Serious games are digital games designed for education or therapy. Virtual reality (VR)-based serious games have shown potential in enhancing motor learning, but their role in improving gross motor skills in children with ASD in special education remains underexplored. This randomized controlled trial examined the effectiveness of VR-based serious games in improving gross motor skills in children with ASD. Forty children (6-12 years) from Changsha Special Educational School were randomly assigned to an experimental group (n = 20) receiving VR-based serious game training, or a control group (n = 20) attending traditional physical education classes. The 12-week intervention was assessed using the Test of Gross Motor Development-2 (TGMD-2). The experimental group used a multimedia VR system with nine motor rehabilitation games. After the intervention, both groups showed significant improvements in gross motor skills, but the experimental group showed greater gains in locomotor and object control skills, with significant time × group interaction effects. Despite improvements, average gross motor scores remained below the expected norms, highlighting persistent motor skill challenges. These findings support VR-based serious games as a valuable tool in special education, warranting further exploration for long-term interventions and broader adoption in school settings.

Autism diagnostic criteria relate to difficulties in functioning across multiple developmental domains, that often impact on a person's independence. There are different ways to conceptualise and exercise independence, but no previous studies have questioned how autistic adults do so. This qualitative study aimed to understand how autistic adults define and experience independence. It was designed to further our understanding of how autistic adults account for and use coping strategies to overcome barriers to independent living and navigate their way to their desired level of independence. Twelve semi-structured interviews were conducted with autistic adults living in the United Kingdom. The data were analysed using reflexive thematic analysis. The researchers generated three major themes. The first theme 'Independence is "not a one-size-fits-all"' highlights that there is no one definition or concept of independence for autistic people; these are relative and uniquely individual. The second theme '"Being autistic has its setbacks" in a neurotypical world' describes the obstacles encountered by autistic adults seeking independence within a society that favours neurotypical norms. The third theme 'Finding ways of making it work' captures strategies autistic adults use in achieving or maintaining independence. The findings from this study provide a foundation for future research exploring domains of independence for autistic adults. The perceived desirability of achieving different degrees of in(ter)dependence and the fluctuating nature of self-sufficiency are explored through lived experience. Increasing understanding of barriers and challenges to independence has the potential to empower autistic adults and improve services and support.

Autism early intervention research has indicated a research-to-practice gap, including continued use of practices with inadequate research support, and insufficient use of empirically supported practices. The present study explored the processes and mechanisms through which providers working with young children on the autism spectrum learn, select, and implement the various practices in their clinical repertoires. We addressed the role of providers' priorities, competence, and experience with (and needs for) professional development (PD), as well as whether, in clinical practice, a provider selects for implementation interventions based on domains.

High sleep quality in parents has been linked to positive parenting outcomes, including reduced parenting stress and increased life satisfaction. However, the daily dynamics of these factors remain underexplored, especially in families of children with autism spectrum disorder (ASD). This study examined the reciprocal relationships between daily sleep quality, parenting stress, and life satisfaction among parents of children with ASD. Seventy-five Chinese parents (M = 36.21 years, SD = 3.77 years; 57 mothers) of children with ASD (M = 5.43 years, SD = 1.56 years; 67 boys) participated in a 14-day diary study. Parents reported their subjective sleep quality, parenting stress, and life satisfaction at the same time each day across 7 survey questions. Dynamic structural equation modeling revealed two significant autoregressive effects: parents' perceptions of parenting stress and life satisfaction on a given day tended to persist into the following day. Moreover, better-than-average sleep quality on a given night predicted lower parenting stress and higher life satisfaction the next day. However, daytime fluctuations in parenting stress and life satisfaction did not influence sleep quality that night. hese preliminary findings suggest a unidirectional impact of sleep quality on perceived parenting stress and life satisfaction among these parents. Target interventions aimed at improving sleep quality, such as cognitive-behavioral therapy for insomnia (CBT-I) or structured sleep hygiene programs, may be essential for reducing parenting stress and enhancing life satisfaction in parents of children with ASD. These interventions should prioritize promoting consistent sleep routines and managing stress-related sleep disruptions.

