Neurotype-Matching, but Not Being Autistic, Influences Self and Observer Ratings of Interpersonal Rapport

Being able to be myself: Understanding autonomy and autonomy-support from the perspectives of autistic adults with intellectual disabilities

LAY ABSTRACT

Autistic young adults with intellectual disabilities want to be autonomous but are less autonomous than other people. However, they can be autonomous with appropriate support. We wanted to learn how we can support autistic adults with intellectual disabilities to be more autonomous. We designed our study with help from five autistic community partners to make sure the research was relevant to autistic people and would improve their lives. We talked with eight autistic young adults with intellectual disabilities about autonomy. We defined "talk" as verbal language, as well as non-verbal cues such as body language, facial expressions, vocalizations, and laughter. We did art projects and played games while we talked. We met in small groups over multiple sessions. Our participants told us that being autonomous meant being able to be themselves. They told us three main ways to support their autonomy: (1) having choice and control, (2) being able to communicate in their own way, and (3) being in a safe environment. Families, support staff, and caregivers can use this information to help autistic young adults with intellectual disabilities to be autonomous.

Social self-efficacy and mental well-being in autistic adults: Exploring the role of social identity

LAY ABSTRACT

In the past, research has suggested that autistic people are not able to communicate well with non-autistic people because of autistic people's communication difficulties. However, newer theories question this conclusion. It is now thought that the communication difficulties may be because autistic and non-autistic people both struggle to understand each other. This study explores how these differences in shared understanding relate to autistic people's mental well-being, confidence in social situations and social identities (groups that we belong to and that influence how we see ourselves). We created an online survey taken by 512 autistic adults, which included questions about their confidence being social with people from different groups (such as other autistic people or people they share a hobby with), about the social groups they felt they belong to and about their mental well-being. First, participants reported higher social confidence when interacting with members of a social group they belonged to. Second, being confident during these interactions was linked to higher mental well-being. Finally, the groups participants belonged to did not influence the link between social confidence and mental well-being. These findings are important as they help us better understand autistic people's experiences of social interactions and what contributes to good and poor mental well-being in autistic people. They also help us to think further about how to improve autistic people's well-being.

Associations between autistic traits, depression, social anxiety and social rejection in autistic and non-autistic adults

Autistic people frequently experience negative judgements from non-autistic people, often fuelled by misconceptions that autistic people lack empathy. Understanding responses to negative social judgement among autistic people is crucial because of the potential negative impact on wellbeing and future interactions. We investigated the role of autistic traits, social anxiety, and depression on behavioural indices of social rejection in 20 autistic (AUT; 11 males) and 40 non-autistic (N-AUT; 21 males) university students. Participants completed the Social Judgement Task (SJT) where they predicted whether they were liked by another person, then received feedback on whether those evaluations were correct. Participants also completed an Age Judgement Task (AJT) where they estimated the age of the pictured person. The AUT group had lower positive expectation scores, meaning less tendency to predict being liked. Across the whole sample, higher social anxiety predicted greater tendency to anticipate rejection from others, not autistic traits. These findings suggest early experiences of rejection might lead to a negative self-bias in autistic people and emphasise the importance of using a transdiagnostic approach by showing that social anxiety rather than autistic traits is associated with expectation of social rejection.

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

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.

Korean autistic persons facing systemic stigmatization from middle education schools: daily survival on the edge as a puppet

Introduction

Korean autistic persons who have endured an integrated secondary education system have been exposed to school bullying, causing trauma and stigma to them. It also blocks them from entering a tertiary education system and a decent work, resulting in a lower quality of life. However, research on how it affects autistic persons has not yet been conducted in Korea.

Methods

Fourteen adult autistic persons in the Republic of Korea participated in the semi-structured focused group interviews. Their conversations were analyzed through qualitative coding.

Results

The interview results show the rare voice of Korean autistic people. Although interviewees experienced physical, verbal, and sexual violence against them during the secondary education period, they could not get substantial assistance from schools and society. Interviewees agreed that bullying is inherent in the secondary education system of Korea, even in Korean culture. They experienced the cause of bullying being attributed to them as victims rather than perpetrators, and impunity is given to the bullying assailants. Early analyses of this article confirm that such experiences are combined with the sociocultural climate of elitism, meritocracy, and authoritarianism in the Republic of Korea.

Conclusion

The study confirmed that the autistic person's bullying experience does not come from the social inability of autistic people but the "profound" competition and discriminative atmosphere of the society. The result urges further studies on the bullying experience of East Asian autistic persons and the construction of Korean intervention strategies to prevent school violence against Koreans with disabilities, especially autistic pupils.

Social skills in neurodevelopmental disorders: a study using role-plays to assess adolescents and young adults with 22q11.2 deletion syndrome and autism spectrum disorders

BACKGROUNDS

Social skills are frequently impaired in neurodevelopmental disorders and genetic conditions, including 22q11.2 deletion syndrome (22q11DS) and autism spectrum disorders (ASD). Although often assessed with questionnaires, direct assessment provides a more valid estimate of the constructs. Role-plays (i.e., simulates situational settings) therefore appear to be an appropriate indicator of social skills in daily life.

METHODS

This co-registered study involved 53 individuals with 22q11DS, 34 individuals with ASD, and 64 typically developing (TD) peers aged 12-30 years. All participants were assessed with role-plays as well as parent-reported questionnaires and clinical interviews focusing on social skills, functioning and anxiety.

RESULTS

Both clinical groups showed impaired social skills compared to TD, but distinct social profiles emerged between the groups. Individuals with 22q11DS displayed higher social appropriateness and clarity of speech but weaker general argumentation and negotiation skills, with the opposite pattern observed in participants with ASD. No association was found between social skills measured by direct observation and caregiver reports. Social anxiety, although higher in clinical groups than in TD, was not associated with role-plays.

