Journal of Neurodevelopmental Disorders

Background Diagnosis and treatment monitoring of attention-deficit/hyperactivity disorder (ADHD) largely rely on subjective assessments, highlighting the need for objective markers. Voice features and speech embeddings represent promising candidates for such markers, as they may capture alterations in speech production relevant to ADHD. However, it remains unclear which speech features are most informative for distinguishing ADHD and monitoring treatment effects, and which speech tasks most reliably elicit such differences. Methods Twenty-seven children with ADHD and 27 age-matched neurotypical controls completed six speech tasks across two study visits. Children with ADHD were unmedicated at baseline (first visit) and were assessed under prescribed methylphenidate treatment at follow-up, whereas controls underwent repeated assessment without intervention. Established acoustic voice features (eGeMAPS) and high-dimensional speech embeddings (WavLm, Whisper) were extracted and analysed using linear mixed models to examine baseline group differences and group-by-time interaction effects reflecting medication-associated change patterns. Results At baseline, children with ADHD differed significantly from controls in frequency, spectral, and temporal voice features, characterized by lower and more variable pitch, altered spectral properties, and reduced rhythmic stability. Group-by-time interaction effects indicated medication-associated modulation in the ADHD group, including reduced loudness variability and increased precision of vowel articulation at follow-up, changes not observed in controls. Speech embeddings revealed additional baseline and interaction effects beyond established acoustic features. Free speech tasks, particularly picture description, yielded the most robust and consistent effects. Conclusion Children with ADHD differed from neurotypical controls in vocal features at baseline and showed distinct longitudinal change patterns consistent with medication-related change. These findings support further investigation of speech-based measures as candidate digital phenotypes and potential digital biomarkers in ADHD, with picture description emerging as a particularly promising task for future clinical assessment protocols.

PurposeNavigational ability develops throughout childhood alongside the maturation of brain regions supporting egocentric and allocentric processing. In Autism Spectrum Disorder (ASD), atypical hippocampal development may impact flexible spatial memory; however, findings on navigational ability in autistic children remain inconsistent. This study aimed to compare both objective and perceived navigation ability in children with ASD and typically developing (TD) peers. MethodTwenty-six children with high-functioning ASD and twenty-five age- and gender-matched TD children (M_age = 12.04 years, SD = 1.64) completed a battery of navigational tasks from the Spatial Performance Assessment for Cognitive Evaluation (SPACE), including Path Integration, Egocentric Pointing, Mapping, Associative Memory, and Perspective Taking. Perceived navigation ability was assessed using the Santa Barbara Sense of Direction (SBSOD) scale. ResultsNo significant group differences were observed across any objective navigation tasks. However, children with ASD reported significantly lower perceived navigation ability compared to TD peers. ConclusionThese findings suggest a dissociation between perceived and actual navigational ability in ASD. By early adolescence, objective navigation performance appears intact, potentially reflecting sufficient maturation of underlying neural systems or the presence of compensatory mechanisms. The results underscore the importance of incorporating objective, task-based measures when assessing cognitive abilities in autistic populations.

Atypical social functioning is a core feature of autism, yet findings remain fragmented across components and development. We aimed to systematically integrate this literature and characterize the organization, development, and moderators of social functioning in autism. We conducted a systematic review and meta-analysis of behavioral studies published between January 1990 and August 2025, identified through PubMed, Web of Science, and prior reviews, including studies with clinically diagnosed autistic individuals and neurotypical controls. A qualitative synthesis and two complementary quantitative meta-analyses were performed, with risk of bias evaluated through study-level characteristics. A total of 2,622 studies (94,114 autistic and 172,847 neurotypical individuals across 32 countries) were included, covering 22 social components that clustered into five domains. Overall group differences were substantial (Hedges g = -0.744, 95% CI [-0.797, -0.690]). Differences emerged earliest in motivation-based processes ([~]6 months), followed by motor, emotion, and inference domains, and showed age-related divergence alongside improvement in some skills. Cross-domain analyses revealed stronger interdependencies in autism and an organizational pattern most consistent with serial relationships among domains. These findings should be interpreted in light of methodological heterogeneity, underpowered samples, and uneven cultural representation. Together, the results provide an integrative framework for understanding the organization and development of social functioning in autism, with implications for precision subtyping, developmentally timed interventions, and neurodiversity-informed research and policy. This study was pre-registered (PROSPERO: CRD42024566141).

