Exploring the construct validity of the Camouflaging Autistic Traits Questionnaire: A factor analytic study.

LAY ABSTRACT: Autistic people describe having to mask or 'camouflage' their autistic selves to fit into certain social settings. Many researchers have used the CAT-Q to measure the extent to which autistic people engage in camouflaging. However, some researchers have questioned whether the CAT-Q measures camouflaging or whether it measures other related experiences and behaviours associated with social anxiety, fear of being negatively judged or social autistic traits. In our study, we analysed the CAT-Q to check whether it is indeed similar to or different from these related experiences. To do this, we asked 308 autistic adults to complete the CAT-Q and questionnaires about social anxiety, fear of being negatively judged and autistic social features. Then, we put all the CAT-Q items together with the items from each of the other measures in three separate analyses (called factor analyses) to see how the items would group together. These analyses showed us whether camouflaging behaviours are distinguishable and different from, or cluster together with, these other experiences. We found that most of CAT-Q items grouped together separately from the other measures' items, suggesting that camouflaging differs from these other related experiences. Only some items from one of the CAT-Q subscales clustered together with some social anxiety and autistic items, suggesting these may need to be teased out better in the future. Generally, our findings show that we can use the CAT-Q to measure camouflaging behaviours among autistic people.

FMT intervention decreases urine 5-HIAA levels: a randomized double-blind controlled study.

Background: Autism spectrum disorder (ASD) is often linked to gastrointestinal issues and altered serotonin metabolism. Emerging evidence suggests gut microbiota influence both, with fecal microbiota transplantation (FMT) offering a potential therapeutic approach. However, its impact on serotonin metabolism and ASD symptoms is not well understood. In this study, we aimed to evaluate the clinical effects of FMT and examine changes in specific urinary metabolites in children with ASD. Methods: A randomized double-blind controlled trial was performed to evaluate the clinical effects of FMT on GI and ASD-related symptoms. Gastrointestinal symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS), and the ASD-related symptoms were assessed using the Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), and Social Responsiveness Scale (SRS) scores. Urinary metabolites were analyzed by homogeneous enzyme immunoassay using commercially available kits. Results: Significant improvements in GI and core ASD symptoms were observed following FMT intervention. The average GSRS scores decreased from 30.17 (before) to 19 (after; p < 0.0001), CARS scores decreased from 36.22 to 33.33 (p < 0.0001), SRS scores decreased from 151.17 to 137.5 (p = 0.0002), and the ABC scores decreased 76.39 to 53.17 (p < 0.0001) in the FMT group. However, in the placebo group, GSRS, CARS, and SRS scores showed no significant changes, while ABC scores decreased from 72 to 58.75 (p = 0.034). The FMT group also showed a significant reduction in urinary 5-hydroxyindoleacetic acid (5-HIAA) levels from 8.6 to 7.32 mg/L (p = 0.022), while other metabolites showed no significant changes. Conclusion: FMT is a safe and effective treatment for improving GI and core symptoms in children with ASD, with 5-HIAA showing potential as a urinary biomarker for treatment response.

Factors underlying differences in knowledge, explicit stigma and implicit biases towards autism across Hong Kong, the United Kingdom and the United States.

LAY ABSTRACT: Attitudes towards autism vary across countries. Some of this variation could reflect differences in cultural values across countries, or differences in how much people know about autism. Until now, most research on this topic has asked people directly about their attitudes towards interacting with autistic people. As a result, we understand little about why some people unconsciously hold negative attitudes towards autism, and whether these unconscious attitudes vary across countries. We studied explicit attitudes (willingness to interact), implicit attitudes (unconscious beliefs), knowledge about autism, and cultural values in university students from Hong Kong, the United Kingdom and the United States. We found that people were less willing to interact with autistic people if they knew less about autism, aligned with a competitive and hierarchical society ('vertical individualism'), did not see themselves as part of a collective whose members are equal (less 'horizontal collectivism'), and if they unconcsciously associated autism with negative attributes. Students in Hong Kong were less willing to interact with autistic people and had less understanding of autism compared to those in the United Kingdom and the United States. Unconscious biases did not differ across countries. Our findings highlight the need to combat misconceptions about autism to improve attitudes towards autistic people, especially in Hong Kong. Unfortunately, our results suggest that acquiring more accurate knowledge may not be sufficient to alter unconscious biases. Further research is needed to determine the factors underlying unconscious biases.