CONCLUSIONS

This study highlights the need to train social skills through tailored interventions to target the specific difficulties of each clinical population. It also highlights the importance of combining measures as they do not necessarily provide the same outcome.

Non-autistic observers both detect and demonstrate the double empathy problem when evaluating interactions between autistic and non-autistic adults

LAY ABSTRACT

The "double empathy problem" refers to breakdowns in communication and understanding that frequently occur between autistic and non-autistic people. Previous studies have shown that autistic people often establish better rapport and connection when interacting with other autistic people compared to when interacting with non-autistic people, but it is unclear whether this is noticeable to non-autistic observers. In this study, 102 non-autistic undergraduate students viewed and rated video recordings of "get to know you" conversations between pairs of autistic and non-autistic adults. Sometimes the pairs were two autistic people, sometimes they were two non-autistic people, and sometimes they were "mixed" interactions of one autistic and one non-autistic person. Observers tended to rate non-autistic participants and their interactions the most favorably, but-consistent with the "double empathy problem"-they rated mixed interactions between autistic and non-autistic people as the least successful. They also perceived that only non-autistic people disclosed more when interacting with a non-autistic conversation partner. Autistic participants' partners in the conversations tended to evaluate them more favorably than did outside observers, suggesting that personal contact may facilitate more positive evaluations of autistic people. Furthermore, observers expressed less social interest in participants than did the autistic and non-autistic participants in the interactions. Together, these findings suggest that non-autistic observers both detect and demonstrate some aspects of the double empathy problem.

Automated extraction of speech and turn-taking parameters in autism allows for diagnostic classification using a multivariable prediction model

Autism spectrum disorder (ASD) is diagnosed on the basis of speech and communication differences, amongst other symptoms. Since conversations are essential for building connections with others, it is important to understand the exact nature of differences between autistic and non-autistic verbal behaviour and evaluate the potential of these differences for diagnostics. In this study, we recorded dyadic conversations and used automated extraction of speech and interactional turn-taking features of 54 non-autistic and 26 autistic participants. The extracted speech and turn-taking parameters showed high potential as a diagnostic marker. A linear support vector machine was able to predict the dyad type with 76.2% balanced accuracy (sensitivity: 73.8%, specificity: 78.6%), suggesting that digitally assisted diagnostics could significantly enhance the current clinical diagnostic process due to their objectivity and scalability. In group comparisons on the individual and dyadic level, we found that autistic interaction partners talked slower and in a more monotonous manner than non-autistic interaction partners and that mixed dyads consisting of an autistic and a non-autistic participant had increased periods of silence, and the intensity, i.e. loudness, of their speech was more synchronous.

Comparing narrative writing of autistic and non-autistic College students

We compared short stories by autistic (n = 19) and non-autistic (n = 23) university students. We used automated software and content analysis to code students' stories. We found that writings were more similar than different. However, autistic students' stories were rated at a higher reading level (p = .013) than non-autistic students'. Autistic students' stories contained fewer grammatical errors (p = .02) but were less likely to include a climax (p = .026). Autistic students reported more positive writing affect than non-autistic students (p = .026). Higher writing affect was associated with writing highly fictional texts (p = .03) that contained more sentences (p = .005). Findings suggest writing may be a strength for autistic students and opportunities to write creatively may promote positive affect toward writing.

Innovation through neurodiversity: Diversity is beneficial

LAY ABSTRACT

Neurodivergences such as autism have been previously viewed from a negative, 'deficit', perspective. However, research is beginning to show the benefits of being autistic, and the positive outcomes of neurodiverse interactions. Diversity in the way we think can lead to diversity in the outcomes we produce. In this study, we asked independent raters to compare the similarity of towers built by autistic and non-autistic individuals in single-neurotype (both people were autistic or both people were non-autistic) and neurodiverse (one autistic person and one non-autistic person) pairs, to see whether people would be more or less likely to copy someone who shared their diagnostic status. Our results showed there was the least similarity in design in the neurodiverse pairs; people were less likely to copy the design of the previous builder if that person had a different autistic status to themselves. This could imply people felt more confident in copying someone with a similar neurotype, mirroring results from rapport studies where autistic individuals reported greater rapport with other autistic participants than with non-autistic participants. This also shows there was more evidence of creativity in designs, and innovation from stimulus design (the tower they had watched being built) when the pairs had different autistic diagnoses. This could inform practice and support involving autistic people, encouraging education and care providers to create more diverse methods and designs for support mechanisms, content delivery, and research data collection.

Partner similarity and social cognitive traits predict social interaction success among strangers

Social interactions are a ubiquitous part of engaging in the world around us, and determining what makes an interaction successful is necessary for social well-being. This study examined the separate contributions of individual social cognitive ability and partner similarity to social interaction success among strangers, measured by a cooperative communication task and self-reported interaction quality. Sixty participants engaged in a 1-h virtual social interaction with an unfamiliar partner (a laboratory confederate) including a 30-min cooperative 'mind-reading' game and then completed several individual tasks and surveys. They then underwent a separate functional MRI session in which they passively viewed video clips that varied in content. The neural responses to these videos were correlated with those of their confederate interaction partners to yield a measure of pairwise neural similarity. We found that trait empathy (assessed by the interpersonal reactivity index) and neural similarity to partner both predicted communication success in the mind-reading game. In contrast, perceived similarity to partner and (to a much lesser extent) trait mind-reading motivation predicted self-reported interaction quality. These results highlight the importance of sharing perspectives in successful communication as well as differences between neurobiological similarity and perceived similarity in supporting different types of interaction success.