The aim of this study was to compare differences in cognitive, adaptive, and language function in young children referred for concerns for autism spectrum disorder (ASD) who are diagnosed with ASD vs those not diagnosed with ASD (no ASD). This prospective diagnostic study of 349 children < 6 years of age, with 250 diagnosed with ASD and 99 with no ASD, was conducted at 8 diagnostic centers. There were no differences in cognition between those diagnosed with ASD and those with no ASD. As compared to those with no ASD, children with ASD had significantly lower language and adaptive functioning. Children with no ASD had language and adaptive functioning similar to their cognitive function. Differences between developmental domains were also compared within the ASD and no ASD groups. There were no differences between any 2 areas of function in the no ASD group. However, there were significant differences within the ASD group, with cognitive function significantly higher than both language function and adaptive function. This study suggests that a discrepancy between adaptive and language skills beyond that expected based on cognitive function should heighten concern for ASD. Beyond the categorical diagnosis of ASD, it is important to assess all these developmental domains to develop comprehensive plans for interventions.

Autism spectrum disorder (ASD) is a developmental disorder that warrants early intervention. This systematic review evaluated the efficacy of parent-mediated natural developmental behavioral interventions (NDBIs) for children aged 0-6 with ASD across various randomized controlled trials (RCTs) and explored the limitations of these interventions. A systematic search was conducted across the PubMed, Web of Science, Embase, and Scopus databases to identify RCTs, and the selected studies were assessed for quality. The search was conducted through January 2024 and identified eight RCTs that, despite varying methodological rigor, collectively suggest benefits for social communication, language skills, and parent‒child interactions in individuals with ASD. Future research should implement standardized intervention protocols, employ sensitive assessment tools, and provide detailed statistical analysis plans to improve the generalizability and reliability of the outcomes of this study.

Several studies have investigated false memory production in autistic adults, yet it remains unclear whether susceptibility to false memories differs from non-autistic adults and what mechanisms might contribute to any differences. This study examines the mechanisms behind false memory formation in autistic adults using the Deese-Roediger-McDermott (DRM) paradigm.

Identifying a "core deficit" is essential for early detection and intervention in developmental disorders among children. However, the presence of a core deficit within autism spectrum disorder (ASD) continues to be unclear. Therefore, the purpose of this study was to examine the possibility of the core deficit in autism spectrum disorders. This study evaluated 543 children diagnosed with ASD by using Chinese version of the Psychoeducational Profile-Third Edition (CPEP-3). Structural equation modeling (SEM) was used to construct single-factor models (assuming the presence of a core deficit) and a multi-factor model (assuming the absence of core deficits) based on the assessed data, and then to compare the fit of the two types of models. Assessments revealed developmental delays and adaptive challenges among the children with ASD. The single-factor model assuming the "motor" domain as the "core deficit" showed a superior fit (CFI = 0.86, AIC = 356.47, ECVI = 0.66) than other single-factor models. The multi-factor model, which assumes no core deficit, provided a better fit and greater predictive accuracy (CFI = 0.87, AIC = 351.94, ECVI = 0.65) than all single-factor models. ASD is characterized by widespread developmental delays and adaptive challenges. While motor impairment may serve as an effective predictor of these issues, it does not fully account for the diverse and complex symptomatology observed in children with ASD. The symptoms in these children likely arise from multiple factors, which are not adequately explained by a single core deficit model.

The purpose of this research study was to determine the effect of self-monitoring with I-Connect on communication initiation attempts by elementary school students on the autism spectrum who are non-speaking or minimally speaking and participate in an alternate assessment. Initiations are essential for developing basic communication skills for this population of students.

