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Epilepsy is one of the most common neurological disorders in young people, which disrupts daily life and results in an increased risk of victimization. Archival data from the 2018/2019 National Survey of Children's Health (NSCH), a nationally representative cross-sectional survey, were used. Data from the NSCH were collected via parent reports and analyzed for children aged 6-17 years (N = 25500). The results indicated that children with epilepsy (CWE) were significantly more likely to be frequently bullied than children with less stigmatizing chronic health conditions (i.e., asthma) and typical peers, but there was no significant association between the severity of epilepsy and the frequency of victimization. Furthermore, the degree of school engagement did not significantly moderate the relationship between epilepsy severity and frequency of victimization. However, the degree of school engagement was associated with the frequency of victimization in CWE, such that more school engagement was associated with less parent-reported victimization. Overall, these findings support the growing evidence that CWE are at a higher risk of being bullied and need unique interventions regardless of epilepsy severity and that school engagement should be further examined to reduce victimization among CWE.

Objective: People with intellectual disabilities have historically often been excluded from cognitive based therapies, due to their cognitive deficits. However, adults with intellectual disabilities have been found to have the core cognitive abilities necessary to engage in Cognitive Behaviour Therapy. Despite this emerging evidence, the capacity for children with intellectual disabilities to engage with cognitive based therapies has not been fully explored. Method: Fourteen children, between the ages of 8 and 17 with intellectual disabilities, completed cognitive mediation tasks and a discrimination task. Five had a moderate intellectual disability, six had a mild intellectual disability and three had intellectual functioning in the borderline range. Inclusion criteria: These tasks completed assessed children's ability to identify, discriminate between, and link thoughts, emotions and behaviours. Results: Potential correlates of intelligence, verbal abilities and age were investigated. Participants' performance on the discrimination task was varied. High accuracy was seen in the cognitive mediation tasks. Conclusion: Results from this pilot study demonstrate that children with intellectual disabilities may have some of the skills required for Cognitive Behaviour Therapy, however children may require some training in cognitive mediation tasks before completing Cognitive Behaviour Therapy. As children have the foundational skills to engage in cognitive based therapies, this supports the need for future research trials investigating the use of adapted Cognitive Behaviour Therapy for children with intellectual disabilities.

School transfers may be particularly challenging for students with special educational needs (SEN), and may negatively impact academic and social outcomes for these students. In countries with multiple placement options for students with SEN, although transfers between different types of placements are plausible, studies on this phenomenon are rare. The current study investigates individual placement trajectories over 11 years of compulsory education, using administrative data from a Swiss canton (i.e. federal state) about students with intensive SEN support. We employed sequence analysis to describe individual characteristics of placement trajectories (type of placements attended, number and timing of transfers), and to identify typical placement trajectories. Findings indicate that students with SEN experience frequent placement transfers, however, high variability between individual placement trajectories exists. Four clusters representing typical placement trajectories emerged. The clusters differed in the placements predominately attended by students, the number of transfers experienced, as well as in the distribution of students' age, gender and first language. These differences may reflect variations between clusters in the type and severity of students' SEN. Our study results underscore the importance of understanding the dynamics of placement trajectories for students with SEN, contributing valuable insights into the complexities of their educational journeys.

Background: Suicidality in individuals with intellectual disability is a critical but under-researched area. This systematic review aims to synthesize existing literature on the prevalence, risk factors, and interventions for suicidality among individuals with intellectual disability. Methods: Adhering to the PRISMA guidelines, a comprehensive review of databases was conducted for empirical studies on suicidality in intellectual disability. Data were extracted on sample characteristics, methodologies, and key findings. Results: Nineteen studies met the inclusion criteria. Consistent risk factors, notably comorbid psychiatric disorders, emerged. Passive suicide methods predominated with a positive correlation between higher intellectual functioning and increased suicidal behaviors. Conclusions: The increased vulnerability to suicide in this population highlights the need for targeted interventions and comprehensive risk assessments. Much future research is required in the face of paucity of data with the priority on developing specific suicide prevention tools while addressing cultural stigmas to enhance support for this population.

The current study investigated the effects of an integrative exercise intervention on the behaviours in children with autism spectrum disorder (ASD), and if they were influenced by ASD symptom severity. Sixty-six children (7.56 ± 2.03 yrs.) with ASD were enrolled and categorised as having mild (n = 22), moderate (n = 18) or severe (n = 26) symptoms of ASD by teachers using the Gilliam Autism Rating Scale 2nd edition. Participants completed a school-based, eight-week, integrative exercise intervention, consisting of three, one-hour sessions per week. Teachers rated the symptoms of ASD in each participant pre- and post-intervention using the Aberrant Behaviour Checklist. There were significant improvements in behaviours post-intervention for all children (p < 0.05; r = 0.20-0.33); however, sub-group analysis indicated that participants with severe ASD experienced greater improvements in irritability, social withdrawal, stereotypic behaviour, and inappropriate speech (p < 0.05). The findings highlight the benefits of school-based integrative exercise interventions for improving behaviours in children with ASD.

Rett syndrome (OMIM #312750) is a progressive neurodevelopmental disease with clinical manifestations including loss of spoken language and apraxia. We summarized per PRISMA guidelines findings on their non-verbal social skills. Twelve studies (n = 479 females, 1.6-52 years) were sorted into a (non-)interventional design including video-coding, eye-tracking, and questionnaire studies. Across methodology, poor non-verbal social functioning was found, with eye gaze function being the most examined modality. Findings showed similar responsiveness to social stimuli as typically developing subjects but with difficulties in sustained attention and in recognizing novel social stimuli. Particularly, the music treatment showed to improve their skills. Concluding, due to severe movement disorder and apraxia, the brief gaze intent might be misconstrued beyond the caregiver's perception or familiar situations.

Research has consistently shown that individuals with Autism Spectrum Disorder (ASD) exhibit Empathy deficits. The aim of this study was to systematically review and meta-analyze the research conducted in the domain of cognitive and affective Empathy in Autism. The author also attempted to see the influence of moderators, such as age, culture, and measure-used, on the effect sizes. To fulfill the objective, the meta-analysis was performed on 35 studies that fulfilled the inclusion criteria with the help of the Meta-essentials, which is a free excel meta-analysis tool that facilitates the integration of effect sizes from various studies. The results indicated that the ASD group differs significantly from typically developing (TD) group in both cognitive and affective empathy. The effect size for cognitive empathy was very large (1.26), whereas, for affective empathy, the effect size was medium (0.58). Further, there was a significant moderating effect of the type of measure used on cognitive empathy. However, there are a few limitations of the present meta-analysis. Firstly, it does not shed light on how symptom severity in Autism influences empathy. Secondly, all the possible moderating variables influencing empathy could not be considered. Lastly, the generalizability of the findings may be limited owing to the limitations present in the included studies themselves. The present meta-analysis has implications for conceptualizing cognitive and affective empathy appropriately, and developing appropriate measures to assess empathy in the Autism population.

