Differentiating Post–Digital Nannying Autism Syndrome from Autism Spectrum Disorders in Young Children: A Comparative Cross-Sectional Study

Hamid Reza Pouretemad, Saeid Sadeghi, Reza Shervin Badv, and Serge Brand


Excessive exposure of young children to digital devices has increased in recent years. Much research has shown that early excessive screentime is associated with autistic-like symptoms. This study aimed to differentiate children with Post–Digital Nannying Autism Syndrome (PDNAS) from children with autism spectrum disorders (ASD) and typically developing children (TDC), both behaviorally and cognitively. This study is comparative and cross-sectional and included three groups of children. The first group consisted of 15 young children with subthreshold autism symptoms. They had not received a formal diagnosis of ASD and had been exposed to digital devices for more than half of their waking time. The second group consisted of 15 young children with ASD, and the third group consisted of 15 young TDC. A lifestyle checklist, a modified checklist for autism in toddlers (M-CHAT), a behavioral flexibility rating scale-revised (BFRS-R), the Gilliam autism rating scale (GARS-2), and a behavior rating inventory of executive functioning-preschool version (BRIEF-P) were used to compare the three groups. The results showed that executive functions and behavioral flexibility were more impaired in children with ASD than in children with PDNAS and in TDC. Also, we found that there was no significant difference in the severity of autism symptoms between the children with ASD and the children with PDNAS. Early excessive exposure to digital devices may cause autism-like symptoms in children (PDNAS). Children with PDNAS are different from children with ASD in executive functions and behavioral flexibility. Further research is needed in this area.



Cognitive control and cognitive flexibility predict severity of depressive symptoms in parents of toddlers with autism spectrum disorder

Saeid Sadeghi, Hamid Reza Pouretemad, Serge Brand


Having a toddler with autism spectrum disorder (ASD) can be challenging for parents and may negatively impact on parents’ mental health. This study examined the relationship between parental depressive symptoms and their cognitive control and cognitive flexibility, and toddlers’ ASD symptoms. A total of 68 parents with toddlers with ASD participated in this crosssectional study. Parents completed a series of questionnaires covering the toddlers’ symptoms of ASD (Gilliam Autism Rating Scale (GARS-2), and their symptoms of depression (Beck Depression Inventory (BDI-II)) and their cognitive control and cognitive flexibility (Cognitive Control and Flexibility Questionnaire (CCFQ)). Pearson correlation coefficient and linear regression were used to analyze the data. Toddlers’ greater severity of ASD symptoms (r = 0.33; p < 05), parents’ a lower ability of cognitive control (r = -0.62; p < 01) and cognitive flexibility (r = -0.33; p < 05) were associated with parents’ greater severity of depressive symptoms. Toddlers’ severity of ASD (11%) and parents’ cognitive control (39%) and cognitive flexibility (11%) explained significant changes of the variance of parents’ depressive symptoms. Parents’ cognitive control, but less so toddlers’ severity of ASD, predicted the severity of their depressive symptoms. Interventions to improve cognitive control among parents of toddlers with ASD might favorably impact on parents’ symptoms of depression.



Dual Profile of Environmental Enrichment and Autistic-Like Behaviors in the Maternal Separated Model in Ratt, 2021

Mansouri, M., Pouretemad, H., Wegener, G., Roghani, M., Afshari, M., Mallard, C., & Ardalan, M. (2021). Dual Profile of Environmental Enrichment and Autistic-Like Behaviors in the Maternal Separated Model in Rats. International Journal of Molecular Sciences, 22(3), 1173.


Background: Environmental Enrichment (EE) has been suggested as a possible therapeutic intervention for neurodevelopmental disorders such as autism. Although the benefits of this therapeutic method have been reported in some animal models and human studies, the unknown pathophysiology of autism as well as number of conflicting results, urge for further examination of the therapeutic potential of EE in autism. Therefore, the aim of this study was to examine the effects of environmental enrichment on autism-related behaviors which were induced in the maternal separation (MS) animal model. Material and Methods: Maternally separated (post-natal day (PND) 1–۱۴, ۳ h/day) and control male rats were at weaning (PND21) age equally divided into rats housed in enriched environment and normal environment. At adolescence (PND42–۵۰), the four groups were behaviorally tested for direct social interaction, sociability, repetitive behaviors, anxiety behavior, and locomotion. Following completion of the behavioral tests, the blood and brain tissue samples were harvested in order to assess plasma level of brain derived neurotrophic factor (BDNF) and structural plasticity of brain using ELISA and stereological methods respectively. Results: We found that environmental enrichment reduced repetitive behaviors but failed to improve the impaired sociability and anxiety behaviors which were induced by maternal separation. Indeed, EE exacerbated anxiety and social behaviors deficits in association with increased plasma BDNF level, larger volume of the hippocampus and infra-limbic region and higher number of neurons in the infra-limbic area (p < 0.05). Conclusion: We conclude that environmental enrichment has a significant improvement effect on the repetitive behavior as one of the core autistic-like behaviors induced by maternal separation but has negative effect on the anxiety and social behaviors which might have been modulated by BDNF. View Full-Text


