Objective To explore the effectiveness of caregiver skill training in improving the symptoms of children with autism spectrum disorder (ASD) and parental psychological defense mechanism, so as to provide evidence for clinical intervention of autistic children. Methods A total of 120 ASD children and their parents who have seen a doctor in a tertiary care children′s hospital in Chongqing from May to November 2021 were selected as the study subjects and were divided into the control group and the intervention group according to the voluntary principle. The control group received conventional intervention, while children and parents in the intervention group received caregiver skills training for 6 weeks, of which online theoretical training lasted for 4 weeks with a frequency of 5 times/week, and offline practical skills training lasted for 2 week with a frequency of 1.5 hours/time, 5 times/week. Before the intervention, at the end of the intervention, and one month after the end of the intervention, the defense ability of parents in the two groups was assessed using the Defense Mechanism Questionnaire (DSQ), the intervention effect of the children in the two groups was evaluated using the Autism Behavior Checklist (ABC) and the infant-junior middle school social adaptive capacity scale(SM). Results At the end of the intervention, the score of immature defense mechanism of parents in the intervention group was 3.79 ± 1.29, which was significantly lower than that in the control group (4.28 ± 1.14) (t＝-2.281, P <0.05). One month after the end of the intervention, the scores of immature defense mechanism and intermediate defense mechanism of parents in the intervention group were significantly lower than those in the control group (t=-2.490, -2.196, P <0.05). The score of autism behavior checklist in the intervention group was 55.25±8.89, significantly lower than that in the control group (60.32±9.61) (t =-2.997, P<0.05), and the time effect was significant (F=73.54, P <0.05).At the end of the intervention and one month after the end of the intervention, compared with the control group, the number of children with moderate and severe abnormalities in social life ability in the intervention group was significantly reduced (Z＝-2.119,-3.164, P<0.05). Conclusion Caregiver skill training can effectively improve the immature defense mechanism of parents and reduce the symptoms of ASD children.

Objective To explore the relationship between folic acid related metabolites and autism spectrum disorder (ASD), so as to provide theoretical basis for the etiology and pathogenesis of ASD. Methods From June 2017 to December 2018, children who received rehabilitation training in designated rehabilitation institutions for autism in Harbin were collected. Seventy autistic children and seventy matched healthy children were enrolled in this case-control study. The levels of folic acid related metabolites in plasma were measured by liquid chromatography tandem-mass spectrometry (LC-MS/MS), and its association with the clinical phenotype of ASD children was analyzed. Results ASD children had higher plasma levels of cystathionine (Z=2.59), total glutathione (tGSH) (t=5.29), homocysteine (Hcy) (t=2.23), cysteine (t=11.37), methionine (t=3.14) compared to healthy control (P<0.05), but the difference in the levels of adenosine(Z=1.20) and cystine(t=1.75) in plasma between the two groups was not significant (P>0.05). The level of tGSH in ASD children was positively correlated with the scores of social communication score in Social Responsiveness Scale (SRS) (r=0.322, P<0.05). Conclusion Abnormal expression of folic acid related metabolites in ASD children is correlated with the scores of clinical phenotypic features of ASD, and the underlying mechanism needs to be further explored.

Autism spectrum disorder(ASD) is a typical form of pervasive developmental disorder characterized by social interaction and communication disorders,attention deficits,narrow interests,and repetitive/stereotypical behavior patterns. In recent decades,the prevalence rate of autism has been on the rise all over the world and there is a lack of specific treatments. Therefore,it is very urgent to search for sensitive and specific biomarkers and specific treatments. Exosomes are nanoscale vesicles that can be released by most cell types in the central nervous system. Bioactive macromolecules such as RNA,proteins and lipids in exosomes participate in the material exchange and information exchange of various nerve cells, and play an important role in the regulation of nerve development, differentiation,regeneration and synaptic regulation. With the development of molecular biology and the improvement of diagnostic technology,exosomes have gradually become the focus of ASD research due to their advantages of convenient collection,stable structure,easy degradation of macromolecules in exosomes and the ability to pass the blood-brain barrier. It has been reported that exosomes are related to the occurrence and development of ASD,and may be an important source of diagnostic markers for ASD and a new drug treatment carrier. This article reviews the research progress of exosomes in ASD,in order to provide reference for early diagnosis,clinical treatment and prognosis judgment of ASD.

Autism spectrum disorder(ASD) is a heterogeneous neurodevelopmental disorder characterized by impairments in social communication and restricted and repetitive behaviors and interests,with symptom onset during the first few years of life. Over the past two decades,neuroimaging has revealed numerous findings of atypical activity and abnormal connectivity of "social brain" networks,including analysis of faces and gaze by the fusiform face area(FFA),emotional processing in the amygdala,mentalizing in the default mode network(DMN) and imitation and understanding of others′ actions by the regions associated with the mirror neuron system(MNS),yet no consensus view on crucial developmental causes of social communications deficits has emerged. Aside from methodological challenges and studies on the connectivity of individual brain networks,the deeper problem concerns the strong heterogeneity of ASD. This inconsistent finding may be due to changes in diagnostic criteria and the atypical neurodevelopment trajectories of autism at preschool period. Therefore,cohort studies on subtypes of autism and of longitudinal cohort with a large sample are warranted.