Autism is associated with significantly higher rates of internalizing and externalizing disorders compared to neurotypical (NT) individuals. Emotion dysregulation (ED) is prevalent in autistic individuals and has been proposed to underlie both internalizing disorders and behavioral challenges in autism. This study sought to use a meta-analytic approach to examine the magnitude of ED severity in autistic samples compared to NT and other clinical (OC) samples. Following a review of the literature, a total of 35 studies were included in the analyses. In general, when comparing autistic to non-autistic individuals, findings suggest a medium magnitude of difference in ED severity between autistic and comparison groups overall. Subgroup analyses indicate that autistic individuals experience significantly higher ED severity when compared to NT peers. However, when compared to OC peers, the effect is small, suggesting the severity of ED may be more similar between OC and autistic groups. Moderators were also explored, including autistic traits, age, and sex composition. These findings provide integral information about the severity of ED in autistic populations compared to other non-autistic populations, assisting in further clarifying the presence of mental health challenges in autistic youth.

This study tackles the question: how is literacy engagement enacted in the context of significant disability? We delve into the complex literacy practices of Kalika, a three-year-old child with Rett syndrome, a rare neurodevelopmental disorder, to elucidate how she engages with printed text. Rett syndrome leads to near total loss of verbal communication and limited functional hand use, making it particularly challenging to participate in traditionally recognized forms of literacy engagement. Using in-depth qualitative data from both in- and out-of-school settings, we conduct a micro-level analysis of Kalika's behaviours during story time rituals. In order to bring analytic coherence to the data, we classified her modalities of literacy engagement under two broad categories: 1) kinesics, which included a) corporal (entailing full body positioning and motion), b) oral (involving contact with mouth or expression), c) oculesics (relating to eye gaze), and d) haptic (relating to hands) elements as well as 2) vocalics (pertaining to vocal tone and vocalisation). Our analysis elucidates the sophisticated, complex multimodal practices that Kalika enacts to engage with texts. For far too long, students with significant disabilities have been viewed from deficit perspectives, neglected within the literature as well as in the classroom, and thought to require additional instruction to learn how to engage with texts. We suggest that perhaps it is a question, instead, of educators and scholars learning to expand their own frames of reference.

Purpose: Developmental changes in sleep in youth with autism spectrum disorder (ASD) are understudied. In non-ASD youth, adolescents exhibit a "night owl chronotype" (i.e., later sleep/wake timing) and social jetlag (i.e., shifts in sleep timing across school nights and weekends), with corresponding sleep problems. The purpose of this study is to evaluate age trends in chronotype, social jetlag, and sleep problems in high-risk youth with ASD. Methods: Youth with ASD (N = 171), ages 5-21 years old, were enrolled at the time of admission to specialized psychiatric units. Caregivers reported children's demographic information, habitual sleep timing, and sleep problems. Multivariate analyses evaluated the effect of age on chronotype, social jetlag, and sleep problems and the effects of chronotype and social jetlag on sleep problems. Covariates and moderators included sex, race, verbal ability, autism symptom severity, supplemental melatonin, and pubertal status. Results: Older age was associated with later chronotype, more social jetlag, fewer sleep anxiety/co-sleeping problems, fewer night waking and parasomnia problems, and more daytime alertness problems. The effect of age on chronotype was stronger for youth with greater social affective symptom severity. Mediation analyses showed that later chronotype statistically mediated the association between age and daytime alertness problems. Conclusions: Youth with ASD may exhibit night owl chronotype behavior and social jetlag as they enter adolescence. Shifts toward a later chronotype may be exacerbated by autism severity and may contribute to alertness problems and sleepiness during the day. Chronotype is modifiable and may be leveraged to improve daytime functioning in youth with ASD.

Background: Children with motor delays are at increased risk for delayed means-end problem-solving (MEPS) performance. Objectives: To evaluate children with motor delays: 1) the impact of motor delay severity and MEPS mastery timing on developmental trajectories of MEPS; and 2) the effectiveness of Sitting Together And Reaching To Play (START-Play) intervention for improving MEPS. Methods: This represents a secondary analysis from a multi-site randomized controlled trial, with blinded assessors and prospective registration. Children with mild or significant motor delays (n=112, Mean=10.80, SD=2.59 months at baseline) were randomly assigned to START-Play or usual care early intervention (UC-EI) and assessed at five visits across one year using the Means-End Problem-Solving Assessment Tool that included three 30-second MEPS trials per visit. Task mastery occurred at the first visit the child achieved the highest level of performance in at least two of the three trials. Multilevel analyses evaluated trajectories of MEPS outcomes dependent upon the timing of MEPS mastery, motor delay severity, and intervention group. Results: At baseline, children with mild motor delays demonstrated better MEPS than children with significant delays, but this difference was only observed for children who achieved mastery late. Children with significant delays demonstrated greater improvements in MEPS in the post-intervention phase compared to children with mild delays. No MEPS differences were found between START-Play and UC-EI. Conclusion: Motor delay severity and timing of task mastery impacted MEPS trajectories, whereas START-Play intervention did not impact MEPS for children with motor delays.

The COVID-19 lockdown and the implementation of remote learning brought challenges to children with ADHD and their parents. This research aimed to examine the spatial and technical preconditions and quality of support for children with ADHD during remote learning and to determine their mothers' burdens with the children's school tasks during the first lockdown. Another aim was to determine the degree of academic accommodation of teaching, the mother's burden with the school tasks, and the impact of the intensity of the children's difficulties on mothers' stress levels. The study had 61 mothers of children with ADHD, aged 30 to 53, as participants. Data were collected using an online questionnaire. The perspective of mothers showed that spatial conditions were not appropriate for holding online classes. Furthermore, teaching materials during online classes were not adapted to the child's needs, teachers did not send teaching materials through the available online services in a proper manner, and more than a third of the mothers stated that there was no interactive teaching at all and that there was no individual contact with teachers. Most mothers state that they are burdened with the child's school tasks more than compared to the period before the lockdown. It has also been shown that attention symptoms, lack of academic accommodations, and school workload have statistically significant effects on maternal stress.

Understanding the overlap of symptoms between oppositional defiant disorder (ODD) and obsessivecompulsive disorder (OCD) experienced by youth is pertinent for accurate diagnosis. A quantitative, retrospective, cross-sectional design format was used to assess the relationship between ODD and OCD in addition to evaluating the difference in ODD severity and symptoms based on OCD severity. Symptoms and severity ratings of ODD and OCD were collected from youth diagnosed with ODD (N = 179). Fisher's exact test and a Wilcoxon signed-rank test were performed. There were significant relationships between frustration related to obsessions and compulsions and the ODD symptoms of annoyance and anger. Results suggested that OCD severity predicted an increase in scores for ODD severity and symptoms.

This study aimed to identify the reality of the rehabilitation of people with intellectual disabilities and their employment from the point of view of their parents in the city of Mecca, where a questionnaire was designed as a tool for collecting data, and the sample of the study consisted of (142) parents of persons with intellectual disabilities enrolled in vocational rehabilitation programs in schools of intellectual education and institutes of intellectual education in the Holy City of Mecca, and were selected in a random way. The results of the study indicated that the reality of rehabilitation and employment of persons with intellectual disabilities came at a moderate level. The results showed that the obstacles to rehabilitation and employment came at a high level. The results also showed that there were no statistically significant differences ([alpha less than or equal to]0.05) in the following variables (gender, age, educational qualification), while there are statistically significant differences ([alpha less than or equal to]0.05) attributable to the variable (level of disability) where they appeared in favor of fragile syndrome in the level of reality of rehabilitation and employment, while in favor of Down syndrome in the obstacles that prevent rehabilitation and employment.

