Discovery of 4 different subtypes of autism paves way for personalised care
Each subtype exhibits distinct developmental, medical, behavioural and psychiatric traits, and different patterns of genetic variation.
The discovery of four different subtypes of autism is a major step toward understanding the condition's genetic underpinnings and improving care, researchers reported in Nature Genetics.
According to researchers, the four autism subtypes can be categorised as: Behavioural Challenges, Mixed Autism Spectrum Disorder with Developmental Delay, Moderate Challenges, and Broadly Affected.
Each subtype exhibits distinct developmental, medical, behavioural and psychiatric traits, and importantly, different patterns of genetic variation, the researchers said.
The findings are drawn from a study of more than 5,000 children with autism, ages four to 18, and nearly 2,000 of their non-autistic siblings. The study looked for nearly 240 traits in each individual, from social interactions to repetitive behaviours to developmental milestones.
While the four subtypes may share some traits – like developmental delays and intellectual disability - the genetic differences suggest distinct mechanisms are behind what appear on the surface to be similar characteristics.
The timing of genetic disruptions and the effects on brain development differ with each subtype, researchers found.
As a result, some of the genetic impact of autism may occur before birth, while other effects may emerge as children grow, according to the study.
'What we're seeing is not just one biological story of autism, but multiple distinct narratives,' study co-leader Natalie Sauerwald of the Flatiron Institute in New York said in a statement.
'This helps explain why past genetic studies (of autism patients) often fell short,' she said.
'It was like trying to solve a jigsaw puzzle without realising we were actually looking at multiple different puzzles mixed together. We couldn't see the full picture, the genetic patterns, until we first separated individuals into subtypes.' REUTERS
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Organised crime groups pushing drug-laced vapes in Asia including Singapore: UN, Singapore News
SINGAPORE - Over several weeks in 2025, a woman tried to get her 19-year-old son arrested over his addiction to drug-laced e-vaporisers, specifically Kpods. The once-active teenager had become withdrawn since November 2024, when he started puffing Kpods, which are vapes laced with etomidate, a powerful anaesthetic. He also started cutting his own face and arms with a knife. "We saw many videos of people on TikTok saying Kpods can make a person suicidal, so we tried to stop him," Susan (not her real name) told The Straits Times, adding that her husband decided to install security cameras at home. They saw him on video stumbling out of his room. He was struggling to walk. "I spoke to him the next day to ask him what happened, and he said he had injured his legs while lion-dancing, so I did not suspect too much," she said. Over the next few days, they noticed their son would change between five and 10 pairs of shorts throughout the night. Susan suspected he had lost the ability to control his bladder whenever he was high on etomidate, which various reports said can also result in hand tremors, unsteadiness, sluggishness and mental confusion. Desperate to get him help, she reached out to the authorities and told them her son was using Kpods. Currently, those found guilty of consumption of a controlled drug can be jailed for up to 10 years, fined up to $20,000, or both. She was told etomidate is not a Class A controlled drug. At most, her son would be slapped with a fine for using a vape. She showed ST a phone log of calls she made to different agencies. In Singapore, etomidate is governed by the Poisons Act. A licence is required for its importation or sale. Those found in possession or found using pods containing etomidate can be jailed for up to two years, fined up to $10,000, or both. Looming crisis There is evidence to show that vapes sold in Asia are increasingly laced with synthetic drugs and pharmaceutical products like etomidate. In Malaysia, where vaping is allowed in some states, the Health Ministry revealed that 65.6 per cent of vape liquids seized in 2023 and 2024 contained dangerous drugs. Previous reports revealed that a significant number of vapes seized in Singapore had originated from Malaysia. Vape pods mixed with etomidate, or Kpods, reared their head in Singapore in March 2024, when the Health Sciences Authority (HSA) told ST it had detected a case of vapes containing ketamine and three cases of vapes containing etomidate. The HSA raided an industrial unit and seized more than 8,700 vapes and its components worth around $137,000, including etomidate-laced