Objective To systematically evaluate the anxiety assessment tools for children with autism spectrum disorder(ASD) at home and abroad, in order to provide evidence for practice and research in this field. Methods Eleven electronic databases were searched. Studies on the development of anxiety assessment tools and/or the testing of psychometric properties for children with ASD were included and evaluated according to the COSMIN standards. Results A total of 31 articles in English language that appraised 16 anxiety assessment tools for ASD children were yielded and included in the systematic review. Among the 16 tools, ten were developed for typically developed children, five were specifically adapted for children with ASD, and one was developed to measure the anxiety of both typically developed children and ASD children. The Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD) demonstrated the best psychometric properties. Conclusions Among the tools in English, ASC-ASD is the most recommended anxiety assessment tool for children with ASD. To our best knowledge, the Chinese version of ASC-ASD is still not found, which can be prioritized for translation and validation.

Objective To investigate the difference in fecal intestinal flora instructure and short chain fatty acids between children with autism spectrum disorder (ASD) and healthy children, so as to provide new clues for the prevention and treatment of ASD from the perspective of intestinal flora. Methods A total of 25 ASD childrendiagnosed in the Department of Pediatrics, Afficiated Hospital of Jiangsu University were enrolled in the ASD group from January to November 2019. Meanwhile 24 healthy children with typical growth and development who took physical examination were selected as control group. Their feces samples were collected. 16SrRNA sequencing was used to analyze the structure of the intestinal microflora, and gas chromatography was used to detect the content of short-chain fatty acids in feces. Results Compared with the control group, ASD children had a significant decrease in the abundance (Chao index and Ace index) and diversity (Shannon index) of intestinal flora (t=2.917, 2.890, 3.353, P＜0.05), an increase in the abundance of Firmicutes and Proteus and a decrease in the abundance of Bacterioidetes at the phylum level(t=3.180, 5.761, 5.970, P＜0.05). At the genus level, ASD children had a significant decrease in the abundance of Bacterioides, Bifidobacterium, Blautia and Streptococcus, a significant increase in the abundance of Clostridium and Sutterella (Z=2.440, 3.100, 3.620, 3.500, 4.200, 4.054, P＜0.05). Compared with the control group, the levels of acetic acid, propionic acid and total short chain fatty acids in ASD group were significantly increased, while the butyric acid was significantly decreased(t=3.040, 3.220, 2.560, 4.100, P<0.05). Spearman correlation analysis showed Bifidobacterium was negatively correlated with propionic acid and total short chain fatty acids(r=－0.422,－0.412, P＜0.05). Conclusions There are significant changes in the structure of intestinal flora and the content of short chain fatty acids in feces of ASD children. The increase of the content of propionic acid and the total short chain fatty acids caused by the decrease of Bifidobacterium may be related to ASD.

Objective To compare the difference in contingency discrimination training between children with autism spectrum disorder (ASD) and normal children, in order to provide suggestions for the intervention of ASD children. Methods A total of 22 children diagnosed with ASD in the Department of Children's Health Care of Shanghai Children's Hospital and 24 normal children matched with age and intelligence quotient (IQ) were selected into this study from July 2020 to October 2021. Children in both groups took contingency discrimination training, and the difference was compared. Results The score of positive and negative contingency discrimination training under motivational manipulation between ASD children and normal children had no significant difference (Z=1.35,1.63, P＞0.05). ASD children scored significantly lower in positive and negative contingency discrimination training with external visualization signs than normal children (Z=2.83, 5.04, P＜0.05). And for ASD children, the score of positive contingency discrimination training with external visualization signs was significantly different with that of negative contingency discrimination training with external visualization signs (Z=3.17, P＜0.05). Conclusion ASD children have lower contingency discrimination training with external visualization signs than normal children. In addition, ASD children have lower negative contingency discrimination training with external visualization signs than positive contingency discrimination training with external visualization signs. Therefore, it is recommended that training related to contingency discrimination training with external visualization signs should be added to the rehabilitation training of ASD children.

