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Talebi Azadboni T, Nasiri S, Khenarinezhad S, Sadoughi F. Effectiveness of serious games in social skills training to autistic individuals: A systematic review. Neurosci Biobehav Rev 2024; 161:105634. [PMID: 38494122 DOI: 10.1016/j.neubiorev.2024.105634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/19/2024]
Abstract
Autism Spectrum Disorder (ASD) is a complex neurological condition that significantly impacts individuals' daily lives and social interactions due to challenges in verbal and non-verbal communication. Game-based tools for psychological support and patient education are rapidly gaining traction. Among these tools, teaching social skills via serious games has emerged as a particularly promising educational strategy for addressing specific characteristics associated with autism. Unlike traditional games, serious games are designed with a dual purpose: to entertain and to fulfill a specific educational or therapeutic goal. This systematic review aims to identify and categorize serious computer games that have been used to teach social skills to autistic individuals and to assess their effectiveness. We conducted a comprehensive search across seven databases, resulting in the identification and analysis of 25 games within 26 studies. Out of the 104 criteria assessed across these studies, 57 demonstrated significant improvement in participants. Furthermore, 22 of these studies reported significant enhancements in at least one measured criterion, with 13 studies observing significant improvements in all assessed outcomes. These findings overwhelmingly support the positive impact of computer-based serious game interventions in teaching social skills to autistic individuals.
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Affiliation(s)
- Tahere Talebi Azadboni
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Somayeh Nasiri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Khenarinezhad
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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Edwards C, Love AMA, Jones SC, Cai RY, Nguyen BTH, Gibbs V. 'Most people have no idea what autism is': Unpacking autism disclosure using social media analysis. Autism 2024; 28:1107-1119. [PMID: 37606257 PMCID: PMC11067419 DOI: 10.1177/13623613231192133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
LAY ABSTRACT Autism disclosure - that is sharing their autism diagnosis or identity with a person or people - is a difficult decision for many autistic people. While telling people they are autistic can be positive and helpful, it can also create a lot of problems. What we have learnt is that disclosure is really complicated. Rather than asking research participants questions about what might happen, we looked at what people were saying on public social media posts (Reddit and Twitter) about what did happen. We used three years of posts that were related to autism disclosure from a wide range of adults (autistic and non-autistic). Four main ideas were created from our data, with the key finding being that society does not understand autism. This lack of understanding creates problems for autistic people in work, dating, healthcare and mental health. The remaining ideas were that autistic people should have privacy and be treated with respect, that autistic representation can help society and that non-autistic people need to do more to help autistic people. Our findings support that society needs to do more through autism advocacy, better media representation and more public role models. Increasing the accuracy of understanding of autism across society will mean that autistic people can feel safer to disclose if they want to.
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Affiliation(s)
- Chris Edwards
- Autism Spectrum Australia, Australia
- Griffith University, Australia
| | | | | | | | | | - Vicki Gibbs
- Autism Spectrum Australia, Australia
- University of Sydney, Australia
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Chen YWR, Ng DY, Tseng MH, Bundy A, Cordier R. The impact of coping behaviors on perceived competence and social anxiety in the everyday social engagement of autistic adolescents. Autism 2024; 28:1268-1279. [PMID: 37776008 DOI: 10.1177/13623613231196773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
LAY ABSTRACT Individuals who cope well with challenges may engage in social situations more successfully. We examined how well autistic adolescents coped, depending on how competent they felt and how much anxiety they experienced during social activities. We included 133 individuals (82 autistic, 51 neurotypical) between the ages of 10 and 16 years. Participants carried a mobile device that prompted them seven times a day for 7 days to record what they were doing, how competent they felt and how much anxiety they experienced. We used the Coping Inventory to understand how well participants coped with environmental challenges and met their needs for growth. Autistic adolescents were more likely than neurotypical peers to feel anxious while doing activities with adults. Autistic adolescents who had more difficulty coping with challenges were more likely to feel anxious when doing leisure activities with peers. Interestingly, autistic adolescents who coped better with challenges tended to feel less competent in social situations. However, those better able to meet their needs for growth tended to perceive their social competence positively. These findings can help practitioners develop strategies and programs to reduce the negative social experiences of autistic adolescents by helping them cope better.
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Affiliation(s)
| | | | - Mei-Hui Tseng
- National Taiwan University, Taiwan
- National Taiwan University Hospital, Taiwan
| | | | - Reinie Cordier
- Northumbria University, UK
- Curtin University, Australia
- University of Cape Town, South Africa
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Kentrou V, Livingston LA, Grove R, Hoekstra RA, Begeer S. Perceived misdiagnosis of psychiatric conditions in autistic adults. EClinicalMedicine 2024; 71:102586. [PMID: 38596613 PMCID: PMC11001629 DOI: 10.1016/j.eclinm.2024.102586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Many autistic people, particularly women, do not receive an autism diagnosis until adulthood, delaying their access to timely support and clinical care. One possible explanation is that autistic traits may initially be misinterpreted as symptoms of other psychiatric conditions, leading some individuals to experience misdiagnosis of other psychiatric conditions prior to their autism diagnosis. However, little is currently known about the frequency and nature of psychiatric misdiagnoses in autistic adults. Methods Using data collected in the first half of 2019 from an ongoing longitudinal register of autistic adults in the Netherlands, this study explored the frequency of perceived psychiatric misdiagnoses before receiving an autism diagnosis. Gender differences were also explored. A sample of 1211 autistic adults (52.6% women, mean age 42.3 years), the majority of whom were Dutch and relatively highly educated, was evaluated. Findings Results showed that 24.6% (n = 298) of participants reported at least one previous psychiatric diagnosis that was perceived as a misdiagnosis. Personality disorders were the most frequent perceived misdiagnoses, followed by anxiety disorders, mood disorders, chronic fatigue syndrome/burnout-related disorders, and attention-deficit/hyperactivity disorder. Autistic women (31.7%) reported perceived misdiagnoses more frequently than men (16.7%). Women were specifically more likely than men to report perceived misdiagnoses of personality disorders, anxiety disorders, and mood disorders. Women also reported prior psychiatric diagnoses more often in general (65.8% versus 34.2% in men). Within the group of individuals with a prior diagnosis, perceived misdiagnoses were equally likely for men and women. Interpretation One in four autistic adults, and one in three autistic women, reported at least one psychiatric diagnosis, obtained prior to being diagnosed with autism, that was perceived as a misdiagnosis. Inaccurate diagnoses are linked to long diagnostic pathways and delayed recognition of autism. These findings highlight the need for improved training of mental health practitioners, in order to improve their awareness of the presentation of autism in adulthood and of the complex relationship between autism and co-occurring conditions. The current study constitutes a first step towards showing that autistic adults, and particularly women, may be at greater risk of experiencing misdiagnoses. Future studies based on larger, more representative samples are required, to replicate current findings and provide more reliable estimates of the overall frequency of misdiagnoses as well as the frequency of misdiagnoses for specific psychiatric conditions. Funding This study was made possible by funding from the Netherlands Organisation for Health Research and Development (ZonMW), project number 60-63600-98-834.
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Affiliation(s)
- Vasiliki Kentrou
- Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lucy A Livingston
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Grove
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Rosa A Hoekstra
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sander Begeer
- Department of Clinical Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Capiotto F, Romano Cappi G, Mirlisenna I, Mazza A, Cicinelli G, Lauritano C, Keller R, Dal Monte O. Autonomic and hedonic response to affective touch in autism spectrum disorder. Autism Res 2024. [PMID: 38685201 DOI: 10.1002/aur.3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
Interpersonal touch plays a crucial role in shaping relationships and encouraging social connections. Failure in processing tactile input or abnormal tactile sensitivity may hamper social behaviors and have severe consequences in individuals' relational lives. Autism Spectrum Disorder (ASD) is characterized by both sensory disruptions and social impairments, making affective touch an ideal meeting point for understanding these features in ASD individuals. By integrating behavioral and physiological measures, we investigated the effects of affective touch on adult individuals with ASD from both an implicit and explicit perspective. Specifically, at an implicit level, we investigated whether and how receiving an affective touch influenced participants' skin conductance tonic and phasic components. At the explicit level, we delved into the affective and unpleasant features of affective touch. Overall, we observed lower skin conductance level in ASD compared to TD subjects. Interestingly, the typically developing (TD) group showed an increased autonomic response for affective touch compared to a control touch, while ASD subjects' autonomic response did not differ between the two conditions. Furthermore, ASD participants provided higher ratings for both the affective and unpleasant components of the touch, compared to TD subjects. Our results reveal a noteworthy discrepancy in ASD population between the subjective experience, characterized by amplified hedonic but also unpleasant responses, and the physiological response, marked by a lack of autonomic activation related to affective touch. This insightful dissociation seems crucial for a deeper understanding of the distinctive challenges characterizing people with ASD and may have implications for diagnosis and therapeutic approaches.
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Affiliation(s)
| | | | | | | | - Giovanni Cicinelli
- Adult Autism Center, Mental Health Department, Local Health Unit ASL Città di Torino, Turin, Italy
| | - Chiara Lauritano
- Adult Autism Center, Mental Health Department, Local Health Unit ASL Città di Torino, Turin, Italy
| | - Roberto Keller
- Adult Autism Center, Mental Health Department, Local Health Unit ASL Città di Torino, Turin, Italy
| | - Olga Dal Monte
- Department of Psychology, University of Turin, Turin, Italy
- Department of Psychology, Yale University, New Haven, Connecticut, USA
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6
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Mantzalas J, Richdale AL, Li X, Dissanayake C. Measuring and validating autistic burnout. Autism Res 2024. [PMID: 38660943 DOI: 10.1002/aur.3129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2024] [Indexed: 04/26/2024]
Abstract
Researchers have begun to explore the characteristics and risk factors for autistic burnout, but assessment tools are lacking. Our study comprehensively examined and compared the psychometric properties of the unpublished 27-item AASPIRE Autistic Burnout Measure (ABM), and personal and work scales of the Copenhagen Burnout Inventory (CBI) to evaluate their efficacy as screening measures for autistic burnout, with a group of 238 autistic adults. Exploratory factor analyses (EFA) revealed a 4-factor structure for the ABM and a 2-factor structure for the CBI personal scale (CBI-P). Factorial validity and dimensionality were examined with four exploratory models which indicated a unidimensional structure for the ABM with an overarching 'Autistic Burnout' construct, and multidimensional CBI-P structure comprising two subscales and overarching 'Personal Burnout' construct. Other reliability and validity indicators included Spearman correlations, analysis of variance, receiver operating characteristics, sensitivity, specificity, and intra-class correlations (ICC). The ABM and CBI-P were strongly correlated with depression, anxiety, stress, and fatigue. Unexpectedly, correlations between the burnout measures and camouflaging, and wellbeing measures were moderate. Potential overlap between burnout and depression and fatigue was examined through EFA, which supported convergent validity of the ABM and depression measure, while correlations and ICC analyses revealed mixed results. We concluded that the ABM and the CBI-P Emotional Exhaustion subscale were valid preliminary screening tools for autistic burnout. Testing with larger and more diverse autistic samples is required to further examine the psychometric properties of the ABM, and to understand the relationships between autistic burnout and depression, and masking.
