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Individuals with 16p11.2 copy number variant (CNV) show considerable phenotypic heterogeneity. Although autism spectrum disorder (ASD) is reported in approximately 20–23% of individuals with 16p11.2 CNVs, ASD‐associated symptoms are observed in those without a clinical ASD diagnosis. Previous work has shown that genetic variation and prenatal and perinatal birth complications influence ASD risk and symptom severity. This study examined the impact of genetic and environmental risk factors on phenotypic heterogeneity among 16p11.2 CNV carriers. Participants included individuals with a 16p11.2 deletion (N = 96) or duplication (N = 77) with exome sequencing from the Simons VIP study. The presence of prenatal factors, perinatal events, additional genetic events, and gender was studied. Regression analyses examined the contribution of each risk factor on ASD symptomatology, cognitive functioning, and adaptive abilities. For deletion carriers, perinatal and additional genetic events were associated with increased ASD symptomatology and decrements in cognitive and adaptive functioning. For duplication carriers, secondary genetic events were associated with greater cognitive impairments. Being female sex was a protective factor for both deletion and duplication carriers. Our findings suggest that ASD‐associated risk factors contribute to the variability in symptom presentation in individuals with 16p11.2 CNVs. Lay Summary There are a wide range of autism spectrum disorder (ASD) symptoms and abilities observed for individuals with genetic changes of the 16p11.2 region. Here, we found perinatal complications contributed to more severe ASD symptoms (deletion carriers) and additional genetic mutations contributed to decreased cognitive abilities (deletion and duplication carriers). A potential protective factor was also observed for females with 16p11.2 variations. Autism Res 2020, 13: 1300–1310. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Serving children with mental health needs in public schools, particularly in rural areas, remains a challenge. Initiating, developing, and maintaining innovative programs can be difficult, especially for diverse minority communities in the United States. Creative partnerships have the potential to mutually enhance each partner’s ability to secure resources for, provide needed services to, and improve the academic and social-emotional well-being of diverse, rural public education students. This article describes the ̀Ike Pilialoha (bonds of knowledge, friendship, and love) Program—a school-consultation pilot program that uses resources from a local nonprofit health organization, the local state Department of Education, and the federal government. Positive evaluation outcomes for the overall evaluation program are provided, as well as information on educational resources, implications, and lessons learned that may benefit other rural students and families.

Approximately one third of children with autism spectrum disorder (ASD) reportedly lose skills within the first three years, yet a causal mechanism remains elusive. Considering evidence of strong genetic effects for ASD and findings that distinct phenotypes in ASD associate with specific genetic events, we examined rates of parent-reported regression in the Simons Simplex Collection with likely gene disrupting (LGD) mutations from five distinct classes: FMRP target genes, genes encoding chromatin modifiers, genes expressed preferentially in embryos, genes encoding postsynaptic density proteins, and essential genes. Children with ASD and mutations in postsynaptic density genes were more likely to experience regression, while a trend suggested that children with ASD and mutations in embryonic genes were less likely to have skill losses.

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