Objective To compare the diagnostic value between Autism Diagnostic Observation Schedule Second Edition(ADOS-2) Module-1 and Children Autism Rating Scale (CARS) for children with autism spectrum disorder (ASD), in order to provide reference for clinical application. Methods From January 2019 to March 2022, a total of 104 children who firstly visited and diagnosed in the Department of Neurological Rehabilitation, Guangdong Women and Children Hospital were enrolled in this study, including 60 ASD children (ASD group:30 cases of high function and 30 cases of low function,), 24 children with global developmental delay (GDD) and 20 normal children (non-ASD group). All children were assessed by ADOS-2 Module-1 and CARS. The consistency of diagnostic results between the two scales and the criteria of American Diagnostic and Statistical Manual of Mental Disorders-5(DSM-5) was evaluated, and the sensitivity and specificityof the two scales in the diagnosis of ASD were compared. Results 1) The consistency between ADOS-2 module 1 and DSM-5 was good (Kappa=0.862),as well as between ADOS-2 module 1 and CARS (Kappa=0.695).The consistency was medium between CARS and DSM-5 (Kappa=0.509), 2) The sensitivity of ADOS-2 module 1 was significantly better than that of CARS (χ²=13.333, P<0.001). There was no significant difference in the sensitivity and specificity between diagnosing children with IQ≥70 and children with IQ <70(P>0.05). The sensitivity of CARS in the diagnosis of children with IQ <70 was significantly better than that of children with IQ≥70 (χ²=7.500, P=0.006), but the specificity was not statistically significant (P>0.05). Conclusions ADOS-2 module-1 and CARS are both important tools to assist in the diagnosis of ASD, and ADOS-2 module-1 has higher sensitivity and specificity in the early diagnosis of ASD children. In clinical work, it is recommended to lower the diagnostic threshold of CARS for children with IQ ≥ 70 in order to improve the diagnostic sensitivity of CARS and reduce the rate of missed diagnosis.

Objective To investigate the effect of altered 2-arachidonoylglycerol(2-AG) levels on autistic behaviors in VPA-induced rats(ASD model), so as to provide evidence for identifying the etiology of ASD. Methods The rats were divided into CON group, VPA group(ASD), acute JZL184 injection group [VPA+40 mg/kg JZL184 group(VPA+40AJ)], chronic JZL184 injection group [including VPA+1 mg/kg JZL184 group(VPA+1RJ), VPA+3 mg/kg JZL184 group(VPA+3RJ) and VPA+10 mg/kg JZL184 group(VPA+10RJ) ]. The ASD-like behavior of rats in each group was assessed. The levels of endocannabinoids(eCBs) in the hippocampus of rats were detected by liquid chromatography-mass spectrometry. Western blot was used to test the expression levels of related receptors and metabolic enzymes in eCB system. Results The levels of 2-AG and AEA in VPA group were significantly lower than those in CON group(P<0.05). After JZL184 intervention, the levels of 2-AG in VPA+3RJ group and VPA+10RJ group significantly increased(P<0.05). Compared with the CON group, the number of buried marbles, self-grooming time and spontaneous activities increased significantly in VPA group, and the sociability index and the social preference index decreased(P<0.05). After JZL184 intervention, the number of buried marbles, self-grooming time and spontaneous activities decreased, and the sociability index and the social preference index in VPA+40AJ group increased significantly, the self-grooming time of the rats in VPA+1RJ group decreased. After JZL184 intervention, the number of buried marbles, self-grooming time and spontaneous activities decreased, and the social preference index of the rats in VPA+3RJ group increased significantly. The number of buried marbles and self-grooming time decreased, and the social preference index of the rats in VPA+10RJ group increased significantly(P<0.05).The protein expressions of CB1R, DAGL, MAGL and FAAH in VPA group were significantly higher than those in CON group(P<0.05).After JZL184 intervention, the protein expressions of DAGL and MAGL of the rats in VPA+3RJ group were significantly down-regulated, and MAGL in VPA+10RJ group were also significantly down-regulated(P<0.05). Conclusions Low eCBs signal is associated with autistic behaviors in VPA-induced rats, and boosting 2-AG levels can improve repetitive and stereotypical behaviors, hyperactivity and social functions in ASD rats.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized as heterogeneous clinical manifestations.Developmental regression, regarded as a specific subtype in ASD, is getting more and more attention.However, the influencing factors of regression are not clear.It is generally believed that it is a kind of developmental disorder caused by genetics, environment and their interaction.This review aims to summarize the influencing factors increasing risk of regressive autism from the perspective of environment and genetics, thereby providing references for the recognition and interventions in early childhood.

Self-awareness is the basis for the development of individuals' social interaction ability. Abnormal self-development is not only an important mechanism to explain the social interaction disorders in autistism spectrum disorder(ASD),but also one of the reasons for the occurrence of problematic behaviors. The paper reviews related researches on self-awareness of ASD children,expounds the influence of abnormal self-development on the core symptoms of ASD children,and summarizes the clinical empirical research on self-awareness training of ASD children,aiming to provide reference for the plan development of rehabilitation for ASD children. Further studies should emphasize self-development of ASD children,especially the psychological self-development,and focus on developing the methods to improve the self-cognition ability of ASD children,so as to promote their development of social interaction disorders and improve the core symptoms.

Currently, the underlying mechanisms of etiology and manifestations ofautism spectrum disorder (ASD) are still poorly understood.More and more studies have shown that changes in intestinal microbes and their metabolites (such as short-chain fatty acids, γ-aminobutyric acid, etc.) may be related to the pathogenesis of ASD.Therefore, this paper reviews the studies related to the changes and mechanisms of gut microbes and metabolites in ASD children, and analyzes the possible differences and associations of gut microbes and metabolites between ASD children and healthy children, in order to explore the influence of changes in intestinal microbes and their metabolites on children ASD, and to provide some new ideas for the diagnosis and treatment of ASD.