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Affiliation(s)
- Jane Mantzalas
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Xia Li
- La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
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Bradley S, Moore F, Duffy F, Clark L, Suratwala T, Knightsmith P, Gillespie-Smith K. Camouflaging, not sensory processing or autistic identity, predicts eating disorder symptoms in autistic adults. Autism 2024:13623613241245749. [PMID: 38634458 DOI: 10.1177/13623613241245749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
LAY ABSTRACT This study aimed to explore the impact of Autistic identity (i.e. feeling like you belong to the Autistic community), sensory profiles (e.g. being over or under responsive to sensations) and camouflaging behaviours (i.e. masking) on eating disorder symptoms in Autistic adults. 180 Autistic people were recruited from the community and NHS. The Autistic people completed online questionnaires measuring Autistic identity, sensory profiles, camouflaging behaviours, autistic traits and eating disorder symptoms. The analysis showed that higher levels of camouflaging behaviour predicted higher levels of eating disorder symptoms. Sensory profiles were related to but did not predict eating disorder symptoms and there was no relationship between level of Autistic identity and eating disorder symptoms. This shows that camouflaging is the most important predictor of eating disorder symptoms in Autistic people, and warrants further exploration.
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Affiliation(s)
| | | | - Fiona Duffy
- The University of Edinburgh, UK
- NHS Lothian, UK
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Woodhouse E, Hollingdale J, Davies L, Al-Attar Z, Young S, Vinter LP, Agyemang K, Bartlett C, Berryessa C, Chaplin E, Deeley Q, Freckelton I, Gerry F, Gudjonsson G, Maras K, Mattison M, McCarthy J, Mills R, Misch P, Murphy D, Allely C. Identification and support of autistic individuals within the UK Criminal Justice System: a practical approach based upon professional consensus with input from lived experience. BMC Med 2024; 22:157. [PMID: 38609939 PMCID: PMC11015650 DOI: 10.1186/s12916-024-03320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. METHODS This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. RESULTS The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. CONCLUSION Greater attention needs to be given to this population as they navigate the CJS.
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Affiliation(s)
- Emma Woodhouse
- Compass Psychology Services Ltd, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Zainab Al-Attar
- University of Oxford, London, UK
- University College London, London, UK
- Victoria University, Melbourne, Australia
- University of Central Lancashire, Preston, UK
| | - Susan Young
- Psychology Services Limited, London, UK
- University of Reykjavík, Reykjavík, Iceland
| | - Luke P Vinter
- Department of Criminology, University of Derby, Derby, UK
| | | | | | | | - Eddie Chaplin
- London South Bank University, Institute of Health and Social Care, London, UK
| | - Quinton Deeley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Autism Unit, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Freckelton
- Law Faculty and Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Castan Chambers, Melbourne, Australia
| | - Felicity Gerry
- Libertas Chambers, London, UK
- Crockett Chambers, Melbourne, Australia
| | - Gisli Gudjonsson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Jane McCarthy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Auckland, Auckland, New Zealand
| | - Richard Mills
- AT-Autism, London, UK
- Department of Psychology, University of Bath, Bath, UK
| | | | - David Murphy
- Broadmoor Hospital, West London NHS Trust, London, UK
| | - Clare Allely
- School of Health and Society, University of Salford, Manchester, UK.
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Martin J. Why are females less likely to be diagnosed with ADHD in childhood than males? Lancet Psychiatry 2024; 11:303-310. [PMID: 38340761 DOI: 10.1016/s2215-0366(24)00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
ADHD is less likely to be diagnosed in females than males, especially in childhood. Females also typically receive the diagnosis later than males and are less likely to be prescribed ADHD medication. Understanding why these sex differences in clinical care and treatment for ADHD occur is key to improving timely diagnosis in people affected by ADHD. This Personal View is a conceptual review synthesising literature on this topic. This publication considers potential biological explanations (eg, genetic factors), influence of diagnostic practices (eg, criteria suitability, diagnostic overshadowing, and sex-specific diagnostic thresholds), and sociocultural explanations (eg, sex differences in presentation and compensatory behaviours), for the observed sex differences in ADHD clinical practice. This Personal View also outlines future research directions for improving understanding of sex differences in recognition and diagnosis of ADHD.
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Affiliation(s)
- Joanna Martin
- Centre for Neuropsychiatric Genetics and Genomics and Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK.
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10
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Boettcher J, Orm S, Fjermestad KW. Autism traits, social withdrawal, and behavioral and emotional problems in a Norwegian cohort of adolescents with rare genetic disorders. Res Dev Disabil 2024; 147:104699. [PMID: 38367299 DOI: 10.1016/j.ridd.2024.104699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Adolescents with rare genetic disorders represent a population that can be at risk in psychosocial terms. Despite its importance, the association of autism traits and social withdrawal in behavioral and emotional problems in adolescents with rare genetic disorders remains understudied. AIM The study aimed to empirically examine the clinical characteristics of adolescents with rare genetic disorders with a behavior theory-driven approach. METHOD We investigated the behavioral and emotional problems and current and lifetime autistic traits in a sample of 93 Norwegian adolescents (Mage = 13.2 years, SDage = 2.4, rangeage 10-17, 62.4% females, 37.6% males) with various rare genetic disorders. The adolescents were investigated cross-sectionally utilizing standardized psychometric questionnaires rated by their parents. RESULTS More current and lifetime autistic traits and social withdrawal were all associated with more internalizing problems. Further analyses demonstrated that social withdrawal partially mediated the positive association between current autistic traits and internalizing problems. In contrast, social withdrawal fully mediated the positive association between lifetime autistic traits and internalizing problems. CONCLUSION AND IMPLICATIONS Our results demonstrate important characteristics of adolescents with rare genetic disorders that may guide clinicians and future interventions. Social withdrawal may be prodromal to internalizing problems such as anxiety and depression. Thus, clinically addressing social withdrawal can represent a means to prevent internalizing problems in adolescents with rare genetic disorders and autistic traits.
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Affiliation(s)
- Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg, Eppendorf, Germany.
| | - Stian Orm
- Division Mental Health Care, Innlandet Hospital Trust, Norway; Department of Psychology, Inland Norway University of Applied Sciences, Norway
| | - Krister Westlye Fjermestad
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway; Department of Psychology, University of Oslo, Norway
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11
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van der Putten WJ, Mol AJJ, Radhoe TA, Torenvliet C, Agelink van Rentergem JA, Groenman AP, Geurts HM. The relationship between camouflaging and mental health: Are there differences among subgroups in autistic adults? Autism 2024; 28:908-919. [PMID: 37497845 PMCID: PMC10981194 DOI: 10.1177/13623613231185402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
LAY ABSTRACT When autistic people use strategies to hide their autistic characteristics, we call this camouflaging. Autistic adults suggested that camouflaging can result in mental health difficulties. That is, people who report to camouflage also report mental health difficulties. However, since there are many differences between autistic people, this relationship may also differ between subgroups. Therefore, in this study we investigated whether camouflaging and mental health difficulties are related and whether this relationship is equal for all autistic adults. For this study, 352 autistic adults aged 30-84 years filled in the Dutch Camouflaging Autistic Traits Questionnaire to measure camouflaging and the Symptom Checklist-90 Revised to measure mental health difficulties. We found that camouflaging was moderately related to mental health difficulties. This means that people who report more camouflaging also report more mental health difficulties. When we looked closer, we found that this relationship was strong for only a small subgroup of autistic adults. In most other autistic adults, there was a small or no relationship between camouflaging and mental health difficulties. Therefore, it is important that clinicians are aware of camouflaging and its possible relationship with mental health difficulties, but that they do not generalize the negative consequences to everyone.
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Affiliation(s)
- Wikke J van der Putten
- Leo Kannerhuis (Youz/Parnassia Group), The Netherlands
- University of Amsterdam, The Netherlands
| | - Audrey JJ Mol
- Leo Kannerhuis (Youz/Parnassia Group), The Netherlands
| | | | | | | | | | - Hilde M Geurts
- Leo Kannerhuis (Youz/Parnassia Group), The Netherlands
- University of Amsterdam, The Netherlands
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Schiltz HK, Williams ZJ, Zheng S, Kaplan-Kahn EA, Morton HE, Rosenau KA, Nicolaidis C, Sturm A, Lord C. Measurement matters: A commentary on the state of the science on patient reported outcome measures (PROMs) in autism research. Autism Res 2024; 17:690-701. [PMID: 38429884 DOI: 10.1002/aur.3114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
High quality science relies upon psychometrically valid and reliable measurement, yet very few Patient Reported Outcome Measures (PROMs) have been developed or thoroughly validated for use with autistic individuals. The present commentary summarizes the current state of autism PROM science, based on discussion at the Special Interest Group (SIG) at the 2022 International Society for Autism Research (INSAR) Annual Meeting and collective expertise of the authors. First, we identify current issues in autism PROM research including content and construct operationalization, informant-structure, measure accessibility, and measure validation and generalization. We then enumerate barriers to conducting and disseminating this research, such as a lack of guidance, concerns regarding funding and time, lack of accessible training and professionals with psychometric skills, difficulties collecting large representative samples, and challenges with dissemination. Lastly, we offer future priorities and resources to improve PROMs in autism research including a need to continue to evaluate and develop PROMs for autistic people using robust methods, to prioritize diverse and representative samples, to expand the breadth of psychometric properties and techniques, and to consider developing field specific guidelines. We remain extremely optimistic about the future directions of this area of autism research. This work is well positioned to have an immense, positive impact on our scientific understanding of autism and the everyday lives of autistic people and their families.
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Affiliation(s)
- Hillary K Schiltz
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, California, Los Angeles, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, Universtiy of California San Francisco, San Francisco, California, USA
| | - Elizabeth A Kaplan-Kahn
- Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah E Morton
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Kashia A Rosenau
- Department of Medicine, University of California Los Angeles, California, Los Angeles, USA
| | - Christina Nicolaidis
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- School of Social Work, Portland State University, Portland, Oregon, USA
| | - Alexandra Sturm
- Department of Psychological Science, Loyola Marymount University, Los Angeles, California, USA
| | - Catherine Lord
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, California, Los Angeles, USA
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van der Putten WJ, Mol AJJ, Groenman AP, Radhoe TA, Torenvliet C, van Rentergem JAA, Geurts HM. Is camouflaging unique for autism? A comparison of camouflaging between adults with autism and ADHD. Autism Res 2024; 17:812-823. [PMID: 38323512 DOI: 10.1002/aur.3099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
Camouflaging (using (un)conscious strategies to appear as non-autistic) is thought to be an important reason for late autism diagnoses and mental health difficulties. However, it is unclear whether only autistic people camouflage or whether people with other neurodevelopmental or mental health conditions also use similar camouflaging strategies. Therefore, in this preregistered study (AsPredicted: #41811) study, we investigated if adults with attention-deficit/hyperactivity-disorder (ADHD) also camouflage. Adults aged 30-90 years filled in the Dutch Camouflaging Autistic Traits Questionnaire (CAT-Q-NL), the ADHD Self-Report (ADHD-SR) and the Autism Spectrum Quotient (AQ). We investigated differences in camouflaging between adults with ADHD, autism, and a comparison group in an age and sex-matched subsample (N = 105 per group). We explored if autism and ADHD traits explained camouflaging levels in adults with an autism and/or ADHD diagnosis (N = 477). Adults with ADHD scored higher on total camouflaging and assimilation subscale compared to the comparison group. However, adults with ADHD scored lower on total camouflaging, and subscales compensation and assimilation than autistic adults. Autism traits, but not ADHD traits, were a significant predictor of camouflaging, independent of diagnosis. Thus, camouflaging does not seem to be unique to autistic adults, since adults with ADHD also show camouflaging behavior, even though not as much as autistic adults. However, as the CAT-Q-NL specifically measures camouflaging of autistic traits it is important to develop more general measures of camouflaging, to compare camouflaging more reliably in people with different mental health conditions. Furthermore, focusing on camouflaging in adults with ADHD, including potential consequences for late diagnoses and mental health seems a promising future research avenue.