The causes of severe neuropsychiatric deteriorations among patients with previously stable autism spectrum disorder (ASD) are poorly understood and present substantial challenges for care. We aimed to characterize the prevalence of autoimmune and inflammatory conditions and markers, as well as musculoskeletal findings, among youth with ASD experiencing a suspected post-infectious neuropsychiatric deterioration. The Stanford Immune Behavioral Health (IBH) Clinic is a specialty program for youth with neuropsychiatric deteriorations that are suspected to be post-infectious (non-psychosocial). We report findings for 43 consecutive patients with ASD (70% male [30 of 43]) evaluated in the IBH Clinic. The average (SD) age at clinical presentation was 12.0 (4.0) years. Juvenile arthritis was diagnosed in 15 patients (35%), predominantly enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). Seven patients had ultrasonographic evidence of joint effusions and/or synovitis without meeting juvenile idiopathic arthritis (JIA) criteria. Autoimmune conditions other than arthritis were observed in 9 patients (21%). The mean (SD) age at arthritis and other autoimmune condition diagnoses were 16.2 (5.5) and 12.7 (4.9) years, respectively. We observe markers of immune activation during neuropsychiatric deteriorations in over half of patients (60% [26 of 43]), including markers of autoimmunity (33% [12 of 36]), complement activation (41% [13 of 32]), immune dysregulation/inflammation (11% [4 of 37]), and vasculopathy (30% [13 of 43]). One-third (37% [16 of 43]) demonstrated two or more markers. These data underscore the importance of targeted immune evaluation--including musculoskeletal imaging and inflammatory marker screening--in ASD patients who have had a suspected post-infectious behavioral regression. Lay SummaryIn this cohort study of 43 patients with autism spectrum disorder (ASD) and suspected post-infectious deteriorations, more than half had laboratory markers of immune activation (using a limited panel), one-third had joint inflammation (confirmed by ultrasound), and additional autoimmune conditions were observed in 21%. From this, we conclude that patients with ASD who experience a suspected post-infectious neuropsychiatric deterioration may have underlying inflammation which may contribute to neuropsychiatric and behavioral regressions, highlighting the importance of immunologic and rheumatologic evaluation in clinical assessment.

Genetic counselling outcome measures are increasingly adapted for diverse clinical contexts. While the Genetic Counselling Outcome Scale (GCOS-24) is available in Swedish, no autism-specific version has been developed. Therefore, we adapted the Swedish GCOS-24 using the English version of the modified GCOS-24 (mGCSOS-24) to create a Swedish autism-specific mGCOS-24. Thereafter, we evaluated both the Swedish autism mGCOS-24 and the Swedish general GCOS-24 using Rasch analysis to assess their psychometric properties. Both instruments exhibited structural challenges, including multidimensionality, disordered thresholds, local item dependence, and invariance issues. For the Swedish autism mGCOS-24, we were able to identify subscales with acceptable measurement properties. However, applying the same structure to the Swedish general GCOS-24 did not resolve its broader limitations. This study introduces the first Swedish autism-specific mGCOS-24 and represents the first Rasch-based evaluation of any GCOS-24 or mGCOS-24 in Swedish. Our findings highlight important opportunities for measure refinement but also indicate that new or more substantially adapted tools may be needed to capture outcomes of genetic counselling in autistic populations.

