Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial.

BACKGROUND: Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED-based smoking cessation intervention can help people to quit smoking. METHODS: In this multicentre, parallel-group, randomised controlled superiority trial conducted between January and August 2022, adults who smoked daily and attended one of six UK EDs were randomised to intervention (brief advice, e-cigarette starter kit and referral to stop smoking services) or control (written information on stop smoking services). The primary outcome was biochemically validated abstinence at 6 months. RESULTS: An intention-to-treat analysis included 972 of 1443 people screened for inclusion (484 in the intervention group, 488 in the control group). Of 975 participants randomised, 3 were subsequently excluded, 17 withdrew and 287 were lost to follow-up. The 6-month biochemically-verified abstinence rate was 7.2% in the intervention group and 4.1% in the control group (relative risk 1.76; 95% CI 1.03 to 3.01; p=0.038). Self-reported 7-day abstinence at 6 months was 23.3% in the intervention group and 12.9% in the control group (relative risk 1.80; 95% CI 1.36 to 2.38; p<0.001). No serious adverse events related to taking part in the trial were reported. CONCLUSIONS: An opportunistic smoking cessation intervention comprising brief advice, an e-cigarette starter kit and referral to stop smoking services is effective for sustained smoking abstinence with few reported adverse events. TRIAL REGISTRATION NUMBER: NCT04854616.

Autistic and nonautistic adolescents do not differ in adaptation to gaze direction.

Predictive processing accounts of autism posit that autistic individuals' perception is less biased by expectations than nonautistic individuals', perhaps through stronger precision-weighting of prediction errors. Since precision-weighting is fundamental to all information processing, under this theory, the differences between autistic and nonautistic individuals should be domain-general and observable in both behavior and brain responses. This study used EEG, behavioral responses, and eye-tracking co-registration during gaze-direction adaptation, to investigate whether increased precision-weighting of prediction errors is evident through smaller adaptation after-effects in autistic adolescents compared with nonautistic peers. Multilevel modeling showed that autistic and nonautistic adolescents' responses were consistent with behavioral adaptation, with Bayesian statistics providing extremely strong evidence for the absence of a group difference. Cluster-based permutation testing of ERP responses did not show the expected adaptation after-effect but did show habituation to repeated stimulus presentation, and no group difference was detected, a result not consistent with the theoretical account. Combined with the few other available studies, the current findings raise challenges for the theory, suggesting no fundamental difference in precision-weighting of prediction errors in autism.

Selecting an e-cigarette for use in smoking cessation interventions and healthcare services: findings from patient and public consultation for the COSTED trial.

OBJECTIVES: The Cessation of Smoking Trial in the Emergency Department (COSTED) trial aims to ascertain whether brief advice, the provision of an e-cigarette starter kit and referral to stop smoking services (SSS), increases smoking cessation in people attending the emergency department. Patient and public involvement (PPI) and scoping work were undertaken to select an appropriate e-cigarette for the trial. DESIGN AND SETTING: PPI consultation and feasibility scoping about potential devices with a professional and lay panel, all based in England. Consultation was via email, telephone or video interview. This work took place between April and July 2021, prior to recruitment commencing for the COSTED trial. PARTICIPANTS: A professional panel (n=7) including representatives from academia, SSS and the independent vaping industry, and a PPI lay panel (n=3) who smoke or vape. RESULTS: The professional panel recommended a shortlist of devices which were tested by the PPI lay panel. Key criteria for selecting an appropriate e-cigarette for smoking cessation intervention include satisfaction, usability, affordability and availability. Simplicity of use was highlighted by the PPI lay panel, who found refillable devices complex, and availability of consumables was highlighted as more important than price by both panels. The pod device selected for inclusion was rated highly for satisfaction and usability and had mid-price range and consumables which were widely available. CONCLUSIONS: To select the most appropriate device for the COSTED trial, each criterion required assessment to ensure the best fit to the intervention context and needs of the target population. There is a need for guidance to help enable decision-making about choice of vape products, tailored to service users' needs. We propose a bespoke checklist template, based on our findings, to assist with this process. This has applicability to the recent government announcement of a 'Swap to Stop' programme, offering a vaping starter kit to smokers across England, allowing services flexibility to shape their own programmes and models of delivery. TRIAL REGISTRATION NUMBER: Clinical trial number NCT04854616; pre-results.