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Affiliation(s)
- W J van der Putten
- Leo Kannerhuis, Autism Outpatient Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - A J J Mol
- Leo Kannerhuis, Autism Outpatient Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
| | - A P Groenman
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - T A Radhoe
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - C Torenvliet
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - J A Agelink van Rentergem
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - H M Geurts
- Leo Kannerhuis, Autism Outpatient Clinic (Youz/Parnassia Group), Amsterdam, The Netherlands
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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14
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O'Connor RA, Doherty M, Ryan-Enright T, Gaynor K. Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience. Autism 2024; 28:816-830. [PMID: 38145308 DOI: 10.1177/13623613231215026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
LAY ABSTRACT Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.
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Affiliation(s)
- Rachel Ag O'Connor
- School of Psychology, University College Dublin, Republic of Ireland
- Health Service Executive, Republic of Ireland
| | - Mary Doherty
- Brighton and Sussex Medical School, Brighton, UK
- Our Lady's Hospital, Navan, Republic of Ireland
| | - Theresa Ryan-Enright
- School of Psychology, University College Dublin, Republic of Ireland
- Health Service Executive, Republic of Ireland
| | - Keith Gaynor
- School of Psychology, University College Dublin, Republic of Ireland
- DETECT, Early Intervention Service, Blackrock, Republic of Ireland
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Keating CT, Hickman L, Geelhand P, Takahashi T, Leung J, Monk R, Schuster B, Rybicki A, Girolamo TM, Clin E, Papastamou F, Belenger M, Eigsti IM, Cook JL, Kosaka H, Osu R, Okamoto Y, Sowden-Carvalho S. Cross-cultural variation in experiences of acceptance, camouflaging and mental health difficulties in autism: A registered report. PLoS One 2024; 19:e0299824. [PMID: 38507392 PMCID: PMC10954134 DOI: 10.1371/journal.pone.0299824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Abstract
Recent findings suggest that stigma and camouflaging contribute to mental health difficulties for autistic individuals, however, this evidence is largely based on UK samples. While studies have shown cross-cultural differences in levels of autism-related stigma, it is unclear whether camouflaging and mental health difficulties vary across cultures. Hence, the current study had two aims: (1) to determine whether significant relationships between autism acceptance, camouflaging, and mental health difficulties replicate in a cross-cultural sample of autistic adults, and (2) to compare these variables across cultures. To fulfil these aims, 306 autistic adults from eight countries (Australia, Belgium, Canada, Japan, New Zealand, South Africa, the United Kingdom, and the United States) completed a series of online questionnaires. We found that external acceptance and personal acceptance were associated with lower levels of depression but not camouflaging or stress. Higher camouflaging was associated with elevated levels of depression, anxiety, and stress. Significant differences were found across countries in external acceptance, personal acceptance, depression, anxiety, and stress, even after controlling for relevant covariates. Levels of camouflaging also differed across countries however this effect became non-significant after controlling for the covariates. These findings have significant implications, identifying priority regions for anti-stigma interventions, and highlighting countries where greater support for mental health difficulties is needed.
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Affiliation(s)
- Connor Tom Keating
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Lydia Hickman
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Philippine Geelhand
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Toru Takahashi
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Joan Leung
- School of Psychology, University of Auckland, Auckland, New Zealand
| | - Ruth Monk
- Autistic Member of the Autism New Zealand Community Advisory Group, New Zealand/School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Bianca Schuster
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Department of Cognition, Emotion and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Alicia Rybicki
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Teresa Marie Girolamo
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States of America
| | - Elise Clin
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Fanny Papastamou
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Marie Belenger
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, United States of America
| | - Jennifer Louise Cook
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Hirotaka Kosaka
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Yuko Okamoto
- Waseda Institute for Advanced Study, Waseda University, Tokyo, Japan
| | - Sophie Sowden-Carvalho
- Centre for Developmental Science, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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McMaughan DJ, Lewis C, McGehee A, Noreen D, Parker E, Criss MM. Meaningful Social Inclusion and Mental Well-Being Among Autistic Adolescents and Emerging Adults: Protocol for a Community-Based Mixed Methods Study. JMIR Res Protoc 2024; 13:e52658. [PMID: 38483470 PMCID: PMC10979331 DOI: 10.2196/52658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND In the United States, autistic people face high rates of co-occurring mental illnesses and premature death due to self-harm, which are indicators of threats to mental well-being. Social inclusion may enhance mental well-being and resilience among autistic people. According to Simplican and colleague's (2015) model of social inclusion for people with intellectual and developmental disabilities, social inclusion is an interaction between community participation and interpersonal relationships. There is limited research on social inclusion that includes the integration of interpersonal relationships and community participation among autistic people or the impact of social inclusion on the well-being of autistic people. Additionally, little evidence exists regarding how autistic people prefer to be included in the community or form interpersonal relationships. OBJECTIVE The long-term objective of this project is to improve social inclusion factors to support the mental well-being of autistic people. This protocol describes a community-based, mixed methods pilot study to develop a definition of meaningful social inclusion for autistic people and to understand the relationship between meaningful social inclusion and mental well-being among autistic adolescents and emerging adults. METHODS The project uses a community-based, sequential mixed methods design with a formative phase (Phase 1) that informs a survey phase (Phase 2) and concludes with a process evaluation of the community engagement process (Phase 3). During Phase 1, we will recruit 10 community partners (autistic adults and stakeholders) and conduct sharing sessions to cocreate a definition of meaningful social inclusion and a survey of meaningful social inclusion and well-being. During Phase 2, we will recruit 200 participants (100 autistic adolescents and emerging adults and 100 caregivers) to complete the survey. We will examine whether meaningful social inclusion predicts well-being given sociodemographic factors using ordered logistic regression, with well-being categorized as low, medium, and high. During Phase 3, the community partners from Phase 1 will complete a survey on their experiences with the project. RESULTS Ethics approval was obtained for this project in March 2023. We have recruited community partners and started the Phase 1 focus groups as of September 2023. Phase 2 and Phase 3 have not yet started. We expect to complete this study by March 2025. CONCLUSIONS Using a community-based, mixed methods approach, we intended to develop a definition of meaningful social inclusion for autistic people and understand the role meaningful social inclusion plays in the well-being of autistic people. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52658.
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Affiliation(s)
- Darcy Jones McMaughan
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Casey Lewis
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Amy McGehee
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Dani Noreen
- Neurodiversity Unbound, Aurora, CO, United States
| | - Elliot Parker
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
| | - Michael M Criss
- Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States
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17
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Baiden KMP, Williams ZJ, Schuck RK, Dwyer P, Wang M. The Social Validity of Behavioral Interventions: Seeking Input from Autistic Adults. J Autism Dev Disord 2024:10.1007/s10803-024-06297-3. [PMID: 38470531 DOI: 10.1007/s10803-024-06297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
Many in the autistic community have expressed concerns regarding the use of behavioral interventions with autistic children, suggesting that these interventions may not be socially valid. Though behavioral interventions have evolved to be more naturalistic and child-centered, little structured research has been done to explicitly seek autistic perspectives on the acceptability of specific components of behavioral interventions. Autistic adults (N = 235) were recruited online to take the Autism Intervention Attitudes Scale (AIAS), a questionnaire designed to gather feedback on common intervention goals and practices. Results indicate that participants find goals and practices that highlight quality of life, safety, and autistic interactions acceptable, while those that focus on normalization based on neurotypical standards are not. An exploratory graph analysis revealed three communities of goals ("uncontroversial goals", "controversial goals", and "social goals"). Comparison between naturalistic and structured intervention components additionally showed that autistic participants favored naturalistic strategies. These findings are in line with known criticisms of behavioral intervention from autistic adults, but also provide more information on the specific ways in which behavioral interventions can be reformed. This information can guide professionals in the development of appropriate goals and decisions around intervention planning.
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Affiliation(s)
- Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA.
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, USA
| | - Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
- Olga Tennison Autism Research Centre (OTARC), School of Psychology and Public Health, La Trobe University, Bundoora, VIC, Australia
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, USA
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18
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Cook J, Hull L, Mandy W. Improving Diagnostic Procedures in Autism for Girls and Women: A Narrative Review. Neuropsychiatr Dis Treat 2024; 20:505-514. [PMID: 38469208 PMCID: PMC10926859 DOI: 10.2147/ndt.s372723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/14/2024] [Indexed: 03/13/2024] Open
Abstract
Biases exist in the diagnostic process for autism spectrum disorder (henceforth "autism"), which result in some girls and women being diagnosed later or missed entirely. Current diagnostic tools may not capture the full range of behavioural presentations of autism, leading to under-identification. This review explores why these biases may occur, and how diagnostic procedures could be adapted to better identify autistic girls and women. We recommend that diagnostic assessments are adjusted to capture a broader range of behavioural exemplars of autism; that camouflaging of autistic traits is taken into account; and that care is taken to ensure co-occurring mental health conditions do not overshadow autism diagnosis. We offer recommendations, building on gold-standard diagnostic guidelines, for how diagnostic procedures can be improved for girls and women.
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Affiliation(s)
- Julia Cook
- Social, Genetic and Developmental Psychiatry Centre, King’s College London, London, UK
| | - Laura Hull
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Will Mandy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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19
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Milner V, Colvert E, Hull L, Cook J, Ali D, Mandy W, Happé F. Does camouflaging predict age at autism diagnosis? A comparison of autistic men and women. Autism Res 2024; 17:626-636. [PMID: 38031639 DOI: 10.1002/aur.3059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
It is frequently reported that females are likely to receive an autism diagnosis at a later age than their male counterparts, despite similar levels of autistic traits. It has been suggested that this delay in diagnosis may in part reflect the propensity of females, more than males, to engage in camouflaging behaviors that reduce the appearance of autism-related traits. This article presents two studies which examined the relationship between gender/sex, camouflaging, and age at diagnosis in two samples of (cis-gender) autistic adults. Study 1 included data from three online samples including 242 autistic men and 570 autistic women aged 18-75 years. Study 2 included data from a longitudinal population-based sample including 24 autistic men and 35 autistic women aged 20-24 years. Camouflaging was measured with the self-report Camouflaging Autistic Traits Questionnaire (CAT-Q). Overall, the results showed that, on average, females were diagnosed later than males. There was a stronger relationship between camouflaging and age at autism diagnosis (AaD) for females, compared with males. Within sample one, there was a significant camouflaging-by-sex interaction; high-camouflaging females had a later AaD. The role of autistic traits and changes in attitudes towards female autism and camouflaging need further exploration. These findings highlight the need for greater clinician and key stakeholder awareness and understanding of camouflaging behavior, particularly for females, during the diagnostic process.
