Autism-related dietary preferences mediate autism-gut microbiome associations.

There is increasing interest in the potential contribution of the gut microbiome to autism spectrum disorder (ASD). However, previous studies have been underpowered and have not been designed to address potential confounding factors in a comprehensive way. We performed a large autism stool metagenomics study (n = 247) based on participants from the Australian Autism Biobank and the Queensland Twin Adolescent Brain project. We found negligible direct associations between ASD diagnosis and the gut microbiome. Instead, our data support a model whereby ASD-related restricted interests are associated with less-diverse diet, and in turn reduced microbial taxonomic diversity and looser stool consistency. In contrast to ASD diagnosis, our dataset was well powered to detect microbiome associations with traits such as age, dietary intake, and stool consistency. Overall, microbiome differences in ASD may reflect dietary preferences that relate to diagnostic features, and we caution against claims that the microbiome has a driving role in ASD.

Digital Endpoints for Assessing Instrumental Activities of Daily Living in Mild Cognitive Impairment: Systematic Review.

BACKGROUND: Subtle impairments in instrumental activities of daily living (IADLs) can be a key predictor of disease progression and are considered central to functional independence. Mild cognitive impairment (MCI) is a syndrome associated with significant changes in cognitive function and mild impairment in complex functional abilities. The early detection of functional decline through the identification of IADL impairments can aid early intervention strategies. Digital health technology is an objective method of capturing IADL-related behaviors. However, it is unclear how these IADL-related behaviors have been digitally assessed in the literature and what differences can be observed between MCI and normal aging. OBJECTIVE: This review aimed to identify the digital methods and metrics used to assess IADL-related behaviors in people with MCI and report any statistically significant differences in digital endpoints between MCI and normal aging and how these digital endpoints change over time. METHODS: A total of 16,099 articles were identified from 8 databases (CINAHL, Embase, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and Scopus), out of which 15 were included in this review. The included studies must have used continuous remote digital measures to assess IADL-related behaviors in adults characterized as having MCI by clinical diagnosis or assessment. This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS: Ambient technology was the most commonly used digital method to assess IADL-related behaviors in the included studies (14/15, 93%), with passive infrared motion sensors (5/15, 33%) and contact sensors (5/15, 33%) being the most prevalent types of methods. Digital technologies were used to assess IADL-related behaviors across 5 domains: activities outside of the home, everyday technology use, household and personal management, medication management, and orientation. Other recognized domains-culturally specific tasks and socialization and communication-were not assessed. Of the 79 metrics recorded among 11 types of technologies, 65 (82%) were used only once. There were inconsistent findings around differences in digital IADL endpoints across the cognitive spectrum, with limited longitudinal assessment of how they changed over time. CONCLUSIONS: Despite the broad range of metrics and methods used to digitally assess IADL-related behaviors in people with MCI, several IADLs relevant to functional decline were not studied. Measuring multiple IADL-related digital endpoints could offer more value than the measurement of discrete IADL outcomes alone to observe functional decline. Key recommendations include the development of suitable core metrics relevant to IADL-related behaviors that are based on clinically meaningful outcomes to aid the standardization and further validation of digital technologies against existing IADL measures. Increased longitudinal monitoring is necessary to capture changes in digital IADL endpoints over time in people with MCI. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022326861; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=326861.

ACT-i, an insomnia intervention for autistic adults: a pilot study.

BACKGROUND: Insomnia and disturbed sleep are more common in autistic adults compared with non-autistic adults, contributing to significant social, psychological and health burdens. However, sleep intervention research for autistic adults is lacking. AIMS: The aim of the study was to implement an acceptance and commitment therapy group insomnia intervention (ACT-i) tailored for autistic adults to examine its impact on insomnia and co-occurring mental health symptoms. METHOD: Eight individuals (6 male, 2 female) aged between 18 and 70 years, with a clinical diagnosis of autism spectrum disorder, and scores ranging from 9 to 26 on the Insomnia Severity Index (ISI) participated in the trial. Participants were assigned to one of two intervention groups (4 per group) within a multiple baseline over time design for group. Participants completed questionnaires pre-intervention, post-intervention, and at 2-month follow-up, actigraphy 1 week prior to intervention and 1 week post-intervention, and a daily sleep diary from baseline to 1 week post-intervention, and 1 week at follow-up. RESULTS: At a group level there were significant improvements in ISI (λ2=10.17, p=.006) and HADS-A (anxiety) (λ2=8.40, p=.015) scores across the three time points. Clinically reliable improvement occurred for ISI scores (n=5) and HADS-A scores (n=4) following intervention. Client satisfaction indicated that ACT-i was an acceptable intervention to the participants (median 4 out of 5). CONCLUSIONS: This pilot study with eight autistic adults indicates that ACT-i is both an efficacious and acceptable intervention for reducing self-reported insomnia and anxiety symptoms in autistic adults.