Neuroligin-3 (NLGN3) was first identified as a risk gene associated with autism spectrum disorder (ASD). The initial variant, p.R451C, associating NLGN3 with ASD has been heavily investigated, yet little is known about the functional consequences of other NLGN3 variants. Furthermore, while most of the identified variants are present in males with maternally inherited variants from unaffected mothers, several de novo variants were observed in females, suggesting a possible functional difference between de novo and maternally inherited variants. To address the functional consequences of NLGN3 variants in vivo, we generated transgenic Drosophila models corresponding to one de novo variant (p.R175W) identified in one female proband, and two maternally inherited variants (p.R451C and p.R597W) identified in male probands. In Drosophila, loss of the fly homolog, Nlg3, altered sleep patterns, synaptic architecture, and vesicle dynamics, which were rescued by the expression of the human NLGN3Ref allele. When comparing the variants, the de novo p.R175W variant and the maternally inherited p.R451C variant altered synapse morphology and sleep patterns, with minimal effects on vesicle dynamics, and the p.R597W variant altered sleep and vesicle dynamics with minimal impact on synapse morphology. Using overexpression models, human NLGN3Ref altered sleep patterns and synaptic morphology. Moreover, the p.R175W variant exacerbated sleep phenotypes, and the p.R175W and p.R451C variants exacerbated synapse morphology phenotypes. Together, our findings suggest that de novo NLGN3 variants identified in females are likely gain-of-function, while maternally inherited variants have mixed loss-and gain-of-function effects. Moreover, the location of the variants may contribute to the distinct functional differences we observed. Some NLGN3 variants disrupt synaptic development, while other variants alter synaptic function, suggesting that NLGN3 variants have differential effects. These functional differences may provide insight into the heterogeneity of individuals with ASD. Author SummaryAutism spectrum disorder (ASD) is a common neurodevelopmental disorder. Mutations in the Neuroligin-3 (NLGN3) gene are associated with ASD but very few of these mutations have been characterized in animal models. Most of these mutations affect male individuals who maternally inherited their genetic mutation; however, more rarely female individuals may present with a genetic mutation that was not identified in either of the parents. Here, we utilized the fruit fly model to investigate how three different mutations, one mutation identified in a female and two mutations identified in males, affect the flys behavior and synapse development. We identified altered sleep patterns in some of our mutants which is consistent with sleep disturbances being highly comorbid with ASD. Additionally, we identified alterations in synapse development and function which is consistent with the role of NLGN3 in synapse formation and maturation. Together, our findings support that NLGN3 is important for regulating the synapse and mutations in this gene can alter its function. However, different mutations can have differential effects. This demonstrates the need to assess multiple variants simultaneously because each variant may have distinct functional significances.

Adult ADHD is increasingly recognized across the lifespan, yet the psychometric equivalence of the Adult ADHD Self-Report Scale (ASRS) remains unverified for older populations. This study examined age-related Differential Item Functioning (DIF) in 600 adults (n = 100 per decade, ages 20-80) who completed the 18-item ASRS. Using a bi-factor Graded Response Model, we extracted latent ADHD trait scores ({omega}H = .895) and assessed DIF via ordinal logistic regression with adaptive age modeling. Five of 18 items exhibited significant uniform DIF. At equivalent latent severity, older adults were less likely to endorse hyperactivity symptoms in Part A (fidgeting, feeling "driven by a motor") but more likely to endorse specific symptoms in Part B (careless mistakes, misplacing items, interrupting). From ages 20 to 80, expected Part A scores decreased by 1.36 points (~0.27 per decade), while Part B scores increased by 1.15 points (~0.23 per decade). These findings indicate a phenotypic redistribution of ADHD symptoms as individuals age. Because the 6-item Part A screener serves as the primary clinical gatekeeper, its concentration of negative DIF suggests standard screening practice may systematically underestimate ADHD severity in older adults. We recommend using the full 18-item ASRS when screening older populations and suggest that developing age-adjusted norms would improve diagnostic accuracy.

