Molecular Autism

Transcranial magnetic stimulation can provide noninvasive measures of cortical excitability and plasticity, but relationships between these measures and clinically observable features of autism are not fully characterized. Nineteen autistic participants aged 15 to 40 years were included in the analysis of a left primary motor cortex continuous theta-burst stimulation (cTBS) biomarker protocol. Motor evoked potentials were measured at baseline and at seven assessments from 5 to 60 min after stimulation. Linear mixed-effects models evaluated whether clinical measures moderated the post-stimulation motor evoked potential log-response ratio over time. Aberrant Behavior Checklist (ABC) and Attenuated Behavior Questionnaire (ABQ) analyses were restricted to the same 15 participants with caregiver-informant assessments. Catatonia severity, social impairment, ABQ Motor Total, ABQ Total, and cognitive ability did not significantly moderate the post-stimulation response. ABC Inappropriate Speech was associated with progressively greater post-stimulation facilitation (standardized Time-by-Inappropriate Speech interaction: beta = +0.688, SE = 0.210, 95% CI +0.276 to +1.099; Holm-adjusted P = .008 across eight informant-rated models). Two individual speech-related items ("Talks excessively" and "Talks to self loudly") survived false-discovery-rate correction. An exploratory eight-item ABC phenotype showed a large descriptive in-sample association (beta = +0.904, SE = 0.200, P less than .001) and directionally positive held-out performance. However, full-pipeline permutation tests were nonsignificant for both Pearson (r = .357, two-sided empirical P = .360) and Spearman correlations (rho = .446, two-sided empirical P = .261). Caregiver-rated inappropriate speech may be associated with altered post-cTBS motor cortical facilitation in autism. The candidate phenotype remains hypothesis-generating and requires independent validation.

Autism spectrum disorder (ASD) is a neurodevelopmental condition often associated with auditory symptoms, including impairments in sound perception and hypersensitivity. These symptoms are thought to be partly due to the delayed development of the auditory brainstem, as evidenced through aberrant auditory brainstem responses (ABRs) and exaggerated startle responses in infants diagnosed with ASD. Loss-of-function mutations in CNTNAP2, a gene implicated in auditory processing and language development, are causally associated with ASD. Accordingly, knocking out Cntnap2 causes auditory brainstem impairments in rats; however, it is unknown if similar disruptions are observed in mice due to a possible conserved role of Cntnap2 in the auditory brainstem. To test this, we characterized the development of auditory processing, reactivity, and sensory filtering in juvenile and adult Cntnap2 knockout (KO) mice. We found that juvenile KO mice exhibited larger ABR wave III amplitudes and smaller wave IV widths, which normalized in adult mice, suggesting the possibility of transient hyperexcitability in the developing auditory brainstem. Additionally, our acoustic startle measurements revealed sex-specific phenotypes in which male KO mice exhibit an exaggerated startle response that persists into adulthood, while prepulse inhibition (PPI) remained generally intact in KO mice at both ages. These results demonstrate that loss of Cntnap2 in mice produces auditory brainstem abnormalities similar to rats, but causes species- and sex-specific effects on auditory reactivity, establishing the mouse model as a complementary animal model for investigating neural mechanisms underlying auditory dysfunction in ASD.

Autism arises from diverse genetic risk factors, yet how they converge to produce core symptoms and contribute to its sex bias remains unestablished. Oxytocin increases sociability in multiple murine autism models, presenting an opportunity to identify a potentially shared mechanistic basis across etiologies. Here we show that spontaneous social investigation triggers overlapping patterns of aberrant functional connectivity across social and sensory brain regions in two knockout (KO) mouse models, which are rescued by oxytocin. We also report that, during social investigation, wildtype mice exhibit sexually dimorphic oxytocin release and neuronal activity dynamics in the nucleus accumbens and the amygdala. These patterns are disrupted in both KO models, but can be restored by sex- and circuit-specific stimulation of endogenous oxytocin release, accompanied by enhanced social engagement. These findings identify impaired oxytocin recruitment of sexually dimorphic social circuits as a convergent consequence of autism-risk gene mutations that may underlie low sociability.