Background: Over 50% of individuals with aphasia face ongoing word-finding issues. Studies have found phonologically oriented therapy helpful for English speakers, but this has not yet been studied in French. It is essential to assess the effectiveness of such a therapy in French, considering the distinct linguistic typologies between both languages, which may impact the outcomes of phonologically oriented interventions. Aim: This paper evaluates the effectiveness of French Phonological Component Analysis (Fr-PCA) on communication skills of individuals with chronic aphasia and the impact of individual factors on treatment success. Methods & Procedures: Eighteen individuals with chronic aphasia received 15 h of Fr-PCA therapy over 5 weeks. Naming accuracy for treated and untreated words was measured before and after therapy, as well as at 3- and 6-month follow-ups. Secondary outcome measures included standardized tests measuring within-level generalization (object and action naming) and across-level generalization (repetition, verbal fluency, oral comprehension, communication effectiveness reported by a frequent communication partner). Outcomes & Results: Fr-PCA led to improved accuracy for treated (17 participants out of 18) and untreated words (9 participants out of 18), with gains maintained at 6-month follow-up (7 participants out of 10 for treated and 6 participants out of 10 for untreated), and generalization to communication effectiveness reported by a frequent communication partner (11 participants out of 16). Age, apraxia of speech severity and initial anomia severity impacted therapy gains. Conclusions & Implications: Though more research is needed, results suggest Fr-PCA benefits French individuals living with aphasia. Identifying individual factors influencing therapy gains could enable clinicians to improve therapy tailoring.

Background: The dialect spoken by children influences diagnostic decision-making regarding the identification and severity of speech sound disorder (SSD). Aims: The primary objective was to review papers that examined the influence of dialect on the identification of SSD in Vietnamese-speaking children. Methods & Procedures: Five studies of mono- and multilingual Vietnamese-speaking children living in Vietnam and Australia were reviewed to examine the influence of dialect on the assessment and analysis children's speech. The main Vietnamese dialects (Standard, Northern, Central, Southern) differ in the production of consonants, vowels and tones. Main contribution: Most speech assessments define correct production using the standard dialect of a language. Insights from recent studies of Vietnamese provide recommendations for also considering dialect in diagnostic decision-making. First, we recommend adding column(s) to the assessment score sheet that includes the dialectal variants spoken by adults in the child's family or community. Second, we calculate the accuracy of production twice, based on the standard form and dialectal form. Third, we report the percentage of consonants correct--standard (PCC-S) and percentage of consonants correct--dialect (PCC-D). Conclusions & Implications: Diagnostic decision-making is influenced by dialectal variation in children's speech, so speech and language therapists need to compare standard and dialectal productions when undertaking assessments, analysis and diagnostic decision-making.

Previous research on employment outcomes of autistic adults mainly assessed if they work and under what terms, with mostly anecdotal descriptions of where they work. This study aimed to identify the employment sector distribution of autistic employees compared to the general workforce in the Netherlands and to explore possible background predictors. Participants were 1115 employed autistic adults (476 male; 627 female; 12 other; mean age: 40.75) who completed a cross-sectional survey assessing employment sector, gender, age, age at diagnosis, educational level, degree of autistic traits, and presence of focused interests. Dutch workforce data were retrieved from the Central Bureau of Statistics. Results indicated significant differences in sector distribution across the two populations. Autistic adults were over-represented in the sectors healthcare & welfare, information technology, and public-army-charity, which were the three most-common sectors for this group. In economics & finances, and industry & construction, higher proportions were found in the general workforce. Most autistic employees in the healthcare & welfare sector were females while having a higher educational degree and being male predicted placement in information technology. The broad distribution of autistic employees beyond the information technology sector was notable, supporting the need for an individual approach to employment integration.

The objective of this study was to explore the role that Autistic identity, sensory processing and camouflaging behaviours have on eating disorder symptomology in Autistic adults. Previous research has focused on cognitive and sensory factors to explain the association between autism and eating disorders, but the roles of social identity and camouflaging are yet to be explored. Autistic participants (N = 180) were recruited from NHS settings and community groups. The participants completed online questionnaires measuring autistic identity, camouflaging behaviours, sensory processing, autistic traits and eating disorder symptoms. Multiple regression revealed that camouflaging significantly predicted eating disorder symptoms. Although sensory processing was related, it did not significantly predict eating disorder symptom severity. In addition, there was no significant relationship between autistic identity and eating disorder symptom severity. This study highlights the impact that camouflaging behaviours and sensory processing can have on eating disorder symptomatology in autism and may indicate important considerations for the treatment of eating disorders in Autistic people.

Background: Sleep problems are common in adults with ADHD and may be bidirectionally associated with ADHD severity and other psychiatric symptoms. We investigated the prevalence of positive screenings for various sleep disorders, and their association with psychiatric comorbidities in a large sample of adults with ADHD from a specialized outpatient clinic. Methods: We included data of 3,691 adult patients diagnosed with ADHD, who had filled out a screener for sleep disorders (Holland Sleep Disorders Questionnaire (HSDQ)) as part of routine diagnostic assessment. The HSDQ screens for the sleep disorders insomnia, parasomnia, hypersomnia, circadian rhythm sleep disorders (CRSD), restless legs syndrome (RLS)/periodic limb movement disorder (PLMD), and sleep-related breathing disorders (SBD). As delayed sleep phase syndrome (DSPS) is very frequent in ADHD, we additionally screened for DSPS. Psychiatric comorbidities were diagnosed through clinical assessment and the Mini International Neuropsychiatric Interview (M.I.N.I.) Plus, which assesses 26 psychiatric disorders following the classification of the DSM-5. All data were retrieved from the electronic patient files. Results: Mean age was 35.4 and 49.4% of the patients were female. About 60% of the adults with ADHD screened positive for any sleep disorder. Highest prevalences were found for symptoms of DSPS (36%), insomnia (30%), and RLS/ PLMD (29%). Sleep problems in adults with ADHD were associated with comorbid depression, anxiety, substance use disorder, personality disorder, and post-traumatic stress disorder. Conclusion: Adults with ADHD often report sleep problems, which are associated with specific psychiatric comorbidities. Systematic screening for sleep disorders in adult patients with ADHD can contribute to a better understanding of their complaints and may aid improved and integrated treatment for the sleep and psychiatric problems.