Symptoms and steroid dose adjustments following the Covid-19 vaccine in patients with adrenal insufficiency.

BACKGROUND: A proportion of patients with adrenal insufficiency (AI) require increases in their maintenance glucocorticoids following the Covid-19 vaccine as a result of vaccine-related symptoms or development of incipient or frank adrenal crisis. In a large cohort of AI patients, we aim to characterise symptoms, changes in glucocorticoid dosage, occurrence of adrenal crises and whether there are differences between the mRNA and adenovirus vector vaccines. PATIENTS AND METHODS: Patients with AI of any aetiology were invited to complete a short, structured questionnaire of their experience of the Covid-19 vaccination. RESULTS: 279 of the 290 patients enrolled to this study fully completed the questionnaires. 176, 100 and 3 received the Astra Zeneca (AZ), Pfizer-BioNTech (PB) and Moderna (MD) as initial vaccine respectively; and for the second vaccine, 170, 99 and 10 received AZ, PB and MD respectively. Moderate to severe symptoms occurred in 44.8 and 39.7% after the first and second vaccines respectively, were of early onset (6.0 h, IQR 2-12 &. 6.0 h, IQR 2-24 h) and short duration (24 h, IQR 12-72 h & 26 h, IQR 12-72 h). 34.4 and 29.7% increased their maintenance glucocorticoid dose. DISCUSSION: The Covid-19 vaccines appear well-tolerated in patients with AI, with similar frequency of symptoms to that reported in the background population. The AZ vaccine leads to slightly greater post-vaccination symptom burden and need to increase glucocorticoid dosage, but this does not translate to greater adverse outcomes.

Age differences in priming as a function of processing at encoding.

It is unclear whether implicit memory (priming) is affected by aging. Some studies have reported no difference between young and older adults, while others have uncovered reliable reductions. An important factor that may explain these discrepancies is the manner of encoding. Processing requirements (perceptual/conceptual) have varied considerably between studies, yet processing abilities are not equally affected by aging. This study examined whether processing during encoding moderates age effects on priming. Young and older participants studied object-word pairs and made natural/manufactured (conceptual) and left/right rotation (perceptual) judgements in relation to the word or object. Objects served as targets on a subsequent continuous identification with recognition task to assess priming and recognition. Priming and recognition were greater in young than older adults for attended items, with a larger effect size in the conceptual than the perceptual condition. Findings suggest that age differences in priming may be a function of processing at encoding.

Rhythmic visual stimulation as a window into early brain development: A systematic review.

Rhythmic visual stimulation (RVS), the periodic presentation of visual stimuli to elicit a rhythmic brain response, is increasingly applied to reveal insights into early neurocognitive development. Our systematic review identified 69 studies applying RVS in 0- to 6-year-olds. RVS has long been used to study the development of the visual system and applications have more recently been expanded to uncover higher cognitive functions in the developing brain, including overt and covert attention, face and object perception, numeral cognition, and predictive processing. These insights are owed to the unique benefits of RVS, such as the targeted frequency and stimulus-specific neural responses, as well as a remarkable signal-to-noise ratio. Yet, neural mechanisms underlying the RVS response are still poorly understood. We discuss critical challenges and avenues for future research, and the unique potentials the method holds. With this review, we provide a resource for researchers interested in the breadth of developmental RVS research and hope to inspire the future use of this cutting-edge method in developmental cognitive neuroscience.

Null effects of temporal prediction on recognition memory but evidence for differential neural activity at encoding. A registered report.

Previous research has demonstrated that rhythmic presentation of stimuli during encoding boosts subsequent recognition and is associated with distinct neural activity compared with when stimuli are presented in an arrhythmic manner. However, it is unclear whether the effect is driven by automatic entrainment to rhythm or non-rhythmic temporal prediction. This registered report presents an Electroencephalographic (EEG) study aimed at establishing the cognitive and neural mechanisms of the effect of temporal prediction on recognition. In a blocked design, stimulus onset during encoding was systematically manipulated in four conditions prior to recognition testing: rhythmic fixed (RF), rhythmic variable (RV), arrhythmic fixed (AF), and arrhythmic variable (AV). By orthogonally varying rhythm and temporal position we were able to assess their independent contributions to recognition enhancement. Our behavioural results did not replicate previous findings that show a difference in recognition memory based on temporal predictability at encoding. However, event-related potential (ERP) component analysis did show an early (N1) interaction effect of temporal position and rhythm, and later (N2 and Dm) effects driven by temporal position only. Taken together, we observed effects of temporal prediction at encoding, but these differences did not translate to later effects of memory, suggesting that effects of temporal prediction on recognition are less robust than previously thought.

