Infant attachment does not depend on neonatal amygdala and hippocampal structure and connectivity

Infant attachment is an antecedent of later socioemotional abilities, which can be adversely affected by preterm birth. The structural integrity of amygdalae and hippocampi may subserve attachment in infancy. We aimed to investigate associations between neonatal amygdalae and hippocampi structure and their whole-brain connections and attachment behaviours at nine months of age in a sample of infants enriched for preterm birth. In 133 neonates (median gestational age 32 weeks, range 22.14-42.14), we calculated measures of amygdala and hippocampal structure (volume, fractional anisotropy, mean diffusivity, neurite dispersion index, orientation dispersion index) and structural connectivity, and coded attachment behaviours (distress, fretfulness, attentiveness to caregiver) from responses to the Still-Face Paradigm at nine months. After multiple comparisons correction, there were no significant associations between neonatal amygdala or hippocampal structure and structural connectivity and attachment behaviours: standardised β values - 0.23 to 0.18, adjusted p-values > 0.40. Findings indicate that the neural basis of infant attachment in term and preterm infants is not contingent on the structure or connectivity of the amygdalae and hippocampi in the neonatal period, which implies that it is more widely distributed in early life and or that network specialisation takes place in the months after hospital discharge.

The Associations Between Camouflaging, Autistic Traits, and Mental Health in Nonautistic Adults

Background

Camouflaging is frequently reported in autistic people and entails the disguising of autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a nonautistic sample, examining the relationship between autistic traits, self-reported camouflaging, gender, and mental health.

Method

In total 110 nonautistic adults completed standardized self-report questionnaires that measured autistic traits, mental health symptoms, and camouflaging behaviors. Hierarchical multiple linear regression models were used to analyze data and examine the unique contributions of autistic traits and camouflaging to mental health.

Results

Self-reported autistic traits were associated with increased symptoms of poor mental health. However, autistic traits were not associated with mental health symptoms when controlling for self-reported camouflaging, and self-reported camouflaging predicted increased mental health symptoms over and above the effects of autistic traits. Women had poorer mental health than men in our sample, and in women there was a stronger relationship between camouflaging and mental health than in men.

Conclusions

Camouflaging may contribute to poor mental health outcomes in the general population, just as it does for autistic people, to the extent that camouflaging more clearly relates to mental health profile than self-reported autism traits. This suggests camouflaging is an important construct for understanding mental health in general, and for exploring the complex relationship between autism and autistic traits.

Views on sharing mental health data for research purposes: qualitative analysis of interviews with people with mental illness

BACKGROUND

Improving the ways in which routinely-collected mental health data are shared could facilitate substantial advances in research and treatment. However, this process should only be undertaken in partnership with those who provide such data. Despite relatively widespread investigation of public perspectives on health data sharing more generally, there is a lack of research on the views of people with mental illness.

METHODS

Twelve people with lived experience of mental illness took part in semi-structured interviews via online video software. Participants had experience of a broad range of mental health conditions including anxiety, depression, schizophrenia, eating disorders and addiction. Interview questions sought to establish how participants felt about the use of routinely-collected health data for research purposes, covering different types of health data, what health data should be used for, and any concerns around its use.

RESULTS

Thematic analysis identified four overarching themes: benefits of sharing mental health data, concerns about sharing mental health data, safeguards, and data types. Participants were clear that health data sharing should facilitate improved scientific knowledge and better treatments for mental illness. There were concerns that data misuse could become another way in which individuals and society discriminate against people with mental illness, for example through insurance premiums or employment decisions. Despite this there was a generally positive attitude to sharing mental health data as long as appropriate safeguards were in place.

CONCLUSIONS

There was notable strength of feeling across participants that more should be done to reduce the suffering caused by mental illness, and that this could be partly facilitated by well-managed sharing of health data. The mental health research community could build on this generally positive attitude to mental health data sharing by following rigorous best practice tailored to the specific concerns of people with mental illness.

Short report: Evaluation of wider community support for a neurodiversity teaching programme designed using participatory methods

LAY ABSTRACT

Children with diagnoses such as autism, attention-deficit/hyperactivity disorder (ADHD), dyslexia and so on often experience bullying at school. This group can be described as neurodivergent, meaning they think and process information differently from most people. Previous research suggests that increasing people's knowledge can be an effective way to reduce stigma and bullying. Therefore, we decided to create a primary school resource to teach about neurodiversity - the concept that all humans vary in how our brains work. Working with educators, our research team - which included neurodivergent people - developed plans for a teaching programme called Learning About Neurodiversity at School (LEANS). Next, we wanted to know whether these plans, developed by our small neurodiverse team, would be endorsed by the wider community. To find out, we conducted an online feedback survey about our plans for the resource. We analysed feedback from 111 people who participated. Most of them identified as neurodivergent (70%) and reported being familiar with neurodiversity (98%), meaning they could provide an informed opinion on our plans. Over 90% of people expressed support for the planned programme content described in the survey, and 73% of them approved our intended definition of the resource's core concept, neurodiversity. From these results, we concluded that there was a high level of support for the planned LEANS programme content across those from the wider community who completed the survey. Consequently, we continued developing the LEANS programme in line with the initial plans from our neurodiverse team. The completed resource is now available as a free download.

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.

Short report: Autistic adults' recommendations on how to improve autistic portrayals in TV-series and movies

BACKGROUND

TV-series and movies are important sources of knowledge about autism for the general public.

AIMS

This study's purpose was to elicit autistic adults' opinions on portrayals of autistic characters in film and television productions and how this can be improved.

METHODS AND PROCEDURE

In this study, we examined the recommendations of autistic adults (n = 798, M_age = 30.3, 48% female) and non-autistic adults (n = 1463, M_age = 35.0, 62% female) from 90 countries on how film and television productions can improve autistic portrayals.

OUTCOMES AND RESULTS

Autistic adults rated three improvement factors as most important: (1) Appointing autistic writers, (2) Having an autistic consultant, and (3) Representing greater diversity in autistic characters. Compared to the non-autistic groups, autistic adults rated "Appointing autistic writers" as more important. Autistic participants also endorsed "Having an autism-expert consultant" and "Making the character display all relevant diagnostic criteria" significantly less than non-autistic groups.

CONCLUSIONS AND IMPLICATIONS

Participants strongly endorsed that autistic adults should to a much larger extent be included as writers, consultants and actors to enhance the making of autistic characters in film and TV.