Autism spectrum disorder(ASD) is a neuropsychiatric developmental disorder that begins in infancy and childhood. Steroid hormones may result in the onset of ASD by affecting neuropsychiatric development. This article reviews the relationship between common steroid hormones and ASD.

Objective To summarize and analyze the treatment time and diagnosis months of children with autism spectrum disorder (ASD) registered and diagnosed in Xuhui District since the early autism screening in communities(primary health care institutions) was carried out from 2012 to 2020, so as to provide basis for identifying ASD children earlier and faster. Methods Children aged 18 to 24 months with positive results in routine screening, and children who were suspected with social interaction problems and with abnormal results of the age screening scale or Denver Ⅱ during the physical examination of 18 to 24 months with negative screening and non 18 - 24 month old children in Xuhui District Maternal and child health care center and 13 community health service centers, were referred through the green channel to the developmental behavior specialist clinic of the Child Healthcare Department of the Pediatric Hospital Affiliated to Fudan University for diagnosis. Children diagnosed with ASD were enrolled in this study, and were divided into three different reasons for consultation: Diagnosis in 18 to 24 months old with a positive screening result, diagnosis beyond 18 to 24 months old with a positive screening result, diagnosis in 18 to 24 months old with a false negative screening result. One way ANOVA was used for inter-group comparison and LSD method was used to compare the two groups when the difference was statistically significant. Results Among 121 children diagnosed with ASD, 82 cases aged 18 to 24 months with a positive screening result were diagnosed, 18 cases aged beyond 18 to 24 months with a positive screening result were diagnosed, 21 cases aged 18 to 24 months with a false negative screening result were diagnosed, with an average age of (26.34±9.08) months. The age of diagnosis was significantly different among the three groups (F=21.22, P<0.001). There was no significant difference in the age of diagnosis for the four reasons for consultation among doctor referrals and parental self-referrals in children aged 18 to 24 months with a false negative screening result, referrals for systematic medical examinations and referrals for school and nursery admissions for children beyond 18 to 24 months with a positive screening result (F=1.746, P=0.176). Conclusions The age of diagnosis is generally earlier for children managed by the child health care system and routinely screened in Xuhui District. Diagnosis is confirmed earlier for children aged 18 to 24 months with a positive screening result.

Objective To investigate the changes of development and adaptive behavior in children with autism spectrum disorder (ASD) in different years, so as to provide theoretical basis for early identification, diagnosis and rehabilitation training of ASD. Methods The assessment results by Gesell Development Scale and S-M scores of ASD children aged 1 to 5 who were diagnosed for the first time in the Department of Child Health Care of Children's Hospital of Chongqing Medical University in 2015, 2017 and 2019 were retrospectively analyzed. Results There were no significant differences in total development quotient (DQ) of GDS and S-M scores of ASD children in the year 2015, 2017 and 2019 (F=0.920, 0.495,P>0.05). Children with ASD in different years had developmental delay(DD) on different levels, and there were significant differences in scores of DQ in gross motor area (F=9.683, P< 0.05), distribution of DQ in gross motor area and fine motor area (χ²＝22.583, 11.596, P<0.05). The DQ scores of fine motor and social behavior area of girls with ASD were higher than those of boys (Z＝2.023,2.837, P<0.05). There were significant differences in DQ and S-M score in ASD children at different age groups (H=56.557, 185.824, 37.935, 8.038, 68.752, 32.657, P<0.05). Conclusions No significant changes are seen in the level of DD and adaptive behavior for ASD children in recent five years. There are gender and age differences in the development level and social living skills of ASD children, and the retardation of gross motor development has become more and more obvious in recent years. Standardized assessment of development and adaptive behavior should be conducted as soon as possible for ASD children, and the results should be interpreted according to the gender and age of children in order to give comprehensive assessment and precise clinical intervention.

Objective To investigate emotional and behavior problems and dietary behavior problems in preschool children with autism spectrum disorders (ASD), and to explore the relationship between them. Methods From August 2020 to April 2021, 150 preschool ASD children were evaluated by parent version of Strengths and Difficulties Questionnaire (SDQ) and Preschoolers' Eating Behavior Questionnaire (PEBQ) to know about their emotional and behavioral problems and dietary behavior problems. The relationship between emotional and behavior problems and dietary behavior problems was analyzed by Logistic regression analysis. Results In terms of the common emotional and behavior problems, the detection rates of peer interaction problems, social behavioral problems and hyperactivity were 86.0%, 72.7% and 51.3%, respectively. The rate of common dietary behavior problems was as follows:lack of the active eating ability (83.3%), picky eating (57.3%), emotional eating (42.0%).Conduct problem was a risk factor for food response problem (OR=3.48, 95%CI:1.04 - 11.63) and emotional eating (OR=6.11, 95%CI=1.56 - 23.86). Social behavioral problems were risk factors for picky eating (OR=3.07,95%CI:1.40 - 6.74)and lack of eating initiative(OR=5.32,95%CI:1.25 - 22.70). Hyperactivity was the risk factor for picky eating (OR=3.40,95%CI:1.65 - 7.00) and bad eating habits(OR=4.29,95%CI:1.55 - 11.88). Conclusions Emotional and behavior problems and dietary behavior problems of preschool ASD children are relatively serious. Emotional and behavior problems are associated with picky eating, lack of the active eating ability, food response problems, bad eating habits and emotional eating in preschool ASD children.