The role of interpersonal synchrony in forming impressions of autistic and non-autistic adults

When people meet, they almost instantaneously form an impression of each other. First impressions of character traits and rapport are less favourable when people with autism spectrum condition (ASC) are judged compared to non-autistic people. Little is known about the behavioural differences that drive these altered impressions. In the present study, we investigated the influence of interpersonal synchrony on impression formation of autistic and non-autistic people. Specifically, we used lagged cross-correlations to assess how much each interactant's motion energy, a measure which can be determined from video recordings, influenced the other interactant's motion energy. In short, silent clips of dyadic conversations, we asked non-autistic participants to rate their impression of one of the two interactants, which was solely based on the outlines of both interactants. We expected that the amount of leading of the target interactant, their diagnostic status as well as the interaction of these factors would influence impression formation. We found that while the amount of leading had a positive effect on the impressions of non-autistic interactants, this was not true for interactants with ASC. This suggests that interpersonal synchrony of motion energy is one driver of less favourable impressions of autistic compared to non-autistic people.

The experiences of medical students with ADHD: A phenomenological study

Attention Deficit/Hyperactivity 'Disorder' (ADHD) is a form of neurodivergence, characterised by lifelong differences in attention, impulsivity, and hyperactivity. University students with ADHD underachieve academically and tend to have lower levels of self-esteem. Medical schools have an obligation to minimise barriers for students with ADHD. Understanding the experiences of medical students with ADHD is vital to promote inclusive approaches. Our exploratory research question was: "What are the experiences of medical students with ADHD?" This was an interpretive phenomenological study. Loosely structured interviews were conducted with participants (medical students with ADHD) over Zoom. Subsequent transcripts were analysed using interpretive phenomenological analysis. Six people participated. Our analysis identified the following themes: Identity and diagnosis; ADHD profile; system issues; conflict, competition and compensation; improving the experience. Participants reported experiences of bullying and isolation at medical school, perpetrated by doctors and peers, as well as feelings of alienation when unable to conform on placement and in exams. From this, participants adopted survival strategies, such as masking, to avoid being ostracised. All recognised their ADHD status when their mental health deteriorated during their medical studies. Of those who disclosed their diagnosis, none were offered personalised support. Participants feared disclosure, largely due to weaponised professionalism and the effects of toxic competitiveness in medicine. They yearned for a sense of belonging. Participants reported strengths associated with ADHD such as empathy and working well under pressure, which are highly desirable aptitudes for doctors. This study has highlighted areas where medical schools can be instrumental in cultivating an environment where medical students with ADHD can thrive, not just survive. This may take the form of peer support groups, alongside reasonable adjustments throughout medical school-particularly for Objective Structured Clinical Examinations, for example. Enabling these students to thrive may help to prevent early burnout and subsequent attrition from medicine.

Exploring the different cognitive, emotional and imaginative experiences of autistic and non-autistic adult readers when contemplating serious literature as compared to non-fiction

Introduction

Recent research has demonstrated how reflections on serious literature can challenge dominant social-deficit views of autism. This method enables autistic readers to explore social realities more slowly and carefully, encouraging detail-focused considerations. Previous research has also shown that autistic and non-autistic readers reflecting on serious literature together are able to achieve mutuality in a way that enables them to overcome the double empathy problem. However, the advantages of reading aloud designs have yet to be explored with autistic and non-autistic readers due to previous concerns amongst autistic people on the issue of being read aloud to. The present study aimed to explore how an adapted shared reading design that compared serious literature and non-fiction would enable autistic and non-autistic readers to imaginatively engage in the reading experience.

Methods

Seven autistic and six non-autistic participants read 8 short text extracts alone while listening to pre-recorded audio of an experienced reader reading each text aloud. Participants completed a reflective questionnaire for each text and a follow-up interview where moving parts of the text were then re-read aloud before discussion. Half of these texts were serious literature, while the other half were non-fiction. Similarly, half of the texts explored fictional social realities that depicted a lack of mutuality, or non-fiction accounts of autism; while the other half explored broader emotional experiences.

Results

Thematic and literary analysis of participant reflections and follow-up interviews revealed three main themes: (1) From Surface Reading to Intuitive Engagement, (2) Imaginative Feeling and (3) Going Forward from the Reading Experience.

Discussion

The findings showed that autistic readers were better able to hold onto the detailed complexity of serious literature, while non-autistic readers tended to reduce information down to key ideas and understandings for later generalization. Findings are discussed in relation to future shared reading designs.

Autistic Adult Perspectives on Occupational Therapy for Autistic Children and Youth

The Autistic community values neurodiversity-positive approaches rather than behavioral interventions for Autistic children; however, little is known about what that would look like in occupational therapy. Frequently, researchers seek parent perspectives for understanding Autistic children's preferences, while to date insufficient attention has been paid to Autistic adults as valuable informants on the Autistic experience of Autistic children. The objective of the study was to understand Autistic adult perspectives on pediatric occupational therapy for Autistic children. We sought and thematically analyzed data from a large Facebook group and an occupational therapy podcast on Autistic values, needs, and experiences in pediatric occupational therapy. Participants described wanting therapy that supported Autistic identities rather than trying to "fix" children, changing environments or tasks to promote participation, and setting goals that address self-advocacy and autonomy. Occupational therapy practitioners should critically reflect on their practice's alignment with Autistic values and start to shift their practice as needed.