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Affiliation(s)
- Victoria Milner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, UK
| | - Emma Colvert
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, UK
| | - Laura Hull
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Julia Cook
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Dorota Ali
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, UK
| | - William Mandy
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, UK
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20
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Rynkiewicz A, Zheng S, Lacroix A. Special considerations for assessing and caring for autism in girls and women. Curr Opin Psychiatry 2024; 37:71-77. [PMID: 38085884 DOI: 10.1097/yco.0000000000000913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW As the specificities of autistic women are increasingly recognized, this review aims to highlight emerging areas of research. These areas primarily focus on measurement bias of diagnostic tools, the physical and mental health of autistic women, and the unique aspects of the lives of autistic women, both personally and professionally across all life stages. RECENT FINDINGS Conventional diagnostic tools struggle to capture the specificities of autism in females, but more sensitive instruments like the GQ-ASC (Girls' Questionnaire for Autism Spectrum Conditions), later also referred to as Q-ASC (Questionnaire for Autism Spectrum Conditions) in the scientific literature, show better performances. Autistic women face particular challenges, including an increased risk of physical and mental health problems throughout their lives as women (puberty, motherhood, menopause). Autistic women also encounter specific difficulties in their employment that require greater consideration. SUMMARY The findings of this review identify research areas that need to be developed to better understand and support autistic girls and women and to enhance clinical practice for them.
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Affiliation(s)
- Agnieszka Rynkiewicz
- Department of Psychiatry, College of Medical Sciences, University of Rzeszow, Rzeszow
- Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdansk, Poland
| | - Shuting Zheng
- Department of Psychiatry and Behavioral Sciences, University of California, California, San Francisco, USA
| | - Adeline Lacroix
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
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Loo BRY, Teo TJY, Liang MJ, Leong DJ, Tan DW, Zhuang S, Hull L, Livingston LA, Mandy W, Happé F, Magiati I. Exploring autistic adults' psychosocial experiences affecting beginnings, continuity and change in camouflaging over time: A qualitative study in Singapore. Autism 2024; 28:627-643. [PMID: 37300411 DOI: 10.1177/13623613231180075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
LAY ABSTRACT Over their lifetimes, many autistic people learn to camouflage (hide or mask) their autism-related differences to forge relationships, find work and live independently in largely non-autistic societies. Autistic adults have described camouflaging as a 'lifetime of conditioning . . . to act normal' involving 'years of effort', suggesting that camouflaging develops over an autistic person's lifetime and may start early on, in childhood or adolescence. Yet, we know very little about why and how autistic people start to camouflage, or why and how their camouflaging behaviours continue or change over time. We interviewed 11 Singaporean autistic adults (9 male, 2 female, 22-45 years old) who shared their camouflaging experiences. We found that autistic adults' earliest motivations to camouflage were largely related to the desire to fit in and connect with others. They also camouflaged to avoid difficult social experiences (such as being teased or bullied). Autistic adults shared that their camouflaging behaviours became more complex and that, for some, camouflaging became a part of their self-identity over time. Our findings suggest that society should not pathologise autistic differences, but instead accept and include autistic people, to reduce the pressure on autistic people to hide who they truly are.
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Affiliation(s)
| | | | | | | | - Diana Weiting Tan
- Macquarie University, Australia
- The University of Western Australia, Australia
| | - Sici Zhuang
- The University of Western Australia, Australia
| | | | | | | | | | - Iliana Magiati
- National University of Singapore, Singapore
- The University of Western Australia, Australia
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22
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Liu CH, Chen YL, Chen PJ, Ni HC, Lai MC. Exploring camouflaging by the Chinese version Camouflaging Autistic Traits Questionnaire in Taiwanese autistic and non-autistic adolescents: An initial development. Autism 2024; 28:690-704. [PMID: 37427427 DOI: 10.1177/13623613231181732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
LAY ABSTRACT Camouflaging is a coping strategy used by some autistic and other neurodivergent people to fit in neurotypical social contexts. The self-reported Camouflaging Autistic Traits Questionnaire has been validated for use in research with adults in some Western societies, but not in non-Western cultural-ethnic groups. We translated Camouflaging Autistic Traits Questionnaire into traditional Chinese and examined the use of this measure in Taiwanese adolescents via both self-report and caregiver-report in 100 autistic and 105 non-autistic adolescents. Both self-reported and caregiver-reported Chinese version Camouflaging Autistic Traits Questionnaire were composed of two factors (i.e. a "compensation-masking" subscale and an "assimilation" subscale). Both adolescent self-reported and caregiver-reported Chinese version Camouflaging Autistic Traits Questionnaire total score and subscales were reliable in measurement, and they highly correlated with each other. Taiwanese autistic adolescents were more likely to camouflage than non-autistic adolescents, especially on assimilation. Female autistic adolescents showed higher assimilation than male autistic adolescents. Higher camouflaging, especially assimilation, was associated with higher stress in autistic and non-autistic adolescents alike. Both self-reported and caregiver-reported Chinese version Camouflaging Autistic Traits Questionnaire were reliable and offered meaningful information to help us understand the social coping experiences of autistic and non-autistic adolescents.
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Affiliation(s)
| | | | - Pei-Jung Chen
- Chang Gung Memorial Hospital at Taoyuan, Taiwan
- King's College London, UK
| | | | - Meng-Chuan Lai
- Centre for Addiction and Mental Health, Canada
- The Hospital for Sick Children, Canada
- University of Toronto, Canada
- University of Cambridge, UK
- National Taiwan University Hospital and College of Medicine, Taiwan
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23
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Muraškaitė I, Žardeckaitė-Matulaitienė K. The effect of autism phenotype and diagnosis disclosure on students' desire for social distance from autistic peers. Autism 2024:13623613241230128. [PMID: 38411107 DOI: 10.1177/13623613241230128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
LAY ABSTRACT Autistic students experience loneliness, rejection from peers, which might negatively affect both their well-being, as well as academic results. Others have studied this topic, however, the existing research does not analyze the desire for social distance from autistic female students in higher education. The goal of this study was to evaluate whether the way autism is expressed and disclosing the autism diagnosis had an effect on students' willingness to interact with autistic male and female students. We also analyzed participants' knowledge about autism, contact with autistic people in the past and its pleasantness in relation to their willingness to interact with autistic students described in the scenarios of the present study. We found that students were less willing to interact with autistic male students compared to autistic female students, as well as with autistic students whose diagnosis was not disclosed compared to autistic students whose diagnosis was disclosed to the raters. In addition, students who reported more pleasant contact with autistic individuals in the past were more willing to socially interact with autistic students if their diagnosis was disclosed. Students with higher knowledge of autism expressed greater willingness to interact with autistic males and autistic students regardless of diagnosis disclosure. Findings suggest that autistic males and individuals who prefer not to disclose their diagnosis are more vulnerable to social exclusion. More subtle expressions of autism need to be researched further.
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24
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Han E, Scior K, Grace K, Heath E, Dufresne S, Crane L. 'Who, When, How to Share': Pilot study of a new disclosure decision-making programme for autistic adults. Autism 2024:13623613231221685. [PMID: 38339979 DOI: 10.1177/13623613231221685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
LAY ABSTRACT 'Who, When, How to Share' is a new programme that aims to support autistic adults in making decisions around sharing their autistic identity with others. The programme involves working through a self-help guide independently over 3 weeks with optional peer support. We wanted to find out if autistic adults would join the programme and find it useful. Thirty-two autistic adults took part in the programme and 19 of them completed it. Most participants who completed the programme liked the programme and found it helpful, but some felt that they needed more time and support to complete it. They suggested that the programme would be more accessible if it was more interactive, such as including videos and other ways to gain feedback on their progress. Surveys filled in by participants before and after the programme suggested that they became more confident and less stressed about sharing their autistic identity with others, but some felt they still needed to build more confidence in order to handle negative attitudes from others. More work is needed to improve and test the programme further.
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Affiliation(s)
- Emeline Han
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, UK
| | - Katrina Scior
- UCL Research Department of Clinical, Educational and Health Psychology, UK
| | - Kana Grace
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, UK
| | | | - Simone Dufresne
- Eliot-Pearson Department of Child Study & Human Development, Tufts University, USA
| | - Laura Crane
- Centre for Research in Autism and Education (CRAE), IOE, UCL's Faculty of Education and Society, UK
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Schuck RK, Dwyer P, Baiden KMP, Williams ZJ, Wang M. Social Validity of Pivotal Response Treatment for Young Autistic Children: Perspectives of Autistic Adults. J Autism Dev Disord 2024; 54:423-441. [PMID: 36427175 PMCID: PMC10821825 DOI: 10.1007/s10803-022-05808-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
The social validity of autism behavioral intervention has been questioned. Naturalistic Developmental Behavioral Interventions (NDBIs) attempt to address some concerns, but it is unclear whether autistic people consider NDBIs socially valid. Social validity of an NDBI, Pivotal Response Treatment (PRT), was investigated through autistic adults commenting on videos of autistic children receiving PRT. Qualitative coding of responses generated three themes: respect for individuals; assessment of intervention implementation; and socioemotional considerations. Although video brevity limits the scope of the present study's conclusions, participants highlighted PRT components that appeared socially valid (e.g., reinforcing attempts, following the child's lead) and aspects appearing invalid (e.g., overemphasis on spoken language). Therefore, adjustments appear necessary for PRT to be fully acceptable to the autistic community.
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Affiliation(s)
- Rachel K Schuck
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Patrick Dwyer
- Department of Psychology, University of California, Davis, Davis, USA
- Center for Mind and Brain, University of California, Davis, Davis, USA
| | - Kaitlynn M P Baiden
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, USA
| | - Mian Wang
- Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA
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Lacroix A, Harquel S, Mermillod M, Garrido M, Barbosa L, Vercueil L, Aleysson D, Dutheil F, Kovarski K, Gomot M. Sex modulation of faces prediction error in the autistic brain. Commun Biol 2024; 7:127. [PMID: 38273091 PMCID: PMC10810845 DOI: 10.1038/s42003-024-05807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
Recent research suggests that autistic females may have superior socio-cognitive abilities compared to autistic males, potentially contributing to underdiagnosis in females. However, it remains unclear whether these differences arise from distinct neurophysiological functioning in autistic males and females. This study addresses this question by presenting 41 autistic and 48 non-autistic adults with a spatially filtered faces oddball paradigm. Analysis of event-related potentials from scalp electroencephalography reveal a neurophysiological profile in autistic females that fell between those of autistic males and non-autistic females, highlighting sex differences in autism from the initial stages of face processing. This finding underscores the urgent need to explore neurophysiological sex differences in autism and encourages efforts toward a better comprehension of compensation mechanism and a clearer definition of what is meant by camouflaging.