Objective: Autistic individuals may face elevated risk for PTSD, yet the degree to which this risk differs by sex remains unknown. We examined the association between autism and incident PTSD, characterized sex differences in risk, identified high-risk subgroups, and described post-diagnosis clinical trajectories. Method: We conducted a population-based matched cohort study using Swedish national registers. Individuals born 1990 through 2010 were followed from age 6 years through December 31, 2017. Autistic individuals (N=42,862) were matched 1:10 to controls (N=412,251) on sex and birth year. Cox proportional hazards regression estimated hazard ratios (HRs) for incident PTSD. Among those who developed PTSD, we compared care utilization, hospitalization rates, and persistence of care contacts. Results: During mean follow-up of 5.1 years, 401 autistic individuals (0.9%) and 903 controls (0.2%) developed PTSD (incidence rates: 18.3 vs 4.2 per 10,000 person-years). Autism was associated with 4.4-fold increased PTSD risk (HR=4.37; 95% CI, 3.93-4.86). Risk was higher among females (HR=4.79) than males (HR=3.39; P interaction=.006). Among autistic individuals, comorbid ADHD conferred additional risk (HR=1.38; 95% CI, 1.14-1.68). Ten-year cumulative incidence reached 6.0% among autistic females with ADHD. Autistic individuals with PTSD had higher care utilization (mean visits: 5.0 vs 3.9; P<.001), more psychiatric hospitalizations (27.9% vs 19.8%; P=.002), and more persistent courses (24.8% vs 12.3% with contacts in all 3 post-diagnosis years; P=.001). Conclusion: Autism is associated with substantially elevated PTSD risk, particularly among females with comorbid ADHD. When PTSD occurs, autistic individuals experience more severe and persistent clinical courses, supporting targeted screening and sustained follow-up.

Atypical sensory experiences are highly prevalent in autistic children and include both hyper- and hypo-responsivity, often accompanied by sensory overload. Alpha oscillations (7-13 Hz), which dynamically regulate cortical excitability, represent a plausible neural mechanism underlying these phenomena: reduced alpha activity is associated with enhanced sensory responsiveness, whereas increased alpha supports suppression of external input. Although decreased alpha power has been repeatedly reported in autism, it remains unclear whether this reduction reflects lower oscillatory amplitude or reduced temporal stability of alpha rhythms, two mechanisms with distinct neurophysiological implications. To better characterize alpha activity in autism, we examined resting-state alpha dynamics in non-autistic children (NA; n = 39), autistic children (AU; n = 52), and siblings of autistic children (SIB; n = 26), aged 8-14 years. We combined traditional broadband measures of relative alpha power, parametric separation of periodic and aperiodic activity, and single-event analyses that quantify the temporal structure of alpha oscillations. Both broadband relative alpha power and periodic alpha power were reduced in autism over parietal regions, replicating prior findings. Importantly, ordinal analyses revealed an intermediate profile in siblings, supporting a liability-related gradient of alpha alterations. However, single-event analyses demonstrated that the average amplitude of individual alpha bursts did not differ between groups. Instead, autistic children showed significantly shorter alpha burst duration and reduced alpha abundance (i.e., proportion of time occupied by rhythmic alpha episodes), with siblings again exhibiting intermediate values. Linear regression analyses confirmed that reductions in relative and periodic alpha power were primarily driven by decreased alpha abundance rather than diminished burst amplitude. These findings indicate that altered alpha activity in autism reflects reduced temporal stability and density of alpha events rather than weaker oscillatory amplitude per se. Reduced persistence of alpha rhythms may therefore represent a neural marker of altered cortical excitability and sensory regulation in autism. Lay summaryAutistic children often experience the world differently at the sensory level, including being more easily overwhelmed by sounds, lights, or other stimuli. In this study, we looked at a type of brain activity called alpha rhythms, which help regulate how strongly the brain responds to incoming information. We found that, in autistic children, these alpha rhythms were not weaker when they occurred, but they lasted for a shorter time and happened less often. Siblings of autistic children showed an intermediate pattern. These results suggest that sensory differences in autism may be linked to less stable brain rhythms that normally help control sensory input. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=158 SRC="FIGDIR/small/716324v1_ufig1.gif" ALT="Figure 1"> View larger version (32K): org.highwire.dtl.DTLVardef@1be733dorg.highwire.dtl.DTLVardef@7fea49org.highwire.dtl.DTLVardef@1ee9124org.highwire.dtl.DTLVardef@17af139_HPS_FORMAT_FIGEXP M_FIG C_FIG

