"It Defines Who I Am" or "It's Something I Have": What Language Do [Autistic] Australian Adults [on the Autism Spectrum] Prefer?

How can we make therapy better for autistic adults? Autistic adults' ratings of helpfulness of adaptations to therapy

Autistic people are at elevated risk of mental health conditions and experience significant barriers to effective support. While adaptations to therapy for autistic people have been proposed by clinicians, there is limited research on how helpful autistic people themselves rate these. We aimed to address this gap. Participants were 130 autistic adults aged 18 to 64 years (85.4% female) who completed an online survey of the helpfulness of 55 therapy adaptations. Overall, we found positive ratings of helpfulness for approximately half of the adaptations. However, significant variability was found at an individual level with most adaptations rated from not helpful through to extremely helpful. Neurodiversity-affirming adaptations were rated highest overall. Participants shared additional adaptations including general good practice, financial, modality, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Findings highlight similarities and differences between clinician and autistic people's perspectives, underscoring the need to include autistic people. Limitations of the restricted sample and generalizability are acknowledged. Future research including more diverse samples would be of value to expand on this research. The need to understand general preferences of autistic people and to individualize to the specific client is underscored by findings to begin bridging the mental health support gap for autistic people.Lay AbstractAutistic people experience more mental health conditions like depression or anxiety than non-autistic people. They are also more likely to experience difficulties in accessing mental health supports Clinicians have published suggestions on how to improve therapy for autistic people. However, whether these ways to adapt (i.e. adaptations) therapy for autistic people are seen as helpful by autistic people themselves has not been investigated. We recruited 130 autistic adults to complete an online survey. They rated 55 adaptations to therapy from "Not at all helpful" to "Extremely helpful." We also asked for ideas of additional adaptations. Adaptations classified as neurodiversity affirming (e.g. having a therapist that embraces differences in brains and provides support to affirm neurodivergent identity) were rated highest. Approximately half of adaptations were rated positively at a group level. However, for almost every adaptation at least one person rated it as not at all helpful and at least one rated it as extremely helpful. Additional adaptations were around general good practice, financial cost, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Our findings add how helpful autistic people themselves rate adaptations to therapy and similarities and differences to clinicians. This is important to consider how these perspectives can differ. Findings also identify additional suggestions that clinicians could use in their practice and ideas for future research. Findings can help autistic adults in advocating for adaptations to therapy that address their needs by providing a list of possible adaptations. Furthermore, findings may help clinicians to better support their autistic clients.

Self-compassion as an antidote to self-stigma and shame in autistic adults

Autistic individuals are frequently exposed to stigmatizing attitudes and discrimination. Through the lived experience of stigmatizing attitudes, autistic people can internalize the negative stereotypes associated with autism. This phenomenon is known as self-stigma. In non-autistic populations, self-stigma is associated with shame and negative mental health outcomes. In this study, we aim to better understand the mental health outcomes associated with self-stigma in autism and to investigate whether and how self-compassion compared to camouflaging may protect from self-stigma in autistic individuals. For this purpose, 689 adults who reported a diagnosis of autism were recruited online and completed self-reported questionnaires for self-stigma (Internalized Stigma of Mental Illness Scale-9 items), self-compassion (Self-Compassion Scale-short form), depression (Depression, Anxiety and Stress Scale-21) and camouflaging (Camouflaging Autistic Traits Questionnaire). We conducted mediation analysis and moderated mediation analysis. Our results indicate that self-stigma is highly prevalent in autistic adults (45.5%), correlated to depression (ρ (687) = 0.437, p < 0.001) and that internalized shame mediates the relationship between self-stigma and depressive symptoms (b = 1.48, 95% confidence interval = (1.11, 1.94)). Self-compassion moderates this mediation (Indirect Effect, IE = -0.305, 95% confidence interval = (0.601, 0.014), β = 0.183, z = 2.012, p = 0.044), whereas camouflaging does not (IE = 0.003, 95% confidence interval = (0.009, 0.015), β = 0.0531, z = 0.514, p = 0.607). These results highlight the protective effect of self-compassion on the negative impacts of self-stigma in autistic individuals. Future research should explore how to adapt existing compassion-focused interventions and evaluate their feasibility and efficacy to reduce self-stigma and shame in autistic populations.Lay abstractWhat is already known about the topic?Autistic individuals are frequently exposed to stigmatizing attitudes and discrimination. Negative stereotypes about autism, such as dangerousness or inability to work, are very frequent in our societies. Through exposure to these stigmatizing ideas, autistic people can internalize these ideas and begin to believe them to be true about themselves. This is self-stigma. Past research conducted with non-autistic individuals indicate that self-stigma can lead people to feel ashamed of who they are and deteriorate their mental health.What this paper adds?In this paper, we found that self-stigma in autistic people increases depressive symptoms through feelings of shame. We then showed that relating to self with compassion - that is, to be friendly towards oneself (kindness), be aware of one's feelings and thoughts (mindful awareness) and realize that everyone feels pain and makes mistakes (common humanity) - helps reducing the negatives consequences of self-stigma on mental health. We also demonstrated that camouflaging does not modify the impact of self-stigma on mental health.Implications for practice, research or policy?Because self-compassion can protect from the negative effects of self-stigma, future research should explore how to adapt existing compassion-focused interventions and evaluate their feasibility and efficacy to reduce self-stigma and shame in autistic people.

Adults with Autism Prefer Person-First Language in Dutch: A Cross-Country Study

The correct language to refer to someone with a diagnosis of autism spectrum disorder has received a lot of attention in recent years. Studies in English-speaking countries found a main identity-first language (IFL) preference (e.g. autistic person) opposed to a person-first language preference (PFL) (e.g. person with autism) among adults with autism. However, a recent study conducted in a Dutch-speaking country (the Netherlands) reported a PFL preference (Buijsman et al., 2023). The goal of the current study was to gain insights into language preferences in two Dutch-speaking countries and, in contrast to previous studies, give participants the option to indicate not having a specific language preference. In the current study, we asked 414 Dutch-speaking adults with autism, living either in Belgium or the Netherlands, to fill in an online questionnaire about their language preference. We found that over half of the participants had a PFL preference (54%), followed by having no preference (27%). Only 14% of them had an IFL preference, and 5% proposed another term. Having more years of education was identified as a predictor for having an IFL preference when compared to a PFL preference, while being older predicted having no preference compared to a PFL preference. The majority of Dutch-speaking adults with autism showed a PFL preference, which is in contrast to findings from English-speaking countries, but in accord with a recent study conducted in the Netherlands (Buijsman et al., 2023). Implications of this finding for language use are discussed.

Autistic young adults' experiences in physical activity: A phenomenological study

Young adulthood is a key period for establishing lifelong physical activity (PA) habits, yet little is known about how autistic young adults experience PA. The purpose of this study was to explore how autistic young adults make sense of their PA experiences and the meanings they ascribe to those experiences. Thirteen autistic young adults (ages 22-25) participated in semi-structured interviews about their PA experiences. A phenomenological qualitative approach with an interpretivist paradigm guided this study. Participants described how their PA experiences evolved over time. In childhood, many engaged in team sports, often encouraged by their parents. As they transitioned to adulthood, they shifted toward more independent activities (e.g. running, yoga). Social support from friends and teammates was a strong motivator, while personal achievements (e.g. reaching fitness goals) helped to build a sense of pride. Many participants emphasized the mental and emotional benefits of PA, including increased confidence, reduced stress, and a greater sense of control. These findings described how autistic young adults engaged in PA as they moved into adulthood and pointed to important factors to consider when creating supportive PA opportunities for this population.Lay AbstractMany autistic young adults face challenges in staying physically active as they grow older. This study explores how they experience physical activity (PA), what it means to them, and how their participation changes over time. We talked to 13 autistic young adults (ages 22-25) about their PA experiences from childhood to adulthood. We used a qualitative approach to identify key themes in their stories. Participants shared how their experiences with PA changed over time. As children, many played team sports, often because their parents encouraged them to join. As they got older, they preferred activities they could do on their own, like running or yoga. Friends and teammates helped motivate them to stay active, while setting and reaching personal fitness goals gave them a sense of pride. Many also said that PA helped them feel better emotionally, giving them more confidence, reducing stress, and making them feel more in control of their lives. These findings show how PA can positively impact autistic young adults and provide information into how to create better PA opportunities for them. Encouraging independence, building motivation, and promoting social connections can help support their participation in PA.

Atypical antipsychotics for autism spectrum disorder: a network meta-analysis

RATIONALE

Individuals with autism spectrum disorder (ASD) exhibit a wide variety of symptoms related to social interaction and behaviour. Atypical antipsychotics have been widely evaluated and prescribed to treat distressing symptoms (e.g. irritability, aggression, obsessions, repetitive behaviours, etc.) in children and adults with ASD. Still, their effects and relative efficacy remain unclear.

OBJECTIVES

Primary: to assess the comparative benefits of atypical antipsychotics for irritability through network meta-analyses in children and adults with ASD at short-term follow-up. Secondary: to assess the benefits and harms of atypical antipsychotics, compared to placebo or any other atypical antipsychotic, for different symptoms (e.g. aggression, obsessive-compulsive behaviours, inappropriate speech) and side effects (e.g. extrapyramidal symptoms, weight gain, metabolic side effects) in children and adults with ASD at short-, medium- and long-term follow-up.