Background: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by deficits in social communication and interaction, and restricted interests or repetitive behaviors. ASD is approximately four times more prevalent in males than in females. In this study, we investigated whether sex hormones or sex chromosomes underlie the male bias in ASD susceptibility. Methods: We used the MG4E mouse model, in which microglial eIF4E overexpression produces robust male-biased ASD-like phenotypes. To distinguish the contributions of sex hormones and sex chromosomes, MG4E mice were crossed with four-core-genotype (FCG) mice carrying Sry gene manipulations, generating eight genotypes of experimental mice. Social interaction and repetitive behaviors were assessed using standard behavioral assays. Dendritic spine density was quantified in Thy1-GFP mice. Expression of estrogen receptors (ERs) and androgen receptor (AR) was examined in microglia isolated from control and MG4E mice. Results: Sex hormones, rather than non-Sry genes on sex chromosomes, are responsible for the male-biased deficits in social interaction and the increase in dendritic spine density. At postnatal day 14, ERs were undetectable in microglia, whereas ER expression was readily detected in neurons. Conclusions: These findings demonstrate that sex hormones are a major determinant of the increased susceptibility of males to ASD-like phenotypes in MG4E mice. The absence of ER expression in microglia suggests that sex hormones may act indirectly through hormone-responsive neurons to regulate microglia-neuron interactions during neurodevelopment.

Phelan-McDermid syndrome (PMS) is a genetic neurodevelopmental disorder caused by a microdeletion within chromosome 22q13.3 1-6, and accounts for [~]1-3% of cases of autism spectrum disorders (ASD). Individuals with PMS typically present with neonatal hypotonia, severe speech delay, intellectual disability, motor impairments, and autism-related features, although additional manifestations such as epilepsy, sleep disturbances, and developmental regression are common. As in ASD, there is considerable heterogeneity in cognitive and behavioral impairments in PMS, making it difficult to determine which features arise directly from SHANK3/Shank3 deficiency and how deficits manifest across development. In the present study, we transferred the targeted Shank3 mutation, previously characterized on the Sprague Dawley background, onto the Long-Evans strain and performed a longitudinal behavioral assessment of Shank3-deficient rats from infancy to adulthood. The rats were evaluated for delays in early sensory and motor development, and ultrasonic vocalizations as neonates, social behavior, short term memory and gait as juveniles, and cognitive-executive dysfunction using a touchscreen-based visual discrimination and reversal learning task as adults. Despite profound reductions and/or complete loss of Shank3 protein expression, heterozygous and homozygous male and female rats showed normal physical and neurological reflexes across development, yet female Shank3 knockout pups showed a selective reduction in distress-associated ultrasonic vocalizations. As juveniles, subtle abnormalities emerged in short-term memory and limb coordination, while social preference for novelty and recognition was normal. Prominent behavioral abnormalities were observed in adults characterized by rapid and error-prone responding to visual stimuli during discrimination learning and reversal. These data suggest that rats with complete or partial Shank3 deficiency produce a selective behavioral profile in which high-order cognitive dysfunction is more pronounced than deficits in basic sensorimotor or select social behaviors. More broadly, these findings highlight executive dysfunction as a key consequence of the loss of Shank3. For the first time, we report the loss of Shank3 expression on a Long-Evans background strain as a valuable translational tool for investigating cognitive dysfunction and therapeutic windows in Shank3-associated disorders.

Autism is a common neurodevelopmental condition with considerable between-person variability and unknown biological etiology. Diagnosis of autism in adults relies on measurement of performance (e.g., clinician rating of social behavior, standardized assessment of cognition) and self-report of autism features. Our prior work revealed a strong relationship between clinician ratings of social function in autism and in vivo measures of synaptic density as measured by [11C]UCB-J PET (Matuskey et al., 2025). However, it is not understood how the measured aspects of the autism phenotype index underlying biology. Here, in a sample of 12 autistic adults, we address this question by relating synaptic density imaging to a range of performance measures, such as cognition and face recognition, in contrast to self-report measures. Our results identify a dissociation between these measurement types in that synaptic density correlates strongly with measures of performance but shows virtually no relationship with self-report. These findings suggest that, while self-report and performance measures share variance in characterizing phenotypes in autism, they diverge when mapping onto the underlying biology. Results suggest that higher synaptic density may index a general mechanism that facilitates social and cognitive performance across a range of tasks. These data also indicate that performance and self-report measures are not interchangeable in capturing brain-behavior correspondences in autism, a finding that can guide measure selection in future biomarker studies and clinical research.