Altered functional connectivity of unimodal sensory and multisensory integration networks is related to symptom severity in autism spectrum disorders.

BACKGROUND: Atypical sensory processing is a prevalent feature in autism spectrum disorders (ASD) and constitutes a core diagnostic criterion in the Diagnostic and Statistical Manual of Mental of Disorders, 5th edition (DSM-5). However, neurocognitive underpinnings of atypical unimodal and multimodal sensory processing and their relationships with autism symptoms remain unclear. METHODS: This study examined intrinsic functional connectivity (FC) patterns among five unimodal sensory and multisensory integration (MSI) networks in ASD with a large multi-site dataset (n = 646), and investigated the relationships among altered FC, atypical sensory processing, social communicative deficits, and overall autism symptoms with correlation and mediation analyses. RESULTS: Relative to typically developing (TD) controls, the ASD group demonstrated increased FC of the olfactory network, decreased FC within the MSI network, and decreased FC of the MSI-unimodal-sensory networks. Furthermore, altered FC was positively associated with autism symptom severity, and such associations were completely mediated by atypical sensory processing and social communicative deficits. CONCLUSIONS: ASD-specific olfactory overconnectivity and MSI-unimodal-sensory underconnectivity lend support to the Intense World Theory and Weak Central Coherence Theory, suggesting olfactory hypersensitivity at the expense of multisensory integration as potential neural mechanisms underlying atypical sensory processing in ASD. These atypical FC patterns further suggest potential targets for psychological and neuromodulatory interventions.

GAIA therapeutic farm: Prospective study on multidisciplinary care efficacy.

INTRODUCTION: The therapeutic farm "GAIA" in Sidi Thabet is a non-profit organization created in 2009, situated in the North-Western suburbs of the capital Tunis/Tunisia. Its main aims are the day-care for and the socio-professional integration of children and young adults between age 6 and 30 with diverse types of disability through multiple activities, such as pet assisted therapy and horticulture. AIM: to assess the potential benefits of therapeutic on-farm management. METHODS: We conducted a prospective study including 50 children and young adults aged 7 to 30 years with intellectual disabilities and/or autism spectrum disorders. Study participants were evaluated before inclusion and after 10 months of care using a self-established questionnaire collecting socio-demographic and clinical variables, an evaluation of competences, and the Child Behavior Checklist (CBCL). RESULTS: Mean sub scores (externalization/internalization) of CBCL decreased significantly (p<0.002). Competences were significantly improved in the following domains: understanding of verbal language, gross and fine motor skills, body hygiene, spatial and temporal orientation, preschool and school learning achievements and social integration. CONCLUSIONS: These positive initial results should encourage the further development of this initiative with support of the community.

The Daydream Spectrum: The Role of Emotional Dysregulation, Internalized Stigma and Self-Esteem in Maladaptive Daydreaming Among Adults With ADHD, ASD, and Double Diagnosis.

