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ImportanceHeterogeneous mental health outcomes during the COVID-19 pandemic are recognized in the general population, but it has not been systematically assessed in youth with neurodevelopmental disorders (NDD), including autism spectrum (ASD).ObjectiveIdentify subgroups of youth with ASD/NDD based on the pandemic impact on symptoms and service changes, as well as predictors of outcomes.Design, Setting, and ParticipantsThis is a naturalistic observational study conducted across 14 North American and European clinical and/or research sites. Parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) adapted for Autism and Related Neurodevelopmental Conditions (AFAR) were cross-sectionally collected from April to October 2020. The sample included 1275, 5-21 year-old youth with ASD and/or NDD who were clinically well-characterized prior to the pandemic.Main Outcomes and MeasuresTo identify impact subgroups, hierarchical clustering analyzed eleven AFAR factors measuring pre- to pandemic changes in clinically relevant symptoms and service access. Random forest classification assessed the relative contribution in predicting subgroup membership of 20 features including socio-demographics, pre-pandemic service, and clinical severity along with indices of COVID-19 related experiences and environments empirically-derived from AFAR parent responses and global open sources.ResultsClustering analyses revealed four ASD/NDD impact subgroups. One subgroup - broad symptom worsening only (20% of the aggregate sample) - included youth with worsening symptoms that were above and beyond that of their ASD/NDD peers and with similar service disruptions as those in the aggregate average. The three other subgroups showed symptom changes similar to the aggregate average but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Pre-pandemic factors (e.g., number of services), pandemic environments and experiences (e.g., COVID-19 cases, related restrictions, COVID-19 Worries), and age emerged in unique combinations as distinct protective or risk factors for each subgroup. Together they highlighted the role of universal risk factors, such as risk perception, and the protective role of services before and during the pandemic, in middle childhood.Conclusions and RelevanceConcomitant assessment of changes in both symptoms and services access is critical to understand heterogeneous impact of the pandemic on ASD/NDD youth. It enabled the delineation of pathways to risk and resilience that include universal and ASD/NDD specific contributors.

Genetics, environment, and their interactions impact autism spectrum disorder etiology. Smoking is a suspected autism spectrum disorder risk factor due to biological plausibility and high prevalence. Using two large epidemiological samples, we examined whether autism spectrum disorder was associated with prenatal paternal smoking in a Discovery sample ( N = 10,245) and an independent Replication sample ( N = 29,773). Paternal smoking was retrospectively assessed with questionnaires. Likelihood of having autism spectrum disorder was estimated with the Autism Spectrum Screening Questionnaire at three levels: low (Lay abstract What is Already Known about This Subject: Genetics, (including de novo mutations), environmental factors (including toxic exposures), and their interactions impact autism spectrum disorder etiology. Paternal smoking is a candidate risk for autism spectrum disorder due to biological plausibility, high prevalence, and potential intervention. What This Study Adds: This original study and its replication confirms that paternal factors can substantially contribute to autism spectrum disorder risk for their offspring. It specifically indicates that paternal smoking both before and during pregnancy contributes significantly to autism spectrum disorder risk. Implications for practice, research, or policy: Smoking prevention, especially in pregnancy planning, may decrease autism spectrum disorder risk in offspring.

UCLA PEERS® for Adolescents is a widely applied program among a number of social skills training programs developed over the years. We synthesized current research evidence on the PEERS program to evaluate the treatment effect on four commonly used outcome measures. 12 studies met inclusion criteria for the review and nine met the criteria for meta-analysis. Results showed moderate to large pooled effects across measures and informants in favor of the PEERS program, with the largest effect seen in social knowledge improvement and the smallest effect in the frequency of get-togethers. The heterogeneity of effects across studies were examined and the limitations of the current evidence were discussed.

Introduction Atypical response to sensory stimuli is common in the autism spectrum disorder (ASD) population. While sensory over-responsivity in the gustatory domain (GOR) among ASD has been frequently reported, previous reviews were not solely focused on GOR in the ASD population. This review sheds light on pertinent sensory functions in ASD, differences in GOR between those with and without ASD, and concepts related to GOR in ASD. Results Neurobiological mechanisms in GOR were less studied in the population with ASD. Also, it is not clear if GOR is from difficulties of differentiation, detection threshold, and multisensory integration. Among thirty-six studies using behavioral questionnaires, a greater proportion of ASD (36-72%) had GOR compared to typically developing (TD, 20%) individuals. Furthermore, the ASD population repeatedly showed severe GOR scores relative to the TD cohort. Brain imaging studies suggested aberrant neural responses to oral stimuli as a contributing factor. It is posited that GOR contributes to food selectivity and poor dental care among ASDs. Poor nutritional outcomes among ASDs are controversial. However, severe GOR and food selectivity in reported cases present life-threatening events like pulmonary hypertension mediated by vitamin deficiencies. In addition, being underweight or overweight was associated with GOR in youths with ASD, raising a chronic health concern for general health and well-being. Another emerging consideration is the role of gut microbiome disruption in individuals with ASD and its relationship with GOR. Finally, the ASD population showed more common gastrointestinal problems than their TD counterparts, implying that GOR could be a consequence of anxiety from prior gastrointestinal experiences. Conclusion To provide families with ASD with an environment that promotes healthy development and growth, we need further research, development of clinical management, and policy changes. Thus, we recommend the targeted study of the neural mechanisms, microbiome consequences, and evidence-based intervention for GOR in ASDs.

Backgrounds Despite multiple studies demonstrating no relationship between childhood vaccination and increasing Autism Spectrum Disorder (ASD) prevalence, parental fear for vaccination and subsequent refusal to vaccinate their children continue, resulting in recent outbreaks of childhood infections such as measles in the US. We examine the relationship between the completion of 6 recommended vaccinations in childhood and the likelihood for having developmental psychopathology. Methods Two large-scale South Korean epidemiologic samples were used to examine whether completion of childhood vaccinations decrease likelihood of having ASD as assessed by Autism Spectrum Screening Questionnaire (ASSQ) and behavioral problems scores. Parental reports on vaccination completion were categorized in groups: Results 84.3 % of DS and 80.1 % of RS participants were fully vaccinated. In the DS, after adjusting for demographics and confounders, children with incomplete-vaccinations were at greater risk for ASD when compared to those fully vaccinated (adjusted odds ratio [aOR] = 1.42, 95 % Confidence Interval [CI] 1.17−1.73 with 4−5 vaccinations; aOR = 2.33, CI 1.53−3.56 with vaccination Conclusions We replicate our own and prior findings that vaccination does not increase ASD risk. Further, completing recommended vaccinations may offer protection against the risk of having ASD and other developmental psychopathology.