Repetitive Patterns Of Behavior Research Articles

Covid-19's impact on the mental and psychological health of people with autisms: a narrative review

The restrictions on the coronavirus disease (COVID-19) have had a significant emotional impact on the general population and could lead to high levels of psychological distress. Individuals with autism spectrum disorder (ASD) may be more vulnerable in this widespread because of persistent difficulties in social interaction and communication as well as constrained and repetitive patterns of behavior. The goal of this study is to review studies that assess how COVID-19 affects autistic people's psychological and mental health. This study is a narrative review. The subjects included in these studies consisted of individuals with autism, their parents, families and caregivers. The findings revealed that responses to the pandemic varied, with some autistic persons displaying improvements and others demonstrating deterioration in mental health. Variables like biological vulnerability, isolation, and loss of social support, adjustments to household roles and dynamics, and family conflicts all related to reductions in mental health.

A Comparative Study of the Theory of Mind and Pretend Play in Children With High-Functioning Autism and Healthy Peers Aged 5-7 Years

Background and Aims Autism spectrum disorder is one of the neurodevelopmental disorders. The main symptoms of this disorder are problems in communication and social interactions, and having repetitive and limited patterns of behaviors. Considering the importance of the theory of mind (TOM) and pretend play in cognitive and social development of children and the existence of mentioned problems in children with autism, this study aims to compare the effects of pretend play and the TOM between normal children and children with high-functioning autism (HFA). Methods In this analytical-comparative study, 45 normal children and 18 children with HFA were selected. They underwent TOM test and Child Initiated Pretend Play Assessment (CHIPPA). Then, the collected data were analyzed. Results The mean total score of TOM test was 9.94 in autistic children and 28.96 in normal children. The mean percentages of elaborated pretend actions in total were 87.96 and 43.45 in normal children and children with HFA, respectively. The mean number of object substitutions was 16.47 in normal children and 2.81 in children with HFA. Also, the mean number of imitated actions in total was 2.02 in normal children and 3.06 in children with HFA. Conclusion Autistic children have poorer performance in the TOM test and pretend play compared to normal peers. They have poorer elaborated pretend actions and object substitutions; however, the number of imitated actions in the pretend play is low in both groups.

Antipsychotic Medication Adverse Effect on Autistic Patients among Saudi Papulation

Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent impairments in social communication and restricted, repetitive patterns of behavior. Pharmacological treatments for the core symptoms of ASD are currently lacking, with existing medications primarily targeting associated symptoms and comorbidities such as irritability and psychiatric conditions. Early implementation of behavioral therapies has shown promise in alleviating core ASD symptoms and improving functional outcomes. Combining behavioral therapies with psychopharmacological monitoring is considered a beneficial approach. Methodology: This cross-sectional study aimed to assess the level of knowledge regarding autism spectrum disorders among general care physicians and psychiatric physicians in a specific region. A self-reported questionnaire, comprising demographic information, understanding of autism, experience with patients with autism, and knowledge-based questions, was administered. The collected data were analyzed using Statistical Package for Social Science (SPSS) software. Results: The study included 286 participants, with 59.1% acknowledging inadequate knowledge of autism spectrum disorders. However, 40.2% reported experience in diagnosing and collaborating with individuals with ASDs. Among the participants, 80.8% were aware of the challenges faced by children with ASDs in social interaction, communication, and behavior, while 61.9% correctly recognized the higher prevalence of ASDs in boys. The study also revealed potential adverse consequences of antipsychotic medication use in individuals with ASDs, including weight increase (67.8%), hyperprolactinemia (29.4%), extrapyramidal symptoms (32.2%), drowsiness (56.1%), and cognitive adverse effects (18.3%). Conclusion: This study highlights a lack of knowledge among healthcare providers regarding Autism Spectrum Disorders (ASDs). This has implications for accurate diagnosis and effective treatment. The study also emphasizes the potential adverse consequences of using antipsychotic medications in individuals with ASDs. Additional education and training are needed to address these knowledge gaps and improve care for individuals with ASDs.