OBJECTIVE: Maladaptive daydreaming (MD) is characterized by vivid, excessive fantasy activity that becomes prioritized over other activities and may result in avoidant coping strategies. Little is known about the relationship between MD and internalized stigma in the neurodivergent sample. The current study aimed to examine emotional dysregulation, escapism and self-perception (self-esteem and internalized stigma) as potential determinants of MD in three groups: adults on the autism spectrum, with ADHD, and both diagnoses ("AuDHD"), including their neurodivergent symptoms (autistic traits, empathizing, ADHD symptoms). METHODS: A sample of 293 persons (139 with ADHD, 74 on the autism spectrum, and 80 with both diagnoses) completed self-report scales concerning ADHD symptoms, autism spectrum symptoms, empathizing, self-esteem, daydreaming as escapism, emotional dysregulation, maladaptive daydreaming, and internalized stigma. A correlation analysis was implemented. Additionally, a group comparison and quantile regression for the 25th, 50th, and 75th percentile of maladaptive daydreaming in the three groups were executed. RESULTS: The results showed that internalized stigma, emotional dysregulation, escapism, and self-esteem have significant associations with MD in the neurodiverse sample. The ADHD group achieved the lowest scores in emotional dysregulation, discrimination experience, and social withdrawal. The groups did not vary in MD rates, stereotype endorsement, stigma resistance, nonacceptance of emotional responses, and impulse control difficulties. The AuDHD group achieved higher results than the ASD group only in the ADHD symptoms. Quantile regression revealed differences in the predictors of maladaptive daydreaming in the three groups. ADHD symptoms and self-suppression escapism were significant predictors for the higher levels of MD in persons with singular autism or ADHD diagnosis. CONCLUSION: The results showed no differences in MD rates, although there were significant variations in predictive features among the three samples. The role of internalized stigma and self-esteem was highlighted in the results as significant associates of MD prevalence. These outcomes expand the current knowledge in the context of maladaptive daydreaming, internalized stigma, self-esteem and emotional dysregulation in a neurodiverse sample and allow for proposing clinical applications and further research directions.

Facilitating positive emotions in people with challenges by combining conventional occupational training and a novel farming program: a feasibility study.

OBJECTIVE: Japan has a system of occupational therapy programs known as self-reliance training (training for daily living), which helps people with various disabilities lead more meaningful lives. Recently, it has been shown that green care farms are beneficial for dementia care and that agricultural and horticultural work has a positive impact on people with intellectual disabilities and mental disorders. This study examined the health-improving effects of farm activities and developed an attractive program for adolescents with developmental and intellectual disabilities who use independent training facilities. The program comprised agricultural and horticultural activities such as vegetable cultivation and management, flower planting, and flower arrangement. RESULTS: No significant differences were observed in any of the measures for positive mood before and after the usual program (UP). However, anger-hostility and depression-dejection improved significantly after the farm program (FP) (p < .05). Self-efficacy improved significantly after both UP and FP (p < .10). Free responses were obtained from UP (131 responses) and FP (126 responses) participants; thematic analysis of FP participants' statements revealed that positive comments included "confidence in accomplishing tasks," "anticipation and joy of growing plants," and "motivation for gardening activities."

Evaluating Sleep in Autism Using CSHQ and CSHQ-Autism - A Perspective Through the Cultural Lens.

The Child Sleep Hygiene Questionnaire (CSHQ) and its adapted version for autistic children, known as CSHQ-Autism, have gained recognition as essential tools for studying pediatric sleep patterns. 67 autistic children were evaluated using these questionnaires. 52 children screened positive on the CSHQ while 18 were screened positive on the CSHQ-Autism. Notably, both tools showed elevated ratings in the domains of sleep anxiety and co-sleeping, which may hinder their ability to accurately distinguish sleep disturbances. However, the prevalence of sleep anxiety/co-sleeping in Indian culture was found to be linked to more severe sleep disorders, while also serving as a protective factor against separation anxiety and sudden infant death syndrome (SIDS). Therefore, while the CSHQ and CSHQ-Autism serve as valuable assessment tools, their scores may be inflated by ingrained cultural norms in the Indian context.

Coping strategies adopted by caregivers of children with autism in the Limpopo Province, South Africa.

