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Some researchers suggest difficulties synchronising with a partner could underpin the social differences associated with Autism Spectrum Condition, potentially acting as a marker for autism. Social Motor Synchrony (SMS) is one aspect of synchrony that could augment observational diagnostic procedures. However, the full breadth of literature examining SMS in autism has not been systematically reviewed. A systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines yielded 29 papers meeting inclusion criteria. Of 21 studies including a comparison group, all indicated weaker SMS between two autistic partners and in mixed-neurotype partnerships compared with two non-autistic partners. Papers involving mixed-neurotype pairs without a comparison group showed higher than chance SMS and demonstrated an increase in SMS over time following rhythm-based interventions. Although research so far demonstrates weaker SMS in pairs involving an autistic partner compared with non-autistic pairs, we identified several limitations which may have influenced SMS in autistic people and their partners. Further work is needed with autistic partnerships, more natural and preferred tasks within comfortable settings and partnerships, and more work to identify the basis of synchrony differences. We set out implications for design of further research. When two people interact, they often fall into sync with one another by moving their bodies at the same time. Some say autistic people are not as good as non-autistic people at moving at the same time as a partner. This has led some researchers to ask whether measuring synchrony might help diagnose autism. We reviewed the research so far to look at differences in Social Motor Synchrony (SMS) (the way we move together) between autistic people and people they interact with. The research suggests that interactions involving an autistic partner (either two autistic partners, or an autistic and non-autistic partner) show lower synchrony than a non-autistic pair. However, we recognised elements in the research so far that may have affected SMS in interactions involving an autistic person. One way SMS may have been affected in research so far might be the way interactions have been set up in the research studies. Few papers studied interactions between two autistic people or looked at synchrony in comfortable environments with autistic-preferred tasks. The studies also do not explain why synchrony might be different, or weaker, in pairs involving autistic partners. We use these limitations to suggest improvements for future research. [ABSTRACT FROM AUTHOR]

In the typically developing population, social touch experiences are influenced by several factors, including the biological sex of toucher and receiver, the body area wherein the touch is delivered and the social context in which the tactile exchange occurs. However, it is currently unexplored how social touch experiences of autistic adults are modulated by these factors. We sought to address this by utilizing a self-report body-painting task. Our main results show that autistic, compared with non-autistic, adults reported lower levels of pleasantness, erogeneity and appropriateness, specifically in intimate and friendly social contexts and in body areas typically touched in these situations. Importantly, sex played a major role in group differences. For instance, although autistic females reported, across social contexts, less pleasantness than both non-autistic females and autistic males, they experienced similar levels of appropriateness in the professional social context, usually deemed as touch-appropriate. Our findings provide new support to the hypothesis that social touch is experienced and possibly conceptualized differently by autistic compared with non-autistic adults. Moreover, by identifying the factors that influence social touch processing in autistic adults, our results might aid the development of support for autistic individuals seeking help in the spheres of social and intimate touch. What is already known about the topic? At least in neurotypical individuals, social touch represents an important channel for emotional communication associated with social bonding and pain/anxiety modulation. Autistic adults report to avoid social touch more and to have different tactile sensitivity than their non-autistic comparisons. What this paper adds? Few studies specifically investigated social touch in autistic individuals, and none of them examined the role of participants' sex, social context in which social touch occurs, and specific body areas being touched. In our study, adult participants reported how pleasant, erogenous and appropriate they would consider touches delivered by another person over their entire body in intimate (date), friendly (dance class) and professional (physiotherapy-massage session) social contexts. Autistic adults reported social touch to be less pleasant, erogenous and appropriate specifically in intimate and friendly social contexts and in body areas typically touched in these situations. Importantly, autistic females seem more at risk to experience unpleasant social touch as, although they considered it more unpleasant than non-autistic females and autistic males, they did consider it similarly appropriate in professional social contexts where touch is normed to be socially appropriate. Implications for practice, research or policy Our results might improve awareness and understanding about autistic adults' different, and often more discomforting, experience of social touch and thus help consider and respect it during everyday social interactions. Our results might also benefit future research investigating, for instance, the neural underpinnings of social touch differences in autism or aiming at developing support for autistic individuals seeking help in the diverse spheres of social touch. [ABSTRACT FROM AUTHOR]

Lay abstracts are brief descriptions or summaries of research that are targeted at a general audience. They are held as an important means for the research community to provide greater transparency to the general public and to increase visibility of the pertinent research. This study aims to examine the extent to which lay abstracts published in the journal Autism are comprehensible to a lay audience in terms of readability measures. Results showed that lay abstracts published in Autism were more readable than their corresponding abstracts but were less readable than plain English texts (e.g. news reports). To our knowledge, this is probably the first comparative study on the readability of lay abstracts. Possible explanations for and implications of these findings were offered. Research papers are sometimes hard to follow. Lay abstracts give a short account of research papers. However, it is unclear whether lay abstracts are readable to the lay people. This study examined the readability of 570 abstracts and lay abstracts published between 2020 and 2022 in the journal Autism. We found that that lay abstracts are easier to read than abstracts but are harder to read than news reports. The findings suggest that lay abstracts, on average, are hard to read for the lay people. We propose that the journal and its authors may invite reviewers from outside the research community to test whether a lay abstract is readable. [ABSTRACT FROM AUTHOR]

Medicaid is a major insurer of autistic people. However, during the transition to adulthood, autistic individuals are more likely than people with intellectual disability to lose their Medicaid benefits. Individuals with intellectual disability may have greater success maintaining Medicaid coverage during this time because most states provide coverage to individuals with intellectual disability throughout adulthood, which is not the case for autism. Using national Medicaid data from 2008 to 2016, we estimated the probability of intellectual disability diagnosis accrual among autistic Medicaid beneficiaries. Medicaid beneficiaries ages 8 to 25 with 1+ inpatient or 2+ outpatient autism spectrum disorder claims, but no intellectual disability claim, in a 12-month eligibility period were included. We used a person-month discrete-time proportional hazards model. Disruptions in Medicaid coverage were operationalized as 2+ consecutive months of no coverage before coverage resumed (yes/no). One in five autistic individuals ages 8–25 accrued an intellectual disability diagnosis. The probability of accruing an intellectual disability diagnosis was higher among autistic individuals who had disruptions in Medicaid coverage compared to those without disruptions, and peaked at age 21 (during the transition to adulthood). Expanding Medicaid to cover autistic people of all ages could decrease the need for intellectual disability diagnosis accrual and improve health outcomes for autistic adults. What is known? In most states, Medicaid waivers provide individuals with an intellectual disability diagnosis generous healthcare coverage throughout adulthood. By comparison, fewer Medicaid programs are available for autistic individuals, and they are more likely to experience disruptions, or gaps, in Medicaid coverage and subsequently not re-enroll. What this paper adds? One in five autistic individuals with Medicaid coverage between ages 8 and 25 accrued a new intellectual disability diagnosis. The probability of a new intellectual disability diagnosis was higher among those who had previous disruptions in Medicaid coverage. Implications for research and policy. Expanding Medicaid to cover autistic people of all ages could decrease the need for intellectual disability diagnosis accrual. Input from autistic individuals and their families regarding their health insurance access and healthcare experiences is critically important to understanding next steps for research. [ABSTRACT FROM AUTHOR]