This study investigated how the school experiences and personal characteristics of youth with Intellectual Disabilities (ID) contribute to their longitudinal trajectories of anxiety. To this end, we relied on a sample of 390 youth with mild (48.2%) to moderate (51.8%) levels of ID, aged from 11 to 22 (M = 15.70), and recruited in Canada (n = 140) and Australia (n = 250). Across three yearly time points, all participants completed self-report measures of anxiety, school climate, and victimization. Our results revealed a slight normative decrease in anxiety over time and showed that experiences of school victimization were associated with higher levels of anxiety (initially and momentarily) and increases in victimization were accompanied by increases in anxiety over time. Perceptions of attending a school that fosters security and promotes learning also tended to be accompanied by lower levels of anxiety (initially and momentarily). Momentary increases in perceptions of attending a school that fosters positive peer interactions were associated with momentary decreases in anxiety, whereas momentary increases in perceptions of attending a school characterized by positive teacher-student relationships and an equitable treatment of all students both led to small momentary increases in anxiety once all other components of student school experiences were considered. The theoretical and practical implications of these results are discussed.

Autistic children are at higher risk of experiencing adverse childhood experiences, which lead to negative health outcomes such as sleep difficulties. In the general population, family resilience can help reduce the negative impact of adverse childhood experiences on child functioning. The aim of this study was to examine the impact of adverse childhood experiences on sleep duration, and whether family resilience moderates this impact in autistic children. With data from 2882 caregivers of children with autism from the National Survey of Children's Health, we examined the role of family resilience on the relationship between adverse childhood experiences and sleep duration. As shown in previous findings, there was a main effect of adverse childhood experiences on sleep duration. There was no significant main effect of family resilience on sleep duration. Results also show that family resilience moderates the relationship between adverse childhood experiences and sleep duration, possibly serving as a protective factor.

Purpose: To investigate serum levels of VEGF, IGF-1 and FGF-2, and relationships with several clinical characteristics in children and adolescents with autism spectrum disorder (ASD) with and without bipolar disorder (BD). Method: 40 subjects with ASD + BD as study group, and 40 subjects with ASD as control group were included. Serum levels of VEGF, IGF-1, and FGF-2 were measured using commercial enzyme-linked immunosorbent assay kits. Results: The study group was significantly higher than the control group in terms of ASD severity, self-harming behavior and sleep disturbance. Serum VEGF and FGF-2 levels were significantly higher in the ASD + BD group than in the control group. There was no significant difference in serum IGF-1 levels between the two groups. There was no correlation between VEGF, IGF-1 and FGF-2 serum levels and ASD severity in the study group. However there was a negative correlation between VEGF levels and age at first diagnosis of BD, and a positive correlation between IGF-1 levels and the number of bipolar episodes in the study group. Conclusion: Growth factors like VEGF and FGF-2 may be potential biomarkers of bipolar disorder in young subjects with ASD. Given the difficulty of clinical management of BD in young subjects with ASD, potential biomarkers would help clinicians in the diagnosis and follow up of BD in this special population. Further research is needed whether VEGF and FGF-2 can be potential biomarkers in the clinical management of young subjects with ASD and BD.

An interview-informed synthesized contingency analysis (IISCA; Hanley et al. in J Appl Behav Anal 47:16-36, 2014) and related skill-based treatment process can result in socially valid outcomes for clients exhibiting severe challenging behavior when implemented by professionals and then transferred to parents (e.g., Santiago et al. in J Autism Dev Disord 46:797-811, 2016). However, many families do not have access to professionals trained to implement functional analyses or function-based treatments (Deochand & Fuqua Behav Anal Pract 9:243-252, 2016). Experimenters in the present study coached three parents of children with autism exhibiting severe challenging behavior through implementing an IISCA and resulting skill-based treatment process through distance-based collaborative consulting. All parents achieved differentiated functional analyses, taught their children to emit functional replacement skills, and reduced challenging behavior relative to baseline.

The COVID-19 lockdown affected children, especially those with autism spectrum disorder, due to the disruption in rehabilitation and educational activities. We conducted a cross-sectional study of 315 preschool-aged children, 35 of which had autism, to investigate this impact. A questionnaire was administered to explore socio-demographic status, familiar/home environment, and COVID-19 exposure. The clinical features of autistic subjects were also examined. Seven variables were considered to describe the effect of pandemic: "Remote learning, Behavior changes, Home activities, Sleep habits, Night awakenings, Physical activity, Information about the virus." The lockdown had a significant impact on Remote learning, Behavior changes, and Information about the virus in participants with autism. Moreover, we found a worsening in repetitive movements, echolalia, restricted interests, and aggressive behaviors.

A brief, parent-led, transdiagnostic cognitive behavioral therapy (CBT) approach demonstrated utility among youth struggling with emotional problems during the COVID-19 pandemic. Homework completion between sessions is directly associated with psychotherapy treatment outcomes in non-parent-led CBT interventions. The present study sought to examine the relationship between homework completion and treatment response in a parent-led transdiagnostic CBT protocol. The first aim was to determine if completion of between session CBT homework was associated with change in symptom severity. The second aim was to determine if pre-treatment anxiety severity, social anxiety severity, and depressive symptoms were associated with treatment outcomes. One-hundred twenty-nine parents of youth (ages 5-13) with significant emotional problems received 6 sessions of telehealth parent-led CBT during the COVID-19 pandemic. Data on children's anxiety symptomology, clinical severity, homework compliance, depression, family relationships, perceptions on the impacts of the pandemic, treatment response, and therapists rating of symptom improvement were collected. Homework completion explained 9% of the variance in symptom improvement at post-treatment. Greater homework completion was associated with a significantly higher odds of treatment response (OR = 1.52, p = 0.001). Child anxiety severity, depressive symptoms, family relationships, and perceptions on the impacts of the COVID-19 pandemic were not significantly related to treatment outcome. Completion of homework predicted treatment outcomes in parent-led, transdiagnostic CBT for youth with emotional problems during the COVID-19 pandemic, while controlling for parent-rated anxiety, depression, family relationships, and COVID-related distress. Enhancing and targeting homework compliance between CBT sessions should be a central element of parent-led treatment.

Objective: ADHD is subject to stigma from the general population. Exposure to stigma poses the risk of developing self-stigma of youth and parents, but few studies have focused on self-stigma of ADHD. Furthermore, parental factors have been implicated in self-stigma of youth, but no previous research has assessed the association between self-stigma of parents and youth. Therefore, the objective of this study was to better understand the experience of self-stigma of youth and their parents in the context of ADHD. Method: Fifty-five youth with ADHD (aged 8-17) and one parent reporter per youth completed surveys to report their experiences. Results: The results of this study found that both youth and parents reported significantly lower self-stigma scores compared to most previously published research. Parents of boys reported higher self-stigma scores compared to parents of girls. Youth who reported higher self-stigma also reported lower self-esteem. Self-stigma scores in youth were predicted by inattentive symptoms but not hyperactive/impulsive symptoms or parental self-stigma. Conclusion: Results emphasize the importance of understanding self-stigma of ADHD, symptom severity, and the need for interventions for families with ADHD.