Children with autism spectrum disorder (ASD) are at heightened risk of unintentional drowning. We examined the epidemiological patterns of unintentional drowning incidents involving children diagnosed with ASD treated in US emergency departments (EDs). Data for this study came from the 2016-2020 Nationwide ED Sample. Children aged 1-19 years diagnosed with ASD and treated in EDs were identified using ICD-10-CM code F84.0. Weighted multivariable logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of drowning-related ED visits associated with ASD. During the study period, there were an estimated 21,226 unintentional drowning-related ED visits in children, including 369 in children diagnosed with ASD. Compared to children without ASD, ED visits for unintentional drownings in children with ASD were more likely to have occurred in swimming pools (47.45% vs. 41.21%), natural water (15.55% vs. 8.82%), and bathtubs (8.08% vs. 4.79%). Among children with ASD, unintentional drowning-related ED visits occurred more commonly in children > 10 years (43.20% vs. 18.19%) and were more likely to result in hospital admission (35.14% vs. 22.02%) than among children without ASD. With adjustment for demographic characteristics, ASD was associated with more than a 2-fold increased odds of ED-treated unintentional drowning (aOR = 2.31; 95% CI 1.84, 2.89). Epidemiologic patterns of unintentional drowning are different between children with and without ASD. Targeted interventions designed to increase supervision, provide adaptive swimming lessons, and enhance environmental safety may reduce the risk of unintentional drownings among children diagnosed with ASD.

Despite extensive research efforts, it is unclear how autistic and non-autistic individuals compare in their ability to recognize emotions. Differences in demographic and task factors have been proposed as explanations for divergent findings, but limitations in samples and designs have obscured insight into this possibility. This study investigated the extent of emotion recognition differences among autistic adults and the influence of these factors upon them. We recruited a large sample of autistic and non-autistic adults (N = 1,239) spanning across adulthood (18-76 years). In three online experiments, we compared their performance in recognizing emotions from basic facial expressions, complex expressions conveyed by the eyes alone, and prosodic elements of speech. Autistic individuals performed as well as non-autistic ones in terms of recognition accuracy/sensitivity across measures and emotional categories but took longer to do so. We also detected comparable influences of age, estimated intelligence quotient, and gender (as well as task demands) on both groups. While autistic adults may differ in how they process emotional stimuli, they can do so effectively when given sufficient time. Accordingly, efforts to help autistic individuals improve their ability to recognize emotions may be more fruitful if they focus on efficiency over accuracy. Additionally, reaction time data may offer greater insight than accuracy into differences between autistic and non-autistic individuals on emotion recognition tasks. The similar effects of the demographic and task factors we analyzed on both groups suggest that explanations of the discrepancies in prior literature lie elsewhere.

Few studies have asked autistic adults and caregivers directly about what has most positively and negatively impacted their lives. This study sought to: (a) identify positive and negative factors experienced by autistic adults and caregivers; (b) test for within-subject differences in endorsement of promotive factors reported specific to four stages of development; and (c) test for differences in factors between adults with varying cognitive ability (i.e., less cognitively able [LCA; verbal IQ < 70] and more cognitively able [MCA; verbal IQ ≥ 70]). Participants included 91 autistic adults and caregivers. Autistic adults' VIQs ranged from 4 to 139. Participants completed a modified version of the Social/Emotional Functioning Interview which consists of open-ended questions about positive and negative factors experienced across development. Autistic adults and caregivers, regardless of cognitive abilities, frequently reported people supports as more helpful than specific services, aspects of education, or generative activities from early childhood through adulthood. For both cognitive groups, generative activities were increasingly important after childhood. Services were more frequently identified as helpful by LCA caregivers in adulthood, while education was reported more by MCA caregivers and autistic adults. Differences by cognitive ability in negative factors included that more LCA caregivers reported poorly prepared professionals/caregivers as disruptive, while more MCA caregivers and autistic adults reported family conflict and bullying. Positive and negative factors identified through interviews of lived experiences can inform targeted care based on strengths and needs across cognitive abilities and life stages.