The current study explored the role of pre-existing and pandemic-time child, family or environmental factors in the presentation of mental health symptoms of autistic youth and their parents during the pandemic. Participants were parents/carers of autistic children (Autism Spectrum Treatment and Resilience Cohort, N = 67, M age = 9 years) and adolescents (QUEST cohort, N = 112, M age = 17 years). Parents completed an online survey that asked about child and parental mental health, infection experience, and changes to education arrangements, family life, housing and finances during the pandemic. Pre-existing measures of mental health, autism and adaptive functioning were also utilised. More engagement and enjoyment in education provision and going outside was associated with better child and parental mental health. In multivariate multiple linear regression models, more pre-existing attention deficit hyperactivity disorder symptoms were associated with more behavioural/attention deficit hyperactivity disorder symptoms during the pandemic in the pre-adolescent cohort, and with greater emotional symptoms in the adolescent cohort. More pre-existing parental mental health problems were associated with more parental mental health symptoms during the pandemic in both cohorts. Knowledge of pre-existing mental health and pandemic-related stressors may help care planning. Encouraging engagement and enjoyment in education and promoting physical exercise are key intervention targets. Ensuring access to attention deficit hyperactivity disorder medication and support is important, especially if this is managed jointly across school and home. What is already known about the topic: The COVID-19 pandemic and the associated restrictions impacted all of society. There is emerging evidence showing a range of impacts on autistic children and young people and their families. Further research that looks at how individuals coped during the pandemic while considering how they were doing before the pandemic is needed. What this paper adds: This article explores whether how well autistic youth were doing before the pandemic influenced how they coped during the pandemic. It also looked at how well their parents were doing during the pandemic and whether any pre-pandemic factors influenced how they coped. Samples of both primary-school-aged autistic children and autistic teenagers and their parents were surveyed to answer these questions. More engagement and enjoyment in education provision during the pandemic and getting outside more were linked with better child and parental mental health during the pandemic. More attention deficit hyperactivity disorder before the pandemic was linked with more attention deficit hyperactivity disorder and behavioural problems during the pandemic in primary-school-aged autistic children, and more emotional problems during the pandemic in autistic teenagers. Parents with more mental health problems during the pandemic had more mental health problems before the pandemic. Implications for practice, research or policy: Encouraging engagement and enjoyment in education and promoting physical exercise are key intervention targets. Ensuring access to attention deficit hyperactivity disorder medication and support is important, especially if this is managed jointly across school and home. [ABSTRACT FROM AUTHOR]

Many autistics report being distressed by eye contact, but eye-tracking studies suggest that eye contact is associated with hypo-arousal rather than hyper-arousal in autism. Within a live face-to-face paradigm combining a wearable eye-tracker with electrodermal activity sensors, 80 adults (40 autistics) defined words in front of an experimenter either staring at their eyes (direct gaze condition) or looking elsewhere (averted gaze condition). Autistics did not differ from neurotypicals in their eye behaviours nor their skin conductance responses. Autistics did not appear distressed when they were looking at the experimenter's eyes in the direct gaze condition. However, neurotypicals, compared to autistics, might experience more stress when looking at the experimenter in the averted gaze condition, even after controlling for social anxiety and alexithymia. In comparison to autistics, neurotypicals might be hyper-aroused when they look at someone avoiding eye contact. Based on a bidirectional perspective on interactional difficulties in autism, we speculate that the neurotypicals' distress when their attempts to eye contact are not reciprocated could make their behaviour insistent, which, in turn, could make the autistics uncomfortable. In our study, participants' partner remained passive, displaying no specific reaction when a mutual gaze was shared or not. Future studies should test different partner reactions to gaze in various social contexts. What is already known about the topic? Autistics are usually reported to share less eye contact than neurotypicals with their interlocutors. However, the reason why autistics might pay less attention to eyes looking at them is still unknown: some autistics express being hyper-aroused by this eye contact, while some eye-tracking studies suggest that eye contact is associated with hypo-arousal in autism. What this paper adds? This study is based on a highly controlled live face-to-face paradigm, combining a wearable eye-tracker (to study eye behaviours) with electrodermal activity sensors (to assess potential stress). We draw a nuanced picture of social attention in autism, as our autistic participants did not differ from our neurotypical group in their eye behaviours nor their skin conductance responses. However, we found that neurotypicals, compared to autistics, seemed to be much more distressed when their interlocutor did not gaze at them during the experiment. Implications for practice, research or policy: Our study encourages to consider social interaction difficulties in autism as a relational issue, instead as an individual deficit. This step might be first taken in research, by implementing paradigms sensitive to the experimenter's role and attitude. [ABSTRACT FROM AUTHOR]

We conducted a multi-pronged investigation of different types of reporting bias in autism early childhood intervention research. First, we investigated the prevalence of reporting failures of completed trials registered on clinicaltrials.gov, and found that only 7% of registered trials were updated with results on the registration platform and only 64% had associated published reports. Next, we investigated the extent to which inadequate reporting prevents inclusion in meta-analytic summary estimates by identifying reports of studies that were eligible for inclusion in a prior meta-analysis, and found that 25% were excluded due to inadequate reporting. Finally, we investigated selective reporting practices by analyzing the protocols of the studies included in the meta-analysis which had been registered on any trial registry and coding their timing, completeness, and consistency. We found that 23% of studies were pre-registered, 71% were late-registered, and 5% were registered at an unclear date. Only 8% of registrations specified all of the necessary components. Evidence of selective reporting was common; 36% failed to report a registered outcome, 61% reported unregistered outcomes, 23% switched primary and secondary outcomes, and 43% had assessment timepoints that differed from registration specification. Given the inadequacy of registration and reporting practices, we offer practical recommendations to facilitate improvement for the field of autism research. When researchers fail to report their findings or only report some of their findings, it can make it difficult for clinicians to provide effective intervention recommendations. However, no one has examined whether this is a problem in studies of early childhood autism interventions. We studied how researchers that study early childhood autism interventions report their findings. We found that most researchers did not register their studies when they were supposed to (before the start of the study), and that many researchers did not provide all of the needed information in the registration. We also found that researchers frequently did not publish their findings when their studies were complete. When we looked at published reports, we found that many of the studies did not report enough information, and that many studies were reported differently from their registrations, suggesting that researchers were selectively reporting positive outcomes and ignoring or misrepresenting less positive outcomes. Because we found so much evidence that researchers are failing to report their findings quickly and correctly, we suggested some practical changes to make it better. [ABSTRACT FROM AUTHOR]