A longitudinal examination of perinatal testosterone, estradiol and vitamin D as predictors of handedness outcomes in childhood and adolescence.

The developmental origins of handedness remain elusive, though very early emergence suggests individual differences manifesting in utero could play an important role. Prenatal testosterone and Vitamin D exposure are considered, yet findings and interpretations remain equivocal. We examined n = 767 offspring from a population-based pregnancy cohort (The Raine Study) for whom early biological data and childhood/adolescent handedness data were available. We tested whether 18-week maternal circulatory Vitamin D (25[OH]D), and testosterone and estradiol from umbilical cord blood sampled at birth predicted variance in direction of hand preference (right/left), along with right- and left-hand speed, and the strength and direction of relative hand skill as measured by a finger-tapping task completed at 10 (Y10) and/or 16 (Y16) years. Although higher concentrations of Vitamin D predicted more leftward and less lateralized (regardless of direction) relative hand skill profiles, taken as a whole, statistically significant findings typically did not replicate across time-point (Y10/Y16) or sex (male/female) and were rarely detected across different (bivariate/multivariate) levels of analysis. Considering the number of statistical tests and generally inconsistent findings, our results suggest that perinatal testosterone and estradiol contribute minimally, if at all, to subsequent variance in handedness. Vitamin D, however, may be of interest in future studies.

Program evaluation of a recuperative care pilot project.

OBJECTIVE: A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals. DESIGN: The study is a descriptive postprogram evaluation. SAMPLE: A total of 73 referrals were made to the project with 23 admissions. MEASURE: Data regarding number and type of referrals for admission, cost of respite care per guest and per day, hospital costs avoided, referrals to community services, and discharge destination were collected. INTERVENTION: A case management care model was used. The project staff included a public health nurse and an outreach worker. RESULTS: One local hospital accounted for 65% of all admissions. Admitting diagnoses were abscess/wound care (44%) followed by postsurgery recovery (17%). Housing resources (65%) was a common referral with 22% of guests discharged to stable housing. Actual length of stay exceeded the planned length by an average of 24 days. Total cost per guest per day was $157.45 which is an estimated savings to referring acute care facilities of between $18,000 and $48,000 per day. CONCLUSIONS: The project demonstrated an ability to provide unhoused individuals a place to recuperate following hospitalization in a cost-effective manner. Challenges and recommendations of the program going forward were identified.

Study protocol for the Australian autism biobank: an international resource to advance autism discovery research.

BACKGROUND: The phenotypic and genetic heterogeneity of autism spectrum disorder (ASD) presents considerable challenges in understanding etiological pathways, selecting effective therapies, providing genetic counselling, and predicting clinical outcomes. With advances in genetic and biological research alongside rapid-pace technological innovations, there is an increasing imperative to access large, representative, and diverse cohorts to advance knowledge of ASD. To date, there has not been any single collective effort towards a similar resource in Australia, which has its own unique ethnic and cultural diversity. The Australian Autism Biobank was initiated by the Cooperative Research Centre for Living with Autism (Autism CRC) to establish a large-scale repository of biological samples and detailed clinical information about children diagnosed with ASD to facilitate future discovery research. METHODS: The primary group of participants were children with a confirmed diagnosis of ASD, aged between 2 and 17 years, recruited through four sites in Australia. No exclusion criteria regarding language level, cognitive ability, or comorbid conditions were applied to ensure a representative cohort was recruited. Both biological parents and siblings were invited to participate, along with children without a diagnosis of ASD, and children who had been queried for an ASD diagnosis but did not meet diagnostic criteria. All children completed cognitive assessments, with probands and parents completing additional assessments measuring ASD symptomatology. Parents completed questionnaires about their child's medical history and early development. Physical measurements and biological samples (blood, stool, urine, and hair) were collected from children, and physical measurements and blood samples were collected from parents. Samples were sent to a central processing site and placed into long-term storage. DISCUSSION: The establishment of this biobank is a valuable international resource incorporating detailed clinical and biological information that will help accelerate the pace of ASD discovery research. Recruitment into this study has also supported the feasibility of large-scale biological sample collection in children diagnosed with ASD with comprehensive phenotyping across a wide range of ages, intellectual abilities, and levels of adaptive functioning. This biological and clinical resource will be open to data access requests from national and international researchers to support future discovery research that will benefit the autistic community.