Background: Stuttering, a neurodevelopmental speech fluency disorder, is associated with intermittent disruptions of speech-motor control. Behavioural treatments for adults who stutter (AWS) concentrate on adopting speech patterns that enhance fluency, such as speaking rhythmically or prolonging speech sounds. However, maintaining these treatment benefits can be challenging. Neuroimaging studies suggest that supplementary motor area (SMA) which play a crucial role in speech initiation, planning and internal timing shows aberrant activation in speech production of AWS and may contribute to stuttering. Preliminary evidence suggests that brain stimulation may impact responsiveness to behavioural treatments. Aims: The present study aims to investigate whether excitatory repetitive transcranial magnetic stimulation (rTMS) of the SMA and rhythmic speech can consistently reduce stuttering severity across various measures. Methods and Procedures: Ten self-identified Cantonese-speaking AWS participated in this double-blinded, sham-controlled clinical trial study (NCT 05472181). The participants underwent 10 sessions of rhythmic speech training across two phases, combined with either neuronavigated rTMS or sham, with a 2-week washout period between phases. The stuttering severity was assessed through various outcome measures, including the percentage of syllables stuttered, self-perceived stuttering severity, and the brief version of Unhelpful Thoughts and Beliefs About Stuttering before and after each treatment phase. Outcomes and Results: Results demonstrated improved speech fluency in various speaking contexts, with no significant difference between rTMS and sham conditions immediately and 1 week post-treatment. Notably, rTMS specifically led to less stuttering in tongue twister production (d = -0.70). Both treatment conditions effectively reduced self-perceived stuttering severity and negative thoughts and beliefs about stuttering. Conclusions and Implications: The findings of this study indicate that stimulating the SMA reduced stuttering, only in the production of tongue twisters that may require greater motor control and coordination. Furthermore, it indicates that rhythmic speech might help alleviate negative beliefs and anxiety related to stuttering. This research contributes to our understanding of neuromodulation in stuttering treatment and the role of the SMA in speech motor control and emphasises the need for more research on the potential benefits and limitations of applying rTMS in this condition.

This study aimed at analyzing the differences in challenging behaviors between adults with intellectual disability and ASD and those who only had intellectual disability, as well as to explore associations between transdiagnostic and clinical variables to these differences. Therapists and educators of 163 adults with intellectual disability (83 with additional ASD diagnosis) completed the test battery. Mean difference analysis and univariate analyses of covariance were performed to determine the impact of clinical variables and transdiagnostic variables on the frequency and severity of challenging behaviors. Results showed that adults with ASD and intellectual disability presented higher frequency and severity of these behaviors. A significant effect of the diagnosis of ASD on the frequency and severity of self-injuries and stereotypies was found. Also, some transdiagnostic variables influencing the presence of these behaviors were highlighted. These factors should be considered when planning and designing interventions for behavioral problems in this population.

This study reports on a five-year data set about the deaths of 599 individuals in New South Wales Australia, who at the time of their death were living in out-of-home care. Analysis aimed to: i) gain a clearer understanding of place of death for people with intellectual disability; and ii) identify and analyse associated variables to investigate how well they predict place of death for this population. Hospital admissions, polypharmacy and living situation were the strongest standalone predictors of place of death. A hospital death was more likely if the target population were subject to polypharmacy, lived in a group home, had a moderate intellectual disability or had GORD. Death, and place of death, is an issue requiring individual consideration. This study has identified some of the variables that need attention when supporting people with intellectual disability to have a good death.

Background: Children with intellectual and developmental disabilities are at a higher risk of developing dental caries. Few scoping reviews have been conducted in India to understand their issues. We aimed to summarise the distribution and risk factors of dental caries among children and adolescents with intellectual disabilities in India. Methods: A scoping review was conducted based on the Arksey O Malley framework. Quality assessment of studies, descriptive and thematic analyses were also conducted. Results: We charted, collated, and summarised from four databases. Thirty-one studies met the study criteria consisting of children and adolescents with intellectual disabilities. Median caries prevalence was 70%, decayed missing and fIlled permenant teeth (DMFT) was 2.4, decayed missing and filled decidous teeth (dmft) was 2.36, and DMFS was 3.7. Major determinants were the severity of disability, socioeconomic status and parents' education. Oral care and dental visits were inadequate. Conclusion: Further exploration is required to improve access and reduce caries experience and prevalence among children with intellectual and developmental disabilities in India.

Autism is heterogeneous, which complicates providing tailored support and future prospects. We aim to identify subgroups in autistic adults with average to high intelligence, to clarify if certain subgroups might need support. We included 14 questionnaire variables related to aging and/or autism (e.g., demographic, psychological, and lifestyle). Community detection analysis was used for subgroup identification in an original sample of 114 autistic adults with an adulthood diagnosis (autism) and 58 non-autistic adults as comparison group (COMP), and a replication sample (N[subscript Autism] = 261; N[subscript COMP] = 287), both aged 30-89 years. Next, we identified subgroups and assessed external validity (for cognitive and psychological difficulties, and quality of life [QoL]) in the autism samples. To test specificity, we repeated the analysis after adding 123 adults with ADHD, aged 30-80 years. As expected, the autism and COMP groups formed distinct subgroups. Among autistic adults, we identified three subgroups of which two were replicated. One of these subgroups seemed most vulnerable on the cluster variables; this subgroup also reported the most cognitive and psychological difficulties, and lowest QoL. Adding the ADHD group did not alter results. Within autistic adults, one subgroup could especially benefit from support and specialized care, although this must be tested in future studies.

Purpose: The heterogeneity of autism is well documented, but few studies have studied the heterogeneity of gesture production ability in autistic children. The present study aimed to identify subgroups of autistic children who displayed heterogeneous gesture production abilities and explore the underlying factors, including autism characteristics, intellectual ability, and language ability, that were associated with the heterogeneity. Methods: A total of 65 Chinese autistic children (mean age = 5;3) participated. Their autism characteristics and intellectual ability were assessed by standardized measurements. Language output and gesture production were captured from a parent-child interaction task. Results: We conducted a hierarchical cluster analysis and identified four distinct clusters. Cluster 1 and Cluster 2 both had low gesture production whereas Cluster 3 and Cluster 4 had high gesture production. Both Clusters 1 and 2 had relatively strong autism characteristics, in comparison to Clusters 3 and 4. Conclusions: Our findings revealed that children with stronger autism characteristics may gesture less often than those with weaker characteristics. However, the relationship between language ability and intellectual ability and gesture production was not clear. These findings shed light on the directions of intervention on gesture production for autistic children, especially those with stronger autism characteristics.

Prevalence of hearing loss in children with autism spectrum disorder (ASD) is uncertain, as it is more challenging to assess hearing function in children with developmental difficulties (DD). We aimed to determine the prevalence and profiles of hearing loss in preschool children with ASD in a Southeast-Asian population who passed newborn hearing screening. A retrospective study of preschool children with DD (ASD, Global Developmental Delay (GDD), and Speech and Language Delay (SLD)) attending the Child Development Unit (CDU) at our hospital was performed. Three hundred and thirty-three children (ASD: n = 129; GDD: n = 110; and SLD: n = 94) underwent hearing assessments. Of these, 10.8% of children (n = 36, comprising 15 with ASD, 12 with GDD and 9 with SLD) had confirmed hearing loss. Hearing loss was predominantly bilateral in children with ASD and GDD; in those with SLD, unilateral and bilateral hearing loss were equally common. Conductive hearing loss occurred as frequently as sensorineural hearing loss in children with ASD and SLD, but was the dominant subtype in those with GDD. Moderate to severe hearing loss (n = 2) was noted only in children with ASD. Children with ASD and GDD required significantly more audiology visits and procedures to obtain conclusive hearing test results, compared to those with SLD. The need to identify hearing loss and monitor for resolution is particularly important in vulnerable populations with communication deficits, such as in those with ASD.