Atypical connectivity aids conversation in autism

It is well-established that individuals with autism exhibit atypical functional brain connectivity. However, the role this plays in naturalistic social settings has remained unclear. Atypical patterns may reflect core deficits or may instead compensate for deficits and promote adaptive behavior. Distinguishing these possibilities requires measuring the 'typicality' of spontaneous behavior and determining how connectivity relates to it. Thirty-nine male participants (19 autism, 20 typically-developed) engaged in 115 spontaneous conversations with an experimenter during fMRI scanning. A classifier algorithm was trained to distinguish participants by diagnosis based on 81 semantic, affective and linguistic dimensions derived from their use of language. The algorithm's graded likelihood of a participant's group membership (autism vs. typically-developed) was used as a measure of task performance and compared with functional connectivity levels. The algorithm accurately classified participants and its scores correlated with clinician-observed autism signs (ADOS-2). In support of a compensatory role, greater functional connectivity between right inferior frontal cortex and left-hemisphere social communication regions correlated with more typical language behavior, but only for the autism group. We conclude that right inferior frontal functional connectivity increases in autism during communication reflect a neural compensation strategy that can be quantified and tested even without an a priori behavioral standard.

'Someone like-minded in a big place': Autistic young adults' attitudes towards autistic peer support in mainstream education

LAY ABSTRACT

Autistic young people may struggle in mainstream schools and feel disconnected from their peers and their school. We know that autistic adults can benefit from spending time with other autistic people, but we don't know if this is the case for younger autistic people. We conducted interviews with 13 autistic young adults in the United Kingdom who recently left mainstream schooling. We asked them if they would have been interested in being involved in autistic peer support when they were at school, and if so, what that peer support should look like. Results indicated that autistic young people were enthusiastic about the idea of peer support. They thought it was important that peer support was flexible to suit their needs at different times, as well as inclusive, positive, and embracing neurodiversity. They also discussed the potential benefits and difficulties of having a peer support system within a school setting. This adds to the growing body of research on the potential benefits of autistic-autistic interactions on autistic people's well-being and sense of belonging. Findings can be used to help design pilot peer support projects in schools that can be tested to see how effective they are.

For autistic persons by autistic persons: Acceptability of a structured peer support service according to key stakeholders

INTRODUCTION

Social support is a protective factor in the mental health of autistic people. Furthermore, prejudice regarding autistic people is a constraint for the development of social support programmes by autistic peers.

METHODS

The objective of this study is to describe the anticipated acceptability of structured peer support programmes for and by autistic persons. Fifteen key stakeholders (six autistic adults, four caregivers and five service providers) participated in in-depth semistructured interviews. A qualitative thematic analysis of the content of the verbatim was carried out.

FINDINGS

We found that while a structured peer social support programme is acceptable to autistic people and caregivers, there was no consensus among service providers. The latter expressed doubts about the ability of autistic people to offer support. The framing of discussions between peers, the training of peer helpers, the support for autistic leadership and an organization that considers the communicational and sensory characteristics of autistic persons, could influence adherence to such a programme. Moreover, a space without service providers is an important condition for the acceptability of a peer support programme.

CONCLUSION

A structured peer support service for and by autistic persons could be an innovative way to answer the unmet support needs of autistic people. It seems essential to anticipate potential barriers and facilitators and to communicate among health professionals to promote this approach and reduce possible prejudice about the ability of autistic people to offer support to their peers. More studies are necessary.

PATIENT OR PUBLIC CONTRIBUTION

Fifteen key stakeholders who are involved in autistic people's trajectory of service and support participated in this research. We are a research team composed of healthcare professionals and researchers, in addition to one member of our team being an autistic advocate and a mental health peer-support mentor. Two members of our team are also parents of autistic children. The comprehensibility of the questions for the interview was consulted and discussed with one autistic advocate-collaborator.

A capabilities approach to understanding and supporting autistic adulthood

There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum’s capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives.

The focus on functional deficits in conventional autism research constrains understanding of autistic lives. In this Review, Pellicano et al. appraise research on autistic adulthood through a capabilities lens to identify areas where autistic adults thrive, and where more research and services are needed to enhance their quality of life.

The impact of a positive autism identity and autistic community solidarity on social anxiety and mental health in autistic young people

LAY ABSTRACT

Autism is a diagnosis given to individuals by professionals but is also increasingly seen as an identity which an individual can choose for themselves. We wanted to explore how having autism as an identity affects autistic young people. There is evidence that autistic adults have better psychological well-being when they feel more solidarity with other autistic people and feel positively about being autistic. We know that autistic teenagers often feel anxious in social situations. Having a positive autism identity might help alleviate social anxiety associated with being autistic. We wanted to find out if autistic young people who felt more solidarity with other autistic people, and had more positive feelings about autism, had better psychological well-being and less social anxiety. We asked 121 autistic people aged 15-22 years to complete some questionnaires. These questionnaires asked about the young person's autism traits, social anxiety, and psychological well-being. The questionnaires also asked how satisfied they felt to be autistic (satisfaction) and how much solidarity they felt with the autism community (solidarity). We found that autistic young people who had higher autism satisfaction had better psychological well-being and lower social anxiety. Young people who felt more solidarity with other autistic people had higher psychological well-being. There was no association between autism solidarity and social anxiety. We conclude that is important to support autistic young people to develop positive feelings about autism and to feel solidarity with other autistic people.

Effects of an Educational Presentation About Autism on High School Students' Perceptions of Autistic Adults

Background

Social communication difficulties are a clinical characteristic of autism, but social interactions are reciprocal in nature and autistic individuals' social abilities may not be the only factor influencing their social success. Nonautistic individuals' social perceptions and behavior also contribute to autistic individuals' social difficulties. Previous research has identified that nonautistic individuals' perception of autistic individuals is influenced by autism knowledge and the quantity and quality of exposure to autistic people. The current research aimed to examine how autistic adults are perceived by high school students, assess whether quality and quantity of autism contact predicts these perceptions, and explore whether these perceptions are malleable.