Autistic people often have an atypical profile of abilities: while excelling in some structured paradigms, many report difficulties with making real-life decisions. To test whether decision-making in autism is different from in typically developing controls, we reviewed 104 studies that compared decision-making performance between autistic and comparison participants (N = 2712 autistic and N = 3189 comparison participants) between 1998 and 2022. Our searches revealed four main decision-making paradigms that are widely used in the field of decision neuroscience: perceptual discrimination, reward learning, metacognition and value-based decision-making paradigm. Our synthesis highlights that perceptual processing and reward learning were similar between autistic and comparison participants, whereas value-based decision-making and metacognitive accuracy were often different between groups. Furthermore, decision-making differences were most pronounced when the autistic participant was explicitly probed to report on an internal belief, while implicit markers of the same decision (e.g. error-related response times) were usually not different. Our findings provide evidence in favour of a metacognitive explanation of decision-making atypicalities in autism. Lay summary: Many autistic people report difficulties with real-life decision-making. However, when doing decision-making tests in laboratory experiments, autistic people often perform as well or better than non-autistic people. We review previously published studies on autistic people's decision-making, across different types of tests, to understand what type of decision-making is more challenging. To do this, we searched four databases of research papers. We found 104 studies that tested, in total, 2712 autistic and 3189 comparison participants on different decision-making tasks. We found that there were four categories of decision-making tests that were used in these experiments: perceptual (e.g. deciding which image has the most dots); reward learning (e.g. learning which deck of cards gives the best reward); metacognition (e.g. knowing how well you perform or what you want); and value-based (e.g. making a decision based on a choice between two outcomes that differ in value to you). Overall, these studies suggest that autistic and comparison participants tend to perform similarly well at perceptual and reward-learning decisions. However, autistic participants tended to decide differently from comparison participants on metacognition and value-based paradigms. This suggests that autistic people might differ from typically developing controls in how they evaluate their own performance and in how they make decisions based on weighing up the subjective value of two different options. We suggest these reflect more general differences in metacognition, thinking about thinking, in autism. [ABSTRACT FROM AUTHOR]

The language used to refer to autism has been a topic of ongoing debate. Research in English-speaking countries indicated an overall preference for identity-first language ('autistic person') among autistic adults rather than person-first language ('person with autism'). We examined terminology preference in Dutch autistic adults (n = 1026; 16–84 years; 57% women) and parents of autistic children (n = 286) via an online survey. A majority of self-reporting adults with autism (68.3%) and parents (82.5%) demonstrated a person-first language preference. A younger age, higher IQ and more autistic traits predicted a relatively stronger identity-first language preference in autistic adults. We conclude that language and culture may impact terminology preference of adults with autism and parents. For now, we advocate to use a mix of person-first language and identity-first language in academic papers to cover the full range of preferences. There are different words to describe people with an autism diagnosis. For instance, we can put the person before autism (e.g. 'person with autism'), or we can put autism before the person (e.g. 'autistic person'). Previous research showed that autistic adults in English-speaking countries generally liked it better when autism is placed before the person. Yet, people also greatly differ in the words they like and dislike. In this study, we examined word preference in Dutch autistic adults (n = 1026; 16–84 years; 57% women) and parents of autistic children (n = 286). Via an online questionnaire, we asked our participants to select one term for autistic people that they liked best. The results showed that most adults with autism (68.3%) and parents (82.5%) preferred to put the person before autism. Younger adults, with a higher intelligence, and with more autistic traits, were a bit more likely to put autism before the person. We conclude that there are large differences in the words that people prefer. Because we found different results in our Dutch participants compared to participants in English-speaking countries, we think that the Dutch language or culture may also play a role in word preference. For now, we advise autism researchers to use both person-first and autism-first language. [ABSTRACT FROM AUTHOR]

The breadth of available non-pharmacological interventions for autistic children, with varying evidence for efficacy summarised in multiple systematic reviews, creates challenges for parents, practitioners, and policymakers in navigating the research evidence. In this article, we report the findings of an umbrella review of 58 systematic reviews of non-pharmacological interventions for autistic children (aged 0–12 years). Positive therapeutic effects were identified for Behavioural interventions, Developmental interventions, Naturalistic Developmental Behavioural Interventions, Technology-based interventions, and Cognitive Behaviour Therapy across several child and family outcomes. Positive effects for certain practices within Sensory-based interventions and 'other' interventions were limited to select child and family outcomes. Both inconsistent and null intervention effects were found for Treatment and Education of Autistic and related Communication-handicapped Children, and Animal-assisted interventions across outcomes. The possible influence of child (chronological age, core autism characteristics, and related skills) and delivery (agent, mode, format, and amount) characteristics on intervention effects was rarely examined, and inconsistent where reported. Twenty-seven systematic reviews (47%) were rated as 'high' quality. Few systematic reviews examined children's participation and quality of life or adverse effects. The findings highlight the need for individualised evidence-based decision-making when selecting interventions for autistic children. What is already known about the topic? The delivery of evidence-based interventions is an important part of the clinical pathway for many autistic children and their families. However, parents, practitioners, and policymakers face challenges making evidence informed decisions, due to the wide variety of interventions available and the large, and often inconsistent, body of evidence regarding their effectiveness. What this paper adds? This is a comprehensive umbrella review, also known as a 'review of reviews', which examined the range of interventions available, the evidence for their effectiveness, and whether effects were influenced by factors relating to individual children (e.g. chronological age, core autism characteristics, and related skills) or the ways interventions were delivered (by whom and in what setting, format, mode, and amount). There was evidence for positive therapeutic effects for some, but not all, interventions. No single intervention had a positive effect for all child and family outcomes of interest. The influence of child and delivery characteristics on effects was unclear. Implications for practice, research, and policy The findings provide parents, practitioners, and policymakers with a synthesis of the research evidence to inform decision-making and highlight the importance of individualised approaches in the absence of clear and consistent evidence. The findings also highlight the need to improve consistency and completeness in reporting of research studies, so that the same questions may be answered more comprehensively in the future. [ABSTRACT FROM AUTHOR]

