where naps are normative. This pilot study examined sleep–behavior associations and the potential protective role of napping in 53 school-aged children in China (26 autistic, 27 neurotypical, aged 6–12). Sleep was assessed both objectively (1-week actigraphy and sleep diaries) and subjectively (Children's Sleep Habits Questionnaire), and behavioral outcomes were measured via the Child Behavior Checklist. Autistic children showed significantly more sleep disturbances than neurotypical peers, including greater bedtime resistance, longer sleep onset delay, more frequent night waking, and shorter total sleep. Night waking was a key correlate of behavioral problems in both groups. Importantly, longer nap durations were associated with weaker associations between sleep disturbances and behavioral outcomes. Temporal analyses further indicated that shorter nocturnal sleep was associated with longer next-day naps, while nap duration was not significantly associated with same-day night sleep. These findings highlight the potential relevance of culturally embedded nap routines in relation to behavioral difficulties and may inform context-sensitive sleep support strategies in neurodevelopmental populations.

Autism and Cortical Thickness Deviation From Neurotypical Controls: Evidence for a Spatial Association With Serotonin Receptors

Wed, 01 Apr 2026 23:57:16 -0700

ABSTRACT

Cortical thickness (CT) differences between autistic individuals (AI) and neurotypical controls have been consistently reported, yet the neurochemical mechanisms underlying these differences remain insufficiently understood. Neurotransmitter receptor systems exhibit distinct spatial distributions across the cortex and influence synaptic maturation, plasticity, and cortical organization. Consequently, mapping CT deviations onto these receptor density gradients provides a biologically informed framework for investigating the potential underlying neurochemical architectures of observed structural patterns in autism. A total of 1035 structural MRIs (AI n = 505, neurotypical controls n = 530) were included from Autism Brain Imaging Data Exchange (ABIDE). Group contrasts and individual-level deviations from age-predicted CT patterns were computed. These spatial patterns were correlated with neurotransmitter receptors cortical density distributions (D1, D2, 5HT1a, 5HT2a, 5HT4, 5HT6, mGluR5) from previous PET studies. Widespread vertex-wise deviations in CT were observed in AI in comparison to neurotypical controls. At the group level, CT differences were spatially aligned with the cortical density of serotonin receptors (5HT1a: r = 0.22, FDR-p = 0.032; 5HT4: r = 0.21, FDR-p = 0.032). At the individual level, greater deviations from predicted CT, if mapped onto specific neurotransmitter receptor density gradients, correlated with greater difficulties in the social and communication domains. The findings provide novel evidence that serotonin receptors may play a role in shaping cortical structural brain differences between AI and neurotypical controls. The link between CT differences and spatial distributions of the serotoninergic system offers a translational perspective for future targeted support strategies focused on serotonergic pathways.

Disrupted Modular Integration of the Reward System Is Associated With Social Deficits in Autism Spectrum Disorder

Mon, 30 Mar 2026 19:33:38 -0700

ABSTRACT

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with atypical social communication as a core symptom. Variations in social information processing in individuals with ASD are associated with the social brain, which encompasses four specific subnetworks, that is, reward system, theory of mind network, mirror neuron system, and face perception network. However, the relationship between neural mechanisms of altered social functioning and modular integration of these subnetworks within the social brain remains unclear in ASD. With resting-state functional MRI (rs-fMRI) data from two large-scale datasets (ABIDE I and II), we computed the participation coefficient to explore the abnormal modular integration of the four subnetworks in 298 ASDs and 348 typically developing (TD) controls. Then, its associations with clinical symptoms, neurotransmitter systems, and transcriptional signatures were investigated. Additionally, the age effect on aberrant modular integration was estimated with linear regression models. Finally, we assessed the reproducibility of our results from a meta-perspective using other datasets. ASD participants exhibited increased integration of the reward system relative to TDs, which was correlated with Social Responsiveness Scale total score, the neurotransmitters such as 5HT1a and GABAa, and the disruption of the transcriptional signatures including cell proliferation and migration as well as tube and tissue morphogenesis. Additionally, the modular integration abnormality of the reward system was stable across development and replicated across datasets. We revealed a symptom-related, neurotransmitter- and transcriptional signature-associated, age-stable, and reproducible modular integration abnormality of the reward system in ASD. This hyper-integration was linked to reduced GABAa and serotonin receptor densities, providing neuroimaging and molecular evidence supporting the excitatory-inhibitory imbalance theory of ASD and insights into the mechanisms underlying social variations in ASD.

