Recent reports indicate that sustained interaction with conversational artificial intelligence (AI) systems can, in a small subset of users, contribute to the emergence or stabilisation of delusional experience. Existing accounts typically attribute such cases either to individual vulnerability or to failures of safety engineering. These explanations are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues that the risk arises from the relational and ontological structure of the interaction itself. Conversational AI generates ontological dissonance: a conflict between the appearance of relational presence and the absence of any subject capable of sustaining it. Maintained through a communicative double bind and amplified by attentional asymmetries, this dissonance tends, under conditions of affective vulnerability, to stabilise into a technologically mediated analogue of folie à deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies the ethical and clinical implications for the design and use of conversational AI.
Digital mental health tools-including telehealth, mobile applications, wearable devices, machine learning, and artificial intelligence-are changing the way patients and providers manage mental health care. This review summarizes the current research findings of digital interventions on patient access to care, the factors impacting personalized care, and overall patient engagement. Gaps of knowledge and future considerations are discussed, including careful observation of existing barriers to care. Clinical recommendations are discussed for clinicians who are considering implementing digital mental health tools into practice.
Listing tools were found to ameliorate drug treatment in older people; the FORTA (Fit-fOR-The-Aged) list is a clinically validated positive-negative list of medication appropriateness. Here, we retrospectively analyze longitudinal correlations between the FORTA score and key measures of physical and cognitive function in older people. 504 participants of a multi-center cohort study (AgeCoDe/AgeQualiDe) for whom the FORTA score (sum of over- and under-treatment errors) had been assessed were studied at three follow-up (FU) time points (FU 6-8; mean age range 87.9-89.7 years); comparisons between data at these FUs separated by 10 months were available for 292-328 patients. The univariate analysis of the association between FORTA_Delta_76 (change of FORTA score between FU 6 and 7) and ADL (Activities of Daily Living)_Delta_76 (- 0.155, p < 0.01) and between FORTA_Delta_76 and MMSE (Mini-Mental State Examination)_Delta_76 (- 0.203, p < 0.01) revealed significant correlations. Multivariable analysis (using a forward selection model, p < 0.05) revealed a significant association between FORTA_Delta_76 and MMSE_Delta_76 (p < 0.05). Univariate analyses for other comparisons were only significant for FORTA_Delta_86 and MMSE_Delta_86. This study indicates that longitudinal non-interventional changes of the FORTA score as an integral index of medication appropriateness are associated with changes in ADL and MMSE: the lower this score the better the functional outcome. These findings are in line with earlier interventional data and underscore the potential of FORTA to improve clinical endpoints in older people.
Major Depressive Disorder (MDD) is characterized by heterogeneous pathogenesis that extends beyond traditional monoamine deficits. A paradigm shift is recognizing neuroinflammation as a central, critical driver of both illness onset and resistance to treatment. The CXCL12/CXCR4 system is traditionally associated with immune cell trafficking, but increasing evidence reveals its powerful regulatory role in neuropsychiatric disorders. We performed a comprehensive synthesis demonstrating that CXCL12/CXCR4 axis acts as a direct molecular modulator of neurotransmission, neuroplasticity, and glial cell signaling. Specifically, this axis can modulate a multiple molecular pathways linked with the glutaminergic, GABAergic, and serotonergic systems, and mediating neuroplasticity and glial cell function. Functionally, CXCL12/CXCR4 axis has twofold character - it can strengthen neurotoxic processes through overactivation of NMDAR and excessive Ca2+ influx. On the other hand, it can also play protective role by preventing excitotoxicity, supporting neurogenesis, enhancing GABA synthesis, and dendritic spines stabilization. This review focuses on identifying potential mechanisms across in vitro, animal, and human studies to establish the CXCL12/CXCR4 axis as a powerful biomarker and, critically, an unexploited therapeutic target.
Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder that remains chronic unless intervened with evidence-based intervention. Cognitive behavioral therapy (CBT) with exposure and response prevention is the gold-standard psychological intervention for OCD, but many individuals do not receive this intervention due to barriers to accessing treatment. Mental health technology tools such as telehealth, computerized programs, internet-delivered CBT, and mobile applications have been adopted to expand the accessibility of CBT. An up-to-date summary of the evidence base of technology-mediated formats of CBT for OCD treatment is provided. Clinical benefits offered by such approaches, current limitations, and future research directions are discussed.