Autism Spectrum Disorder: general aspects and concerns about Brazilian politics

Autism Spectrum Disorder (ASD) encompasses a highly variable set of neurodevelopmental disorders with early onset and non-degenerative pattern. According to the World Health Organization's International Classification of Diseases (11th Revision), ICD-11, ASD is characterized as “persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual's age and sociocultural context.”

Effectiveness of Anodal Transcranial Direct Current Stimulation of Left Dorsolateral Prefrontal Cortex in Facial Emotion Recognition and Clinical Symptoms of Boys with Autism Spectrum Disorder

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a deficit in communication and social skills, stereotypical and repetitive patterns of behaviors, interests, and activities. The gold standard treatment, behavioral therapy, imposes a great cost on families, and its efficacy depends on the life stage at which the therapy is started. As an alternative treatment, the efficacy and safety of transcranial direct current stimulation (tDCS) have been investigated in different patient groups; however, its efficacy on facial emotion recognition (FER) has not been investigated in children with ASD. Objectives: We investigated the effectiveness of anodal tDCS of the left dorsolateral prefrontal cortex (DLPFC) in FER and clinical symptoms of children with ASD. Methods: Twenty-four boys with ASD were selected from a school in Tehran, Iran. The eligible participants were randomized to receive the intervention (15 minutes of electrical stimulation) or not (20 seconds with device-off; control group). The emotion recognition task and autism treatments evaluation checklist (ATEC) were evaluated before and after the intervention and compared using the mixed ANOVA test. Results: Eleven boys in each group completed the study. The groups were similar regarding mean age, ASD severity, and intelligence quotient. The interactive effect of group and time was significant on both scales (emotion recognition task and ATEC). Conclusions: Anodal tDCS of DLPFC is an effective therapeutic method for specific behaviors, including FER, in school-aged boys with ASD. Further studies are required to suggest this treatment as a safe and effective strategy in children with ASD.

Classification of low-functioning and high-functioning autism using task-based EEG signals

Autism is a neurodevelopmental disorder marked by a lack of interpersonal, social, and communication skills, and repetitive and limited behavioral patterns. Autism exhibits a different severity and level of functioning, ranging from high functioning (HF) to low functioning (LF), as per their intellectual/developmental abilities. Identifying the level of the functionality remains crucial in treating and training Autistic children. Brain functioning widely varies during task performance, and the consequent neural representations can act as potential biomarkers. This work aims to classify LF, and HF autistic children based on electroencephalography (EEG), a promising neural underpinning technique acquired while performing cognitive tasks. But task-based EEG data acquisition from autistic children remains challenging and hinders effective classification procedures due to inadequate sample sizes and difficulty acquiring artifact-free signals. Acquired EEG signals were pre-processed for artifact removal to overcome this limitation, and a Gaussian bootstrapping data augmentation technique was employed to strengthen the dataset. Frequency band-specific absolute power, relative power, and derived parameters such as theta-to-alpha ratio and theta-to-beta ratio were extracted. The statistically relevant features were considered for classifying high and low-functioning autism using a kernel-based support vector machine (SVM). Results show that the fine gaussian kernel outperformed the other kernel methods with an average accuracy of 99.9% in the classification process. Thus, this work seems to effectively employ task-based EEG parameters to distinguish the LF and HF groups rather than depending on behavioral measures to categorize autism.

Acetylcholinesterase inhibitors for autistic spectrum disorders.

