Connections between the middle frontal gyrus and dorso-ventral attention network associate with the development of attentional symptoms.

BACKGROUND: The right MFG has been proposed as a convergence site for the DAN and VAN, regulating both networks and enabling flexible modulation of attention. However, it is unclear if the connections between the right MFG and these networks can predict changes in ADHD symptoms. METHODS: This study used data from the Children School Functions and Brain Development project (n = 713, 56.2% boys). Resting-state fMRI was employed to analyze the connections of the right MFG with DAN/VAN, connectome-based predictive modeling was applied for longitudinal prediction, and ADHD PRS were used for genetic analysis. RESULTS: The ADHD symptoms were associated with the connections between the right MFG and DAN subregion, including the FEF, as well as the VAN subregions, namely the IPL and IFG. Furthermore, these connections of the right MFG with FEF, IPL, and IFG could significantly predict changes in ADHD symptoms over one year and mediate the prediction of ADHD symptom changes by PRS for ADHD. Finally, the validation samples confirmed that the functional connectivity between the right MFG and FEF/IPL in ADHD patients was significantly weaker than that in the typically developing controls, and this difference disappeared after medication. CONCLUSIONS: The connection of right MFG with DAN and VAN can serve as a predictive indicator for changes in ADHD symptoms over the following year, while also mediating the prediction of ADHD symptom changes by PRS for ADHD. These findings hold promise as potential biomarkers for early identification of children at risk of developing ADHD.

Association of gene polymorphisms and the decreased expression of long non-coding RNA LOC553103 with rheumatoid arthritis.

BACKGROUND: Long non-coding RNAs (lncRNAs) are involved in many key bioprocesses, including the occurrence and development of rheumatoid arthritis (RA). We aimed to analyze the association of genetic variants of long non-coding RNA LOC553103 and its peripheral blood mononuclear cells (PBMC) expression with RA. METHODS: We enrolled 457 RA patients and 551 healthy controls and conducted a case-control study to analyze the relationship between LOC553103 gene rs272879 and the susceptibility of RA by TaqMan single nucleotide polymorphism genotyping. Among them, we sampled 92 cases and 92 controls, respectively, to detect the PBMC level of LOC553103 using quantitative real-time polymerase chain reaction technology. We explored the association between LOC553103 rs272879 and its PBMC expression levels in 71 RA patients. Mann-Whitney, Chi-square, and Spearman correlation analysis were used for statistical analysis and P-value <.05 was considered statistically significant. RESULTS: The genotype frequency of LOC553103 rs272879 CC was increased, and CG was decreased in RA patients compared to the control group (χ2 = 6.772, P = .034). The LOC553103 expression level in PBMC of RA patients was downregulated compared to healthy control (Z = -4.497, P < .001). Moreover, negative correlations were observed between the PBMC level of LOC553103 and erythrocyte sedimentation rate (rs = -0.262, P = .018), white blood cell count (rs = -0.382, P = .004), platelet (rs = -0.293, P = .030), and disease activity score in 28 joints (rs = -0.271, P = .016) in RA patients. CONCLUSIONS: This study provides the first evidence supporting an association between LOC553103 gene polymorphisms and susceptibility of RA and a relationship of PBMC level of LOC553103 with clinical manifestations and laboratory indicators of RA patients.

English as a foreign language teachers' burnout: The predicator powers of self-efficacy and well-being.

Educators have recently garnered significant focus for the crucial role they play, particularly concerning their emotions. These emotions have the potential to either boost their progress in their profession or hinder their progress, like burnout which may trigger or intensify poor mental health and quit the job. Burnout arises from the intermittent occurrence of emotional distress among English as a foreign language (EFL) educators as they fulfill their professional duties. To shed more light on the issue, it is fundamental to contemplate the teacher's belief in their capabilities, known as self-efficacy, which can reduce the probability of burnout and prevent work-related stress while also promoting beneficial results. Moreover, it has been evidenced that the vital role of educators' well-being is prominent in this procedure. Therefore, the importance of these two constructs concerning the impact they have on teacher burnout was taken into consideration in this study. To achieve this objective, a group of 403 English educators participated in the measurement of the concepts being studied. To scrutinize the causal connections between the variables, a Structural Equation Modeling (SEM) approach was employed. The study showed that teachers' efficacy in their ability to perform their job effectively was responsible for explaining 82 % of changes in burnout, while their level of well-being played a role in accounting for 42 % of changes in teachers' burnout levels. The data disclosed that while every factor independently contributed to burnout, the self-efficacy of the teachers held greater influence as a predictor of burnout in comparison to their well-being. Ultimately, particular academic suggestions are specified.

