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Abstract Background: Difficulties with aspects of social interaction, including empathy, comprise a core symptom of autism spectrum conditions (autism). Sympathy is a specific form of empathy and involves both cognitive and affective empathy. Data are presented from a new task of self-reported sympathy and personal distress. Methods: Participants with autism (93 males; 161 females) and controls (40 males, 93 females) took part in an online survey via the Autism Research Centre or Cambridge Psychology websites. Participants completed a task where they were asked to rate photographic images that were either of distressing, neutral or happy scenes, according to the amount of sympathy they had for the individual in the photo and the degree of personal distress they felt. All participants also completed the Empathy Quotient (EQ). Results: Significant differences were found between the autism and control groups for both self-reported sympathy and personal distress, with participants with autism giving lower ratings than controls. Control females scored significantly higher than control males in both sympathy and distress. Sympathy and distress ratings in the autism group did not differ significantly by sex. EQ showed positive correlations with sympathy and distress scores. Conclusions: Using a new measure of self-reported sympathy, we found that both males and females with autism gave lower ratings of sympathy when viewing people in distressing scenarios, compared to controls. ; The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n° 115300, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007 - 2013) and EFPIA companies' in kind contribution. The authors were also supported by Autism Research Trust, the MRC and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust.

The results leading to this publication have received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Any views expressed are those of the author(s) and not necessarily those of the funders.

Importance The global prevalence of autism spectrum disorder (ASD) has been reported to be between 1% and 2% of the population, with little research in Black, Asian, and other racial/ethnic minority groups. Accurate estimates of ASD prevalence are vital to planning diagnostic, educational, health, and social care services and may detect possible access barriers to diagnostic pathways and services and inequalities based on social determinants of health. Objective To evaluate whether socioeconomic disadvantage is associated with ASD prevalence and the likelihood of accessing ASD services in racial/ethnic minority and disadvantaged groups in England. Design, Setting, and Participants This case-control prevalence cohort study used the Spring School Census 2017 from the Pupil Level Annual Schools Census of the National Pupil Database, which is a total population sample that includes all English children, adolescents, and young adults aged 2 to 21 years in state-funded education. Data were collected on January 17, 2017, and analyzed from August 2, 2018, to January 28, 2020. Exposures Age and sex were treated as a priori confounders while assessing correlates of ASD status according to (1) race/ethnicity, (2) social disadvantage, (3) first language spoken, (4) Education, Health and Care Plan or ASD Special Educational Needs and Disability support status, and (5) mediation analysis to assess how social disadvantage and language might affect ASD status. Main Outcomes and Measures Sex- and age-standardized ASD prevalence by race/ethnicity and 326 English local authority districts in pupils aged 5 to 19 years. Results The final population sample consisted of 7 047 238 pupils (50.99% male; mean [SD] age, 10.18 [3.47] years) and included 119 821 pupils with ASD, of whom 21 660 also had learning difficulties (18.08%). The standardized prevalence of ASD was 1.76% (95% CI, 1.75%-1.77%), with male pupils showing a prevalence of 2.81% (95% CI, 2.79%-2.83%) and female pupils a prevalence of 0.65% (95% CI, 0.64%-0.66%), for a male-to-female ratio (MFR) of 4.32:1. Standardized prevalence was highest in Black pupils (2.11% [95% CI, 2.06%-2.16%]; MFR, 4.68:1) and lowest in Roma/Irish Travelers (0.85% [95% CI, 0.67%-1.03%]; MFR, 2.84:1). Pupils with ASD were more likely to face social disadvantage (adjusted prevalence ratio, 1.61; 95% CI, 1.59-1.63) and to speak English as an additional language (adjusted prevalence ratio, 0.64; 95% CI, 0.63-0.65). The effect of race/ethnicity on ASD status was mediated mostly through social disadvantage, with Black pupils having the largest effect (standardized mediation coefficient, 0.018; P < .001) and 12.41% of indirect effects through this way. Conclusions and Relevance These findings suggest that significant differences in ASD prevalence exist across racial/ethnic groups and geographic areas and local authority districts, indicating possible differential phenotypic prevalence or differences in detection or referral for racial/ethnic minority groups. ; ARU received funding from the Gillings Fellowship in Global Public Health and Autism Research, Grant Award YOG054 to the Cambridge Institute of Public Health (PI Carol Brayne). SBC received funding from Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777394. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. SBC also received funding from the Autism Research Trust, Autistica, the MRC, the Wellcome Trust and the NIHR Cambridge Biomedical Research Centre. The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of Health and Social Care.