SEARCH METHODS

We searched CENTRAL, MEDLINE, 10 other databases, and two trial registers, together with reference checking, citation searching and contact with study authors to identify studies for inclusion. The latest search was 3 January 2024.

ELIGIBILITY CRITERIA

Randomised controlled trials (RCTs) comparing any atypical antipsychotic drug with placebo or another atypical antipsychotic drug for adults and children with a clinical diagnosis of ASD.

OUTCOMES

Critical outcomes included irritability, aggression, weight gain, extrapyramidal side effects, obsessive-compulsive behaviours and inappropriate speech.

RISK OF BIAS

We used the Cochrane RoB 2 tool to assess risk of bias in the included studies.

SYNTHESIS METHODS

We performed statistical analyses using a frequentist network meta-analysis for combined estimates for the outcome irritability and a random-effects model for pairwise comparisons for other outcomes. We rated the certainty of the evidence using GRADE.

INCLUDED STUDIES

We included 17 studies with 1027 randomised participants. One study evaluated adults (31 participants); the remaining 16 studies evaluated children (996 participants). The interventions were risperidone, aripiprazole, lurasidone and olanzapine.

SYNTHESIS OF RESULTS

Comparative efficacy on irritability Based on the network meta-analysis, risperidone and aripiprazole may reduce symptoms of irritability compared to placebo in the short term in children with ASD (risperidone: mean difference (MD) -7.89, 95% confidence interval (CI) -9.37 to -6.42; 13 studies, 906 participants; low-certainty evidence; aripiprazole: MD -6.26, 95% CI -7.62 to -4.91; 13 studies, 906 participants; low-certainty evidence). Lurasidone probably results in little to no difference in irritability compared to placebo in the short term (MD -1.30, 95% CI -5.46 to 2.86; 13 studies, 906 participants; moderate-certainty evidence). Efficacy and safety on other outcomes We are very uncertain about the effects of atypical antipsychotics on aggression compared to placebo at short-term follow-up in children with ASD (risk ratio (RR) 1.06, 95% CI 0.96 to 1.17; 1 study, 66 participants; very low-certainty evidence). The certainty of the evidence was very low due to concerns about risk of bias and serious imprecision. We are very uncertain about the effects of atypical antipsychotics on the occurrence of weight gain (above predefined levels) compared to placebo in the short term in children with ASD (RR 2.40, 95% CI 1.25 to 4.60; 7 studies, 434 participants; very low-certainty evidence). We are also very uncertain about the effects of atypical antipsychotics on weight gain (in kilograms) compared to placebo in the short term in children with ASD (MD 1.22 kg, 95% CI 0.55 to 1.88; 3 studies, 297 participants; very low-certainty evidence). In both, the certainty of the evidence was very low due to concerns about risk of bias and serious imprecision. We are very uncertain about the effects of atypical antipsychotics on the occurrence of extrapyramidal side effects compared to placebo in the short term in children with ASD (RR 2.36, 95% CI 1.22 to 4.59; 6 studies, 511 participants; very low-certainty evidence). The certainty of the evidence was very low due to concerns about risk of bias and serious imprecision. Atypical antipsychotics may improve obsessive-compulsive behaviours compared to placebo in the short term in children with ASD (MD -1.36, 95% CI -2.45 to -0.27; 5 studies, 467 participants; low-certainty evidence). The certainty of the evidence was low due to concerns about risk of bias and heterogeneity. Atypical antipsychotics may reduce inappropriate speech compared to placebo in the short term in children with ASD (MD -1.44, 95% CI -2.11 to -0.77; 8 studies, 676 participants; low-certainty evidence). The certainty of the evidence was low due to concerns about risk of bias and heterogeneity. We were unable to evaluate the effects of other atypical antipsychotics. Furthermore, our findings on adults with autism were scarce due to the lack of available studies.

AUTHORS' CONCLUSIONS

Risperidone and aripiprazole may reduce symptoms of irritability compared to placebo in children with ASD in the short term, but lurasidone probably has little to no effect on irritability compared to placebo. Other benefits and potential harms observed ranged from moderate- to very low-certainty evidence. The available data did not allow comprehensive subgroup analyses. New randomised controlled trials with larger sample sizes are needed to balance the efficacy and safety of interventions with enough certainty, which are currently scarce (or even absent in the case of the adult population). Authors should report population and intervention characteristics transparently, providing disaggregated or individual patient data when possible. Furthermore, consistent measurement methods for each outcome should be reported to avoid problems during the data synthesis process.

FUNDING

This Cochrane review had no dedicated funding.

REGISTRATION

Protocol available via 10.1002/14651858.CD014965.

Navigating Inclusive Language in Veterinary Medicine: A Step Toward a More Equitable Workplace

Stigmatizing language, often rooted in unconscious bias, can reinforce power imbalances, perpetuate stereotypes, and compromise inclusivity. Inclusive language-defined as communication that respects diversity, acknowledges lived experiences and promotes equality-fosters a supportive and welcoming environment for all team members and clients. Its application extends to verbal interactions, written communication, policies, and educational materials. Strategies to implement inclusive language include adopting people-first phrasing, avoiding ableist expressions, respecting gender diversity, and embracing cultural humility. Organizations can further support inclusivity through training programs and leadership modeling. By prioritizing inclusive language, veterinary teams not only strengthen collaboration and equity but also enhance team dynamics, client satisfaction, and patient care. Recognizing the power of words and choosing them thoughtfully promotes a culture of belonging and respect, benefiting individuals and the organization as a whole.

Effect of AAC technology with embedded literacy supports on the participation of children who are emerging symbolic communicators during shared reading

PURPOSE

This study evaluated the impact of high-tech augmentative and alternative communication designed with features to support literacy development on the active participation of children who are emerging symbolic communicators within shared storybook reading, a key context for language and literacy learning.

METHOD

Four children who were emerging symbolic communicators diagnosed with autism or a developmental disability with autism-like features participated in the ABAB single case experimental design. Condition A represented participants' typical lack of access to aided augmentative and alternative communication. Condition B represented access to high-tech aided augmentative and alternative communication featuring colour photos to support comprehension and a feature designed to support foundational reading skills.

RESULT

Despite variability in participation and required prompting, all participants demonstrated increased linguistic participation with access to augmentative and alternative communication. Nonoverlap of all pairs was calculated to estimate the condition effect size; calculations suggested augmentative and alternative communication had a moderate to strong effect for all participants.

CONCLUSION

This study supports and expands upon literature documenting the importance of access to high-tech aided augmentative and alternative communication that is thoughtfully designed for children who have emerging symbolic communication. Still, this study was limited in size and scope and more comprehensive research is needed to understand how best to support language and literacy learning opportunities.

Eating Behaviors of Autistic Women with an Eating Disorder

Background: Autistic women with eating disorders (EDs) often present with more complex EDs and may not fully benefit from current treatments, yet the reasons for this remain unclear. This study aims to examine the eating behaviors of autistic women with EDs and how these differ from those of (1) non-autistic women with EDs, (2) autistic women without EDs, and (3) non-autistic female controls. It investigates autism-related eating behaviors, traditionally disordered eating behaviors, and avoidant-restrictive food intake disorder (ARFID)-related behaviors to better understand their complex ED presentations. Methods: A cross-sectional study was conducted with 30 autistic women with EDs, 30 non-autistic women with EDs, 29 autistic women without EDs, and 60 non-autistic female controls. Participants completed questionnaires assessing eating behaviors, quality of life, and comorbid psychological symptoms. Results: Autistic women with EDs exhibited higher levels of both autism-related and disordered eating behaviors than all other groups, including food selectivity, mealtime rigidity, and sensory-related eating difficulties. They also reported notable weight and shape concerns. Additionally, they showed higher levels of comorbidity and reported lower mental health-related quality of life compared to all other groups. Conclusions: These findings suggest that the overlap of autism-related and disordered eating behaviors contributes to the complexity and severity of EDs in autistic women, potentially limiting the effectiveness of current treatment approaches. Developing autism-informed interventions that address sensory sensitivities, rigidity, and cognitive differences may improve treatment outcomes. Future research should explore how these factors interact in maintaining ED pathology and identify strategies to distinguish adaptive from maladaptive eating behaviors.

Item Analysis of an Early Social Responsiveness Scale for Assessing Autism Risk

Early diagnosis of autism spectrum disorder (ASD) is vital for effective intervention and improves social and behavioral development. The previous literature has shown that the Early Social Responsiveness (ESR) assessment is effective at detecting ASD risk in individuals as early as 13 months of age ("parent study"). However, an item analysis that examines individual item scores has not been conducted to further elucidate the strength of this assessment. In this study, we analyzed an existing dataset (collected in the parent study) containing individual item responses from the ESR assessment of 120 children (n = 61 males and n = 59 females; age range = 15-24 months). Through item analysis, we determined which ESR items or item sets are best at differentiating ASD risk from non-ASD risk. Ease of social engagement (i.e., questions assessing the administrator's perceived level of effort in engaging the child) was the most effective risk indicator, with the hat and tickle activities being least effective at indicating ASD risk. These results could contribute to optimizing the scale and facilitating its clinical adoption.