Autistic youth are more likely to experience depression than their non-autistic peers, yet research on risk and protective factors to depression in this population is limited. Behavioral activation (i.e., prioritizing and engaging in meaningful activities), including social activities, is an important mechanism in the pathway to depression in non-autistic youth that is understudied in autism. Ratings of youth depressive symptoms and behavioral and social activation at one timepoint from 100 autistic youth without intellectual disability and 100 of their caregivers were analyzed. The study aims were to examine caregiver and youth ratings of youth internalizing symptoms and behavioral and social activation, inter-rater reliability on study variables, and associations between depressive symptoms and behavioral and social activation in autistic youth by rater. Results revealed significant differences in youth and caregiver ratings on all variables and inter-rater reliability ranged from poor to moderate. Across both raters, more severe anxiety symptoms and lower behavioral activation were associated with more severe depressive symptoms; social activation, specifically the number of friends youth have, was significant in caregiver ratings only. Findings can be leveraged to enhance risk stratification and intervention efforts for autistic youth experiencing depression.

Children with autistic symptoms experience challenges in school settings, yet little is known about their academic profiles and the mechanisms underlying the association between autistic symptoms and academic achievement. This study examined the association between autistic symptoms and academic achievement in a population-based sample of children with and without (sub)clinical autism spectrum disorder (ASD). We also investigated potential sex differences and assessed if the association is mediated by vocabulary skills and behavior problems. Information was available for 2038 participants (48.3% boys), and autistic symptoms were assessed using the Social Responsiveness Scale (M = 6.8 years). Diagnosis of ASD was clinically confirmed in 28 children. Academic achievement was determined by a nationwide, standardized test assessed at the end of primary school (M = 11.8 years). Children with more autistic symptoms in early childhood had lower achievement scores in language, mathematics, and world orientation by the end of primary education. There were no sex differences. Furthermore, vocabulary skills and behavior problems partly mediated the association between autistic symptoms and academic achievement. Then, by using propensity matching technique, we compared 140 matched typically developing peers with 28 children diagnosed with ASD. These results indicated no differences in academic achievement between children diagnosed with ASD and their matched typically developing peers. We conclude that autistic symptoms associate with lower academic achievement but by carefully matching on background variables and potential confounders, the academic achievement of children with clinical ASD might not differ from that of their typically developing peers.

When studies use different scales to measure continuous outcomes, standardised mean differences (SMD) are required to meta-analyse the data. However, outcomes are often reported as endpoint or change from baseline scores. Combining corresponding SMDs can be problematic and available guidance advises against this practice. We aimed to examine the impact of combining the two types of SMD in meta-analyses of depression severity. We used individual participant data on pharmacological interventions (89 studies, 27,409 participants) and internet-delivered cognitive behavioural therapy (iCBT; 61 studies, 13,687 participants) for depression to compare endpoint and change from baseline SMDs at the study level. Next, we performed pairwise (PWMA) and network meta-analyses (NMA) using endpoint SMDs, change from baseline SMDs, or a mixture of the two. Study-specific SMDs calculated from endpoint and change from baseline data were largely similar, although for iCBT interventions 25% of the studies at 3 months were associated with important differences between study-specific SMDs (median 0.01, IQR -0.10, 0.13) especially in smaller trials with baseline imbalances. However, when pooled, the differences between endpoint and change SMDs were negligible. Pooling only the more favourable of the two SMDs did not materially affect meta-analyses, resulting in differences of pooled SMDs up to 0.05 and 0.13 in the pharmacological and iCBT datasets, respectively. Our findings have implications for meta-analyses in depression, where we showed that the choice between endpoint and change scores for estimating SMDs had immaterial impact on summary meta-analytic estimates. Future studies should replicate and extend our analyses to fields other than depression.

This study aimed to investigate the gap between adaptive functioning and cognitive functioning, especially verbal and nonverbal intelligence quotient (IQ) in Chinese children with ASD. We systematically explored cognitive functioning, ASD severity, early signs of developmental abnormalities, and socioeconomic factors as mediating factors of adaptive functioning. We enrolled 151 children (age: 2.5?6 years) with ASD and categorized them into one group with IQ [greater than or equal to] 70 and another with IQ < 70. The two groups were calibrated for age, age at diagnosis, and IQ, and the relationship of adaptive skills with vocabulary acquisition index (VAI) and nonverbal index (NVI) were separately analyzed. Results show that the gap between IQ and adaptive functioning was significant in children with ASD having IQ [greater than or equal to] 70, with both VAI and NVI showing statistically significant differences (all P < 0.001). VAI correlated positively with scores for overall adaptive skills and specific domains, whereas NVI had no significant correlations with adaptive skill scores. Age of first walking unaided had an independent positive correlation (all P < 0.05) with scores of adaptive skills and specific domains. IQ-adaptive functioning gap is significant in children with ASD having IQ [greater than or equal to] 70, suggesting that defining "high-functioning autism" merely on the basis of IQ is not appropriate. Verbal IQ and early signs of motor development are specific and possible predictors of adaptive functioning in children with ASD, respectively.

Active methodologies such as gamification, combined with emerging technologies like augmented reality, are enhancing learning environments that facilitate the development of essential competencies. Particularly, students with Autism Spectrum Disorder (ASD) require reinforcement of their Communicative Competence (CC) to activate their abilities to communicate effectively in different contexts, and interventions supported by this type of methodology and resources can contribute to this goal. The aim of this study is to analyse the contribution of an Augmented Gamified Environment to the development of CC in a sample of 54 subjects diagnosed in public Special Education centres. Correlational methodology is adopted with an exploratory and analytical approach. Individualized intervention sought to relate students' level of interaction and immersion in the environment's narrative to the increase in their CC. Their degree of autonomy when interacting with the tablet and immersion in the game was measured using observation-based instruments with categories that allowed for subsequent statistical analysis. Additionally, the influence of gender, age, severity of ASD, comorbidities, and type of language on the level of competence achieved was contrasted. The results show that engagement in mission execution favoured their CC. It was observed that the higher the immersion in the challenges, the higher the CC of the students. Specifically, older students with less severe ASD, functional oral language, and no comorbidity exhibited higher levels of CC. In conclusion, intervention for optimal results must be tailored to individual characteristics, present engaging narratives, and integrate playful activities that require communicative strategies.

