Human-centered AI in healthcare teams: integrating clinical oversight, EHR auditability, and reimbursement pathways for responsible adoption.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder (NDD) with onset in early childhood. Core symptoms comprise impaired social interaction, communication deficits, and stereotyped repetitive behaviors, significantly impacting children’s social functioning and learning. Moreover, 75–85% of children with ASD have comorbid NDDs such as attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and tic disorders. Tic disorders are brief, repetitive, nonrhythmic motor or vocal phenomena, but their distinction from stereotyped behaviors in children with ASD can be clinically challenging because both may present as repetitive movements and may co-occur in the same patient. Despite their clinical relevance, the neurobiological characteristics of tic comorbidity in ASD remain incompletely understood. The cortico–striato–thalamo–cortical (CSTC) circuit regulates cortical-subcortical excitation–inhibition balance and has been implicated in the pathophysiology of tic disorders and is also relevant to neurodevelopmental alterations in ASD. Neuroimaging studies of tic disorders have reported alterations in frontal cortical morphology and in the volumes of the caudate nucleus, putamen, pallidum, and thalamus. ASD has also been associated with morphological abnormalities in cortical and subcortical regions within the CSTC circuit. However, the direction and regional distribution of these findings have been inconsistent. Such discrepancies may reflect differences in age, medication exposure, symptom severity, sample size, imaging protocols, segmentation methods, and statistical approaches. These overlapping but heterogeneous findings indicate that isolated regional measures may be insufficient to distinguish ASD with tic comorbidity from ASD alone. Trace elements are essential for central nervous system structure and function, and are closely linked to growth and cognitive development in NDD. Studies report decreased serum levels of zinc, iron (Fe), and ionized serum magnesium (iMg), along with elevated lead and copper, in children with ASD., These imbalances are associated with neural impairment and biological dysfunction. Similar alterations—reduced zinc and iron, elevated lead—are seen in tic disorders, aligning with ASD trends. However, changes in copper and iMg remain controversial,, likely due to limited sample sizes and geographic variations. Given these inconsistencies, and considering the potential relevance of iMg to neuronal excitability and neurodevelopment, iMg was included as a candidate predictor in the present study.