Assessing communicative-pragmatic ability in telehealth: e-ABaCo in autistic individuals

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication. Autistic individuals who are verbally fluent, often show difficulties in pragmatic ability, i.e. the capacity to use language and other expressive means, as gestures or the tone of the voice, to convey meaning in a given context. During the COVID-19 pandemic, the use of various technologies such as videoconferencing and internet for the delivery of healthcare services, i.e. telehealth, has proven to be effective, accessible and safe tools for remote healthcare. However, there are few tools to assess pragmatic skills in telehealth. This study investigates the effectiveness of the telehealth-adapted Assessment Battery for Communication (e-ABaCo), a clinical tool previously validated for in-person assessments, to evaluate pragmatic abilities in autistic individuals. We expect a substantial equivalence in performance for the administration of the adapted version of e-ABaCo compared to the face-to-face one.

Methods

We compared the performance of 30 autistic adolescents, of which 15 assessed via telehealth (ASD TH) and 15 assessed face-to-face (ASD FtF), with that of 15 adolescents with typical development (face-to-face assessment). The groups were matched for age, sex, and intellectual quotient. E-ABaCo was used to assess both comprehension and production of communicative ability realized through different expressive means, i.e. linguistic, extralinguistic and paralinguistic, as well as social appropriateness.

Results

In line with the expectation, the pragmatic performance of autistic adolescents showed a substantial equivalence when comparing the assessments conducted via telehealth and face-to-face modality. Moreover, in line with the relevant literature, there was a significant difference between the ASD groups' performance (both FtF and TH) and the control group of the adolescents with typical development (CG FtF) in all pragmatic aspects assessed, i.e. the Pragmatic total score, comprehension and production abilities, and all the expressive means investigated.

Discussion

These results confirm the potential usefulness of telehealth assessment procedures, and demonstrate the sensitivity and validity of e-ABaCo for conducting an effective assessment of pragmatic skills in on-line modality in autistic adolescents.

Brief Report: School Anxiety, School Attendance and School Refusal/Distress Following an Autism-Specific Parent-Mediated Intervention for Anxiety in Preschoolers

PURPOSE

Autistic children have an increased likelihood of experiencing anxiety, even in the preschool years. Studies evaluating anxiety interventions in autistic children have tended to focus upon home or community settings. This study expands upon previous work to evaluate whether a parent-mediated intervention for autistic preschool children's anxiety impacts later school anxiety and school attendance.

METHOD

Data for this study comes from a randomised controlled trial of an autism-specific program designed to reduce and/or prevent anxiety in autistic preschoolers; CLK-CUES. In addition to pre- and post-group anxiety measures, the trial included data from parents and teachers one year later, once the children started school. Teacher-reported school anxiety and parent-reported school attendance data were available for the CLK-CUES (n = 15) and control group (n = 13).

FINDINGS

Children whose parents received CLK-CUES had lower levels of separation anxiety in school and significantly lower non-attendance rates than the control group. This was predominantly due to a significant between-group difference in the number of days missed due to school refusal/distress.

INTERPRETATION

Findings indicate promise for this autism-specific anxiety program to reduce school anxiety and support school attendance in young autistic children. Further research with larger samples and an extended follow-up is warranted.

Study protocol for the EYEdentify project: An examination of gaze behaviour in autistic adults using a virtual reality-based paradigm

INTRODUCTION

Autism Spectrum Condition (ASC) is characterised by difficulties in social communication and interaction, which may pose significant challenges to daily functioning throughout life. While current diagnostic methods for ASC often rely on measures based on subjective reports, there is a growing need for objective, quantifiable measures to support current clinical assessment of ASC. Eye-tracking technology records eye and gaze movements in real time and provides a direct and objective method for assessing social attention. Integrating eye-tracking within virtual reality (VR) environments presents a novel approach for capturing gaze behaviour in dynamic, ecologically valid social scenarios. This study aims to investigate whether VR-based eye information can reveal group differences in gaze behaviour between autistic adults and neurotypical controls in simulated social interactions.

METHODS

This case-control study will include 140 adults diagnosed with ASC and 50 neurotypical controls, matched by age and gender. Participants will engage in six VR-based social scenarios, which vary in social complexity and the presence of non-social distractors. Eye information will be measured using eye-tracking technology integrated into a head-mounted display. Gaze behaviour will be analysed through fixation-based metrics on parameters including number of fixations, mean fixation time, and dwell time, on predetermined Areas of Interest.

ANALYSIS

Statistical analyses will assess between-group differences in gaze behaviour as well as correlations between gaze metrics and clinical measures of social functioning, social cognition and symptom severity.

DISCUSSION

This study utilises VR-based eye-tracking to investigate novel paradigms for assessing gaze behaviour in ASC in immersive, interactive environments and aims to advance the current understanding of visual social attention in ASC. Positive outcomes from this study may support further research into VR-based eye-tracking to supplement existing clinical assessment methods.

Autism Early Intervention Providers: Their Priorities, Use of Empirically Supported Practices, and Professional Development Needs

PURPOSE

Autism early intervention research has indicated a research-to-practice gap, including continued use of practices with inadequate research support, and insufficient use of empirically supported practices. The present study explored the processes and mechanisms through which providers working with young children on the autism spectrum learn, select, and implement the various practices in their clinical repertoires. We addressed the role of providers' priorities, competence, and experience with (and needs for) professional development (PD), as well as whether, in clinical practice, a provider selects for implementation interventions based on domains.

METHOD

Providers (n = 136) responded to an online survey to report the interventions they used, their outcome domain priorities, confidence, and their desire for PD.

RESULTS

The most commonly used interventions were reinforcement, modeling, prompting, and visual supports, which are all supported by research evidence and classified as empirically supported practices. While most providers reported using empirically supported practices, many also used unsupported practices, especially in the sensory domain. Providers' top priority domains for intervention were communication, challenging behavior, adaptive behavior, and social skills. Provider confidence regarding the evidence-base of the practices they used was domain-specific and related to provider priorities. Providers reported interest in PD in all empirically supported practices and in all domains.

CONCLUSION

Results may inform the delivery of PD in early intervention services for providers working with children on the autism spectrum, to support the best possible outcomes for this population and mitigate the research-to-practice gap.

Transitioning to college during COVID-19: A brief report on incoming students' self-reports of mental health from 2020 to 2022

Objective: Depression and anxiety have been identified as growing concerns for many populations in the United States, including young adults. We investigated how internalizing symptoms may have changed throughout the COVID-19 pandemic among students transitioning to college.Participants: Participants were incoming undergraduates in Fall 2020, 2021, and 2022 at Northeastern Universities (N = 263).Methods: Participants completed self-reports of mood, repetitive thinking, and social satisfaction within two weeks of beginning their first college semester.Results: Depression and anxiety symptoms appear to differ by year, such that both have increased over time. These results seem to be co-occurring with an increase in repetitive negative thinking - a known predictor of depression and anxiety.Conclusions: These preliminary results suggest that mental health concerns in young adults may be worsening despite the resumption of in-person activities post-initial pandemic onset. This highlights the need to monitor and intervene on mental health in students transitioning to college.

An Exploration of Online and In-Person Administration of the Kaufman Brief Intelligence Test, Second Edition (KBIT-2) in Children and Adolescents Being Evaluated for Autism Spectrum Disorder

PURPOSE

 Most assessment tools used to diagnose and characterize autism spectrum disorder (ASD) were developed for in-person administration. The coronavirus disease 2019 (COVID-19) pandemic resulted in the need to adapt traditional assessment tools for online administration with only minimal evidence to support validity of such practices.

METHODS

The current exploratory study compared scores from online administration of the Kaufman Brief Intelligence Test, Second Edition (KBIT-2) during the pandemic to scores derived from follow-up testing using traditional in-person administration. Participants were 47 children and adolescents (M age = 9.48 years, SD = 4.06; 68.10% male) who participated in a telehealth diagnostic evaluation for ASD that included online administration of the KBIT-2. Participants were invited to complete the KBIT-2 a second time during an in-person study visit.

RESULTS

Pearson's correlation coefficients suggested acceptable to good reliability between online and in-person administration. Although most participants' online and in-person scores were within one standard deviation of each other, results suggested statistically significant differences between scores derived from the two modalities. Additionally, 19-26% of participants (depending on domain examined) had scores that differed by more than one standard deviation. Notably, all but one of these participants was under the age of 12 years.

CONCLUSION

Findings suggest that online administration of the KBIT-2 is likely appropriate for older children and adolescents with ASD. However, additional research is needed to test online administration of intellectual assessments for children with ASD.

'That connection with community… it is just a positive thing': Mentoring autistic adolescents participating in community coding programmes

INTRODUCTION

Little is known regarding the experiences of mentoring autistic adolescents. The aim of the study was to explore the process of mentoring autistic youth participating in community coding programmes through the perspective of mentors and facilitators.