Autism spectrum disorder(ASD) is a group of children persistent complex developmental disorders of nervous system characterized by social and interactive obstacle. Nonverbal communication ability,including the use of gestures,is found abnormal in the early stage and is closely linked with language development. This paper reviews the effects of common gestures on language.

Gestures precede language and promote language development. The types and functions of gestures in children with autism spectrum disorder(ASD) have atypical use and development,and the slow development of gesture-language trajectories can become a key early behavior marker for children with ASD. The development of gestures is significantly related to the later language,cognition,social interaction and ASD diagnosis. Early evaluation and monitoring of gesture function should be carried out in ASD children. Personalized training based on the characteristics of gestures,and intervention using gestures as an intermediary can promote language,cognitive and social development,thus to improve rehabilitation effects.

Objective To systematically interview the effects of gluten-free and casein-free (GFCF) diets in children with autism spectrum disorder(ASD), in order to provide scientific reference for clinical treatment. Methods Literature searches were conducted in PubMed, EBSCO, Cochrane Library, SpringerLink, Vip, Wan-fang and China National Knowledge Internet (CNKI) database. Only randomized controlled trails were included, and the quality of the literature was evaluated. Results A total of 7 studies with 181 ASD samples were included. Seven articles all studied the effects of GFCF diets on core symptoms of ASD, five articles showed that the GFCF diets could not improve the core symptoms of ASD. Two articles studied the effects of GFCF diets on gastrointestinal symptoms of ASD, but neither of them showed that GFCF diets could improve the gastrointestinal symptoms of ASD. Conclusion GFCF diets could not improve the core symptoms and gastrointestinal symptoms of ASDchildren.

Objective To compare the developmental characteristics of 2- to 3- year-old children with autism spectrum disorder(ASD) or developmental language disorder(DLD) by Gesell Developmental Scale(GDS),in order to provide evidence for early diagnosis and intervention. Method From March 2020 to March 2021,children with ASD(n=78) and DLD(n=80) were evaluated by GDS,their development characteristics were analyzed and compared retrospectively. Results 1) The average developmental quotient(DQ) of ASD children was lower than that of DLD children. Except for the gross motor,the DQs of adaptability,fine motor,language and personal-social in ASD children were significantly lower than those of DLD group(t=16.043,6.208,14.219,10.811,P<0.001). 2) The language development of ASD children was predominantly severely and moderately impaired(48.72%,33.33%),while the language development of DLD children was most mildly impaired(77.5%). Fifty percent of ASD children had a mild impairment in personal-social area and no one case was normal. However,68.75% of DLD children had a mild impairment in personal-social area,and 30% of personal-social DQ was at normal or borderline level. Conclusions Except for the gross motor energy area,the average DQs of other developmental areas in ASD children are lower than those in DLD children. Familiarity with the Gesell developmental characteristics of ASD children and DLD children is helpful for the early identification,rehabilitation and education plan development as well as the prognosis of children with ASD and DLD.

目的 对1名有仿说能力、能识认日常物品的孤独症谱系障碍(ASD)儿童(男,62个月)进行心智解读能力(TOM)干预。方法 整合运用示范法、提示法、视频建模法等循证证据证明有效的干预策略,从区分自己和他人身体、区分自我和他人所属物品、区分自我和他人社会关系、自我身体的控制、自我行为控制等方面对儿童进行系统行为训练。共经过9个月的训练,训练前、训练5个月、训练后采用ToM量表、心理教育概况中文版(第三版)(PEP-3)、儿童期孤独症评定量表第二版(CARS-2)标准化工具对儿童能力进行评估。结果 经过训练,儿童ToM量表任务通过率达到100%,PEP-3量表各维度的发展月龄增加,CARS-2量表得分降低。结论 以自我概念为切入点,对ASD儿童ToM能力进行干预,可以有效提升其社交沟通能力,适合应用于具备一定仿说、认知能力的ASD儿童中。

Sleep disorders, as one of the most common comorbid disorders in children with autism spectrum disorder (ASD), have attracted extensive clinical and research attention in recent years.Sleep disorders are significantly related to the core symptoms of ASD, affect the children's function, quality of life and efficacy of intervention and rehabilitation, and also cause great parenting distress and economic burden on parents.At the international level, sleep disorders especially for insomnia have been integrated in the assessment and treatment for ASD, yet the relevant work in China is much less developed and pediatric professionals has insufficient ability to assess and treat sleep disorders in ASD children.Therefore, this review introduces the assessment and treatment strategies for sleep disorders in ASD children in order to inform clinical and research work.