Documentary analysis as an assessment tool.

BACKGROUND: Documentary analysis of existing information, such as newspaper articles, is an identified method for use in an assessment to provide a descriptive explanation of existing problems or assets. The intention of this case study is to explore the effectiveness of documentary analysis of newspaper articles as a tool to inform an assessment of factors influencing the implementation of a medical respite for the homeless. Two questions framed the assessment; (a) What was occurring or might occur that will affect the development of a medical respite; and (b) What opportunities or threats are generated as a result? METHODS: Articles from two local newspapers identified themes related to the three external forces of change that impact medical respites; (a) funding; (b) community resistance; and (c) the health care system. RESULTS: Three themes emerged: a) uncertain funding; b) neighborhood resistance, and c) improved access to healthcare would result from the Affordable Care Act. CONCLUSION: Use of documentary analysis of newspaper articles provided applicable content for the assessment. Themes from the assessment informed strategic planning, such as addressing potential neighborhood resistance.

Using the Vulnerability Index® to Assess the Health Needs of a Homeless Community.

Compiling a health needs profile of a difficult-to-reach population such as the homeless can be challenging, particularly when using a community-based participatory research approach. In this article, we describe our experience using the Vulnerability Index® (VI), a questionnaire developed by 100,000 Homes Campaign to assess and prioritize individuals in need of housing based on their risk of mortality. We found the VI easy to administer and helpful in creating a health needs profile of participants.

Temporal change in urban fish biodiversity-Gains, losses, and drivers of change.

Our aim was to examine temporal change in alpha and beta diversity of freshwater fish communities in rivers that have urbanized over the same period to understand the influence of changes in land use and river connectivity on community change. We used biological (2001-2018), land use (2000-2015), and connectivity data (1987-2017) from Toronto, Ontario, Canada. We used linear mixed effects models to determine the strength of upstream land use, connectivity, and their changes over time to explain temporal change in alpha and beta diversity indices. We examined beta diversity using the temporal beta diversity index (TBI) to assess site-specific community change. The TBI was partitioned into gains and losses, and species-specific changes in abundance were assessed using paired t-tests. There were more gains than losses across the study sites as measured by TBI. We found little to no significant differences in species-specific abundances at aggregated spatial scales (study region, watershed, stream order). We found different relationships between landscape and connectivity variables with the biodiversity indices tested; however, almost all estimated confidence intervals overlapped with zero and had low goodness-of-fit. More fish biodiversity gains than losses were found across the study region, as measured by TBI. We found TBI to be a useful indicator of change as it identifies key sites to further investigate. We found two high value TBI sites gained non-native species, and one site shifted from a cool-water to warm-water species dominated community, both of which have management implications. Upstream catchment land use and connectivity had poor explanatory power for change in the measured biodiversity indices. Ultimately, such spatial-temporal datasets are invaluable and can reveal trends in biodiversity useful for environmental management when considering competing interests involved with urban sprawl in the ongoing "Decade on Restoration."

Recommendations to advance digital health equity: a systematic review of qualitative studies.

The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users' needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice.

Stress and well-being in autistic adults: Exploring the moderating role of coping.

The wider stress literature points to negative associations between stress and well-being. Similarly, the use of engagement coping strategies and disengagement coping strategies in the face of stress are related to improved and reduced well-being respectively. However, in the autistic population stress and coping research is limited to date, and the extent to which coping may moderate the relationship between stress and well-being is not known. Using data from an Australian online study, we explored the potential moderating (i.e. buffering or exacerbating) role of coping in the relationship between stress and well-being in a sample of autistic adults (N = 86). Our findings indicated that increased stress was associated with lower well-being. Further, moderation analyses showed that while both engagement coping (e.g. problem solving, positive appraisal) and disengagement coping (e.g., self-distraction, being in denial) strategies had significant positive and negative direct effects on well-being respectively; engagement coping also moderated the relationship between stress and well-being, buffering the impact of stress on well-being. Our results illustrate the different underlying mechanisms by which coping strategies may be associated with stress and well-being. They also highlight the potential protective role of engagement coping strategies, which can be incorporated into the promotion and maintenance of well-being in autistic adults.

Brief Report: Discrete Effortful Control Skills Moderate Relations Between Childhood Behavioural Inhibition and Mental Health Difficulties in Autistic Youth.