METHOD

A descriptive qualitative research design was used involving focus groups or one-on-one interviews with mentors (n = 5) and facilitators (n = 5) volunteering at two community coding programmes in Western Australia and Victoria. Data were thematically analysed through an iterative process.

CONSUMER AND COMMUNITY INVOLVEMENT

An autistic individual was involved in piloting the discussion guide for the semi-structured interviews.

FINDINGS

Thematic analysis identified three primary themes, including (1) the mentoring process; (2) Mentor outcomes including sub-themes of development of mentor attributes, professional development and personal wellbeing and satisfaction; and (3) support needs and opportunities.

CONCLUSION

Practical supports and training within community coding clubs may aid mentors and facilitators in supporting the needs of autistic youth in the community.

PLAIN LANGUAGE SUMMARY

In this project, we explored the views of mentors and facilitators of community coding clubs for autistic adolescents. The community clubs were run on Saturdays for 2-4 hours during school term time. A total of 10 participants (five mentors and five facilitators) agreed to meet with the research team to discuss their experiences. We found that mentors and facilitators needed support to develop their mentoring skills which helped them to grow, made them feel better and gave them a feeling of satisfaction. Our study showed the importance of understanding autism spectrum and supporting mentors and facilitators. We showed how mentoring programmes are an emerging approach that occupational therapists can engage with to better support autistic youth with their strengths and passions.

Physiotherapists Identify Movement Difficulties in Autistic Children Using Subjective and Objective Measures: An Observational Study

OBJECTIVE

To explore the assessment practices and identification of movement difficulties in autistic children aged 12 months to 6 years by physiotherapists in Australia.

METHODS

Registered physiotherapists providing services to autistic children ages 12 months - 6 years completed a survey. The survey was distributed via closed physiotherapy social media (Facebook) pages in Australia from March to June 2022. The survey included 8 items on strategies/approaches to assessment, 47 items on measurement, and 23 items on movement difficulties.

RESULTS

85 physiotherapists completed the survey. Findings indicated that parent reports, observations, and movement analyses were the most commonly used assessment strategies employed 100% of time, followed by musculoskeletal assessments (80%) and standardized assessments (50%). Of standardized assessments used, Alberta Infant Motor Scale (AIMS) was used most, by over 69% of physiotherapists, with multiple versions of five other standardized assessments used by over 52% of physiotherapists, namely Movement Assessment Battery for Children, Neurological Sensory Motor Developmental Assessment, Bruininks-Oseretsky Test of Motor Proficiency, Developmental Coordination Disorder Questionnaire and Test of Gross Motor Development. A range of movement difficulties were frequently identified in developmental delays (86% of time), gross motor (85%), coordination (82%), motor planning (81%), and hypotonia (80%).

CONCLUSIONS

Physiotherapists in Australia use a variety of methods to examine movement difficulties in young autistic children, suggesting that this frequently occurs prior to autism diagnosis.

"Giving Me the Self-Confidence to Tackle It": Mothers' Experiences Participating In The Engaged Eaters Program, A Caregiver-Mediated Feeding Intervention

The purpose of this study was to understand caregivers' experience of participating in a caregiver-mediated in-home feeding intervention, the Engaged Eaters Program, for their young autistic child. This qualitative study utilized a thematic approach to analyze post-intervention semi-structured interviews with thirteen mothers of autistic children between the ages of 2 to 7 years after they participated in the intervention. Interview questions focused on the child and family experience, what worked well, what could be improved, and how the intervention integrated into family routines. Four major themes were identified: In-Home Intervention, Parent Skill and Knowledge, Increased Social Participation, and Parent Responsibilities and Challenges. Sub-themes provided descriptions of learning practical tools to support their child, increasing self-efficacy, and impacts on family life. Mothers described an increase in tangible skills that were easily practiced in the home environment that improved their confidence and self-efficacy in feeding their children. They also described how participation did require more work and time commitment for them beyond their regular responsibilities. The caregiver experience is essential to understand for intervention effectiveness while simultaneously addressing child, caregiver, and family needs. By focusing on the mothers' experiences, individualized needs, and self-efficacy, we were able to better understand how integrating an intervention into the family context and daily routines may be beneficial for the whole family.

The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis

OBJECTIVE

Avoidant/restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by extensive avoidance and/or restriction of food. Existing research demonstrates that ARFID is over-represented in Autistic populations and vice-versa, with both groups exhibiting shared characteristics. This meta-analysis investigated the co-occurrence between ARFID and autism via determination of autism prevalence in ARFID populations, and ARFID prevalence in Autistic groups.

METHOD

This review systematically identified literature evaluating those with ARFID and Autistic individuals. Literature was searched for using SCOPUS, MEDLINE, and Web of Science. Selected publications included Autistic individuals and those with ARFID who either received a formal diagnosis of autism and/or ARFID or met clinical threshold cut-off scores on validated autism and/or ARFID questionnaires. Prevalence was reported in proportion-based values alongside 95% confidence intervals (CIs).

RESULTS

This meta-analysis identified 21 studies (kARFID = 18 papers; kAutism = 3 papers) comprising of n = 7442 participants (nARFID = 1708; nAutism = 5734). Prevalence of autism diagnoses was 16.27% in those with ARFID (95% CI = 8.64%-28.53%), and ARFID prevalence in Autistic groups was 11.41% (95% CI = 2.89%-35.76%). Gender and ethnicity served as significant sources of heterogeneity in ARFID papers. There was insufficient data to provide comparator values or prevalence across study population and distinct underpinning drivers of ARFID.

DISCUSSION

Meta-analytic findings highlight significant rates of co-occurrence between autism and ARFID, suggesting that in clinical settings, it may be beneficial to consider screening Autistic individuals for ARFID and vice-versa. Future research should further investigate co-occurrence across ARFID profiles, gender, and ethnicity.

The Suicide Assessment Kit-Modified Interview: Development and preliminary validation of a modified clinical interview for the assessment of suicidal thoughts and behavior in autistic adults

The increased prevalence of suicide among autistic people highlights the need for validated clinical suicide screening and assessment instruments that are accessible and meet the unique language and communication needs of this population. We describe the preliminary preregistered psychometric validation of the Suicide Assessment Kit-Modified Interview, in a sample of 98 autistic adults (58% women, 34% men, 7% nonbinary; MAGE = 41.65, SD = 12.96). A four-item negative affect score derived from the Suicide Assessment Kit-Modified Interview demonstrated adequate reliability (ω = 0.796, BCa 95% confidence interval = [0.706, 0.857]), as well as good convergent validity with related measures. Ordinal Suicide Assessment Kit-Modified Interview "categories" (1-5) demonstrated divergent validity (rs = -0.067 to 0.081) and good convergent validity, strongly correlating with mental health (rs = 0.446 to 0.744) and suicide assessment instruments (rs = 0.576 to 0.696). Suicide Assessment Kit-Modified Interview categories showed strong ability to predict participants identified by clinicians as "above low risk" of future suicide attempt (area under the curve = 0.887, posterior Mdn = 0.889, 95% credible interval = [0.810, 0.954], PAUC > 0.8 = 0.976). Suicide Assessment Kit-Modified Interview classifications > "Category 3" provided an observed sensitivity of 0.750 (Mdn = 0.810, [0.669, 0.948], PSe > 0.8 = 0.544) and an observed specificity of 0.895 (Mdn = 0.899, [0.833, 0.956], PSp > 0.8 = 0.995) for "above low risk" status. Our findings indicate that the Suicide Assessment Kit-Modified Interview is a psychometrically strong clinical assessment tool for suicidal behavior that can be validly administered to autistic adults without intellectual disability.Lay AbstractPeople with a diagnosis of autism are at increased risk of death by suicide. There is a need for clinical instruments that are adapted to the needs of autistic people. In this study, we modified and evaluated a clinical suicide interview (Suicide Assessment Kit-Modified Interview) for use with autistic people who do not have an intellectual disability. Autistic people helped us to modify the original version of the instrument by improving the questions, providing explanations for difficult terms or concepts, and recommending that we use different rating scales. Our results support the use of Suicide Assessment Kit-Modified Interview for assessing autistic adults without intellectual disability for suicidal thoughts and behavior. In the future, we will test how well Suicide Assessment Kit-Modified Interview works in clinical settings and with different clinical populations.

Comparison of learning text vs. picture symbol AAC representations for young children on the autism spectrum

Children on the autism spectrum1 with minimal speech are generally provided with augmentative and alternative communication (AAC) systems that represent vocabulary using picture symbols (i.e., color line drawings). However, there has been minimal research investigating the comparative effectiveness of picture symbols vs. other types of symbol representation (e.g., text) in supporting the communication of children on the autism spectrum. Using a single case adapted alternating treatments experimental design, the current study compared learning of picture symbol and text representations, measured by the accurate identification and functional use of novel AAC symbols by young children on the autism spectrum with minimal speech. Two participants demonstrated notable acquisition of both picture symbols and text. The remaining four children had difficulty demonstrating learning of either symbol representation type. These results suggest that different symbol representations (e.g., digital photographs), layouts (e.g., visual scene displays), and/or instructional procedures (e.g., more naturalistic methods) may have been a better fit for these four participants. Additionally, variability in performance across participants underscores the critical importance of personalization of AAC systems - including symbol representation - based on comprehensive assessment of individual strengths and needs.

