Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science

Gender and family-role portrayals of autism in British newspapers: An intersectional corpus-based study

A recent large-scale study on the portrayal of autism in British newspapers revealed a deficit-based coverage, which concentrated on children and boys in particular, typically represented from the mothers' perspective. This follow-up study refines these representations, considering how they differ by gender and family role. We analysed 2998 text samples, which discussed autism in the context of four combinations of gender and family roles, namely, BOY, GIRL, FATHER and MOTHER. These samples included sources with different publication dates, reporting style and political orientation. Autism representations remained negative regardless of gender and family role. Over time, stories about autistic girls started to emerge, identifying them as a distinct group explicitly compared to autistic boys. Newspapers, especially broadsheets, associated girls with diagnostic difficulties, camouflaging and sometimes gender dysphoria - discussed particularly for those assigned female at birth. The child's autism was more often attributed to maternal than paternal behaviours or lifestyle. Autistic mothers were mentioned more often than fathers and were portrayed negatively. We conclude that newspapers portray female autism as less significant than male autism and, in addition, place mothers under more ethical scrutiny than fathers. These disparities reflect both historical biases in autism research and gender and family-role stereotypes.

Community Priorities for Outcomes Targeted During Professional Supports for Autistic Children and their Families

PURPOSE

Professional supports play an important role in aiding autistic children's learning, participation, and overall wellbeing. Yet, limited research exists on stakeholders' perspectives and preferences regarding targeted outcomes for children undergoing support facilitated by professionals. This study investigated stakeholder views on the priority and appropriateness of outcomes intentionally targeted during the provision of supports to autistic children.

METHOD

A survey of 181 participants (including 72 autistic adults, 85 parents, and 69 professionals) from Australia and New Zealand was conducted. Participants rated the appropriateness and priority of 47 potential child and parent outcomes within the context of support.

RESULTS

The highest priority outcome was improving child mental wellbeing, with the lowest being reducing sensory seeking or avoidant behaviours. Priority ratings for certain outcomes differed based on the child's age. Over half of the participants rated reducing sensory seeking/avoidant behaviours and reducing focused interests as inappropriate outcomes of supports. Further, variations in the appropriateness of outcomes differed among participant groups.

CONCLUSION

Reflecting the growing acceptance of neurodiversity-affirming practices, these results underscore support for targeting outcomes that are meaningful to the autistic and autism communities, with less emphasis on those which reflect neurotypical behavioural standards.

'It depends entirely on the nature of those supports': Community perceptions of the appropriateness of early support services for autistic children

Autistic advocates emphasise the need for neurodiversity-affirming and strengths-based approaches to support services; however, little is known about broader community perspectives regarding the appropriateness of offering early support services to autistic children. This co-designed mixed-methods study employed surveys to gather insights from 253 participants in Australia and New Zealand, including autistic adults, parents, and professionals. Participants shared views on the appropriateness of early support services for autistic children. About half of participants indicated that it was appropriate to provide early support services, while the other half indicated that it depended on the nature of those support services. Reflexive thematic analysis resulted in three overarching themes which explain these views. 'They are children first, after all' emphasises the importance of preserving childhood experiences and involving children in decision-making. 'We shouldn't be aiming to fix the child' underscores the need for support services to align with neurodiversity-affirming approaches. Finally, 'Supports are beneficial' highlights the perceived positive impact that early, individualised support services can provide for autistic children. These findings predominantly signal a shift away from medicalised models towards a neurodiversity-affirming approach across participant groups.Lay abstractWe do not know much about what support services people think are okay for young autistic children. This study was a survey of 253 people. We asked autistic adults, parents, and professionals from Australia and New Zealand whether they thought it was okay to provide support services to autistic children. About half the people who shared their thoughts said it was okay to provide support services to autistic children and the other half said it depended on what the support service was like. They had three main ideas about whether support services were okay or not. The first one is that we should remember that these autistic children are children first, so we need to keep their childhood experiences in mind and let them have a say in decisions. The second is that we should not try to 'fix' the child, but instead, use supports that respect and understand the unique ways the child thinks. The final idea is that early, personalised help is good for autistic children and can make a positive difference in their lives. This study suggests that we should focus on what each child needs, think about how children can join in, and provide help in ways that respect autistic children.

Incorporating special interests to investigate the language system in autism: A feasibility pilot fMRI study

Most autistic individuals have sustained, focused interests in particular topics or activities. In some cases, these special interests have been shown to motivate communicative behaviors, a domain in which many autistic individuals experience challenges. We conducted a pilot study with 15 autistic children (ages 8.18 - 13.27 years, mean(SD)= 11.17(1.62), 3 female/11 male/1 nonbinary), comparing brain responses elicited by short narratives tailored to individuals' special interests to responses elicited by generic, non-tailored narratives. Using functional magnetic resonance imaging (fMRI), we found that autistic children did not show typical language responses to generic narratives. However, they did show heightened responses to the narratives that incorporated their special interests relative to the generic narratives in language regions and in regions associated with reward and self-reference. Brain responses for personalized narratives were also more consistent across children than responses for the generic narratives. These results suggest that personalizing stimuli by incorporating special interests might be a promising approach for neuroimaging in autistic participants.

LAY SUMMARY

In a pilot sample of autistic children, we found that listening to short narratives tailored to each child's special interest elicited higher responses in the brain than listening to non-personalized narratives. Brain responses across children were also more similar for the special interest narratives. Thus, personalizing stimuli to special interests may be a promising approach for neuroimaging studies of autism.

Examining the barriers and facilitators to mental health service provision for autistic people in Ireland: a survey of psychiatrists

BACKGROUND

Autistic people have high levels of mental ill-health and an increased risk of suicide across the lifespan. Yet autistic people report difficulties communicating with healthcare professionals and accessing a range of healthcare services. At the same time, mental healthcare workers in other countries are reporting links between confidence when working with autistic patients and the degree of autism knowledge and training they can access.

METHODS

We sought to examine what factors helped or hindered Irish mental healthcare colleagues when working with autistic healthcare service users. An online survey using quantitative and qualitative metrics was circulated among psychiatrists who are members of the College of Psychiatrists of Ireland, both in training and at consultant level, from April 2021 to April 2022.

RESULTS

Knowledge of autism was high among psychiatrists (n = 140), but self-efficacy scores were variable, particularly in relation to care pathways. Self-efficacy was better among psychiatrists with caseloads of children and youth or individuals with co-occurring intellectual disabilities. Three key qualitative themes emerged relating to capacity and training of mental health professionals, ways to improve mental health services provision for autistic individuals and also the critical need for co-creation and neurodiversity affirmative care.

CONCLUSIONS

The study highlighted critical systemic and professional challenges in providing mental health care to autistic people in Ireland. We provide recommendations for reducing these challenges and for enabling the development of inclusive, evidenced-based care to autistic individuals.