Autism spectrum disorder(ASD) is a group of neurodevelopmental disorders,often accompanied by circadian rhythm disorders and sleep problems. Sleep problems may not only aggravate some of the core symptoms of ASD children,but also affect the effect of rehabilitation training. The clinical manifestations of sleep problems in ASD children are various,but the exact mechanism is not clear. Studies have found that it is closely related to abnormal melatonin secretion and metabolism,and melatonin treatment is effective and safe. This paper mainly reviews the sleep problems of ASD children and the research progress related to melatonin in order to provide basis for improving sleep quality of ASD children and formulating effective intervention programs.

Objective To evaluate the screening efficacy of autism spectrum disorder (ASD) by the Bayley Scales of Infant Development-Ⅰ(BSID Ⅰ) combined with Modified Checklist for Autism in Toddlers, Revised with Follow Up (M-CHAT-R/F), in order to provide clinical basis for early ASD screening in primary child care system.Methods Infants aged 6 to 12 months, who participated in Early Developmental Risk and Abnormality Screening Program for 0 - 3 Years Old Children in Yiwu Maternal and Child Health Hospital using BSID Ⅰ evaluation from January to December 2019 were enrolled in this for a prospective cohort study.BSID Ⅰ were conducted in the children with positive autism alert indexin Autism Diagnosis and Rehabilitation Guide issued by the Ministry of Health in 2010.Infants with abnormal mental development index (MDI) and psychomotor development index (PDI) (MDI or PDI<80) were followed up. M-CHAT-R/F assessment was performed at 18 months of age, then further diagnosis of ASD was made based on DSM-5 by a specialist.Results Totally 3 096 cases were included in the study, of whom 535 cases with positive autism alert index and421 cases (13.60%) had abnormal BSID Ⅰ results. At 18 months of age, a total of 38 (9.97%) children were screened positive by M-CHAT-R/F evaluation, and 16 children were finally diagnosed with ASD. When taking BSID Ⅰ MDI<80 as a predictor, its proportion was significantly different between ASD group and non-ASD group (χ²=10.28, P<0.01). The positive predictive value of BSID Ⅰ for ASD screening was 0.076, which increased to 0.42 when combined with M-CHAT-R/F.Conclusions BSID Ⅰ combined with M-CHAT-R/F can improve the positive predictive value of ASD screening in infants. It is suggested that m-CHAT-R /F screening at 18 months of age should be performed in infants with BSID Ⅰ MDI<80, thus to provide a new method for early screening of ASD.

Autism spectrum disorder (ASD) is a common and complex neurodevelopmental disorder. Nutrition plays an important role in the growth and development of children, and there is a certain relationship with the occurrence, development and prognosis of ASD subtypes. With the deepening of research, correlating ASD symptoms with serum nutrient levels has been extremely challenging. This manuscript takes folic acid and vitamin A (VA) as examples to review the new ideas of using nutrient signaling pathway as a potential biomarker of ASD, hoping to provide reference for further exploring the occurrence, diagnosis and treatment of ASD.

Autism spectrum disorder (ASD) is a complex of neurodevelopmental disorder. There are no targeted drugs to ASD, and the main treatment is behavioral intervention. Electronic health (e-health) programs for intervention and management of ASD have attracted considerable attention. This paper focuses on the research progress in e-health for ASD, so as to provide evidence for professionals.

Objective To investigate the relationship between severely picky eating and the core symptoms among children with autism spectrum disorder(ASD),so as to provide reference for early identification and targeted intervention. Methods From May 2018 to December 2019,1 349 children aged 2 to 7 years were enrolled in this study from 13 hospitals in 13 cities across the country,meanwhile 1 170 typically developed children were recruited. A self-made questionnaire was used to investigate the picky eating status of ASD children. Autism Behavior Scale(ABC),Social Response Scale(SRS) and Childhood Autism Rating Scale(CARS) were used to assess the core symptoms of ASD children. Linear regression was used to analyze the impact of severely picky eating on physical growth and core symptoms of ASD. Results The rate of severely picky eating in ASD children was 56.5%(763/1 349),which was 29.7%(348/1 170) in TD children. It was found that ASD and the age of children in two groups were risk factors for occurrence of severe picky eating after adjusting for confounding factors(OR=3.075,1.183,1.156,P＜0.05). Severely picky eating significantly affected ASD children's weight,body mass index(BMI),scores of ABC scale and subscales,scores of SRAS scale and subscales(β=-0.220,-0.319,6.305,1.139,2.111,1.043,1.427,0.946,5.908,0.597,1.029,1.517,1.328,1.503,P<0.05). Conclusions There is a high incidence and persistence of severely picky eaters in autistic children. Severely picky eating has significant impact on children's weight growth and BMI,and is associated with core symptoms of ASD. Therefore,clinical medical staff should pay more attention to the assessment of picky eating behaviors in ASD children,so as to carry out early identification and precise intervention of children.