Studies of the general population suggest that the risk for mental health difficulties conferred by dispositional behavioural inhibition (BI) may be modified by self-regulation; however, this possibility has not been explored in the context of autism. This study investigated the moderating effects of attentional-, activation-, and inhibitory control on the relationship between childhood BI and anxiety and depression among 47 autistic youths (55% male, Mage = 19.09 years, SD = 2.23). Childhood BI was associated with anxiety at low but not high levels of attentional- and activation control, and depression at low but not high levels of attentional control. However, there were no moderating effects of inhibitory control. These preliminary findings are partially consistent with those from the general population and point to avenues for future work.

Brief Report: Longitudinal Role of Coping Strategies on Mental Health Outcomes in Autistic Youth and Adults.

The stress literature suggests that coping strategies are implicated in mental health outcomes. However, the longitudinal relationship between coping strategies and mental health in the autistic adult population has not yet been examined. This 2-year longitudinal study examined the predictive role of both baseline and change in coping strategy use over time (i.e., an increase or decrease) on anxiety, depression, and well-being after 2-years in 87 autistic adults aged 16 to 80 years. Controlling for baseline mental health, both baseline and increase in disengagement coping strategies (e.g., denial, self-blame) predicted higher anxiety and depression, and lower well-being, while an increase in engagement coping strategies (e.g., problem solving, acceptance) predicted higher well-being. These findings extend the current coping literature in autistic adults, offering insight into mental health support and intervention options.

Development of the Impact of Diagnosis Scale-Revised (IODS-R).

No tools quantify the experience, psychological, and practical impact of receiving a diagnosis from a non-deficit perspective. Autism is increasingly late diagnosed in adulthood. The Impact of Diagnosis Scale (IODS) was initially developed for borderline personality disorder. We aimed to develop a revised version suitable for autistic adults and potentially other diagnostic groups. Following a trial of a preliminary revision, the researchers and autistic research advisors co-produced an expanded pool of 46 items, scored on 7-point Likert-type scale, within 6 hypothesized domains. Scale reduction processes were applied to data from 125 formally diagnosed autistic adults. Following iterative rounds of factor analysis using maximum likelihood estimation with Promax rotation, 22 items were retained across 4 domains to comprise the IODS-R. The IODS-R adds new understanding to the experience of receiving an autism diagnosis in adulthood. It may be useful for evaluating diagnostic services and other diagnostic groups.

The impact of sleep quality, fatigue and social well-being on depressive symptomatology in autistic older adolescents and young adults.

Depression and poor sleep quality commonly co-occur with autism, and depression has been associated with loneliness and reduced social support. In non-autistic samples, poor sleep quality and daytime fatigue also contribute to depression. However, the contribution of sleep quality and fatigue to depressive symptoms, and how they interact with social factors to influence depression in autism remain unexplored. Our aim was to examine these relationships in 114 young autistic adults aged 15-25 years (57% male) from the SASLA online, longitudinal study (baseline and 2-year follow-up). Hierarchical multiple regression models examined the association between social well-being (social integration and social contribution; T1), sleep quality (T1, T2), and fatigue (T1, T2) on depression (T1, T2). Two mediation models were conducted on T1 data predicting depression from sleep quality though fatigue and sleep quality through social well-being. Depression and fatigue scores did not change over 2 years, but sleep quality worsened. The T1 regression model was significant (R2 = 36%) with fatigue and social contribution individually predicting depression symptomatology. The longitudinal regression model was also significant (adjusted R2 = 57%) with social contribution (T1) as the only significant predictor of depression (T2). Fatigue trended towards mediating the sleep quality-depression relationship, while social well-being was a significant partial mediator of this relationship. Results highlight that sleep quality, fatigue, and social well-being contribute to depression among young autistic adults. Interestingly, fatigue and social well-being were independently associated with depression. Thus, addressing sleep quality and associated fatigue, and social well-being is important when treating depression in autistic individuals.

Interactions between the lipidome and genetic and environmental factors in autism.

Autism omics research has historically been reductionist and diagnosis centric, with little attention paid to common co-occurring conditions (for example, sleep and feeding disorders) and the complex interplay between molecular profiles and neurodevelopment, genetics, environmental factors and health. Here we explored the plasma lipidome (783 lipid species) in 765 children (485 diagnosed with autism spectrum disorder (ASD)) within the Australian Autism Biobank. We identified lipids associated with ASD diagnosis (n = 8), sleep disturbances (n = 20) and cognitive function (n = 8) and found that long-chain polyunsaturated fatty acids may causally contribute to sleep disturbances mediated by the FADS gene cluster. We explored the interplay of environmental factors with neurodevelopment and the lipidome, finding that sleep disturbances and unhealthy diet have a convergent lipidome profile (with potential mediation by the microbiome) that is also independently associated with poorer adaptive function. In contrast, ASD lipidome differences were accounted for by dietary differences and sleep disturbances. We identified a large chr19p13.2 copy number variant genetic deletion spanning the LDLR gene and two high-confidence ASD genes (ELAVL3 and SMARCA4) in one child with an ASD diagnosis and widespread low-density lipoprotein-related lipidome derangements. Lipidomics captures the complexity of neurodevelopment, as well as the biological effects of conditions that commonly affect quality of life among autistic people.