Background: Helsmoortel-Van der Aa syndrome, caused by pathogenic variants in ADNP, is characterised by substantial clinical heterogeneity, but how biological sex influences disease biology and treatment response remains an emerging area of investigation. Here, we investigated whether sex modifies the behavioural and molecular consequences of Adnp deficiency, the response to the investigational drug candidate davunetide (NAP), and the clinical phenotype of Helsmoortel-Van der Aa syndrome. Methods: We studied male and female Adnp heterozygous mice harbouring the p.Leu822Hisfs*6 variant and sex-matched wild-type littermates using continuous 24-h behavioural phenotyping, hippocampal genome-wide DNA methylation and bulk RNA sequencing. NAP effects on behaviour, hippocampal ADNP protein abundance, and epi-transcriptomic responses were assessed using genotype-by-treatment models. Four Core Genotypes mice were assessed to distinguish sex-chromosome and gonadal contributions to hippocampal Adnp transcript expression, and reproductive-tissue transcriptomes were analysed in Adnp mice to unravel a possible endocrine component of the disease. Findings were compared with clinical and developmental data from 129 individuals with Helsmoortel-Van der Aa syndrome. Findings: Adnp deficiency produced a shared overall behavioural phenotype in male and female mice, but through distinct patterns of behavioural disruption, indicating that sex modifies the implementation rather than the magnitude of the phenotype. This distinction was also evident at the molecular level: hippocampal DNA methylation was predominantly determined by genotype and showed convergence between sexes, whereas transcriptional responses diverged, with mitochondrial pathways predominating in males and chromatin, RNA processing, and cell-cycle pathways in females. NAP partially shifted behavioural abnormalities towards the wild-type state in both sexes and increased hippocampal ADNP protein abundance in heterozygous mice, without reversing the underlying methylation phenotype. Its transcriptional effects were markedly broader in males, indicating a sex-dependent molecular response to treatment. In reproductive tissues, Adnp deficiency was associated with convergent alterations in steroid hormone biosynthesis, despite no evidence for direct regulation of hippocampal Adnp expression by sex-chromosome complement or gonadal hormonal state. By contrast, sex was not associated with robust differences across the clinical and developmental features assessed in 129 individuals with Helsmoortel-Van der Aa syndrome after correction for multiple testing. Interpretation: Biological sex modifies how Adnp deficiency is expressed at behavioural and molecular levels, but these differences do not necessarily define distinct clinical phenotypes. The convergence of the methylation response alongside greater divergence in transcriptional and behavioural responses identifies sex as a modifier of disease biology rather than a determinant of the core phenotype. The sex-dependent response to NAP further indicates that biological sex may influence pharmacological responses even when treatment-associated behavioural improvement is observed in both sexes. These findings support consideration of biological sex as a prespecified variable in preclinical and clinical studies of Helsmoortel-Van der Aa syndrome and suggest that systematic investigation of sex-dependent biology may also be relevant to therapeutic development across rare diseases. Keywords: Helsmoortel-Van der Aa syndrome (HVDAS), Activity-Dependent Neuroprotective Protein (ADNP), autism spectrum disorder, intellectual disability, sex, mouse model, behaviour.

Altered sensitivity to sounds despite normal peripheral hearing is common in neurodevelopmental disorders but the underlying mechanisms remain poorly understood. Here we investigate tonotopic organization in 86 children (6-11 years) with autism spectrum and related neurodevelopmental disorders as well as typically developing (TD) peers, using a child-friendly, passive listening, functional magnetic resonance imaging design. In TD children, tonotopic maps in primary auditory cortex resembled the typical high-low-high frequency gradients previously reported in adults, while children with autism showed an overrepresentation of high frequencies consistent with what has been observed in animal models of autism. Higher frequency tuning further correlated with greater caregiver-reported sound but not touch sensitivities. Importantly, tonotopy is a core organizational feature of auditory cortex that develops early in life and remains relatively stable after the critical period of heightened plasticity ends. Thus, these results suggest that atypical auditory processing in autism may result from early disruption to tonotopic map formation. Longitudinal neuroimaging studies are needed to understand the genetic and environmental causes of altered auditory cortex topology and its long-term consequences for higher-level auditory, language, and social communication development.