Rapid eye movement (REM) sleep behaviour disorder (RBD), particularly its idiopathic/isolated form (iRBD), is a prodromal marker for α-synucleinopathies, including Parkinson's disease, dementia with Lewy bodies and multiple system atrophy. Machine learning (ML) offers opportunities to improve diagnosis and risk stratification in this high-risk group. We conducted a systematic review of PubMed, Embase (Ovid) and Medline (Ovid) from 2014 to September 2025, following PRISMA guidelines. From 335 records identified, 202 remained after duplicate removal and 75 studies on adult humans with clinically diagnosed RBD or iRBD that applied and validated an ML model were included. Fifty-eight studies addressed diagnosis, four studied RBD phenotypes, and thirteen evaluated prediction of phenoconversion to overt α-synucleinopathy. Across diagnostic studies, reported accuracies ranged from ∼63% to ∼99.7%, with median values around 90%, using polysomnography, EEG, neuroimaging, molecular and behavioural markers. Phenoconversion models (often using dopaminergic imaging or multimodal features) achieved AUCs up to ∼0.94, but frequently relied on small, single-centre cohorts with heterogeneous definitions of phenoconversion and limited external validation. A wide variety of ML algorithms was used (n ~ 30), most commonly support vector machines, random forests and logistic regression. Overall, ML approaches show promise for scalable diagnosis and risk stratification in iRBD, but progress is constrained by methodological bias, inconsistent endpoints, data imbalance and a lack of explainable, externally validated models. We outline methodological priorities to make future ML tools clinically interpretable and translatable.
Growing evidence suggests pesticide exposure can affect emotional well-being; limited research exists across adolescence and young adulthood. We examined cross-sectional and longitudinal associations of pesticide biomarkers with anxiety and depression scores. We analyzed 646 participants from Ecuadorian agricultural communities: 510 in 2016 (ages 11-17y) and 485 in 2022 (17-24y). Twelve urinary insecticide metabolites were measured. Validated questionnaires assessed depression and anxiety. Generalized estimating equations (GEE) estimated associations for continuous scores and logit GEE calculated odds ratios (OR) of elevated symptoms, adjusting for demographic and anthropometric variables. In 2016, an interquartile range higher overall pesticides summed (β = 1.01 95%CI:[0.48, 1.53]), organophosphates summed (β = 0.99 [0.47, 1.51]), 3,5,6-trichloro-2-pyridinol (TCPy; β = 0.97 [0.49, 1.45]), pyrethroids summed (β = 0.69 [0.11, 1.27]) and 3-phenoxybenzoic acid (β = 0.31 [0.01, 0.61]) were positively associated with depression. Detectable 5-hydroxy imidacloprid (OHIM) doubled elevated depression odds. In 2022, higher sulfoxaflor isomers were protective, but higher clothianidin increased elevated depression odds. Longitudinally, depression was positively associated with overall pesticides summed (β = 0.06 [0.02, 0.11]), organophosphates summed (β = 0.05 [0.001, 0.10]), TCPy (β = 0.06 [0.02, 0.10]), pyrethroids summed and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (trans-DCCA; β = 0.01 [0.003, 0.02]). For anxiety, in 2016 detectable trans-DCCA (OR = 2.52 [1.52, 4.16]) was associated with elevated symptoms. In 2022, higher clothianidin increased elevated anxiety odds (OR = 1.44 [1.07, 1.93]). Longitudinally, trans-DCCA (OR = 1.39 [1.03, 1.87]) and OHIM (OR = 1.44 [1.02, 2.04]) increased elevated anxiety odds. Organophosphates, pyrethroids, and neonicotinoids were generally linked to higher depression and anxiety, while sulfoximines and one organophosphate appeared protective. OHIM and trans-DCCA showed consistent adverse associations across years.