Relationships between the Nevada brief cognitive assessment instrument and the St. Louis University mental status examination in the assessment of disability applicants.

Mental status examinations of individuals applying for disability are most often authorized as "2-hour" evaluations and are to include a complete clinical and employment history, assessment of neurocognitive functions, an estimate of general level of intelligence, psychological and social adjustment, functional abilities, and a complete multipage report of the results. In the interest of meeting these demands we have been using the Nevada brief cognitive assessment instrument (NBCAI) to rapidly estimate verbal intelligence, and we have adopted the Saint Louis University Mental Status Examination (SLUMS) to investigate neurocognitive functions. Areas of correspondence and differences between these screens are presented along with an explanation of why execution of both screens could be useful in addressing psychological questions concerning disability. The two instruments failed to correlate significantly in a group of patients undergoing pre-surgical evaluation likely because this sample was more highly educated and more homogeneous than the sample of disability referrals. For example, although the ages of the samples were close (disability sample mean and standard deviation age: 43.88 and 11.35 years; pre-surgical sample mean and standard deviation age: 46.14 and 2.84 years), they differed considerably in level of education (disability sample mean and standard deviation: 11.03 and 2.15; pre-surgical mean and standard deviation: 15.22 and 2.84). The pre-surgical group had mean performances close to the ceiling levels of both instruments.

Coping-resilience profiles and experiences of stress in autistic adults.

Emerging studies allude to high stress in autistic adults. Considering the detrimental impact of stress on health outcomes, examining individual resources which may influence the extent to which stress is experienced (e.g., coping and resilience) is vital. Using a person-focused approach, this study aimed to identify coping-resilience profiles, and examine their relations to general perceived stress and daily hassles in a sample of autistic adults (N = 86; aged 19-74 years). Cluster analysis identified four coping-resilience profiles (i.e., high cope/ low resilience, low cope/ high resilience, engage cope/ high resilience, and disengage cope/ low resilience). The high cope/ low resilience and disengage cope/ low resilience groups had significantly higher general perceived stress than the remaining groups. No significant group differences were noted in relation to daily hassles. Jointly addressing coping and resilience may be beneficial on the perceived stress experienced in autistic adults. The use of coping-resilience profiles may also allow for the personalization of stress management and support options in the autistic adult population.

Associations between coping strategies and mental health outcomes in autistic adults.

Compared to the general population, mental health difficulties are commonly reported in autistic adults. However, the ways in which coping strategies are associated with mental health and well-being in this population remain unknown. Further, we do not know if, and if so, how these associations might differ to that of non-autistic adults. In this study, we hypothesized that in both our autistic (N = 255) and non-autistic (N = 165) adult samples, disengagement coping strategies (e.g., denial) would relate to poorer mental health and well-being, while engagement coping strategies (e.g., problem solving) would relate to better mental health and well-being. Regression analyses revealed that higher use of disengagement coping strategies was significantly associated with higher levels of anxiety and depression, and lower levels of well-being in both samples. In contrast, increased use of engagement coping strategies was associated with better well-being, but only in the autistic sample. Our results contribute to the characterization of negative and positive mental health outcomes in autistic adults from a coping perspective, with potential to offer novel information regarding coping strategies to consider when addressing support options for mental health difficulties in the autistic adult population. LAY SUMMARY: Mental health conditions (such as anxiety and depression) and poor well-being are commonly reported in autistic adults. Research suggests that how one copes with stress is associated with one's mental health and well-being. However, we have little information about how coping strategies relate to the mental health of autistic adults, and whether this might be different in non-autistic adults. In this study, we examined the relationship between coping strategies and mental health in a large group of autistic individuals aged 15-80 years. We then compared this with similar aged non-autistic individuals. We found that in both the autistic and non-autistic individuals, using more disengagement coping strategies (such as being in denial, blaming oneself) was related to poorer mental health and well-being. Additionally, using more engagement coping strategies (such as problem solving, acceptance) was related to better mental health and well-being, but only in the autistic individuals. These results can help inform support services, as they highlight the coping strategies that may need to be focused on (i.e., developing engagement coping strategies and reducing disengagement coping strategies) in order to better support the mental health of autistic individuals.