In Part 1 of this UK-based study, across four timepoints between March and October 2020, autistic children and young people showed higher levels of parent-reported depression and anxiety symptoms than those with other special educational needs and disabilities. In this study, we draw on qualitative data from 478 parents/carers of autistic pupils and those with other special educational needs and disabilities to conduct a longitudinal qualitative content analysis examining stability and change in the mental health of these young people, and their parents/carers, during the first 6 months of the COVID-19 pandemic. Worry and psychological distress were dominant categories at all timepoints and we noted that, in line with quantitative findings, worry in autistic pupils stayed stable over time but decreased for those with other special educational needs and disabilities. The third dominant category was wellbeing and we saw evidence that removing demands, especially the demand to attend school, was a driver of wellbeing for a significant minority of pupils, particularly autistic pupils, and their parents/carers. Overall, we observed no differences in mental health experiences between the two groups of parents, also mirroring quantitative findings. We know that autistic children and young people, and their caregivers, are at increased risk of mental ill health. We asked whether the first 6 months of COVID-19 exacerbated that risk, and whether the implications were different for autistic pupils and their caregivers, than for those with other special educational needs and difficulties. In a linked paper, we found that caregivers of autistic pupils reported higher levels of depression and anxiety symptoms in their children than parents of children with other special educational needs and difficulties (Toseeb & Asbury, 2022). For pupils with other special educational needs and difficulties, their parent-reported anxiety symptoms eased over time while remaining high throughout for autistic pupils. There were no differences in mental health and wellbeing between caregivers of autistic pupils and those with other special educational needs and difficulties. Here, we used parents' written descriptions of their own and their child's mental health during the first 6 months of COVID-19 to explore these linked findings in greater depth. We identified strong evidence of worry and distress for all, but most prominently autistic children and young people. Our finding that worry and distress declined over time for pupils with other special educational needs and difficulties, but not for autistic pupils, was supported and we observed a few differences between caregivers. We also found evidence of wellbeing throughout the sample, and examples of some (mainly autistic) pupils benefitting from a reduction in demands (e.g. going to school). This has implications for our understanding of the school experience for autistic pupils. Findings suggest that the mental health of autistic children and young people may have been disproportionately affected during the first 6 months of COVID-19 and that careful consideration of optimal support, from both health and education perspectives, is vital. [ABSTRACT FROM AUTHOR]

Social support has a positive impact on quality of life (QoL) in neurotypical older adults and young autistic adults, but the association for older autistic adults is unclear. Autistic adults (n = 388; mean age = 40–83 years) were recruited via Simons Powering Autism Research for Knowledge (SPARK) Research Match. Participants completed questionnaires online querying demographic information, depression, and anxiety symptomatology, QoL (physical, psychological, social, environmental, and autism-specific) and social support (instrumental, subjective, and social interactions). Regression analyses examined whether different aspects of social support contributed to models explaining each domain of QoL. Models explaining QoL were significant. Subjective social support significantly contributed to the models for all aspects of QoL; social interactions contributed to the models for Physical and Psychological QoL, whereas instrumental support contributed to models for social, environmental and autism-specific QoL. Social support is an important contributor to the QoL of middle-aged and older autistic adults, after accounting for demographic factors and depression. Further studies are required to understand whether age-related changes in social support and QoL are the same for autistic as non-autistic older adults in order to identify and implement appropriate support. Social support can take many forms, such as practical help, time spent socially with others, or the satisfaction with personal relationships. Social support is known to affect quality of life (QoL) in both non-autistic older and autistic young adults. QoL reflects how satisfied an individual is with their life either overall or in a certain area. We know little about middle-aged and older autistic adults' experiences of social support or QoL. In this study, 388 adults aged 40–83 years old, completed online questionnaires asking about background such as age and sex, depression and anxiety symptoms, QoL (physical, psychological, social, environmental, and autism-specific), and different types of social support. Even after taking into account background, depression, and anxiety, social support was important for individuals' QoL. To our knowledge this is the first paper to examine the relationship between social support and QoL in middle-aged and older autistic adults. Improving social support may have a significant impact on the QoL of older autistic adults. Future studies should examine whether age-related changes in social support (size, content, and arrangement of social networks) that are common in non-autistic aging, also occur among older autistic adults. [ABSTRACT FROM AUTHOR]

Inclusive education is a key strategy in addressing the needs of children with autism and other developmental disabilities in sub-Saharan Africa, who rarely access specialist care or quality education. We aimed to systematically review qualitative research on stakeholder experiences, attitudes and perspectives on inclusive education for pupils with developmental disabilities in mainstream schools in sub-Saharan Africa. We searched five databases and selected relevant studies through a two-stage screening process. We synthesised the papers identified through template analysis of the Results and Discussion sections, guided by the Consolidated Framework for Implementation Research. Thirty-two publications met the inclusion criteria. The studies were conducted in seven countries and explored the experiences of pupils with developmental disabilities, parents, peers without developmental disabilities and teachers. Multiple barriers (e.g. unclear policies, insufficient training and support for teachers) and opportunities (e.g. teachers' commitment to inclusion, collaboration between teachers, the work of non-governmental organisations (NGOs)) for implementing inclusive education for pupils with developmental disabilities in sub-Saharan Africa were identified, occurring across national and community contexts and school, classroom and individual teacher levels. To effectively implement inclusive education for pupils with developmental disabilities, teachers need access to appropriate training, resources and support. Governments can capitalise on motivated teachers and the relevant work of NGOs. In sub-Saharan Africa, there are few services for children with developmental disabilities such as autism and intellectual disability. One way to support these children is to include them in mainstream schools. However, currently, African children with developmental disabilities are often excluded from mainstream education opportunities. People involved (e.g. teachers, families and children) can offer information on factors that could ease or interfere with inclusion. This article discusses the findings of published studies that explored the views of relevant groups on including children with developmental disabilities in mainstream schools in sub-Saharan Africa. We systematically searched the literature and identified 32 relevant articles from seven countries in sub-Saharan Africa. We found that unclear policies and insufficient training, resources and support for teachers often blocked the implementation of inclusive education. Factors in favour of inclusive education were the commitment of many teachers to include pupils with developmental disabilities and the work of non-governmental organisations (NGOs), which provided resources and training. This review suggests that motivated teachers should be provided with appropriate training, resources and support for inclusive education, directly and by promoting the work of NGOs. [ABSTRACT FROM AUTHOR]