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Affiliation(s)
- Adeline Lacroix
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France.
| | - Sylvain Harquel
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
- Defitech Chair in Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, EPFL, Geneva, Switzerland
| | - Martial Mermillod
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
| | - Marta Garrido
- Cognitive Neuroscience and Computational Psychiatry Lab, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
- Graeme Clark Institute for Biomedical Engineering, University of Melbourne, Melbourne, VIC, Australia
| | - Leonardo Barbosa
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
- Fralin Biomedical Research Institute at VTC, Virginia Tech, Roanoke, VA, 24016, USA
| | - Laurent Vercueil
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
| | - David Aleysson
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, 38000, Grenoble, France
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, WittyFit, F-63000, Clermont-Ferrand, France
| | - Klara Kovarski
- Sorbonne Université, Faculté des Lettres, INSPE, Paris, France
- LaPsyDÉ, Université Paris-Cité, CNRS, Paris, France
| | - Marie Gomot
- UMR 1253 iBrain, Université de Tours, Inserm, Tours, France
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Vuijk R, Turner W, Zimmerman D, Walker H, Dandachi-FitzGerald B. Schema therapy in adults with autism spectrum disorder: A scoping review. Clin Psychol Psychother 2024. [PMID: 38214936 DOI: 10.1002/cpp.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Schema therapy (ST) in adults with autism spectrum disorder (ASD) have gained increasing interest in clinical practice and research. However, to date, there has been no synthesis of the literature on ST as treatment for adults with ASD. Through a scoping review, we aim to summarize the emerging research and literature on ST for adults with ASD. METHODS A comprehensive literature search of three electronic databases was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Publications were included that examined ST in adults with ASD and non-clinical adults with autistic traits. RESULTS Systematic searches identified a total of 11 publications, all published since 2014, with the majority being conducted by Dutch and Japanese researchers. Of the 11 publications, 1 described an ST-informed social interaction training, 1 was an ST protocol, 2 described conceptual ST models, 2 were case examples, 2 examined early maladaptive schemas (EMSs) and 3 investigated the effectiveness of ST interventions. In summary, the theoretical exploration, practical examples of the application of ST and research findings with preliminary evidence of ST, EMSs and schema modes (SMs) in adults with ASD point towards the potential of ST for the treatment of adults with ASD. DISCUSSION The current scoping review highlights preliminary research findings and offers valuable suggestions for clinicians treating adults with ASD. This review underscores the need for development of and research in specialized ST protocols and programmes tailored to adults with ASD with chronic mental conditions, such as personality disorders (PDs).
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Affiliation(s)
- Richard Vuijk
- Sarr Autism Rotterdam (Parnassia Psychiatric Institute), Rotterdam, The Netherlands
| | - Wesley Turner
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - David Zimmerman
- Minds & Hearts, Stones Corner, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Hugh Walker
- Minds & Hearts, Stones Corner, Queensland, Australia
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Lenders M, Ouwens MA, Wilting RMHJ, Videler AC. First things first: An exploration of the effects of psychoeducation for older autistic adults. Autism 2024:13623613231219745. [PMID: 38197411 DOI: 10.1177/13623613231219745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
LAY ABSTRACT After receiving an autism diagnosis, psychoeducation (i.e. information regarding autism) is a first intervention. We adjusted a psychoeducation program that was originally developed by the Dutch Association for Autism for older adults to enhance its feasibility and efficacy in later life. We expected that participants would report an increase in knowledge and acceptance of the diagnosis and that people close to them would also observe this. Indeed, we found this and participants and those close to them agreed on this. Furthermore, we found some evidence that older autistic adults were better at coping with their autism. We found no positive intervention effects on psychological distress. The feedback of participants and informants about the psychoeducation program was largely positive. In future research, we advise using larger group samples and larger time scales and we also advise to further adjust the program to the needs and requirements of older adults, and to help older autistic adults to construct a new narrative of themselves, and the life they have lived, in the light of the recent autism diagnosis.
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Affiliation(s)
| | | | | | - Arjan C Videler
- GGz Breburg, The Netherlands
- Tilburg University, The Netherlands
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Schuck RK, Fung LK. A dual design thinking - universal design approach to catalyze neurodiversity advocacy through collaboration among high-schoolers. Front Psychiatry 2024; 14:1250895. [PMID: 38268559 PMCID: PMC10806093 DOI: 10.3389/fpsyt.2023.1250895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Neurodiversity describes the fact that humans all have different brains with unique qualities that contribute to society. Though understanding of neurodiversity is gaining traction among the general public, there remains considerable stigma and prejudice toward neurodiverse people. One way to combat these issues is to teach individuals about neurodiversity and encourage them to develop advocacy skills. Development of such knowledge is especially important for adolescents, as they have the capacity to make small (e.g., interpersonal interactions) and large (e.g., school-wide) impacts. Methods Eighty-nine high schoolers participated in a two-week virtual summer camp in 2022; research consent/assent was obtained from 19 (11 neurodiverse/neurodivergent). Campers learned about neurodiversity, Universal Design for Learning (UDL), and Design Thinking (DT) through lectures from researchers and neurodivergent people, as well as group activities and discussions. Campers worked in small groups to design a neurodiversity advocacy project based on the principles of UDL and DT. Each group was facilitated by camp counselors-some of whom were neurodiverse-who were all committed to neurodiversity advocacy. Participants completed questionnaires about autism, ADHD, and dyslexia pre- and post-camp. Some also completed optional post-camp interviews. Results Pre-camp stigma toward neurodiverse conditions was generally low. However, autism stigma was significantly higher than dyslexia stigma (Z = -2.24, p = 0.025). After camp, autism stigma decreased (Z = -2.98, p = 0.003;) and autism [t(13) = 3.17, p = 0.007] and ADHD [t(13) = 2.87, p = 0.013] knowledge improved. There were no significant changes in ADHD or dyslexia stigma or dyslexia knowledge. Participants reported enjoying collaborating with other campers and learning about UDL and DT. Thematic analysis of interviews generated four themes: Increased Understanding of Neurodiversity; Increasing Empathy and Becoming Less Judgmental; Creating a Neurodiverse Community; and More Awareness is Needed. Discussion This pilot investigation suggests that a virtual summer camp can be effective in improving attitudes toward and knowledge of neurodiversity. Qualitative analysis indicated participants became more accepting after the camp, both in terms of being less judgmental toward neurodiverse people and more self-accepting among neurodivergent campers. Future research should investigate the long-term effects of such a program, particularly with diverse samples of students.
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Affiliation(s)
- Rachel K. Schuck
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- Department of Education, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Lawrence K. Fung
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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Field SL, Williams MO, Jones CRG, Fox JRE. A meta-ethnography of autistic people's experiences of social camouflaging and its relationship with mental health. Autism 2024:13623613231223036. [PMID: 38197398 DOI: 10.1177/13623613231223036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
LAY ABSTRACT Some autistic people describe trying to hide autistic behaviour and seem more neurotypical. Researchers called this 'social camouflaging' and have linked it with mental health difficulties. We used a step-by-step approach to identify research where autistic people talk about social camouflaging to explore the relationship between camouflaging and poor mental health. Thirteen studies were combined. The results describe how society negatively impacts autistic people's mental health, and camouflaging is a way to try and cope with this. Many autistic people find their camouflaging strategies have accidental negative consequences which also affect their mental health. Strategies which seemed 'successful' involved a lot of self-monitoring, were very mentally demanding or were very habitual and seemed to have more of an effect on mental health. This might be important for clinicians who support autistic people with mental health difficulties.
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Affiliation(s)
| | | | | | - John R E Fox
- Cardiff University, UK
- University of Liverpool, UK
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Riebel M, Krasny-Pacini A, Manolov R, Rohmer O, Weiner L. Compassion focused therapy for self-stigma and shame in autism: a single case pre-experimental study. Front Psychiatry 2024; 14:1281428. [PMID: 38260795 PMCID: PMC10800541 DOI: 10.3389/fpsyt.2023.1281428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Exposure to public stigma can lead to the internalization of autism-related stigma (i.e., self-stigma), associated with negative health, occupational and social outcomes. Importantly, self-stigma is linked to shame and social isolation. Although elevated self-stigma has been reported in autistic adults, to the best of our knowledge, interventions designed to target this issue are lacking. Compassion is an effective way to reduce the emotional correlates of self-stigma (i.e., shame) and their impacts on mental health. However, no study has investigated whether compassion focused therapy (CFT) can effectively reduce self-stigma in autistic adults. The present study aims at investigating whether and how self-compassion improvement following CFT may reduce self-stigma and shame in an autistic individual. Methods A single case pre-experimental design (SCED) was used with weekly repeated measures during four phases: (i) pure baseline without any intervention (A), (ii) case conceptualization (A'), (iii) intervention (B) where CFT was delivered, (iv) follow-up without intervention (FU). The participant is a 46-year-old autistic man with high self-stigma and shame. Self-report measures of self-compassion and self-stigma and a daily idiographic measure of shame were used. Results There was a large increase in self-compassion between pure baseline (A) and the intervention phase (A'B) (Tau-U = 0.99), maintained at follow-up. Similarly, there was a moderate decrease of self-stigma (Tau-U = 0.32). In contrast, when we compared the whole baseline phase AA' (i.e., considering the conceptualisation phase as baseline) to the intervention (B), there was no change in self-stigma (Tau-U = -0.09). There was no change in self-stigma between the intervention (B) and follow-up (Tau-U = -0.19). There was a moderate decrease in daily shame reports between the baseline (AA') and the intervention (B) (Tau-U = 0.31) and a moderate decrease between the pure baseline (A) and intervention phase (A'B) (Tau-U = 0.51). Conclusion CFT was feasible for this autistic client and our results show that CFT led to the improvement of self-compassion. Changes on self-stigma measures were moderate. Self-stigma may need more time to change. Because self-stigma is involved in poorer social functioning and mental health in autistic adults, our results are promising and suggesting conducting more large-scale studies on CFT in autistic adults.