Background Phonemic awareness deficits are a core feature of Specific Learning Disorder-Reading (SLD-R). How task- and language-specific factors influence these deficits in alphasyllabary languages may help clarify the cognitive mechanisms underlying reading impairment in SLD-R. Methods Thirty children with a DSM-5 diagnosis of SLD-R (mean age 11.4 years) and 29 age-matched typically developing children were given phoneme blending (words and pseudowords) and segmentation tasks in Malayalam. The effects of age and consonant clusters on task performance were evaluated. Results Children with SLD-R performed significantly worse than controls across most phonemic awareness tasks, with the largest deficits observed in pseudoword blending and word blending, and smaller deficits in segmentation. No significant difference was observed for initial phoneme deletion. In typically developing children, age showed strong positive correlations with phonemic performance across most tasks, whereas the SLD-R group showed weak or absent correlations, except in word blending and initial phoneme deletion. Consonant clusters significantly affected performance in both groups, with SLD-R showing more severe deficits. Conclusions Phonemic awareness deficits observed in SLD-R in alphasyllabary languages like Malayalam are more prominent in tasks where lexical support is absent, like pseudoword blending. These deficits vary across task types and linguistic complexity. Phonemic awareness improves with age in typically developing children, while improvement is uneven in children with SLD-R. The findings suggest that phonemic awareness deficits are a core feature of SLD-R across languages, but their manifestation is shaped by orthographic and linguistic characteristics of the writing system.

BackgroundTourette Syndrome (TS) is a neurodevelopmental movement disorder involving involuntary motor and vocal tics believed to be characterised by disordered neural inhibition. Cortical representations have previously been manipulated by disruptions in the inhibitory neurotransmitter {gamma}-aminobutyric acid (GABA). However, while facial tics are the most reported motor tic, it is unclear if facial sensorimotor representations differ in TS. MethodsSixteen individuals with Tourette Syndrome (TS) or chronic tic disorder and twenty typically developing (TD) control participants underwent 3-Tesla functional magnetic resonance imaging (fMRI). Blood-oxygenation level-dependent (BOLD) responses were measured during a block-design task comprising cued facial movements of common facial tics (blinking, grimacing and jaw clenching). Activations in bilateral pre- and post-central cortices and supplementary motor areas (SMA) were examined. Conjunction analyses identified voxels commonly and uniquely activated across movements within each group. ResultsBoth groups showed significant activations in the bilateral sensorimotor cortices and SMA in response to blink, grimace and jaw clench movements, with no significant between-group differences. Between-group similarities were lowest for unique blink maps. Common voxel maps also revealed low between-group similarity, with reduced sensorimotor activation and no shared SMA activation across movements in the TS group. ConclusionVoluntary facial sensorimotor representations do not differ between groups. However, low similarities between group unique blink maps may reflect greater prevalence of blinking tics in TS. Additionally, reduced overlap in sensorimotor activation and absent common SMA engagement across cued movements in the TS group may indicate altered motor integration or action initiation.

Objective: While ADHD symptoms often decline from childhood into adulthood, the underlying neurobiological mechanisms, such as altered brain maturation or neural reorganization, remain incompletely understood. This study investigated how grey matter development relates to ADHD symptom trajectories into adulthood. Method: We analyzed data of individuals with ADHD and controls from the longitudinal Dutch NeuroIMAGE cohort, utilizing dimensional ADHD symptom scores (Conners Parent Rating Scale) from three waves and T1-weighted structural MRI scans from the final two waves. Using General Linear Models with permutation-based inference, we examined: 1) cross-sectional associations between ADHD symptoms and vertex-wise cortical thickness and surface area, and subcortical volumes at Wave 1 (n = 765, mean age = 16.95 years); and 2) longitudinal associations between symptom progression and brain morphometric changes (Wave 0 to 1: n = 644, mean age = 11.55-17.24 years; Wave 1 to 2: n = 149, mean age = 16.45-20.11 years). Results: Cross-sectionally, at Wave 1, more ADHD symptoms were related to widespread reductions in surface area, most prominently in the frontal cortex, and smaller volumes of the cerebellum, amygdala, and hippocampus. Longitudinally, symptom improvement from Wave 1 to Wave 2 was associated with stronger reductions in surface area, particularly in prefrontal and occipital regions, and with more pronounced cortical thinning across multiple brain regions. Conclusion: These findings suggest an association between symptom trajectories and structural brain changes, indicating that clinical improvement in ADHD behaviors might coincide with ongoing neural refinement during the transition to adulthood.