Communication deficits are a defining feature of autism spectrum disorder (ASD) and among the earliest detectable markers of atypical neurodevelopment. Yet how specific genetic ASD risk factors shape the developmental trajectory of vocal communication remains poorly understood. Fragile X syndrome (FXS) is the most common inherited cause of ASD, resulting from the transcriptional silencing of the FMR1 gene, and a majority of FXS individuals exhibit impaired language development and atypical vocal communication. Rodent ultrasonic vocalizations (USVs) produced during maternal isolation provide a tractable model for studying the developmental trajectory of early vocal communication in FXS. Here, we characterized isolation- induced USVs in Fmr1 knockout (KO) and littermate wildtype (WT) rats from postnatal days 3- 21 to determine whether Fmr1 mutation disrupts the acoustic structure, temporal organization, or sequential syntax of USVs across postnatal development. We found that Fmr1 KO rat pups exhibited reduced call number during the peak developmental window for isolation-induced calling (p6-p10), while acoustic structure and temporal organization were largely preserved. Network analysis of call transitions revealed that WT pups exhibited a progressive increase in syntactic complexity from p3-p10. However, this developmental trajectory was significantly altered and delayed in Fmr1 KO pups. Together, these findings demonstrate that Fmr1 mutation not only disrupts vocal production but the developmental expansion of syntactic flexibility in rats, highlighting USV syntax as a sensitive marker of atypical communicative development in FXS models.

Autistic individuals with intellectual disability (ASD+ID) and profound autism are rarely studied in neuroscience research due to barriers including communication challenges, sensory sensitivities, anxiety, and elevated behavioral support needs. Consequently, biomarker development in autism fails to include the portion of the autistic population with highest support needs and greatest potential to benefit from treatments derived from imminent advances in personalized medicine. Here we present a multimodal, participant-centered protocol for simultaneous electroencephalography (EEG) and eye-tracking (ET) acquisition to advance clinical trial readiness research in this underserved population. The protocol combines individualized behavioral supports and an adaptive EEG-ET acquisition platform. Pre-visit caregiver interviews informed participant-specific research plans, including customized visual supports, reinforcement strategies, and EEG net desensitization procedures. A gaze-contingent stimulus presentation system used participant-preferred videos to support attention to experimental stimuli and behavior consistent with data acquisition (e.g., refraining from movement) while dynamically adapting stimulus delivery based on visual engagement with the assay and real-time assessment of data quality. By quantifying attended trials in real time and prioritizing unattended stimulus classes, the paradigm maximizes acquisition efficiency to minimize participant burden. This approach was utilized to deploy candidate biomarkers with demonstrated replicability in the Autism Biomarkers Consortium for Clinical Trials (ABC-CT): the N170 event-related potential to faces, resting-state EEG, and visual attention to human faces (measured with ET). Feasibility was evaluated in 76 children with ASD+ID (M age = 8.76 years; IQ = 32.4) and a small comparison sample of 8 children with intellectual disability without autism (M age = 8.91 years; IQ = 45.9). Usable EEG data (>7 minutes) were acquired in 61% (ASD+ID) and 88% (ID) of participants, respectively. Sufficient ET data were obtained from 67% (ASD+ID) and 63% (ID) of participants, respectively. Findings demonstrate the feasibility of inclusive biomarker acquisition and provide a framework for expanding participation of individuals with ASD+ID and profound autism in neuroscience research. Ongoing research seeks to evaluate this approach in larger samples and to demonstrate feasibility in multisite research studies.