This study was funded by the Gillings Fellowship in Global Public Health and Autism Research (Grant Award YOG054) and the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement No. 777394). ; The Soviet occupation of the Baltic States followed by joining the United Nations (UN) and European Union make these countries an interesting point of comparison in the development of autism and education policy. This study investigates how policies changed following the transition and how the right and access to education are facilitated for autistic children by performing a path dependence analysis. All Baltic States created new education policies following the transition out of the Soviet era, with their accession to the UN and their appetite to follow internationally available guidance. The right to education for all children in was adopted in all education systems. Education facilities for children with disabilities were implemented in all countries. Afterward, all countries started toward the development of more inclusive systems. Nevertheless, the majority of policies did not specify for autism, yet covered special education needs in general. A development in Latvia should be noted, where various special education needs are outlined in national policy, along with provisions and professional assistance required to address them in mainstream or special classrooms. Ultimately, education policy flourished after the transition. Their development caught up to other European Union countries and they are currently working on implementing inclusive education.

The results leading to this publication have received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Any views expressed are those of the author(s) and not necessarily those of the funders.

Children with special education needs (SEN), such as children with autism, benefit from being included in education along with typical peers. However, development and implementation of inclusive education (IE) is considered difficult. This paper identifies conditions that facilitate IE development for children with autism in the European Union and benchmarks to track IE policy development. Education policy data from 30 legislative regions in the European Union were analyzed through a qualitative comparative analysis using eight conditions: a definition of SEN, the right to education for children with SEN, support for teaching staff, support services for children with SEN, individualized learning outcomes, parental involvement, and mixed mainstream classes. The right to education for children with SEN is implemented in all regions under study. Seven of the examined conditions were associated with IE: an established definition of SEN, support for teaching staff, support services for children with SEN, individualized learning outcomes, parental involvement, IE policies, and mixed mainstream classrooms. Mixed classrooms and support services for children with SEN were identified as necessary for IE. IE policies and support for teaching staff were present in all scenarios that facilitated IE. While the analysis was initially focused on autism, the policies consisted predominantly of general SEN policies, allowing the results to be interpreted in a wider context, beyond autism. Ultimately, mixed mainstream classrooms and support services for children with special needs were found essential for consistent IE development. Support for teaching staff and IE policies facilitate IE and should be further explored and implemented.

The results leading to this publication have received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 777394 for the project AIMS-2-TRIALS. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Any views expressed are those of the author(s) and not necessarily those of the funders.