"The Languages That You Know Draw the Boundary of Your World": A Thematic Analysis of the Experiences of Autistic Bilingual Adults Living in the United Kingdom

Background

Although being bilingual (knowing two or more languages) is becoming a more common experience globally, little is known about the combined experience of bilingualism and autism. Research currently available focuses on quantifying language and cognitive development, and the only two qualitative accounts of first-hand experiences are from either bilingual children or highly multilingual adults (with four languages or more), which may not represent the wider autistic bilingual population. All other accounts focus on parents or practitioners. This qualitative study reports the experiences of autistic bi- and multilingual adults, focusing on barriers and enablers to language learning and the reported benefits of bilingualism.

Methods

Thirty-nine U.K.-based autistic bilingual adults (41% female, mean age = 33.2 years, range = 16-61) with knowledge of two to seven languages (mean = 3.6, standard deviation = 1.4) completed an online Demographic and Language Questionnaire, including three open-ended questions about the interplay between autism and bilingualism. A thematic analysis was conducted on the responses to these open-ended questions.

Results

Participants perceived many opportunities and benefits brought by bilingualism, in terms of relationships, hobbies, mobility, employment, education, and cultural insight. Respondents reported social communication as being a major benefit of being bilingual, and discussed how bilingualism had broadened their mindset, while identifying factors that had enabled or challenged their language learning journey.

Conclusions

This study builds upon the few reports available to highlight the experiences that are shared by autistic bilingual people regardless of the number of languages they know. It is the first study to report the perspectives of U.K.-based autistic bilingual adults who, in most cases, grew up in a bilingual environment. Accounts of the factors that can facilitate or hinder language learning will inform the development of strategies to better support autistic people. These findings have implications for bilingual families and practitioners supporting autistic bilingual people.

Patient satisfaction with mental and physical health services: Findings from a UK-wide online survey

Introduction - Despite extensive debate surrounding mental health services in the UK, there is little empirical evidence regarding the views of those who use them. We therefore used data collected as part of a wider survey to examine satisfaction amongst those seeking treatment from mental and physical health services. Methods - An online survey designed with input from people with experience of mental illness was used to measure satisfaction with NHS mental and physical health services at first contact and in the previous 12 months. Results - A total of 2187 people responded. During the 12 months prior to the survey, 526 respondents had sought mental health care and 1379 had sought physical health care. Participants were significantly more satisfied with their most recent contact with mental health services (48.1% very/satisfied) than with their first contact (38.2% very/satisfied). More than 1 in 10 respondents who sought mental health care (11.4%) stated that they received no treatment/support from the NHS, compared to approximately 1 in 20 respondents who sought physical health care (4.6%). Of those who received the mental health treatment they requested (n = 424), most were satisfied or very satisfied with their care (54.7%), although this was lower than the corresponding figure (77.9%) for satisfaction with physical health care received (n = 1190). Conclusion -There was evidence that mental health services are satisfactory for a slim majority of users, but people were generally more satisfied with NHS physical health care. This survey was conducted in the year prior to the coronavirus disease 2019 pandemic. Future research could examine what influences satisfaction with care and whether this picture has changed following the emergence of the pandemic and consequent impact on health service delivery and daily life.

Emotion regulation and cortisol response to the still-face procedure in preterm and full-term infants

In infancy, stress responses and emotion regulation are often coupled. Both are impacted by prematurity, though their relationship to one another in the case of infants born preterm is not fully understood. We investigated emotion regulation behaviours, cortisol reactivity and recovery and coupling between emotion regulation and cortisol reactivity to and recovery from a stressor in preterm infants. 53 preterm and 67 full-term infants with mean (range) gestational age at birth 29⁺³ (24⁺⁰-31⁺⁶) and 39⁺³ (36⁺²-42⁺⁰) weeks respectively were exposed to a socio-emotional stressor, the still-face (SF) paradigm, at 9 months of age (corrected for prematurity). The duration of negative affect and self-comforting behaviours exhibited in response to the SF, coded from a 10-minute video-taped interaction, were compared between groups. Saliva was collected from a subset (20 preterm, 24 term infants) at three timepoints: pre-SF and 20- and 30-minutes post SF. Cortisol concentrations at each timepoint were compared between groups. Associations between behavioural measures and cortisol concentrations were explored. There was no significant difference in duration of self-comforting behaviour between preterm and term infants. Preterm infants spent a significantly smaller proportion of time in a negative affective state compared to term infants (0.18 vs 0.25 s, p = 0.03). Salivary cortisol concentration was significantly higher in the preterm compared to the term group 30 min post SF (2.85 vs 1.77 nmol/L, p = 0.009), though findings were no longer significant after adjusting for time of day of sampling and socioeconomic deprivation. After controlling for time of day, greater negative affect was correlated with higher cortisol concentration 30 min post SF in the full-term (r = 0.58, p = 0.004) but not the preterm group (r = -0.01, p > 0.05). Our findings suggest altered response to an acute stressor in preterm infants, manifesting as a muted emotional response, and a lack of coupling between endocrine and behavioural stress response. Replication studies in larger samples would help to further understand biological stress repose in preterm infants and its relationship to behaviour, time of day and deprivation.

"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.

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.

Experience of clinical services shapes attitudes to mental health data sharing: findings from a UK-wide survey

BACKGROUND

Routinely-collected mental health data could deliver novel insights for mental health research. However, patients' willingness to share their mental health data remains largely unknown. We investigated factors influencing likelihood of sharing these data for research purposes amongst people with and without experience of mental illness.

METHODS

We collected responses from a diverse sample of UK National Health Service (NHS) users (n = 2187) of which about half (n = 1087) had lifetime experience of mental illness. Ordinal logistic regression was used to examine the influence of demographic factors, clinical service experience, and primary mental illness on willingness to share mental health data, contrasted against physical health data.

RESULTS

There was a high level of willingness to share mental (89.7%) and physical (92.8%) health data for research purposes. Higher levels of satisfaction with the NHS were associated with greater willingness to share mental health data. Furthermore, people with personal experience of mental illness were more willing than those without to share mental health data, once the variable of NHS satisfaction had been controlled for. Of the mental illnesses recorded, people with depression, obsessive-compulsive disorder (OCD), personality disorder or bipolar disorder were significantly more likely to share their mental health data than people without mental illness.