Importance There is increasing interest in the potential of psilocybin to treat mental health and neurodevelopmental conditions. At high doses, the therapeutic benefit of psilocybin is linked to greater functional connectivity or integration between large-scale brain networks which underpin mood, emotion and cognition. However, it is unknown how the brain responds to psilocybin in autism - a condition characterised by both altered functional connectivity and differential response to drugs. Thus, a first step before clinical trials of psilocybin involving autistic people, is to evaluate the response of the autistic brain to psilocybin, initially at low dose. Objective Low doses of psilocybin were used to test the hypothesis that the functional connectivity of large-scale resting-state brain networks respond differently in autistic and non-autistic adults. Design The PSILAUT study had a pseudo-randomised, cross-over, double-blind, case-control design. There was no evaluation of clinical efficacy. PSILAUT was not a Clinical Trial according to UK regulations. Data collection was conducted from January 2023 to August 2024. Setting Single-centre, study conducted at the Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, United Kingdom. Participants Adult (> 18 years) participants with and without an autism spectrum disorder (ASD) diagnosis were recruited and matched for age, sex and IQ. Autistic participants were included if they had an existing diagnosis (DSM-IV, DSM-5 or ICD-10 criteria). Exposures A single oral dose of 2 or 5 mg psilocybin or (inactive) placebo administered on separate visits at least one week apart. Main Outcomes and Measures Resting-state fMRI was acquired to investigate the change in functional connectivity within and between brain networks, as measures of network integrity and integration, respectively. Results A total of 67 participants were recruited (18-58 years at first visit; 30 non-autistic participants, mean [SD] age, 30.0 [8.3] years, 15 males [50%] and 37 autistic participants, mean [SD] age, 28.6 [9.2] years, 19 males [51%]). We report for the first time that the autistic brain responds differently to low doses of psilocybin, despite no group differences in network connectivity in the baseline placebo condition. 5 mg psilocybin elicited the greatest shifts in functional connectivity in both groups, but in different directions. In non-autistic participants only, on average, after 5 mg psilocybin within-network connectivity of the frontoparietal ({beta} = -0.053, T = -2.73, FDR-corrected P value = 0.027, Cohen d = -0.71) and limbic networks ({beta} = -0.087, T = -2.59, FDR-corrected P value = 0.021, Cohen d = -0.61) decreased. In contrast, in autistic participants, 5 mg psilocybin increased between-network connectivity (i.e. integration) of higher-order and attentional networks, but decreased connectivity between the same networks in non-autistic participants (default mode and frontoparietal networks, dose x group interaction: {beta} = 0.053, T = 2.91, FDR-corrected P value = 0.042; dorsal and ventral attention networks, dose x group interaction: {beta} = 0.059, T = 2.31, FDR-corrected P value = 0.015). Across the whole sample, the extent to which psilocybin elicited an increase in connectivity between higher-order ({beta} = 0.33, T = 2.16, FDR-corrected P value = 0.036) and attentional ({beta} = 0.36, T = 2.43, FDR-corrected P value = 0.036) networks was positively correlated with core autistic traits quantified using the Autism Quotient. Conclusions and Relevance Functional brain networks that support mood, emotion and cognition are more responsive to low dose psilocybin in autistic adults compared to non-autistic adults. Given that increased network integration is associated with clinical utility, future applications of psilocybin in autistic people should include the evaluation of low doses.

Individuals with autism spectrum disorder (ASD) often show aversion to affective touch (AT). However, the neural mechanism of this abnormality in cortices remains poorly understood probably due to the lack of effective animal models. Here, we used a canine model to address this issue by leveraging the intimate dog-human interactions. In a newly-designed heterospecific AT paradigm, we found that dogs carrying mutations in Shank3, a high-risk gene for ASD, avoided human AT. In vivo single-unit recording analysis showed that AT-evoked oscillations in the dorsal medial prefrontal cortex (dmPFC) were significantly altered in Shank3 mutant dogs. Shank3 mutation also reduced the number of neurons encoding AT in the dmPFC. Importantly, the aversion to AT and altered neural processing in Shank3 mutants were largely rescued by a GABAA receptor antagonist pentylenetetrazole. Together, these findings provide neural mechanisms for abnormal AT processing in ASD and suggest potential biomarkers for therapeutic strategies.

Background: Autism spectrum disorder is a prevalent neurodevelopmental condition featuring marked social difficulties. Oxytocin supplementation shows promising therapeutic efficacy in alleviating autism-like traits in rodent models, but clinical effects in humans remain inconsistent. The rodent-derived social salience network (SSN) comprises several oxytocin-modulated brain regions implicated in social behavior, but its conservation has not been established in humans. Here we assess, for the first time, functional connectivity (FC) within a homologous human SSN in autistic men to examine its relationship with behavioral traits and modulation by oxytocin. Methods: The human SSN atlas was collated from open-access cortical and subcortical parcellations, and used to retrospectively analyze a resting-state fMRI dataset of adult men with autism from a previously published, randomized, placebo-controlled oxytocin trial. SSN-wide and sub-network ROI-to-ROI FC correlations with social trait expression and salivary oxytocin concentrations were performed at baseline and post-administration. Treatment specific outcomes on FC were calculated using ANCOVA. Results: We observed SSN sub-network FC correlations with social and repetitive behavioral scores and identified strong oxytocin sensitivity of nucleus accumbens-somatosensory and paraventricular nucleus-somatosensory circuits at baseline. Following nasal spray administration, a strengthening of amygdala-somatosensory circuit was detected as the largest oxytocin-induced FC shift. Notably, baseline connectivity within this circuit strongly predicted treatment response, with individuals having lower baseline FC showing greater post-treatment FC. Conclusions: These findings provide first evidence for clinical relevance of the SSN in humans with autism and highlight circuits that may represent promising biomarkers for predicting oxytocin responsiveness.