Autism spectrum disorder (autism) is a neurodevelopmental condition characterised by impairments in social communication and interaction, plus restricted, repetitive patterns of behaviour and interests. Whilst some people embrace autism as part of their identity, others struggle with their difficulties, and some seek treatment. There are no current interventions that result in complete reduction of autism features. Acetylcholine is a neurotransmitter for the cholinergic system and has a role in attention, novelty seeking, and memory. Low levels of acetylcholine have been investigated as a potential contributor to autism symptomatology. Donepezil, galantamine, and rivastigmine (commonly referred to as acetylcholinesterase inhibitors) all inhibit acetylcholinesterase, and have slightly different modes of action and biological availability, so their effectiveness and side-effect profiles may vary. The effect of various acetylcholinesterase inhibitor on core autism features across the lifespan, and possible adverse effects, have not been thoroughly investigated. To evaluate the efficacy and harms of acetylcholinesterase inhibitors for people with the core features (social interaction, communication, and restrictive and repetitive behaviours) of autism. To assess the effects of acetylcholinesterase inhibitors on non-core features of autism. In November 2022, we searched CENTRAL, MEDLINE, Embase, eight other databases, and two trials registers. We also searched the reference lists of included studies and relevant reviews, and contacted authors of relevant studies. Randomised controlled trials (RCTs), comparing acetylcholinesterase inhibitors (e.g. galantamine, donepezil, or rivastigmine) of varying doses, delivered orally or via transdermal patch, either as monotherapy or adjunct therapy, with placebo. People of any age, with a clinical diagnosis of autism were eligible for inclusion. We used standard methodological procedures expected by Cochrane. Our primary outcomes were core features of autism and adverse effects. Secondary outcomes were language, irritability, hyperactivity, and general health and function. We used GRADE to assess certainty of evidence. We included two RCTs (74 participants). One study was conducted in Iran, the second in the USA, although exact location in the USA is unclear. Galantamine plus risperidone versus placebo plus risperidone One study compared the effects of galantamine plus risperidone to placebo plus risperidone (40 participants, aged 4 years to 12 years). Primary and secondary outcomes of interest were measured postintervention, using subscales of the Aberrant Behavior Checklist (score 0 to 3; higher scores = greater impairment). Very low-certainty evidence showed there was little to no difference between the two groups postintervention for social communication (mean difference (MD) -2.75, 95% confidence interval (CI) -5.88 to 0.38), and restricted and repetitive behaviour (MD -0.55, 95% CI -3.47 to 2.37). Overall autism features were not assessed. Adverse events may be higher in the galantamine plus risperidone group (75%) compared with the placebo plus risperidone group (35%): odds ratio 5.57, 95% CI 1.42 to 21.86, low-certainty evidence. No serious adverse events were reported. Low-certainty evidence showed a small difference in irritability (MD -3.50, 95% CI -6.39 to -0.61), with the galantamine plus risperidone group showing a greater decline on the irritability subscale than the placebo group postintervention. There was no evidence of a difference between the groups in hyperactivity postintervention (MD -5.20, 95% CI -10.51 to 0.11). General health and function were not assessed. Donepezil versus placebo One study compared donepezil to placebo (34 participants aged 8 years to 17 years). Primary outcomes of interest were measured postintervention, using subscales of the Modified Version of The Real Life Rating Scale (scored 0 to 3; higher scores = greater impairment). Very low-certainty evidence showed no evidence of group differences immediately postintervention in overall autism features (MD 0.07, 95% CI -0.19 to 0.33), or in the autism symptom domains of social communication (MD -0.02, 95% CI -0.34 to 0.30), and restricted and repetitive behaviours (MD 0.04, 95% CI -0.27 to 0.35). Significant adverse events leading to study withdrawal in at least one participant was implied in the data analysis section, but not explicitly reported. The evidence is very uncertain about the effect of donepezil, compared to placebo, on the secondary outcomes of interest, including irritability (MD 1.08, 95% CI -0.41 to 2.57), hyperactivity (MD 2.60, 95% CI 0.50 to 4.70), and general health and function (MD 0.03, 95% CI -0.48 to 0.54) postintervention. Across all analyses within this comparison, we judged the evidence to be very low-certainty due to high risk of bias, and very serious imprecision (results based on one small study with wide confidence intervals). The study narratively reported adverse events for the study as a whole, rather than by treatment group. Evidence about the effectiveness of acetylcholinesterase inhibitors as a medication to improve outcomes for autistic adults is lacking, and for autistic children is very uncertain. There is a need for more evidence of improvement in outcomes of relevance to clinical care, autistic people, and their families. There are a number of ongoing studies involving acetylcholinesterase inhibitors, and future updates of this review may add to the current evidence.

Differential Diagnosis of ICD-11 Personality Disorder and Autism Spectrum Disorder in Adolescents.

