Long-term Behavioral Consequences of the COVID-19 Pandemic for Autistic Individuals and Their Mothers.

Long-term effects of the COVID-19 pandemic on autistic individuals and their families are recently emerging. This study investigated these effects in 40 mother-child dyads by measuring the behavioral problems of autistic individuals (via Aberrant Behavior Checklist) and their mothers' anxiety levels (via Beck Anxiety Inventory) during the pre-pandemic period, one month after, and one year after its onset. One year into the pandemic, aberrant behaviors of autistic individuals worsened only for those whose mothers had high anxiety levels. The continued negative impact of the COVID-19 pandemic on the behavior of autistic individuals is related to their mother's anxiety level, highlighting the need to support maternal mental health in families with individuals with autism.

Autism in Turkey: demographics, behavior problems, and accompanying medical conditions in a sample of Turkish youth with autism spectrum disorder.

Autism spectrum disorder (ASD) is an etiologically heterogeneous neurodevelopmental condition that eludes a single explanation or cure. Epidemiological studies reveal risk factors, relevant comorbidities, and behavioral correlates to reach a better understanding of ASD. To contribute such data from an understudied ASD population, this paper presents epidemiological data from a Turkish sample of individuals with ASD (n = 911, 748 boys (82.1%) and 163 girls (17.9%) between 1 and 18 years of age). Average age at diagnosis was 31.06 ± 11.88 months, and the male-to-female ratio was 4.6:1. Three in 4 individuals with ASD had obsessive behaviors, and 1 in 4 had allergic conditions, inappropriate sexual behaviors, self-harming behaviors, and harmful behaviors towards others. One in 3 received a dietary treatment for at least 3 months; almost half received vitamin supplements; the majority (70%) did not experience constipation; and 2 in 3 were picky eaters. This paper presents data on the age of diagnosis, gender ratios, accompanying behaviors, and dietary interventions in Turkish individuals with ASD, which are topics of current research interest about ASD. Such data from non-Western populations may supplement epidemiological knowledge gained from Western populations to help reach a more comprehensive understanding of this condition with many unknowns.

Zoom Fatigue, Psychological Distress, Life Satisfaction, and Academic Well-Being.

Little is known about the psychological consequences of the recently increased utilization of videoconferencing, which has enabled life to proceed as close to normal as possible during the COVID-19 pandemic. To understand the psychological consequences of this recent global lifestyle change in different populations, the psychometric validation of the Zoom Exhaustion and Fatigue Scale (ZEFS) and the relationship of this construct with academic well-being, mental well-being, and life satisfaction are presented. In a sample of 470 Turkish university students (57 percent female, Mage = 20.26 ± 2.18, ranging between 18 and 33 years), first-order and second-order confirmatory factor analyses confirmed the construct validity of the scale, and the item response theory results yielded appropriate item difficulty and discrimination. ZEFS scores were significantly and positively associated with anxiety, depression, and stress, and negatively associated with life satisfaction and academic well-being, supporting the scale's concurrent validity. Incremental validity was shown with mediational models demonstrating significant and separate indirect effects of Zoom exhaustion and fatigue on life satisfaction and academic well-being, both mediated by psychological distress. The results suggest ZEFS to be a valid and reliable tool to evaluate the psychological consequences of videoconferencing, which has globally increased during the COVID-19 pandemic, in non-Western samples. By showing the relationships of Zoom exhaustion and fatigue with psychological distress, life satisfaction, and academic well-being, the present study highlights potential avenues to be addressed to protect the mental well-being of all individuals who have integrated videoconferencing as part of their daily lives.

Self-Compassion Scale for Youth: Turkish Adaptation and Exploration of the Relationship with Resilience, Depression, and Well-being.

Self-compassion refers to being kind, understanding, and accepting toward oneself in times of failure, frustration, or negative feelings. Since self-compassion is related to both physical and psychological well-being, measuring and understanding self-compassion in different populations carries importance for their mental well-being and life satisfaction outcomes. One such group is the youth, who experience unique developmental challenges. For this purpose, a Self-Compassion Scale for Youth (SCS-Y) was developed (Neff et al., 2021) and this paper presents its Turkish adaptation. The Turkish translation of SCS-Y was tested on a sample of Turkish youth (N = 450, 61.8% female, M age= 13.09 ± 1.59, range = 11-15) and was found to have acceptable reliability. The scale showed a similar structure to the original testing on American youth with a bifactor model of a general self-compassion score and six subscale scores, and a two-bifactor model where negative and positive aspects are grouped together. Self-compassion was positively related to resilience and well-being, and negatively related to depression. A serial mediation analysis showed self-compassion to have a direct and positive effect on resilience, and to have an indirect effect on well-being mediated by resilience and depression. Given that the trainable skill of self-compassion is associated with higher resilience, lower depression, and better well-being, the value of this scale and its different adaptations becomes evident, as they enable measuring self-compassion in youth in various populations such as the present Turkish one and guiding the design of future interventions to increase self-compassion, targeted for the specific concerns of the youth.