Association of emotional and behavioral problems with the development of the substantia nigra, subthalamic nucleus, and red nucleus volumes and asymmetries from childhood to adolescence: A longitudinal cohort study.

The substantia nigra (SN), subthalamic nucleus (STN), and red nucleus (RN) have been widely studied as important biomarkers of degenerative diseases. However, how they develop in childhood and adolescence and are affected by emotional behavior has not been studied thus far. This population-based longitudinal cohort study used data from a representative sample followed two to five times. Emotional and behavioral problems were assessed with the Strengths and Difficulties Questionnaire (SDQ). Linear mixed models were used to map developmental trajectories and behavioral regulation. Using an innovative automated image segmentation technique, we quantified the volumes and asymmetries of the SN, STN and RN with 1226 MRI scans of a large longitudinal sample of 667 subjects aged 6-15 years and mapped their developmental trajectories. The results showed that the absolute and relative volumes of the bilateral SN and right STN showed linear increases, while the absolute volume of the right RN and relative volume of the bilateral RN decreased linearly, these effects were not affected by gender. Hyperactivity/inattention weakened the increase in SN volume and reduced the absolute volume of the STN, conduct problems impeded the RN volume from decreasing, and emotional symptoms changed the direction of SN lateralization. This longitudinal cohort study mapped the developmental trajectories of SN, STN, and RN volumes and asymmetries from childhood to adolescence, and found the association of emotional symptoms, conduct problems, and hyperactivity/inattention with these trajectories, providing guidance for preventing and intervening in cognitive and emotional behavioral problems.

Neural specialization with generalizable representations underlies children's cognitive development of attention.

From childhood to adulthood, the human brain develops highly specialized yet interacting neural modules that give rise to nuanced attention and other cognitive functions. Each module can specialize over development to support specific functions, yet also coexist in multiple neurobiological modes to support distinct processes. Advances in cognitive neuroscience have conceptualized human attention as a set of cognitive processes anchored in highly specialized yet interacting neural systems. The underlying mechanisms of how these systems interplay to support children's cognitive development of multiple attention processes remain unknown. Leveraging developmental functional magnetic resonance imaging with attention network test paradigm, we demonstrate differential neurocognitive development of three core attentional processes from childhood to adulthood, with alerting reaching adult-like level earlier, followed by orienting and executive attention with more protracted development throughout middle and late childhood. Relative to adults, young children exhibit immature specialization with less pronounced dissociation of neural systems specific to each attentional process. Children manifest adult-like distributed representations in the ventral attention and cingulo-opercular networks, but less stable and weaker generalizable representations across multiple processes in the dorsal attention network. Our findings provide insights into the functional specialization and generalization of neural representations scaffolding cognitive development of core attentional processes from childhood to adulthood. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Development of the triadic neural systems involved in risky decision-making during childhood.

Risk-taking often occurs in childhood as a compex outcome influenced by individual, family, and social factors. The ability to govern risky decision-making in a balanced manner is a hallmark of the integrity of cognitive and affective development from childhood to adulthood. The Triadic Neural Systems Model posits that the nuanced coordination of motivational approach, avoidance and prefrontal control systems is crucial to regulate adaptive risk-taking and related behaviors. Although widely studied in adolescence and adulthood, how these systems develop in childhood remains elusive. Here, we show heterogenous age-related differences in the triadic neural systems involved in risky decision-making in 218 school-age children relative to 80 young adults. Children were generally less reward-seeking and less risk-taking than adults, and exhibited gradual increases in risk-taking behaviors from 6 to 12 years-old, which are associated with age-related differences in brain activation patterns underlying reward and risk processing. In comparison to adults, children exhibited weaker activation in control-related prefrontal systems, but stronger activation in reward-related striatal systems. Network analyses revealed that children showed greater reward-related functional connectivity within and between the triadic systems. Our findings support an immature and unbalanced developmental view of the core neurocognitive systems involved in risky decision-making and related behaviors in middle to late childhood.

Increased serum visfatin level is associated with fat deposition of the lumbar spine in ankylosing spondylitis patients.