The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021

BACKGROUND

High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods.

METHODS

For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article.

FINDINGS

An estimated 61·8 million (95% uncertainty interval 52·1-72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8-927·2) per 100 000 people, equivalent to 1064·7 (898·5-1245·7) autistic males per 100 000 males and 508·1 (424·6-604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8-16·3) DALYs, equivalent to 147·6 (100·2-208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0-178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7-284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0-237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6-229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9-194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years.

INTERPRETATION

The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals.

FUNDING

Queensland Health and the Bill & Melinda Gates Foundation.

Language, theory of mind and cognitive skills in Arabic-speaking children with and without autism: Evidence from network and cluster analyses

INTRODUCTION

Autism spectrum disorder (ASD) is characterized by impairments in social interactions, social communication, and repetitive and stereotyped patterns of behavior. Previous studies have reported mixed findings regarding the links between language (i.e., phonology, morphosyntax, lexicon, and pragmatics), theory of mind (ToM), executive functions (EFs), and central coherence measures in children with ASD.

METHODS

A total of 163 Palestinian-Arabic-speaking children aged 4-11 participated: 76 with ASD and 87 with typical language development (TLD). The children`s phonological, morphosyntactic, lexical, and pragmatic skills, along with verbal and non-verbal ToM abilities were evaluated. Additionally, cognitive assessments included non-verbal IQ, EF, and central coherence processing.

RESULTS

Group-level results showed that children with ASD scored lower than their TLD peers in all measures. Network analysis revealed robust interconnections between language, ToM, and cognitive skills in both groups. In autistic children, language was a central node, with pragmatics prevailing over morphosyntax and lexicon, while age was central in the TLD group. Cluster analysis identified four language clusters within the ASD group, demonstrating dissociations between language domains: (1) high performance across all domains, (2) moderate performance in phonology and morphosyntax with low pragmatic abilities, (3) moderate performance in phonology and lexicon with low morphosyntax and pragmatics, and (4) moderate phonology and lexicon with extremely poor morphosyntax and pragmatics. Autistic children with enhanced language abilities performed better in verbal and non-verbal ToM and EF tasks.

CONCLUSIONS

Our findings underscore the variability in language, ToM, and cognitive profiles of autistic children, showing dissociation within and between different domains in some autistic children. These results offer insights for applied interventions.

Conducting ethical, co-produced research with autistic individuals with an eating disorder: best practice guidelines

There is a notable overlap between autism and eating disorders (EDs), and autistic individuals may experience poorer ED treatment outcomes than non-autistic peers. To make meaningful change in this field, it is imperative that we actively engage in co-production of research, however there are currently no guidelines to support co-production with autistic people with eating disorders. This paper reports on best practice guidelines that were co-produced across a series of workshops bringing together autistic people with EDs, researchers, clinicians, third-sector organisations, and parents/carers. The guidelines are intended to be used as a foundation for future co-produced autism and ED research. By creating a trusted, ethical co-production relationship, we hope to generate more clinically meaningful and translatable research.

Participatory longitudinal qualitative interview study to understand Autistic gynaecological and obstetric health: the Autism from menstruation to menopause study protocol

INTRODUCTION

Autism is a lifelong minority neurotype present from birth. There is a dearth of credible evidence to suggest gender variation in Autism prevalence, despite historical under-diagnosis of women. Autistic people Assigned Female At Birth (AFAB) have worse physical and mental health compared with non-Autistic peers. To date, the reproductive health experiences of Autistic AFAB people have been under-investigated.

METHODS AND ANALYSIS

This study aims to co-develop a quality improvement intervention to improve the reproductive health of Autistic people. The study uses Community Partnered Participatory Research (an approach similar to Community-Based Participatory Research), largely through a Community Council that co-governs the study. To understand reproductive health needs, a longitudinal qualitative investigation using creative methods will be undertaken with 100 Autistic AFAB people with 10 waves of data collection over 5 years (interview n=500-1000). Participants will be purposively selected to include harder-to-reach members of the Autistic community, including those who are non-speaking or semi-speaking, have a learning disability and those from marginalised ethnicities. Data will be analysed thematically with Community Council involvement. Intervention development will be undertaken from 2029 onwards.

ETHICS AND DISSEMINATION

We are an Autistic-led team that adopts a social model of disability. However, this study raises ethical issues relating to sensitive topics and marginalised populations. Accordingly, we have robust procedures in place to assess capacity to ensure informed consent and to allow participants to take part without opting into data sharing. Ethical approval has been awarded by the Swansea University School of Health and Social Care Research Ethics Committee. We will publish our findings as open access articles in peer-reviewed journals.

Approaches, Goals, and Scientific Integrity in Music Therapy Research with Individuals on the Autism Spectrum: An Integrative Review

Scientific integrity is fundamental to evidence-based practice (EBP) and essential in music therapy (MT) research and clinical practice. Researchers conducted an integrative review of approaches and interventions employed by music therapists (MTs) with individuals on the autism spectrum in the context of how studies are analyzed by the National Autism Center (NAC) and National Clearinghouse on Autism Evidence and Practice (NCAEP). Researchers identified 880 database records meeting initial search criteria (i.e., autism spectrum disorder, autism, PDD-NOS, MT, and music interventions); 36 studies remained after screening for duplication, topic relevance, and adherence to inclusion criteria. Included studies were published between 1964 and 2021, in English language, in free open-access journals, worldwide; peer reviewed; conducted by MTs; empirical quantitative, qualitative, or mixed-methods design; intervention-based; and presented separate data for participants on the autism spectrum. Content and quantitative analyses identified deficits in scientific integrity and the following gaps in studies reviewed: Motor Skills and Placement (NAC-defined intervention targets), Computer-based and Songwriting and Composition (MT techniques), and Wellness and Bonny Method of Guided Imagery in Music (clinical approaches); no patterns were evident among NAC Interventions with MT techniques and approaches. Analysis of 5-point Scientific Merit Ratings yielded a mean 2.78 rating. A comparison of NAC and NCAEP terminology (i.e., how MT researchers report independent variables) indicated eight titles mention specific non-music interventions, 19 mention MT, 14 include music-based technique descriptors, and two mention both non-music interventions and MT. Researchers offer guidelines regarding identity-inclusive language, scientific integrity, and clarity of EBPs within MT intervention research with individuals on the autism spectrum.

Routine vaccine uptake in school-aged autistic and non-autistic youth: A linked database study

OBJECTIVES

This study was conducted to determine whether school-aged autistic youth received routine vaccines at a lower rate than their non-autistic peers.

METHODS

In Nova Scotia (NS), Canada, vaccines routinely delivered in early adolescence are administered to Grade 7 students through a school-based Public Health vaccination program. NS youth eligible to receive Grade 7 vaccinations between 2011 and 2017 were included in this study. Autism spectrum disorder (ASD) diagnoses were determined from administrative health data. Rates of receipt of any Grade 7 vaccine and of individual vaccines were compared between autistic and non-autistic youth. Subgroup analyses included comparing Grade 7 vaccine receipt between autistic youth and their non-autistic siblings and early childhood vaccine receipt between autistic and non-autistic cohorts.

RESULTS

The rates of receipt of any vaccine were 73% among 916 autistic youth and 82% among 49,599 non-autistic youth (adjusted relative risk = 0.91; 95% confidence interval = 0.87-0.95). Similar results were found for individual vaccines. Subgroup analyses revealed lower rates of Grade 7 vaccine receipt among autistic youth compared to among their non-autistic siblings. Rates of early childhood vaccine receipt did not differ between autistic and non-autistic cohorts.

CONCLUSION

Autistic youth were under-vaccinated compared to their non-autistic peers for Grade 7 vaccinations. Lower vaccination rates in autistic youth than in their non-autistic siblings suggest that setting-related factors may contribute more to the under-vaccination of autistic youth than parental vaccine hesitancy. Barriers to vaccine uptake for school-aged autistic youth, including those unique to school-based vaccination programs, must be explored and addressed.

Pre-pandemic Executive Function Protects Against Pandemic Anxiety in Children with and Without Autism Spectrum Disorder

The COVID-19 pandemic may have exacerbated depression, anxiety, and executive function (EF) difficulties in children with autism spectrum disorder (ASD). EF skills have been positively associated with mental health outcomes. Here, we probed the psychosocial impacts of pandemic responses in children with and without ASD by relating pre-pandemic EF assessments with anxiety and depression symptoms several months into the pandemic. We found that pre-pandemic inhibition and shifting difficulties, measured by the Behavior Rating Inventory of Executive Function, predicted higher risk of anxiety symptoms. These findings are critical for promoting community recovery and maximizing clinical preparedness to support children at increased risk for adverse psychosocial outcomes.