The International Classification of Diseases 11th Revision (ICD-11) introduces fundamentally new diagnostic descriptions for personality disorder and autism spectrum disorder. Instead of the traditional categorical taxonomies, both personality disorder and autism spectrum disorder are described as being on a continuum. Accumulating research has pointed out that, in some cases, adolescents with autism spectrum disorder are at risk of being confused with having a personality disorder, which particularly applies to female adolescents. Case reports describe how adult autistic women struggled with social and identity roles as children and adolescents, using compensatory strategies such as social imitation and other types of camouflaging. Furthermore, some adolescents with autism display emotion dysregulation and self-injury. The ICD-11 recognizes that features of autism spectrum disorder may resemble features of personality disorder, but the two diagnoses have not yet been formally compared to one another. The present article therefore sought to outline and discuss the overlap and boundaries between the ICD-11 definitions of personality disorder and autism spectrum disorder and propose guiding principles that may assist practitioners in differential diagnosis with female adolescents. We specifically highlight how aspects of the self and interpersonal functioning along with emotional, cognitive, and behavioral manifestations may overlap across the two diagnoses. Restricted, repetitive, and inflexible patterns of behavior, interests, and activities are core features of autism spectrum disorder, which may be masked or less pronounced in female adolescents. Collecting a developmental history of the early presence or absence of autistic features is vital for a conclusive diagnosis, including features that are typically camouflaged in females. A number of future directions for research and clinical practice are proposed.

Effects of video self‐modeling on the preference and reinforcer value of toys for children diagnosed with autism spectrum disorder

AbstractA primary characteristic of autism spectrum disorder includes restrictive and repetitive patterns of behavior. Because having few preferred items and activities can lead to social, communicative, and educational barriers, it is important to increase the number of preferred stimuli in the individual's environment. One way to do this is through conditioned reinforcement via observation. Such procedures involve the acquisition of a skill or change in behavior as a result of indirect contact (i.e., observation) with contingencies received by others. While conditioning through observation has been shown to be effective, one novel approach is video self‐modeling. The purpose of the current study was to assess the effects of video self‐modeling on the preference and reinforcer value of toys for children diagnosed with autism spectrum disorder.

Understanding the link between immunosuppressant and natural killer cell in the progression of autism: The role of natural killer cell and mammalian target of rapamycin in autistic brain

Natural killer cell plays a major role in the pathogenesis of neurodevelopmental disorder including autism spectrum disorder (ASD). ASD is a neurodevelopmental disorder that is associated with symptoms that reduce the quality of life of affected individuals such as social interaction deficit, cognitive impairment, intellectual disabilities, restricted, and repetitive behavioral patterns. This disorder begins in early childhood and continues throughout adulthood. ASD pathogenesis is associated with alteration in natural killer (NK) cells as well as mammalian target of rapamycin signaling functioning that leads to altered physiological processes during development. Here, we review literature highlighting the role of immunosuppressants especially rapamycin and azathioprine and their impact on treating the neurodevelopmental disorder and mechanism by which these drugs may act to ameliorate the autistic symptoms. Furthermore, this review discusses reports highlighting the role of NK cells and familial adenomatous polyposis gene in the etiology of ASD. This review suggests that further investigative work on these drugs could be vital in the management of ASD.

Factors Associated with Anxiety Disorders in Chinese Children with Autism Spectrum Disorder in Hong Kong

Background: Autism Spectrum Disorder (ASD) is a pervasive neurodevelopment disorder characterised by impairment in social communication and presence of restricted, repetitive patterns of behaviour, interests, or activities. A growing body of research has shown that children with ASD experience significantly greater anxiety levels than typically developing children. Anxiety disorders have been found to be one of the most prevalent psychiatric comorbidities in this population of children and are associated with debilitating psychosocial impairment. Objective: This study aimed to examine factors associated with anxiety disorders among Chinese children diagnosed with ASD in Hong Kong. Methods: This cross-sectional study was conducted at a child and adolescent psychiatry outpatient clinic from August 2019 to April 2020. The sample consisted of one hundred thirty-two subjects aged 6 to <12 years who had a diagnosis of ASD. Structured interviews and questionnaires including the Diagnostic Interview Schedule for Children, Parenting Stress Index-Short Form, Parenting Styles and Dimensions Questionnaire and a socio-demographic questionnaire were administered for the assessment of anxiety disorders and their associated factors. Results: Greater qualitative deficits in reciprocal social interaction skills, attention-deficit/hyperactivity disorder and maternal mood disorder were found to be significantly associated with anxiety disorders in children with ASD. Conclusion: Anxiety disorders are prevalent among children with ASD. Early recognition and identification of comorbid anxiety disorders are necessary in the diagnostic process of ASD. This study enriches our understanding of the factors associated with anxiety disorders in this population of children. For future research directions, furthering our understanding on the aetiological pathways, course of illness, and outcome of anxiety disorders in autistic children is highly warranted.