Teaching Turn-Taking Skills to Children with Autism using a Parrot-Like Robot, 2020

Pegah Soleiman, Hadi Moradi, Maryam Mahmoudi, Mohyeddin Teymouri, Hamid Reza Pouretemad


Robot Assisted Therapy is a new paradigm in many therapies such as the therapy of children with autism spectrum disorder. In this paper we present the use of a parrot-like robot as an assistive tool in turn taking therapy. The therapy is designed in the form of a card game between a child with autism and a therapist or the robot. The intervention was implemented in a single subject study format and the effect sizes for different turn taking variables are calculated. The results show that the child robot interaction had larger effect size than the child trainer effect size in most of the turn taking variables. Furthermore the therapist point of view on the proposed Robot Assisted Therapy is evaluated using a questionnaire. The therapist believes that the robot is appealing to children which may ease the therapy process. The therapist suggested to add other functionalities and games to let children with autism to learn more turn taking tasks and better generalize the learned tasks.


بهبود کنش اجرایی در کودکان دارای اتیسم توسط برنامه ساعت بازی خانگی، ۱۳۹۹

حمیدرضا پوراعتماد – استاد گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه شهید بهشتی، تهران، ایران

اسماعیل شیری – دکتری روانشناسی بالینی

پوراعتماد حمیدرضا، شیری اسماعیل. بهبود کنش اجرایی در کودکان دارای اُتیسم توسط برنامه ساعت بازی خانگی. کومش. ۱۳۹۹; ۲۳ (۱) :۸۴-۹۴


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Brain connectivity analysis in fathers of children with autism, 2020

Mehdizadehfar, V., Ghassemi, F., Fallah, A., Mohammad-Rezazadeh, I., & Pouretemad, H. (2020). Brain connectivity analysis in fathers of children with autism. Cognitive Neurodynamics, 14(6), 781-793.



Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which changes in brain connectivity, associated with autistic-like traits in some individuals. First-degree relatives of children with autism may show mild deficits in social interaction. The present study investigates electroencephalography (EEG) brain connectivity patterns of the fathers who have children with autism while performing facial emotion labeling task. Fifteen biological fathers of children with the diagnosis of autism (Test Group) and fifteen fathers of neurotypical children with no personal or family history of autism (Control Group) participated in this study. Facial emotion labeling task was evaluated using a set of photos consisting of six categories (mild and extreme: anger, happiness, and sadness). Group Independent Component Analysis method was applied to EEG data to extract neural sources. Dynamic causal connectivity of neural sources signals was estimated using the multivariate autoregressive model and quantified by using the Granger causality-based methods. Statistical analysis showed significant differences (p value < ۰.۰۱) in the connectivity of neural sources in recognition of some emotions in two groups, which the most differences observed in the mild anger and mild sadness emotions. Short-range connectivity appeared in Test Group and conversely, long-range and interhemispheric connections are observed in Control Group. Finally, it can be concluded that the Test Group showed abnormal activity and connectivity in the brain network for the processing of emotional faces compared to the Control Group. We conclude that neural source connectivity analysis in fathers may be considered as a potential and promising biomarker of ASD.


A systematic review of program circumstances in training social skills to adolescents with high-functioning autism, 2020

Mirzaei, S. S., Pakdaman, S., Alizadeh, E., & Pouretemad, H. (2020). A systematic review of program circumstances in training social skills to adolescents with high-functioning autism. International Journal of Developmental Disabilities, 1-10.


Despite many programs for educating social skills to adolescents with autism, insufficient attention has been paid to examine the optimal conditions and strategies that are important for improvement and generalization of the learned skills. So after reviewing and searching for three PubMed, Scopus, and ProQuest databases, 20 studies were finally analyzed and shared conditions were extracted. The results showed that the most important condition is parental involvement. The rehearsal and practice of social skills, attention to developmental trajectories, strengths and weaknesses of the individual and use of quantitative and qualitative tools are the other circumstances. In conclusion, taking into account these conditions for improvement, generalization and durability of the skills can be helpful.


Autistic-Like Behaviours and Associated Brain Structural Plasticity are Modulated by Oxytocin in Maternally Separated Rats, 2020

Mansouri, M., Pouretemad, H., Roghani, M., Wegener, G., & Ardalan, M. (2020). Autistic-Like Behaviours and Associated Brain Structural Plasticity are Modulated by Oxytocin in Maternally Separated Rats. Behavioural Brain Research, ۱۱۲۷۵۶.