Biochemical Verification of Tobacco-Use as an Inclusion Criterion in Smoking Cessation Trials- Lessons From the Cessation of Smoking Trial in the Emergency Department.

INTRODUCTION: Biochemical verification of smoking status prior to recruitment into smoking cessation trials is widely used to confirm smoking status, most commonly using exhaled carbon monoxide (CO). There is variation in the level of CO used as a biochemical inclusion criterion, and thus the possibility for people reporting to be current smokers to be incorrectly excluded from trials. METHODS: As part of the Cessation of Smoking Trial in the Emergency Department, people attending the Emergency Department (ED) who reported being current daily smokers underwent CO testing to confirm eligibility. Elective semi-structured interviews were undertaken with the researchers who recruited participants. As part of the interviews, researchers were asked their views and experiences with CO testing. RESULTS: Of the 1320 participants who reported being current daily smokers and underwent CO testing, 300 (22.7%) blew a CO reading of 7 ppm or less and were excluded from taking part. Possible explanations offered by researchers for participants blowing low CO readings were (1) long wait times in the ED, therefore a long period having elapsed since people had last smoked and (2) patients having reduced smoking for the period before the ED attendance due to ill health. CONCLUSIONS: Biochemical verification has the potential to improve internal validity of smoking cessation for inclusion in trials, but at the cost of reduced generalisability through exclusion of participants who would receive the intervention if it were implemented in practice. We would recommend researchers carefully consider whether it is appropriate and necessary to include biochemical verification as an inclusion criterion.

Cessation of smoking trial in the emergency department (CoSTED): protocol for a multicentre randomised controlled trial.

INTRODUCTION: Attendees of emergency departments (EDs) have a higher than expected prevalence of smoking. ED attendance may be a good opportunity to prompt positive behaviour change, even for smokers not currently motivated to quit. This study aims to determine whether an opportunist smoking cessation intervention delivered in the ED can help daily smokers attending the ED quit smoking and is cost-effective. METHODS AND ANALYSIS: A two-arm pragmatic, multicentred, parallel-group, individually randomised, controlled superiority trial with an internal pilot, economic evaluation and mixed methods process evaluation. The trial will compare ED-based brief smoking cessation advice, including provision of an e-cigarette and referral to local stop smoking services (intervention) with the provision of contact details for local stop smoking services (control). Target sample size is 972, recruiting across 6 National Health Service EDs in England and Scotland. Outcomes will be collected at 1, 3 and 6 months. The primary outcome at 6 months is carbon monoxide verified continuous smoking abstinence. ETHICS AND DISSEMINATION: The trial was approved by the South Central-Oxford B Research Committee (21/SC/0288). Dissemination will include the publication of outcomes, and the process and economic evaluations in peer-reviewed journals. The findings will also be appropriately disseminated to relevant practice, policy and patient representative groups. TRIAL REGISTRATION NUMBER: NCT04854616; protocol V.4.2.

A Pilot E-Cigarette Voucher Scheme in a Rural County of the United Kingdom.

INTRODUCTION: E-Cigarette voucher schemes have been piloted across the UK to support populations to quit smoking. This short report evaluates a scheme that targets vulnerable and disadvantaged smokers who had failed to quit smoking by other means. METHODS: Descriptive summary evaluation of service data on smoking outcomes and qualitative data from selected participants, as "key-informants" (n = 4) and key stakeholders (stop smoking staff, vape shop staff, and general practitioners [GPs]). RESULTS: In total, 668 participants were referred to the scheme, and 340 participants redeemed a voucher. By intention to treat analysis (ITT) 143/668 (21%) were recorded as quit smoking at 4 weeks. At 12 weeks, 7.5% of participants had quit, by ITT. Overall, the pilot project was well received by clients as it offered an affordable route into vaping for smoking cessation. GPs supported the scheme and appreciated being able to offer an alternative to entrenched smokers. CONCLUSIONS: The scheme shows promise in supporting entrenched smokers to quit smoking. The offer of similar voucher schemes across the UK suggests the potential to reduce overall smoking prevalence and associated morbidity and mortality. IMPLICATIONS: Working with GPs in a deprived area, it was possible to set-up a vape shop voucher scheme for smoking cessation. Patients with comorbidities who had tried and failed to quit smoking previously were referred to receive a vape shop voucher to be redeemed for an initial starter kit, alongside support from the stop smoking service. This innovative scheme enabled 42% of entrenched smokers who redeemed a voucher to successfully quit smoking within 4 weeks.