Informant-report measures for screening symptoms of autism spectrum disorder (ASD) and other neurodevelopmental disorders (NDDs) are needed for low-resource settings if early identification is to be prioritized because early developmental concerns are likely to be expressed by parents and other caregivers. This paper describes the initial psychometric evaluation of the Nigeria Autism Screening Questionnaire (NASQ). Parents and other caregivers completed the NASQ on 12,311 children ages 1 to 18 in a Nigerian population sample as part of the World Bank National General Household Survey conducted in the country in 2016. Factor analyses indicated a parsimonious three-factor structure with social communication/interaction, repetitive sensory motor, and insistence on sameness dimensions. Measurement invariance was excellent across age and sex. Reliability of the subscales and total scale was good, and item response theory analyses indicated good measurement precision in the range from below average to high scores, crucial for screening, and tracking ASD symptoms. Studies with gold standard ASD diagnostic instruments and clinical confirmation are needed to evaluate screening and diagnostic accuracy. The NASQ appears to be a reliable instrument with a clear factor structure and potential for use in screening and tracking ASD symptoms in future Nigerian samples. [ABSTRACT FROM AUTHOR]

Affective prosody recognition is an important area of research in autism spectrum conditions where difficulties in social cognition have been frequently observed. To probe into the mixed results reported in the literature, we conducted a systematic review with meta-analysis and examined potential factors that could explain the inconsistent results. Our literature search included six electronic databases for studies that compared the affective prosody recognition performance in individuals with autism spectrum condition with typically developing participants, which yielded 23 papers eligible for quantitative synthesis. Using a random-effects model, we obtained a moderate-to-large pooled effect (Hedges' g = −0.63) for the overall affective prosody recognition performance of autism spectrum condition participants, which, however, reduced substantially (to −0.26) and became non-significant after the correction for publication bias. The number of answer codes was found to be a significant moderator for the effect estimate, whereas the number of speakers was not. Moreover, the magnitude of the pooled effect estimate varied across emotions. The findings suggested moderate differences in affective prosody recognition ability between autism spectrum condition and typically developing individuals, which reduced to marginal difficulties for autism spectrum condition when the impact of publication bias was taken into account. Diversity in the number of answer codes could have differential effects on affective prosody recognition performance in autism spectrum condition, which varied across emotions. The present review and meta-analysis demonstrated the insufficiency of research on affective prosody recognition in autism spectrum condition, highlighting a need for further exploration of the contributors and underlying mechanisms for specific affective prosody recognition difficulties. Differences in understanding others' emotions and attitudes through features in speech (e.g. intonation) have been observed in individuals with autism spectrum conditions, which contribute greatly to their social communication challenges. However, some studies reported that individuals with autism spectrum condition performed comparably to typically developing individuals on affective prosody recognition. Here, we provide a comprehensive review with statistical analysis of 23 existing studies on this topic to examine potential factors that could explain the discrepancies. Compared with typically developing individuals, autism spectrum condition participants generally appeared to encounter more difficulties in affective prosody recognition. But this finding was likely due to the tendency of the existing research to overly focus on deficits in autism. The affective prosody recognition performance in individuals with autism spectrum condition was closely related to the number of answer options offered to them. Moreover, the degree of difficulty in affective prosody recognition encountered by individuals with autism spectrum condition varied across emotions. The findings of this systematic review highlighted the need for further research on affective prosody recognition in autism (e.g. studies that include tonal language speakers and autism spectrum condition individuals with lower cognitive or verbal abilities). [ABSTRACT FROM AUTHOR]

Repetitive and restricted behaviours are a core feature of autism, and cognition in autistic individuals may also be repetitive and restricted. We aimed to investigate the relationship between repetitive behaviours and repetitive thinking. We predicted that autistic people would experience more repetitive, perseverative, visual and negative cognition than controls. We predicted that repetitive thinking would be associated with repetitive behaviours in the autistic participants. We recruited autistic (n = 54) and control (n = 66) participants who completed measures of insistence on sameness and obsessive-compulsive behaviours. Participants then took part in 5 days of descriptive experiencing sampling, recording their thoughts when a random alarm sounded. Consistent with our hypothesis, autistic participants reported more repetitive thinking. Contrary with our other hypotheses, autistic participants reported equivalent frequency of perseveration, visual thoughts and negative thoughts to non-autistic participants. Moreover, participants who reported more obsessive thinking reported more repetitive behaviour (insistence on sameness), but there was no such relationship between repetitive thinking and behaviour. Autistic participants who reported more repeated thoughts in the descriptive experience sampling had significantly lower obsessive thinking scores. We conclude that anxiety focused cognitions may drive insistence on sameness behaviours, and that the relationship between repetitive cognition and behaviour is complex and warrants further investigation. A core feature of autism is the tendency to do the same activity or behaviour repetitively. We wanted to find out if autistic people also experience repetitive thinking, for example, having the same thoughts repeatedly. We thought that there would be a link between repetitive behaviour and repetitive thinking. We asked 54 autistic people and 66 non-autistic people to complete questionnaires measuring repetitive behaviours and obsessive thinking. Next, participants were trained by a researcher to record their thoughts using a structured paper form. They then completed 5 days of thought recording, which they did each time a random alarm sounded on their mobile phone. We found that autistic people had more repetitive thoughts than non-autistic people, but they did not report having more negative or visual thoughts compared with non-autistic people. Autistic people who had more repetitive thoughts during the 5 days of thought recording did not report more repetitive behaviour. However, autistic people who reported more obsessive thinking, for example, more negative and unwanted thoughts, also reported higher levels of repetitive behaviour. We conclude that some repetitive behaviours may be linked to anxiety and that more research is needed to better understand repetitive behaviours in autism. [ABSTRACT FROM AUTHOR]