Potential Role of Epigenetics and Redox Signaling in the Gut-Brain Communication and the Case of Autism Spectrum Disorder.

The gut-brain axis refers to the bidirectional connection and communication between the gastrointestinal tract and the central nervous system. This paper explores two routes for this communication that have hitherto remained under-examined: epigenetics and redox signaling and their implications for autism spectrum disorder (ASD). The gut microbiota may induce epigenetic changes in the gut and potentially in the brain through their fermentation products. Instead of through other conceptualizations of them acting as neurotransmitters, gut microbial products may act as epigenetic agents, which are supported by the effects of gut bacterial-derived metabolites on gene regulation and expression. In addition to their epigenetic effects, gut bacterial-derived communicative agents can also influence host signaling by contributing to and even substituting host reactive oxygen species (ROS) production. These ROS can act as second messengers and exert oxidative activity on proteins to influence immune, inflammatory, and other signaling processes. ROS and epigenetic mechanisms may have interactive effects as well. ROS, in addition to their role in signaling pathways and cellular redox alterations, also influence redox-sensitive transcription factors, thereby having an effect on gene expression. Specifically, ROS are involved in the activation of transcription factors, chromatin remodeling, and histone/protein deacetylation. These two proposed mechanisms correspond with the recent findings related to ASD, where a cofactor that is shown to be lower in ASD has antioxidative properties, responds to epigenetic modulation, and increases via microbiota interventions. The current evidence reviewed here suggests the need to update models of the gut-brain communication to include these two mechanisms. Such a modeling can also contribute to understanding the unknowns of host metabolism and physiology in ASD and afford potential therapeutic avenues for this as well as other psychiatric and physiological conditions.

Can school teachers' willingness to teach ASD-inclusion classes be increased via special education training? Uncovering mediating mechanisms.

Changing teacher willingness to teach inclusive classes is critical in achieving optimal outcomes for students with autism spectrum disorder (ASD). The present study investigated the mechanisms underlying the effects of a teacher training in special education strategies for students with ASD on mainstream school teachers' behavioral intentions toward inclusive education. Specifically, the role of attitudes and autism self-efficacy were explored as mediators in this process. The sample comprised 763 mainstream school teachers from eleven cities in Northeastern Turkey who participated in an intensive training that included special education strategies for students with ASD, evidence-based special education applications, and inclusive education practices. Statistical mediation analyses revealed that the training increased teachers' willingness to teach inclusive classes and intention to implement special education techniques in the regular education classroom through increasing their autism self-efficacy. However, though attitudes toward inclusive education was a significant predictor of both willingness to teach inclusive classes and intent to use special education techniques, the training did not improve attitudes. Based on these findings, additional strategies or components to change attitudes toward inclusive education were recommended to be integrated into the teacher training programs on special education strategies for inclusive education.

Virulence factor-related gut microbiota genes and immunoglobulin A levels as novel markers for machine learning-based classification of autism spectrum disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental condition for which early identification and intervention is crucial for optimum prognosis. Our previous work showed gut Immunoglobulin A (IgA) to be significantly elevated in the gut lumen of children with ASD compared to typically developing (TD) children. Gut microbiota variations have been reported in ASD, yet not much is known about virulence factor-related gut microbiota (VFGM) genes. Upon determining the VFGM genes distinguishing ASD from TD, this study is the first to utilize VFGM genes and IgA levels for a machine learning-based classification of ASD. Sequence comparisons were performed of metagenome datasets from children with ASD (n = 43) and TD children (n = 31) against genes in the virulence factor database. VFGM gene composition was associated with ASD phenotype. VFGM gene diversity was higher in children with ASD and positively correlated with IgA content. As Group B streptococcus (GBS) genes account for the highest proportion of 24 different VFGMs between ASD and TD and positively correlate with gut IgA, GBS genes were used in combination with IgA and VFGMs diversity to distinguish ASD from TD. Given that VFGM diversity, increases in IgA, and ASD-enriched VFGM genes were independent of sex and gastrointestinal symptoms, a classification method utilizing them will not pertain only to a specific subgroup of ASD. By introducing the classification value of VFGM genes and considering that VFs can be isolated in pregnant women and newborns, these findings provide a novel machine learning-based early risk identification method for ASD.

Behavioral Implications of the Covid-19 Process for Autism Spectrum Disorder, and Individuals' Comprehension of and Reactions to the Pandemic Conditions.

