Hyperfocus or flow? Attentional strengths in autism spectrum disorder

Sensory-movement underpinnings of lifelong neurodivergence: getting a grip on autism

While the autism diagnosis emphasizes "deficits" in social communication, the article advances that sensory-movement differences underpin autism through a review of the following sources of evidence. This account critically challenges "autistic regression", with evidence that sensory-movement features appear by birth as the earliest signs of autism and underlie the behavioral differences used for diagnosis, which may reflect adaptations to inherent differences and misunderstandings from others. Sensory and motor differences are salient to autistic people, but they often go underrecognized by others. They cause cascading effects in infancy on behavior and communication through differences in sensorimotor learning, automatic imitation, eye contact, sensory perception, and interests. The article then explains how sensory processing differences may influence reduced perceptual narrowing, which involves a bottom-up information processing style grounded in the surrounding environment. Furthermore, this bottom-up processing may grow from reduced sensory integration in feedback loops potentially involving the cerebellum of the brain. The article then moves into implications for the widespread consequences of these inherent differences on quality of life. The article closes with implications for autism as a construct (including underestimated empathy and pain), testing the theory, providing sensory-sensitive support and acceptance of autistic people, and applications to diverse autistic people. The theory may apply particularly well to autistic women and girls, autistic people with speech divergence, autistic people with ADHD, and autistic people with co-occurring sensory and motor-related neurodivergences. Throughout the article, the theory also provides clinical, neurological, and experiential evidence for sensory and motor differences as lifelong, challenging the notion of "losing" (an) autism (diagnosis) as instead reflecting (risky and not necessarily "successful") camouflaging.

Transient Reduction of Frontal Midline Theta Activity During Attentional Shifts in Healthy Young Adults

The prefrontal cortex, well-developed in humans, plays a crucial role in various behavioural outcomes. Neuronal resources are limited, however, and must be appropriately allocated. A specific type of theta activity, known as frontal midline theta (Fmθ), is intermittently observed in the frontal midline region during intense concentration to tasks. Meanwhile, the power of Fmθ activity is stronger in individuals with excessive concentration than in those who are not engaged in such state. Fmθ activity in healthy young adults is therefore speculated to be reduced when shifting attention from one target to another. However, the neuronal mechanisms of Fmθ reduction are largely unknown. In this study, 20 healthy young male adults performed 2-back cognitive tasks including two pieces of information (colour and position). Participants initially pay attention to one of them at the start of the task, and then to shift attention to the other when the screen's background colour was changed. Transient reduction of theta activity was observed with the attentional shift, and high current source density was observed in the medial prefrontal and the anterior cingulate regions. Reduction of alpha activity in the left inferior parietal lobe was simultaneously observed during the attentional shift. Moreover, there was a significant positive correlation between the reduction of Fmθ and alpha activity in the left parietal area. The reduction of Fmθ activity and the change in activity of the inferior parietal lobe may play an essential role in disengaging from intense concentration and the appropriate attentional shift. Trial Registration: UMIN000051023.

College Students Recognize Characteristics of Autism, but Struggle to Differentiate Between Characteristics of Autism and Other Disabilities

The current study evaluates whether college students can identify characteristics of autism as diagnostic for autism, and characteristics of other disabilities as not diagnostic for autism. This study also examines metacognitive awareness of autism knowledge, evaluating whether college students can accurately calibrate their confidence in their beliefs about autistic characteristics. 283 college students completed the Autism Symptomatology Knowledge Assessment (McMahon et al. Research in Autism Spectrum Disorders 71:101499, 2020). In this assessment, participants were presented with characteristics of autism and other disabilities and asked to identify which characteristics could be used to diagnose someone with autism. For each characteristic, participants indicated how certain they were in their response. Participants more accurately categorized characteristics of autism, particularly social interaction and communication challenges, as being consistent with an autism diagnosis. Participants had more difficulty identifying that characteristics of other disabilities, especially anxiety, ADHD, and learning disabilities, were not diagnostic for autism. For autistic characteristics, participants' confidence and accuracy were positively correlated, such that participants who responded accurately were more confident in their response than those who responded inaccurately. For other disability characteristics, confidence and accuracy were typically not correlated or inversely correlated, indicating poor metacognitive awareness. College students confuse autism with other disabilities, which may have important implications in real-world contexts. Furthermore, individuals with poor metacognitive awareness of their autism knowledge may not realize that they are confusing autism with other disabilities, such that they may not seek out additional corrective information about autism.

The co-occurrence of functional neurological disorder and autism spectrum disorder: a systematic literature review and meta-analysis

BACKGROUND

Recent studies reveal increasing interest in the link between Autism Spectrum Disorder (ASD) and Functional Neurological Disorder (FND), prompting a systematic review and meta-analysis of their co-occurrence.

METHOD

The review covered a comprehensive literature search across multiple databases up to November 2024, focusing on peer-reviewed studies of ASD and FND co-occurrence. Twenty-four studies qualified for inclusion.