CONCLUSIONS

These findings suggest that positive experiences of health services and personal experience of mental illness are associated with greater willingness to share mental health data. NHS satisfaction is a potentially modifiable factor that could foster public support for increased use of NHS mental health data in research.

Perspectives and Experiences of Autistic Multilingual Adults: A Qualitative Analysis

Background

The combined experience of autism and bilingualism is poorly understood, leading to poor support for autistic people in multilingual environments or those interested in languages. While most available studies focus on the language and cognitive profiles of autistic bilinguals, or on the experiences of parents, little is known about the lived experiences of autistic multilinguals.

Methods

To address this question, this study examined the impact of autism and multilingualism on the lives of 54 autistic multilingual adults who completed an online survey assessing the profiles of autistic bi- and multilinguals. We conducted a thematic analysis of responses to the survey's open-ended questions to explore motivations for learning languages and the perceived benefits of being both autistic and multilingual.

Results

There was a wide range of language profiles in the sample, with various levels of proficiency, ages of acquisition, and learning environments. Respondents felt that being autistic can both positively and negatively influence language learning. They reported various motivating factors for the acquisition of multiple languages, including social aspects and a predisposition for language learning. Respondents reported many benefits of multilingualism, such as educational, employment, or leisure opportunities; social skills and understanding of other people; self-confidence in their own abilities; and relationships with family, friends, and the worldwide autistic community.

Conclusions

Unlike previous work with autistic multilinguals involving case studies, the larger sample involved here offers valuable insight into the profiles and experiences of this overlooked population. Importantly, autistic people can experience numerous benefits from multilingualism. These findings will have implications for language education practices as well as for multilingual families and the practitioners who support them.

Lay summary

Why was this study done?: We wanted to understand what it feels like to be both autistic and multilingual, in a world where it is often assumed that both cannot go together. The combined experience of autism and bilingualism is poorly understood. This leads to poor support for autistic people in bilingual environments or for those interested in languages. Most studies available focus on the language and mental abilities of autistic bilinguals, or on the experiences of parents. However, very few studies focus on the lived experiences of autistic multilinguals themselves.What was the purpose of this study?: The purpose of this study was to understand the experiences of autistic multilingual adults. We focused on their learning motivations and the perceived benefits of being autistic and multilingual.What did the researchers do?: Fifty-four autistic multilingual adults completed an online questionnaire designed for autistic bi- and multilinguals. The questionnaire included questions about the respondents' language history and language profiles. There were also open-ended questions about the respondents' motivations for learning languages, and their general experience of being both autistic and multilingual. We analyzed and summarized the responses to these open-ended questions to understand the experience of autistic multilingual adults.What were the results of the study?: Our sample had a diverse range of language profiles and experiences. Respondents thought that autism could be both an advantage and a disadvantage for language learning. They reported a range of motivations for language learning, including a predisposition for language learning. They considered relationships as both a motivation to learn languages and a benefit of multilingualism. Respondents thought that being multilingual had brought them many opportunities for leisure, travels, education, and employment. They considered that being multilingual had improved their self-confidence. They also thought that being multilingual had increased their awareness and understanding of autism, allowing them to connect with the wider autistic population.What do these findings add to what was already known?: Previous research with autistic multilinguals involved only one or two participants. The larger group of autistic multilinguals involved in this study offers valuable insight into the lived experiences of this overlooked population.What are potential weaknesses in the study?: The online questionnaire was not originally designed to collect in-depth data on lived experiences. This means that the questions included very few prompts: respondents were able to discuss the aspects of their experience that were the most important to them. The absence of specific topics in the results does not mean that they are not experienced, but simply that the participants did not spontaneously mention them. Future research should build upon our findings and focus on specific topics, such as learning environments or opportunities.How will these findings help autistic adults now or in the future?: These findings will help autistic adults by highlighting the diversity and richness of their language profiles, abilities, and experiences. This will prompt families, educators, and practitioners to better support and include autistic people in multilingual environments or those interested in languages.

Parent priorities for research and communication concerning childhood outcomes following preterm birth

Background: Children born preterm (before 37 weeks of gestation) are at risk for several adverse childhood outcomes. Parent priorities for research into these outcomes, and preferences for receiving information about these risks, have not previously been established. Here we report the results of an online survey designed to understand parent priorities for research and their preferences for receiving information about childhood outcomes. Methods: An online survey was circulated through social media and was completed by 148 parents of preterm children between the ages of 0 and 12 years from around the United Kingdom (UK). Survey questions were in the form of rating scale, multiple choice, ranking or open-ended free text questions. Descriptive analysis was applied to the quantitative data. Illustrative quotes were extracted from the qualitative free text data and a subset of these questions were analysed using framework analysis. Results: Parent priorities for research centre around identification of factors which can protect against or improve adverse cognitive or developmental outcomes. The majority of parents would prefer for communication to begin within the first year of the child's life. Parents reported a knowledge gap among health visitors, early years educators and schools. Conclusions: In order to align with parent preferences, research should prioritise identification of protective factors and the development of effective interventions to improve outcomes. Training for health visitors and educational professionals could improve the experiences of families and children.

Autistic People's Access to Bilingualism and Additional Language Learning: Identifying the Barriers and Facilitators for Equal Opportunities

Bilingualism is a valuable tool that enriches and facilitates cultural, social and lived experiences for autistic and non-autistic people alike. Research consistently finds no negative effects of bilingualism and highlights the potential for positive effects across cognitive and socio-cultural domains for autistic and non-autistic children. Yet parents of autistic children remain concerned that bilingualism will cause delays in both cognitive and language development and are still frequently advised by practitioners to raise their child monolingually. Evidently, findings from research are not reflected in practice or subsequent advice, and it is essential to identify ways to ensure equal access to additional language learning. We briefly summarise the existing literature on bilingualism and autism, considering perspectives from the bilingual autistic community, and experimental research. We identify the most pertinent barriers to participation for autistic bilingual children in terms of familial, clinical and educational perspectives. We propose novel solutions to promote additional language learning and suggest changes to practice that will contribute to an evidence base for families and practitioners. This commentary makes innovative recommendations at both the individual and societal level to ensure that autistic bilingual people have equal rights and opportunities to language learning and are optimally supported in accessing them.