Previous studies have identified differences in DNA methylation in autistic individuals compared to neurotypical individuals. Yet, it is unclear if this extends to autistic traits-subclinical manifestation of autism features in the general population. Here, we investigate the association between DNA methylation at birth (cord blood), and scores on the Social and Communication Disorders Checklist (SCDC), a measure of autistic traits, in 701 8-year-olds, by conducting a methylome-wide association study (MWAS). We did not identify significant CpGs associated with SCDC. The most significant CpG site was cg14379490, on chromosome 9 (MWAS beta = - 1.78 ± 0.35, p value = 5.34 × 10 -7 ). Using methylation data for autism in peripheral tissues, we did not identify a significant concordance in effect direction of CpGs with p value 0.5). In contrast, using methylation data for autism from post-mortem brain tissues, we identify a significant concordance in effect direction of CpGs with a p value < 10-4 in the SCDC MWAS (binomial sign test, p value = 0.004). Supporting this, we observe an enrichment for genes that are dysregulated in the post-mortem autism brain (one-sided Wilcoxon rank-sum test, p value = 6.22 × 10-5). Finally, integrating genome-wide association study (GWAS) data for autism (n = 46,350) with mQTL maps from cord-blood (n = 771), we demonstrate that mQTLs of CpGs associated with SCDC scores at p value thresholds of 0.01 and 0.005 are significantly shifted toward lower p values in the GWAS for autism (p < 5 × 10-3). We provide additional support for this using a GWAS of SCDC, and demonstrate a lack of enrichment in a GWAS of Alzheimer's disease. Our results highlight the shared cross-tissue methylation architecture of autism and autistic traits, and demonstrate that mQTLs associated with differences in DNA methylation associated with childhood autistic traits are enriched for common genetic variants associated with autism and autistic traits. ; This study was funded by grants from the Medical Research Council, the Wellcome Trust, the Autism Research Trust, and the Templeton World Charity Foundation. The research was conducted in association with the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The UK Medical Research Council and Wellcome (grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This study was supported by grant HD073978 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Environmental Health Sciences, and National Institute of Neurological Disorders and Stroke; and by the Beatrice and Samuel A. Seaver Foundation. We acknowledge iPSYCH and The Lundbeck Foundation for providing samples and funding for the MINERvA dataset. The iPSYCH (The Lundbeck Foundation Initiative for Integrative Psychiatric Research) team acknowledges funding from The Lundbeck Foundation (grant numbers R102-A9118 and R155–2014-1724), the Stanley Medical Research Institute, the European Research Council (project number 294838), the Novo Nordisk Foundation for supporting the Danish National Biobank resource, and grants from Aarhus and Copenhagen Universities and University Hospitals, including support to the iSEQ Center, the GenomeDK HPC facility, and the CIRRAU Center. This research has been conducted using the Danish National Biobank resource, supported by the Novo Nordisk Foundation. The SEED study was supported by Centers for Disease Control and Prevention (CDC) Cooperative Agreements announced under the RFAs 01086, 02199, DD11–002, DD06–003, DD04–001, and DD09–002 and the SEED DNA methylation measurements were supported by Autism Speaks Award #7659 to MDF. The SSC was supported by Simons Foundation (SFARI) award and NIH grant MH089606. The project leading to this application has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777394. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI.

Abstract: This study explores how autism and education policy are affected by austerity measures in Ireland, Portugal, Italy, and Greece by using a path dependence analysis. The implementation of mixed mainstream classrooms and improvements to infrastructure coincided with the ratification of inclusive education policy. Austerity measures appeared temporally associated with furthering of integration and inclusion policy for all countries under study, potentially due to the economic incentives of an integrated system. This trend is especially visible in Ireland, Portugal, and Greece, whereas lesser so in Italy. Even though the initial focus of this analysis was autism, the findings are applicable to the general area of special education needs due to the non‐specific nature of national policies.

The 'Reading the Mind in the Eyes' test (Eyes Test) has been widely used to measure theory of mind (ToM) or the ability to recognize the thoughts and feelings of others. Although previous studies have analysed its relationship with the ability to perceive emotions, the potential links with more complex emotional abilities remain unclear. The aim of the present research was to analyse the relationship between the Eyes Test and each of the emotional intelligence (EI) branches: perceiving, facilitating, understanding and managing emotions. In addition, we were interested in studying these relationships as a function of the Eyes Test difficulty. Eight hundred and seventy-four participants completed the Eyes Test and the Mayer–Salovey–Caruso Emotional Intelligence Test. A stepwise multiple regression analysis for the total score on the Eyes Test revealed that the best fitting model included the understanding, perceiving and managing emotion branches, with the understanding branch being the one most strongly associated with performance on the Eyes Test. Interestingly, stepwise multiple regression analysis for the easiest items of the Eyes Test revealed the same predictors, but, in the case of the most difficult items only the understanding branch was a predictor. These outcomes were not moderated by the influence of gender. Our findings support the notion that the Eyes Test can be used as a ToM task and that it is associated with complex EI abilities. Limitations and future lines of investigation are discussed. ; Spanish Ministry of Economy, Industry and Competitiveness PSI2017-84170-R ; Junta de Andalucía UMA18-FEDERJA-137 UMA18FEDERJA-114 ; German Research Foundation (DFG) FPU15/05179 ; Autism Research Trust ; Wellcome Trust ; Templeton World Charitable Foundation ; NIHR Biomedical Research Centre in Cambridge ; Innovative Medicines Initiative 2 Joint Undertaking (JU) 777394 ; European Union's Horizon 2020 research and innovation programme ; EFPIA ; AUTISM SPEAKS, Autistica, SFARI ; Innovation and Development Agency of Andalusia SEJ-07325