'I did what I could to earn some money and be of use': A qualitative exploration of autistic people's journeys to career success and fulfilment

Employment contributes to well-being, yet many autistic people who want to work face barriers to meaningful employment. Much research focuses solely on employment rates, rather than taking a more holistic view of professional trajectories and occupational experiences. We conducted semi-structured interviews with 18 autistic adults to explore their experiences of, and perspectives on, career success. Our participants highlighted the overarching importance of finding fulfilment in one's career. Using reflexive thematic analysis, we identified five additional key themes: (1) volatile career journeys, (2) the need for continuing career support, (3) the impact (positive or negative) of social interactions, (4) the important role of organisations and (5) the catastrophic impact of poor experiences. Our findings highlight the importance of tailored, lifelong employment support and inclusive workplaces in enabling autistic people to thrive at work. Enabling autistic career fulfilment requires moving beyond entry-level hiring to foster sustainable, fulfilling employment for all autistic people.Lay abstractMany autistic people want to work but have trouble finding jobs they like and can stick with. Most research tries to help more autistic people get jobs, but does not look at whether those jobs are fulfilling, or how people progress once they start working. We spoke to 18 autistic people about their experiences at work, and their ideas about success at work. Participants said finding fulfilment in their careers was key. We found five common 'themes' across the interviews. First, autistic people's careers often take unexpected turns. For example, many participants only got diagnosed as adults, which sometimes changed their work plans. Second, autistic people might need ongoing help with their career, including help with finding jobs they would enjoy and be good at, and advice on how to progress in their job. Third, getting along with others at work is really important. Having supportive colleagues helped our participants thrive, but workplace bullying forced some to leave their jobs. Fourth, workplaces need to be welcoming to everybody. Adjustments and understanding managers helped, but many of our participants' workplaces were not inclusive. Finally, bad work experiences can be devastating for mental health and well-being and negative experiences like bullying led some participants to quit working entirely. Our findings show that lifelong support tailored to each person and welcoming workplaces are important for autistic people to thrive at work. It is not enough to just hire autistic people - we need to help them have jobs they like and can stick with long-term.

Investigating visual perspective taking and belief reasoning in autistic adults: A pre-registered online study

As many autistic individuals report mentalizing difficulties into adulthood, the current pre-registered study investigated potential differences in belief reasoning and/or visual perspective taking between autistic and non-autistic adults. The Seeing-Believing task was administered to 121 gender-balanced participants online (57 with a self- reported diagnosis of an autism spectrum condition and 64 without), as well as Raven's Progressive Matrices (on which the groups did not significantly differ) and the Autism Spectrum Quotient. Non-autistic adults replicated previous findings with this task, revealing slower responses to belief-reasoning than to perspective-taking trials. Autistic adults did not show significantly slower or more error-prone performance during perspective taking and/or belief reasoning. In fact, the autistic group committed significantly fewer mistakes, including fewer altercentric intrusions. The main group difference in response times was a steeper increase with increasing angular disparity between self and other in the autistic group. We discuss our findings in terms of differences in self-other control, but emphasise that our findings cannot be explained in terms of simplistic deficit-based notions of autism and suggest that autistic adults might favour slightly different strategies when judging another's perspective or belief.Lay abstractMany autistic individuals report difficulties in social situations, where they are required to think about what goes on in others' minds. These states of the mind can include how others perceive the world around them, their beliefs, or their desires. While research has shown that autistic children could be delayed in developing their full capacity in this regard, less is known about how adults process others' experiences and beliefs. Here we used a novel task and asked adults to participate online. Participants self-reported whether they had been diagnosed with autism or not and we split them into two groups depending on their response. We also asked participants to fill in a self-report questionnaire about social preferences and habits and we also asked them to conduct a test of their nonverbal reasoning ability. Importantly, the autistic and the non-autistic groups did not differ in their nonverbal reasoning abilities, and on our task, we observed that the autistic group committed fewer mistakes than the non-autistic group. Autistic participants were particularly fast and made fewer mistakes on those responses that overlapped with their own view and belief of reality. In conclusion, our findings do not support a simple view of autism in terms of deficits in either social or more general thinking abilities. Instead, autistic adults might favour slightly different ways of thinking about other's experiences and beliefs that is more firmly linked to their own experience and knowledge.

A mixed method analysis of autistic college students' experiences

Objective: Previous research has suggested that autistic college students experience lower degree completion, along with social and mental health challenges. Other recent work has shown similar outcomes between autistic and non-autistic students. Participants: Participants in this study were autistic college students. Methods: We implemented a mixed methods approach including thematic analysis of interviews conducted at the end of the semester, along with weekly surveys, capturing autistic students' college experiences in real time. Qualitative findings were integrated with quantitative analysis of standardized measures of campus connectedness, student satisfaction and student adjustment to college. Results: Weekly surveys were generally positive with most not reporting any challenges. End of semester interviews reflected similar results. Feelings of belonging on campus and college satisfaction were high. Conclusion: Gathering first-hand accounts on a weekly basis provided a unique account of autistic students' experiences, and while not the case for all, many were successfully navigating the demands of college life.

Clinical genetic counselors' use of people- and identity-first language in regard to patients' identification with disability

The language surrounding disabilities has evolved from derogatory terms to the adoption of people-first language. However, identity-first language is being advocated for by some within the disability community. Using the preferred terminology is crucial to demonstrate respect and prevent stigmatization, especially in healthcare settings like genetic counseling, where language can impact relationships with the community. However, the specific language practices of genetic counselors and their underlying reasons are unclear. This qualitative study explored the language practices employed by genetic counselors when interacting with individuals with disabilities. Fifteen interviews were conducted with genetic counselors who had clinical experience. Reflexive thematic analysis revealed that the perceptions and practices about language used with patients and disability communities overall varied, with overarching themes of people-first language is the preferred and default language, counselors mirror patient language with some exceptions, acknowledging the evolving nature of language, recognizing differences in language preferences, and reacting to outdated terminology. These findings show the importance of continuing education to stay abreast of preferred verbiage within communities and individual patients.

The Utility of the Five Factor Model of Personality as an Organizing Framework for Autism-Related Traits

Growing research suggests that clinical psychological traits are contiguous with normal personality and can be located within the same psychometric frameworks. In this article, we examined whether autism-related traits (ARTs) can plausibly be located within the Five Factor Model (FFM) of personality. Across two studies (Ns = 408 and 423), participants completed measures of ARTs, broad FFM domains, and narrower FFM facets. We used empirically derived criteria to evaluate whether ARTs overlapped (i.e., shared variance) with the FFM domains to a degree that was comparable to FFM facets. Results suggested that most socially oriented ARTs could be represented as facets of the extraversion domain, whereas behaviorally oriented ARTs were more peripheral to the FFM. Cognitively oriented ARTs were less consistently linked with the FFM. These findings highlight the value of the FFM as an organizing framework for ARTs, marking an important step toward synthesis across the personality and autism literatures.

Auditory environments influence the link between Autistic traits and quality of life

Autistic people often report a heightened sensitivity to sound. Yet, research into Autistic people's auditory environments and their impacts on quality of life is limited. We conducted an online survey to understand how auditory environments influence the relationships between Autistic traits and impacts on quality of life (iQoL) due to sound sensitivity. We also sought to determine strategies that Autistic people use to navigate auditory sensitivities in daily life.296 Autistic adults (58.4% women, 15.9% men, 24.3% non-binary +) aged 18-71 years completed the survey comprising a questionnaire with bespoke items measuring auditory experiences in different environments (e.g., noisy vs. quiet) and measures of Autistic traits and iQoL. Our path analyses revealed a significant indirect effect of aversive auditory environments on the relationships between all domains of Autistic traits and iQoL. Notably, the association between non-verbal social communication trait and iQoL was fully mediated by all forms of auditory environments. Additionally, most (n = 217, 73.5%) Autistic participants reported using earplugs and headphones to manage their sound environments in everyday life. Our study demonstrates that many aspects of auditory environments-beyond noise alone-can negatively impact Autistic people's QoL. Addressing barriers created by auditory environments through accommodations should improve QoL for Autistic people.