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Affiliation(s)
- Marie Riebel
- Laboratoire de Psychologie des Cognitions (LPC, UR 4440), Université de Strasbourg, Strasbourg, France
- Centre d’Excellence STRAS&ND, Strasbourg, France
| | - Agata Krasny-Pacini
- Institut Universitaire de Réadaptation Clémenceau, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Inserm U1114, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Rumen Manolov
- Faculty of Psychology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Odile Rohmer
- Laboratoire de Psychologie des Cognitions (LPC, UR 4440), Université de Strasbourg, Strasbourg, France
- Centre d’Excellence STRAS&ND, Strasbourg, France
| | - Luisa Weiner
- Laboratoire de Psychologie des Cognitions (LPC, UR 4440), Université de Strasbourg, Strasbourg, France
- Centre d’Excellence STRAS&ND, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Psychiatrie, Santé Mentale et Addictologie, Strasbourg, France
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Edwards H, Wright S, Sargeant C, Cortese S, Wood-Downie H. Research Review: A systematic review and meta-analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults. J Child Psychol Psychiatry 2024; 65:4-17. [PMID: 37485556 DOI: 10.1111/jcpp.13855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Evidence that autism often manifests differently between males and females is growing, particularly in terms of social interaction and communication, but it is unclear if there are sex differences in restricted and repetitive behaviours and interests (RRBIs) when rigorously focusing on the narrow construct level (i.e., stereotyped behaviour, restricted interests, insistence on sameness, and/or sensory experiences). METHODS We conducted a systematic review and four random effects meta-analyses investigating sex differences in narrow construct measures of RRBIs in autistic children, adolescents, and adults (Prospero registration ID: CRD42021254221). Study quality was appraised using the Newcastle-Ottawa Quality Assessment Scale. RESULTS Forty-six studies were narratively synthesised and 25 of these were included in four random effects meta-analyses. Results found that autistic males had significantly higher levels of stereotyped behaviours (SMD = 0.21, 95% confidence interval (CI) [0.09, 0.33], p < .001) and restricted interests (SMD = 0.18, 95% CI [0.07, 0.29], p < .001) compared to autistic females. In contrast, there were no significant sex differences for sensory experiences (SMD = -0.09, 95% CI [-0.27, 0.09], p = .32) and insistence on sameness (SMD = 0.01, 95% CI [-0.03, 0.05], p = .68). The findings from the narrative synthesis were generally consistent with those from the meta-analyses and also found qualitative sex differences in the way RRBIs manifest. CONCLUSIONS Our findings show significant differences in narrowly defined RRBIs in males and females. Practitioners need to be aware of such differences, which could be contributing to the under-recognition of autism in females and may not be captured by current diagnostic instruments.
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Affiliation(s)
- Hannah Edwards
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
- Hampshire and Isle of Wight Educational Psychology Service (HIEP), Havant, UK
| | - Sarah Wright
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
| | - Cora Sargeant
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health - Developmental Lab, School of Psychology, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York, NY, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Henry Wood-Downie
- Doctorate in Educational Psychology, University of Southampton, Southampton, UK
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Ai W, Cunningham WA, Lai MC. The dimensional structure of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and predictors of camouflaging in a representative general population sample. Compr Psychiatry 2024; 128:152434. [PMID: 37922735 DOI: 10.1016/j.comppsych.2023.152434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES Some autistic people "camouflage" their differences by modeling neurotypical behaviors to survive in a neurotypical-dominant social world. It remains elusive whether camouflaging is unique to autism or if it entails similar experiences across human groups as part of ubiquitous impression management (IM). Here we examined camouflaging engagement and theoretical drivers in the general population, drawing on the transactional IM framework and contextualizing findings within both contemporary autism research and the past IM literature. METHODS A large representative U.S. general population sample (N = 972) completed this survey study. We combined exploratory item factor analysis and graph analysis to triangulate the dimensional structure of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and examined its correspondence with prior autism-enriched psychometric findings. We then employed hierarchical regression and elastic-net regression to identify the predictors of camouflaging, including demographic (e.g., age, gender), neurodivergence (i.e., autistic and ADHD traits), socio-motivational, and cognitive factors. RESULTS We found a three-factor/dimensional structure of the CAT-Q in the general population, nearly identical to that found in previous autism-enriched samples. Significant socio-motivational predictors of camouflaging included greater social comparison, greater public self-consciousness, greater internalized social stigma, and greater social anxiety. These camouflaging drivers overlap with findings in recent autistic camouflaging studies and prior IM research. CONCLUSIONS The novel psychometric and socio-motivational evidence demonstrates camouflaging as a shared social coping experience across the general population, including autistic people. This continuity guides a clearer understanding of camouflaging and has key implications for autism scholars, clinicians, and the broader clinical intersecting with social psychology research. Future research areas are mapped to elucidate how camouflaging/IM manifests and functions within person-environment transactions across social-identity and clinical groups.
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Affiliation(s)
- Wei Ai
- Department of Psychology, University of Toronto, Toronto, Ontario M5S 3G3, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1H4, Canada
| | - William A Cunningham
- Department of Psychology, University of Toronto, Toronto, Ontario M5S 3G3, Canada
| | - Meng-Chuan Lai
- Department of Psychology, University of Toronto, Toronto, Ontario M5S 3G3, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5T 1R8, Canada; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, United Kingdom; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei 100229, Taiwan.
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Bagg E, Pickard H, Tan M, Smith TJ, Simonoff E, Pickles A, Carter Leno V, Bedford R. Testing the social motivation theory of autism: the role of co-occurring anxiety. J Child Psychol Psychiatry 2023. [PMID: 38156503 DOI: 10.1111/jcpp.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The Social Motivation Theory proposes that social reward processing differences underlie autism. However, low social motivation has also been linked to higher anxiety. Given the co-occurrence between autism and anxiety, it is possible that anxiety drives the association between social motivation and autistic characteristics. This study tests the mechanisms underlying the association between social motivation and autistic traits. METHODS Participants were 165 adolescents (71 male), aged 10-16 years, from the Mapping profiles of cognition, motivation and attention in childhood (C-MAPS) study, enriched for autistic traits (70 participants with an autism diagnosis, 37 male). Participants completed a battery of online experimental tasks, including a Choose-a-Movie social motivation task and social cognition measures (theory of mind; emotion recognition), alongside parent-reported child anxiety and autistic traits. RESULTS Higher social motivation was significantly associated with lower autistic traits (β = -.26, p < .001). Controlling for social cognition did not change the association between social motivation and autistic traits. Controlling for anxiety did significantly reduce the strength of the association (unstandardized coefficient change: p = .003), although social motivation remained associated with autistic traits (β = -.16, p = .004). Post hoc analyses demonstrated differential sex-effects: The association between social motivation and autistic traits was significant only in the females (β = -.38, p < .001), as was the attenuation by anxiety (unstandardized coefficient change: p < .001). CONCLUSIONS The association between social motivation and autistic traits could be partially attributed to co-occurring anxiety. Sex-specific effects found in females may be due to environmental factors such as increased social demands in adolescent female relationships. Results are consistent with self-report by autistic individuals who do not identify as having reduced social motivation.
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Affiliation(s)
- Eloise Bagg
- Department of Psychology, University of Bath, Bath, UK
| | - Hannah Pickard
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Manting Tan
- Department of Psychology, University of Bath, Bath, UK
| | - Tim J Smith
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
- Creative Computing Institute, University of the Arts London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
| | - Virginia Carter Leno
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
| | - Rachael Bedford
- Department of Psychology, University of Bath, Bath, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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35
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Grace K, Remington A, Davies J, Crane L. Evaluating measures to assess loneliness in autistic adults. Autism 2023:13623613231217056. [PMID: 38143433 DOI: 10.1177/13623613231217056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
LAY ABSTRACT There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people.
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Jenks E, Selman F, Harmens M, Boon S, Tran T, Hobson H, Eagle S, Sedgewick F. Teaching higher education staff to understand and support autistic students: evaluation of a novel training program. Front Psychiatry 2023; 14:1264895. [PMID: 38188057 PMCID: PMC10770249 DOI: 10.3389/fpsyt.2023.1264895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Background Autistic students are particularly vulnerable to stressors within a university environment and are more likely to experience poor mental health than their non-autistic peers. Students' experiences of stigma from staff and peers, and the masking behaviors they deploy to minimize it, can also result in worsening mental health. Despite these concerns, there is a lack of tailored support for autistic students at university. The current project assesses a co-created training course for university staff focused on debunking stereotypes, educating about the autistic experience at university, mental health presentation among autistic individuals, and practical strategies to improve interactions with autistic students. Methods The Autism Stigma and Knowledge Questionnaire [ASK-Q] was administered before and after the training, to examine changes in trainees' understanding and acceptance of autism and autistic people. Post-training interviews and surveys were also conducted with trainees, covering the impact the training has had on their perceptions of autism, the strategies they found beneficial, and how they will use the materials in future. Results There were no statistically significant differences between pre- and post-training scores on the ASK-Q, likely due to ceiling effects as pre-training scores were high. Thematic analysis of interviews identified five themes: value of lived experience; developing nuanced, in-depth knowledge of autism; training as acceptable and feasible; links to professional practice; and systemic barriers. Conclusion Although ceiling effects meant there were no changes to participant's knowledge about autism and autistic people statistically, the qualitative data reveals the extensive benefits they gained from taking part in the training programs. Scoring highly on the ASK-Q did not mean that people could not learn important new information and benefit from the course. This more nuanced understanding of autism led to practical changes in their practice. Listening to and learning from autistic people was seen as particularly important, highlighting the value of co-production. Our results also emphasize the need for varied approaches to evaluating training effectiveness, as reliance on quantitative data alone would have missed the subtler, but impactful, changes our participants experienced. This has important implications for professional practice, both within higher education and more broadly.
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Affiliation(s)
- Emma Jenks
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Freya Selman
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Miriam Harmens
- Department of Psychology, University of York, York, United Kingdom
| | - Sarah Boon
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Trang Tran
- Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Hannah Hobson
- Department of Psychology, University of York, York, United Kingdom
| | - Sarah Eagle
- School of Education, University of Bristol, Bristol, United Kingdom
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Moore HL, Cassidy S, Rodgers J. Exploring the mediating effect of camouflaging and the moderating effect of autistic identity on the relationship between autistic traits and mental wellbeing. Autism Res 2023. [PMID: 38108621 DOI: 10.1002/aur.3073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
Mental health difficulties are prevalent among autistic adults. Camouflaging (behaving differently to fit in) may be a mechanism by which autistic traits and mental health difficulties relate to each other, but little research has considered the role of different facets of camouflaging. Additionally, autistic identity might buffer against camouflaging and mental health difficulties. This research aims to explore the mediating effects of camouflaging behaviours on the relationship between autistic traits and both positive and negative mental wellbeing, as well as how autistic identity might moderate the relationship between autistic traits and camouflaging, and also mental health. Data were available for 627 autistic adults, recruited through volunteer databases and social media. Participants completed measures of autistic traits, anxiety, depression, positive wellbeing, camouflaging behaviours (compensating for difficulties, masking, and assimilating/putting on an act) and autistic identity. Mediation and moderated mediation models were tested, applying 95% bootstrapped CIs (10,000 resamples) and including age, gender and diagnosis as covariates. There were no significant direct effects between autistic traits and mental wellbeing. Assimilation was a significant mediator of all mental wellbeing measures, and compensation was a significant mediator of positive wellbeing only. Autistic identity was not a significant moderator. Assimilation and compensation should be considered when offering psychological interventions to support mental wellbeing of autistic people. Additional research into external drivers of camouflaging (e.g. stigma) and mechanisms by which camouflaging impacts mental wellbeing, such as autonomy, authenticity, skill mastery and community, may identify other areas of support. Concurrently, societal change is necessary to reduce the need to camouflage.