There is an increasing focus on research exploring autistic communication and community. In this review, we systematically collate and analyse how autistic adults describe their experiences of other autistic people and the relationship this has with their Quality of Life (QoL). Fifty two qualitative papers were analysed using thematic meta-synthesis. Results found many experiences of other autistic people were positive and were associated with improved QoL across a range of domains. The heterogeneity of the autistic experiences described indicates a need for further research to explore which factors predict a positive impact on QoL. Analysis also highlighted a paucity of data on autistic people with co-occurring intellectual disability in relation to this phenomenon. Implications for research and practice are discussed.Research has suggested that autistic people enjoy spending time with other autistic people and find them easier to talk to. We wanted to find out what autistic people say about spending time with other autistic people and whether this makes their life better. We found 52 papers which described this and reviewed what they found. We found that many autistic people had positive experiences of spending time with other autistic people and these experiences had positive impact on their lives in a range of different ways. The papers did not tell us whether this also happens for autistic people with a learning disability. More research is needed to find out more about why spending time with other autistic people helps some autistic people. [ABSTRACT FROM AUTHOR]

Curricula that teach relationship skills to autistic individuals are needed. The purpose of this formative research study was to describe the views of autistic youth about healthy and unhealthy friendships and dating relationships, in order to uncover what types of skills they felt would be useful to learn in a workshop-style intervention in order to have healthier peer relationships. The research was shaped by input from a five-person Advisory Board comprising autistic people. Twenty-five autistic individuals aged 16–22 years old were interviewed. The interviews were analyzed using an inductive content-based analysis approach. Interview participants described finding it challenging to remain motivated to make and maintain friendships, and that they would benefit from education about overcoming anxiety rooted in bad prior experiences that stop them from making new friends, learning when it was safe to take emotional risks, how they could cultivate reciprocity in relationships, and how to identify, communicate, and respect sexual and emotional boundaries. They also voiced a preference for mixed-gender interventions team taught by one neurotypical and one autistic facilitator. The experiences, opinions and preferences of the 25 autistic youth who were interviewed will inform the content of the forthcoming Healthy Relationships on the Autism Spectrum relationship skills intervention. What is already known about the topic? All people can benefit from education about how to have healthy friendships and dating relationships. But specific interventions on relationship skills—like respecting boundaries, identifying warning signs of abuse, or talking about sexual preferences—are too rare, particularly for autistic individuals. The goal of this study was to collect formative data from autistic emerging adults to help create a new, six-session workshop for autistic young adults to support healthy peer relationships. Twenty-five autistic youth aged 16–22 years old were interviewed. What this paper adds? The participants described a need for more and better information about how to support lasting friendships, deal with their anxiety about relationships, and know when friendships or dating relationships were reciprocal and rewarding versus unhealthy. Implications for practice, research, or policy. The results reveal a need for a new and effective intervention that supports healthy relationship skills for autistic people. [ABSTRACT FROM AUTHOR]

Participatory methods are having sweeping effects on research across the globe. To facilitate transparency around these methods, Autism introduced mandatory reporting of community involvement in January 2021. Here, we sought to determine the impact of this policy. To do so, we – a team of Autistic and non-autistic researchers – searched for articles published in Autism in 2019, 2 years before policy implementation, and in 2022, 1 year after. We read 283 eligible articles and double coded each article for general information and details of community involvement. We found a fivefold increase (10.3% pre-implementation vs 54.5% post-implementation) in the reporting of community involvement. Most articles reported involving community members distally, in consulting roles, with researchers retaining full decision-making power. Furthermore, most community involvement was reported in more applied than basic research. A significant minority of papers (17%), however, could not be coded, owing to insufficient or vague information. While this increase in the reporting of community involvement is encouraging, more efforts need to be directed towards (1) improving the transparency in the reporting of community involvement and (2) increasing the frequency with which community members, especially Autistic people, share decision-making power equally with researchers – or even assume control of the research process.There has been a growing push for the Autistic and autism communities to be more actively involved in autism research. From January 2021, the journal Autism made it a rule for authors to report whether they involved community members in their work; and if they did, how they had done so. In this study, we wanted to see how this new rule has changed things. Our team of Autistic and non-autistic researchers read all 283 articles published in Autism in 2019, about 2 years before the rule was in place, and in 2022, about 1 year after. We recorded what each article was about and how the community was involved. We found there was an increase in how often articles talked about community involvement – from about 10% before the rule to over 50% after. Most of these studies, however, only involved community members giving advice, with the researchers making most decisions about the research. This was especially true for applied research (like wellbeing) rather than basic science (like causes of autism). Also, some of these articles were unclear or did not give enough information for us to understand how the community was involved. This tells us that while it is promising that more community involvement is reported, researchers need to describe this involvement more clearly. It is also important for community members to have a bigger say in research by sharing power with the researchers or even leading the research themselves. [ABSTRACT FROM AUTHOR]

The experiences of Autistic1 women students at university are seldom explored. In this paper, women refers to anyone who self-identifies as a woman. Eleven Autistic women students participated in artefact creation and semi-structured interviews exploring their experiences with university lecturers. All data centred on their opinions and lived experiences. Five participants were undergraduate students and six participants were postgraduate students. Data were analysed by thematic analysis and data was categorised into two themes. These themes were: ‘Lecturer Impact’ and ‘Autism Awareness and Acceptance’. ‘Lecturer Impact’ centred around both positive relationships participants had at university with their lecturers, and how they navigated ingrained stigmas about autism that some lecturers held. ‘Autism Awareness and Acceptance’ included the ways in which knowledge about autism in women and a reduction in stigma could be achieved at university, primarily by incorporating the voices of Autistic women students. The findings suggest that Autistic women students’ positive relationships with lecturers are key to success. This was supported by participants wanting their opinions and lived experience to be valued particularly to assist with raising a university culture of autism acceptance. An inclusive environment at university, including Autistic women students is needed to improve positive experiences at university.It is documented that more Autistic woman are becoming university students, but their experiences are not often explored. Eleven Autistic women students made artefacts (such as writing, paintings or poems) and took part in interviews to share their experiences at university. Five participants were undergraduate students and six participants were postgraduate students. The artefacts and words participants shared were looked at closely and some common themes were decided. How lecturers talk to Autistic women students was looked at. Participants said they were lucky if they met helpful lecturers. Also, autism acceptance was explored. Overall, how lecturers treat Autistic women at university is very important. Also, Autistic women students’ opinions about making university a more welcoming place need to be listened to. [ABSTRACT FROM AUTHOR]