Autism diagnostic criteria, and research primarily involving autistic children, highlight verbal and nonverbal behaviors likely to manifest during social interaction that may generate unfavorable impressions of interaction partners (e.g., poor credibility, incompetence). These behaviors are thought to bias evaluations of autistic individuals, particularly within high-stakes contexts (e.g., police or employment interviews). However, the prevalence of those behaviors in autistic adults is unclear. IQ-matched samples of autistic (n = 43) and non-autistic (n = 41) adults participated in a simulated chatroom, exposed to text-based conversations about illegal hacking. Participants were then interviewed about the chatroom in a one-on-one video-recorded online interview with the researcher. We measured the prevalence of 19 verbal and nonverbal behaviors, and memory report characteristics displayed by the interviewees, and investigated differences between the diagnostic groups. Diagnosis had a strong effect on overall behavioral displays but was only associated with minor differences in individual behaviors. Three significant effects indicated greater difficulty interpreting figurative language, longer speech hesitations, and greater verbal intonation for autistic than non-autistic adults. Inter-individual variability within groups and within-individual variability across behaviors highlighted that behaviors were neither ubiquitous nor consistently displayed in combination. There was also a suggestion of more noticeable differences in the behavior of male than female autistic adults. Although minor behavioral differences were detected based on diagnosis, they included behaviors that could lead to negative outcomes for autistic individuals during high-stakes interactions. Whether more pronounced behavioral differences are detected during face-to-face interactions warrants further research.

A series of epidemiological studies conducted in the United States have consistently shown an increased risk of autism spectrum disorder (ASD) in children associated with pre- and postnatal exposure to ambient particulate matter (PM). In Europe, studies are scarce and results are inconsistent. We aimed to investigate the association between prenatal exposure to PM and the risk of ASD in France. ASD cases were participants from the ELENA cohort. Controls children from the ELFE cohort were matched by sex, year (± 2) and region of birth. Prenatal exposures to PM10 and to PM2.5 were estimated between 2008 and 2013 using innovative hybrid spatio-temporal models developed for France. Conditional logistic regression models adjusted for birth season, parent's age at the child birth and parental education level were run. We included 125 ASD cases and 500 controls. Prenatal PM2.5 and PM10 median (IQR) concentration estimates were respectively 16.3 (3.9) µg/m and 22.9 (6.6) µg/m in the whole sample. The conditional logistic regression models showed Odds Ratios (ORs) (Confidence Interval 95%) for ASD risk of 0.72 (0.52-1.01) and 0.84 (0.58-1.22) for an IQR increase in PM2.5 and PM10 prenatal levels, respectively. When restricting population of ASD cases to children born the same year of controls, ORs were 1.79 (0.80-4.01) and 2.23 (0.71-9.04), respectively. Our results did not show that prenatal exposures to PM2.5 and PM10 were associated with the risk of ASD in children in France.Trial Registration Number NCT02625116.

Children and adolescents with autism spectrum disorder (ASD) frequently present with mental health comorbidities and behavioral crises, necessitating inpatient care. However, evidence-based guidelines for psychotropic medication use in specialized inpatient settings remain limited, particularly in non-Western contexts. This study examined the clinical characteristics and prescribing patterns among 269 hospitalized ASD patients (2012-2023), with a focus on how intellectual disability (ID) influences medication decisions. A retrospective analysis was conducted using electronic medical records to assess mental disorders, behavioral challenges, and psychotropic medication use at discharge. Logistic regression analyses was performed to examine factors associated with medication prescribing patterns, including the impact of ID status. Psychotropic medication use was highly prevalent (96.7%), with antipsychotics (89.96%) being the most frequently prescribed class, followed by anxiolytics (35.32%) and antidepressants (33.09%). ID was significantly associated with distinct prescribing patterns: patients with ID had 63% lower odds of antidepressant use (aOR = 0.37, p = 0.001) and 80% lower odds of ADHD medication use (aOR = 0.20, p = 0.009), while being more likely to receive antipsychotics (aOR = 2.74, p = 0.049) and experience polypharmacy (aOR = 1.89, p = 0.028). Additionally, disruptive behaviors and age were key predictors of antipsychotic use, whereas suicidal thoughts/attempts or SIBs independently predicted antidepressant prescribing. These findings suggest that ID status plays a critical role in shaping psychotropic prescribing practices beyond symptom severity alone, potentially reflecting diagnostic overshadowing and safety concerns. Future research should focus on developing tailored clinical assessment tools and treatment protocols for ASD populations with and without ID, while enhancing individualized medication monitoring to optimize therapeutic outcomes.