Mechanistic understanding and biomarkers of gonadotropin-releasing hormone antagonist treatment effect in paedophilic disorder are absent but may enhance outcomes and reduce sexual-offending risk. 52 help-seeking self-referred Swedish men with paedophilic disorder enrolled in a double-blinded, placebo-controlled, randomized clinical trial. Participants underwent task-based fMRI before, and two weeks after, subcutaneous injection of 120mg of degarelix or equal volume of placebo. fMRI blood-oxygen-level-dependent activation was compared between child and adult (child>adult) stimuli in task-derived regions of interest. Primary outcome was within region-of-interest child>adult activation change, whereas secondary outcomes correlated region-of-interest child>adult activation change to change in clinical measurements of risk, paedophilic interest, sexual preoccupation, hyper- and hyposexuality. 19 degarelix and 22 placebo participants had sufficient fMRI data quality. Reductions in paedophilic interest were strongly correlated with increased child>adult cerebellar (vermis) region-of-interest activation following degarelix (r=-0.740, p<0.001) but not placebo (r=0.183, p=0.41; between-group correlation coefficient z=3.347, p<0.001). Treatment did not significantly change child>adult region-of-interest activity. Post hoc analysis indicated that baseline autism symptoms correlated with degarelix-induced changes in paedophilic interest (r=0.717, p<0.001; between-group correlation coefficient z=2.958, p=0.003) and cerebellar activation (r=-0.581, p=0.01; between-group correlation coefficient z=-1.930, p=0.05). Increased child>adult cerebellar activation was associated with degarelix-induced reductions of paedophilic interest, suggesting cerebellar activity as mechanistically important to, and a prospective biomarker of, degarelix treatment effect. Additionally, autism symptoms may inform treatment prediction. Together, these findings have mechanistic and clinical implications for degarelix treatment of paedophilic disorder. EU clinical trials register identifier: 2014-000647-32 https://www.clinicaltrialsregister.eu/ctr-search/trial/2014-000647-32/SE, registered on 05/06/2014.

Background Angelman syndrome (AS) is a rare neurodevelopmental disorder with characteristic electroencephalographic abnormalities caused by loss of function of the maternally inherited UBE3A gene. Converging evidence suggests a disrupted excitation-inhibition (E/I) balance towards hyperexcitability. However, noninvasive approaches capable of characterizing intrinsic cortical excitability and its relationship with large-scale brain dynamics in AS are still lacking. We used resting-state electroencephalography (EEG) to derive cortical excitability, testing the hypothesis that altered local E/I balance in AS is associated with instability of large-scale functional brain networks. Methods We recorded 7 minutes of task-free high-density EEG in 29 individuals with AS and 36 typically developing controls. Source-reconstructed cortical activity was used to compute the excitability index (EI), based on mean spatial phase synchronization in the gamma band. Dynamic functional connectivity was computed and summarized as fluidity index, which estimates temporal variability of network configurations. We assessed group differences and associations between EEG features, clinical variables and caregiver-reported questionnaires. Results AS participants showed increased EI in anterior cingulate, dorsolateral prefrontal, temporoparietal, and occipital regions. Fluidity was larger in AS across frequency bands, indicating greater network instability. EI positively predicted fluidity in widespread regions in AS, whereas the opposite pattern was observed in controls. Higher EI correlated with fewer antiseizure medications and with greater sensory-seeking behavior. Conclusions AS is characterized by cortical hyperexcitability coupled with unstable large-scale network dynamics. The EI provides a biologically meaningful marker linking intrinsic E/I imbalance to behavioral features and treatment-related variables