Obsessional thinking and autistic traits are each uniquely associated with greater traits of gender dysphoria in clinical and nonclinical adult samples

BACKGROUND

Research has demonstrated a strong relationship between autism and gender dysphoria (GD) and that this relationship could be explained by obsessional interests which are characteristic of autism. However, these studies often measured obsessions using either single items which questions the reliability of the findings, or within autistic trait measures meaning the findings may simply index a more general relationship between autistic traits and GD. Therefore, the present study aimed to investigate the relationships between obsessional thoughts and traits of GD using a measure of obsessional thoughts alongside a measure of autistic traits, which was investigated in both non-clinical and clinical samples.

METHODS

A total of 145 non-clinical participants took part in Study 1 and all completed the Autism-Spectrum Quotient (AQ) as a measure of autistic traits, the Obsessive-Compulsive Inventory-Revised (OCI-R) obsessional thoughts subscale as a measure of obsessional thoughts, and the Gender-Identity/Gender-Dysphoria Questionnaire (GIDYQ) to measure traits of GD. For Study 2, a total of 226 participants took part in Study 2 and all completed the same measures as in Study 1. They included participants diagnosed with GD (N = 49), autism (N = 65), OCD (N = 46) and controls with no diagnosis (N = 66).

RESULTS

The hierarchical linear regression for Study 1 showed that both total AQ and OCI-R obsessional thoughts scores were uniquely associated with GIDYQ scores, with no interaction effect between the scores. The results for Study 2, from a hierarchical linear regression, once again found that obsessional thoughts and autistic traits were each uniquely associated with GIDYQ scores, but not their interaction. The GD and autistic groups both reported significantly greater traits of GD than the OCD and control groups, with the GD group reporting higher scores than the autistic group.

LIMITATIONS

Participants self-reported their diagnoses for Study 2, but diagnostic tests to verify these were not administered. Traits of GD were also measured at a single point in time, despite such traits being transient and continuous.

CONCLUSIONS

The results show both obsessional thoughts and autistic traits are uniquely associated with GD, and that autistic people experience greater traits of GD than other clinical groups.

Gaming in the intervention and support process: A realist evaluation of a gaming-based programme

Using games as part of the intervention and support process (sometimes referred to as 'gaming therapy') is an increasingly popular method of supporting autistic youth to develop social competencies and other skills because they are believed to be inherently motivating and fun for youth. Some emerging research has indicated that intervention programmes using games can be beneficial for autistic youth, but little is currently known about why, how and for whom they work. This study conducted a realist evaluation of a programme using the video game "Minecraft" for autistic youth, comprising interviews and observations with autistic youth (n = 4), facilitators (n = 2) and caregivers (n = 6). Findings from interviews and observations suggest that leveraging strengths, sharing power by placing youth in the 'expert role' and learning in a naturalistic and motivating environment provided youth with the opportunities to develop social competencies in communicating their wants and needs and supported the development of social connections, independence and emotion regulation. The results of this realist evaluation may provide a framework for future intervention and support programmes using video games.Lay abstractUsing games as part of the intervention and support process (sometimes called 'gaming therapy') is increasingly used with autistic youth. Gaming is believed to be fun, motivating, and helpful in supporting autistic youth to develop social connections and skills, but very little research has explored this. In this study, we looked at a gaming-based programme that uses Minecraft. We did interviews and observations with youth, facilitators and caregivers of youth to find out why, how and for whom it works. We found that the gaming-based programme could be particularly motivating for youth interested in video games. Facilitators shared the interests of the youth and shared power by placing youth in the 'expert role', while providing youth with opportunities to learn and develop in their own way. Feedback from youth, their caregivers and facilitators suggests that the gaming-based programme might help youth develop social connections, independence and emotion regulation. The results of this realist evaluation may provide a framework for future gaming-based programmes.

Neuro-affirmative support for autism, the Double Empathy Problem and monotropism

Conceptualising autism within a neurodiversity approach raises fundamental questions regarding the nature of the goals pursued in autism support and who is responsible for achieving these goals. The Double Empathy Problem considers deficits in social communication as residing between autistic and non-autistic communicators, rather than solely within the autistic individual. This is important as autistic individuals can have different perceptions of what appropriate goals for autism support should be, when compared to (non-autistic) family, friends and professionals. Monotropism highlights the importance of engaging with the interests of the autistic individual when considering support. This perspective considers the extent to which autistic individuals can self-set and self-achieve autism support goals? Social narratives have a specific goal and explicit description of how to achieve this goal and what the outcome of achieving the goal will be. The Stories Online For Autism app (SOFA-app.com) develops and delivers social narratives for autistic individuals. The SOFA-app has proven to be highly acceptable and effective in supporting autistic individuals. Initially our research focussed on family, friends and professionals developing autism support for autistic children. Subsequently we extended this methodology to explore the self-set goals of autistic adults and children as well as capacity to self-achieve these goals successfully. Digital support for the development and delivery of social narratives to support self-set goals for autistic individuals is recommended. Addressing the Double Empathy Problem and supporting self-set goals are also considered alongside the implications of preferences associated with Monotropism to argue this approach can be considered neuro-affirmative.

Quality-of-life measurement in randomised controlled trials of mental health interventions for autistic adults: A systematic review

Autistic people are more likely to have co-occurring mental health conditions compared to the general population, and mental health interventions have been identified as a top research priority by autistic people and the wider autism community. Autistic adults have also communicated that quality of life is the outcome that matters most to them in relation to mental health research and that they want to be involved more actively in the research process. Our systematic review aimed to determine the extent and nature of (1) quality of life measurement in randomised controlled trials of mental health interventions for autistic adults and (2) community involvement taking place within identified randomised controlled trials. We searched Medline, Embase, APA PsycInfo, Web of Science and grey literature sources. After screening over 10,000 records, 19 studies were eligible and five of those studies measured quality of life as an outcome. Of those five, three included community involvement and two did not report on community involvement. We conclude there is a need for increased use of quality of life measurement when trialling mental health interventions, including the use of measures validated for autistic adults - which would be facilitated by greater autistic involvement in the research process.Lay AbstractAutistic people are more likely to have health problems than the general population. They, and people who care about them, have said mental health research is very important, and some autistic adults have said quality of life is the most helpful area to research when focusing on mental health. Autistic people should also be more deeply involved in making decisions in research. Our review aimed to find out if and how quality of life is being measured when mental health treatments are being tested, and how autistic people and the wider autism community are involved in these studies. We searched four databases and other sources and found over 10,000 records. But just 19 research studies were testing mental health treatments for autistic adults, and only five of those measured quality of life. When they did measure quality of life, it was measured in different ways and there was not much information given on how communities were involved. We suggest mental health research should measure quality of life more often and in ways that are more helpful for autistic people. Our analysis found that mental health research needs to include a wider variety of autistic people, and autistic people should be more involved in the various parts of research.