Anxiety, an affective factor, is pivotal in language learners' success or failure. Findings pointed to its correlation with oral performance, test results, and language skills, namely listening and writing, but only a little with reading. At the current research site, a Vietnamese context, very little evaluation on reading anxiety in English foreign language learning could be found. Therefore, this investigation aimed to explore learners' English foreign language reading anxiety levels, reading techniques used, and the correlation between foreign language reading anxiety (FLRA) and reading strategies (RS). A cross-sectional survey was conducted on 324 university students (including 152 females and 172 males) in a private educational Vietnamese context with two main data-gathering instruments: the Foreign Language Reading Anxiety Scale (FLRAS) and Survey of Reading Strategies (SORS). Results revealed a moderate level of reading anxiety among 68.5% of respondents, while 31.4% had hi- and lo-anxiety levels with the same percentage of 15.7% each. Regarding reading techniques, Problem-Solving Strategies were found to be the most favorable, and those with lo-anxiety used strategic reading more regularly than the others (hi- and mid-anxiety level groups). When it comes to the correlation between FLRA and RS, a statistically negative correlation was found. It means FLRA could decrease when RS increases. Additionally, FLRA was negatively correlated with three RS subscales. Based on the findings, several pedagogical implications were also discussed.

Purpose: The current study examined the predictive role of gestures and gesture-speech combinations on later spoken language outcomes in minimally verbal (MV) autistic children enrolled in a blended naturalistic developmental/behavioral intervention (Joint Attention, Symbolic Play, Engagement, and Regulation [JASPER] + Enhanced Milieu Teaching [EMT]). Method: Participants were 50 MV autistic children (40 boys), ages 54-105 months (M = 75.54, SD = 16.45). MV was defined as producing fewer than 20 spontaneous, unique, and socially communicative words. Autism symptom severity (Autism Diagnostic Observation Schedule--Second Edition) and nonverbal cognitive skills (Leiter-R Brief IQ) were assessed at entry. A natural language sample (NLS), a 20-min examiner-child interaction with specified toys, was collected at entry (Week 1) and exit (Week 18) from JASPER + EMT intervention. The NLS was coded for gestures (deictic, conventional, and representational) and gesture-speech combinations (reinforcing, disambiguating, supplementary, other) at entry and spoken language outcomes: speech quantity (rate of speech utterances) and speech quality (number of different words [NDW] and mean length of utterance in words [MLUw]) at exit using European Distributed Corpora Project Linguistic Annotator and Systematic Analysis of Language Transcripts. Results: Controlling for nonverbal IQ and autism symptom severity at entry, rate of gesture-speech combinations (but not gestures alone) at entry was a significant predictor of rate of speech utterances and MLUw at exit. The rate of supplementary gesture-speech combinations, in particular, significantly predicted rate of speech utterances and NDW at exit. Conclusion: These findings highlight the critical importance of gestural communication, particularly gesture-speech (supplementary) combinations in supporting spoken language development in MV autistic children.

Purpose: Caregivers share critical insight during their child's stuttering evaluation; yet, there have been no empirical studies evaluating whether caregivers provide similar accounts of their 3- to 6-year-old child's communication attitude compared to their child's self-report. This study examined caregiver- and child-reported communication attitude and assessed potential moderators of more comparable caregiver and child ratings (i.e., caregiver confidence, caregiver-child conflict, observer-rated stuttering severity). Method: One hundred thirteen children who stutter ages 3 through 6 years and a primary caregiver were recruited from clinical settings across the United States. Children completed the Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (KiddyCAT) and three speaking samples, which were recorded to assess observer-rated stuttering severity using the Stuttering Severity Instrument--Fourth Edition. Caregivers predicted their child's communication attitude (C-KiddyCAT) and provided a confidence rating for their prediction. Caregivers also rated caregiver-child conflict using the Child-Parent Relationship Scale-Short Form (CPRS-SF). Multiple regression was used to (a) evaluate whether caregiver C-KiddyCAT scores predicted child KiddyCAT scores and (b) assess potential moderators of the relationship between C-KiddyCAT and KiddyCAT scores. Results: Caregiver ratings of their child's communication attitude (C-KiddyCAT) predicted child communication attitude ratings (KiddyCAT). A significant interaction between caregiver-child conflict (CPRS-SF) and caregiver ratings of their child's communication attitude (C-KiddyCAT) suggested caregiver-child conflict changed the underlying relationship between C-KiddyCAT and KiddyCAT scores, such that low conflict resulted in more similar C-KiddyCAT and KiddyCAT scores. Neither caregiver confidence nor observer-rated stuttering severity influenced the relationship between C-KiddyCAT and KiddyCAT scores. Conclusions: Although many caregivers predicted communication attitude ratings that closely aligned with their child's report, some caregiver-child dyads provided divergent ratings. Clinicians should interpret caregiver predictions of their child's communication attitude within the context of their full evaluation and the caregiver-child relationship. Assessing both self-reported communication attitude and caregiver predictions of their child's communication attitude provides a meaningful starting point to counseling caregivers about cognitive components of stuttering for preschool- and kindergarten-age children who stutter.

Background: Endovascular clot retrieval (ECR) is known to reduce global disability at 3 months post stroke however limited research exists regarding the trajectory of specific clinical impairments including language, swallowing and cognitive deficits between onset and 3 months. Aims: To assess language, swallowing, and cognitive performance following ECR and explore whether impairment severity is correlated with modified Thrombolysis in Cerebral Infarction score (mTICI), stroke severity or quality of life (QoL). Methods: Assessment was completed within 7 days (T1), 1 month (T2) and 3 months (T3) post-stroke. Performance was measured with the Functional Oral Intake Scale (FOIS), Repeatable Battery for Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT A and B) and Brixton Spatial Awareness Test. The Western Aphasia Battery (WAB) was used for left hemisphere stroke. QoL was measured with the Stroke and Aphasia Quality of Life Scale. Results: Twenty-five participants (median 72 years; 64% male) were prospectively recruited following ECR. High reperfusion success (68% mTICI 3) and low stroke severity post ECR (median 24 h NIHSS = 3, IQR 7-18) were noted. At T1, 10 participants presented with aphasia, eight required a modified diet and 20 had impaired cognition. At T3 all had recovered to a normal oral diet, 39% had persistent cognitive impairment and 45% of patients with left hemisphere stroke remained aphasic. Performance on the WAB, FOIS, RBANS and TMT changed significantly over time (all p < 0.05). The severity score at T1 for all measures, excluding TMT B and Brixton, was significantly correlated with 24 h NIHSS. WAB scores at T3 were correlated with QoL (r = 0.618; p = 0.043). Conclusion: This exploratory study found the longitudinal performance of language, swallowing and cognition significantly improved over time and severity in the first-week post-ECR was correlated with 24 h NIHSS rather than the degree of reperfusion.

Young people with developmental language disorder (DLD) often have poorer mental health compared to those without DLD. However, not all young people with DLD experience such difficulties. Two hundred and eighty-one young people at risk of DLD (45% Female; 53% White British) were identified from a UK based population-cohort. Main caregivers completed questionnaires about their early life (<5 years) and their mental health (at 14 years). Parent-child conflict was revealed to be an early risk factor for all mental health outcomes, at age 14. Additionally, harsh discipline and second-hand smoke predicted worse externalising problems, and gender differences predicted worse internalising problems. Further findings demonstrated that, as the number of risk factors increased, so did the severity of mental health difficulties.