RESULTS

The study included 11,324 participants, predominantly female (73.4%). It estimated the proportion of ASD in FND populations to be 0.10 (95% CI: 0.07-0.15), with significant heterogeneity (I² = 97%, p < 0.01). Subgroup analysis showed variation among different age groups and diagnoses. The proportion of ASD was 0.09 in adults and 0.10 in children with FND, 0.15 in adults and 0.19 in children with Functional Tic-Like Behaviours (FTLB), and 0.07 in children with Functional Seizures (FS).

CONCLUSION

Many studies have reported the co-occurrence of ASD in FND, suggesting a higher-than-expected rate of 10%. Emerging themes exploring the overlapping determinants of FND and ASD, are discussed. However, the significance of this correlation and the overlapping determinants that might explain it, require further research due to the heterogeneity in methodologies, settings, conditions studied and findings. The presence of publication bias warrants cautious interpretation of the results.

Integrating tailored approaches in perioperative care strategies for neurodivergent individuals

Neurodivergent (ND) individuals exhibit variations in communication, behaviors, and cognition, which present both opportunities and challenges in healthcare settings. Anesthesiologists can offer personalized and compassionate care to ND patients throughout the surgical process. Yet, often, there is limited knowledge of the specific actions that anesthesiologists can take to build a healthcare environment that fully recognizes and meets the unique needs of ND patients. This document highlights the importance of integrating tailored communication and supportive strategies throughout the distinct stages of perioperative and intraoperative care.

"In a State of Flow": A Qualitative Examination of Autistic Adults' Phenomenological Experiences of Task Immersion

Background

There is considerable conceptual overlap between Autistic hyperfocus and flow, yet these phenomena have seldom been associated in the literature. Moreover, no studies have provided an in-depth empirical investigation of Autistic people's flow-like or hyperfocus experiences. In this study, we sought to address this gap by investigating Autistic people's phenomenological experiences of task immersion, and how their experiences relate to existing conceptualizations of flow, hyperfocus, and monotropism.

Methods

To address this aim, we drew on data from a broader qualitative study, designed in partnership with Autistic community members, to understand Autistic people's experiences of Autistic inertia. For that broader study, Autistic and non-Autistic researchers conducted semi-structured interviews with 24 Autistic adults about their everyday experiences of starting and stopping tasks. During these interviews, participants repeatedly discussed their experiences of task immersion and the benefits and challenges associated with it. We analyzed these responses specifically, using reflexive thematic analysis, adopting a combination of deductive and inductive approaches within an essentialist framework.

Results

Our participants' accounts closely matched conceptual understandings of flow, Autistic hyperfocus, and monotropism. Specifically, the analysis revealed the all-encompassing nature of task immersion experiences, and how it could be difficult to "find the balance" between the joy and other aspects of everyday life. Despite the drawbacks, participants were glad to be immersed because they felt they could be themselves, with no pretences.

Conclusions

These results are important for reframing task immersion as a state of great potential value to Autistic people's lives, but one that may require additional support if it is to play its role in enabling Autistic people to flourish.

It is More Anxiousness than Role-playing: Social Camouflaging Conceptualization Among Adults on the Autism Spectrum Compared to Persons with Social Anxiety Disorder

PURPOSE

Autistic individuals consider social camouflaging, e.g., masking autistic traits or social skills compensation, as exhausting and effortful, often leading to diminished well-being or burnout, as well as adaptive for satisfying social interactions. Developing camouflaging may result in isolation, social avoidance, increased self-stigmatization, and misdiagnosis, including social anxiety disorder. The study's objective was to explore and conceptualize social camouflaging, with a particular focus on social anxiety symptoms, autistic burnout, and public stigma, among autistic individuals, with two comparative samples: with social anxiety disorder (SAD) and dual diagnoses (SAD + ASD).

METHODS

254 individuals participated in the study (including 186 females, 148 with ASD diagnosis). CAT-Q, AQ-10, AASPIRE's Autistic Burnout Scale, LSAS-SR, The Perceived Public Stigma Scale were used.

RESULTS

The findings suggest differences in the interrelation dynamics between the samples studied, with autistic burnout and social anxiety symptoms of essential significance in camouflaging strategies, and autistic traits being of secondary importance. Structural equation models showed that the proposed conceptualization, with camouflaging and autistic burnout as the outcome variables, exhibited acceptable fit, implying that this strategy is costly and may result in exhaustion.

CONCLUSION

The total score of camouflaging did not differ between the groups studied, suggesting that a tendency to camouflage is rather transdiagnostic, deriving from anxiousness and negative self-perception, not being autistic per se.