Objectives: To assess the serum visfatin levels in patients with ankylosing spondylitis (AS), as well as its correlation with fat deposition of the lumbar spine. Methods: Serum visfatin levels were detected by enzyme-linked immunosorbent assay (ELISA) in 50 AS patients and 75 sex-and age-matched healthy controls. The clinical and laboratory indexes of AS patients were recorded, and the lumbar spine magnetic resonance scan was performed to evaluate the lumbar spine fat deposition in AS patients. The level of serum visfatin and its correlation with lumbar fat deposition were analyzed, and the risk factors of AS lumbar MRI fat deposition were evaluated by Logistic regression. Results: Serum visfatin levels in AS patients were elevated compared with that in healthy controls (p < 0.001), and were more significant in patients with fat deposition and syndesmophyte formation (p = 0.017 and p = 0.014, respectively). Serum visfatin levels were positively correlated with CRP, BASDAI, mSASSS and fat deposition (all p < 0.05). Age (OR = 1.085, 95% CI: 1.005-1.173, p = 0.038), disease duration (OR = 1.267, 95% CI: 1.017-1.578, p = 0.035), and visfatin (OR = 1.846, 95% CI: 1.004-3.393, p = 0.048) were risk factors for fat deposition in AS patients. Conclusions: The level of serum visfatin in AS patients is significantly increased, which is associated with fat deposition on lumbar MRI. Elevated visfatin level is an independent risk factor for AS lumbar fat deposition.

Structural connectome architecture shapes the maturation of cortical morphology from childhood to adolescence.

Cortical thinning is an important hallmark of the maturation of brain morphology during childhood and adolescence. However, the connectome-based wiring mechanism that underlies cortical maturation remains unclear. Here, we show cortical thinning patterns primarily located in the lateral frontal and parietal heteromodal nodes during childhood and adolescence, which are structurally constrained by white matter network architecture and are particularly represented using a network-based diffusion model. Furthermore, connectome-based constraints are regionally heterogeneous, with the largest constraints residing in frontoparietal nodes, and are associated with gene expression signatures of microstructural neurodevelopmental events. These results are highly reproducible in another independent dataset. These findings advance our understanding of network-level mechanisms and the associated genetic basis that underlies the maturational process of cortical morphology during childhood and adolescence.

Short report on navigating access to care for Medicaid-enrolled autistic youth and young adults: Examining accrual of intellectual disability diagnoses in adolescence.

LAY ABSTRACT: What is known? In most states, Medicaid waivers provide individuals with an intellectual disability diagnosis generous healthcare coverage throughout adulthood. By comparison, fewer Medicaid programs are available for autistic individuals, and they are more likely to experience disruptions, or gaps, in Medicaid coverage and subsequently not re-enroll.What this paper adds? One in five autistic individuals with Medicaid coverage between ages 8 and 25 accrued a new intellectual disability diagnosis. The probability of a new intellectual disability diagnosis was higher among those who had previous disruptions in Medicaid coverage.Implications for research and policy. Expanding Medicaid to cover autistic people of all ages could decrease the need for intellectual disability diagnosis accrual. Input from autistic individuals and their families regarding their health insurance access and healthcare experiences is critically important to understanding next steps for research.

Molecular mechanism of NR4A1/MDM2/P53 signaling pathway regulation inducing ferroptosis in renal tubular epithelial cells involved in the progression of renal ischemia-reperfusion injury.

Revealing the possible molecular mechanism of the NR4A1 (nuclear receptor subfamily 4 group A member 1)-MDM2 (MDM2 proto-oncogene)-P53 (tumor protein p53) signaling pathway that induces ferroptosis in renal tubular epithelial cells. Renal ischemia-reperfusion injury (RIRI) -related datasets were obtained from the GEO database. Differentially expressed genes in RIRI were analyzed using R language, intersected with RIRI-related genes in the GeneCard database, and retrieved from the literature to finally obtain differential ferroptosis-related genes. An in vitro cell model of RIRI was constructed using mouse renal cortical proximal tubule epithelial cells (mRTEC cells) treated with hypoxia-reoxygenation (H/R). Bioinformatic analysis showed that NR4A1 may be involved in RIRI through the induction of ferroptosis; in addition, we predicted through online databases that the downstream target gene of NR4A1, MDM2, could be targeted and regulated by ChIP and dual luciferase assays, and that NR4A1 could prevent MDM2 by inhibiting it, and NR4A1 was able to promote ferroptosis by inhibiting the ubiquitinated degradation of P53. NR4A1 expression was significantly increased in mRTEC cells in the hypoxia/reoxygenation model, and the expression of ferroptosis-related genes was increased in vitro experiments. NR4A1 reduces the ubiquitinated degradation of P53 by targeting the inhibition of MDM2 expression, thereby inducing ferroptosis and ultimately exacerbating RIRI by affecting the oxidative respiration process in mitochondria and producing oxidized lipids. This study presents a novel therapeutic approach for the clinical treatment of renal ischemia-reperfusion injury by developing drugs that inhibit NR4A1 to alleviate kidney damage caused by renal ischemia-reperfusion.