Association of GABRG3, GABRB3, HTR2A gene variants with autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental and neurobehavioral disorder characterized by impaired social communication, repetitive and restricted patterns of behavior, activity, or interest, and altered emotional processing. Reported prevalence is 4 times higher in men and it has increased in recent years. Immunological, environmental, epigenetic, and genetic factors play a role in the pathophysiology of autism. Many neurochemical pathways and neuroanatomical events are effective in determining the disease. It is still unclear how the main symptoms of autism occur because of this complex and heterogeneous situation. In this study, we focused on gamma amino butyric acid (GABA) and serotonin, which are thought to contribute to the etiology of autism; it is aimed to elucidate the mechanism of the disease by investigating variant changes in the GABA receptor subunit genes GABRB3, GABRG3 and the HTR2A gene, which encodes one of the serotonin receptors.200 patients with ASD between the ages of 3–9 and 100 healthy volunteers were included in the study. Genomic DNA isolation was performed from peripheral blood samples taken from volunteers. Genotyping was performed using the RFLP method with PCR specific for specific variants. Data were analyzed with SPSS v25.0 program.According to the data obtained in our study; In terms of HTR2A (rs6313 T102C) genotypes, the homozygous C genotype carrying frequency in the patient group and the homozygous T genotype carrying frequency in the GABRG3 (rs140679 C/T) genotypes were found to be significantly higher in the patient group compared to the control group (*p: 0.0001, p: 0.0001). It was determined that the frequency of individuals with homozygous genotype was significantly higher in the patient group compared to the control group and having homozygous genotypes increased the disease risk approximately 1.8 times. In terms of GABRB3 (rs2081648 T/C) genotypes, it was determined that there was no statistically significant difference in the frequency of carrying homozygous C genotype in the patient group compared to the control group (p: 0.36).According to the results of our study, we think that the HTR2A (rs6313 T102C) polymorphism is effective in modulating the empathic and autistic characteristics of individuals, and that the HTR2A (rs6313 T102C) polymorphism is more distributed in the post-synaptic membranes in individuals with a higher number of C alleles. We believe that this situation can be attributed to the spontaneous stimulatory distribution of the HTR2A gene in the postsynaptic membranes because of T102C transformation.In genetically based autism cases, carrying the point mutation in the rs6313 variant of the HTR2A gene and the C allele and the point mutation in the rs140679 variant of the GABRG3 gene and accordingly carrying the T allele provide a predisposition to the disease.

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Special Report: Autism Spectrum Disorder and Inflexible Thinking—Affecting Patients Across the Lifespan