Teaching students to effectively evaluate scientific evidence and advocate for research in the context of autism spectrum disorder and the neurodiversity movement

Connecting socially relevant topics with biological content can boost student engagement and comprehension. Autism Spectrum Disorder (ASD) is an increasingly prevalent diagnosis with a number of intersecting topic areas between developmental biology and social justice. Here I describe two exercises that I developed to engage students in learning opportunities that link scientific process learning goals with real-world applications. First, students examine scientific research practices and work on connecting scientific evidence with conclusions by evaluating the retracted 1998 article by Andrew Wakefield that falsely linked the measles, mumps and rubella vaccination with the development of ASD. Second, students participate in a role-playing exercise to learn about the multiple viewpoints and perspectives that are involved in determining funding levels for scientific research in the United States, including learning about the neurodiversity movement and its impact on establishing ASD research priorities. By explicitly discussing appropriate scientific practices, analyzing the consequences of scientific misconduct and the spread of misinformation, and demonstrating how students can use their voices and their votes to support science funding, we can prepare students to become knowledgeable, empowered, scientifically literate citizens.

Exploring the construct validity of the Camouflaging Autistic Traits Questionnaire: A factor analytic study

'Camouflaging' is a set of strategies used by autistic people to hide or compensate for their autistic characteristics to fit into predominantly non-autistic social environments. Many researchers have used the Camouflaging Autistic Traits Questionnaire (CAT-Q) to measure camouflaging. However, there have been questions about the construct validity of the CAT-Q as a measurement of camouflaging. The present study examined the extent to which CAT-Q items were distinguishable from other theoretically and empirically related measures of social anxiety, fear of negative evaluation and autistic social traits. Autistic adults (N = 308) completed the CAT-Q and social anxiety, fear of negative evaluation and autistic social traits measures. The small-to-large positive associations between camouflaging and social anxiety, fear of negative evaluation and autistic social traits (r = 0.14-0.65) were not indicative of collinearity. Three exploratory factor analyses, in which CAT-Q items were factor-analysed together with social anxiety, fear of negative evaluation and autistic social traits items respectively, showed that CAT-Q items generally loaded onto different factors from social anxiety, fear of negative evaluation and autistic social traits items, with the exception of the CAT-Q Assimilation subscale items, which cross-loaded mostly with autistic social traits items. Overall, the CAT-Q items were positively associated with, but also differentiated from, most social anxiety, fear of negative evaluation and autistic social traits items, providing support for the measure's construct validity.Lay abstractAutistic people describe having to mask or 'camouflage' their autistic selves to fit into certain social settings. Many researchers have used the CAT-Q to measure the extent to which autistic people engage in camouflaging. However, some researchers have questioned whether the CAT-Q measures camouflaging or whether it measures other related experiences and behaviours associated with social anxiety, fear of being negatively judged or social autistic traits. In our study, we analysed the CAT-Q to check whether it is indeed similar to or different from these related experiences. To do this, we asked 308 autistic adults to complete the CAT-Q and questionnaires about social anxiety, fear of being negatively judged and autistic social features. Then, we put all the CAT-Q items together with the items from each of the other measures in three separate analyses (called factor analyses) to see how the items would group together. These analyses showed us whether camouflaging behaviours are distinguishable and different from, or cluster together with, these other experiences. We found that most of CAT-Q items grouped together separately from the other measures' items, suggesting that camouflaging differs from these other related experiences. Only some items from one of the CAT-Q subscales clustered together with some social anxiety and autistic items, suggesting these may need to be teased out better in the future. Generally, our findings show that we can use the CAT-Q to measure camouflaging behaviours among autistic people.

Applied Principles for Inclusive Practice in Neurodevelopmental Research: A Selection and Report of Illustrative Case Studies

Purpose of Review

Inclusive research practices are important for neurodevelopmental studies, facilitating the involvement of community members throughout the research process. Highlighting this value, we reiterate our previously proposed framework for inclusive research practice and present a selection of case studies showcasing successful implementation of inclusive approaches.

Recent Findings

Across four invited case studies, authors illustrate how neurodivergent people can be effectively involved in research, providing meaningful input and shaping outcomes. Our report concludes that these case studies underscore the significance of building relationships, prioritizing community well-being, and considering diverse identities in neurodevelopmental research. We call for careful evaluation of the impact of inclusive practices on community representatives and advocate for enhanced reporting in academic journals, and use of online repositories to share the materials that support coproduction.

Summary

Despite the recognized benefits, a lack of detailed reporting on inclusive methods poses a challenge for researchers. This report provides valuable insights for researchers aiming to instigate, establish or develop their inclusive practice.

'Like it's making my heart run': A strengths-based understanding of the play of autistic children

LAY ABSTRACT

Autistic play is generally described from a deficit perspective where the players themselves have been overlooked. It is important to consult with autistic children themselves about their understanding of play. We asked autistic children about their views on play using many different creative ways that were chosen by the children themselves. We analysed findings using reflexive thematic analysis. Autistic children in this research described play as involving feelings and emotions of pleasure and joy, autonomy and agency, playing by themselves and with others and engagement with materials and activities as meaningful. It is very important that we ask the players themselves what they think about play rather than relying on deficit framed, non-autistic definitions of autistic play. In this article, we will discuss how these findings will help develop future research, theory and practice in respecting children's right to authentic play experiences.

Perception of four intellectual and developmental disabilities based on search engine and news portrayal

BACKGROUND

For people with intellectual and developmental disabilities, other's perceptions of them based on their condition often begin before birth and go on to impact relationships, opportunities, and self perception across the life course. Search engine results and news media, which may portray these conditions stereotypically or in poor light, are often a key source in these perceptions. Our purpose was to understand how search engine results and available news media can shape perceptions on certain intellectual and developmental disabilities.

METHODS

We developed an online Likert-scale survey to measure differences in perceptions based off first available search engine results, images, and news headlines of four intellectual and developmental disabilities: cerebral palsy, Down syndrome, Prader-Willi syndrome, and Angelman syndrome. These four conditions were selected to compare less prevalent (Prader-Willi and Angelman) and more prevalent conditions (Down syndrome and cerebral palsy). Perception questions addressed general impression and aspects of the disability experience expected to be impacted by perception from others. We recruited via multiple social media platforms, flyers posted in the Boston area, and word of mouth to local communities and friends.

FINDINGS

229 individuals opened the survey, and 125 responses were used in analysis. Mean responses to Prader-Willi syndrome were significantly more negative than responses to cerebral palsy, Down syndrome, and Angelman syndrome across all variables. Responses to Angelman syndrome were also more negative than responses to Down syndrome. Significant differences between conditions found when treating the data as continuous were confirmed when treating the data as ordinal.

CONCLUSION

Lesser-known intellectual and developmental disabilities, such as Prader-Willi syndrome and Angelman syndrome, are subject to more negative portrayal in media, leading to more negative perception, which may impact social opportunity and quality of life. Combined with our finding that the perception of Prader-Willi syndrome follows the ideals of the medical model of disability more closely than the social model, a need for social model of disability training and education for physicians and other medical providers is clear.

"What does 'often' even mean?" Revising and validating the Comprehensive Autistic Trait Inventory in partnership with autistic people

BACKGROUND

In this study, we revised the comprehensive autistic trait inventory (CATI)-a self-report inventory of autistic traits, in collaboration with autistic people and provided preliminary evidence for its validity as a self-report measure of autistic traits in the general population. An established strength of the CATI is its ability to capture female autistic traits. Our project aimed to extend this further, to increase the inventory's accessibility, and to minimise stigma induced by deficit-based representations of autistic experience.

METHODS

Together with 22 individuals from the autism and autistic communities, we created the Revised Comprehensive Autistic Trait Inventory (CATI-R). Revisions included rewording items to increase clarity or reduce stigma and expanding items to capture diverse autistic experiences. We also present a series of guidelines for developing self-report inventories of subclinical neurodivergent traits. We validated the CATI-R within a large sample (n = 1439), comprising people with a self-reported autism diagnosis (n = 331), people who self-identified as autistic (n = 44), and non-autistic participants (n = 1046).