Background: Emotion- and problem-focused coping strategies are frequently employed by caregivers of autistic children to increase their general well-being and resilience to the stress of raising the child. Although these strategies cannot directly address the situation, it is useful for handling stressful situations that cannot change. Objectives: The study seeks to explore and understand the emotion- and problem-focused strategies that caregivers use to cope with the challenges of raising a child with autism. Method: This was a qualitative, exploratory and descriptive research study. Twenty-eight caregivers were purposive-convenient sampled from the public special schools where their autism spectrum disorder (ASD) children are schooling. Semi-structured interviews were used to gather data, which were then transcribed and subjected to thematic analysis. Results: Positive emotion-focused strategies include positive reappraisal, reframing and acceptance. Negative emotion-focused strategies include denial, emotional release, cognitive distortion, self-isolation, overprotection, negative self-talk, punishment and religion. Problem-focused coping strategies include active and adaptive coping, peer group, professional support and social support. Conclusion: The coping methods that have been identified can be integrated into intervention programmes and serve as a guide for specialised institutions that offer more extensive knowledge and assistance to families who are caring for children with ASD. Contribution: The study contributes to understanding the emotion- and problem-focused strategies adopted by rural caregivers in managing their emotions, interpretation of the situation and adjusting to the demands of raising an autistic child.

Longitudinal change in symptom severity in children with ASD: Results from the ELENA cohort.

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition and understanding the changes in autism symptoms over time is crucial for tailoring support and interventions. This study therefore aimed to investigate the changes in symptom severity in a large cohort of children with ASD over a three-year follow-up period and identify factors that influence these changes. The study included 575 children diagnosed with ASD, ranging in age from 2 to 12 years, who were assessed at baseline and again 3 years later using the Autism Diagnostic Observational Schedule-2 (ADOS-2). ASD severity changes were investigated using the ADOS calibrated severity score (CSS) scores for total, social affect (SA) and restricted and repetitive behaviors (RRB). Results highlight four distinct patterns: stable high, stable low, increased, and decreased severity. The ADOS CSS total score changed for half of the sample, reflecting an increase in ASD severity for 21.9% and a decrease for 29.1% of children. For the other half, the ADOS CSS score remained stable, either high (34.4%) or low (14.6%). While the majority of previous studies reported stability in ASD severity, our findings revealed significant variability with frequent improvements in SA symptoms whereas RRBs remained stable or worsened. Our findings also showed that an improvement in SA was associated with the youngest group and early diagnosis. However, no clinical or sociodemographic factors were linked to changes in RRB, emphasizing the necessity for RRB-specific therapies. The third six-year follow-up point of the ongoing ELENA cohort study will map the long-term trajectories of the severity of ASD symptoms and their potential risk factors.

Sport and Autism: What Do We Know so Far? A Review.

Autism, or autism spectrum disorders, is a neurodevelopmental condition characterized by limitations in social interaction, communication skills, and repetitive behaviors. Although motor disorders were previously considered marginal in autism, recent research has highlighted their significance. Numerous studies have underscored the positive impact of sports on autistic individuals. This article presents a comprehensive overview of the literature regarding the effects of sport interventions on autistic individuals and aims to extract general and practical recommendations. Initially, the article reviews the various characteristics of autism that are positively impacted by sports, ranging from psycho-social skills to motor behavior. Subsequently, it examines how different configurations of sports practice (individual/collective, indoor/outdoor, etc.) may be suitable for autistic individuals. Literature research was conducted in two databases, resulting in the inclusion of 92 articles meeting longitudinal criteria (i.e., containing full sport/physical activity programs with pre-to-post analyses) out of 1665 initially identified articles. The findings suggest that individuals with autism can benefit from sports across a wide range of physical, psychological, and social factors. Importantly, there is no full contraindication for any activity, although some may require specific step-by-step preparation. Each activity has the potential to provide benefits in specific areas, as discussed in the article. In conclusion, further research is needed to explore the most effective strategies for implementing sports programs and maximizing their benefits for individuals across the autism spectrum.

Correction of Batch Effect in Gut Microbiota Profiling of ASD Cohorts from Different Geographical Origins.