Early psycho-social experiences influence the developing brain and possible onset of various neurodevelopmental disorders, such as Autism Spectrum Disorder (ASD). ASD is characterized by a variety of brain abnormalities, including alteration of oxytocin receptors in the brain. Recently, early life adverse experiences, such as maternal separation (MS), have been shown to constitute risk factors for ASD in preclinical studies. Therefore, the main aims of the current study were to i) explore the association between onset of autistic-like behaviours and molecular/structural changes in the brain following MS, and ii) evaluate the possible beneficial effects of oxytocin treatment on the same parameters.

Method and Material

Male rats were exposed to the maternal separation from post-natal day (PND) 1 to PND14. After weaning, daily injections of oxytocin (1 mg/kg, ip) were administered (PND 22-30), followed by examination of autism-related behaviours at adolescence (PND 42-50). Brain structural plasticity was examined using stereological methods, and the plasma level of brain derived neurotrophic factor (BDNF) was analysed using ELISA.


We found that maternal separation induced autistic-like behaviours, which was associated with increase in the hippocampal CA1 stratum radiatum (CA1.SR) volume. In addition, we observed increase in the infralimbic brain region volume and in the number of the pyramidal neurons in the same brain region. Maternal separation significantly increased the plasma BDNF levels. Treatment with oxytocin improved autistic like behaviours, normalized the number of neurons and the volume of the infralimbic region as well as the plasma BDNF level (p < 0.05).


Maternal separation induced autistic-like behaviours, brain structural impairment together with plasma BDNF level abnormality, which could be improved by oxytocin treatment.


Common elements of parent management training programs for preschool children with autism spectrum disorder, 2020

Eskandari, B., Pouretemad, H., Mousavi, M., & Farahani, H. (2020). Common elements of parent management training programs for preschool children with autism spectrum disorder. Asian Journal of Psychiatry, 52, 102149.


Parent management training is a general set of interventions used as a part of a variety of clinical approaches to reduce behavioral problems of children. These behavioral problems in children with special needs (such as autism spectrum disorder) take a more complex form. The objective is to present elements, needed to develop parent management training program to reduce behavioral problems in preschool children with autism spectrum disorder. At first, all parent management training programs for reducing behavioral problems of preschool children were collected. Subsequently, all programs were reviewed from the perspective of having a systematic review or meta-analysis, confirming the effectiveness of this program at preschool age. After that, interviews with experts and parents were conducted to identify effective elements on development of this program. In the next step, a set of components was obtained using information about parent management training programs as well as items obtained from interviews with experts and parents. At this stage, 10 experts were asked to rate the items according to their importance using the Delphi method. The items that achieved the required scores were introduced as main items. The number of them was 13 and included items such as full assessment of the child and appropriate communication with the child. Considering the characteristics of children with autism spectrum disorder will require changes in some parts of parent management training program, therefore, it is necessary to develop a specific program for these children to cover all of their characteristics.



مفهوم پردازی اضطراب همبود در اختلال طیف اتیسم: یک مرور نظامدار یکپارچه، ۱۳۹۹

بهزادپور سمانه، پوراعتماد حمیدرضا، اکبری زردخانه سعید. مفهوم‌پردازی اضطراب همبود در اختلال طیف اتیسم: یک مرور نظام‌دار یکپارچه. کومش. ۱۳۹۹; ۲۳ (۱) :۱۱-۱۹


هدف: در بسیاری از مطالعات، همبودی اضطراب با اختلال اتیسم در کودکان و نوجوانان گزارش شده است. هدف از این مطالعه بررسی تبیین‌های اضطراب در کودکان و نوجوانان دارای اتیسم در ادبیات پژوهشی است.
مواد و روش‌ها: این مطالعه، یک مرور یک‌پارچه پیشینه است و سه پایگاه اطلاعاتی یعنی Scopus، ScienceDirect و PubMed از سال‌های ۲۰۰۰ تا ۲۰۱۹ با یک استراتژی جستجوی جامع، مورد وارسی قرار گرفتند. در نتیجه این جستجو، ۵۷۶ مقاله بازیابی شدند. بر اساس روش پریزما و با استفاده از ملاک‌های ورود و خروج، ۱۱ مقاله برای ورود به پژوهش انتخاب شدند.
یافته‌ها: بر اساس نتایج مطالعات، ۳ تبیین یافت شد: ۱) علائم مرکزی اتیسم از جمله فقدان مهارت‌های اجتماعی و بیش پاسخ‌دهی حسی زیربنای اضطراب در اتیسم است ۲) نقایص در تنظیم هیجانی زیربنای اضطراب در اتیسم است ۳) عدم تحمل ابهام عامل اصلی در ظهور اضطراب در اتیسم است.
نتیجه‌گیری: کودکان دارای اتیسم داری نقایص جدی شناختی و حتی معماری شناختی متفاوتی دارند. بنابراین لازم است که در تبیین اضطراب در اتیسم به این ویژگی‌ها و نقایص توجه شود و یک مفهوم‌پردازی از اضطراب در اتیسم بر اساس ویژگی‌های شناختی ارائه شود.