Age and processing effects on perceptual and conceptual priming.

Explicit (declarative) memory declines with age, but age effects on implicit (nondeclarative) memory are debated. Some studies have reported null changes in implicit memory (e.g., priming in word-fragment completion, perceptual identification, category exemplar generation) with age, while others have uncovered declines. One factor that may account for these discrepancies is processing. Evidence suggests that conceptual and perceptual processes are not equally affected by ageing, yet processing requirements have varied greatly between studies. Processing may moderate age effects on priming, but no study has systematically examined this issue. This registered report presents an experiment to manipulate processing (conceptual / perceptual) during incidental encoding of words, prior to measures of perceptual (perceptual identification) and conceptual (category verification) priming. The perceptual and conceptual priming tasks were matched on all characteristics except processing, making them highly comparable. The four orthogonal conditions (perceptual encoding, perceptual test [PP]; conceptual encoding, perceptual test [CP]; perceptual encoding, conceptual test [PC]; conceptual encoding, conceptual test [CC]) were designed to clarify situations in which age effects on implicit memory emerge, which holds important practical and theoretical implications. Significant effects of Age, Test, and an Age × Processing interaction emerged. Priming was greater in young than older adults and on the perceptual than the conceptual test, but in contrast to the predictions, the age difference was only significant when prior encoding was perceptual (i.e., in the PP and CP conditions).

Domestic/Family Homicide: A Systematic Review of Empirical Evidence.

BACKGROUND: Domestic/family homicide (D/FH) is a global social, economic and public health problem. To date, the research studies into risk factors associated with D/FH has largely focused on intimate partner homicide (IPH). A more contemporary approach recognizes that D/FH extends beyond the intimate partner relationship. This systematic review sought to identify and quantify the individual, relationship, community and societal factors in the empirical evidence literature on D/FH. METHODS: Eight electronic databases were searched from January 1999 to December 2020. Published journal articles on studies of D/FH were included if the study included victims and/or perpetrator of D/FH, reported risk and/or protective factors associated with D/FH, reported primary data and was published in English. Factors were descriptively synthesized by the categories of the social ecological model and D/FH sub-type. RESULTS: Three hundred and forty published articles met the inclusion criteria. From 1999 to 2020 the number of articles on D/FH increased globally from 10 to 40 respectively, declining to 23 in 2020. Almost half of the articles examined populations located in the Americas (160, 47.1%), predominately the United States and the majority of articles used quantitative designs (277, 81.5%). The forms of homicide more commonly studied were intimate partner (171, 50.3%), and filicide (98, 28.8%). Approximately 90% of articles reported individual victim and perpetrator factors, 64.7% examined relationship factors, 17.9% examined community factors and 15.6% examined societal factors. CONCLUSION: To inform universal and targeted D/FH elimination and prevention strategies, more research across different regions and a greater emphasis on community and societal-level factors is needed.

A user-guided personalization methodology to facilitate new smart home occupancy.

Smart homes are becoming increasingly popular in providing people with the services they desire. Activity recognition is a fundamental task to provide personalised home facilities. Many promising approaches are being used for activity recognition; one of them is data-driven. It has some fascinating features and advantages. However, there are drawbacks such as the lack of ability to providing home automation from the day one due to the limited data available. In this paper, we propose an approach, called READY (useR-guided nEw smart home ADaptation sYstem) for developing a personalised automation system that provides the user with smart home services the moment they move into their new house. The system development process was strongly user-centred, involving users in every step of the system's design. Later, the user-guided transfer learning approach was introduced that uses an old smart home data set to enhance the existing smart home service with user contributions. Finally, the proposed approach and designed system were tested and validated in the smart lab that showed promising results.

Temporal Expectation Improves Recognition Memory for Spatially Attended Objects.

