Dr Ray O’Connor takes a look at the latest clinical papers on autism, and how Longitudinal autism cohort studies have shown the importance of developmental and adaptive skills starting in the early years
Autism (also called Autism Spectrum Disorder or ASD) is a neurodevelopmental condition with varied trajectories through the lifespan, leading to individualized patterns of strengths and challenges. It is defined by challenges with social communication and the presence of restricted or repetitive partners of behaviour or interest.
Dr Ray O’Connor
As more autistic children and youths access healthcare and related services, there is a growing need for evidence-informed approaches that recognize their strengths, support diverse developmental pathways, and promote meaningful outcomes.
This narrative review1 provides a helpful up to date summary of the state of autism globally. Longitudinal autism cohort studies show the importance of developmental and adaptive skills starting in the early years, followed by emerging co-occurring conditions, and opportunities for autonomy and community participation when approaching adulthood. Recent studies estimate that approximately 1-2 per cent of children worldwide are autistic.
Studies of interventions to support developmental outcomes in autistic children have shown benefits; however, adverse events from therapies and outcomes prioritized by autistic people must be also taken into account.
Programs for autistic children and youth are making some progress by including members of diverse communities, developing and adapting interventions to meet their needs. Most importantly, autistic people have highlighted the many contributors to a ‘good life’, prominent among which are acceptance and meaningful inclusion.
Paracetamol (acetaminophen) is one of the most commonly used drugs in pregnancy worldwide. It is the recommended treatment for pain relief and fever in pregnancy. In September 2025, the US president advised against using Tylenol (acetaminophen) during pregnancy, citing risks of autism in children exposed to the drug in utero.
The objective of this umbrella review of systematic reviews2 was to assess the quality, biases, and validity of evidence on maternal paracetamol (acetaminophen) use during pregnancy and the risk of autism and attention deficit/hyperactivity disorder (ADHD) in offspring. The authors searched Medline, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews, along with grey literature, Epistemonikos, and the reference lists of included studies from inception to September 30, 2025.
They included systematic reviews of randomised trials and cohort, case-control, or cross sectional studies that reported maternal paracetamol use during pregnancy and the diagnosis of autism or ADHD in offspring. Nine reviews (40 studies) reporting on autism (six studies) and ADHD (17 studies) in offspring were included.
Four reviews undertook meta-analysis. The overlap of primary studies included in the reviews was very high (corrected covered area 23 per cent). The reviews reported a possible to strong association between maternal paracetamol intake and autism or ADHD or both in offspring. Seven of the nine reviews advised caution when interpreting the findings owing to the potential risk of bias and confounding in the included studies.
Confidence in the findings of the reviews was low (two reviews) to critically low (seven reviews) based on the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) criteria. Only one review included studies (n=2) reporting autism and ADHD in offspring that appropriately adjusted for familial factors and unmeasured confounding through sibling controlled analyses. In both studies, the increased risk of autism in offspring (one study, hazard ratio 1.05) and ADHD (two studies, 1.07) observed in the whole cohort analyses did not persist in sibling controlled analyses for autism. The authors concluded that existing evidence does not clearly link maternal paracetamol use during pregnancy with autism or ADHD in offspring.
Pre-term children exhibit a higher prevalence of ASD than the general population. The unique neurodevelopmental characteristics of preterm children present challenges in screening for and diagnosing ASD.
This systematic review and meta-analysis3 evaluated the diagnostic performance of currently used ASD screening tools in the preterm population. The database search was conducted by using MEDLINE, PsycINFO, PubMed, Embase, and CINAHL in July 2024. Articles that quantified the diagnostic accuracy of ASD screening tools in the preterm population were included. Nine studies were included in this review, and only four studies in the meta-analyses. All studies were assessed for risk of bias, applicability, and certainty.
The results were as follows. Sensitivity of screening tools for ASD in preterm children ranged from zero per cent to 100 per cent, whereas specificity ranged from 38 per cent to 98 per cent. Pooled data were available for the Modified Checklist for Autism in Toddlers (two studies) and Social Communication Questionnaire, (two studies), with pooled sensitivities of 55 per cent and 53 per cent and specificities 85 per cent and 90 per cent, respectively. The authors found that there was significant study heterogeneity, limiting the number of studies from which to pool diagnostic accuracy data.
They concluded that screening tools vary in their ability to identify ASD in the preterm population, underscoring how overlapping behavioural phenotypes may confound early identification. They recommend that there is a critical need to refine and assess ASD screening tools in preterm children, facilitating timely interventions in this cohort.
The relationship between ASD and screen time (ST) has been extensively studied; but the evidence remains inconsistent. This systematic review4 aimed to provide a robust quantitative assessment of the relationship between ASD and ST by consolidating and analysing available evidence to offer a more precise understanding of this complex association.
A comprehensive search was conducted in PubMed, Web of Science, Embase, and Scopus, covering literature published from January 1, 2006 to June 12, 2024. In total, 30 studies involving 356,666 participants met the inclusion criteria.
The findings revealed a significant association between screen exposure in preschool children and the development of ASD, with a longer duration of screen exposure correlating with an increased likelihood of being diagnosed with autism.
Furthermore, autistic people tend to have longer daily screen use and are at a higher risk of screen addiction compared to non-autistic individuals. These findings emphasize the importance of limiting ST for preschoolers and autistic people. However, the level of evidence supporting these conclusions is very low.
The authors recommend that future studies should focus on controlling for confounding factors, using more objective measures, and further investigate the relationship between screen engagement styles (active or passive), screen use patterns (screen devices and content), and ASD. 
References:
Penner M et al. Advances in supporting development in autistic children and youth. BMJ 2026;393:e086562. http://dx.doi.org/10.1136/bmj‑2025‑086562.
Sheikh J et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ 2025;391:e088141. http://dx.doi.org/10.1136/bmj-2025.
Thomas KE et al. Screening for Autism in Preterm Children: A Systematic Review. Pediatrics 2025 Oct 1;156(4):e2024069837. doi: 10.1542/peds.2024-069837.
Yuan G et al. Screen Time and Autism Spectrum Disorder: A Comprehensive Systematic Review of Risk, Usage, and Addiction. J Autism Dev Disord. 2026 Apr;56(4):1573-1587. doi: 10.1007/s10803-024-06665-z.