Measuring the Impact of Bilingualism on Executive Functioning Via Inhibitory Control Abilities in Autistic Children

One factor that may influence how executive functions develop is exposure to more than one language in childhood. This study explored the impact of bilingualism on inhibitory control in autistic (n = 38) and non-autistic children (n = 51). Bilingualism was measured on a continuum of exposure to investigate the effects of language environment on two facets of inhibitory control. Behavioural control of motor impulses was modulated positively through increased bilingual exposure, irrespective of diagnostic status, but bilingual exposure did not significantly affect inhibition involving visual attention. The results partially support the hypothesis that bilingual exposure differentially affects components of inhibitory control and provides important evidence for families that bilingualism is not detrimental to their development.

Parent priorities for research and communication concerning childhood outcomes following preterm birth

Background: Children born preterm (before 37 weeks of gestation) are at risk for several adverse childhood outcomes. Parent priorities for research into these outcomes, and preferences for receiving information about these risks, have not previously been established. Here we report the results of an online survey designed to understand parent priorities for research and their preferences for receiving information about childhood outcomes. Methods: An online survey was circulated through social media and was completed by 148 parents of preterm children between the ages of 0 and 12 years from around the United Kingdom (UK). Survey questions were in the form of rating scale, multiple choice, ranking or open-ended free text questions. Descriptive analysis was applied to the quantitative data. Illustrative quotes were extracted from the qualitative free text data and a subset of these questions were analysed using framework analysis. Results: Parent priorities for research centre around identification of factors which can protect against or improve adverse cognitive or developmental outcomes. The majority of parents would prefer for communication to begin within the first year of the child's life. Parents reported a knowledge gap among health visitors, early years educators and schools. Conclusions: In order to align with parent preferences, research should prioritise identification of protective factors and the development of effective interventions to improve outcomes. Training for health visitors and educational professionals could improve the experiences of families and children.

Social cognition following preterm birth: A systematic review

Social cognitive abilities are affected by preterm birth, but pathways to, and risk factors for this outcome are not well mapped. We examined direct assessment tasks including objective coding of parent-child play to chart social development in infancy and pre-school years. A systematic search and data-extraction procedure yielded seventy-nine studies (4930 preterm and 2109 term children, aged birth - five years), for inclusion. We detected a pattern of reduced social attention in the first 12 months of life with evidence of reduced performance in social cognitive tasks later in the preschool years. However, we did not identify a consistent, distinctive preterm social phenotype in early life. Instead, the interactive behaviour of preterm infants reflects factors from outside the social cognitive domain, such as attention, language, and socioeconomic status. By combining data across samples and measures we revealed the role of domain-general skills, which may in future prove fruitful intervention targets.

Inclusive Practices for Neurodevelopmental Research

Purpose of Review

Inclusive research practice is both a moral obligation and a practical imperative. Here we review its relevance to the study of neurodevelopmental diversity in particular, briefly describing a range of inclusive research models and justifying their use. The review itself is inclusively co-authored with three autistic collaborators and community leaders who all have extensive experience of research involvement.

Recent Findings

Drawing on theoretical arguments and specific exemplar projects, we describe six key considerations in the delivery of inclusive research. These are the following: taking the first steps towards inclusive practice; setting expectations; community-specific inclusion measures; inclusion and intersectionality; the role of empowerment; and knowledge exchange for inclusion. Together, these sections provide an illustrated guide to the principles and process of inclusive research.

Summary

Inclusive research practice is both beneficial to and a requirement of excellence in neurodevelopmental research. We call for greater engagement in this participatory research agenda from grant-awarding bodies to facilitate not just inclusive but also emancipatory research.

Eye-tracking for longitudinal assessment of social cognition in children born preterm

BACKGROUND AND OBJECTIVES

Preterm birth is associated with atypical social cognition in infancy, and cognitive impairment and social difficulties in childhood. Little is known about the stability of social cognition through childhood, and its relationship with neurodevelopment. We used eye-tracking in preterm and term-born infants to investigate social attentional preference in infancy and at 5 years, its relationship with neurodevelopment and the influence of socioeconomic deprivation.

METHODS

A cohort of 81 preterm and 66 term infants with mean (range) gestational age at birth 28⁺⁵ (23⁺² -33⁺⁰ ) and 40⁺⁰ (37⁺⁰ -42⁺¹ ) respectively, completed eye-tracking at 7-9 months, with a subset re-assessed at 5 years. Three free-viewing social tasks of increasing stimulus complexity were presented, and a social preference score was derived from looking time to socially informative areas. Socioeconomic data and the Mullen Scales of Early Learning at 5 years were collected.

RESULTS

Preterm children had lower social preference scores at 7-9 months compared with term-born controls. Term-born children's scores were stable between time points, whereas preterm children showed a significant increase, reaching equivalent scores by 5 years. Low gestational age and socioeconomic deprivation were associated with reduced social preference scores at 7-9 months. At 5 years, preterm infants had lower Early Learning Composite scores than controls, but this was not associated with social attentional preference in infancy or at 5 years.

CONCLUSIONS

Preterm children have reduced social attentional preference at 7-9 months compared with term-born controls, but catch up by 5 years. Infant social cognition is influenced by socioeconomic deprivation and gestational age. Social cognition and neurodevelopment have different trajectories following preterm birth.

A clinical and cost-effectiveness trial of a parent group intervention to manage challenging restricted and repetitive behaviours in young children with autism spectrum disorder: study protocol for a randomised controlled trial

BACKGROUND

Restricted and repetitive behaviours vary greatly across the autism spectrum, and although not all are problematic some can cause distress and interfere with learning and social opportunities. We have, alongside parents, developed a parent group based intervention for families of young children with autism, which aims to offer support to parents and carers; helping them to recognise, understand and learn how to respond to their child's challenging restricted repetitive behaviours.

METHODS

The study is a clinical and cost-effectiveness, multi-site randomised controlled trial of the Managing Repetitive Behaviours (MRB) parent group intervention versus a psychoeducation parent group Learning About Autism (LAA) (n = 250; 125 intervention/125 psychoeducation; ~ 83/site) for parents of young children aged 3-9 years 11 months with a diagnosis of autism. All analyses will be done under intention-to-treat principle. The primary outcome at 24 weeks will use generalised estimating equation (GEE) to compare proportion of children with improved RRB between the MRB group and the LAA group. The GEE model will account for the clustering of children by parent groups using exchangeable working correlation. All secondary outcomes will be analysed in a similar way using appropriate distribution and link function. The economic evaluation will be conducted from the perspective of both NHS costs and family access to local community services. A 'within trial' cost-effectiveness analysis with results reported as the incremental cost per additional child achieving at least the target improvement in CGI-I scale at 24 weeks.