Long-acting injectable buprenorphine may be a promising treatment option for adolescents and young adults with opioid use disorder (OUD). However, little is known about its safety, tolerability, and effectiveness in this age group. We conducted a 1-year feasibility study of elective inpatient buprenorphine induction followed by administration of long-acting injectable buprenorphine and linkage to ongoing substance use care in individuals <21 years in a safety-net health system (n = 18). Eighteen of 22 (82%) of patients admitted to an inpatient unit for buprenorphine initiation opted to receive the long-acting injectable formulation upon completion of induction. Of 18 patients who received long-acting injectable buprenorphine, 15 (83%) and 12 (67%) remained in care at one- and two-months post discharge, respectively. Eleven (61%) participants received repeat doses at both one- and two-months post discharge. Fourteen (78%) and 12 (67%) participants had not returned to opioid use at one- and two- months post discharge, respectively. The findings from this study of adolescents and young adults with OUD demonstrated that inpatient initiation of long-acting injectable buprenorphine after a brief induction with short-acting buprenorphine may be safe, well tolerated, and effective in terms of linkage, retention in care, and return to opioid use.
To develop a semi-automated method to segment "black hole" lesions on post-gadolinium 2D T1-weighted images (GdT1) in multiple sclerosis (MS) that follows radiological intensity rules and perform multi-center validation. Multi-center spin-echo GdT1 images and accompanying proton-density (PD)/T2-weighted images and manual T2 lesion masks of the REFLEXION study (NCT00813709) of suspected/early MS were used. Briefly, the proposed method segments cortical gray matter (GM) to derive a T1-weighted intensity threshold, which is applied inside co-registered T2 lesion masks to segment black hole lesion voxels. It was optimized on a training set (N = 40, 57.5% female, mean age 31.4 ± 8.7 (standard deviation) years), and 274 patients formed the test set (61.3% female, age 31.8 ± 8.4 years). Performance was quantified by the Dice similarity coefficient (DSC) and the intraclass correlation coefficient (ICC) for absolute agreement with manual segmentations. Lesion-wise sensitivity and specificity were calculated. Optimization resulted in: (1) GM selection as minimally 0.8 total WM plus GM partial volume, masked by MNI cortex; (2) normalized mutual information-driven linear co-registration of T2 to GdT1 images, interpolating T2 lesion masks using trilinear interpolation and 0.6 threshold; (3) mean intensity inside GM mask used as upper intensity threshold. The optimized method had acceptable spatial accuracy (DSC: 0.39 ± 0.26) and good volumetric accuracy (ICC: 0.84, 95% CI [0.72, 0.90]. Lesion-wise sensitivity was 0.91 ± 0.19, and lesion-wise specificity was 0.62 ± 0.22. The proposed method to semi-automatically segment black holes from post-gadolinium T1-weighted images shows acceptable performance. As a potential aid to radiologists, the method is not recommended to be used entirely without human intervention. Question T1-hypointense "black hole" lesions reflect disease severity in multiple sclerosis but are not routinely quantified due to a lack of reliable analysis methods. Findings A rule-based semi-automated method for GdT1 "black hole" lesion segmentation was developed and optimized, and then validated in a large unseen multi-center test set. Clinical relevance This method adds quantitative information about GdT1 "black hole" lesions to the radiological assessment of multiple sclerosis disease severity, when false positives are manually removed. This can enhance the characterization of individual patients and advance the understanding of the disease.
Depression is a prevalent mental health issue among older adults, often exacerbated by chronic illness, social isolation, and age-related cognitive changes. Standard treatments (e.g., pharmacotherapy and cognitive behavioral therapy) may not always be effective, acceptable, or accessible for this population. Mindfulness-Based Cognitive Therapy (MBCT) integrates mindfulness practices with cognitive therapy and may offer a scalable, non-pharmacological approach to late-life depression. To evaluate the effectiveness of MBCT on depressive symptoms in adults aged ≥60 years. Secondary outcomes were anxiety symptoms and quality-of-life indicators when reported. We searched PubMed (MEDLINE) and Scopus for randomized controlled trials (RCTs) comparing MBCT with control conditions in adults aged ≥60 years. Random-effects meta-analyses were conducted using standardized mean differences (Hedges g) for depressive symptom severity across scales. Because fewer than 10 studies were available per outcome, publication bias was not formally assessed. Three RCTs (total n = 178) met inclusion criteria. Two RCTs (n = 121) contributed data to the post-intervention meta-analysis of depressive symptoms. MBCT was associated with significantly lower depressive symptom severity than control conditions (pooled Hedges g = -0.92, 95% CI -1.30 to -0.55; I2 = 0%). Evidence for anxiety and quality-of-life outcomes was limited and could not be pooled; no eligible trials reported relapse/recurrence outcomes. MBCT may reduce depressive symptoms in older adults compared with control conditions, but the evidence base remains small and heterogeneous in measures and comparators. Larger, methodologically rigorous trials with standardized outcomes and longer follow-up are needed to clarify effectiveness for anxiety, quality of life, and durability of effects.