Longitudinal development of the human white matter structural connectome and its association with brain transcriptomic and cellular architecture.

From childhood to adolescence, the spatiotemporal development pattern of the human brain white matter connectome and its underlying transcriptomic and cellular mechanisms remain largely unknown. With a longitudinal diffusion MRI cohort of 604 participants, we map the developmental trajectory of the white matter connectome from global to regional levels and identify that most brain network properties followed a linear developmental trajectory. Importantly, connectome-transcriptomic analysis reveals that the spatial development pattern of white matter connectome is potentially regulated by the transcriptomic architecture, with positively correlated genes involve in ion transport- and development-related pathways expressed in excitatory and inhibitory neurons, and negatively correlated genes enriches in synapse- and development-related pathways expressed in astrocytes, inhibitory neurons and microglia. Additionally, the macroscale developmental pattern is also associated with myelin content and thicknesses of specific laminas. These findings offer insights into the underlying genetics and neural mechanisms of macroscale white matter connectome development from childhood to adolescence.

Psychotropic Medication Use in Children and Youth with Autism Enrolled in Medicaid.

Children with autism frequently present with complex mental health diagnoses and psychotropic medications are often a component of comprehensive biopsychosocial treatment plans for these conditions. The purpose of this study is to provide rates and patterns of psychotropic medication use, and predictors thereof, in children and youth with autism enrolled in Medicaid across the US. This study examined national Medicaid claims from 2008 to 2016 of all children and youth with autism ages 0-21 years enrolled in Medicaid. Psychotropic medication use was examined across several child and youth characteristics, including age, co-occurring mental health conditions, sex, and race and ethnicity. About half of children and youth with autism enrolled in Medicaid had at least one psychotropic prescription in a year, a number that decreased slightly across the study period due to decreases in the prescription of antipsychotics. As new medications for autism or co-occurring conditions are developed and deployed, and as the understanding of the characteristics of the population of children with autism evolves, studying rates of medication usage helps to understand utilization patterns and differences in access to quality care.

What Components of Working Memory Are Impaired in Children with Reading and/or Mathematics Difficulties?

Both reading difficulties (RD) and mathematics difficulties (MD) are common neurodevelopmental disorders. The co-occurrence of RD and MD, known as comorbid RDMD, is estimated to range between 21% and 45% of children with learning disabilities. Deficits in working memory have been reported in both RD and MD groups, as well as among comorbid RDMD. However, previous comorbidity studies have only examined the role of some components of working memory, and they do not strictly match their groups on relevant reading and mathematics tasks. Thus, the purpose of this study is to examine the nature of working memory deficits in comorbid RDMD after matching groups based on reading and mathematics tasks. We assessed four groups of children (RD [n = 21, Mage = 10.96 years], MD [n = 24, Mage = 11.04 years], comorbid RDMD [n = 26, Mage = 10.90 years], and chronological-age controls [n = 27, Mage = 10.96 years]) on measures of the phonological loop (word span and digit span forward tasks), central executive (complex word and digit span), and updating tasks (word and digit 2-back). The results of ANCOVA (covarying for gender and non-verbal IQ) showed first that the RD and RDMD groups performed significantly worse than the MD and control groups in both measures of the phonological loop. For the central executive and updating tasks, we found an effect based on stimulus type. For word-related tasks, the RD and comorbid RDMD groups performed worse than the MD and control groups, and for number-related tasks, the MD and comorbid RDMD groups performed worse than the RD and control groups. Taken together, our findings provide support for the correlated liability model of comorbidity, which indicates that working memory deficits experienced by the RDMD group are an additive combination of deficits observed in the RD and MD groups, suggesting that working memory tasks used to examine underlying deficits in reading and/or mathematics difficulties may dictate whether or not significant group differences are found.

Functional connectome through the human life span.