Methods

One hundred fifty-one senior high school students (15-19 years old) completed the First Impression Scale after viewing video recordings of 20 autistic and 20 nonautistic adults in social situations, either before or after viewing a 50-minute educational presentation detailing the everyday experiences of autistic people and participating in a question-and-answer session. We assessed students' prior experiences with autistic people using the Quantity and Quality of Contact Scale and their own self-perceived social competence using the Multidimensional Social Competence Scale.

Results

Consistent with previous studies, students rated autistic adults less favorably than nonautistic adults. However, the educational presentation produced modest but significant improvements on these ratings, with students who viewed the presentation rating autistic adults as more attractive and likable and reporting greater social interest in them compared to those who had not yet viewed the presentation. Furthermore, consistent with a double empathy framework, exploratory analyses indicated that self-reports of greater social competence among students was associated with greater bias against autistic adults, whereas reports of higher quality interactions with autistic people were associated with less bias.

Conclusion

Previous research has demonstrated that nonautistic adults evaluate autistic people less favorably and report lower social interest in them relative to nonautistic controls. In this study, we extend these findings to adolescents but find these biases are somewhat malleable, with education about autism exerting some modest benefits. Changing nonautistic attitudes about autistic differences may provide an avenue for improving interactions for autistic individuals without putting the onus on autistic individuals to change or mask their behavior and identity.

Neurodivergent participatory action research for Virtual Reality (VR)

Purpose

This paper aims to raise awareness of and argue for the use of participatory methods for the research and development of Virtual Reality (VR) applications designed for neurodivergent groups. This includes exploring why it is important to meaningfully include neurodivergent groups and the benefits their inclusion provide.

Design/methodology/approach

VR is becoming increasingly widespread as a consumer product and interventional tool. It is vital for researchers and developers to embrace best practices in these early stages of using the technology, making certain that neurodivergent people have the best possible outcomes.

Findings

The neurodivergent community is dissatisfied with many of the research directions currently being undertaken. This dissatisfaction arises from conflicting priorities between different stakeholders and the lack of input from the community. Participatory research brings neurodivergent people into the research process, whether as members of the research team or as consultants at key steps. Effective participatory research ensures that the priorities of the neurodivergent community are better incorporated in research, as well as enabling the development of more effective applications for VR.

Originality/value

Participatory methods are unutilised in the development of applications aimed for neurodivergent people. By describing their use and utility in other areas, this article aims to encourage other VR researchers to take neurodivergent people on board.

Exploring the role of interpersonal contexts in peer relationships among autistic and non-autistic youth in integrated education

The double empathy problem theory posits that autistic social difficulties emerge from an interpersonal misalignment in social experiences and expectations between autistic and non-autistic people. Supporting this, emerging research reveals better social outcomes in interactions within than across neurotypes among autistic and non-autistic people, emphasizing the need to examine the role of the interpersonal context in autistic social outcomes. However, research on peer relationships among autistic youth primarily focuses on individual characteristics in isolation from the interpersonal context. To address this, this preliminary study explored the effects of student-peer neurotype match on peer relationships among autistic and non-autistic youth in an integrated educational setting. We plotted the peer relationship networks among youth in a school club based on systematic observations of peer interactions over eight 45-min sessions. Descriptive network statistics (node degree and strength) showed that both autistic and non-autistic youth had more and stronger peer relationships with their same- than cross-neurotype peers. Assortativity coefficients revealed a tendency for youth to connect with peers of the same neurotype, rather than with peers with similar social popularity or activity. We further modeled the effects of student-peer neurotype match on peer relationships using exponential random graph models. The findings suggested that student-peer neurotype match predicted the total strength of peer relationships above and beyond the effects of student neurotype, individual heterogeneity in social popularity and activity, and the tendency of mutuality in social relationships. We discussed the strengths and limitations of this study and the implications for future research and inclusion practice.

Verbal entrainment in autism spectrum disorder and first-degree relatives

Entrainment, the unconscious process leading to coordination between communication partners, is an important dynamic human behavior that helps us connect with one another. Difficulty developing and sustaining social connections is a hallmark of autism spectrum disorder (ASD). Subtle differences in social behaviors have also been noted in first-degree relatives of autistic individuals and may express underlying genetic liability to ASD. In-depth examination of verbal entrainment was conducted to examine disruptions to entrainment as a contributing factor to the language phenotype in ASD. Results revealed distinct patterns of prosodic and lexical entrainment in individuals with ASD. Notably, subtler entrainment differences in prosodic and syntactic entrainment were identified in parents of autistic individuals. Findings point towards entrainment, particularly prosodic entrainment, as a key process linked to social communication difficulties in ASD and reflective of genetic liability to ASD.

The Components of Interpersonal Synchrony in the Typical Population and in Autism: A Conceptual Analysis

Interpersonal synchrony – the tendency for social partners to temporally co-ordinate their behaviour when interacting – is a ubiquitous feature of social interactions. Synchronous interactions play a key role in development, and promote social bonding and a range of pro-social behavioural outcomes across the lifespan. The process of achieving and maintaining interpersonal synchrony is highly complex, with inputs required from across perceptual, temporal, motor, and socio-cognitive domains. In this conceptual analysis, we synthesise evidence from across these domains to establish the key components underpinning successful non-verbal interpersonal synchrony, how such processes interact, and factors that may moderate their operation. We also consider emerging evidence that interpersonal synchrony is reduced in autistic populations. We use our account of the components contributing to interpersonal synchrony in the typical population to identify potential points of divergence in interpersonal synchrony in autism. The relationship between interpersonal synchrony and broader aspects of social communication in autism are also considered, together with implications for future research.