LAY ABSTRACT: Getting a diagnosis of autism can take long, because autism is different across people, but also because it depends on the way it gets diagnosed. This is especially important in poorer countries or in the case of poor people living in wealthier countries that have significant groups of disadvantaged communities. We adapted a 10-item version of the Q-CHAT-25 questionnaire for use in routine health check-ups programme in Chile and recruited 287 participants under the age of three divided into three groups: Controls (125), Developmental Delay (149) and Autism Spectrum Condition (13). Our results show that a short questionnaire for autism screening can be successfully applied in a health-check programme in poor resource settings. Our results show that our questionnaire had good overall performance, not different to its longer version, the Q-CHAT-25. Our questionnaire was autism specific, with good sensitivity and reliability, and is suitable to be used in a screening setting. This study provides evidence that the implementation of Autism Spectrum Condition screening programmes using the Q-CHAT-10 provides value for money and improves diagnosis of Autism Spectrum Condition in those participating in routine health check-up programmes in developing countries or poor areas of wealthy countries. ; The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: A.R-U. received funding from the Gillings Fellowship in Global Public Health and Autism Research, Grant Award YOG054 to the Cambridge Institute of Public Health (PI Carol Brayne). S.BC. received funding from Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 777394. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. S.B-C. also received funding from the Autism Research Trust, Autistica, the MRC, the Wellcome Trust and the NIHR Cambridge Biomedical Research Centre. The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust.

BACKGROUND: This report maps autism and special education needs (SEN) policies, alongside teacher responsibilities in the education of children with SEN in Austria, Hungary, Czech Republic, and Slovakia. METHODS AND PROCEDURE: A policy path analysis using a scoping review as an underlying methodological framework was performed. OUTCOMES AND RESULTS: The end of communism and accession to the European Union were critical for the countries under study. They passed crucial policies after international policies and adopted a three-stream approach towards providing education: (1) special schools; (2) special classes in mainstream schools; or (3) mainstream classes. Special schools remain for children that cannot participate in mainstream schools. Teachers are given high levels of responsibility. CONCLUSION AND IMPLICATIONS: Changes in international guidance greatly impacted Austria, Hungary, Slovakia and the Czech Republic. The education systems aim for inclusion, though segregation remains for children that cannot thrive in mainstream schools. Teachers are pivotal in the education of children with SEN, more so than with typical children.

The Soviet occupation of the Baltic States followed by joining the United Nations (UN) and European Union make these countries an interesting point of comparison in the development of autism and education policy. This study investigates how policies changed following the transition and how the right and access to education are facilitated for autistic children by performing a path dependence analysis. All Baltic States created new education policies following the transition out of the Soviet era, with their accession to the UN and their appetite to follow internationally available guidance. The right to education for all children in was adopted in all education systems. Education facilities for children with disabilities were implemented in all countries. Afterward, all countries started toward the development of more inclusive systems. Nevertheless, the majority of policies did not specify for autism, yet covered special education needs in general. A development in Latvia should be noted, where various special education needs are outlined in national policy, along with provisions and professional assistance required to address them in mainstream or special classrooms. Ultimately, education policy flourished after the transition. Their development caught up to other European Union countries and they are currently working on implementing inclusive education.

AbstractThis study explores how autism and education policy are affected by austerity measures in Ireland, Portugal, Italy, and Greece by using a path dependence analysis. The implementation of mixed mainstream classrooms and improvements to infrastructure coincided with the ratification of inclusive education policy. Austerity measures appeared temporally associated with furthering of integration and inclusion policy for all countries under study, potentially due to the economic incentives of an integrated system. This trend is especially visible in Ireland, Portugal, and Greece, whereas lesser so in Italy. Even though the initial focus of this analysis was autism, the findings are applicable to the general area of special education needs due to the non‐specific nature of national policies.