Autism spectrum disorder (ASD) is one of the most common neurodevelopmental disorders. The absence of a clear aetiology strengthens the need to identify quantitative biomarkers capable of diagnosing the condition and assessing the severity of symptoms. We implemented a normative modelling framework based on EEG effective connectivity (EC), leveraging recordings collected in three centers, in typical development (TD) and ASD participants with age spanning from 5 to 19 years. Deviations from the normative evolution were tested as ASD biomarkers, compared with standard EC metrics. Normative EC metrics supported accurate classification of ASD vs TD participants (0.82 AUC), reaching 0.95 AUC when combined with behavioral subscales, significantly outperforming a classification based on behavioral data alone. In ASD participants, selected metrics in the Temporo-Parietal-Frontal network predicted social responsiveness scale (SRS) values with high significance (SRS Total R^2=0.42, p=0.0005). These results suggest that normative EC values constitute robust and generalizable ASD biomarkers.

Pharmacological treatments targeting core autistic features remain limited. In neurotypical adults, cannabidiol (CBD) alters mismatch negativity (MMN), an electrophysiological marker of automatic auditory deviance detection that has been associated with autistic traits. The effects of CBD on MMN, as measured using electroencephalography (EEG), in autistic children remain unknown. This secondary analysis of a pilot randomised, double-blind, placebo-controlled crossover trial examined the effects of 12 weeks of oral CBD oil on MMN during a duration-deviant auditory oddball task. We hypothesised that CBD would produce more negative MMN amplitudes and shorter peak latencies relative to placebo. Nineteen autistic children (6-12 years, 8 female) received CBD (dose) and placebo in randomised order, separated by an 8-week washout. Age-adjusted linear mixed-effects models tested Time (baseline, follow-up) x Treatment (CBD, placebo) effects on mean MMN amplitude and peak latency separately at Fz and FCz. Exploratory Spearman correlations examined baseline associations between MMN and Developmental Behaviour Checklist-2 (DBC-2) Social Relating scores. At FCz, latency decreased following CBD but increased following placebo but did not survive FDR correction (p = .029, pFDR = .058) and no other interactions were significant. Higher baseline DBC-2 Social Relating scores were associated with more negative MMN amplitude at FCz (rho = -.58, pFDR = .028) and Fz (rho = -.59, pFDR = .028). These findings provide tentative evidence that CBD may modulate MMN latency in autistic children. Larger trials should clarify CBDs effects on MMN and further examine the association between MMN amplitude and social-relating difficulties.

Background: Autism spectrum disorder (ASD) is neurobiologically heterogeneous, and group comparisons may mask effects confined to subgroups. We tested whether distinct biotypes exist within ASD using unsupervised clustering of multimodal MRI. Methods: We analyzed 149 participants with ASD and 129 typically developing (TD) controls from the Autism Brain Imaging Data Exchange II (6 sites; age 5 to 64 years). Site-harmonized features comprised free water (FW), tissue anisotropy and diffusivity, diffusion tensor image analysis along the perivascular space (DTI-ALPS), cerebrospinal fluid (CSF) volumes and exploratory resting-state regional homogeneity. ASD participants were clustered with k-means using global (7 features) and regional (17 features) sets, with robustness tested by permutation and two further algorithms. TD participants were projected post hoc to test specificity. A composite imaging score was related to Social Responsiveness Scale (SRS) subscales, symptom severity and IQ using partial correlations with false discovery rate correction. Results: Clustering identified an elevated free-water (EFW) biotype comprising approximately 10% of ASD participants, defined by markedly increased FW (d = +4.91 versus remaining ASD participants), reduced tissue anisotropy, reduced DTI-ALPS and enlarged ventricles. It was recovered across feature sets and algorithms (permutation p < .0001) and departed from TD norms, unlike the remaining ASD participants. The composite score correlated with social-perceptual and communicative SRS subscales, most strongly social awareness (r = +0.253, q = .026), but not with symptom severity or IQ. FW related to social motivation in children and adolescents (r = +0.287, q = .037) but not adults. Limitations: Each person was scanned once, so we cannot tell whether these brain differences cause social difficulties or how they change with age. The subgroup was small, clinical data were incomplete, the sample was mostly male with a wide age range, and the findings await confirmation in an independent group. Free water can reflect inflammation, swelling or tissue loss, so its biological meaning remains uncertain. Conclusions: We identify an ASD subgroup defined by extracellular fluid excess and altered white matter that is associated with greater social difficulties. If replicated, this signature may help stratify autistic individuals in mechanistic studies and clinical trials.