DISCUSSION

This is an efficacy trial to investigate the clinical and cost-effectiveness of a parent group based intervention designed to help parents understand and manage their child's challenging RRB. If found to be effective, this intervention has the potential to improve the well-being of children and their families, reduce parental stress, greatly enhance community participation and potential for learning, and improve longer-term outcomes.

TRIAL REGISTRATION

Trial ID: ISRCTN15550611 Date registered: 07/08/2018. Sponsor and Monitor: Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust R&D Manager Lyndsey Dixon, Address: St Nicholas Hospital, Jubliee Road, Gosforth, Newcastle upon Tyne NE3 3XT, lyndsey.dixon@cntw.nhs.uk , Tel: 0191 246 7222.

Commentary: What conflicts of interest tell us about autism intervention research-a commentary on Bottema-Beutel et al. (2020)

Bottema-Beutel, Crowley, Sandbank, and Woynaroski (Journal of Child Psychology and Psychiatry, 2020) have performed a Herculean and invaluable task in their investigation of conflicts of interest (COIs) in nonpharmacological early autism intervention research. Drawing on a meta-analysis of 150 articles reporting group designs, they found COIs in 105 (70%), only 6 (5.7%) of which had fully accurate COI statements. Most reports had no COI statements, but among the 48 (32%) which did, the majority of those declaring no COIs had detectable COIs (23 of 30; 77%). Thus, COI reporting in the literature examined is routinely missing, misleading, and/or incomplete; accurate reporting is the exception rather than the rule. That 120 of the 150 reports were published in 2010 or later, compared to 6 pre-2000, tells us this is not about practices confined to decades past. Instead, it reflects and is a telling indictment of established standards in autism intervention research.

Co-development of a Best Practice Checklist for Mental Health Data Science: A Delphi Study

Background: Mental health research is commonly affected by difficulties in recruiting and retaining participants, resulting in findings which are based on a sub-sample of those actually living with mental illness. Increasing the use of Big Data for mental health research, especially routinely-collected data, could improve this situation. However, steps to facilitate this must be enacted in collaboration with those who would provide the data - people with mental health conditions. Methods: We used the Delphi method to create a best practice checklist for mental health data science. Twenty participants with both expertise in data science and personal experience of mental illness worked together over three phases. In Phase 1, participants rated a list of 63 statements and added any statements or topics that were missing. Statements receiving a mean score of 5 or more (out of 7) were retained. These were then combined with the results of a rapid thematic analysis of participants' comments to produce a 14-item draft checklist, with each item split into two components: best practice now and best practice in the future. In Phase 2, participants indicated whether or not each item should remain in the checklist, and items that scored more than 50% endorsement were retained. In Phase 3 participants rated their satisfaction with the final checklist. Results: The final checklist was made up of 14 "best practice" items, with each item covering best practice now and best practice in the future. At the end of the three phases, 85% of participants were (very) satisfied with the two best practice checklists, with no participants expressing dissatisfaction. Conclusions: Increased stakeholder involvement is essential at every stage of mental health data science. The checklist produced through this work represents the views of people with experience of mental illness, and it is hoped that it will be used to facilitate trustworthy and innovative research which is inclusive of a wider range of individuals.

The Impact of Bilingualism on the Executive Functions of Autistic Children: A Study of English-Arabic Children

There is evidence to suggest that certain executive functions are impaired in autistic children, contributing to many daily challenges. Regular use of two languages has the potential to positively influence executive functions, though evidence is mixed. Little is known about the impact of bilingualism on the executive functions of autistic children, with only a handful of studies published worldwide to date. This study investigated the impact of bilingualism on sustained attention, interference control, flexible switching and working memory, in Arabic-English autistic children (n = 27) and their typically developing peers (n = 66), aged 5-12 years old. Groups were matched on age, nonverbal IQ and socioeconomic status, and completed a battery of computerized tests. Results showed an advantage for bilingual autistic children relative to their monolingual peers in sustained attention, and equivalent performance between bilingual and monolingual autistic children on all other executive functions. There were no generalized positive effects of bilingualism, and typically-developing children performed better than autistic children on all measures. The findings indicate that bilingualism does not negatively impact the executive function skills of autistic children, and that it might mitigate difficulties in sustained attention. LAY SUMMARY: Contrary to widespread belief, but in line with previous research, this study showed that speaking two languages did not harm thinking skills in autistic children. The thinking skills evaluated in this study included the ability to focus over a period of time, the ability to resist distractions, the ability to move back and forth between tasks, and the ability to use short-term memory. In fact, speaking two languages might help reduce difficulties that autistic children might face when focusing over a period of time.

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

The Double Empathy Problem suggests that communicative difficulties between autistic and non-autistic people are due to bi-directional differences in communicative style and a reciprocal lack of understanding. If true, there should be increased similarity in interaction style, resulting in higher rapport during interactions between pairs of the same neurotype. Here, we provide two empirical tests of rapport, with data revealing whether self- and observer- rated rapport varies depending on the match or mismatch in autism status within a pair. An additional opportunity afforded by these data is to examine the effect of the autism status of the rater on the perceived rapport between matched and mismatched pairs. In Study 1 72 participants were allocated to one of three dyad conditions: autistic pairs (n = 24), non-autistic pairs (n = 24) and mixed pairs (n = 12 autistic; n = 12 non-autistic). Each participant completed three semi-structured interactions with their partner, rating rapport after each interaction. Non-autistic pairs experienced higher self-rated rapport than mixed and autistic pairs, and autistic pairs experienced higher rapport than mixed pairs. In Study 2 (n = 80) autistic and non-autistic observers rated interactional rapport while watching videoed interactions between autistic pairs, non-autistic pairs, and mixed pairs (n = 18, a subset of participants in Study 1). Mixed pairs were rated significantly lower on rapport than autistic and non-autistic pairs, and autistic pairs were rated more highly for rapport than non-autistic pairs. Both autistic and non-autistic observers show similar patterns in how they rate the rapport of autistic, non-autistic, and mixed pairs. In summary, autistic people experience high interactional rapport when interacting with other autistic people, and this is also detected by external observers. Rather than autistic people experiencing low rapport in all contexts, their rapport ratings are influenced by a mismatch of diagnosis. These findings suggest that autistic people possess a distinct mode of social interaction style, rather than demonstrating social skills deficits. These data are considered in terms of their implications for psychological theories of autism, as well as practical impact on educational and clinical practice.