Development and Validation of a Short Version Eye‐Tracking Paradigm for the Screening and Diagnosis of Autism Spectrum Disorder in Qatar

Mon, 30 Mar 2026 00:00:00 -0700

ABSTRACT

Objective behavioral assessments for autism spectrum disorder (ASD) are often time-intensive and require substantial clinical expertise. Eye-tracking–based paradigms offer quantifiable measures of social attention that can complement traditional tools. The current study builds on our previously validated Arabic-language Autism Index (AI) by developing and validating a 4 min short version designed to improve feasibility in clinical and community settings while maintaining diagnostic accuracy. A total of 236 participants (127 with ASD, 109 non-autistic controls including those with developmental delays (DD)) aged 1–16 years were assessed using an eye-tracking paradigm consisting of 19 short dynamic videos depicting social and non-social scenes. The AI was computed as the ratio of dwell time toward social versus non-social stimuli. Diagnostic classification was established using ADOS-2 and SCQ. Reliability and validity were assessed using Cronbach's α, Pearson's r, and ROC analyses, including age-stratified performance and comparison with the original 10 min version. Feasibility was assessed by the proportion of valid stimuli. The short-version AI demonstrated excellent internal consistency (α = 0.91) and test–retest reliability (r = 0.83). Diagnostic accuracy was high (AUC = 0.878, SE = 0.023), with age-stratified AUCs ranging from 0.846 to 0.939. AI scores correlated strongly with ADOS-2 severity (r = 0.54, p < 0.001) and SCQ total scores (r = 0.43, p < 0.001). Compared with the 10 min original version (AUC = 0.73), the short paradigm achieved higher accuracy and feasibility (valid stimuli: 89% vs. 80%). The current eye-tracking paradigm demonstrates promising diagnostic performance while substantially reducing assessment time and cognitive demand. The findings provide initial evidence supporting its potential as a scalable and cross-cultural tool for ASD screening and diagnosis, with further validation in independent and clinical cohorts supporting its translation into routine clinical practice.

Autistic Adolescents' Quality of Life: Perceived Social Competence and Social Anxiety as Key

Sat, 28 Mar 2026 00:04:59 -0700

ABSTRACT

Autistic adolescents often report lower social and overall quality of life (QoL) associated with limited social skills and behavioral challenges. Awareness of social limitations and social anxiety can worsen QoL, yet the specific roles of these factors remain underexplored. This study examined how social skills, challenging behaviors, social anxiety, and self-perceived social competence influence QoL in autistic adolescents. A total of 117 autistic participants (age = 12.6 ± 2.2 years; female = 13.7%, male = 86.3%) completed measures including the Pediatric Quality of Life Inventory, the Social Anxiety Scale for Adolescents, and the Self-Perception Profile for Children/Adolescents Social Competence Subscale. Caregivers assessed social skills and challenging behaviors using the Social Skills Improvement System Rating Scales. Linear regressions, controlling for age, sex, and autistic characteristics, revealed that lower overall QoL was significantly associated with higher social anxiety (β = −0.48, p < 0.001), lower perceived social competence (β = 0.21, p < 0.05), and more challenging behaviors (β = −0.24, p < 0.01) among autistic adolescents. Furthermore, lower social QoL was associated with social anxiety (β = −0.52, p < 0.001) and perceived social competence (β = 0.28, p < 0.01). These factors accounted for 45.5% of overall and 51.6% of social QoL variance. The findings highlighted the importance of supporting self-perception, addressing emotional distress, and managing behavioral challenges to improve QoL in autistic adolescents.

The problem of heterogeneity in autism: Response to Mottron (2021) “Aradical change in our autism research strategy is needed: Back to prototypes”

Lynn Waterhouse — Fri, 30 Jul 2021 00:31:25 -0700

Autism Research, EarlyView.

A Data Driven Approach Reveals That Anomalous Motor System Connectivity is Associated With the Severity of Core Autism Symptoms

Daniel E. Lidstone, Rebecca Rochowiak, Stewart H. Mostofsky, Mary Beth Nebel — Fri, 22 Jan 2021 21:25:14 -0800

This study examined whether disruptions in connectivity involving regions critical for learning, planning, and executing movements are relevant to core autism symptoms. Spatially constrained ICA was performed using resting-state fMRI from 419 children (autism spectrum disorder (ASD) = 105; typically developing (TD) = 314) to identify functional motor subdivisions. Comparing the spatial organization of each subdivision between groups, we found voxels that contributed significantly less to the right posterior cerebellar component in children with ASD versus TD (P <0.001). Next, we examined the effect of diagnosis on right posterior cerebellar connectivity with all other motor subdivisions. The model was significant (P = 0.014) revealing that right posterior cerebellar connectivity with bilateral dorsomedial primary motor cortex was, on average, stronger in children with ASD, while right posterior cerebellar connectivity with left-inferior parietal lobule (IPL), bilateral dorsolateral premotor cortex, and supplementary motor area was stronger in TD children (all P ≤0.02). We observed a diagnosis-by-connectivity interaction such that for children with ASD, elevated social-communicative and excessive repetitive-behavior symptom severity were both associated with right posterior cerebellar-left-IPL hypoconnectivity (P ≤0.001). Right posterior cerebellar and left-IPL are strongly implicated in visuomotor processing with dysfunction in this circuit possibly leading to anomalous development of skills, such as motor imitation, that are crucial for effective social-communication.

Lay Summary

This study examines whether communication between various brain regions involved in the control of movement are disrupted in children with autism spectrum disorder (ASD). We show communication between the right posterior cerebellum and left IPL, a circuit important for efficient visual-motor integration, is disrupted in children with ASD and associated with the severity of ASD symptoms. These results may explain observations of visual-motor integration impairments in children with ASD that are associated with ASD symptom severity.