Background: Adult autism services research is hampered by a lack of accessible self-reported outcome measures. The AASPIRE Outcomes Project used a community-based participatory research (CBPR) approach to create and test the AASPIRE Measurement Toolkit, a set of accessible survey instruments for use in real-world settings. The core toolkit contains 12 characteristics modules and 19 outcome measures, each with self-reported and caregiver-reported versions. Methods: In a prior phase of the project, we collaboratively adapted, revised, or co-created all instruments. We used our CBPR-nested Delphi process, our collaborative adaptation/creation process, and cognitive interviews to ensure accessibility and content validity. We then conducted a longitudinal survey to validate the 19 outcome measures in a pragmatic sample of 870 autistic adults from two healthcare systems, two disability service systems, and the larger autistic community in the United States. Participants completed surveys at 3 time points over 12-18 months. A 15% random subset completed an additional retest survey 2 weeks after the second time point. We assessed 1) accessibility using completion rates and perceived ease of use; 2) internal consistency using Cronbach's alphas and omegas; 3) convergent validity using Pearson's correlations; 4) two-week test-retest reliability using interclass correlation coefficients; and 5) six-month responsiveness to change by comparing self-perceived change with change in scores. Results: Over 90% of participants reported the survey items were easy to understand; over 90% of participants who started the survey completed all applicable sections at each time point; and participants answered 99% of items on each instrument. The outcome measures and their pre-determined subscales demonstrated strong accessibility, content validity, internal consistency reliability, test-retest reliability, convergent and discriminant validity, and responsiveness to change. Conclusion: The AASPIRE Measurement Toolkit is accessible and includes 19 outcome measures with strong initial psychometric properties. We will report in-depth assessments of construct and structural validity separately for each measure. All instruments are available for free and can help clinicians, service providers, advocacy organizations, and researchers assess the effectiveness of interventions and follow changes in outcomes over time.

Early childhood mental health problems are common and difficult to detect due to reliance on caregiver reports of often unobservable symptoms. This study quantified threat response movement patterns during a 30-second laboratory threat induction task using wearable inertial sensors. Movement patterns were used to examine (1) changes in stimuli response across the task (task validity) and (2) associations with symptom severity (clinical validity). Sacral accelerometer and gyroscope data were analyzed from 91 children aged 4-8 years during the brief task, 48.4% of whom had a mental health diagnosis. Consistent with task validity, Turning Speed varied across task phases differing in potential threat intensity. Consistent with clinical validity, internalizing symptoms were associated with smaller Turning Angle, possibly indicating vigilance. This effect was moderated by comorbid externalizing symptoms, such that children with high internalizing and high externalizing symptoms exhibited larger Turning Angles, possibly indicating avoidance. Findings demonstrate that brief wearable-enabled tasks can capture subtle objective behavioral markers of threat responses and underscore the importance of considering comorbid symptom dimensions in early childhood mental health screening.

Developmental stuttering is a complex neurodevelopmental disorder characterized by disfluent speech. At the individual level, the behavioral manifestations of stuttering vary considerably, likely reflecting heterogeneity in underlying neural mechanisms. In this study, we examined individual-specific differences in the brains of children who stutter (CWS), by implementing normative modeling, a framework that quantifies how an individual deviates from an age- and sex-matched reference population. We applied this approach to identify individual-specific structural brain atypicalities using gray and white matter volumes. These volumes were derived from MRI scans from a large mixed-longitudinal dataset of 235 and 240 scans from CWS and fluent controls respectively, aged between 3 and 12 years. Individual deviation maps capturing these atypicalities were then used to cluster CWS into subtypes based on similarities in their neuroanatomical profiles. This analysis identified four neural subtypes with distinct neuroanatomical atypicalities relative to fluent controls. The key findings were a basal ganglia-thalamo-cerebellar subtype associated with higher stuttering severity and lower rates of recovery, and a white matter subtype characterized by mild severity and a higher likelihood of recovery. The remaining two subtypes showed cerebellar differences alongside alterations in brain regions involved in sensorimotor integration. Moreover, cerebellar volume atypicalities were present in all four subtypes, indicating that cerebellar alterations were present across otherwise distinct neural profiles and may represent a shared neuroanatomical feature of stuttering. These findings indicate that examining individual-specific neural differences and subtyping based on patterns of neural atypicalities provides valuable insight into the heterogeneity of developmental stuttering and represents a promising direction for improving our understanding of the disorder.

