Background/Objectives: Sleep disturbances are among the most prevalent and persistent comorbidities in children and adolescents with autism spectrum disorder (ASD), affecting up to 83% of this population. These disturbances not only impact the quality of life but are increasingly recognized as significant contributors to behavioral dysregulation. Methods: This systematic review synthesizes evidence from 26 studies published between 2010 and 2024, examining the association between sleep problems and behavioral outcomes in individuals with ASD aged 2 to 18 years. Results: The findings reveal consistent associations between sleep-onset insomnia, night walking, bedtime resistance, and various behavioral difficulties, including aggression, hyperactivity, and emotional dysregulation. Internalizing symptoms and exacerbation of core ASD features were also linked to chronic sleep problems. Studies employing objective sleep measures, such as actigraphy and polysomnography, further supported these associations by identifying disruptions in sleep architecture correlated with behavioral severity. While most included studies were of moderate to high methodological quality, the limited number of randomized controlled trials and heterogeneity of sleep and behavior assessment tools highlight the need for standardization. Conclusions: Overall, the review emphasizes the importance of routine sleep evaluation in ASD clinical care and supports targeted sleep interventions as a potential strategy to reduce behavioral problems and improve developmental outcomes.

Background: Early detection of autism spectrum disorder (ASD) is essential, as the first two years of life represent a critical window of neuroplasticity during which timely interventions can improve developmental outcomes. Traditional diagnostic methods, such as ADOS and ADI-R, rely on caregiver reports and structured observations, limiting ecological validity and accessibility. Eye-tracking (ET) offers a non-invasive, scalable approach to assess early atypical gaze patterns. Objectives: This systematic review and meta-analysis synthesized evidence on the diagnostic accuracy of ET for early ASD detection and its potential as an adjunctive screening tool. Methods: A comprehensive search of PubMed, Scopus, Web of Science, Medline, and the Cochrane Library identified studies published between January 2015 and July 2025. Eligible studies evaluated ET in infants and toddlers (≤36 months) for early ASD identification, following PRISMA guidelines. Results: Out of 513 records, 57 studies were included. Most studies reported reduced fixation on social stimuli, atypical gaze following, and preference for geometric over social images in infants later diagnosed with ASD. Pooled effect sizes indicated a moderate-to-large difference between ASD and typically developing groups in social fixation time (Hedges’ g ≈ 0.65, 95% CI: 0.48–0.82, I² = 58%). Studies integrating machine learning algorithms (n = 14) achieved improved sensitivity (up to 89%) and specificity (up to 86%) compared with conventional gaze metrics. Conclusions: Overall, ET shows strong potential as an early adjunctive screening method for ASD. Nonetheless, methodological heterogeneity and lack of standardized protocols currently limit clinical translation, underscoring the need for multi-center validation and task standardization.

Background/Objectives: Congenital heart defects (CHDs) are the most common congenital anomalies, and survival into adolescence and adulthood now exceeds 90%. Increasing evidence suggests that children and adolescents with CHD face elevated risks of psychological, psychiatric and neurodevelopmental disorders. This systematic review aims to synthesize recent evidence on mental health outcomes, cognitive profiles, quality of life and associated risk factors in pediatric CHD. Methods: This review was conducted according to PRISMA 2020 guidelines. Five databases (PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched for studies published between January 2015 and November 2025. Eligible studies (observational, interventional and neuroimaging) included participants aged 0–18 years with any type of CHD and reported psychological, psychiatric, neurodevelopmental, cognitive or health-related quality-of-life outcomes. Due to substantial heterogeneity, findings were synthesized narratively. Results: Sixty-one studies involving over 120,000 participants were included. Children and adolescents with CHD showed increased prevalence of anxiety, depression, attention-deficit/hyperactivity disorder, autism spectrum disorder and post-traumatic stress symptoms compared with peers without CHD. Neurodevelopmental impairments, particularly in executive functioning, attention and memory, were frequently reported, especially in complex CHD and single-ventricle physiology. Health-related quality of life was consistently reduced, mainly in emotional and social domains. Parental mental health, disease severity and cumulative medical burden were significant correlates. Neuroimaging studies identified structural and functional brain alterations associated with cognitive and emotional vulnerability. Conclusions: Pediatric CHD is associated with substantial psychological and neurodevelopmental burden, particularly in complex disease. Early identification and integration of routine psychological care within multidisciplinary CHD programs are essential to improve long-term outcomes.