Objective To compare maternal anxiety between children with autism spectrum disorder (ASD) and children with typical development (TD), and to explore the associations of maternal anxiety with emotional and behavioral problems in children with ASD. Methods A total of 55 ASD children and 74 TD children aged 6 to 12 years were recruited in this study. Station-Trait Anxiety Inventory (STAI) was used to evaluate maternal anxiety, and Strengths and Difficulties Questionnaire (SDQ) was used to assess children's emotional and behavioral problems. Results Mothers of ASD children had a higher level of maternal anxiety including state anxiety score and trait anxiety score (t=5.272, 4.484, P<0.05). In terms of SDQ, ASD children had higher scores of emotional and behavioral problems, hyperactivity/attention deficit, emotional symptoms, peer relationship problems and conduct problems(t=10.791, 7.482, 4.295, 12.925, 3.544, P＜0.05), and lower score of prosocial behaviors than TD children (t=5.084, P<0.01). In children with ASD, both maternal state anxiety and trait anxiety score were positively associated with total difficulties score [S-AI: β=0.83 (95%CI: 0.19 - 1.46), T-AI: β=0.60 (95%CI: 0.05 - 1.14), P<0.01] and emotional symptoms score [S-AI: β=2.28 (95%CI: 0.72 - 3.84), T-AI: β=2.04 (95%CI:0.74 - 3.33), P<0.01]. In TD children, maternal state anxiety score was positively associated with total SDQ score [β=0.50 (95%CI: 0.03 - 0.96), P<0.05] and conduct problem score [β=1.74 (95%CI:0.19 - 3.30), P<0.05], maternal trait anxiety score was positively related to conduct problem score [β=1.54 (95%CI: 0.09~3.00), P<0.05]. Conclusions Mothers of ASD children have higher levels of anxiety than those of TD children. Maternal anxiety is associated with emotional problems in ASD children, while it is associated with conduct behaviors in TD children.

Objective To explore the developmental trajectory of restricted and repetitive behavior (RRB) in children with autism spectrum disorder (ASD), and to determine whether there is a correlation between RRB and sensory gating, so as to provide reference for clinical diagnosis and treatment. Methods From August 2018 to May 2021, 89 children with ASD and 76 children with global developmental delay (GDD) in Children's Rehabilitation Department of the Fifth Affiliated Hospital of Zhengzhou University were selected into this study. RRB was assessment by the Repetitive Behavior Scale-Revised (RBS-R), and cerebral sensory gating was evaluated by the sensory gating P50 ratio, and the correlation was analyzed. Results There was no significant correlation of the total scores, low-level and high-level of RRB with sensory gating in ASD children and GDD children (P>0.05). There was no significant decrease with age in the total scores, low-level and high-level of RRB in ASD children (P>0.05). However, RRB score was negatively related to the age of children with GDD (r=-0.43 to -0.23, P<0.01). Conclusions The developmental trajectory of RRB in ASD children is not a simple negative linear curve with age. There is no significant correlation between RRB and sensory gating. P50 may not be an effective index to predict repetitive and stereotyped behaviors.

Objective To explore the association between maternal passive smoking exposure before/during pregnancy and the risk of autism spectrum disorders (ASD) in offspring, so as to provide theoretical reference for the prevention of ASD. Methods A total of 141 children diagnosed with ASD (ASD group) in Guangzhou Women and Children's Medical Center and a rehabilitation organization and 247 healthy children (control group) were enrolled in this case-control study. The questionnaire survey was performed to collect the general characteristics and parental passive smoking exposure information. Univariate and multivariate Logistic regression analysis were used to examine the association between perinatal maternal passive smoking exposure and the risk of ASD in their offspring. Results Maternal passive smoking exposure either before pregnancy (crude OR=6.69,95%CI:2.33 - 19.25) or during pregnancy(crude OR=5.78,95%CI:2.15 - 15.49) had significantly increased the risk of ASD in their offspring. After adjusting the confounders such as children's sex, parity, maternal education, maternal vitamin intake and paternal passive smoking before pregnancy, the trends above remained. After sex matching, the sensitivity analysis showed that maternal tobacco exposure before and during pregnancy still served as a risk factor for offspring's ASD. Conclusion Perinatal maternal passive smoking exposure might be associated with the increasing risk of offspring's ASD.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder found in early childhood,mainly characterized by social disorder,stereotyped behaviors and restricted interests,all of which limit and impair children's daily life functions.In recent years,there are more and more kinds of interventions for ASD,and applied behavior analysis (ABA) is currently the only form of treatment for ASD endorsed by the US Surgeon General.Its effectiveness has been proven and it is now widely used in the treatment of ASD children.This paper reviews the basic theory,function and effect of ABA compared with other intervention methods.

Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by social communication disorders of varying severity,repetitive behaviors and a narrow range of interests.ASD has become one of the important causes of mental disability in children and adolescents in China,and early intervention is beneficial to the prognosis of children.However,there are often missed diagnosis and misdiagnosis phenomena in the diagnosis of ASD.Based on previous studies,this review combs the manifestation types and causes of missed diagnosis and misdiagnosis of ASD,and discusses possible countermeasures.

Autism spectrum disorder (ASD) is a common and complex neurodevelopmental disorder for which there is no specific treatment and the clinical practice is mainly based on behavioral interventions,causing a huge economic burden to the families and society.The etiology of ASD is unclear and is recognized as the result of interaction of a complex genetic background with environmental risk factors,resulting in different clinical manifestations of children with ASD.Current evidence suggests that malnutrition,especially micronutrient deficiencies in utero and in early postnatal period,may be associated with the onset and clinical manifestations of ASD.These measures,including ensuring sufficient micronutrients during pregnancy,strengthening micronutrient monitoring for ASD children,and timely and reasonable intervention,may reduce the incidence of ASD and improve the behaviors of children with ASD to some extent.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder onset in the early stage of development.There is a consensus that early identification,early detection and early intervention of ASD can greatly improve the prognosis of children with ASD.In the early intervention of ASD,the role of family intervention has attracted more and more attention,and has gradually become the research hotspot of early intervention of ASD in the world.This paper discusses the aspects that may be involved in the management and evaluation of family intervention for young children with ASD.

Somatosensory disorder refers to abnormalities in the somatosensory system's perception and processing of stimuli from the skin and deep tissues.It is one of the core symptoms of autism spectrum disorder (ASD),which seriously affects children's social,communication and adaptation skills development and prognosis.There are many studies on somatosensory disorders,but the mechanism between ASD and somatosensory disorders is still unclear.Therefore,this article will review the neurobiological mechanisms of somatosensory disorders and further analyze the known neurobiological mechanisms of ASD combined with somatosensory disorders,thereby providing an idea for understanding the role of somatosensory disorders in the pathogenesis of ASD and for exploring ASD intervention methods.

Autism spectrum disorder (ASD) is a generalized neurodevelopmental disorder with social disorders and narrow interest as common symptoms.Genetic contributions are its main pathogenesis.Research on ASD susceptibility genes is a hot topic in the medical field at home and abroad.Voltage-gated calcium channels (VGCC) are essential for the regulation of neuronal action potential and neurotransmitter release.Currently,all 10 subtypes of the VGCC encoding genes have been found to be associated with ASD.So this review aims to summarize the research progress of the 10 genes encoding VGCC and ASD.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder.At present,the pathogenesis of ASD is not clear,and there is no effective treatment.In recent years,many studies have shown that vitamin D plays an important role in brain development and the occurrence and development of ASD.This review combs the progress on the mechanisms of vitamin D in ASD.

Autism spectrum disorders (ASD) is one of the serious public problems affecting children′s health,characterized by social communication disorder,narrow interest or activity range and repetitive stereotyped behavior.In recent years,increasing studies have shown that the level of vitamin D (Vit D) in ASD children is significantly lower than that of healthy children with the same age,and vitamin D deficiency may be related to the pathogenesis of ASD.This paper reviews the research progress on vitamin D and ASD.

Autism spectrum disorders (ASD) are a group of neurodevelopmental disorders characterized by barriers to social interaction in varying degrees, and narrow interests and stereotypes. Symptoms appear early in childhood and usually persist throughout the life cycle. In the Second National Disability Survey and Standards published in 2006 in mainland of China, ASD was included in the category of mental disorders, and the Guidelines for the Diagnosis and Treatment of Children with Autism were established. Despite increasing public awareness of ASD in China, most studies are more focused on early diagnosis and comprehensive intervention. Researches regarding the school placement, performance and social skills of ASD children are still at early stage. This review briefly describes the performance and social skills development of ASD children to future support school-age children with autism in China.

Autism spectrum disorder (ASD) is a series of neurodevelopmental diseases with retarding social-emotional interaction, language and nonlinguistic communication, as well as fellowship with peers, resulting in inferior social development.Conventional diagnostic instruments such as Autism Diagnostic Observation Schedule-Revised (ADOS-R) and Autism Diagnostic Interview (ADI-R) have been used in screening, and methods of Applied Behavior Analysis (ABA), Treatment and Education of Autistic and Communication Handicapped Children (TEACCH), as well as Social Story have been applied in treatments.However, great challenges are still in front of the facts of early accurate diagnosis and workable intervene with ASD.Rapid development of artificial intelligence (AI) has led medicine into a smart age.With the application of AI in medicine, ASD have the potential to be identified timely and accurately, and get progress in treatment in the core symptoms.Meanwhile, AI also makes it possible to better resolve the issues of inadequate medical resources and large treatment costs.This article has reviewed recent literature on AI in ASD and unveiled the research results related to machine learning, virtue reality technology, robot--mediated intervention, and the ethics and prospect of AI in autism rehabilitation.