"I Knew She'd Get It, and Get Me": Participants' Perspectives of a Participatory Autism Research Project

Introduction

Autistic advocates and their supporters have long argued that conventional research practices provide too few opportunities for genuine engagement with autistic people, contributing to social disenfranchisement among autistic people. We recently described one attempt to develop and implement a participatory study in which a team of autistic and nonautistic researchers worked together to gather life histories from late-diagnosed autistic people. In the current study, we sought to understand the impact of this participatory approach on the participants themselves.

Methods

We spoke to 25 Australian late-diagnosed autistic adults (aged 45-72 years), who had been interviewed by an autistic researcher using an oral history approach. We asked them about their experience of being involved in that project and the research process more broadly. We thematically analyzed participants' interviews.

Results

Participants responded overwhelmingly positively to the opportunity to tell their life history, considering it illuminating and empowering. While recounting their life history was often described as "exhausting" and "draining," participants also reported feeling "supported all the way" and agreed "it was made easier because I had an autistic researcher interviewing me." One participant went so far as to say that they "probably would have dropped out [of the project] if it was run by people who weren't autistic."

Conclusions

These findings demonstrate that the benefits of coproduction to researchers and community partners extend to study participants and to the quality of the research itself. Involving autistic partners in the research process, especially in its implementation, can play a crucial role in enhancing autism research.

Evidence of partner similarity for autistic traits, systemizing, and theory of mind via facial expressions

It has been hypothesised that romantic partners are more similar than chance in relation to autistic traits. To test this theory, we recruited n = 105 heterosexual couples and examined within-couple correlations for autistic traits [measured using the Autism Spectrum Quotient (AQ)], empathizing [measured using the Empathy Quotient (EQ)], and systemizing [measured using the Systemizing Quotient-Revised (SQ-R)]. For a subsample that attended the lab (n = 58 couples), we also investigated theory of mind via facial expressions using the Reading the Mind in the Eyes Test (RMET) and attention to detail, a component within systemizing, using the Embedded Figures Task (EFT). Variable-centred analyses revealed positive within-couple correlations for all measures except EQ, although these effects were only statistically significant for unmarried couples and not for married/engaged couples. Follow-up analyses indicated that the observed couple similarity effects are likely consistent with people pairing with those more similar than chance (initial assortment) rather than becoming alike over time (convergence), and to seeking out self-resembling partners (active assortment) rather than pairing in this manner via social stratification processes (social homogamy). Additionally, a significant within-couple correlation for autistic traits was observed at the meta-analytic level. However, it should be noted that the meta-analytic effect size estimate was small (r = 0.153) and indicates that only ~ 2% of variance in a person’s score on a phenotypic measure of autistic traits can be predicted by that of their partner.

The Neurodiversity Approach(es): What Are They and What Do They Mean for Researchers?

This paper presents the concepts of "neurodiversity" and the "neurodiversity approaches" towards disability and discusses how confusion regarding the meaning of these concepts exacerbates debate and conflict surrounding the neurodiversity approaches. For example, some claim the neurodiversity approaches focus solely on society and deny contributions of individual characteristics to disability (a controversial stance), whereas this paper joins other literature in acknowledging the contributions of both individual and society to disability. This paper also addresses other controversies related to neurodiversity, such as uncertainty regarding the scope of the approaches - to whom do they apply? - and their implications for diagnostic categories. Finally, it provides recommendations for developmental researchers who wish to carry out neurodiversity-aligned research: scholars are urged to study both individual neurodivergent people and the contexts around them; to consider both strengths and weaknesses; to recognize their own biases; and to listen to and learn from neurodivergent people.

"A Group of Fellow Travellers Who Understand": Interviews With Autistic People About Post-diagnostic Peer Support in Adulthood

Receiving a diagnosis of autism in adulthood can be a life changing event, impacting identity, relationships, and mental health. A lack of post-diagnostic support has been highlighted by autistic adults, their allies, clinicians, and service providers. It can be a source of distress for autistic adults, reinforcing feelings of social isolation and rejection. Peer support could be a cost-effective, flexible, and sustainable model to provide community-based support for autistic adults. However, there is little research on the value of peer support, despite calls from the autistic community. This qualitative study explored autistic experiences and needs post-diagnosis, identifying specific ways that peer support may benefit them, and exploring the limitations of peer support. Twelve autistic adults who had all received an autism diagnosis in adulthood completed a semi-structured interview focussing on the diagnostic experience, post-diagnostic support needed and provided, engagement with the autistic community, and post-diagnostic peer support. Thematic analysis of interview transcripts resulted in four themes: (1) Mismatch in support needed and provided; (2) Community connection; (3) Flexible and personalised support; and (4) Sustainability. Participants indicated that peer support may be a useful mechanism to support autistic adults’ post-diagnosis and offers unique opportunities not available through other support channels. Though informal peer support exists, it could be more sustainable and effective if well-supported and funded.

A Letter to the Editor Regarding Bambara et al. (2021), "Using Peer Supports to Encourage Adolescents With Autism Spectrum Disorder to Show Interest in Their Conversation Partners"

PURPOSE

The purpose of this letter is to address interpretations regarding Bambara et al.'s (2021) study and help resolve potential for further missteps within this line of research.

CONCLUSION

There is clear value in teaching skills that are wanted by autistic people. The primary issue within the article is that it does not acknowledge the double empathy problem and is constructed based on only a neurotypical system of interpretation or communication style. What is being promoted is to address skills autistic participants request.