Hospitals are motivated to create more autism friendly environments to optimise access and experience for the community. However, there is a lack of clarity in what the term autism friendly in hospital settings means. We conducted a scoping review of four online databases and eleven national autism organisations to determine existing definitions for autism friendly within hospital settings. To operationalise the meaning of autism friendly hospital care, we then reviewed barriers and facilitators to hospital care from the perspective of autistic patients. Within the seven studies that considered the meaning of autism friendly, we found that the term autism friendly within a hospital context is undefined. To operationalise the meaning of autism friendly within hospitals, we identified barriers and facilitators in 16 studies that examined the hospital experience of autistic patients. We identified 19 facilitators and 23 barriers across three categories: people, place, and time. Flexibility underpinned the three categories, with flexible people, flexible place, and flexible timing reported as being integral to improving the hospital experience of patients with autism. Our findings provide clear guidance for creating autism friendly hospital care.

This study examined how self-construal, a key aspect of cultural structure, influences teacher training to improve autism awareness and reduce stigma. It explored autism awareness, self-construal, and stigma levels among potential educators, as well as the relationships between these factors. The study also investigated the mediating role of self-construal in the link between autism awareness and stigma. The study included 1031 potential educators-individuals with no teaching experience with students with ASD but likely to work with them in the future. Participants were selected through purposeful sampling. Data were collected using a demographic form, Autism Awareness Scale, Self-Construal Scale, and Stigma Scale. The study found that both autonomous and relational self-construals significantly impacted autism awareness and stigma. These cultural factors influenced how potential educators perceive and respond to ASD. The analysis highlighted the mediating role of self-construal between autism awareness and stigma. The study concluded that self-construal, as a cultural element, plays a significant role in shaping potential educators' approaches to autism awareness and stigma reduction. It is recommended that teacher training programs incorporate cultural factors like self-construal to complement efforts in enhancing autism awareness and reducing stigma, ensuring that potential educators' cultural structures do not outweigh their professional qualifications in interactions with students with ASD.

There is a need for research on autism questionnaire psychometrics outside of the standardization sample. This study investigated the factor structure of the Autism Spectrum Rating Scales-Parent report for ages 6-18 (ASRS) in a well-characterized community sample of 696 children (autism [AUT] n = 231; non-autism [NOT] n = 465; X̄age = 10.03) prospectively evaluated with the Autism Diagnostic Observation Schedule-2, a gold-standard autism diagnostic measure. The original author-identified structure demonstrated poor model fit. Exploratory Factor Analysis with a randomly selected half of the sample (n = 346) suggested retaining 17-items on three factors (Rigid/Sensory, Social, and Executive Function [EF]), explaining 55% of the variance. Confirmatory Factor Analysis with the remaining participants (n = 350) indicated good model fit. Partial measurement invariance was observed for diagnostic (AUT/NOT) and gender (male/female) groups. Correlations with the DSM-5 (an ASRS scale) were high. Mean differences were observed between AUT/NOT groups for Social; when controlling for age, marginal differences (p = 0.02 - 0.03) were observed for all factors but EF. Social also demonstrated significant AUC regardless of control variables. However, AUC values for Social and other factors, while significant, were in the poor range; correlations with ADOS-2 scores were weak or non-significant. Despite improving the factor structure, the Total-17 does not appear to measure ASD-specific traits. However, these findings provide a basis for further research on ASD questionnaires.