Neural Processing of Speech Sounds in Autistic Kindergarteners as a Predictor of Reading Outcomes

Phonology is an important foundation of reading development; however, little is known about the neural substrates of speech sound processing and reading development in autistic children. We investigated early auditory event-related potentials (ERPs) in response to speech sounds and their association with reading ability (word recognition and reading comprehension). 56 kindergarteners (28 ASD, 28 TD) completed an ERP task using rhyming, bisyllabic pseudowords (/gibu/ and /bidu/) in an old/new design: 50% "old" and 50% "new" stimuli presented following a sensitization block of 100% "old" stimuli. Behavioral measures of reading ability were completed at kindergarten entry and exit. Results from generalized linear mixed models revealed a significant three-way interaction between stimuli ("new" vs. "old"), diagnosis (ASD vs. TD), and reading ability (for word recognition and reading comprehension) for P1 and P2 amplitude. Follow-up analyses revealed that autistic children with lower reading abilities showed greater P1 and P2 amplitudes for "new" vs. "old" stimuli, with effects ranging from marginal to significant (p's 0.04-0.07). Regression analyses revealed that old/new ERP difference scores significantly predicted later word recognition at kindergarten year-end (P1 amplitude: p = .05; P2 amplitude: p = .04), but not reading comprehension, controlling for sex and nonverbal IQ. Autistic children with poorer reading skills, specifically those with weaker word recognition abilities, show neural differences when processing speech sounds compared to autistic peers with greater reading ability and typically developing children. A better understanding of the neural basis of speech sound processing could enhance our insight into the heterogeneity in reading among individuals with ASD and guide future treatment approaches.

Parental Acceptance and Understanding of Autistic Children (PAUACS) - an Instrument Development Study

Currently there are no instruments designed to assess parents' acceptance and understanding of their autistic child. We aimed to develop and evaluate the reliability and validity of a parent-report scale assessing parents' acceptance and understanding of their autistic child - the Parental Acceptance and Understanding of Autistic Children Scale (PAUACS). A total of 158 parents (74 non-autistic, 42 autistic, 42 questioning; mean age 42.69 years) of autistic children (mean age 10.80 years) completed an online survey comprising the prototype PAUACS as well as validated measures of parental sensitivity, neurodiversity affirming attitudes, autistic traits, mental health, and child adjustment and family experience. A subsample of participants (n = 97; 61.4%) completed the PAUACS questionnaire a second time, 2 weeks later, to assess for test-retest reliability. The final 30-item scale demonstrated excellent internal reliability (α = 0.89) and test-retest reliability (intraclass correlation = 0.92). Exploratory factor analysis revealed a clean structure comprising four distinct factors: Understanding (α = 0.86), Innate (α = 0.74), Acceptance (α = 0.82), and Expectations (α = 0.73). Overall, the PAUACS demonstrates good construct validity. Preliminary evidence of convergent validity and divergent validity was demonstrated. Preliminary evidence suggests PAUACS is a reliable and valid tool in assessing parents' acceptance and understanding of autistic children.

Brief Report: Learning About Autism: Is the Source of Autism Knowledge Associated with Differences in Autism Knowledge, Autism Identity, and Experiences of Stigma

People on the autism spectrum can learn about autism from various sources, likely differing in the information, portrayal, and discussion they offer. The present study investigates where autistic people learn about autism, and whether their information source is associated with their level of autism knowledge, perceptions of stigma, and development and expression of an autism identity. A survey of 198 Australian adults with an autism diagnosis showed that learning about autism from conventional sources (e.g., professionals, parents) was associated with more internalised stigma, lower endorsement of special abilities and autism identity, whereas online blogs and social media showed the opposite pattern as well as more accurate knowledge of autism. The findings raise questions about how authoritative sources of information discuss autism.

Autistic Traits, Communicative Efficiency, and Social Biases Shape Language Learning in Autistic and Allistic Learners

There is ample evidence that individual-level cognitive mechanisms active during language learning and use can contribute to the evolution of language. For example, experimental work suggests that learners will reduce case marking in a language where grammatical roles are reliably indicated by fixed word order, a correlation found robustly in the languages of the world. However, such research often assumes homogeneity among language learners and users, or at least does not dig into individual differences in behavior. Yet, it is increasingly clear that language users vary in a large number of ways: in culture, in demographics, and-critically for present purposes-in terms of cognitive diversity. Here, we explore how neurodiversity impacts behavior in an experimental task similar to the one summarized above, and how this behavior interacts with social pressures. We find both similarities and differences between autistic and nonautistic English-speaking individuals, suggesting that neurodiversity can impact language change in the lab. This, in turn, highlights the potential for future research on the role of neurodivergent populations in language evolution more generally.

Heterogeneity and convergence across seven neuroimaging modalities: a review of the autism spectrum disorder literature

Background

A growing body of literature classifies autism spectrum disorder (ASD) as a heterogeneous, complex neurodevelopmental disorder that often is identified prior to three years of age. We aim to provide a narrative review of key structural and functional properties that differentiate the neuroimaging profile of autistic youth from their typically developing (TD) peers across different neuroimaging modalities.

Methods

Relevant studies were identified by searching for key terms in PubMed, with the most recent search conducted on September 1, 2023. Original research papers were included if they applied at least one of seven neuroimaging modalities (structural MRI, functional MRI, DTI, MRS, fNIRS, MEG, EEG) to compare autistic children or those with a family history of ASD to TD youth or those without ASD family history; included only participants <18 years; and were published from 2013 to 2023.

Results

In total, 172 papers were considered for qualitative synthesis. When comparing ASD to TD groups, structural MRI-based papers (n = 26) indicated larger subcortical gray matter volume in ASD groups. DTI-based papers (n = 14) reported higher mean and radial diffusivity in ASD participants. Functional MRI-based papers (n = 41) reported a substantial number of between-network functional connectivity findings in both directions. MRS-based papers (n = 19) demonstrated higher metabolite markers of excitatory neurotransmission and lower inhibitory markers in ASD groups. fNIRS-based papers (n = 20) reported lower oxygenated hemoglobin signals in ASD. Converging findings in MEG- (n = 20) and EEG-based (n = 32) papers indicated lower event-related potential and field amplitudes in ASD groups. Findings in the anterior cingulate cortex, insula, prefrontal cortex, amygdala, thalamus, cerebellum, corpus callosum, and default mode network appeared numerous times across modalities and provided opportunities for multimodal qualitative analysis.

Conclusions

Comparing across neuroimaging modalities, we found significant differences between the ASD and TD neuroimaging profile in addition to substantial heterogeneity. Inconsistent results are frequently seen within imaging modalities, comparable study populations and research designs. Still, converging patterns across imaging modalities support various existing theories on ASD.

The Relation of Linguistic Awareness Skills to Reading and Spelling for Autistic and Non-Autistic Elementary School-Age Children

PURPOSE

For non-autistic children, it is well established that linguistic awareness skills support their success with reading and spelling. Few investigations have examined whether these same linguistic awareness skills play a role in literacy development for autistic elementary school-age children. This study serves as a first step in quantifying the phonological, prosodic, orthographic, and morphological awareness skills of autistic children; how these skills compare to those of non-autistic children; and their relation to literacy performance.

METHOD

We measured and compared the phonological, prosodic, orthographic, and morphological awareness skills of 18 autistic (with average nonverbal IQs) and 18 non-autistic elementary school-age children, matched in age, nonverbal IQ, and real-word reading. The relations between linguistic awareness and the children's word-level literacy and reading comprehension skills were examined, and we explored whether the magnitude of these relations was different for the two groups. Regression analyses indicated the relative contribution of linguistic awareness variables to performance on the literacy measures for the autistic children.

RESULTS

The non-autistic children outperformed the autistic children on most linguistic awareness measures. There were moderate-to-strong relations between performances on the linguistic awareness and literacy measures for the non-autistic children, and most associations were not reliably different from those for the autistic children. Regression analyses indicate that the performance on specific linguistic awareness variables explains unique variance in autistic children's literacy performance.

CONCLUSION

Although less developed than those of their non-autistic peers, the linguistic awareness skills of autistic elementary school-age children are important for successful reading and spelling.

Person- and identity-first language in autism research: A systematic analysis of abstracts from 11 autism journals

LAY ABSTRACT

There are many ways to refer to an individual who is on the autism spectrum. A recommended approach has been to use person-first language (PFL), such as "person with autism." A different approach is to use identity-first language (IFL), such as "autistic person." Recent studies focused on different groups of people (e.g. autistic self-advocates, parents, and practitioners) show that some groups prefer PFL (practitioners) while others prefer IFL (autistic self-advocates). However, less is known about how researchers use PFL and IFL in academic writing (e.g. studies published in scientific journals) involving autistic research participants. Our study examined 12,962 journal abstracts (short summaries of scientific articles) from 11 academic journals that publish autism research findings. We wanted to know (a) about the use of PFL and IFL across abstracts, and (b) how PFL and IFL use has changed annually over time. We examined data for all journals individually and grouped together. Our findings showed that journal abstracts generally use PFL (65%) with some using either IFL (16%) or both PFL and IFL (20%). However, journals varied, with some showing a clear majority for PFL and a couple for IFL. Examining trends over time across journals showed that while PFL appeared to be the majority for most journals, IFL has steadily increased in the recent few years. Our study helps us understand how autism researchers write about autistic individuals and offers implications for helping researchers intentionally make choices about the language used in their autism research studies.