Wearable technology holds promise for improving mental health care by enabling continuous, objective monitoring of physiologic parameters. Building on decades of psychophysiology research, wearables can provide an additional source of measurement for implementing measurement-based care in learning mental health systems. This review describes wearable use across inpatient and outpatient settings, identifying gaps and opportunities in clinical care and research. While widely studied in outpatient, wearables hold immense potential for in inpatient settings. Advancements needed include user-centered design, better understanding of complex populations and settings, and use of modern analytical methods to generate clinically actionable mental health insights for all.
Adolescence is a critical developmental period during which parenting practices interact with temperament and sociocultural context to shape mental health and adaptation. Most parenting models are derived from Western settings, with limited evidence from India. This simultaneous mixed methods study drew on cross sectional data from the Indian Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA) cohort, including adolescents aged 12-17 years (parent report n = 931; child report n = 836). Exploratory factor analysis was conducted on parent and child versions of the Alabama Parenting Questionnaire. Qualitative data were obtained through in-depth interviews with 31 adolescents and their parents and analysed using thematic analysis. Findings were integrated at the interpretation stage. The original APQ structure did not replicate. Parent reports yielded three dimensions-Involvement/Positive Parenting, Poor Monitoring, and Corporal Punishment-while child reports yielded five, distinguishing father's and mother's involvement. Inconsistent disciplining did not emerge as a distinct construct. Qualitative findings indicated high involvement and behavioural and psychological control, largely driven by academic goals. Adolescents experienced these practices as both supportive and restrictive, with parental openness shaping communication. Contextual pressures, including resource constraints and urban stressors, contributed to a competency-control paradox. Parenting of adolescents in India must be understood within its relational and sociocultural ecology. While involvement and control function as primary supports, excessive control may constrain broader competency development. Integrating parent and adolescent perspectives is essential for culturally grounded research and intervention.
Digital phenotyping-the moment-by-moment quantification of human behavior using data from smartphones and wearables-offers new pathways for mental health research and care. This review summarizes current trends, tools, and applications of digital phenotyping, highlighting its growing clinical relevance in early detection, symptom monitoring, and personalized interventions. Although studies increasingly demonstrate its feasibility and clinical utility across conditions such as depression, anxiety, and schizophrenia, challenges persist. These challenges include inconsistent data quality, small and nonrepresentative samples, lack of methodological standardization, and pressing ethical considerations about privacy and transparency.
Depression is a highly prevalent and disabling disorder affecting approximately 5% of the adult population worldwide. Despite its impact, the underlying pathophysiology remains insufficiently understood, and current treatments are only partially effective. Understanding electrophysiological correlates of depression offers promise for a better grasp of the underlying brain mechanisms and might even guide novel treatment approaches, including neuromodulation. EEG is particularly attractive for this purpose due to its wide availability, cost-effectiveness, and potential for direct neuromodulatory targeting. We conducted a PROSPERO-registered systematic review in accordance with PRISMA guidelines to assess resting-state EEG activity in adult patients with depression, diagnosed according to DSM-IV/V or ICD-10/11. Included studies reported cross-sectional or correlational data on well-established quantitative EEG measures such as power, cordance, peak frequency, and alpha asymmetry. Semiquantitative analyses using modified albatross plots and meta-analyses were performed. Study quality was assessed with a modified Newcastle-Ottawa Scale. Fifty-two studies met the inclusion criteria. Semiquantitative findings showed a trend for increased low-frequency (delta and theta) and high-frequency (beta and gamma) power, as well as left frontal alpha asymmetry, in depressed patients compared to healthy controls. However, meta-analysis only confirmed a significant increase in beta power. Results regarding disease severity correlations and data on peak alpha frequency and cordance were insufficient for interpretation. Risk of bias across studies was high. Our results support a potential role for increased beta oscillations in depression. These oscillations may reflect disrupted corticolimbic control and reward processing and partially overlap with mechanisms implicated in chronic pain and fatigue. Further investigation is warranted into their potential as a diagnostic tool or even a biomarker, as well as their potential use as a neuromodulatory treatment target.