devices. In April, Singapore got its first indication that young people here were using Kpods after a 13-year-old girl was found behaving erratically outside the State Courts while puffing on an e-cigarette. A subsequent raid of her home found that she had an etomidate-laced device in her possession. Since then, videos have emerged online of young people behaving erratically, allegedly after using Kpods. [[nid:719505]] In the first half of 2025, HSA detected 28 cases involving Kpods, up from 10 cases recorded in 2024. According to a report by the United Nations Office on Drugs and Crime (UNODC) published in May, products sold in Singapore as Kpods have been found to contain either etomidate or ketamine, which is a Class A controlled drug. The UNODC report describes a looming crisis in South-east Asia and East Asia, where drug syndicates and organised crime groups, which have converged, are lacing vapes with synthetic drugs and pharmaceutical products like etomidate. These groups are using their combined resources and expertise to constantly change the formulas for synthetic drugs or new psychoactive substances (NPS). In general, NPS are defined under anti-drug laws by their synthetic formulas. Drug-testing tools use the formulas to identify an NPS. The UNODC report said etomidate first appeared in significant amounts in China after synthetic cannabinoids were scheduled as a controlled drug there. "In recent years, China has reported an increase in the illicit use of pharmaceutical products as drug suppliers seek substitutes for mainstream drugs (methamphetamine and heroin), sometimes to get around emerging drug controls of NPS," said the report. It noted that etomidate - a hypnotic agent - was found to be added to e-liquids for use with vaping products following the class scheduling of synthetic cannabinoids in 2021. "Symptoms of etomidate overuse primarily include intoxication-like effects, hand tremors, unsteadiness, as well as anxiety, panic, sluggishness, and mental confusion, and its use has been associated with public safety accidents," the report said. Inshik Sim, lead analyst at the UNODC's office for South-east Asia and the Pacific, told ST that etomidate use in the region exploded during Covid-19, when the pandemic disrupted trade routes and stifled the supply chain for organised crime groups and their drug trade. As drug trafficking syndicates struggled to move methamphetamine from Myanmar into China, syndicates switched to clinical-grade chemicals. "Criminal groups needed to find an alternative. Etomidate, which is used in clinical practice, really started to appeal to some of these users," said Sim. The drug was initially mixed into e-cigarettes, which are devices that resemble the shape and size of a cigarette, and later incorporated into vape oils. Since its introduction, Sim said the UNODC has received reports of a significant rise in Kpod use throughout South-east Asia and East Asia. "There's a high probability that such products will gain more popularity in the region - similar to ketamine, which did not start off as a major drug in South-east Asia, but has gained in popularity," added Sim. The UNODC report said in East and South-east Asia, vaping products were commonly found to contain synthetic cannabinoids. "However, following the class scheduling of synthetic cannabinoids in China in 2021, there has been an increase in other substances detected in vaping products. "In addition to etomidate, countries have also reported detecting ketamine and methamphetamine. "Of note, Thailand has reported the emergence of vaping products containing ketamine, sometimes in combination with methamphetamine or etomidate, called 'Kpods'," the report said. These drug-laced vapes are already in Singapore. On June 14, 2024, HSA found 14 vapes suspected to contain tetrahydrocannabinol, the primary psychoactive compound found in cannabis. Youth market Hong Kong has been grappling with a Kpod problem among its young people, who refer to the drug as "space oil". In 2024, public hospitals in the city treated more than 130 suspected space oil abusers, three of whom died. A quarter of the cases involved young people under 18. In February, the government listed space oil as a dangerous drug and banned four substances often used to make the narcotic - etomidate and its three chemically similar analogues metomidate, propoxate and isopropoxate. The UNODC's Sim said organised crime groups have been adapting to evolving demand, particularly the rising popularity of vaping among young people. "In many countries, there is already an established market for vaping. Organised crime groups understand that. "They also understand that those in this group may not necessarily want to inject themselves with heroin or methamphetamine, so why not mix it into the vapes