RESULTS

We successfully validated a revision of the CATI. A confirmatory factor analysis supported the six-subscale structure (two-factor bifactors model: Chi-squared = 2705.73, p < .001, RMSEA = .04, SRMR = .03, CFI = .95, TLI = .94). Spearman's rank correlations showed positive relationships between all subscales (all rs >  .56, ps < .001). Convergent validity was demonstrated by significant correlations between the CATI-R and two contemporary inventories of autistic traits: the AQ (rho = .86, p < .01) and BAPQ (rho = .82, p < .01). Finally, a measurement invariance analysis indicated that total-scale scores can be compared across genders.

LIMITATIONS

Our study presents only initial evidence for the validity of the CATI-R that should be enriched with further analyses and types of data, including a larger number of participants who do not identify as male or female.

CONCLUSIONS

This project provides a revised trait inventory that resonates with actual autistic experience, along with guidelines for creating self-report measures that are sensitive, accessible, and non-stigmatising.

Application of the international classification of functioning, disability, and health in autism and attention-deficit hyperactivity disorder: A scoping review

LAY ABSTRACT

The International Classification of Functioning, Disability, and Health (ICF) is a framework designed by the World Health Organization (WHO) to help different sectors, such as healthcare, social services, education, and policy, understand how people with health-related issues function (do the things they want to and need to do) in their daily lives. This framework has also been used to guide clinical practice and research in autism and attention-deficit hyperactivity disorder (ADHD). To make it more practical, shorter versions of the ICF called Core Sets have been developed. We wanted to explore how the ICF and the ICF Core Sets have been used in research relating to autism and ADHD. We looked at the research that had been previously published on this topic by conducting a systematic search and review. Seventy-eight studies meeting our criteria were included in our review. Results show that the ICF has been applied in many ways across various contexts. However, most of the research has focused on autism, mainly involving children. The review highlights that although the ICF was used in some studies, the underlying philosophies of the framework were not always followed. The medical perspective still influenced the way research was done and interpreted. Nevertheless, using the ICF in the right way can help shift research on neurodevelopmental conditions like autism and ADHD toward a more holistic approach, moving away from solely focusing on medical aspects.

Describing Outcomes in Autistic Young Adults One Year After High School Graduation

PURPOSE

Research documents poor outcomes for autistic adults in the domains of employment, independent living, and social relationships. Measurement and sample limitations in prior studies may have amplified past estimates of poor outcomes. The goal of the current study was to improve upon past approaches and to create and describe a measurement approach to capture adult outcomes that reflected the context of young adulthood and the perspectives of autistic individuals, pairing objective outcome indicators with subjective satisfaction indicators.

METHODS

Thirty-six autistic young adults (mean age 19.8 years) and a parent completed self-report surveys. Using these data, we defined an objective and subjective (i.e., satisfaction) outcome indicator in each of three domains: productivity (employment or post-secondary education), social well-being (frequency of contact with friends), and living situation (autonomy).

RESULTS

Three-quarters of young adults experienced at least 5 out of 6 positive outcomes. Over 90% were engaged in school, work, or a structured transition program, and an equal percentage were satisfied with their productivity activity. Over three-quarters of adults had a good amount of contact with friends and were satisfied with their social life. Most young adults had a moderate level of autonomy in their daily lives, and all were satisfied with their living situation.

CONCLUSION

Tailoring outcome measurement approaches specifically for autistic young adults provided a more optimistic portrayal of outcomes than previously noted in the literature. The approach used better reflects a neurodiversity approach and may be useful for evaluating the effectiveness of transition services or interventions.

Understanding Camouflaging, Stigma, and Mental Health for Autistic People in Japan

Background

Camouflaging refers to behaviors in which autistic individuals mask their autistic characteristics and "pass" as non-autistic people. It is postulated that camouflaging is a response to stigma, and preliminary evidence supports this hypothesis. However, research on this topic outside of Western countries is limited. This study replicated and extended previous work in the West that examined the relationships between camouflaging, stigma, and mental health of autistic adults, with a Japanese sample.

Methods

Two-hundred eighty-seven autistic people living in Japan (146 men, 120 women, 14 nonbinary, 5 other gender identities, 2 preferred not to say; mean age = 37.5 years, standard deviation = 9.8 years) completed an online survey on camouflaging, perceived stigma, coping strategies for stigma, mental well-being, generalized anxiety, social anxiety, and depression. We used hierarchical multiple regression analyses to investigate the relationships between camouflaging and stigma and coping strategies for stigma. Mediation analyses were also employed to examine whether camouflaging mediated the relationships between stigma and autistic people's mental health.

Results

Replicating previous work, we found that higher camouflaging was associated with higher perceived stigma. Both coping strategies of hiding/denying and valuing/embracing stigmatized characteristics were positively related to camouflaging. Camouflaging mediated the association of stigma with depression, generalized anxiety, and social anxiety (but not well-being).

Conclusions

Our findings support the hypothesis that camouflaging is closely related to autism-related stigma and can influence the impact of stigma on mental health. More work around social outreach and addressing autism-related stigma would be beneficial to reduce the negative role of camouflaging.

Operationalizing the ICF Core Sets for Autism and ADHD: A Multiple-Methods Feasibility Study

The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization's (WHO) standard for assessing individual functioning. Over the last decade, the ICF has been made more accessible for autism and ADHD through the development and validation of tailored shorter ICF versions for these diagnoses, ICF Core Sets. To further enhance their applicability in research and practice, these Core Sets have been operationalized and implemented on an online platform, the ICF CoreSets platform. Here, we describe the iterative development process of the CoreSets platform. This multiple-methods study examines user feedback on the operationalization of the Core Sets and the feasibility of the CoreSets platform as a functional assessment for autism and ADHD. We collected a total of 678 assessments from the CoreSets platform. Individuals diagnosed with autism and/or ADHD, their relatives, participants from the general population, and professionals completed and provided feedback on the usability of the CoreSets platform. Qualitative feedback via interviews and focus groups were also collected. Qualitative data were analysed via content analysis, while quantitative data were examined using univariate and descriptive techniques. Findings show that the ICF CoreSets platform is feasible and user-friendly, but areas for improvement were also indicated, leading to additional refinement of the operationalization and platform. The operationalization of the ICF Core Sets and their implementation in the CoreSets platform appears adequate for use in research and practice, particularly after revisions indicated by future users, and is now ready for psychometric standardization.

Virtual environments as a novel and promising approach in (neuro)diagnosis and (neuro)therapy: a perspective on the example of autism spectrum disorder

Over the last three decades, dynamically evolving research using novel technologies, including virtual environments (VEs), has presented promising solutions for neuroscience and neuropsychology. This article explores the known and potential benefits and drawbacks of employing modern technologies for diagnosing and treating developmental disorders, exemplified by autism spectrum disorder (ASD). ASD's complex nature is ideal for illustrating the advantages and disadvantages of the digital world. While VEs' possibilities remain under-explored, they offer enhanced diagnostics and treatment options for ASD, augmenting traditional approaches. Unlike real-world obstacles primarily rooted in social challenges and overwhelming environments, these novel technologies provide unique compensatory opportunities for ASD-related deficits. From our perspective in addition to other recent work, digital technologies should be adapted to suit the specific needs of individuals with ASD.