Several measures have been developed to assess loneliness in the general population. Here, we examined if, and how accurately, widely-used measures capture the experience of loneliness in autistic adults. A total of 203 autistic participants from the UK completed an online survey, which included two widely-used loneliness questionnaires: the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and the Social and Emotional Loneliness Scale for Adults (SELSA). Participants completed the measures and provided their views on how well they captured their experiences of loneliness. A direct measure, asking participants how often they felt lonely, was also completed. Results demonstrated that scores on the UCLA and SELSA questionnaires positively correlated with the direct measure of loneliness, suggesting that these tools accurately index autistic experiences of loneliness. However, qualitative responses suggested that participants found both scales difficult to complete. Using reflexive thematic analysis, we identified three themes that encapsulated participants' views: (1) failing to distinguish between the characteristics/experiences of loneliness and being autistic, (2) loneliness is not a static trait and (3) inappropriate wording. Given that our sample of autistic participants tended to prefer the UCLA scale to the SELSA, we provide initial recommendations around how the UCLA scale could be adapted for autistic adults. There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people. [ABSTRACT FROM AUTHOR]

The alexithymia hypothesis posits that specific aspects of the autistic socio-cognitive profile, namely emotion recognition difficulties, can be explained by the increased prevalence of alexithymia in autistic populations. However, this hypothesis has largely been tested in adults. We tested whether co-occurring alexithymia could account for associations between autistic traits and two key domains of socio-emotional cognitive functioning in adolescence. Participants were 184 (44% male) children aged 10–16 years with and without a diagnosis of autism (n = 75 autistic), who completed experimental measures of emotion recognition and theory of mind. Parents completed assessment of autistic traits and alexithymia. Pre-registered analyses tested associations between autistic traits and socio-cognitive task performance, and whether including alexithymia as an additional predictor changed the nature of the association between autistic traits and task performance. Results showed participants with higher levels of autistic traits performed lower on emotion recognition and theory of mind tasks, and that these associations were not significantly altered by including alexithymia in the models. Results suggest that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in young adolescents and when using parent-report measures, alexithymia may not be associated with emotion recognition or theory of mind ability. Alexithymia is a sub-clinical condition characterised by difficulties identifying and describing one's own emotions, which is found in many, but not all autistic people. The alexithymia hypothesis suggests that certain aspects of socio-cognitive functioning typically attributed to autism, namely difficulties in emotion recognition, might be better explained by often co-occurring alexithymia. It is important to understand what is specific to autism and what is due to other co-occurring characteristics to develop appropriate support for autistic people. However, most research on this topic has been conducted in adults, which limits our knowledge about the relevance of this theory to younger autistic populations. This study tested whether difficulties in emotion recognition and theory of mind traditionally associated with autism might be better explained by alexithymia in a sample of adolescents with and without a diagnosis of autism. Results found that difficulties in emotion recognition and theory of mind were both associated with autistic traits, and this was not accounted for by individual differences in levels of alexithymia. This research suggests that more work is needed to understand the applicability of the alexithymia hypothesis in younger populations, but that at least in adolescents and when using parent-report measures, alexithymia may not account for emotion recognition or theory of mind difficulties associated with autistic traits. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of external factors on the experiences and family relationships of autistic adolescents and their families. A qualitative approach was used, with in-depth interviews conducted with 30 participants, including autistic adolescents, siblings and parents from within families with an autistic adolescent family member. The findings suggest that external factors significantly influence the well-being of autistic adolescents and their families. The school environment was identified as a significant factor, with sensory overload, bullying and adverse interactions with teachers having a negative impact on the mental health and quality of family relationships for participants. In addition, the study highlighted that isolation and stigma were major concerns for families, suggesting a need for public efforts to raise awareness and understanding of autism. The lack of appropriate support and services was also identified as a significant challenge that families face. The study highlights the need for person-centred approaches to service provision, which involves including autistic adolescents and their families in the design and delivery of support and services. The study recommends collaboration among schools, service providers, and families, as well as efforts to promote autism-friendly environments in schools and the broader community. The influence of the environment on different groups of people with disabilities has rarely been studied in the context of neurodevelopmental disabilities, such as autism, in adolescence. This study explored how external responses to autism affect the experiences, outcomes and family relationships of autistic adolescents and their family members, including siblings and parents. This study adds to the knowledge of factors that contribute to the social disadvantage and exclusion autistic adolescents and their families face in their communities. Interviews with 30 participants from families with an autistic adolescent show that external factors greatly impact the well-being of autistic adolescents and their families. The school environment, including sensory overload, bullying and negative interactions with teachers, was found to be a key factor that negatively influenced mental health and family relationships. The study also revealed that isolation and stigma are major concerns for families, indicating the importance of public awareness campaigns to increase understanding of autism. In addition, the lack of adequate support and services presented significant challenges for families. The study emphasises the importance of person-centred approaches to providing services, which involve including autistic individuals and their families in designing and delivering support. [ABSTRACT FROM AUTHOR]

Autistic people diagnosed in adulthood often report that the experience can be life-changing, but there are issues with the diagnostic pathway. Few studies consider the views of people currently seeking diagnosis or contextualise the experience of diagnosis around developing an autistic identity. In this qualitative participatory study, we explored experiences of navigating an autism diagnosis in adulthood in the UK. We recruited six women (aged 21–46 years) who were seeking diagnosis, who worked with the academic researchers across four sessions to develop the study, share their experiences and analyse the themes. In one session, they completed a semi-structured interview alongside photovoice, a community-based action method, to explain and reflect on their experiences. We used reflexive thematic analysis to identify patterns, with four key themes identified: (1) 'everything shattered', (2) 'being seen', (3) 'understanding not judgement, please' and (4) 'here's a leaflet, off you go'. The themes reflected a desire for change and improved support for both diagnosis and developing autistic identity. Following photovoice methodology, together we identified actions to improve adult diagnosis, including involving autistic people in making improvements to the diagnostic criteria, for key professional and community groups to listen more to autistic people and for diagnostic support services to be flexible and appreciative of wider neurodivergence and intersectionality. Lots of people seek an autism diagnosis as an adult, and they often say that being diagnosed can be positively life-changing, but the experience of getting a diagnosis can be difficult. We often do not hear the views of people currently looking for a diagnosis, or talk to them about how diagnosis relates to their identity. In our study, we looked at experiences of people currently seeking an autism diagnosis in the UK. We used participatory methods, where six people seeking diagnosis were included as collaborators in the research. They took part in four different sessions, where they helped to shape the research, took part in interviews about their experiences and helped to analyse the patterns in all the interviews. We also used something called photovoice during the interviews, where they could use photos to show how they felt about navigating a diagnosis. We identified four common themes: (1) everyone had experienced some form of crisis before seeking diagnosis; (2) when they realised they were autistic, they felt seen; (3) the diagnostic process and criteria were not working, and they felt judged by clinicians and (4) there was limited support available after diagnosis. In another session, we identified actions that need to be taken which have implications for policy and practice, including improving the diagnostic process and criteria with autistic people, autistic people being listened to more by people like general practitioners and clinicians and diagnosis services needing to be more flexible and appreciate different aspects of someone's identity and neurodivergence. [ABSTRACT FROM AUTHOR]