Autistic peer-to-peer information transfer is highly effective

LAY ABSTRACT

Sharing information with other people relies on the ability to communicate well. Autism is defined clinically by deficits in social communication. It may therefore be expected that autistic people find it difficult to share information with other people. We wanted to find out whether this was the case, and whether it was different when autistic people were sharing information with other autistic people or with non-autistic people. We recruited nine groups, each with eight people. In three of the groups, everyone was autistic; in three of the groups, everyone was non-autistic; and three of the groups were mixed groups where half the group was autistic and half the group was non-autistic. We told one person in each group a story and asked them to share it with another person, and for that person to share it again and so on, until everyone in the group had heard the story. We then looked at how many details of the story had been shared at each stage. We found that autistic people share information with other autistic people as well as non-autistic people do with other non-autistic people. However, when there are mixed groups of autistic and non-autistic people, much less information is shared. Participants were also asked how they felt they had got on with the other person in the interaction. The people in the mixed groups also experienced lower rapport with the person they were sharing the story with. This finding is important as it shows that autistic people have the skills to share information well with one another and experience good rapport, and that there are selective problems when autistic and non-autistic people are interacting.

Using a knowledge exchange event to assess study participants' attitudes to research in a rapidly evolving research context

Background: The UK hosts some of the world’s longest-running longitudinal cohort studies, which make repeated observations of their participants and use these data to explore health outcomes. An alternative method for data collection is record linkage; the linking together of electronic health and administrative records. Applied nationally, this could provide unrivalled opportunities to follow a large number of people in perpetuity. However, public attitudes to the use of data in research are currently unclear. Here we report on an event where we collected attitudes towards recent opportunities and controversies within health data science.

Methods: The event was attended by ~250 individuals (cohort members and their guests), who had been invited through the offices of their participating cohort studies. There were a series of presentations describing key research results and the audience participated in 15 multiple-choice questions using interactive voting pads.

Results: Our participants showed a high level of trust in researchers (87% scoring them 4/5 or 5/5) and doctors (81%); but less trust in commercial companies (35%). They supported the idea of researchers using information from both neonatal blood spots (Guthrie spots) (97% yes) and from electronic health records (95% yes). Our respondents were willing to wear devices like a ’Fit-bit’ (88% agreed) or take a brain scan that might predict later mental illness (73%). However, they were less willing to take a new drug for research purposes (45%). They were keen to encourage others to take part in research; whether that be offering the opportunity to pregnant mothers (97% agreed) or extending invitations to their own children and grandchildren (98%).

Conclusions: Our participants were broadly supportive of research access to data, albeit less supportive when commercial interests were involved. Public engagement events that facilitate two-way interactions can influence and support future research and public engagement efforts.

'I never realised everybody felt as happy as I do when I am around autistic people': A thematic analysis of autistic adults' relationships with autistic and neurotypical friends and family

LAY ABSTRACT

Although autistic people may struggle to interact with others, many autistic people have said they find interacting with other autistic people more comfortable. To find out whether this was a common experience, we did hour-long interviews with 12 autistic adults. We asked them questions about how it feels when spending time with their friends and family, and whether it felt different depending on whether the friends and family were autistic or neurotypical. We analysed the interviews and found three common themes in what our participants said. First, they found spending with other autistic people easier and more comfortable than spending time with neurotypical people, and felt they were better understood by other autistic people. Second, autistic people often felt they were in a social minority, and in order to spend time with neurotypical friends and family, they had to conform with what the neurotypical people wanted and were used to. Third, autistic people felt like they belonged with other autistic people and that they could be themselves around them. These findings show that having time with autistic friends and family can be very beneficial for autistic people and played an important role in a happy social life.

Bilingualism in autism: Language learning profiles and social experiences

LAY ABSTRACT

Bilingualism changes the way people relate to others. This is particularly interesting in the case of autism, where social interaction presents many challenges. A better understanding of the overlap between the social variations of bilingualism and autism could unveil new ways to support the social experiences of autistic people. This research aims to understand the language learning and social experiences of autistic people who speak one, two or more languages. A total of 297 autistic adults (aged between 16 and 80 years) completed an online questionnaire that included general demographic questions, social life quality self-rating questions, language history questions, and open questions about the respondents' bilingualism experience. Respondents had a wide range of language experiences: there were 89 monolingual English speakers, 98 bilinguals, 110 respondents knew three languages or more, all with a wide range of abilities in their languages. In the full group, younger respondents were more satisfied with their social life, and respondents with many languages were more satisfied with their social life than respondents with few languages. In the multilingual group, younger respondents were more satisfied with their social life, and the more skilled in their third language the more satisfied with their social life. This is the first study describing the language history and social experiences of a large group of bilingual and multilingual autistic adults. It highlights how autistic people can encounter a new language, learn it and use it in their daily life, and how their bilingualism experiences shape their social life.

Beyond the Core-Deficit Hypothesis in Developmental Disorders

Developmental disorders and childhood learning difficulties encompass complex constellations of relative strengths and weaknesses across multiple aspects of learning, cognition, and behavior. Historically, debate in developmental psychology has been focused largely on the existence and nature of core deficits—the shared mechanistic origin from which all observed profiles within a diagnostic category emerge. The pitfalls of this theoretical approach have been articulated multiple times, but reductionist, core-deficit accounts remain remarkably prevalent. They persist because developmental science still follows the methodological template that accompanies core-deficit theories—highly selective samples, case-control designs, and voxel-wise neuroimaging methods. Fully moving beyond “core-deficit” thinking will require more than identifying its theoretical flaws. It will require a wholesale rethink about the way we design, collect, and analyze developmental data.

Impact of preterm birth on brain development and long-term outcome: protocol for a cohort study in Scotland

INTRODUCTION

Preterm birth is closely associated with altered brain development and is a leading cause of neurodevelopmental, cognitive and behavioural impairments across the life course. We aimed to investigate neuroanatomic variation and adverse outcomes associated with preterm birth by studying a cohort of preterm infants and controls born at term using brain MRI linked to biosamples and clinical, environmental and neuropsychological data.