Developing and Implementing an Integrated Family Education Program (IPMD-F) for Parents of Children With Reading Difficulties: Insights From an Action Research Study

PURPOSE

This research aims to identify the problems and needs of families of children with reading difficulties, develop an Integrated Process-Based Family Education Program (IPMD-F) to address these needs, and implement it.

METHODS

The study used a community-based participatory action research approach, following a four-stage process: general information collection, needs identification and action plan creation, development and implementation of the IPMD-F, and evaluation. Conducted during the 2023-2024 academic year in Ankara, Turkey, with 16 volunteer parents of children diagnosed with learning disabilities, data were collected using qualitative and quantitative tools. Qualitative data were analyzed using thematic reflexive analysis, while quantitative data were analyzed using the Wilcoxon signed-rank test to determine pre-test and post-test score differences.

FINDING

Findings derived from a synthesis of personal development theory, a holistic approach, and a neurodiversity perspective revealed that the program assisted parents in attaining a holistic outlook, reinforcing parent-child communication, and cultivating coping strategies. Our assessment also substantiated the program's efficacy in practice.

CONCLUSION

This study highlights that the IPMD-F can be a significant resource for families of children with reading difficulties and suggests broader implementation of such programs.

From Symptomatology to Functioning - Applying the ICF to Autism Measures to Facilitate Neurodiversity-Affirmative Data Harmonization

PURPOSE

A considerable number of screening and diagnostic tools for autism exist, but variability in these measures presents challenges to data harmonization and the comparability and generalizability of findings. At the same time, there is a movement away from autism symptomatology to stances that capture heterogeneity and appreciate diversity. The International Classification of Functioning, Disability and Health (ICF) provides a classification system that can support content harmonization of different screening and diagnostic tools for autism while enabling the translation of diagnostic information into functioning.

METHOD

Here we linked commonly used screening and diagnostic measures within the field of autism to the ICF to facilitate the unification of data obtained from these measures.

RESULTS

As expected, screening and diagnostic measures primarily focus on body functions and activities and participation domains of the ICF, and much less on environmental factors, reflecting biomedical and adaptive behavior operationalizations of autism derived from diagnostic manuals.

CONCLUSION

By translating symptomology-based information to the continuous and diagnostically neutral view of functioning, the ICF linking presented here may provide a means to harmonize measures of autism characteristics while enabling diagnostic information to be re-examined through a more neurodiversity-affirmative lens.

Use of Serious Games in Interventions of Executive Functions in Neurodiverse Children: Systematic Review

BACKGROUND

Serious games (SG) have emerged as promising tools for cognitive training and therapeutic interventions, especially for enhancing executive functions. These games have demonstrated the potential to support individuals with diverse health conditions, including neurodevelopmental and cognitive disorders, through engaging and interactive experiences. However, a comprehensive understanding of the effectiveness of SG in enhancing executive functions is needed.

OBJECTIVE

This systematic review aims to assess the impact of serious games on executive functions (EF), focusing on attention, working memory, cognitive flexibility, and inhibitory control. In addition, it explores the integration of SG into educational and therapeutic settings for individuals with cognitive and neurodevelopmental conditions. Only open access articles published from 2019 to the search date were included to capture the most recent advancements in the field.

METHODS

A comprehensive search was conducted on June 20, 2024, across Scopus, Web of Science, and PubMed databases. Due to limited direct results linking SG and neurodiversity, separate searches were performed to analyze the relationship between SG and EF, as well as SG and neurodiverse populations. Two independent reviewers assessed the quality and risk of bias of the included studies using the Risk of Bias 2 tool for randomized studies and the Risk of Bias in Non-Randomized Studies of Interventions tool for nonrandomized studies.

RESULTS

The review identified 16 studies that met the inclusion criteria. Of these, 15 addressed the use of SG for improving EF in neurodiverse populations, such as children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and down syndrome. These studies demonstrated significant improvements in various EF domains, including attention, working memory, and cognitive flexibility. However, there was notable heterogeneity in sample sizes, participant ages, and game types. Three studies specifically focused on individuals with down syndrome, showing promising results in improving cognitive functions.

CONCLUSIONS

SG hold considerable potential as therapeutic tools for enhancing EF across neurodiverse populations. They have shown positive effects in improving cognitive skills and promoting inclusion in both educational and therapeutic settings. However, further research is required to optimize game design, assess long-term outcomes, and address the variability in study quality. The exclusive inclusion of open access studies may have limited the scope of the review, and future research should incorporate a broader range of studies to provide a more comprehensive understanding of SG's impact on neurodiversity.

TRIAL REGISTRATION

PROSPERO CRD42024563231; https://tinyurl.com/ycxdymyb.

An annotated introductory reading list for neurodiversity

Since its inception, the concept of neurodiversity has been defined in a number of different ways, which can cause confusion among those hoping to educate themselves about the topic. Learning about neurodiversity can also be challenging because there is a lack of well-curated, appropriately contextualized information on the topic. To address such barriers, we present an annotated reading list that was developed collaboratively by a neurodiverse group of researchers. The nine themes covered in the reading list are: the history of neurodiversity; ways of thinking about neurodiversity; the importance of lived experience; a neurodiversity paradigm for autism science; beyond deficit views of ADHD; expanding the scope of neurodiversity; anti-ableism; the need for robust theory and methods; and integration with open and participatory work. We hope this resource can support readers in understanding some of the key ideas and topics within neurodiversity, and that it can further orient researchers towards more rigorous, destigmatizing, accessible, and inclusive scientific practices.

Inner experiences, mental health, and well-being in autistic and non-autistic adults

The nature of autistic adults' everyday inner experiences has been largely unstudied. The purpose of this study was to examine patterns of inner experiences and how they relate to mental health and wellness among autistic and non-autistic adults. Autistic (n = 303) and non-autistic (n = 289) adults (ages 21-82) completed online surveys assessing their anxiety, depression, happiness, life satisfaction, and inner thinking patterns, (inner speaking [i.e., verbal thinking], inner seeing [i.e., visual thinking], unsymbolized thinking, feelings, sensory awareness, self-talk). Group differences in inner thinking were examined using Mann-Whitney U and chi-square tests. Correlations and multiple linear regressions examined associations between inner experiences, mental health, and well-being. Autistic adults had greater use of inner speaking and sensory awareness, compared to non-autistic adults. The most common primary mode of inner experience for both groups was inner speaking, while fewer autistic adults reported that experiencing thoughts as feelings was their primary modality. Autistic adults reported greater use of self-talk for social assessment, self-criticism, and self-management purposes, compared to non-autistic adults. Experiencing thoughts as inner speech and as feelings were associated with anxiety in both groups. Using self-talk for social assessment and self-criticism purposes was correlated with anxiety and depression in both groups, while using self-talk for self-management was associated with depression and anxiety only among autistic adults. The results suggest that autistic and non-autistic adults have similarities in overall patterns of inner thinking, yet autistic adults may be more likely to engage in self-talk as a strategy to manage challenging day-to-day experiences.