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Affiliation(s)
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
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Petty S, Allen S, Pickup H, Woodier B. A Blog-Based Study of Autistic Adults' Experiences of Aloneness and Connection and the Interplay with Well-Being: Corpus-Based and Thematic Analyses. Autism Adulthood 2023; 5:437-449. [PMID: 38116056 PMCID: PMC10726169 DOI: 10.1089/aut.2022.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Background Autistic adults appear to be more vulnerable to mental ill health, with loneliness being a variable associated with multiple outcomes of poorer well-being. However, a description of meaningful social connection that is suitable for autistic adults is missing from this research, along with a missing understanding of the conditions that contribute to well-being. Methods In this study, autistic adults' experiences of connectedness and aloneness were systematically searched for within data collected from blogs. This contributed a creative method to hear the viewpoint of autistic adults. Corpus-based and thematic analyses explored the descriptions and contexts of relationships. A total of 16 autistic authors contributed views. Results Social connection was desired and was achieved through self-acceptance and rejecting deficit-based views of being autistic, and selectively choosing important relationships. Meaningful social connection changed over time, being more difficult to attain in childhood, and benefiting from self-learning and effortfully applying neuro-normative skills in social communication. Loneliness was only described alongside other causes of unhappiness and was not associated with being autistic. Conclusions The findings offer some explanation for the high estimates of both loneliness and mental ill health for autistic adults. We consider the implications for autistic individuals, clinicians, educators, and researchers. We are also cautious not to imply that these views reflect all autistic people. The findings suggest that improvements are needed in society to share communication differences and relationship expectations for autistic individuals to be accepted and valued.
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Affiliation(s)
- Stephanie Petty
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Shannon Allen
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Hannah Pickup
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
| | - Bethannie Woodier
- Department of Psychology, School of Education, Language and Psychology, York St John University, York, United Kingdom
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White SW, Schall C, Santos JD, Maddox BB, Hillier A, Klinger L, Pugliese C. Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults. Autism Adulthood 2023; 5:347-355. [PMID: 38116052 PMCID: PMC10726189 DOI: 10.1089/aut.2022.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one's perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients' self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.
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Affiliation(s)
- Susan W. White
- Center for Youth Development and Intervention, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Carol Schall
- Autism Center for Education, Rehabilitation Research and Training Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jin Delos Santos
- Project REACH, College of Staten Island at the City University of New York, Staten Island, New York, USA
| | - Brenna B. Maddox
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashleigh Hillier
- Department of Psychology, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Laura Klinger
- TEACCH Autism Program, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cara Pugliese
- Center for Autism Spectrum Disorders, Children's National Hospital, Washington, District of Columbia, USA
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Love AM, Edwards C, Cai RY, Gibbs V. Using Experience Sampling Methodology to Capture Disclosure Opportunities for Autistic Adults. Autism Adulthood 2023; 5:389-400. [PMID: 38116059 PMCID: PMC10726168 DOI: 10.1089/aut.2022.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Despite a recent surge in literature contributing to our understanding of autistic individuals' disclosure experiences, the findings remain mixed. Research based on autistic people's perspective often indicates negative outcomes, while research that focuses on nonautistic perspectives is more positive. In addition, no disclosure study has used ecologically valid research methods, which help to reduce the risk of memory biases and are more representative of real-world experiences. The aim of this research was to capture outcomes from real-world disclosure opportunities as reported by a diverse range of autistic adults. Methods Thirty-six autistic adults reported their disclosure opportunities through experience sampling methodology (58% female, 28% male, and 14% nonbinary), multiple times per day or week for 2 months. Importantly, we embedded coproduction from conception to dissemination, ensuring that the outputs are relevant and beneficial for the autistic community. Results In total, participants recorded 231 disclosure opportunities (M = 6.42, SD = 4.83). Two-thirds of opportunities (n = 153) were categorized as disclosure, where the participants decided to share they were autistic, and 33.8% (n = 78) were labeled nondisclosure, where the participants decided not to share that they were autistic. Qualitative thematic analysis of open responses resulted in five themes that illustrated the thought processes during disclosure opportunities, the reactions of others, and reflections following disclosure for autistic adults in our study. Conclusion These findings show that disclosure decisions and outcomes are complex and are influenced by both internal and external factors. Both support for autistic adults navigating this process and knowledge for nonautistic individuals on the experiences of their autistic friends, family, and community members will help to alleviate negative experiences and improve the mental well-being of autistic adults who face these decisions daily.
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Affiliation(s)
- Abigail M.A. Love
- Autism Spectrum Australia, Aspect Research for Autism Practice, Chatswood, New South Wales, Australia
| | - Chris Edwards
- Autism Spectrum Australia, Aspect Research for Autism Practice, Chatswood, New South Wales, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Ru Ying Cai
- Autism Spectrum Australia, Aspect Research for Autism Practice, Chatswood, New South Wales, Australia
- School of Psychological Sciences, Faulty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Vicki Gibbs
- Autism Spectrum Australia, Aspect Research for Autism Practice, Chatswood, New South Wales, Australia
- FMH Translational Research Collective, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Lai MC, Amestoy A, Bishop S, Brown HM, Giwa Onaiwu M, Halladay A, Harrop C, Hotez E, Huerta M, Kelly A, Miller D, Nordahl CW, Ratto AB, Saulnier C, Siper PM, Sohl K, Zwaigenbaum L, Goldman S. Improving autism identification and support for individuals assigned female at birth: clinical suggestions and research priorities. Lancet Child Adolesc Health 2023; 7:897-908. [PMID: 37973254 DOI: 10.1016/s2352-4642(23)00221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 11/19/2023]
Abstract
Emerging evidence suggests that the higher prevalence of autism in individuals who are assigned male than assigned female at birth results from both biological factors and identification biases. Autistic individuals who are assigned female at birth (AFAB) and those who are gender diverse experience health disparities and clinical inequity, including late or missed diagnosis and inadequate support. In this Viewpoint, an international panel of clinicians, scientists, and community members with lived experiences of autism reviewed the challenges in identifying autism in individuals who are AFAB and proposed clinical and research directions to promote the health, development, and wellbeing of autistic AFAB individuals. The recognition challenges stem from the interplay between cognitive differences and nuanced or different presentations of autism in some AFAB individuals; expectancy, gender-related, and autism-related biases held by clinicians; and social determinants. We recommend that professional development for clinicians be supported by health-care systems, professional societies, and governing bodies to improve equitable access to assessment and earlier identification of autism in AFAB individuals. Autistic AFAB individuals should receive tailored support in education, identity development, health care, and social and professional sense of belonging.
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Affiliation(s)
- Meng-Chuan Lai
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick Children, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, ON, Canada; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Anouck Amestoy
- Centre for Autism Spectrum Disorders, Aquitaine Institute for Cognitive and Integrative Neurosciences, Charles Perrens Hospital, University of Bordeaux, Bordeaux, France
| | - Somer Bishop
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Heather M Brown
- Faculty of Education, University of Alberta, Edmonton, AB, Canada
| | - Morénike Giwa Onaiwu
- Autistic Women & Nonbinary Network, Lincoln, NE, USA; Rice University Center for the Study of Women, Gender, and Sexuality, School of Humanities, Houston, TX, USA
| | - Alycia Halladay
- Autism Science Foundation, Scarsdale, NY, USA; Department of Pharmacology and Toxicology, Rutgers University, Piscataway, NJ, USA
| | - Clare Harrop
- Department of Health Sciences and TEACCH Autism Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily Hotez
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Marisela Huerta
- Felicity House, New York, NY, USA; Weill Cornell Medicine, New York, NY, USA
| | - Amy Kelly
- Devereux Advanced Behavioral Health, Villanova, PA, USA
| | - Dylan Miller
- Auxiliary Enterprises, University of Massachusetts, Amherst, MA, USA
| | - Christine Wu Nordahl
- Department of Psychiatry and Behavioral Sciences and MIND Institute, University of California at Davis, Davis, CA, USA
| | - Allison B Ratto
- Center for Autism Spectrum Disorders, Division of Neuropsychology, Children's National Hospital, Washington, DC, USA
| | - Celine Saulnier
- Neurodevelopmental Assessment and Consulting Services, Decatur, GA, USA
| | - Paige M Siper
- Seaver Autism Center for Research and Treatment, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristin Sohl
- ECHO Autism Communities, Department of Child Health, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Sylvie Goldman
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA.
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Jones DR, Sasson NJ. A mixed method comparison of stigma toward autism and schizophrenia and effects of person-first versus identity-first language. Front Psychiatry 2023; 14:1263525. [PMID: 37965364 PMCID: PMC10641499 DOI: 10.3389/fpsyt.2023.1263525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/29/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction While stigma toward autistic individuals has been well documented, less is known about how autism is perceived relative to other stigmatized disabilities. As a highly stigmatized condition with similar social cognitive features to autism, schizophrenia may offer a useful comparison for stigma. Previous studies have found that autistic people may be perceived more favorably than those with schizophrenia, but little is known about the underlying volitional thoughts that contribute to differences in how these conditions are perceived. Methods The present study utilizes a mixed-methods approach, allowing for a detailed understanding of how young adults perceive different diagnostic labels. 533 college undergraduates completed questionnaires reflecting their perceptions of one of eight diagnostic labels: four related to autism (autism, autistic, autism spectrum disorder, or Asperger's), two related to schizophrenia (schizophrenia or schizophrenic), and two related to an unspecified clinical condition (clinical diagnosis or clinical disorder). Participants also completed an open-ended question regarding their thoughts about, and exposure to, these labels. Responses were compared across broader diagnostic categories (autism, schizophrenia, general clinical condition), with thematic analysis used to assess the broader themes occurring within the open-ended text. Results While perceptions did not differ significantly for person-first and identity-first language within labels, several differences were apparent across labels. Specifically, quantitative results indicated greater prejudice towards autism and schizophrenia than the generic clinical condition, with schizophrenia associated with more perceived fear and danger, as well as an increased preference for social distance, compared to autism. Patterns in initial codes differed across diagnostic labels, with greater variation in responses about autism than responses about schizophrenia or the general clinical condition. While participants described a range of attitudes toward autism (patronizing, exclusionary, and accepting) and schizophrenia (fear, prejudice, and empathy), they refrained from describing their attitudes toward the general clinical label, highlighting the centrality of a cohesive group identity for the development of stigma. Finally, participants reported a number of misconceptions about autism and schizophrenia, with many believing features such as savant syndrome to be core characteristics of the conditions. Conclusion These findings offer a more detailed account of how non-autistic individuals view autism and may therefore aid in the development of targeted programs to improve attitudes toward autism.
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Abstract
Some autistic adults experience repeated adverse events, including rejection, victimization and stigmatization. They also describe others being critical and negatively judging them, such as for how they socially interact or for expressing passion for particular interests. The impact of these adverse events can be substantial, including increasing vulnerability for poorer mental health, and contributing to development of negative self beliefs (such as "I am different" or "I do not fit in") and shame-based difficulties. Not all evidence-based psychological therapies are well-received by autistic people, or effective. Given high rates of self-harm and suicidality, finding acceptable and effective therapies for autistic adults is paramount. Here, writing as autistic and non-autistic clinicians and researchers, we outline the theoretical principles of compassion-focused theory and therapy (CFT). We propose that: (1) compassion-focused theory can provide a useful framework for conceptualizing shame-based difficulties some autistic adults experience; (2) CFT can be appropriate for addressing these; and (3) there is an impetus for practitioners to adopt compassion-focused approaches when supporting autistic adults.