BACKGROUND: To date, there have been numerous metataxonomic studies on gut microbiota (GM) profiling based on the analyses of data from public repositories. However, differences in study population and wet and dry pipelines have produced discordant results. Herein, we propose a biostatistical approach to remove these batch effects for the GM characterization in the case of autism spectrum disorders (ASDs). METHODS: An original dataset of GM profiles from patients with ASD was ecologically characterized and compared with GM public digital profiles of age-matched neurotypical controls (NCs). Also, GM data from seven case-control studies on ASD were retrieved from the NCBI platform and exploited for analysis. Hence, on each dataset, conditional quantile regression (CQR) was performed to reduce the batch effects originating from both technical and geographical confounders affecting the GM-related data. This method was further applied to the whole dataset matrix, obtained by merging all datasets. The ASD GM markers were identified by the random forest (RF) model. RESULTS: We observed a different GM profile in patients with ASD compared with NC subjects. Moreover, a significant reduction of technical- and geographical-dependent batch effects in all datasets was achieved. We identified Bacteroides_H, Faecalibacterium, Gemmiger_A_73129, Blautia_A_141781, Bifidobacterium_388775, and Phocaeicola_A_858004 as robust GM bacterial biomarkers of ASD. Finally, our validation approach provided evidence of the validity of the QCR method, showing high values of accuracy, specificity, sensitivity, and AUC-ROC. CONCLUSIONS: Herein, we proposed an updated biostatistical approach to reduce the technical and geographical batch effects that may negatively affect the description of bacterial composition in microbiota studies.

Psychometric Properties of the Chinese Version of the Psy-Flex Among Parents of Children with Autism Spectrum Disorder.

This research aimed to translate the original English version of the Psy-Flex, a scale of psychological flexibility, into Chinese and to test its psychometric properties among parents of children with autism spectrum disorder (ASD). Two phases were conducted: (1) translation from English to Chinese (Psy-Flex-C), followed by a semantic equivalence evaluation between two versions, a pre-test, and an evaluation of the Psy-Flex-C in terms of face validity with 20 parents of autistic children, and content validity of the Psy-Flex-C with eight experts. (2) A cross-sectional study with 248 parents of autistic children was conducted for validation, and a subgroup of 50 participants was randomly selected to assess the test-retest reliability at a 2-week interval. The Psy-Flex-C showed satisfactory semantic equivalence with the original version and demonstrated adequate internal consistency (Cronbach's α = 0.84) and test-retest stability (weighted kappa statistic = 0.88). Concurrent validity was supported by a moderate correlation between the Psy-Flex-C and the Comprehensive Assessment of Acceptance and Commitment Therapy Processes (Pearson's r = 0.54, p < 0.01). The Psy-Flex-C showed a significant mean score difference between parents with high and low parenting stress (t = 5.43, p < 0.001). Similar to the original scale, confirmatory factor analysis showed the best fitting one-factor structure of the Psy-Flex-C (X2/df = 1.62, p = 0.13, RMSEA = 0.05, GFI = 0.99, CFI = 0.99, TLI = 0.98, SRMR = 0.023). The Psy-Flex-C can be a reliable and valid instrument to self-report psychological flexibility in parents of children with ASD. Future research is recommended to test the Psy-Flex-C using diverse samples from different cultures and contexts to enhance its generalizability.

The to be, or not to be, of acting autistic.

LAY ABSTRACT: Autistic characters are becoming more common in film and television, and a growing number of production companies are making efforts to hire autistic actors to play autistic characters. The purpose of this study is to learn about the experiences of professional autistic actors who have played autistic characters in professional media productions. We also explored autistic actors' impressions of the autistic characters they have seen on screen. We interviewed nine professional autistic actors, who discussed their experiences as professional actors playing autistic characters. Interviews revealed the following themes, including (1) the advantages and disadvantages of disclosing autism, (2) professional networks, and (3) windows and mirrors. Throughout the interviews, the actors discussed instances when they needed to identify as being autistic to take advantage of autism-focused employment opportunities, and other instances when they felt more comfortable not identifying as autistic. Actors' professional support networks were knowledgeable about autism and advocated for the inclusion and employment of autistic actors. They appreciated the growing number of autistic characters on screen but hoped more production companies invest in authentic casting initiatives. Actors compel production companies to move away from overplayed stereotypical and misleading portrayals. The actors' recommendations for future autistic characterizations are described.