During disasters and pandemics, vulnerable populations such as patients with mental conditions are known to be overly influenced. Yet, not much is known about how the individuals with autism spectrum disorder (ASD), one of the most common neurodevelopmental conditions globally with a prevalence of 1%, are affected from health-related disasters, especially the current Covid-19 pandemic. Therefore, we conducted an investigation of how individuals with ASD responded to Covid-19 in terms of comprehension and adherence to implemented measures; changes in their behavioral problems; and how their caregivers' anxiety levels relate with these behavioral changes. Our sample consisted of 87 individuals with ASD (15 girls; ages ranged from 3-29, with an average of 13.96 ± 6.1). The majority of our sample had problems understanding what Covid-19 is and the measures it requires. They also had challenges in implementing social distance and hygiene-related regulations of the pandemic. The majority stopped receiving special education during this period. We observed a Covid-19-related clinical presentation that resembled PTSD in individuals with ASD in terms of increased stereotypies, aggression, hypersensitivity, behavioral problems, and sleep and appetite alterations. All subscales of Aberrant Behavior Checklist (ABC) differed significantly between before and after the pandemic conditions. The number of hours the children slept significantly decreased from before to during Covid-19. The anxiety levels of caregivers were high and correlated with the current behavioral problem levels of their children, but not with the level of their behavioral problems before the pandemic. The difference in ABC total score and specifically the lethargy/social withdrawal subscale score predicted parents' anxiety score. Our results suggest that the Covid-19 period inflicts specific challenges to individuals with ASD and their caregivers, underlining the need for targeted, distance special education interventions and other support services for this population.

Novel Personalized Dietary Treatment for Autism Based on the Gut-Immune-Endocrine-Brain Axis.

Autism spectrum disorder (ASD) is a neurodevelopmental condition manifesting with impaired social interaction and communication, and restricted and repetitive behaviors and interests. In this perspective article, a more comprehensive approach than the gut-brain axis, hereby termed the "gut-immune-endocrine-brain" axis, is taken, based on which a personalized treatment plan for ASD is presented. ASD has no known etiology or cure, making desperate parents willing to try any treatment that worked for an individual with ASD, without much regard for its effectiveness, safety or side effects. This has been the case for restrictive dietary interventions as gluten-free/casein-free and ketogenic diets and recently, probiotics have emerged as the new such fad. One of the concerns about these dietary and probiotic treatments is their non-specificity: they may not be effective for all individuals with ASD, not all probiotic strains may have the beneficial qualities advertised indiscriminately for probiotics, and strains conferring benefits in one condition may not be probiotic in another. Not all children with ASD show immune reactivity to dietary proteins in wheat and milk, and wheat and milk may not be the only dietary elements to which reactivity is exhibited, where dietary aquaporins that resemble human aquaporins may elicit antibody reactivity in genetically susceptible individuals, which may include individuals with ASD. These observations are utilized to formulate a three-step plan to create effective, targeted, personalized treatments with as few side effects as possible, enabled by a systems approach connecting the various findings for dietary, immune, and neuroautoimmune reactivity in individuals with ASD.

Error monitoring in decision-making and timing is disrupted in autism spectrum disorder.

Individuals with autism spectrum disorder (ASD) have difficulties in social interactions. The cognitive domains that support these interactions include perceptual decision-making, timing, and error-monitoring, which enable one to appropriately understand and react to the other individual in communicative settings. This study constitutes a comprehensive exploration of decision-making and interval timing in ASD as well as the first investigation of error-monitoring abilities of individuals with ASD regarding their performance in the corresponding domains. We found that children with ASD fared similar to typically developing (TD) children in their first-order task performance in two-alternative forced choice perceptual decision-making and temporal reproduction tasks as well as the secondary tasks (signal detection and free finger tapping tasks). Yet, they had a deficit in error-monitoring in both tasks where their accuracy did not predict their confidence ratings, which was the case for the TD group. The difference between ASD and TD groups was limited to error-monitoring performance. This study attests to a circumscribed impairment in error-monitoring in individuals with ASD, which may partially underlie their social interaction problems. This difficulty in cognitively evaluating one's own performance may also relate to theory of mind deficits reported for individuals with ASD, where they struggle in understanding the mental states and intentions of others. This novel finding holds the potential to inform effective interventions for individuals with ASD that can target this error-monitoring ability to have broad-ranging effects in multiple domains involved in communication and social interaction. Autism Res 2019, 12: 239-248 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Decision-making, timing, and error-monitoring are three of many abilities that underlie smooth social interactions. To date, these domains have been only investigated separately, but given their interactive role in social interactions that are impaired in ASD, we conducted the first study to investigate them together. Children with ASD were as successful as typically developing children in their task performances, but unlike them, were unaware of their errors in both decision-making and timing tasks. This deficit that is limited to error-monitoring can contribute to unraveling the unique cognitive signature of ASD and to formulating interventions with positive implications in multiple domains.