Background: Infant muscle tone reflects early central nervous system integrity and has been associated with later motor and cognitive development, including autism traits. The cerebellum regulates both motor control and higher-order socio-cognitive functions and has been repeatedly implicated in autism, but its role in linking infant muscle tone to adolescent autistic traits has not previously been studied in a large, prospective population cohort. Methods: We used data from the prospective Generation R Study. Infant muscle tone (hypotonia and hypertonia) was assessed via Prechtl examination, and third-trimester fetal transcerebellar diameter was measured using ultrasound n=6,842). Cerebellar morphology at ages 6, 10, and 14 years (n=4,861) was measured using structural MRI. Linear mixed-effects models tested associations between infant muscle tone and 35 anatomical and 10 functional cerebellar regions. Causal mediation models tested whether cerebellar volume mediated associations between infant muscle tone and adolescent autistic traits at age 14 (Social Responsiveness Scale). Results: Hypotonia predicted larger vermis IX volumes across childhood (beta=0.037, pFDR =0.043). Hypertonia showed an age-dependent association with left lateral lobule IX (beta=-0.0027, pFDR =0.041), with differences diminishing with age. Third-trimester transcerebellar diameter did not predict postnatal muscle tone. Given its significant main effect, vermis IX volume was tested as a mediator, but did not mediate the pathway to adolescent autistic traits. However, infant hypotonia showed a small direct association with elevated autistic traits at age 14, specific to girls (beta=0.0255, p=0.020). Conclusions: Infant muscle tone is associated with localized differences in cerebellar volumes. These associations are specific to vermal and left hemispheric lobule IX, a region commonly implicated in spinocerebellar postural control, axial stability, and higher-order sensorimotor integration. Furthermore, infant muscle tone was not predicted by prenatal cerebellar diameter, and cerebellar volumes did not mediate the association between infant hypotonia and adolescent autistic traits in our study. Future research should further investigate these findings in clinical populations, integrating longitudinal whole-brain, multi-modal imaging to clarify the association between infant muscle tone, the cerebellar functioning, and autistic traits.

Background Autism spectrum disorder (ASD) and Intellectual disability (ID) share an in-creased male prevalence, but the biological mechanisms underlying this male bias remain poorly understood. Mice deficient for CC2D1A, a protein scaffold mutated in ASD/ID, have shown multiple male-specific deficits both in ASD-like behaviors and in the regulation of neuronal intracellular signaling pathways. However, previous re-search relied on conditional knockout (cKO) models due to early postnatal lethality of global Cc2d1a KO strains. Thus, the ability to define the developmental impacts of CC2D1A LOF in mice has been limited. While generating a Cc2d1a knock-in strain with V5-HA epitope tags, we found that homozygous animals (Cc2d1aVH/VH) resulted in a hypomorph line that can be used to study developmental loss of CC2D1A. Methods We assessed gross morphology, behavior, and intracellular signaling in male and female Cc2d1aVH/VH animals, where only ~20% of CC2D1A is present. We then crossed this line with a null allele to obtain a more severe hypomorph (Cc2d1a-/VH) and explore phenotypic penetrance thresholds. In addition to the previous phenotypic characterization, we also assessed body composition, feeding, and molecular hall-marks of metabolic function in both sexes. Results We found that ~80% CC2D1A reduction in Cc2d1aVH/VH mice did not recapitu-late any of the behavioral or molecular disruptions seen in cKO models. In contrast, ~90% CC2D1A reduction in Cc2d1a-/VH mice resulted in ASD/ID-like behavioral phe-notypes in males, similar to those reported in cKO lines, with distinct intracellular sig-naling disruptions. Male and female Cc2d1a-/VH mice also showed subtle but signifi-cant adult weight deficits associated with distinct metabolic changes. Limitations These models still do not fully recapitulate the complete CC2D1A LOF found in patients. Due to the analysis of two independent strains over multiple metrics, these studies are not powered to compare statistical differences between sexes and data were analyzed in males and females independently. Conclusions We identified a strikingly narrow CC2D1A expression threshold for the emer-gence of ASD/ID-like behavioral deficits in males. In addition, we revealed a novel role for CC2D1A in adult weight gain. These mouse strains will be useful to better under-stand CC2D1A LOF phenotypes.