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

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

Altered sex differences related to food intake, hedonic preference, and FosB/deltaFosB expression within central neural circuit involved in homeostatic and hedonic food intake regulation in Shank3B mouse model of autism spectrum disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder accompanied by narrow interests, difficulties in communication and social interaction, and repetitive behavior. In addition, ASD is frequently associated with eating and feeding problems. Although the symptoms of ASD are more likely to be observed in boys, the prevalence of eating disorders is more common in females. The ingestive behavior is regulated by the integrative system of the brain, which involves both homeostatic and hedonic neural circuits. Sex differences in the physiology of food intake depend on sex hormones regulating the expression of the ASD-associated Shank genes. Shank3 mutation leads to ASD-like traits and Shank3B -/- mice have been established as an animal model to study the neurobiology of ASD. Therefore, the long-lasting neuronal activity in the central neural circuit related to the homeostatic and hedonic regulation of food intake was evaluated in both sexes of Shank3B mice, followed by the evaluation of the food intake and preference. In the Shank3B +/+ genotype, well-preserved relationships in the tonic activity within the homeostatic neural network together with the relationships between ingestion and hedonic preference were observed in males but were reduced in females. These interrelations were partially or completely lost in the mice with the Shank3B -/- genotype. A decreased hedonic preference for the sweet taste but increased total food intake was found in the Shank3B -/- mice. In the Shank3B -/- group, there were altered sex differences related to the amount of tonic cell activity in the hedonic and homeostatic neural networks, together with altered sex differences in sweet and sweet-fat solution intake. Furthermore, the Shank3B -/- females exhibited an increased intake and preference for cheese compared to the Shank3B +/+ ones. The obtained data indicate altered functional crosstalk between the central homeostatic and hedonic neural circuits involved in the regulation of food intake in ASD.

Turicibacter and Catenibacterium as potential biomarkers in autism spectrum disorders.

Autism spectrum disorders (ASD) are neurodevelopmental disorders characterized by social, behavioral, and cognitive impairments. Several comorbidities, including gastrointestinal (GI) dysregulations, are frequently reported in ASD children. Although studies in animals have shown the crucial role of the microbiota in key aspects of neurodevelopment, there is currently no consensus on how the alteration of microbial composition affects the pathogenesis of ASD. Moreover, disruption of the gut-brain axis (GBA) has been reported in ASD although with limited studies conducted on the Mediterranean population. In our study, we aimed to investigate gut microbiota composition in Lebanese ASD subjects, their unaffected siblings, and a control group from various regions in Lebanon using the 16 S-rRNA sequencing (NGS). Our study revealed a lower abundance of Turicibacter and a significant enrichment on Proteobacteria in the ASD and siblings' groups compared to the controls, indicating that gut microbiota is probably affected by dietary habits, living conditions together with host genetic factors. The study also showed evidence of changes in the gut microbiome of ASD children compared to their siblings and the unrelated control. Bacteroidetes revealed a lower abundance in the ASD group compared to controls and siblings, conversely, Catenibacterium and Tenericutes revealed an increased abundance in the ASD group. Notably, our study identifies alterations in the abundance of Turicibacter and Catenibacterium in ASD children suggesting a possible link between these bacterial taxa and ASD and contributing to the growing body of evidence linking the microbiome to ASD.

Virtual Reality / Augmented Reality (VR/AR) Approach to Develop Social and Communication Skills in Children and Adolescents with Autism Spectrum Disorders Without Intellectual Impairment.