Anxiety among adolescents has increased globally during the COVID-19 pandemic. Adolescents in juvenile detention centers (JDCs) may be particularly vulnerable due to restricted liberty and social isolation. Movement-based interventions such as Dance/Movement Therapy (DMT) have been studied as approaches to support emotional regulation. This exploratory study investigated the psychophysiological effects of a structured DMT intervention on anxiety reduction among adolescents in JDCs, focusing on anxiety-related changes in dopamine (DA) levels and body temperature. This quasi-experimental study included 55 female adolescents from a single juvenile detention center. Participants were allocated to either a non-DMT control group (n = 30, 16.17 ± 1.73 years), which maintained their usual institutional routine throughout the 8-week study period, or a DMT group (n = 25, 16.23 ± 1.68 years) that completed 24 DMT sessions over the same period. Anxiety and physiological measures were assessed before and after the intervention. Anxiety was measured using the Beck Anxiety Inventory (BAI). Physiological measures included mean body temperature (mTb), calculated from tympanic (core) and skin temperature measurements, and plasma DA levels measured using high-performance liquid chromatography (HPLC). Following the intervention, the DMT group showed a significant reduction in BAI scores (-16%, p < 0.001), along with significant increases in mTb (0.11 ± 0.07 °C, p < 0.001) and DA levels (+ 30%, p < 0.001). BAI scores were negatively correlated with mTb and DA levels, whereas mTb was positively correlated with DA levels. This study provides preliminary evidence that DMT may help alleviate anxiety and support psychophysiological regulation among adolescents in JDCs. However, the exploratory design, single-center setting, and all-female sample may limit generalizability. Future multi-center studies with more diverse samples are needed to confirm these findings and clarify the underlying mechanisms.
A strategic imperative in mood disorders is to identify innovative mechanisms that translate into improved therapeutics when compared to the extant options. More specifically, there is a need for treatments with greater efficacy, shorter time-to-peak efficacy, greater durability of effect as well as improved tolerability profiles. Moreover, priority has also shifted towards identifying mood disorder therapeutics capable of targeting domains of psychopathology that are most pervasive, debilitating and inadequately treated by conventional pharmacology (e.g., anhedonia, cognitive impairment). Available preclinical, translational, observational and clinical data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) hold promise as potentially mechanistically-informed therapeutics in persons with mood disorder. Although metabolic effectors are implicated as a putative mechanism of action of GLP-1RAs, non-mutually exclusive targets also include direct effects on neuroplasticity, neurogenesis, neurodifferentiation, neuroprotection, anti-apoptotic and autophagy mechanisms. Available evidence does support origination of adequate and well-controlled clinical studies in both major depressive disorder and bipolar disorder as acute and/or maintenance treatments. Although association with suicidality and GLP-1RAs have been reported, causality has not been established. Moreover, preliminary evidence suggests that GLP-1RAs may benefit aspects of mood disorder psychopathology (e.g., reward) that may be predictive of potential beneficial effects on aspects of suicidality.
Loneliness and social isolation are major public health concerns among older adults and are associated with depression, cognitive decline, frailty, and loss of independence. Companion animals (and dogs in particular) might mitigate these adverse outcomes by fostering emotional support, physical activity, and social interactions. The objective of the present study aimed to evaluate the association between dog ownership and loneliness in community-dwelling older adults. C-KDOG is a multicentre, cross-sectional study conducted between September 2020 and April 2023 at seven investigating centers in France. The participants were aged 75 or over and were living at home. Loneliness was assessed on the 11-item De Jong Gierveld Loneliness Scale. The secondary outcomes included emotional and social loneliness subscores, social isolation (according to the Social Network Index). Associations between dog ownership and loneliness were analyzed using multivariable linear regressions adjusted for sociodemographic, environmental and clinical characteristics. A total of 160 participants were included, of whom 47 were dog owners (mean age: 82 years; females: 116 (73%); living alone: 79 (49%)). The median overall loneliness scores did not differ significantly when comparing dog owners and non-owners. In adjusted models, however, dog ownership was independently associated with lower loneliness. This association was mainly driven by a lower emotional loneliness subscore. Living alone, frailty, depressive symptoms, and sleep problems were independently associated with a greater level of loneliness. Dog ownership was primarily motivated by companionship (81%). Adverse events (such as falls or bites) were rare (5%). Dog ownership was associated with a lower level of emotional loneliness among community-dwelling older adults, independently of living alone frailty and depression. Companion dogs might contribute to emotional well-being in older adults. However, longitudinal studies are needed to confirm causality.