if it can bring more buyers into the market," said Sim. Drug-laced vaporisers are packaged as colourful products, and marketed on social media platforms as being harmless, with zero risk of detection. Sim said organised crime groups are also using vapes to transport and distribute synthetic drugs and pharmaceutical products. Cannabis, for example, produces a distinctive smell that is difficult to hide. But synthetic cannabinoids in vapes are virtually undetectable, said Sim. The rising popularity of such laced vapes has led to the introduction of new drugs in vapes. On June 19, the Malaysian authorities uncovered a criminal syndicate distributing vape pods laced with synthetic cocaine. Nearly 5,000 vape cartridges containing some 9.42 litres of cocaine were seized. The syndicate rented condominium units in Kuala Lumpur to pack drugs in vape form, before sending them to other countries. Three Singaporean men were among those arrested. The usage of such products could lead to episodes of overdose and dependence, it added. Videos have since emerged online, purportedly showing young people shaking uncontrollably while puffing on a vape. Dr Clare Anne Fong, an associate consultant in the Division of Respiratory and Critical Care Medicine at Alexandra Hospital and National University Hospital, said that while etomidate on its own is already addictive, pairing it with nicotine can result in a greater hook. "When nicotine is inhaled with etomidate - which alters one's level of consciousness, similar to a high - Kpods are likely more addictive than traditional vapes," said Dr Fong. Dr Sharen Tian, a family physician at Raffles Medical, said repeated use of etomidate could "result in users seeking the dissociative effects, thereby increasing the risk of dependency". "The clandestine nature of such products, often marketed as Kpods or space oil, exacerbates the issue, especially among youths," said Dr Tian. Assistant Professor Yvette van der Eijk from the School of Public Health at NUS said misinformation on vaping is rife. She said much of this is due to studies funded by the vaping industry, which are often biased and conclude that vaping is safe. "One challenge is that people, especially youths, have access to a lot of misleading information, and need to be taught how to discern between information that misrepresents the harms and information that is accurate," said Dr van der Eijk. Vaping has been banned in Singapore since 2018. Despite that, previous reports state that HSA had seized $41 million worth of vapes from January 2024 to March 2025. That is nearly fivefold the reported value seized from 2019 to end-2023, according to numbers compiled by ST. Many students, from primary schools to institutes of higher learning, have been reported for possessing or using vapes. There were 2,000 such cases in 2024, up from 800 cases in 2022 and 900 cases in 2023. Vaping is not just a social ill. Senior Minister of State for Home Affairs Faishal Ibrahim said in Parliament on Jan 7 that several studies have linked vaping to an increase in risk of drug use. Associate Professor Faishal said that the HSA and Central Narcotics Bureau have come across cases of people using vapes to consume controlled drugs. But he added that such cases still form a minority of cases here. Vape zombies Susan said her son's behaviour resembled those of young people, caught in a recent video on social media, who were stumbling as they walked near Punggol Waterway. She said he was constantly twitching and shaking, even when he was not vaping. "We were very worried about him and tried to talk nicely to him. At that point, he cried and promised to stop," said Susan. He broke his promise before too long. "He lost about 10kg within a month. He totally changed into another person. I couldn't recognise him any more," said Susan, who added that he also became more aggressive and agitated. "He started lying to us, cheating me of my money to purchase more Kpods. He would even ask for money from his grandma, his uncle and aunts," she added. It ended with his arrest over an unrelated offence earlier in 2025. "I really didn't know what to do. I didn't know where to put him, to help him end his addiction," said Susan. Samaritans of Singapore: 1800-221-4444 Singapore Association for Mental Health: 1800-283-7019 Institute of Mental Health's Mental Health Helpline: 6389-2222 Silver Ribbon: 6386-1928 Tinkle Friend: 1800-274-4788 Community Health Assessment Team: 6493-6500/1 Counselling TOUCHline (Counselling): 1800-377-2252 TOUCH Care Line (for seniors, caregivers): 6804-6555 Care Corner Counselling Centre (Mandarin): 1800-353-5800 Online resources [[nid:720127]] This article was first published in The Straits Times . Permission required for reproduction.
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