BACKGROUND: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder that affects a significant proportion of the world's population, particularly children and adolescents. The sensory processing issues can be an evidence-based target for therapeutic/corrective interventions by controlling the intensity and targeted replacement of maladaptive sensory stimuli with neutral stimuli using virtual reality or augmented reality. SUBJECTS AND METHODS: We searched for articles on Pubmed. The search query included ((VR or virtual reality) or (AR or augmented reality)) and (children or adolescents) and (ASD or autism spectrum disorder or autism). RESULTS: Our criteria were met by 25 articles. 19 articles used VR, 5 articles used AR and 1 article used MR. Most interventions offer children and adolescents with ASD individualized tasks. Immersive VR games developed collaborative skills. Other systems encourage and teach directed facial gaze. Evaluation of the effectiveness of learning in VR/AR environment is carried out by means of different scales, qualitative analysis of surveys, questionnaires and interviews, studying the number and duration of eye contacts between the participant and the avatar. It should be noted that almost all studies were conducted on small samples, so their results allow us to draw only preliminary conclusions about the effectiveness of VR /AR. CONCLUSIONS: The following key areas of VR/AR technologies for children and adolescents with high-functioning ASD can be identified: communicating with an avatar, including answering its questions, tracking the child's gaze and encouraging the child to look at the face, placing it in social situations close to real life, practicing common everyday situations, learning to recognize emotions. A VR/AR-based therapy approach may help children with autism spectrum disorder without cognitive impairment to develop higher levels of adaptation in terms of social and communication skills. However, more research is needed to evaluate the effectiveness of different methods.

Determining unmet need: clinical relevance of suspected neurodivergence in first-episode psychosis.

AIMS AND METHOD: We explored the prevalence of autism and attention-deficit hyperactivity disorder in first-episode psychosis. Through service evaluation involving 509 individuals, detailed analyses were conducted on neurodevelopmental traits and patterns of service utilisation. RESULTS: Prevalence of neurodivergence in first-episode psychosis was 37.7%. Neurodivergent individuals used urgent mental health services more frequently (Mann-Whitney U = 25925, Z = -2.832, P = 0.005) and had longer hospital stays (Mann-Whitney U = 22816, Z = -4.886, P ≤ 0.001) than non-neurodivergent people. Neurodivergent people spend more than twice as long in mental health hospitals at a time than the non-neurodivergent people (Mann-Whitney U = 22 909.5, Z = -4.826, P ≤ 0.001). Mediation analysis underscored indirect impact of neurodivergence on hospital stay durations through age at onset of psychosis and use of emergency services. CLINICAL IMPLICATIONS: Prevalence of neurodevelopmental conditions in first-episode psychosis is underestimated. Neurodivergent individuals show increased utilisation of mental health services and experience psychosis earlier. Early assessment is crucial for optimising psychosis management and improving mental health outcomes.

Gesture Imitation Performance and Visual Exploration in Young Children with Autism Spectrum Disorder.

Most studies in children with autism spectrum disorder (ASD) support a decrement in imitation performance. Factors related to visual attention and motor execution have been proposed to explain this phenomenon in ASD. However, studies investigated imitation with various methods, leading to inconsistent findings. Here, we examine imitation performance related to visual attention and motor execution. We focused on the imitation of meaningful and meaningless gestures, consistently reported as more affected than imitation of actions with objects in ASD. The imitation eye-tracking task consisted of a video of an actor demonstrating gestures and prompting children to imitate them. The demonstrations comprised meaningful and meaningless hand gestures, and meaningless facial gestures. We measured the fixation duration to the actor' face during child-directed speech and gesture demonstrations. We video-recorded children to assess their performance. Our sample comprised 100 participants (3.55 ± 1.11 years old), including 84 children with ASD. The ASD and typically developing groups displayed the same visual attention toward gesture demonstrations, although children with ASD spent less time looking at the face during facial stimuli. Visual exploration of actors' gestures did not influence imitation performance. Imitation of meaningful gestures was associated with less severe autistic symptoms, whereas imitation of meaningless gestures was correlated with higher non-verbal cognitive and fine-motor skills. These findings contribute to a better understanding of the complexity of imitation. We delineated the distinct nature of imitation of meaningful and meaningless gestures in children with ASD. We discuss clinical implications in relation to assessment and intervention programs.