A Rapid Evidence Assessment on The Effectiveness of Interventions for Autistic Adolescents with Harmful Sexual Behaviors

The management and treatment of harmful sexual behaviors (HSBs) in autistic adolescents is a complex area of research and clinical practice. Autistic adolescents face unique challenges in understanding social and sexual interactions, putting them at a higher risk of engaging in HSBs. Existing research on interventions for HSBs among autistic adults is growing, but evidence for adolescents is not well understood. Thus, understanding the effectiveness of interventions targeting HSBs in autistic adolescents is crucial. We conducted a rapid evidence assessment to review peer-reviewed research on the effectiveness of interventions for autistic adolescents at risk of or engaging in HSBs. In all, 12 studies met the criteria for review. Inclusion criteria required articles to be published in a peer-reviewed journal, be related to HSB prevention and intervention in adolescents aged 12 to 18 with autism spectrum disorder, be written in English, and include original data. Six databases were used, and we screened the titles and abstracts of 34 studies. The reviewed studies described cognitive-behavioral therapy, pharmacological interventions, family involvement, and multidisciplinary team approaches in addressing HSBs. However, the literature has significant limitations and we suggest that the literature is not robust enough to indicate a promising evidence-based approach for interventions for autistic adolescents who are at risk of or who display and engage in HSBs, and the findings are not transferable to practice. Additional research is required to better prepare healthcare professionals for addressing HSBs in autistic adolescents.

Exploring Emotion Control and Alexithymia in Autistic Adults: An Ecological Momentary Assessment Study

Difficulties in controlling emotions - a proxy for emotion dysregulation (ED)-and difficulties in expressing feelings in words-'absence of emotion labelling' or alexithymia-co-exist in autism and contribute to elevated levels of impulsive and suicidal behaviour. To date, studies linking the two phenomena have relied on retrospective self-reported measures, lacking support for generalizability to real-life situations. The present study investigated in vivo emotion labelling and its impact on emotion control in 29 autistic adults without intellectual disability (ASC) and 28 neurotypical (NT) individuals of similar age, sex, and educational level. Participants were trained in an Ecological Momentary Assessment (EMA) to label their emotions, the arousal dimension, and their emotion control via smartphone over a one-week period. Findings showed that the ASC group experienced more instances of 'having an emotion that I cannot name' and, when they were able to label their emotions, they reported higher rates of negative and conflicting (simultaneously positive and negative) emotions. In both groups, the absence of emotion labelling, and intense negative emotions were associated with impaired emotion control. However, the association between lack of emotional awareness-'I have no emotion'-and impaired emotion control was only evident in ASC individuals. Our study highlights a nuanced facet of emotional processing in the ASC population. Further research is needed to gain a deeper understanding of the complex relationship between ED and alexithymia in autism.

The characterization of feeding challenges in autistic children

LAY ABSTRACT

Feeding challenges are common for autistic children. Currently, research and intervention for feeding challenges focuses on single factors (e.g. behavior or sensory). Research is needed to understand the complexity of feeding challenges. This study provides a comprehensive description of feeding challenges. Furthermore, this study identifies what factors predict the severity and type of feeding challenges experienced by autistic children. Using the Survey for Characterization of Feeding Challenges in Autistic Children-United States, 427 caregivers of autistic children provided information about their child's feeding challenges. Children were between the ages of 2 and 12 with an average age of 8.42 years. Children in the study had a wide variety of feeding difficulties including challenges in early childhood, sensory challenges, difficulty with family mealtime, and variable self-help skills. On average children's feeding challenges were present prior to their autism diagnosis. We found that children who had early feeding challenges had more severe feeding challenges in later childhood. Also, specific early feeding challenges predicted the types of feeding challenges children would have later in childhood. For example, children who had difficulty transitioning to table foods and who continued to restrict their diet over time were more likely to have sensory-based feeding challenges. Results from this study show how feeding challenges present in a wide variety of ways for autistic children. The findings also highlight the importance of screening for feeding challenges in early childhood and collaborating with families to understand individualized feeding challenge experiences. These results could be used to inform evaluation and intervention for feeding.

"Living Independently Means Everything to Me": The Voice of Australian Autistic Adults

Background

Despite the desire of many autistic adults to live independently, recent studies suggest that only about one in six autistic adults do. This includes living alone, with a partner, or with friends. This is a rate that is lower than adults with other disabilities. Existing studies from other countries have explored the potential barriers to independent living, with very few exploring the actual experiences of autistic adults. To the best of our knowledge, there have been no published studies exploring the firsthand moving out experiences of autistic adults globally and none that have explored their independent living experiences in Australia.

Methods

Autistic adults with independent living experience in Australia were invited to partake in an interview to understand their moving out and independent living experiences. Interviews were held virtually, audio recorded, and transcribed. Transcriptions were coded in NVivo and thematically analyzed.

Results

A total of 11 autistic adults were interviewed (aged 21-50 years). Three key themes were derived from the interviews. Autistic adults perceived independent living as important to have their own space with added autonomy and control (Theme 1). However, autistic adults shared that the moving out process and independent living comes with many challenges, and currently supports are limited (Theme 2). Nine of the 11 participants were diagnosed as adults, and they shared the importance of diagnosis and how an earlier diagnosis may have influenced their choice of accommodation and living arrangements (Theme 3).

Conclusions

Findings from this study reiterate the importance of independent living to autistic adults and shed light on the challenges of transitioning to independent living. It further adds to the growing literature about the importance of early diagnosis on later life choices. Better pathways toward adult diagnosis and the provision of supports for the moving out process would be useful to ease transition to independent living for autistic adults.

Mortality risk among Autistic children and young people: A nationwide birth cohort study

LAY ABSTRACT

Existing literature indicates that Autistic people have shorter life expectancy, but little is known about the mortality risk among Autistic children and young people (0-24 years). We used a 15-year nationwide birth cohort study to estimate the mortality risk among Autistic children and young people in Aotearoa/New Zealand. The study included 895,707 children and 11,919 (1.4%) were Autistic. We found that autism was associated with a significantly higher mortality risk compared to the non-Autistic population. In addition, we found that this risk was significantly higher among females compared to males and for those with a co-occurring intellectual disability. Increased efforts are required to better meet the health needs of this population.

Somatosensory temporal sensitivity in adults on the autism spectrum: A high-density electrophysiological mapping study using the mismatch negativity (MMN) sensory memory paradigm

Atypical reactivity to somatosensory inputs is common in autism spectrum disorder and carries considerable impact on downstream social communication and quality of life. While behavioral and survey work have established differences in the perception of somatosensory information, little has been done to elucidate the underlying neurophysiological processes that drive these characteristics. Here, we implemented a duration-based somatosensory mismatch negativity (MMN) paradigm to examine the role of temporal sensitivity and sensory memory in the processing of vibrotactile information in autistic (n = 30) and neurotypical (n = 30) adults. To capture the variability in responses between groups across a range of duration discrepancies, we compared the electrophysiological responses to frequent standard vibrations (100 ms) and four infrequent deviant vibrations (115, 130, 145, and 160 ms). The same stimuli were used in a follow-up behavioral task to determine active detection of the infrequent vibrations. We found no differences between the two groups with regard to discrimination between standard and deviant vibrations, demonstrating comparable neurologic and behavioral temporal somatosensory perception. However, exploratory analyses yielded subtle differences in amplitude at the N1 and P220 time points. Together, these results indicate that the temporal mechanisms of somatosensory discrimination are conserved in adults on the autism spectrum, though more general somatosensory processing may be affected. We discuss these findings in the broader context of the MMN literature in autism, as well as the potential role of cortical maturity in somatosensory mechanisms.

Parent-led Communication Therapy for Young Bilingual Autistic Children: A Scoping Review

A scoping review of the literature was undertaken using JBI guidelines to map the evidence of parent-led therapy (PLT) for young autistic children (≤ 6 years) raised in bilingual environments. Reviewers used Covidence to screen located sources. Sixteen papers met inclusion criteria. A strong acceleration of reports of PLT for young autistic children measured in bilingual environments was observed, with 93.8% of papers (n = 15) published since 2015. Reporting of participants' language environments (home language(s)/L1s and societal language(s)/L2s) was inconsistent. A large majority of these studies, 87.5% (n = 14) were conducted in North America or in collaboration with a North American institution. Diverse PLT programs and methodologies were identified. There is variation in demographic information collected and outcomes reported. Evidence gaps in the literature are identified and the value of undertaking systematic review on this topic is considered. This scoping review points to the necessity of further empirical research and practice that centres parents in early and specific support for autistic children raised in bilingual environments. Suggestions for improving reporting standards of language profiles are provided.

Barriers and facilitators to ethical co-production with Autistic people with an eating disorder

BACKGROUND

Co-production is the collaboration between researchers and the lived experience community in designing, conducting and sharing research. The importance of co-production is increasingly advocated in both the autism and eating disorder fields. Despite this, there remains a lack of clarity at how to define, apply and conduct ethical co-production. Understanding common challenges and what we can do to overcome these challenges are integral to ensuring ethical and meaningful research with Autistic people with an eating disorder. The current study therefore explored: What are the barriers and facilitators to ethical co-production with Autistic people with an ED?