Cognitive strengths in neurodevelopmental disorders, conditions and differences: A critical review

Neurodevelopmental disorders are traditionally characterised by a range of associated cognitive impairments in, for example, sensory processing, facial recognition, visual imagery, attention, and coordination. In this critical review, we propose a major reframing, highlighting the variety of unique cognitive strengths that people with neurodevelopmental differences can exhibit. These include enhanced visual perception, strong spatial, auditory, and semantic memory, superior empathy and theory of mind, along with higher levels of divergent thinking. Whilst we acknowledge the heterogeneity of cognitive profiles in neurodevelopmental conditions, we present a more encouraging and affirmative perspective of these groups, contrasting with the predominant, deficit-based position prevalent throughout both cognitive and neuropsychological research. In addition, we provide a theoretical basis and rationale for these cognitive strengths, arguing for the critical role of hereditability, behavioural adaptation, neuronal-recycling, and we draw on psychopharmacological and social explanations. We present a table of potential strengths across conditions and invite researchers to systematically investigate these in their future work. This should help reduce the stigma around neurodiversity, instead promoting greater social inclusion and significant societal benefits.

Identifying cognitive profiles in children with neurodevelopmental disorders using online cognitive testing

Children with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) tend to exhibit similar deficits in attention and memory ability. Early screening of cognitive deficits in children with NDDs, particularly in preschool children, is fundamental to improving cognitive and academic outcomes. In order to determine cognitive profiles in children with ASD and ADHD, we developed accessible audiovisual instructions for an online battery of 13 cognitive tests. Children ages 4-16 who were diagnosed with ADHD (n = 83), or ASD (n = 37), or who were typically developing children (TD) (n = 86) were recruited. Data were analyzed using a stepwise Discriminant Analysis to determine which cognitive tasks were the strongest discriminators between the diagnostic groups. Results revealed four tasks reflective of working memory, reasoning, and attentional processes, which correctly classified approximately 53-60% of each group. The ADHD group had lower scores on attentional tasks compared to TD, while ASD group had lower scores on reasoning tasks compared to the TD children, and made more attempts across all four tasks. The results from this study stress the need for cognitive screening assessments that include domain-specific items to improve the characterization of executive function deficits and promote academic achievement in all children with NDDs.

Assessment of Sensory Processing Issues in Children with Neurodevelopmental Disorders and Experiences of Maltreatment

This study aims to identify the sensory characteristics of children with both developmental disabilities such as ASD and ADHD and a history of child maltreatment (DM group), children with developmental disabilities (DD group), and typically developed children (TD group). The sensory characteristics of 24 children were assessed through virtual reality and self-administered questionnaires. The results elucidated that the duration of gazing at the "teacher" (60-75 s) was significantly different with the DM group's gaze being shorter than the DD group's gaze (p = 0.042). The duration of the "others" gaze (45-60 s) was also significantly different with the DM group's gaze being longer than the DD and TD groups' gaze (p = 0.018; p = 0.030). Additionally, the scores for tactile sensitivity, taste/smell sensitivity, under-responsive/seeks sensation, and the total short-term sensory profile were significantly different between the DM-DD and DD-TD groups. The scores of the heart rate perception test and Multidimensional Assessment of Interoceptive Awareness were significantly lower in the DM and DD groups. In conclusion, children who have experienced trauma and developmental disabilities may have different sensory characteristics than children with only developmental disabilities or none, implying the need for further research and tailored care.

Unraveling shared susceptibility loci and Mendelian genetic associations linking educational attainment with multiple neuropsychiatric disorders

Background

Empirical studies have demonstrated that educational attainment (EA) is associated with neuropsychiatric disorders (NPDs), suggesting a shared etiological basis between them. However, little is known about the shared genetic mechanisms and causality behind such associations.

Methods

This study explored the shared genetic basis and causal relationships between EA and NPDs using the high-definition likelihood (HDL) method, cross phenotype association study (CPASSOC), transcriptome-wide association study (TWAS), and bidirectional Mendelian randomization (MR) with summary-level data for EA (N = 293,723) and NPDs (N range = 9,725 to 455,258).

Results

Significant genetic correlations between EA and 12 NPDs (rg range - 0.49 to 0.35; all p < 3.85 × 10-3) were observed. CPASSOC identified 37 independent loci shared between EA and NPDs, one of which was novel (rs71351952, mapped gene: ARFGEF2). Functional analyses and TWAS found shared genes were enriched in brain tissue, especially in the cerebellum and highlighted the regulatory role of neuronal signaling, purine nucleotide metabolic process, and cAMP-mediated signaling pathways. CPASSOC and TWAS supported the role of three regions of 6q16.1, 3p21.31, and 17q21.31 might account for the shared causes between EA and NPDs. MR confirmed higher genetically predicted EA lower the risk of ADHD (ORIVW: 0.50; 95% CI: 0.39 to 0.63) and genetically predicted ADHD decreased the risk of EA (Causal effect: -2.8 months; 95% CI: -3.9 to -1.8).

Conclusion

These findings provided evidence of shared genetics and causation between EA and NPDs, advanced our understanding of EA, and implicated potential biological pathways that might underlie both EA and NPDs.