Recent evidence suggests that temporal expectation is beneficial to memory formation. Rhythmic presentation of stimuli during encoding enhances subsequent recognition and is associated with distinct neural activity compared with when stimuli are presented in an arrhythmic manner. However, no prior study has examined how temporal expectation interacts with another important form of facilitation-spatial attention-to affect memory. This study systematically manipulated temporal expectation and spatial attention during encoding to examine their combined effect on behavioral recognition and associated ERPs. Participants performed eight experimental blocks consisting of an encoding phase and recognition test, with EEG recorded throughout. During encoding, pairs of objects and checkerboards were presented and participants were cued to attend to the left or right stream and detect targets as quickly as possible. In four blocks, stimulus presentation followed a rhythmic (constant, predictable) temporal structure, and in the other four blocks, stimulus onset was arrhythmic (random, unpredictable). An interaction between temporal expectation and spatial attention emerged, with greater recognition in the rhythmic than the arrhythmic condition for spatially attended items. Analysis of memory-specific ERP components uncovered effects of spatial attention. There were late positive component and FN400 old/new effects in the attended condition for both rhythmic and arrhythmic items, whereas in the unattended condition, there was an FN400 old/new effect and no late positive component effect. The study provides new evidence that memory improvement as a function of temporal expectation is dependent upon spatial attention.

Development of a Smoke-Free Home Intervention for Families of Babies Admitted to Neonatal Intensive Care.

Neonatal intensive care units (NICUs) have a disproportionately higher number of parents who smoke tobacco compared to the general population. A baby's NICU admission offers a unique time to prompt behaviour change, and to emphasise the dangerous health risks of environmental tobacco smoke exposure to vulnerable infants. We sought to explore the views of mothers, fathers, wider family members, and healthcare professionals to develop an intervention to promote smoke-free homes, delivered on NICU. This article reports findings of a qualitative interview and focus group study with parents whose infants were in NICU (n = 42) and NICU healthcare professionals (n = 23). Thematic analysis was conducted to deductively explore aspects of intervention development including initiation, timing, components and delivery. Analysis of inductively occurring themes was also undertaken. Findings demonstrated that both parents and healthcare professionals supported the need for intervention. They felt it should be positioned around the promotion of smoke-free homes, but to achieve that end goal might incorporate direct cessation support during the NICU stay, support to stay smoke free (relapse prevention), and support and guidance for discussing smoking with family and household visitors. Qualitative analysis mapped well to an intervention based around the '3As' approach (ask, advise, act). This informed a logic model and intervention pathway.

Disruption and adaptation in response to the coronavirus pandemic - Assets as contextual moderators of enactment of health behaviours.

PURPOSE: During the COVID-19 UK first national lockdown (March-July 2020) enactment of healthy behaviours was fundamentally changed due to social restrictions. This study sought to understand perspectives on health behaviour change, as part of a wider study tracking reported health behaviour change over time. METHODS: A purposive sample was selected. N = 40 qualitative interviews were conducted remotely (phone/video) from participants across England and Wales, and transcribed verbatim. Descriptive case studies were shared at regular analysis meetings. Inductive reflexive thematic coding was undertaken and coding was discussed using a team approach to agreeing analytical codes. A multiple lens theoretical perspective was adopted to illuminate the perceived influences and restrictions on participants' reports of health behaviour change. RESULTS: There was a clear progressive narrative for all participants, through initial responses and reactions to the pandemic, framed as 'disruption', then, as lockdown was acclimatized to, evidence of 'adaptation'. Adaptation was seen in terms of modification, substitution, adoption, discontinuation/cessation, stultification, maintenance and recalibration of health behaviours. An illustrative case study exemplifies the narrative encompassing these features and demonstrating the complex non-linear interactions between context and enacted health behaviours. CONCLUSIONS: Individuals responded to pandemic-related social restrictions in complex ways. Those in contexts with existing social assets, community links and established patterns of healthy behaviours were able to respond positively, adapting by modifying behaviour and using technology to engage in healthy behaviours in new and innovative ways. For those in more vulnerable contexts, enacting (negative) health behaviour change was an expression of frustration at the limitations imposed by social restrictions.

Evaluating the effectiveness of e-cigarettes compared with usual care for smoking cessation when offered to smokers at homeless centres: protocol for a multi-centre cluster-randomized controlled trial in Great Britain.