Results of a phase Ib study of SB-121, an investigational probiotic formulation, a randomized controlled trial in participants with autism spectrum disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by core impairments in social communication as well as restricted, repetitive patterns of behavior and/or interests. Individuals with ASD, which includes about 2% of the US population, have challenges with activities of daily living and suffer from comorbid medical and mental health concerns. There are no drugs indicated for the core impairments of ASD. As such, there is a significant need for the development of new medication strategies for individuals with ASD. This first-in-human placebo-controlled, double-blind, crossover study investigated the safety (primary objective) and efficacy of oral SB-121, a combination of L. reuteri, Sephadex® (dextran microparticles), and maltose administered once daily for 28 days in 15 autistic participants. SB-121 was safe and well tolerated. SB-121-associated directional improvements in adaptive behavior measured by Vineland-3 and social preference as measured with eye tracking were noted. These results provide support for further clinical evaluation of SB-121 as a treatment in autistic patients. To evaluate the safety and tolerability of multiple doses of SB-121 in subjects with autism spectrum disorder. Single-center, randomized, placebo-controlled, double-blind, crossover trial. 15 patients with autism spectrum disorder were randomized and analyzed. Daily dosing of SB-121 or placebo for 28 days, followed by approximately a 14 day washout, then 28 days of dosing with other treatment. Incidence and severity of adverse events, presence of Limosilactobacillus reuteri and Sephadex® in stool, and incidence of bacteremia with positive L. reuteri identification. Additional outcomes include changes from baseline on cognitive and behavior tests as well as biomarker levels. Adverse event rates were similar between SB-121 and placebo, with most reported as mild. There were no severe or serious adverse events. No participants had features of suspected bacteremia or notable changes in vital signs, safety laboratory, or ECG parameters from baseline. There was a statistically significant increase from baseline in the Vineland-3 Adaptive Behavior Composite score (p = 0.03) during SB-121 treatment. There was a trend for increased social/geometric viewing ratio following SB-121 treatment compared to placebo. SB-121 was safe and well tolerated. SB-121-associated directional improvements in adaptive behavior measured by Vineland-3 and social preference as measured with eye tracking were noted.Trial registration: clinicaltrials.gov Identifier: NCT04944901.

Differentiated approach to the pharmacotherapy of autism spectrum disorders: biochemical aspects

Autism Spectrum Disorders (ASD) are highly heterogeneous neurodevelopmental disorders caused by a complex interaction of numerous genetic and environmental factors and leading to deviations in the nervous system formation at very early developmental stages. Currently, there are no accepted pharmacological treatments for so-called core symptoms of ASD, such as social communication disorders and restricted and repetitive behavior patterns. The lack of knowledge about biological basis of ASD, the absence of clinically significant biochemical parameters reflecting abnormalities in signaling molecular cascades controlling the nervous system development and functioning, and the lack of methods for selection of clinically and biologically homogeneous subgroups are considered among the causes for the failure of clinical trials of ASD pharmacotherapy. This review considers the possibilities of applying a differentiated clinical and biological approach to the targeted search for ASD pharmacotherapy with an emphasis on biochemical markers associated with ASD and attempts to stratify patients by biochemical parameters. The use of approach such as “target-oriented therapy and assessment of the status of the target before and during the treatment to identify patients with a positive response to treatment” is discussed using the published results of clinical trials as examples. It is concluded that the identification of biochemical parameters for the identification of distinct subgroups among ASD patients requires research on large samples reflecting the clinical and biological diversity of patients with ASD, and the use of unified approaches for such studies. An integrated approach, including clinical observation, clinical-psychological assessment of patient behavior, study of anamnesis and description of individual molecular profiles should become a new strategy for stratifying and subgrouping patients with ASD for clinical pharmacotherapeutic trials, as well as for evaluating its efficiency.

Differentiated Approach to Pharmacotherapy of Autism Spectrum Disorders: Biochemical Aspects

Autism Spectrum Disorders (ASD) are highly heterogeneous neurodevelopmental disorders caused by a complex interaction of numerous genetic and environmental factors and leading to deviations in the nervous system formation at the very early developmental stages. Currently, there are no accepted pharmacological treatments for the so-called core symptoms of ASD, such as social communication disorders and restricted and repetitive behavior patterns. Lack of knowledge about biological basis of ASD, absence of the clinically significant biochemical parameters reflecting abnormalities in the signaling cascades controlling the nervous system development and functioning, and lack of methods for selection of clinically and biologically homogeneous subgroups are considered as causes for the failure of clinical trials of ASD pharmacotherapy. This review considers the possibilities of applying differentiated clinical and biological approaches to the targeted search for ASD pharmacotherapy with emphasis on biochemical markers associated with ASD and attempts to stratify patients by biochemical parameters. The use of such approach as "the target-oriented therapy and assessment of the target status before and during the treatment to identify patients with a positive response to treatment" is discussed using the published results of clinical trials as examples. It is concluded that identification of biochemical parameters for selection of the distinct subgroups among the ASD patients requires research on large samples reflecting clinical and biological diversity of the patients with ASD, and use of unified approaches for such studies. An integrated approach, including clinical observation, clinical-psychological assessment of the patient behavior, study of medical history and description of individual molecular profiles should become a new strategy for stratifying patients with ASD for clinical pharmacotherapeutic trials, as well as for evaluating their efficiency.