The functional connectome of the human brain represents the fundamental network architecture of functional interdependence in brain activity, but its normative growth trajectory across the life course remains unknown. Here, we aggregate the largest, quality-controlled multimodal neuroimaging dataset from 119 global sites, including 33,809 task-free fMRI and structural MRI scans from 32,328 individuals ranging in age from 32 postmenstrual weeks to 80 years. Lifespan growth charts of the connectome are quantified at the whole cortex, system, and regional levels using generalized additive models for location, scale, and shape. We report critical inflection points in the non-linear growth trajectories of the whole-brain functional connectome, particularly peaking in the fourth decade of life. Having established the first fine-grained, lifespan-spanning suite of system-level brain atlases, we generate person-specific parcellation maps and further show distinct maturation timelines for functional segregation within different subsystems. We identify a spatiotemporal gradient axis that governs the life-course growth of regional connectivity, transitioning from primary sensory cortices to higher-order association regions. Using the connectome-based normative model, we demonstrate substantial individual heterogeneities at the network level in patients with autism spectrum disorder and patients with major depressive disorder. Our findings shed light on the life-course evolution of the functional connectome and serve as a normative reference for quantifying individual variation in patients with neurological and psychiatric disorders.

Longitudinal predictions between executive function and general and specific psychiatric problems in school-age children.

This study examined the longitudinal associations of various executive function components with subsequent psychiatric problems in Chinese school-age children. Data from 1,639 children (44.36% girls) ages 6-13 years were drawn from the Children School Functions and Brain Development project. Executive function components were assessed by the cancellation test, the Corsi test, and the Wisconsin Card Sorting Test. Psychiatric problems were determined by parent report. All assessments were administered twice, separated by a 1-year interval. Cross-lagged panel models showed that cognitive flexibility and general psychiatric problems (general p) mutually predicted each other. Worse inhibitory control at baseline significantly predicted more externalizing problems 1 year later, regardless of age, while externalizing problems did not significantly predict inhibitory control 1 year later. Working memory at baseline did not significantly predict internalizing problems and vice versa. These findings demonstrate that better inhibitory control may help to prevent or reduce externalizing problems in Chinese school-age children and that higher cognitive flexibility may help to mitigate general psychiatric problems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stepwise Au decoration-assisted double signal amplified lateral flow strip for ultrasensitive detection of morphine in fingerprint sweat.

Point-of-care testing (POCT) of morphine (MOP) without invasion of privacy is of critical importance for law-enforcement departments to realize on-site rapid screening. In this study, ultrasensitive and non-invasive screening of MOP residues in the fingerprint sweat was easily realized by stepwise Au decoration-assisted double signal amplification and antibody-saving strategies on lateral flow strip (LFS). The construction of LFS was not intrinsically changed compared with traditional LFS except the labeling material on conjugation pad for enhanced signal reporting. The gold nanoparticle-seeded SiO2 was adopted as the labeling materials in place of traditional gold nanoparticles, which acted as the first-round signal amplification and ready for second-round gold deposition-assisted amplification. And the second-round amplification could be completed in just 10 s, which did not alter the intrinsic simplicity of LFS for rapid and on-site screening. With the designed signal amplification principle of LFS, target MOP in the fingerprint sweat can be effectively transferred to the LFS for analysis without invasion of privacy. As low as 0.5 pg MOP in fingerprint sweat can be visually judged with this double signal amplified LFS, the sensitivity of which has been improved at least 10-fold compared with traditional Au-labeled LFS, guaranteeing accurate screening of trace MOP in the fingerprint sweat. Of great importance, the consumption of valuable antibody can be reduced to just 1/20, which greatly reduces the cost of high-throughput screening. This stepwise Au decoration-assisted double signal amplified LFS holds great potential in the ultrasensitive screening of trace analytes in various fields and further widens the application scope of lateral flow strips.

Impact of short-term exposure to ambient air pollution on osteoarthritis: a multi-city time-series analysis in Central-Eastern China.