BACKGROUND AND AIMS: Smoking is extremely common among adults experiencing homelessness, but there is lack of evidence for treatment efficacy. E-cigarettes are an effective quitting aid, but they have not been widely tested in smokers with complex health and social needs. Here we build upon our cluster feasibility trial and evaluate the offer of an e-cigarette or usual care to smokers accessing a homeless centre. DESIGN, SETTING AND PARTICIPANTS: Multi-centre two-arm cluster-randomized controlled trial with mixed-method embedded process and economic evaluation in homeless centres in England, Scotland and Wales. Adult smokers (18+ years; n = 480) accessing homeless centres and who are known to centre staff and willing to consent. INTERVENTION AND COMPARATOR: Clusters (n = 32) will be randomized to either an e-cigarette starter pack with weekly allocations of nicotine containing e-liquid for 4 weeks [choice of flavours (menthol, fruit and tobacco) and strengths 12 mg/ml and 18 mg/ml] or the usual care intervention, which comprises very brief advice and a leaflet signposting to the local stop smoking service. MEASUREMENTS: The primary outcome is 24-week sustained carbon monoxide-validated smoking cessation (Russell Standard defined, intention-to-treat analysis). SECONDARY OUTCOMES: (i) 50% smoking reduction (cigarettes per day) from baseline to 24 weeks; (ii) 7-day point prevalence quit rates at 4-, 12- and 24-week follow-up; (iii) changes in risky smoking practices (e.g. sharing cigarettes, smoking discarded cigarettes) from baseline to 4, 12 and 24 weeks; (iv) cost-effectiveness of the intervention; and (v) fidelity of intervention implementation; mechanisms of change; contextual influences and sustainability. CONCLUSIONS: This is the first study, to our knowledge, to randomly assign smokers experiencing homelessness to an e-cigarette and usual care intervention to measure smoking abstinence with embedded process and economic evaluations. If effective, its results will be used to inform the larger-scale implementation of offering e-cigarettes throughout homeless centres to aid smoking cessation.

Paranoid and misidentification subtypes of psychosis in dementia.

This study aimed to review the neurobiological and neuropsychological correlates of paranoid (persecutory delusions) and misidentification (misidentification delusions and/or hallucinations) subtypes of psychosis in dementia, to establish if they represent distinct subphenotypes. Nine studies were eligible, all included patients with Alzheimer's disease. Greater global cognitive deficits and an accelerated global cognitive decline were observed in the misidentification subtype. Neuroimaging studies showed more marked volume loss in multiple regions in patients with the misidentification subtype, including those involved in object recognition and the processing of information on spatial and temporal context. A single study found greater impairment in visual sustained attention and object recognition in the misidentification subtype. The small number of studies and methodological heterogeneity limit interpretation of the findings. Nevertheless, these findings would tentatively suggest that there may be additional or accelerated pathological change in functional networks involved in visuoperceptual processing in the misidentification subtype. This should be further explored in prospective studies and the investigation extended to other forms of dementia, to gain a transdiagnostic perspective.

Implicit learning in 3-year-olds with high and low likelihood of autism shows no evidence of precision weighting differences.

Predictive Processing accounts of autism claim that autistic individuals assign higher precision to their prediction errors than non-autistic individuals, that is, autistic individuals update their predictions more readily when faced with unexpected sensory input. Since setting the level of precision is a fundamental part of perception and learning, we propose that such differences should be detectable in various domains at a very early age, before clinical symptoms have fully emerged. We therefore tested 3-year-old younger siblings of autistic children, with a high likelihood of later receiving an autism diagnosis themselves, and low-likelihood children with an older sibling without autism. We used a novel implicit learning paradigm to examine the effect of sensory noise on the predictions participants built. In order to learn a sequence, our participants had to select which visual information to attend to and disregard low-level prediction errors caused by the sensory noise, which the theory claims is more difficult for autistic individuals. Contrary to the proposed higher precision-weighting of prediction errors in autism, the high-likelihood children did not show signs of updating their predictions more readily when we added sensory noise compared to the low-likelihood children, either in their reaction times or in the recurrence and determinism of their response locations. These results raise challenges for Predictive Processing theories of autism, specifically for the notion that prediction errors are inflexibly highly weighted by individuals with autism.