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

Since its initial description, the concept of autism has been firmly rooted within the conventional medical paradigm of child psychiatry. Increasingly, there have been calls from the autistic community and, more recently, nonautistic researchers, to rethink the way in which autism science is framed and conducted. Neurodiversity, where autism is seen as one form of variation within a diversity of minds, has been proposed as a potential alternative paradigm. In this review, we concentrate on three major challenges to the conventional medical paradigm - an overfocus on deficits, an emphasis on the individual as opposed to their broader context and a narrowness of perspective - each of which necessarily constrains what we can know about autism and how we are able to know it. We then outline the ways in which fundamental elements of the neurodiversity paradigm can potentially help researchers respond to the medical model's limitations. We conclude by considering the implications of a shift towards the neurodiversity paradigm for autism science.

'It's being a part of a grand tradition, a grand counter-culture which involves communities': A qualitative investigation of autistic community connectedness

LAY ABSTRACT

A sense of being connected to other autistic people has been reported anecdotally. Friendships and connectedness may be important to autistic people and beneficial for their wellbeing. Our research aimed to understand the autistic community by interviewing 20 autistic people about their experiences of being connected to other autistic people. Participants were interviewed in person, over video, using a text-based software to type or over email. Participants detailed three parts of autistic community connectedness: a sense of belonging, social connection with autistic friends and political connectedness. The friendships autistic people had with one another were deemed to be very important to participants because it gave them confidence, provided companionship and made them happy. Some participants did not experience connectedness to the autistic community. These participants also found autism to be less important to their identity and had fewer positive feelings about being autistic. This research is important as it raises awareness that community connectedness is viewed as important to this group. It is possible that community connectedness may help protect the mental health of autistic people when they face stigma or negative life experiences in society.

Understanding Stigma in Autism: A Narrative Review and Theoretical Model

The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.

Investigating Markers of Rapport in Autistic and Nonautistic Interactions

Background

Autism is considered to entail a social impairment whereby autistic people experience difficulty interpreting others' mental states. However, recent research has shown that nonautistic people also have difficulty understanding the mental states of autistic people. This mismatch of understanding may explain lower rapport in interactions between autistic and nonautistic people. As mental states can be expressed externally through socially normed signals, it is important to investigate the role of such signals in autistic, nonautistic, and mixed interactions. This study explores variability in two social signals between autistic, nonautistic, and mixed interactions, and how their use may affect rapport within interactions.

Methods

Videos from a previous study of autistic, nonautistic, and mixed pair interactions in a diffusion chain context in which participants were aware of others' diagnostic status were video coded for mutual gaze and backchanneling as candidate indicators of interactional rapport.

Results

Although use of mutual gaze and backchanneling was lower in mixed pairs than in nonautistic pairs, corresponding to lower ratings of interactional rapport, less backchanneling in autistic pairs of both nonverbal and verbal subtypes corresponded to higher ratings of rapport.

Conclusions

We observed differences in the use of candidate rapport markers between autistic, mixed, and nonautistic interactions, which did not map onto patterns of rapport scores, suggesting differences in reliance on these cues between autistic and nonautistic people. These results suggest that visible markers of rapport may vary by neurotype or pairing and give clues to inform future investigations of autistic interaction.

Challenging Empathic Deficit Models of Autism Through Responses to Serious Literature

Dominant theoretical models of autism and resultant research enquiries have long centered upon an assumed autism-specific empathy deficit. Associated empirical research has largely relied upon cognitive tests that lack ecological validity and associate empathic skill with heuristic-based judgments from limited snapshots of social information. This artificial separation of thought and feeling fails to replicate the complexity of real-world empathy, and places socially tentative individuals at a relative disadvantage. The present study aimed to qualitatively explore how serious literary fiction, through its ability to simulate real-world empathic response, could therefore enable more ecologically valid insights into the comparative empathic experiences of autistic and non-autistic individuals. Eight autistic and seven non-autistic participants read Of Mice and Men for six days while completing a semi-structured reflective diary. On finishing the book, participants were asked to engage in three creative writing tasks that encouraged reflective thinking across the novel. Thematic and literary analysis of the diary reflections and writing tasks revealed three main themes (1) Distance from the Novel; (2) Mobility of Response; (3) Re-Creating Literature. Findings demonstrated the usefulness of serious literature as a research tool for comparing the empathic experiences of autistic and non-autistic individuals. Specifically, autistic individuals often showed enhanced socio-empathic understandings of the literature with no empathy deficits when compared to non-autistic participants.

A Critical Realist Approach on Autism: Ontological and Epistemological Implications for Knowledge Production in Autism Research

The ontological status of autism has been a subject of considerable debate and philosophical approaches of it have been recent and sparse. On the one hand, from its conception, autism has been historically heavily located in the fields of psychiatry, psychology and neuroscience, which often assume access to an "objective," neutral and infallible reality that is external to the research process and is based on the autistic person's biology and behavioural characteristics, which can be scientifically observed and studied. On the other, proponents of the neurodiversity movement argue against medicalised and pathologising approaches to autism and toward approaches that consider social constructions of autism and relations of power. The Critical Realist philosophy can help reconcile the two positions. Critical Realism conceptualises objectivity as a statement about an object, rather than a neutral and infallible reality. Consequently, Critical Realism suggests that access to reality can only occur through fallible theories. It also suggests that effective theorising goes beyond appearances and phenomena and may even contradict them, which can help challenge dominant behaviourist approaches on autism. I then explore how the tenets of Critical Realism can help strengthen autistic-led theories of autism, the arguments they make, as well as how they support the importance of community autism knowledge. Finally, I present how Critical Realism's approach to knowledge itself as well as the process of knowledge creation can strengthen autistic theorising, autistic participation in autism research and autistic emancipation. In the last part of the article, I explore how the concepts of Critical Realism apply to autistic sociability. I start with the debate between structure and agency, how Critical Realism reconciles this debate and the implications for autistic emancipation and autism research. I then present Critical Realism's process of critique and explanation, how they connect to human emancipation and how they can lead to impactful change in autism research by requiring clear links from research to practice, enhancing practices with strong theoretical underpinnings and thus aiding the aims of emancipatory autism research.