Catatonia in autistic individuals may resemble worsening autism yet represent a potentially treatable departure from baseline functioning. We compared item-level catatonic signs in autistic and non-autistic patients and evaluated treatment-associated change during electroconvulsive therapy (ECT). This single-center observational cohort included patients with catatonia who received ECT from May 2022 through April 2026. The 23-item Bush-Francis Catatonia Rating Scale (BFCRS) was assessed longitudinally. Pretreatment BFCRS data were available for 104 patients, including 41 autistic and 63 non-autistic patients, with 993 near-complete repeated assessments available. Pretreatment item presence was modeled using a three-level clinical-group variable with adjustment for age, biologic sex, and calendar year. Compared with non-autistic patients, patients with autism and intellectual disability had higher adjusted odds of eight activated, repetitive, or behaviorally dysregulated signs and lower odds of immobility/stupor. Among 96 patients with paired first and last eligible BFCRS assessments, multiple items improved in both cohorts. Generalized estimating equations demonstrated longitudinal declines in total BFCRS scores and multiple psychomotor-domain scores, with no clinical-group-by-time interaction surviving false-discovery rate correction in unrestricted or 30-, 60-, 90-, and 180-day models. Autism-specific Kanner analyses identified seven significant fixed-endpoint severity-item improvements after false-discovery rate correction, six of which were reproduced longitudinally. Catatonia in autism with intellectual disability was characterized by a phenotype that may resemble worsening autism during later regression, and many constituent signs demonstrated treatment-associated improvement during ECT.

Background: Brain functions emerge from temporally organized neural dynamics, and an appropriate level of neural complexity may support flexible information processing. Electroencephalographic (EEG) studies using multiscale entropy (MSE), which quantifies signal complexity across multiple temporal scales, have reported reduced MSE at longer scales in individuals with autism spectrum disorder (ASD). However, most evidence comes from studies of infant and child samples, leaving adult data scarce, and the associations between reduced MSE, clinical symptoms, and social information processing are insufficiently understood. Methods: We recorded and analyzed EEG data from adults with ASD (n = 47) and typically developing (TD) controls (n = 40) during eyes-closed rest and two movie viewing conditions: Inscapes, comprising dynamically changing abstract visual patterns, and Partly Cloudy, an emotionally engaging animated social narrative. Group and condition effects were assessed using cluster-based permutation tests, and associations between MSE and Social Affect (SA) scores from the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), as well as group differences in event-related MSE changes, were examined using linear mixed-effects models. Results: Across conditions, adults with ASD showed lower MSE at longer scales ({tau} = 16-30), corresponding to effective sampling rates of 12.50-6.67 Hz in the coarse-grained time series, than TD adults. Longer-scale MSE within the ASD-TD difference cluster was negatively associated with ADOS-2 SA scores across diagnostic groups. The difference in event-related MSE change between Social and Non-Social conditions, comparing empathic-pain and mentalizing events in Partly Cloudy with temporally matched non-social windows in Inscapes, was smaller in ASD participants than in TD participants. No significant difference between Social and Non-Social windows was observed among ASD participants, whereas TD participants showed significantly greater MSE change during Social than Non-Social windows. Limitations: This study used a modest sample without an independent replication cohort, and the short event windows limited the precision of the MSE estimation. Conclusions: Reduced longer-scale MSE extends to adults with ASD and is associated with higher ADOS-2 SA scores across diagnostic groups. Event-related findings further suggest attenuated differentiation of longer-scale MSE between socially relevant and matched non-social windows in ASD.