Psychotherapy schools often describe overlapping process phenomena in non-interoperable vocabularies. This pluralism is clinically valuable but computationally costly: datasets become difficult to compare, clinically load-bearing distinctions are collapsed into convenience labels, and artificial intelligence (AI) systems inherit annotation schemes rather than a clinically interpretable intermediate representation. Building on the Perceive–Assess–Dose–Safeguard (PAD-S) framework and the Conflict-Square Algorithm (CSA), this theory article asks a narrower question than the prior PAD-S and CSA papers: can the same variables be formulated as a candidate shared representation layer between heterogeneous observation models and school-specific intervention policies? The proposed layer projects a high-dimensional biopsychosocial state into four clinically observable process coordinates—defensive/avoidant organization (DEF), anxiety/arousal and tolerance (ANX), progression toward direct experience and action (PRO), and self-attack/shame processes (SUP)—plus a safety threshold that constrains admissible intervention intensity. The contribution is architectural rather than empirical: it isolates the representational role from earlier decision-grammar and transcript-coding roles; clarifies the distinction between observations, representation, and policy; specifies a minimal falsifiable family of state-transition models; illustrates translation across four pragmatic therapy families; and defines a staged validation order from reliability and function linkage to transcript-level predictive operationalization and only then sparse equation discovery. The framework should therefore be read as a candidate shared representation layer for computational psychotherapy and computational psychiatry rather than as a therapy protocol, a fitted predictive model, a complete generative theory, or an autonomous decision system. No new dataset, fitted classifier, transcript-level predictive result, or discovered equation is reported here. The article aims instead to state what would count for or against PAD-S/CSA as a clinically interpretable interface for later empirical modeling.
The long-term psychological processing of an autism spectrum disorder diagnosis in parents
IntroductionA child’s ASD diagnosis represents a critical event for parents, often requiring them to face the loss of their child’s ideal image and reevaluate the family life projects. The aim of this study is to explore how parents retrospectively reconstruct and integrate their child’s ASD diagnosis through autobiographical memories.Methods21 parents, 16 mothers and 5 fathers, that received the ASD diagnosis within five years, were administered the Reaction to Diagnosis Interview (RDI). Interviews were audio-recorded, transcribed verbatim and analyzed using a two levels approach. The first one to explore the patterns of meanings that emerged in the whole parents’ autobiographical memories through the Reflexive Thematic Analysis. The second one is to identify patterns of resolution or non-resolution of the impact of the diagnosis.ResultsFindings show suffering and struggling as main themes and subthemes and a prevalence of unresolved diagnoses; gender differences in the way of managing the child-related care tasks, efforts, and coping strategies emerged.DiscussionIn line with literature, our findings suggest that the availability of supportive resources plays a crucial role in facilitating parents’ adjustment and integration of the ASD experience and harmonizing gender differences. They also emphasize that the impact of ASD diagnosis is not a single event but an ongoing process of meaning-making which changes with the child’s developmental path. Our findings highlight the need for cognitive and emotional reconstruction and reframing of parents’ autobiographical memories. These processes play a kay role in shaping how the diagnosis experience is integrated into one’s narrative identity, creating opportunities for transforming the meaning of the remembered experience.
Stigma in adults with ADHD: a systematic review of types, experiences, and potential implications for quality of life
BackgroundAttention deficit hyperactivity disorder (ADHD) is a disorder characterized by hyperactive, impulsive, and/or inattentive symptoms. Adults with ADHD often report reduced quality of life (QoL) across social, educational, and occupational functioning. Part of these deficits may be attributed to stigma, which includes stereotypes, prejudices, discrimination, and negative labelling. While stigma’s effects on QoL have been extensively documented in other mental health conditions, the specific types and impacts of stigma experienced by adults with ADHD remain underexplored in recent reviews.AimsTo identify and describe the different types of stigmas experienced by adults with ADHD, while exploring how stigma may impact QoL’s key domains as defined by WHO (physical domain, psychological domain, level of independence, social relationships, environment, and spirituality/religion/personal beliefs).MethodsA literature search was conducted across APA PsycArticles, Embase, and Ovid MEDLINE(R) for ADHD AND stigma-related keywords. Eligible studies were English, peer-reviewed articles from the past decade involving adults (≥18) and describing or specifying at least one type of stigma.ResultsA total of 17 papers met the inclusion criteria. Stigma types included self-stigma and/or internalized stigma, perceived stigma, public stigma, and structural stigma. QoL domains affected included the psychological domain, social relationships, environment, and level of independence. Greater ADHD symptomatology was positively correlated with more internalized stigma, which in turn was linked to functional impairment, worse self-esteem, and poorer QoL. Self-stigma manifested as self-deprecating labels and ADHD devaluation. Perceived stigma hindered treatment seeking, medication compliance, and diagnostic disclosure, although associations with QoL were insignificant. Public stigma was the most investigated and related to negative societal attitudes, notably in academic contexts. Few studies looked at structural stigma; those that did identified structural barriers to care, though none directly assessed QoL outcomes.ConclusionStigma remains pervasive, though direct effects on QoL domains are less widely investigated. Future studies should investigate structural stigma in more depth and explore causal relationships between stigma and QoL.Systematic Review Registrationhttps://doi.org/10.17605/OSF.IO/Y52HK
Tuning the immune response to mRNA vaccines
Nature Biotechnology, Published online: 29 April 2026; doi:10.1038/s41587-026-03125-0
A strategy to control translation of mRNA vaccines reveals cell type–specific contributions to immunity that may be harnessed to enhance vaccine efficacy.
mRNA vaccine immunity is enhanced by hepatocyte detargeting and not dependent on dendritic cell expression
Nature Biotechnology, Published online: 29 April 2026; doi:10.1038/s41587-026-03099-z
mRNA vaccine efficacy is enhanced by silencing cell-type-specific expression.
Predicting referral need for febrile children in low-resource community settings in South and Southeast Asia
Nature Medicine, Published online: 29 April 2026; doi:10.1038/s41591-026-04338-1
A multicountry cohort study found that prediction models combining clinical parameters with either pulse oximetry or the host biomarker sTREM1 more accurately identified febrile children needing referral than standard WHO criteria.
Low-dose oral nicotinamide mononucleotide for immune thrombocytopenia: a phase 1/2 trial
Nature Medicine, Published online: 29 April 2026; doi:10.1038/s41591-026-04366-x
Preclinical and phase 1/2 trial data show that anti-CD38 monoclonal antibody treatment restores platelet counts in patients with immune thrombocytopenia by increasing nicotinamide adenine dinucleotide (NAD+) levels, and low-dose oral treatment with the NAD+ precursor nicotinamide mononucleotide can similarly increase platelet counts without serious adverse effects.
An agentic framework for autonomous scientific discovery in cancer pathology
Nature Medicine, Published online: 29 April 2026; doi:10.1038/s41591-026-04357-y
Evaluated across 18 multicancer cohorts, the agentic artificial intelligence workflow SPARK uses language as a universal interface to autonomously generate biological ideas.
A septo–entorhinal GABAergic pathway that enables switching between episodic memories
Nature Neuroscience, Published online: 29 April 2026; doi:10.1038/s41593-026-02280-6
How the brain organizes the retrieval of old and new memories remains unknown. Kim et al. identify a septo−entorhinal GABAergic pathway that controls flexible switching between episodic memories during memory retrieval to enable memory updating.
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