The sodium leak channel non-selective (NALCN) is a key regulator of resting membrane potential and cellular excitability in neurons and endocrine cells. Gain-of-function de novo pathogenic variants in NALCN cause severe neurodevelopmental disorders with a broad and heterogeneous clinical spectrum. Partial inhibition of NALCN has been proposed as a therapeutic strategy; however, progress has been limited by the absence of selective pharmacological modulators. This gap largely reflects the lack of a robust heterologous expression system suitable for high-throughput screening, as functional NALCN requires multiple ancillary subunits and its constitutive expression is toxic in commonly used cell lines such as HEK293. To address these challenges, we developed a multitransposon-based approach to generate inducible HEK293 cell lines that stably express the complete NALCN channelosome, including wild-type and disease-associated variants. We further demonstrate that NALCN current expression is cell cycle-dependent, enabling the definition of optimized conditions for consistent and reproducible electrophysiological recordings. Using these cell lines, we conducted a systematic pharmacological characterization of the NALCN channelosome by patch-clamp electrophysiology and identified several candidate modulators that are currently under evaluation. Notably, we revisited NALCN modulation by N-benzhydryl quinuclidine compounds and found that these compounds can restore locomotor phenotypes in an animal model of NALCN gain-of-function. Together, this work establishes a foundational platform for the discovery of NALCN-targeting compounds and opens new therapeutic avenues not only for NALCN-associated neurodevelopmental diseases, but also potentially for psychiatric disorders, chronic pain, and cancer.
Suicide is a leading cause of death among young adults and is influenced by economic crises and the COVID-19 pandemic. This study aims to examine trends in suicide mortality rates in Türkiye between 2007 and 2022 using Joinpoint regression analysis. This retrospective ecological time-trend study utilized publicly available data from the Turkish Statistical Institute. Suicide mortality rates per 100,000 population were calculated by age and gender. Joinpoint regression analysis was applied to identify significant changes in trends over time. Annual Percent Changes (APCs) and Average Annual Percent Changes (AAPCs) were computed. The overall suicide rate increased annually by 5.86% (95% CI: 1.24-12.50) between 2019 and 2022. For females, the APC was 8.11% (95% CI: 0.96-18.43) in the same period. For females, a decreasing trend was observed from 2007 to 2019 (APC: -2.27%), followed by a significant increase between 2019 and 2022 (APC: +8.11%). In contrast, the suicide rate among males exhibited a consistent upward trend from 2007 to 2022 (APC: +2.28%). It has been shown that suicide-related deaths in young adults in Türkiye are increasing. The fact that the increase especially in women is significantly high requires health authorities to take steps in this field.
Epidural anesthesia (LEA) can block the Ferguson reflex, which stimulates the release of maternal oxytocin during labor. LEA may increase the need for synthetic oxytocin (sOT) to augment labor. Recent research has demonstrated an association between a elevated odds of autism spectrum disorder (ASD) and higher doses and durations of sOT. To examine the associations between the duration of LEA, sOT dosing, the duration of sOT exposure, and a diagnosis of ASD. Delivery data from 115 adolescents with ASD were compared to a reference population of 114 adolescents without ASD. The key variables examined were epidural duration (h), the cumulative dose of sOT (milliUnits), and sOT exposure duration (h). The mothers of children with ASD had significantly longer exposure to sOT and LEA with significantly higher cumulative sOT dosage than those in the non-ASD group. Mothers in the ASD group received sOT for a longer time period prior to LEA administration than those in the non-ASD group. This suggests that factors other than LEA impacted sOT usage. Mothers in the ASD group had significantly higher body mass indices, which are associated with the need for higher intrapartum sOT dosing. Any association between LEA and ASD could be due to other variables affecting sOT use, leading to longer durations of both sOT and LEA use, rather than a direct impact of LEA on SOT use. Future studies examining the association between anesthesia or sOT dosing and ASD must include quantitative data on sOT and LEA dosing and exposure duration.