Osteoarthritis (OA) is a threat to public health issue with high morbidity and disability worldwide. However, unequivocal evidence on the link between air pollution and OA remains little, especially in multi-study sites. This study aimed to explore the relationship between short-term exposure to main air pollutants and the risk of OA outpatient visits in multi-study sites. A multi-city time-series analysis was performed in Anhui Province, Central-Eastern China from January 1, 2015, to December 31, 2020. We used a two-stage analysis to assess the association between air pollution and daily OA outpatient visits. City-specific associations were estimated with a distributed lag nonlinear model and then pooled by random-effects or fixed-effects meta-analysis. Stratified analysis was conducted by gender, age, and season. Additionally, the disease burden of OA attributable to air pollutant exposure was calculated. A total of 35,700 OA outpatients were included during the study period. The pooled exposure-response curves showed that PM2.5 and PM10 concentrations below the reference values could increase the risk of OA outpatient visits. Concretely, per 10 ug/m3 increase in PM2.5 concentration was linked to an elevated risk of OA outpatient visits at lag 2 and lag 3 days, where the effect reached its highest value on lag 2 day (RR: 1.023, 95%CI: 1.005-1.041). We observed that a 10 µg/m3 increase in PM10 was positively correlated with OA outpatient visits (lag2 day, RR: 1.011, 95%CI: 1.001-1.025). Nevertheless, no statistical significance was discovered in gaseous pollutants (including SO2, O3, and CO). Additionally, a significant difference was found between cold and warm seasons, but not between different genders or age groups. This study reveals that particulate matter is an important factor for the onset of OA in Anhui Province, China. However, there is no evidence of a relationship of gaseous pollutants with OA in this area.

Reduced volume of the left cerebellar lobule VIIb and its increased connectivity within the cerebellum predict more general psychopathology one year later via worse cognitive flexibility in children.

Predicting the risk for general psychopathology (the p factor) requires the examination of multiple factors ranging from brain to cognitive skills. While an increasing number of findings have reported the roles of the cerebral cortex and executive functions, it is much less clear whether and how the cerebellum and cognitive flexibility (a core component of executive function) may be associated with the risk for general psychopathology. Based on the data from more than 400 children aged 6-12 in the Children School Functions and Brain Development (CBD) Project, this study examined whether the left cerebellar lobule VIIb and its connectivity within the cerebellum may prospectively predict the risk for general psychopathology one year later and whether cognitive flexibility may mediate such predictions in school-age children. The reduced gray matter volume in the left cerebellar lobule VIIb and the increased connectivity of this region to the left cerebellar lobule VI prospectively predicted the risk for general psychopathology and was partially mediated by worse cognitive flexibility. Deficits in cognitive flexibility may play an important role in linking cerebellar structure and function to the risk for general psychopathology.

Unrealized Cross-System Opportunities to Improve Employment and Employment-Related Services Among Autistic Individuals.

Policy Points Employment is a key social determinant of health and well-being for the estimated 5.4 million autistic adults in the United States-just as it is for citizens without disabilities. Evaluation and monitoring of publicly funded employment services is paramount given the dramatic increases in adults with autism who need job supports. Vocational Rehabilitation agencies appeared to be absorbing short-term employment needs of autistic people, but Medicaid was severely lacking-and losing ground-in serving those who need longer-term employment services. Across both Vocational Rehabilitation and Medicaid, we estimated that only 1.1% of working-age autistic adults who potentially need employment services are actually receiving them-leaving an estimated 1.98 million autistic individuals without the employment services that are associated with achievement of well-being. CONTEXT: Employment is a key social determinant of health. As such, high rates of unemployment, underemployment, and poverty across the rapidly growing autistic population are concerning. A web of publicly funded services exists to support the employment, and associated health and well-being, of United States citizens with autism and other intellectual and developmental disabilities, namely through Vocational Rehabilitation (VR) and Medicaid home- and community-based services (HCBS) waivers. Given an absence of overarching surveillance of employment services, this study aimed to characterize the distribution of autistic service users across Medicaid versus VR, understand the types of employment services utilized within these programs and expenditures, and assess overall capacity to provide employment services as needs continue to increase. METHODS: This study examined the distribution of employment services among autistic people compared with those with intellectual disability using 2008-2016 data from the Centers for Medicare & Medicaid Services and the Rehabilitation Services Administration. Estimated need for employment services among autistic individuals was compared with capacity derived from VR service counts and a review of HCBS waivers. FINDINGS: The number of autistic people served through VR tripled during the study years, whereas those served through Medicaid only increased slightly. VR spending increased by 384% over the study years, whereas Medicaid costs decreased by 29%. Across VR and Medicaid, we estimated that only 1.1% of working-age autistic adults who needed employment services received them. CONCLUSIONS: Although VR appeared to be absorbing short-term employment needs of autistic individuals, Medicaid was severely lacking-and losing ground-in serving those who needed longer-term employment services. VR far outpaced Medicaid in both the number of autistic people served and total expenditures across the study years. However, an estimated 1.98 million autistic adults did not receive employment services that could be critical to improving their health and well-being.