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Affiliation(s)
- David Mason
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - James Acland
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Eloise Stark
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Centre for Eudaimonia and Human Flourishing, Stoke House, Linacre College, University of Oxford, Oxford, United Kingdom
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Debbie Spain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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Galvin J, Howes A, Richards G. Longitudinal Associations Between Autistic Traits, Self-compassion, Anxiety and Depression in Autistic and Non-autistic Adults Without Intellectual Disability. J Autism Dev Disord 2023:10.1007/s10803-023-06157-6. [PMID: 37874475 DOI: 10.1007/s10803-023-06157-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE Previous cross-sectional research suggests self-compassion may mediate associations between autistic traits and mental health in autistic and non-autistic adults. However, no research to date has examined these relationships longitudinally. In this study, we used a cross-lagged panel analysis to examine correlations over time between autistic traits, self-compassion, and anxiety/depression. METHODS Participants were from the UK and included autistic (n = 228 at T1, n = 156 at T2, and n = 165 at T3) and non-autistic adults (n = 228 at T1, n = 122 at T2, and n = 124 at T3) without intellectual disability. Participants were recruited through an online participation platform and completed demographics, the Autism Spectrum Quotient (AQ), the Self-Compassion Scale (SCS), and the Hospital Anxiety and Depression Scale (HADS) at baseline (T1), 6 months (T2), and 12 months (T3). RESULTS In the autistic sample, negative correlations were observed between self-compassion and subsequent anxiety/depression across all models and timepoints, and these relationships were not reciprocal (i.e., earlier depression and anxiety did not predict future self-compassion). In the non-autistic sample, the findings generally suggested bi-directional relationships between self-compassion and anxiety/depression. In both groups, an indirect pathway between T1 autistic traits and T3 anxiety/depression via T2 self-compassion was confirmed. CONCLUSION Considering the high prevalence of anxiety and depression among autistic people, and that self-compassion can be cultivated through practice, these findings suggest that self-compassion could be a useful therapeutic target to promote mental health in the autistic population.
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Affiliation(s)
- John Galvin
- Department of Psychology, University of Warwick, Coventry, UK.
| | - Abby Howes
- Norwich Medical School, University of East Anglia, East Of England, UK
| | - Gareth Richards
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
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Keating J, Hashmi S, Vanderwert RE, Davies RM, Jones CRG, Gerson SA. Embracing neurodiversity in doll play: Investigating neural and language correlates of doll play in a neurodiverse sample. Eur J Neurosci 2023. [PMID: 37731194 DOI: 10.1111/ejn.16144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
Doll play may provide opportunities for children to rehearse social interactions, even when playing alone. Previous research has found that the posterior superior temporal sulcus (pSTS) was more engaged when children played with dolls alone, compared to playing with tablet games alone. Children's use of internal state language (ISL) about others was also associated with pSTS activity. As differences in social cognition are frequently observed in autistic people, we were interested in the brain and language correlates of doll play in children with varying levels of autistic traits. We investigated children's (N = 57, mean age = 6.72, SD = 1.53) use of ISL and their pSTS brain activity using functional near-infrared spectroscopy (fNIRS) as they played with dolls and tablet games, both alone and with a social partner. We also investigated whether there were any effects of autistic traits using the parent-report Autism Spectrum Quotient-Children's Version (AQ-Child). We found that the left pSTS was engaged more as children played with dolls or a tablet with a partner, and when playing with dolls alone, compared to when playing with a tablet alone. Relations between language and neural correlates of social processing were distinct based on the degree of autistic traits. For children with fewer autistic traits, greater pSTS activity was associated with using ISL about others. For children with more autistic traits, greater pSTS activity was associated with experimenter talk during solo play. These divergent pathways highlight the importance of embracing neurodiversity in children's play patterns to best support their development through play.
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Affiliation(s)
- Jennifer Keating
- Cardiff University Centre for Human Developmental Science (CUCHDS), School of Psychology, Cardiff University, Cardiff, UK
| | - Salim Hashmi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ross E Vanderwert
- Cardiff University Centre for Human Developmental Science (CUCHDS), School of Psychology, Cardiff University, Cardiff, UK
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
| | - Rhys M Davies
- Cardiff University Centre for Human Developmental Science (CUCHDS), School of Psychology, Cardiff University, Cardiff, UK
| | - Catherine R G Jones
- Cardiff University Centre for Human Developmental Science (CUCHDS), School of Psychology, Cardiff University, Cardiff, UK
| | - Sarah A Gerson
- Cardiff University Centre for Human Developmental Science (CUCHDS), School of Psychology, Cardiff University, Cardiff, UK
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Rivera RA, Bennetto L. Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Front Psychiatry 2023; 14:1243657. [PMID: 37743980 PMCID: PMC10511883 DOI: 10.3389/fpsyt.2023.1243657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.
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Affiliation(s)
- Rachel A. Rivera
- Department of Psychology, University of Rochester, Rochester, NY, United States
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Hotez E, Hudson S. Expanding on "Screening, Diagnosis, and Intervention for Autism: Experiences of Black and Multiracial Families Seeking Care" to Support BIPOC Autistic Postsecondary Students. J Autism Dev Disord 2023; 53:3717-3721. [PMID: 37178427 DOI: 10.1007/s10803-023-06001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Emily Hotez
- Department of General Internal Medicine / Health Services Research, University of California, Los Angeles (UCLA), David Geffen School of Medicine, 911 Broxton Ave, Los Angeles, CA, 90095, USA.
| | - Shanice Hudson
- Hood Medicine Initiative, Inc, Indianapolis, IN, 46205, P.O. Box 55458, USA
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Simcoe SM, Gilmour J, Garnett MS, Attwood T, Donovan C, Kelly AB. Are there gender-based variations in the presentation of Autism amongst female and male children? J Autism Dev Disord 2023; 53:3627-3635. [PMID: 35829944 PMCID: PMC10465371 DOI: 10.1007/s10803-022-05552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
The Questionnaire for Autism Spectrum Conditions (Q-ASC; Attwood, Garnett & Rynkiewicz, 2011) is one of the few screening instruments that includes items designed to assess female-specific ASD-Level 1 traits. This study examined the ability of a modified version of the Q-ASC (Q-ASC-M; Ormond et al., 2018) to differentiate children with and without ASD-Level 1. Participants included 111 parents of autistic children and 212 parents of neurotypical children (5-12 years). Results suggested that the gendered behaviour, sensory sensitivity, compliant behaviours, imagination, and imitation subscales differentiated autistic females from neurotypical females. Compared to autistic males, autistic females had higher scores on gendered behaviour, sensory sensitivity, social masking, and imitation. Results are discussed in relation to early detection of autistic female children.
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Affiliation(s)
- Sarah Mae Simcoe
- School of Applied Psychology, Griffith University, Mt Gravatt, Brisbane, Australia
| | - John Gilmour
- Institute of Social Science Research, University of Queensland, St Lucia, Brisbane, Australia
| | | | - Tony Attwood
- School of Applied Psychology, Griffith University, Mt Gravatt, Brisbane, Australia
- Attwood and Garnett Events, Brisbane, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Mt Gravatt, Brisbane, Australia
| | - Adrian B Kelly
- School of Psychology and Counselling, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
- Centre for Child Health and Well-being, Mental Health and Resilience Theme, Queensland University of Technology, Kelvin Grove, Child Adversity, Brisbane, Australia
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Capp SJ, Agnew-Blais J, Lau-Zhu A, Colvert E, Tye C, Aydin Ü, Lautarescu A, Ellis C, Saunders T, O'Brien L, Ronald A, Happé F, McLoughlin G. Is quality of life related to high autistic traits, high ADHD traits and their Interaction? Evidence from a Young-Adult Community-Based twin sample. J Autism Dev Disord 2023; 53:3493-3508. [PMID: 35802291 PMCID: PMC10465683 DOI: 10.1007/s10803-022-05640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
This study explored whether high autistic traits, high attention deficit hyperactivity disorder (ADHD) traits and their interaction were associated with quality of life (QoL) in a sample of 556 of young-adult twins (Mean age 22 years 5 months, 52% Female). Four participant groups were created: high autistic traits, high ADHD traits, high autistic/ADHD traits, and low ADHD/autistic traits. High autistic traits were associated with lower QoL across domains (physical, psychological, social, and environmental). High ADHD traits associated with lower physical, psychological, and environmental QoL. The interaction of autistic and ADHD traits was not significant in any domain. While mental health difficulties were associated with lower QoL, after accounting for mental health, most relationships between autistic traits, ADHD traits and QoL remained.
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Affiliation(s)
- Simone J Capp
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Medical Sciences Division, Oxford Institute for Clinical Psychology Training and Research, University of Oxford, Oxford, UK.
| | - Jessica Agnew-Blais
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, School of School of Biological and Chemical Sciences, Queen Mary University London, London, UK
| | - Alex Lau-Zhu
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Colvert
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Tye
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ümit Aydin
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexandra Lautarescu
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Claire Ellis
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tyler Saunders
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Edinburgh, Edinburgh, UK
| | - Lucy O'Brien
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angelica Ronald
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, University of London, Birkbeck, London, UK
| | - Francesca Happé
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gráinne McLoughlin
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Clark T, Jung JY, Roberts J, Robinson A, Howlin P. The identification of exceptional skills in school-age autistic children: Prevalence, misconceptions and the alignment of informant perspectives. J Appl Res Intellect Disabil 2023; 36:1034-1045. [PMID: 37157995 DOI: 10.1111/jar.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/30/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although autism is commonly described in terms of deficits, many autistic individuals have been found to demonstrate exceptional skills. The shift to a strengths-based approach in the field of autism necessitates increased understanding of these skills. AIMS This study examined (1) rates of exceptional skills in autistic school-age children as reported by parents and teachers, (2) associations between exceptional skills, autism severity and intellectual disability and (3) correlations between parent and teacher reports of exceptional skills. METHOD Parents and teachers of 76 children attending autism-specific schools in Australia completed online questionnaires. Thereafter, 35 parents and teachers who identified their child as having one or more exceptional skills were interviewed by a clinical psychologist. RESULTS Forty parents (53%) and 16 (21%) teachers reported that their child had at least one exceptional skill (agreement between the parent and teacher reports was low; κ = .03, p = .74). In comparison, clinical psychologist assessments identified 22 children (29%) as having at least one such skill. No statistically significant relationships were identified between exceptional skills, autism severity and intellectual disability. CONCLUSION While different exceptional skills were identified, regardless of children's intellectual functioning or autism severity, parents and teachers varied substantially in their evaluations of these skills. Furthermore, the identified prevalence rates of exceptional skills did not always align with the rates identified in previous studies. The study findings highlight the need for definitional consensus on different types of exceptional skills, and the importance of multiple criteria/multi-instrument approaches in the identification of exceptional skills in autistic children.
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Affiliation(s)
- Trevor Clark
- Aspect Research Centre for Autism Practice, Sydney, Australia
- Griffith Institute for Educational Research, Brisbane, Australia
| | - Jae Yup Jung
- School of Education, The University of New South Wales, Sydney, Australia
| | - Jacqueline Roberts
- Autism Centre of Excellence (ACE), Griffith Institute for Educational Research, Brisbane, Australia
| | | | - Patricia Howlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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