METHODS AND ANALYSIS

Theirworld Edinburgh Birth Cohort is a prospective longitudinal cohort study at the University of Edinburgh. We plan to recruit 300 infants born at <33 weeks of gestational age (GA) and 100 healthy control infants born after 37 weeks of GA. Multiple domains are assessed: maternal and infant clinical and demographic information; placental histology; immunoregulatory and trophic proteins in umbilical cord and neonatal blood; brain macrostructure and microstructure from structural and diffusion MRI (dMRI); DNA methylation; hypothalamic-pituitary-adrenal axis activity; social cognition, attention and processing speed from eye tracking during infancy and childhood; neurodevelopment; gut and respiratory microbiota; susceptibility to viral infections; and participant experience. Main analyses include creation of novel methods for extracting information from neonatal structural and dMRI, regression analyses of predictors of brain maldevelopment and neurocognitive outcome associated with preterm birth, and determination of the quantitative predictive performance of MRI and other early life factors for childhood outcome.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the National Research Ethics Service (NRES), South East Scotland Research Ethics Committee (NRES numbers 11/55/0061 and 13/SS/0143 (phase I) and 16/SS/0154 (phase II)), and NHS Lothian Research and Development (2016/0255). Results are disseminated through open access journals, scientific meetings, social media, newsletters anda study website (www.tebc.ed.ac.uk), and we engage with the University of Edinburgh public relations and media office to ensure maximum publicity and benefit.

Using a knowledge exchange event to assess study participants’ attitudes to research in a rapidly evolving research context

Background: The UK hosts some of the world’s longest-running longitudinal cohort studies, who make repeated observations of their participants and use these data to explore health outcomes. An alternative method for data collection is record linkage; the linking together of electronic health and administrative records. Applied nationally, this could provide unrivalled opportunities to follow a large number of people in perpetuity. However, public attitudes to the use of data in research are currently unclear. Here we report on an event where we collected attitudes towards recent opportunities and controversies within health data science. Methods: The event was attended by ~250 individuals (cohort members and their guests), who had been invited through the offices of their participating cohort studies. There were a series of presentations describing key research results and the audience participated in 15 multiple-choice questions using interactive voting pads. Results: Our participants showed a high level of trust in researchers (87% scoring them 4/5 or 5/5) and doctors (81%); but less trust in commercial companies (35%). They supported the idea of researchers using information from both neonatal blood spots (Guthrie spots) (97% yes) and from electronic health records (95% yes). Our respondents were willing to wear devices like a ’Fit-bit’ (78% agreed) or take a brain scan that might predict later mental illness (73%). However, they were less willing to take a new drug for research purposes (45%). They were keen to encourage others to take part in research; whether that be offering the opportunity to pregnant mothers (97% agreed) or extending invitations to their own children and grandchildren (98%). Conclusions: Our participants were broadly supportive of research access to data, albeit less supportive when commercial interests were involved. Public engagement events that facilitate two-way interactions can influence and support future research and public engagement efforts.

A framework of evidence-based practice for digital support, co-developed with and for the autism community

A wide array of digital supports (such as apps) have been developed for the autism community, many of which have little or no evidence to support their effectiveness. A Delphi study methodology was used to develop a consensus on what constitutes good evidence for digital supports among the broader autism community, including autistic people and their families, as well as autism-related professionals and researchers. A four-phase Delphi study consultation with 27 panel members resulted in agreement on three categories for which evidence is required: reliability, engagement and effectiveness of the technology. Consensus was also reached on four key sources of evidence for these three categories: hands-on experience, academic sources, expert views and online reviews. These were differentially weighted as sources of evidence within these three categories.

Associations of Socioeconomic Deprivation and Preterm Birth With Speech, Language, and Communication Concerns Among Children Aged 27 to 30 Months

IMPORTANCE

Successful acquisition of language is foundational for health and well-being across the life course and is patterned by medical and social determinants that operate in early life.

OBJECTIVE

To investigate the associations of neighborhood disadvantage, gestational age, and English as first language with speech, language, and communication concerns among children aged 27 to 30 months.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used birth data from the National Health Service maternity electronic medical record linked to the Child Health Surveillance Programme for preschool children. The cohort included 28 634 children in the United Kingdom (NHS Lothian, Scotland) born between January 2011 and December 2014 who were eligible for a health review at age 27 to 30 months between April 2013 and April 2016. Data analysis was conducted between January 2018 and February 2019.

EXPOSURES

The associations of neighborhood deprivation (using the Scottish Index of Multiple Deprivation 2016 quintiles), gestational age, and whether English was the first language spoken in the home with preschool language function were investigated using mutually adjusted logistic regression models.

MAIN OUTCOMES AND MEASURES

Speech, language, and communication (SLC) concern ascertained at age 27 to 30 months.

RESULTS

Records of 28 634 children (14 695 [51.3%] boys) with a mean (SD) age of 27.7 (2.2) months were matched. After excluding records with missing data, there were 26 341 records. The prevalence of SLC concern was 13.0% (3501 of 26 963 children with SLC data). In fully adjusted analyses, each 1-week increase in gestational age from 23 to 36 weeks was associated with an 8.8% decrease in the odds of a child having an SLC concern reported at 27 months (odds ratio, 0.92; 95% CI, 0.90-0.93). The odds of a child for whom English is not the first language of having SLC concern at age 27 to 30 months were 2.1-fold higher than those for a child whose first language is English (OR, 2.09; 95% CI, 1.66-2.64). The odds ratio for having an SLC concern among children living in the most deprived neighborhoods, compared with the least deprived neighborhoods, was 3.15 (95% CI, 2.79-3.56). The estimated probabilities for preterm children having an SLC concern were highest for those living in the most deprived areas.

CONCLUSIONS AND RELEVANCE

This study found that SLC concerns at age 27 to 30 months are common and independently associated with increasing levels of neighborhood deprivation and lower gestational age. Policies that reduce childhood deprivation could be associated with improved preschool language ability and potentially avoid propagation of disadvantage across the life course, including for children born preterm.