Best practice for the assessment of autism spectrum disorder (ASD) symptom severity relies on clinician ratings of the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), but the association of these ratings with objective measures of children's social gaze and smiling is unknown. Sixty-six preschool-age children (49 boys, M = 39.97 months, SD = 10.58) with suspected ASD (61 confirmed ASD) were administered the ADOS-2 and provided social affect calibrated severity scores (SA CSS). Children's social gaze and smiling during the ADOS-2, captured with a camera contained in eyeglasses worn by the examiner and parent, were obtained via a computer vision processing pipeline. Children who gazed more at their parents (p = 0.04) and whose gaze at their parents involved more smiling (p = 0.02) received lower social affect severity scores, indicating fewer social affect symptoms, adjusted R[superscript 2] = 0.15, p = 0.003.

Autism is associated with genomic instability, which is regulated by telomere length (TL) and index of global methylation (LINE-1). This study will determine relative TL (RTL) and LINE-1 methylation percentage for 69 patients and 33 control subjects to evaluate their potential role as biomarkers for autism. The results displayed a significant decrease of both RTL and LINE-1 methylation in autistic cases relative to controls (P < 0.001). Analysis of receiver operating characteristics curve revealed that both of RTL and LINE-1 methylation percentage have the ability to serve as autism biomarkers (area under the curve = 0.817 and 0.889, respectively). The statistical analysis revealed positive correlation between the two biomarkers (correlation coefficient = 0.439 and P < 0.001).

Few studies have examined differences in autism spectrum disorder (ASD) phenotype between children from multiplex and simplex families at the time of diagnosis. The present study used an age- and gender-matched, community-based sample (n = 105) from the southwestern United States to examine differences in ASD symptom severity, cognitive development, and adaptive functioning. No significant differences between children from multiplex and simplex families were observed. Exploratory analysis revealed that parents underreported receptive and expressive language and fine motor skills compared to professional observation, especially among children from multiplex families. These findings suggest that diagnosticians may need to consider family structure when choosing and interpreting assessments of receptive language, expressive language, and fine motor skills.

Background: This study investigated differences in the clinical and demographic characteristics of individuals with intellectual disabilities delayed in assessment and treatment hospitals versus individuals who were not delayed. The study further investigated the clinical outcomes of the individuals whose discharge from the hospital was delayed. Method: This was a cohort study using secondary data collected from patient records. Variables included age, ethnicity, levels of deprivation, areas of origin, diagnoses, and the provision of a care and treatment review. A comparison was made between individuals who became delayed despite being clinically ready for discharge and those who were discharged on time. Findings: Individuals with severe intellectual disabilities were more likely to experience delayed discharge from hospital (p = 0.001). Similarly, people who were admitted to hospitals away from their home areas were also more likely to experience delayed discharge (p < 0.001). There were no significant differences between the delayed and nondelayed groups for other factors such as age, deprivation or ethnicity. Individuals who experienced a delay in discharge did not experience an increased rate of adverse incidents compared to the period of active treatment and clinical improvements were maintained during the period of delay. There were low rates of completion of care and treatment reviews before admission, although people who were delayed were more likely to have received a review during admission (78.8% vs. 27.1%). Conclusion: It is important for clinicians and service development leads to be aware that people who are admitted away from their home area and people with severe intellectual disabilities may be at higher risk of experiencing significantly delayed discharge from the hospital. More broadly, many people remained in hospital for a substantial length of time after being assessed as clinically ready for discharge. Due to the low rates of completion before admission, the expansion of community-based care and treatment reviews should also be explored. While people did not suffer increased rates of adverse incidents during their extended stay, their liberty was still restricted, hence there should be a focus on effective community provision. The current model of relying on the willingness of independent providers to support the care of complex individuals requires significant reform.

Mortality disparities among persons with intellectual disability are important to guide health-care practices. The objective was to evaluate mortality patterns of persons with intellectual disability in a nationwide study from 1976 to 2020. This study establishes a Danish nationwide cohort of persons with intellectual disability and age- and sex-matched reference cohort through linkage between several registers. We established a cohort of 79,114 persons with intellectual disability. Standardized mortality ratios were increased for persons with intellectual disability, most pronounced among younger persons and among females. Life expectancies were markedly lower; among persons with intellectual disability 63.6 years among females and 59.8 years among males in 2016-2020 compared to 82.4 and 78.7 years among females and males in the reference cohort. Life expectancies decreased with severity of intellectual disability. This study reports the establishment of a nationwide Danish cohort of persons with intellectual disability.

School absenteeism among children and adolescents has been associated with a myriad of adverse outcomes. Despite a substantial amount of research on school attendance, our understanding of absenteeism in elementary-aged children with mental health difficulties is limited. The current study used a mixed-method sequential explanatory design to gain a better understanding of the links between children's mental health symptoms, age, gender and school absenteeism. The study included two phases: Phase I presented a quantitative investigation of the links between absenteeism and mental health symptoms in a large sample (N = 750) of primarily White (74%) clinic-referred children aged 5-12 years. Phase II used a participant selection model and chart review design to garner a deeper understanding of how school absenteeism presents in children with mental health problems in the elementary years. Results suggested that internalizing symptoms were significantly related to school attendance problems, and this association worsens as children age and as internalizing symptoms increase in severity. Externalizing symptoms were associated with absenteeism as well, but these findings showed that school attendance problems were worse for younger children with low to moderate levels of externalizing symptoms. The qualitative chart review illustrates the complex interplay of school absenteeism and child mental health, particularly for children experiencing co-occurring internalizing and externalizing problems. Children often struggled academically and socially, with some exhibiting increasing levels of school refusal and truancy and others displaying aggressive behaviors resulting in suspensions. Future studies that examine additional contextual factors, such as school and family variables, with longitudinal cross-lagged models and diverse families are needed to develop a comprehensive understanding of causal associations and their impact on children's school attendance across children's development.

Well-being is a balanced way for a disabled child to interact with himself and others and feel comfortable and happy in the activities of his daily life. It also indicates the safety of the mentally disabled child, and that he is free from mental disorders and diseases. This achieves high levels of compatibility, and adaptability to his life quality. Therefore, this study aimed to reveal the level of well-being of children aged 6-12 years with disabilities from the point of view of their parents. Also, it attempted to show any statistical differences in them according to the variables of the disabled child's gender, the type of disability, and the severity of the disability. The descriptive survey method was used. The questionnaire was used as a tool for collecting data. It was applied to a purposive sample of 295 parents of children aged 6-12 years with disabilities in Najran region, southern Saudi Arabia, in 2022. The results showed a weak degree of well-being level for children aged 6-12) years with disabilities from the point of view of the study sample. The results also revealed statistically significant differences in the level of well-being among children aged 6-12 years with disabilities due to the gender of the disabled child in favor of males, the type of disability in favor of learning disabilities, and the severity of disability in favor of the simple disability. The study suggested multiple recommendations focusing on engaging disabled children in extracurricular activities, providing psychological support programs for them, and directing future research to work on identifying ways to confront the difficulties that hinder the progress of disabled children toward acceptable levels of well-being.