Autism severity and its relationship to disability.

Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken byThe Lancet Commission on the future of care and clinical research in autism, which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments.

Ecological-enactive account of autism spectrum disorder

Autism spectrum disorder (ASD) is a psychopathological condition characterized by persistent deficits in social interaction and communication, and restricted, repetitive patterns of behavior and interests. To build an ecological-enactive account of autism, I propose we should endorse the affordance-based approach of the skilled intentionality framework (SIF). In SIF, embodied cognition is understood as skilled engagement with affordances in the sociomaterial environment of the ecological niche by which an individual tends toward the optimal grip. The human econiche offers a whole landscape of affordances, and situated individuals respond to a field of relevant affordances. An important part of SIF is an ecological-enactive interpretation of the free energy principle and predictive processing. Predictive processing accounts indicate that in ASD too much precision is assigned to prediction errors. Autistic persons depend heavily on current sensory information and less on prior beliefs and cannot attune to stable regularities. To reduce uncertainty, they over-rely on routines, strict habits, and a familiar environment—a predictable ecological niche they construct. I argue that skilled intentionality gives us the framework from which to analyze the autistic field of affordances. Autistic patterns of affordance-related bodily states of action readiness are only sensitive to very specific solicitations in the environment and achieve optimal grip in well-known situations. Autism is to be understood as a disorder of bodily normativity. Taking this approach helps us figure out what neurotypical people can do to attune their environment in order to scaffold the needs of autistic individuals by redesigning the landscape of affordances.

Micronutrient Research in Autism Spectrum Disorder. A Clinical Study.

Autistic spectrum disorders are part of the category of neurodevelopmental disorders, characterized by: difficulties in communication and social interaction, restrictive and repetitive patterns of behaviours and activities, which are present throughout the developmental period, and can be diagnosed in the first five years of life. Due to the increase in the incidence of this disorder in recent years, it has become a topic of great interest both to specialists in child and adolescent psychiatry and to researchers in the field. Given the polymorphism of Autism Spectrum Disorder and the need to discover factors that better explain the etiology of this disorder, studies related to biomarkers are extremely varied. One of the areas of study that have exercised particular interest is related to the involvement of metals in the pathology of autism spectrum disorder. Apart from the controversies related to heavy metals that according to studies affect the developmental process, there are studies that suggest that some micronutrients such as zinc, copper, selenium, iron, magnesium, may be involved in the etiology of autism spectrum disorder. Starting from these studies, we set out to investigate to what extent these essential metals for the body are involved in the etiology of autism spectrum disorder and how they influence the severity of symptoms.

Modeling Autism Spectrum Disorders with Induced Pluripotent Stem Cell-Derived Brain Organoids.

Autism spectrum disorders (ASD) are a group of complex neurodevelopmental disorders that affect communication and social interactions and present with restricted interests and repetitive behavior patterns. The susceptibility to ASD is strongly influenced by genetic/heritable factors; however, there is still a large gap in understanding the cellular and molecular mechanisms underlying the neurobiology of ASD. Significant progress has been made in identifying ASD risk genes and the possible convergent pathways regulated by these gene networks during development. The breakthrough of cellular reprogramming technology has allowed the generation of induced pluripotent stem cells (iPSCs) from individuals with syndromic and idiopathic ASD, providing patient-specific cell models for mechanistic studies. In the past decade, protocols for developing brain organoids from these cells have been established, leading to significant advances in the in vitro reproducibility of the early steps of human brain development. Here, we reviewed the most relevant literature regarding the application of brain organoids to the study of ASD, providing the current state of the art, and discussing the impact of such models on the field, limitations, and opportunities for future development.