The meaning of autistic movements

LAY ABSTRACT

What is already known?Moving the body in 'stereotyped', 'repetitive', 'ritualised' or 'unusual' ways is part of the criteria for receiving a diagnosis of autism. However, the reasons for these movements and their personal value are not well understood. Certain ways of moving have become part of a disorder, and have received negative judgements, whereas other movements have not.What this paper adds?We searched online blogs for descriptions of movement written by autistic adults, using their preferred language and definitions. The blog authors said that many types of movement attracted negative judgement, including mis-coordination shown during sports, dancing in unusual places or moving repetitively, such as when stimming. However, movement provided personal benefits, and could enhance thinking and focus, provide meaningful routine, contribute to sensory regulation, release energy, increase body awareness, emotion regulation and strengthen self-identity.Implications for practice and policyMovement could be a well-being resource, used to reduce distraction, overwhelm, confusion and distress for autistic people. This should be considered within personal coping strategies and psychological therapies. The examples provided in this study could inform autism assessments, to ensure that the meanings of movements are considered alongside the appearances of movement. Some movements such as stimming have the same functions as many other ways of moving, including dancing and exercising, which could help to reduce stigma around being autistic if reflected in policy and practice. Improving understanding is important for informing how autism is assessed, and how personal experiences of being autistic are heard.

Student radiographers' confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences

INTRODUCTION

Healthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients.

METHODS

UK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed.

RESULTS

43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students' development of confidence.

CONCLUSION

Several participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers.

IMPLICATIONS FOR PRACTICE

To improve student radiographers' confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

Deepening the participation of neurodivergent youth in qualitative mental health research: Co-development of a general approach and the evaluation of its implementation in a study on emotion

Background

There is a growing expectation that neurodivergent young people, such as those with diagnoses of attention-deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms-length advice. To address this, the Regulating Emotions-Strengthening Adolescent Resilience (RE-STAR) programme has co-developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research.

Methods

Development - Building on the track record of successful collaboration between RE-STAR academic researchers (ARs) and its Youth Researcher Panel (Y-RP), a cycle of meetings was convened to co-develop a collaborative protocol for the participatory approach. Implementation - ARs and Y-RPers applied the general protocol to study a specific topic. This involved co-designing and co-delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co-analysing the interviews. Evaluation - ARs, Y-RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (N = 36) and short open-ended surveys (N = 22).

Results

Development - The protocol for the participatory approach gave detailed advice on how to engage Y-RP members (or equivalent) in the co-design, co-delivery and co-analysis of interviews. Implementation - The approach was successfully implemented by ARs and Y-RPers working together to co-design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co-deliver it and then co-analyse the interview scripts. Evaluation - The implementation experience of the Y-RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics.

Conclusions

This new RE-STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.

Cicchetti's organizational-developmental perspective of Down syndrome: Contributions to the emergence of developmental psychopathology and the study of persons with neurodevelopmental conditions

Dante Cicchetti's earliest work, his studies of social-emotional development in infants and children with Down syndrome, set the stage for the emergence of the larger field of developmental psychopathology. By applying basic developmental principles, methodologies, and questions to the study of persons with Down syndrome, Dante took on the challenge of searching for patterns in atypical development. In doing so, he extended traditional developmental theory and introduced a more "liberal" approach that both continues to guide developmentally based research with persons with neurodevelopmental conditions (NDCs), including Down syndrome. We highlight five themes from Dante's work: (1) appreciating the importance of developmental level; (2) prioritizing the organization of development; (3) examining whether developmental factors work similarly in those with known genetic conditions; (4) rethinking narratives about ways of being; and (5) examining the influence of multiple levels of the environment on the individual's functioning. We highlight ways that these essential lessons anticipated present-day research with persons with a variety of NDCs, including Down syndrome, other genetic syndromes associated with intellectual disability, and autism. We conclude with visions to the future for research with these populations as well as for the field of developmental psychopathology more generally.

Neurodivergence, intersectionality, and eating disorders: a lived experience-led narrative review

Autistic people and those with attention deficit hyperactivity disorder are at a high risk of developing an eating disorder. While there is limited evidence on the relationship between other forms of neurodivergence and eating disorders, research suggests associations between giftedness, intellectual disability, obsessive-compulsive disorder, psychosis, Tourette's syndrome, and disordered eating. Factors underlying disordered eating and/or eating disorder risk for neurodivergent people are multifaceted and complex, encompassing a wide range of intertwined psychosocial, environmental, and biological processes. Moreover, research shows that neurodivergent individuals experience poorer treatment outcomes compared to neurotypical individuals. However, there is a paucity of research in this area overall. More specifically, lived experience-led research remains rare, despite its critical role for improving individualised eating disorder care, as well as mental healthcare more broadly. Indeed, the importance of eating disorder care individuation is increasingly being recognised, particularly within the context of neurodivergence, given the heterogeneous experiences and support needs of neurodivergent people affected by disordered eating and/or eating disorders. Furthermore, despite documented overlaps between various forms of neurodivergence (e.g., co-occurring autism and attention deficit hyperactivity disorder), research looking at eating disorders in the context of neurodivergence through a transdiagnostic perspective is scarce. This lived experience-led narrative review aims to shed light on the intersectional factors underlying elevated disordered eating and/or eating disorder risk for neurodivergent individuals. First, an overview of prevalence data is provided, followed by a thematic framework identifying factors underlying disordered eating and/or eating disorder risk in relation to neurodivergence. A critical appraisal of current eating disorder research and care is then offered before suggestions for neurodiversity-affirming eating disorder care are made. In this view, this paper offers a foundation for future empirical work in this nascent field of inquiry by providing a lived experience-led, transdiagnostic, and intersectional account of eating disorders in the context of neurodivergence.

Measuring the outcomes of support provided to people after a suicide or other sudden bereavement: A scoping review

Systematic collection of outcome measures within suicide bereavement support is vital in building the sector's evidence base. However, there is currently limited understanding around the appropriate and sensitive use of outcome measures. Following the scoping review methodology, a literature review was undertaken to map how programs and interventions that assist individuals bereaved by suicide or other sudden, traumatic deaths gather outcome measures. The search strategy identified 1145 papers, of which 49 met the inclusion criteria. The review identified many ways that outcomes are captured, with custom tools being commonplace. Among standardized tools, the Grief Experience Questionnaire (GEQ) and Beck Depression Inventory (BDI-II) emerged as frequently used. Most articles provided some form of justification for their chosen outcome measure methodology, often citing psychometric robustness over consideration of the impact on service users. The review underscores the need for careful consideration when selecting outcome measure tools or approaches in sudden death bereavement interventions.

Can similarity of autistic traits promote neural synchronization?

People with similar levels of autistic traits are reported to exhibit better interactions than those with larger differences in autistic traits. However, whether this "similarity effect" exists at the neural level remains unclear. To address this gap, the present study employed functional near-infrared spectroscopy (fNIRS) hyperscanning technology to assess inter-brain synchronization (IBS) during naturalistic conversations among dyads with three types of autistic trait combinations (20 high-high, 22 high-low, and 18 low-low dyads). The results revealed that the high-high dyads exhibited significantly lower IBS in the right temporoparietal junction (rTPJ) region compared to the low-low dyads, with no significant differences observed between the high-low group and the other two groups. Moreover, though dyadic differences in conversation satisfaction were positively correlated with dyadic autistic trait differences, IBS only showed a significant negative correlation with the dyadic average autistic trait scores and no significant correlation with the dyadic difference scores of autistic traits. These findings suggest that dyads with high autistic traits may have shared feelings about conversations, but cannot produce IBS through successful mutual prediction and understanding.

Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes

Neurodivergent individuals, including a range of conditions impacting neurological function, are at an increased likelihood of poor life outcomes, such as in functional adaptation, mental health, and well-being. Yet, many live meaningful and fulfilling lives. Resilience may provide some explanation for the heterogeneity in outcomes observed in neurodivergent populations. We conducted a scoping review embedded in a neurodiversity-affirmative approach to provide an understanding of resilience in neurodivergent populations. A total of 176 articles were included in this review and were synthesized using a two-phased process. First, findings were synthesized narratively to examine how resilience has been conceptualized and explored in neurodivergent populations. Second, to identify the bio-psycho-social factors important for resilience in neurodivergent individuals, we converted concepts identified in articles to the nomenclature of the World Health Organizations' International Classification of Functioning, Disability and Health (ICF) using a standardized linking process. We find considerable variability in how resilience is conceptualized and measured in neurodivergent populations. We identified 83 unique ICF categories representing resilience factors, of which only 20 appeared in more than 5% of the articles. Identified ICF categories highlight the importance of support systems such as families and friends, community participation and acceptance, and individual capabilities for resilience.

Identifying autistic children: Priorities for research arising from a systematic review of parents' experiences of the assessment process

LAY ABSTRACT

Hearing about parents' experiences of having their child recognised as autistic could help improve the supports offered to parents. Our article may also help guide future research on this topic. We made a list of the type of research that interested us. We searched the studies already completed, only studying the research that matched our interests. After reading the studies, we rated their quality using the Critical Appraisal Skills Programme tool.It became clear that parents went through four phases during the identification process. The first phase occurred before their child was identified as autistic. The second involved the actual assessment of their child. Parents' emotional reactions to the news were the focus of the third phase. The final phase occurred after their child was identified as autistic. We discuss the findings of our research. As there are sensitivities involved in conducting research on this topic, we identify how researchers can ensure that their research is of the best quality. We are committed to respecting the human rights of all involved, so we emphasise the need for professionals to develop good relationships with the parents of autistic children. Researchers have recently come to see autism as typical of human diversity. We encourage the professionals involved to adopt this understanding of autistic children and make practical suggestions to enable them to do so.

The Earlier, the Better? An In-Depth Interview Study on the Ethics of Early Detection with Parents of Children at an Elevated Likelihood for Autism

Autism is increasingly viewed as an expression of neurodiversity deserving accommodation, rather than merely as a disorder in need of remediation or even prevention. This reconceptualization has inspired calls to broaden the ethical debate on early autism care beyond matters of efficient screenings and effective interventions. We conducted 14 in-depth interviews with 26 parents of infants at an increased likelihood for autism (siblings, preterms and children with persistent feeding difficulties) to understand which benefits and risks these parents see for the implementation of a systematic, early autism detection program in our region. With this study, we aim to contribute empirically to the ethical debate on good and just early autism care in the age of neurodiversity. Data were analyzed according to the QUAGOL-methodology. Three main themes emerged from our analysis. In their evaluation of early autism detection, parents discussed how a diagnosis helps gain a different perspective fostering understanding and recognition for both child and parent. Second, a diagnosis supports parents in adjusting their parenting practices, to justify this deviation from "normal" parenting and to strive for such adjusted environments beyond the nuclear family. Third, an autism diagnosis induces ambiguities parents need to navigate, involving questions on whether and when to mobilize the diagnostic label and which language to use to talk about autism. We discuss the complex position of parents of a (potentially) autistic child in terms of moving back and forth across the ab/normal binary and describe implications for the ethical debate on early autism detection.

Medicalising agents? Teachers' uncertainty and emerging expertise in the age of inclusion policy and medicalisation in Israel

Attention deficit hyperactivity disorder (ADHD) is a paradigmatic case for childhood medicalisation. Critical studies of medicalisation have pointed to the increasing clinical role of schools, with teachers tending to rely on medical treatment of students with ADHD and are perceived as a primary source of diagnostic information. Based on 27 semi-structured interviews with teachers working in two Israeli elementary and middle schools, this research explored how teachers mediate the medicalisation process and understand their responsibilities in the classroom amidst the emphasis on inclusion in contemporary Israel. We found that teachers offer a wide range of explanations of the disorder and its prevalence, and their attitudes to medication are ambivalent. We argue that teachers develop pedagogical (lay) expertise in the field of ADHD in parallel with and in opposition to medical solutions. Such expertise is based on practical experience and close interaction with students. A top-down ideological imperative of inclusion, combined with uncertainty about ADHD, has generated a bottom-up set of preformative practices of 'containment' of troubled students. Teachers' emerging knowledge and practices raise questions about the relationship between medicalisation, policy, expertise and the pragmatic value of medical categories when applied outside the medical establishment.

A Genetic Bridge Between Medicine and Neurodiversity for Autism

Autism represents a large spectrum of diverse individuals with varying underlying genetic architectures and needs. For some individuals, a single de novo or ultrarare genetic variant has a large effect on the intensity of specific dimensions of the phenotype, while, for others, a combination of thousands of variants commonly found in the general population are involved. The variants with large impact are found in up to 30% of autistic individuals presenting with intellectual disability, significant speech delay, motor delay, and/or seizures. The common variants are shared with those found in individuals with attention-deficit/hyperactivity disorder, major depressive disorders, greater educational attainment, and higher cognitive performance, suggesting overlapping genetic architectures. The genetic variants modulate the function of chromatin remodeling and synaptic proteins that influence the connectivity of neuronal circuits and, in interaction with the environment of each individual, the subsequent cognitive and personal trajectory of the child. Overall, this genetic heterogeneity mirrors the phenotypic diversity of autistic individuals and provides a helpful bridge between biomedical and neurodiversity perspectives. We propose that participative and multidisciplinary research should use this information to understand better the assessment, treatments, and accommodations that individuals with autism and families need.

A qualitative interview study on quality of life and ageing experiences of autistic adults

Quality of life across the lifespan has been established as a key research priority by the autism community. Still relatively little is known about the quality of life and ageing experiences of older autistic adults. Most studies to date have used generic measures of quality of life which may not accurately capture the experiences of autistic people. The aim of this qualitative study was to understand how autistic adults experience and define quality of life as they age. We conducted semi-structured interviews with 16 autistic adults aged 40+ from the UK and Luxembourg. Using reflexive thematic analysis, we identified five themes that contribute to quality of life: (1) Diagnosis is pivotal, (2) Connection with others, (3) Autonomy over space and time, (4) 'Paperwork of life', (5) Vulnerability. This study identifies autism-specific aspects of quality of life and highlights ways in which ageing and autism intersect and impact quality of life.

Measurement invariance of the parent-reported Strengths and Difficulties Questionnaire in autistic adolescents

LAY ABSTRACT

Autistic people are more likely than non-autistic people to experience mental health difficulties. The Strengths and Difficulties Questionnaire is often used to screen for these difficulties and to otherwise make important decisions about mental health treatment and research in populations of autistic people. However, this study suggests that parent-reported Strengths and Difficulties Questionnaire scores may not be useful for comparing autistic and non-autistic adolescents at 11, 14 and 17 years old, as well as screening for mental health conditions in autistic adolescents. In addition, several items may be more likely to be endorsed by parents of autistic 17-year-olds than by parents of non-autistic 17-year-olds (and vice versa), which might suggest caution is needed when comparing groups on specific items.

Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial

Background

Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children.

Methods

This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2-3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1-4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529.

Findings

From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, ηp 2 = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support.

Interpretation

A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited.

Funding

Emerging Researcher First Grant from the Health Research Council of New Zealand.

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.