Peer preferences and characteristics of same-group and cross-group social interactions among autistic and non-autistic adolescents

LAY ABSTRACT

Autistic students often experience challenges in peer interactions, especially for young adolescents who are navigating the increased social expectations in secondary education. Previous research on the peer interactions of autistic adolescents mainly compared the social behaviors of autistic and non-autistic students and overlooked the peers in the social context. However, recent research has shown that the social challenges faced by autistic may not be solely contributed by their social differences, but a mismatch in the social communication styles between autistic and non-autistic people. As such, this study aimed to investigate the student-and-peer match in real-world peer interactions between six autistic and six non-autistic adolescents in an inclusive school club. We examined the odds of autistic and non-autistic students interacting with either an autistic peer, a non-autistic peer, or multiple peers, and the results showed that autistic students were more likely to interact with autistic peers then non-autistic peers. This preference for same-group peer interactions strengthened over the 5-month school club in both autistic and non-autistic students. We further found that same-group peer interactions, in both autistic and non-autistic students, were more likely to convey a social interest rather than a functional purpose or need, be sharing thoughts, experiences, or items rather than requesting help or objects, and be highly reciprocal than cross-group social behaviors. Collectively, our findings support that peer interaction outcomes may be determined by the match between the group memberships of the student and their peers, either autistic or non-autistic, rather than the student's autism diagnosis.

Exploring interpersonal and environmental factors of autistic adolescents' peer engagement in integrated education

LAY ABSTRACT

Peer engagement is essential but often challenging for autistic students in integrated education, especially for adolescents. Although peer engagement is bidirectional and context-dependent, research has largely focused on individual characteristics rather than the interpersonal and environmental factors affecting peer engagement. This mixed-methods study examined peer interactions over a school year among 17 adolescents (seven were autistic) in an inclusive school club at a public middle school in the Northeastern United States. The study began with a quantitative phase identifying sessions in which each student was socially engaged with peers more or less often than usual for them. We then qualitatively compared the social interactions and contexts between sessions where each participant experienced high and low peer engagement. Thematic analysis revealed four themes regarding contextual supports and barriers to autistic peer engagement: (1) peer engagement is a participatory process where a student and their peer(s) navigate mutual understanding, shaped by both student and peer social characteristics, openness, and involvement; (2) student-peer synchronicity, such as shared interests or compatibility of social styles, was essential to autistic peer engagement; (3) peer engagement can be supported by activities facilitating joint engagement and exploration of mutual interests; (4) classroom interventions emphasizing strengths can support peer engagement, while normative behavioral standards without peer education on individual differences and diversity can perpetuate peers' negative perceptions of autistic difficulties. The findings have implications for better inclusive practice to support autistic social participation by modifying the peer environments, activities, and classroom interventions.

Overcoming the Double Empathy Problem Within Pairs of Autistic and Non-autistic Adults Through the Contemplation of Serious Literature

Recent research based on the needs of the autistic community has explored the frequent social misunderstandings that arise between autistic and non-autistic people, known as the double empathy problem. Double empathy understandings require both groups to respect neurodiversity by focussing on individuality across groups. This study aimed to explore how literature, through its ability to uncover nuanced emotional response differences between readers, could facilitate double empathy understandings within pairs of autistic and non-autistic adults. A longitudinal, qualitative design was used, with 4 gender-matched pairs. Participants read Of Mice and Men for 1 week, whilst completing a structured, reflective diary. This was followed by 4 one-hour paired reading sessions, where pairs discussed the book and their reflections in depth. Participants were then invited to a final one-on-one interview to discuss their thoughts and experiences of the paired reading sessions. Thematic and literary analysis of the session and interview data revealed four themes (1) The Book as Social Oil; (2) From a World of Difference to a World of Affinity; (3) Emotional Intelligence: From Thinking About to Feeling with; and (4) From Overwhelming to Overcoming. All participants reported having achieved an individualised view of one another to explore their nuanced differences. The non-autistic group reported a more sensitive understanding of what it means to be autistic, while the autistic group overcame concerns about non-autistic people stereotyping autism, and instead reported feeling valued and accommodated by their non-autistic partners.

Autistic Self-Advocacy and the Neurodiversity Movement: Implications for Autism Early Intervention Research and Practice

The growth of autistic self-advocacy and the neurodiversity movement has brought about new ethical, theoretical and ideological debates within autism theory, research and practice. These debates have had genuine impact within some areas of autism research but their influence is less evident within early intervention research. In this paper, we argue that all autism intervention stakeholders need to understand and actively engage with the views of autistic people and with neurodiversity as a concept and movement. In so doing, intervention researchers and practitioners are required to move away from a normative agenda and pay diligence to environmental goodness-of-fit, autistic developmental trajectories, internal drivers and experiences, and autistic prioritized intervention targets. Autism intervention researchers must respond to these debates by reframing effectiveness, developing tools to measure autistic prioritized outcomes, and forming partnerships with autistic people. There is a pressing need for increased reflection and articulation around how intervention practices align with a neurodiversity framework and greater emphasis within intervention programmes on natural developmental processes, coping strategies, autonomy, and well-being.