METHODS

Five workshops were conducted with 30 collaborators exploring barriers and facilitators to ethical co-production. Synchronous (online workshops) and asynchronous (offline discussion forum) data was analysed using thematic analysis. Themes were co-produced by a neurotypical and Autistic researcher with lived/living experience of an eating disorder.

RESULTS

Four themes were identified that explored barriers to ethical co-production: unequal partnerships, the inaccessibility of research, excluded by diagnoses and communication differences. Three themes were identified with regards to facilitators of ethical co-production: shared power (with sub-themes relationships, not roles and creative compensation), clarity and transparency and autism-affirming approaches.

DISCUSSION

Conducting ethical co-production with Autistic people with eating disorders has the potential to generate meaningful research that can be translated into improving the lives of the Autistic and eating disorder community. To achieve this, co-production teams should strive towards shared power and long-term relationships, adapting for communication differences and preferences and operating firmly within an autism-affirming framework. It is hoped that study findings will inspire collaboration, discussion and novel, translatable research.

Influence of a Brief Autism Education Intervention on Peer Engagement and Inclusion At Mainstream Day Camps: A Mixed-Methods Pilot Study

To explore the benefits of a brief autism education intervention on peer engagement and inclusion of autistic children at day camps. A convergent, parallel, two-arm (intervention/no intervention), non-randomized, mixed-methods design was used. The individualized, peer-directed, 5-10 min intervention included four components: (1) diagnostic label, (2) description and purpose of unique behaviors, (3) favorite activities and interests, and (4) strategies to engage. A timed-interval behavior-coding system was used to evaluate engagement between each autistic camper and their peers based on videos taken at camp (days 1, 2, 5). Interviews with campers and camp staff explored why changes in targeted outcomes may have occurred. Percent intervals in which the autistic campers were jointly engaged with peers improved in the intervention group (n = 10) and did not change in the control group (n = 5). A large between group intervention effect occurred by day 5 (Z = - 1.942, η2 = 0.29). Interviews (5 autistic campers, 34 peers, 18 staff) done on the last day of camp in the intervention group garnered three themes: (1) Changed behavioral attribution, (2) Knowledge facilitates understanding and engagement, and (3) (Mis)perceptions of increased inclusion. A brief educational intervention that includes individualized explanatory information and strengths-based strategies might improve peers' understanding of and social engagement with autistic children in community programs such as camps.

Autistic and autism community perspectives on infant and family support in the first two years of life: Findings from a community consultation survey

LAY ABSTRACT

Most support programmes for Autistic children are available only after they are diagnosed. Research suggests that parenting supports may be helpful for parents and their infants, when provided in the first 2 years of life - before a formal diagnosis is given, but when information suggests an infant is more likely to be Autistic. However, we do not know how acceptable these types of supports might be to the Autistic and autism communities. We asked 238 Autistic and non-autistic people - some of whom were parents, and some of whom were professionals working in research, health and education - about their perspectives on very-early supports. People generally agreed that it could be acceptable to work with parents to help them understand and support their child's specific needs and unique ways of communicating. People suggested a variety of support strategies could be acceptable, including parent education, changing the environment to meet an infant's needs, and creating opportunities for infants' to make choices and exercise control. People preferred respectful and accurate language - including the term 'support' (rather than 'intervention') and 'early-in-life' (rather than 'at-risk' of autism, or 'pre-emptive' when describing developmental stage). Continuing to work with community members will help to make sure autism support programmes are relevant and helpful.

Examining an integrated path model of psychological and sociocultural predictors of camouflaging in autistic adults

LAY ABSTRACT

Many autistic people use strategies known as 'camouflaging' to change how noticeable their autistic traits are in social situations. Previous research suggests that camouflaging is largely motivated by psychological and social factors. However, most studies so far have only looked at a few psychosocial factors related to camouflaging. In this study, we explored a model that included several individual psychological factors (such as fear of being negatively judged, self-esteem and autistic identity) and broader social and cultural factors (such as perceived stigma, negative life events, cultural emphasis on conformity and desire to fit in or stand out). We surveyed 225 autistic adults aged 18-77 years online. Our findings showed that several sociocultural factors were indirectly linked to camouflaging through individual psychological factors. Fear of being negatively judged emerged as a strong predictor of camouflaging. Specifically, autistic adults who perceived greater stigma, felt greater pressure to conform, had a lesser desire to stand out and a greater desire to fit in tended to experience a greater fear of being negatively judged and reported more camouflaging. In addition, those who experienced more negative life events were more likely to engage in camouflaging. Our study identifies key psychological and social factors as potential targets for social change. Our findings emphasise that our societies need to shift away from stigmatising attitudes towards accepting and including autistic people, which could reduce the pressure on autistic individuals to camouflage in social situations.

Childhood trauma as a mediator between autistic traits and depression: evidence from the ALSPAC birth cohort

Background

Autism and autistic traits have been associated with greater risk of childhood trauma and adulthood psychopathology. However, the role that childhood trauma plays in the association between autism, autistic traits and depression in adulthood is poorly understood.

Methods

We used a UK-based birth cohort with phenotype and genotype data on autism, autistic traits, childhood trauma and depression in up to 9,659 individuals prospectively followed up from birth until age 28 years. Using mixed-effects growth-curve models, we assessed trajectories of depression symptoms over time according to the presence or absence of autism/ autistic traits and explored whether these differed by trauma exposure. We further investigated the association between autism/ autistic traits and depression in adulthood using confounder-adjusted logistic regression models and undertook mediation analyses to investigate the relationship with childhood trauma.

Results

All autism variables demonstrated increased depressive symptom trajectories between ages 10-28 years. Social communication difficulties (SCDs) were the most strongly associated with a depression diagnosis in adulthood (age 24 OR= 2.15; 95%CIs: 1.22-3.76). Trauma and autistic traits combined to further increase depression symptom scores. Mediation analyses provided evidence for direct pathways between autistic traits and increased risk of depression alongside indirect pathways through increased risk of trauma.

Conclusions

Autism/ autistic traits increase the odds of experiencing childhood trauma and of being diagnosed with depression at age 18 and 24. Depressive symptom trajectories emergent in childhood persist into adulthood. The combined effect of SCDs and childhood trauma is greater than the individual exposures, suggesting worse depression symptomatology following trauma in individuals with SCDs.

Mental Health Professionals' Experiences of Adapting Mental Health Interventions for Autistic Adults: A Systematic Review and Thematic Synthesis

Autistic adults experience high rates of metal health difficulties and face significant barriers to accessing appropriate mental health care. Empirical research and recent professional guidelines emphasise the importance of modifying standard mental health interventions to best meet the needs of autistic adults. This systematic review explored mental health professionals' experiences of adapting mental health interventions for autistic adults. A systematic search was conducted on CINAHL, PsychINFO, PubMed, Scopus, and Web of Science in July 2022. The findings from 13 identified studies were synthesised using thematic synthesis. Three major analytical themes were generated, the unique experience of adapting interventions for autistic clients, factors which facilitate successful adaptations, and challenges to adapting interventions. Each theme contained a number of subsequent sub-themes. Professionals view the process of adapting interventions to be a highly individualised process. A range of personal traits, professional experiences, and systemic, service-based issues were identified in facilitating or challenging this individualised process. Further research regarding adaptations with different intervention models and increased supportive resources are required to enable professionals to successfully adapt interventions for autistic adult clients.

Predictors of Developmental and Adaptive Behaviour Outcomes in Response to Early Intensive Behavioural Intervention and the Early Start Denver Model

Many autistic children require support to meet their learning needs. Given the heterogeneity within the autism spectrum it is plausible that different types of support might be better suited to different children. However, knowledge on what interventions work best for which children is limited. We examined the outcomes of autistic preschool-aged children receiving one of two community early intervention approaches. Our main objective was to understand which baseline child characteristics might be associated with the degree of individual response to intervention-whether prognostically (i.e., irrespective of intervention received) or predictively (i.e., specifically in the context of one or other EI approach). Participants comprised two matched groups of preschool-aged autistic children receiving either Group-based Early Start Denver Model (G-ESDM; n = 42) delivered in a 1:3-4 staff:child ratio or an Early Intensive Behavioural Intervention (EIBI; n = 40) delivered in combination of 1:1 and 1:2 staff:child ratio. Over an approximate one-year follow-up period, children in both groups made significant gains in Developmental Quotient (DQ) scores, and trend-level gains in adaptive behaviour composite scores. Higher attention to a playful adult measured via an eye-tracking task was prognostically indicative of better verbal DQ and adaptive behaviour outcomes for the cohort overall. Moderation analyses indicated a single predictive effect-of pre-program sustained attention for subsequent NVDQ outcomes specific to those children receiving G-ESDM. These findings suggest that fine-grained measures of learning skills offer promise towards the selection and tailoring of intervention approaches to meet individual children's learning needs.