Dietary interventions for autism spectrum disorder: New perspectives from the gut-brain axis.

There is still controversy surrounding the effectiveness of dietary interventions for autism spectrum disorder (ASD), namely the gluten-free/casein free diet and the ketogenic diet. Additionally, as studies mainly investigated their impact on ASD symptoms and behaviors, much remains unknown about their mechanisms of action and physiological effects. Given the recent surge of global interest in the gut-brain axis and its involvement in ASD, we underline the importance of understanding the physiological effects of such restrictive diets that remove certain nutritional items from one's diet. Some evidence has emerged with findings of the gut-microbial, inflammatory, and neuronal effects of these diets. We propose probiotics as a potential alternative that can serve similar biological purposes as these elimination diets and outline different physiological routes whereby probiotics can lead to improvements for individuals with ASD. We hope that future research can delineate the complete physiological effects of these diets. Such knowledge can guide the creation of more informed interventions, which conserve the components resulting in positive behavioral change while being less restrictive and devoid of the harmful effects of limiting certain nutrients.

Gut Microbiota, Inflammation, and Probiotics on Neural Development in Autism Spectrum Disorder.

Recent evidence implicates immune alterations and gut microbiota dysbiosis in at least some subpopulations of individuals with autism spectrum disorder (ASD). Immune and gut alterations in ASD have mostly been studied separately, and the reviews and theoretical models up to now have mainly considered the immune system as one of the routes for gut-brain communication. We take a different perspective and consider possible common mechanisms of action for the gut microbiota and inflammation on the neural basis of ASD. We propose these to be their effects on ASD-susceptibility genes, neurodevelopment, and intestinal and blood-brain barrier integrity. We then use these common mechanisms to offer pathways for potentially beneficial effects of early-life probiotics on the neural development in ASD. This new perspective yields a conceptual framework for creating effective preventions for mothers at risk of giving birth to children with ASD. Such a framework may also inform effective interventions targeting these common mechanisms of action, which may be shared in many ASD cases regardless of their different etiological profiles. Probiotics may be one example of such preventions and interventions. Finally, the common mechanisms offered by this perspective can be useful in the search of comprehensive theories that can account for the complete neurobiological and behavioral symptoms of ASD.

Not just a sum of its parts: How tasks of the theory of mind scale relate to executive function across time.

There is a well-established relationship between theory of mind (ToM) and executive function (EF) during the preschool years. However, less is known about the concurrent and longitudinal relations between EF and specific tasks tapping different aspects of ToM. The current study investigated the ToM-EF relationship across 1 year in 3- to 5-year-old Turkish children using the ToM battery of Wellman and Liu (2004), which measures understanding of diverse desires (DD), diverse beliefs (DB), knowledge access (KA), contents false belief (CFB), explicit false belief (EFB), and hidden emotion (HE). This battery has not yet been used in its entirety to test the predictive relations between ToM and EF. We used peg-tapping and day-night tasks to measure EF. Our sample comprised 150 Turkish preschool children (69 girls) aged 36-60 months at Time 1 (T1) and 49-73 months at Time 2 (T2). Using the ToM composite with all six tasks, when child's age, receptive language, and T1 ability level (EF or ToM) were controlled, T1 EF significantly predicted T2 ToM, whereas T1 ToM did not predict T2 EF. Among DD, DB, KA, false belief understanding (FBU: the composite score of CFB and EFB), and HE, only KA and FBU were significantly associated with EF at T1 and T2. Further regression analyses showed that KA did not have a predictive relationship with EF. Instead, FBU drove the predictive EF-ToM relationship across time. Thus, in Turkish children, earlier EF predicts later ToM, but especially the FBU component, in this well-validated battery.

The Social Living Complex: A New, All Day, Yearlong Intervention Model for Individuals with Autism Spectrum Disorder and Their Parents.

We propose an unprecedented intervention for individuals with autism spectrum disorder (ASD) and their parents: the social living complex. Unlike existing social skills interventions, peer-mediated interventions here are not limited to the school/experiment duration and setting. Whereas other supported living services house adults with ASD only, here children with ASD and their families live and interact with typically developing (TD) individuals. Another novelty is support groups for parents of children with ASD, who report feeling higher levels of stress than parents of TD children and children with other disabilities, feeling isolated, and not receiving social support. This complex will enable the practice and generalization of schooled skills in the lives of children with ASD and foster an accepting, autism-friendly community.