Predicting major mental illness: ethical and practical considerations

SummaryAn increasing body of genetic and imaging research shows that it is becoming possible to forecast the onset of major psychiatric disorders such as depression and schizophrenia before people become ill with ever improving accuracy. Practical issues such as the optimal combination of clinical and biological variables are being addressed, but the application of predictive algorithms to individuals or in routine clinical settings have yet to be tested. The development of predictive methods in mental health comes with substantial ethical questions, including whether people wish to know their level of risk, as well as individual and societal attitudes to the potential adverse effects of data sharing, early diagnosis and treatment, which so far have been largely ignored. Preliminary data suggests that at least some people think predictive research is valuable and would take part in such studies, and some would welcome knowing the results. Future initiatives should systematically assess opinions and attitudes in conjunction with scientific and technical advances.Declaration of interestIn the past 3 years, S.M.L. has received personal fees from Otsuaka, Sunovion and Janssen, and research grant support from Janssen and Lundbeck. A.M.M. has received research support from the Sackler Trust, Eli Lilly and Janssen. S.M.L. is part of the PSYSCAN consortium.

Siblings' experiences of growing up with children with autism in Taiwan and the United Kingdom

BACKGROUND

A child's diagnosis of autism impacts their whole family, in both positive and negative ways, that may be influenced by cultural beliefs.

AIMS

We aimed to describe the experiences of mothers and typically-developing siblings of children with autism in two cultural contexts.

METHODS

Fourteen mother-sibling dyads from Taiwan and the UK participated in semi-structured interviews.

RESULTS

Whilst there were similarities in sibling experiences, a negative tone regarding the influence of autism was more evident in Taiwan, where families also cited societal judgement and cultural-specific expectations. In the UK, a more balanced tone was apparent: mothers emphasised educating and involving the siblings. It is speculated that UK siblings had a greater understanding of their parents' stress, leading to more adaptive family dynamics. Various types of support service were mentioned in the UK, whereas the availability of social services and support appeared to be relatively limited in Taiwan.

IMPLICATIONS

Our data suggest that cultural context may have a significant impact on the responses of the family members. This is mediated by both differences in attitudes and traditions, and availability of resources. Support for family members needs to be sensitive to such cultural differences, as well as recognising positive experiences.

The potential of eye-tracking as a sensitive measure of behavioural change in response to intervention

One challenge to the development of effective interventions to support learning and behavioural change in neurodevelopmental disorders is a lack of suitable outcome measures. Eye-tracking has been used widely to chart cognitive development and clinically-relevant group differences in many populations. This proof-of-concept study investigates whether it also has the potential to act as a marker of treatment effects, by testing its sensitivity to differential change over a short period of exposure to an iPad app in typically developing children. The app targets a key skill in early social communication development, by rewarding attention to people, operationalised via a finger-tap on screen. We measured attention to images taken from the app, and a selection of matched stimuli to test generalisation of effects, at baseline and two weeks later. Children were assigned to either an app-exposure or no-app condition in the intervening period. The app exposure group showed increases in fixation on people for images from the app, and for distant-generalisation photographs, at high levels of complexity. We conclude that, with careful selection of stimuli, eye-tracking has the potential to make a valuable contribution to the range of outcome measures available for psycho-behavioural interventions in neurodevelopmental disorders.

Making the future together: Shaping autism research through meaningful participation

Participatory research methods connect researchers with relevant communities to achieve shared goals. These methods can deliver results that are relevant to people’s lives and thus likely to have a positive impact. In the context of a large and growing body of autism research, with continued poor implementation, and some evidence of community dissatisfaction, there is a powerful case for participatory autism research. In order to develop a framework for such collaborative working, a UK seminar series was organised and co-produced by autistic and non-autistic people with academic, practitioner and lived expertise. This article reports on the outcomes from the series, identifying five topics relevant to building a community of practice in participatory research: Respect, Authenticity, Assumptions, Infrastructure and Empathy. Each topic is connected to a specific example from within and beyond research, to inspire new practices in the field. We call for the development of participatory research skills among the autism research community and the facilitation of greater autistic leadership of, and partnership in, research. Such work, if delivered to a high standard, is likely to lead to better translation into practice and improved outcomes for autistic people and those who support them.

Emotion recognition training in autism spectrum disorder: A systematic review of challenges related to generalizability

PURPOSE

To assess the generalizability of findings from randomized controlled trials (RCTs) evaluating emotion recognition (ER) training for children and adolescents with autism spectrum disorder (ASD).

METHODS

We present a systematic review and narrative synthesis of the determinants of external validity in RCTs on ER training. Generalizability of the findings across situations, populations, settings, treatment delivery, and intervention formats was considered.

RESULTS

We identified 13 eligible studies. Participants were predominantly boys with ASD in the normative IQ range (IQ > 70), with an age span from 4 to 18 years across studies. Interventions and outcome measures were highly variable. Several studies indicated that training may improve ER, but it is still largely unknown to what extent training effects are translated to daily social life.

CONCLUSION

The generalizability of findings from currently available RCTs remains unclear. This underscores the importance of involving children with ASD and their caregivers in informed treatment decisions.

Mental health on screen: A DSM-5 dissection of portrayals of autism spectrum disorders in film and TV

Portrayals of characters with autism spectrum disorders (ASD) in films and TV series are subject to intense debate over whether such representations are accurate. Inaccurate portrayals are a concern as they may lead to increased stereotypes toward the condition. We investigate whether portrayals of characters with autism spectrum disorder in film and TV-series align with DSM-5 diagnostic criteria. Our data show that characters present a full range of characteristics described in the DSM-5. The meaning of this finding is discussed in relation to potential educational value of on screen portrayals and the notion of authenticity in representing the autistic experience.

The Role of the Broader Autism Phenotype and Environmental Stressors in the Adjustment of Siblings of Children with Autism Spectrum Disorders in Taiwan and the United Kingdom

The influence of the broader autism phenotype (BAP) on the adjustment of siblings of children with autism has previously been researched mainly in Western cultures. The present research evaluated a diathesis-stress model of sibling adjustment using a questionnaire study including 80 and 75 mother-typically developing sibling dyads in Taiwan and the United Kingdom (UK). UK siblings reported elevated adjustment difficulties compared to the Taiwanese sample and to normative data. Whilst higher BAP levels were generally associated with greater adjustment difficulties, differences were found across cultures and respondents. Although significant diathesis-stress interactions were found, these were in the opposite direction from those predicted by the model, and differed across cultural settings. Implications for culturally-sensitive sibling support are considered.