The etiology of autism is influenced by genetic and non-genetic factors, with observational studies suggesting associations between early maternal health diagnoses and offspring autism. However, these associations may partly reflect shared familial genetic liability rather than direct causal effects. Using comprehensive national health registers and individual-level genetic data from the iPSYCH cohort (N=117,542), we examined whether maternal health diagnoses are associated with offspring polygenic scores (PGS) for autism. Such associations between maternal health and offspring autism would indicate shared genetic factors and the possibility of genetic confounding in the observational associations. We also tested such associations with PGSs for other neuropsychiatric and neurodevelopmental conditions that are genetically correlated with autism, but with better-powered PGS (due to larger GWAS sample sizes and likely more polygenic genetic architecture), as well as height, a negative control. Several maternal diagnoses were nominally associated with autism PGS in the child, including, e.g., certain obstetric complications, asthma, and obesity. After adjustment for multiple testing, the only statistically significant results included those between maternal diagnoses, predominantly psychiatric, and other neuropsychiatric and neurodevelopmental PGSs in the child. Sensitivity analyses confirmed the robustness of our results across exposure windows, diagnostic settings, and socioeconomic adjustments. These findings indicate that maternal diagnoses associated with autism partially reflect shared genetic liabilities between mothers and their children. However, such genetic effects, as captured by child PGS do not fully explain the observed associations, suggesting additional factors, including e.g., non-genetic familial factors, rare variants, and indirect effects.

The role of digital media in early childhood development remains highly debated, particularly regarding its impact on language acquisition. While excessive or unsupervised screen exposure has been linked to poorer outcomes, less is known about whether structured and interactive uses of technology can support learning. Building on previous research, we evaluated a brief, educator-supervised tablet-based intervention in 246 children aged 2-5 years from low- to middle-socioeconomic backgrounds attending public early education centers. Using a pre-post design with matched study and control groups, children completed 4-8 short training sessions (15 minutes each) involving interactive word-image associations spanning multiple linguistic categories. Preschoolers additionally engaged in prompted vocalization. Across age groups (2-3, 3-4, and 4-5 years), children in the intervention showed greater gains in language comprehension than controls, including receptive language in toddlers ({beta} = 0.49, p = 0.009), vocabulary and morphology in younger preschoolers ({beta} = 0.59-0.68, all p < 0.05), and grammar comprehension in older preschoolers ({beta} = 0.30, p = 0.038). These effects were consistent after accounting for child and parental characteristics. Together, these findings suggest that the developmental impact of digital media depends less on exposure itself than on how it is used. When embedded in structured, socially guided interactions, even brief tablet-based activities may support early language development

A large subset of ASD associated genes, almost 50% of the highest confidence risk genes listed on the Simons Foundation Autism Research Institute database, are epigenetic modifiers. This suggests that the organization of sensory biology and its coupling to underlying genetic control are an important element underpinning this discord. Furthermore, sensory processing changes in individuals with autism spectrum disorder (ASD) has been a growing area of study in recent years. C. elegans have robust readouts for both developmental and sensory biology allowing these signatures of ASD to be systematically modelled. 52 epigenetic modifiers (65 strains) were selected for study in C. elegans based on gene function, presence of orthologues in C. elegans and the availability of viable putative null strains. This highlighted significant changes to reproduction, gross development and sensory processing across the range of epigenetic modifiers. Each strain was filtered against selective criteria for significant sensory and developmental phenotypes allowing for selective phenotypic profiles to emerge. These were three primary groups, those with sensory perturbations but unaffected gross development (6), developmentally affected genes with intact sensory function (10) and finally genes with impaired gross development and sensory function (11). Thus, this study provides a link between sensory and developmental outcomes in ASD associated mutant strains and suggests that more regular sensory testing should be performed in human cohorts to further refine sub-categorisation of ASD cohorts.