A psychoeducation program that was originally developed by the Dutch Association for Autism was adjusted for older adults to enhance its feasibility and efficacy in later life. In this study, we explored the effects of this adapted psychoeducation program for older autistic adults in a pre-test–post-test 6-month follow-up design. A total of 61 patients (55–78 years) and 44 proxies (a person close to them) participated in the study; attrition rate was high for the follow-up assessment. As hypothesized, an increase in knowledge and acceptance of the diagnosis was observed, with a strong and positive correlation between patients and proxies for knowledge. Furthermore, ambiguous results were observed on coping with the diagnosis and no positive effects on psychological distress were found. The feedback of participants and proxies about the psychoeducation program was largely positive. Future research with larger group samples and larger time scales is necessary to gain more insight into the effectiveness of the psychoeducation program. It seems worthwhile to further adjust the program to the needs and requirements of older adults, and to help older autistic adults to construct a new narrative of themselves, and the life they have lived, in the light of the recent autism diagnosis. After receiving an autism diagnosis, psychoeducation (i.e. information regarding autism) is a first intervention. We adjusted a psychoeducation program that was originally developed by the Dutch Association for Autism for older adults to enhance its feasibility and efficacy in later life. We expected that participants would report an increase in knowledge and acceptance of the diagnosis and that people close to them would also observe this. Indeed, we found this and participants and those close to them agreed on this. Furthermore, we found some evidence that older autistic adults were better at coping with their autism. We found no positive intervention effects on psychological distress. The feedback of participants and informants about the psychoeducation program was largely positive. In future research, we advise using larger group samples and larger time scales and we also advise to further adjust the program to the needs and requirements of older adults, and to help older autistic adults to construct a new narrative of themselves, and the life they have lived, in the light of the recent autism diagnosis. [ABSTRACT FROM AUTHOR]

People with autism spectrum conditions (ASC) have difficulties mentally simulating events, perhaps due to a difficulty mentally generating and maintaining a coherent spatial scene – that is, 'scene construction'. The current study compared scene construction ability between autistic adults (N = 55) and age-, gender- and Intelligence Quotient-matched neurotypical adults (N = 63), using a task in which participants were asked to vividly imagine and describe fictitious scenes. Results showed that scene construction was diminished in autistic compared to neurotypical participants and was negatively associated with autistic traits. ASC diagnosis did not influence the frequency of self-reference or sensory experiences, which followed the same pattern in both groups: sight was referenced more than sound, sound was referenced more than both touch and smell, which were both referenced more than taste. Exploratory analysis of some of the cognitive predictors revealed that scene construction ability was associated with individual differences in Theory of Mind and alexithymia. People with autism spectrum conditions (ASC) have difficulties imagining events, which might result from difficulty mentally generating and maintaining a coherent spatial scene. This study compared this scene construction ability between autistic (N = 55) and neurotypical (N = 63) adults. Results showed that scene construction was diminished in autistic compared to neurotypical participants, and participants with fewer autistic traits had better scene construction ability. ASC diagnosis did not influence the frequency of mentions of the self or of sensory experiences. Exploratory analysis suggests that scene construction ability is associated with the ability to understand our own and other people's mental states, and that these individual-level preferences/cognitive styles can overrule typical group-level characteristics. [ABSTRACT FROM AUTHOR]

This study investigated bilingualism effects on the production of focus in 5- to 9-year-old Cantonese–English bilingual autistic children's L1 Cantonese, compared to their monolingual autistic peers as well as monolingual and bilingual typically developing children matched in nonverbal IQ, working memory, receptive vocabulary and maternal education. The results from an elicitation task showed that monolingual autistic children had significantly lower accuracy than typically developing children in producing focus in subject and object positions. Bilingual autistic children in general performed similarly to monolingual autistic children but outperformed their monolingual autistic peers in the production of object focus with a significantly higher accuracy. The total amount of English exposure did not relate to the accuracy of focus production in autistic and typically developing children. Our results also revealed autistic children's tendency to make use of less prosodic means to produce focus. The overall findings indicate that bilingual exposure has no detrimental effect on the language skills of autistic children but might enhance the production of focus in bilingual autistic children's L1 Cantonese. It is commonly believed among professionals and parents that exposure to two languages imposes an additional burden on children with autism spectrum disorder. However, there is a lack of empirical evidence to support or reject this belief. With the prevalence of autism and an increasing number of children growing up bilingual, it is urgent to understand how bilingual exposure interacts with autism. Bilingual autistic children from Hong Kong, with Cantonese as their first language and English as their second language, took part in the study. We used a production game to test how bilingual autistic children use different levels of linguistic knowledge to produce contrastive information in real conversations, compared to their monolingual autistic peers and typically developing children matched in language abilities, nonverbal IQ, working memory and maternal education. We found that bilingual autistic children performed as good as typically developing children in general, and they even performed better than monolingual autistic children. Our findings suggest a bilingual advantage in autistic children in conveying constative information in sentences. We thus encourage parents to engage their children in rich bilingual environments. Clinicians, educators and other professionals may also consider adding bilingual aspects in training programmes to support families raising bilingual autistic children. [ABSTRACT FROM AUTHOR]

School absenteeism is a major societal problem, with a range of potential adverse long-term consequences. This scoping review aimed to provide a comprehensive overview of the research on school absenteeism in autistic children and adolescents, expose important gaps in the literature, and explore possibilities for future systematic reviews. Five relevant databases were searched systematically from inception to June 2023, yielding a total of 46 eligible reports from 42 separate studies. All studies were conducted in high-income countries, and most were published in the last decade. Three major themes emerged: occurrence, contextual factors, and interventions. The results of large-scale population-based studies clearly suggested that autistic children and adolescents were absent from school more often than their non-autistic peers, which partly was attributable to co-occurring conditions. Bullying also emerged as a potential risk factor. Only a few preliminary studies were available on targeted interventions, emphasizing the need for more robust studies. More research is also needed on the mechanisms leading to and maintaining school absenteeism in this group of learners. Overall, the diversity of research questions, methods, and definitions used in this body of research suggests that systematic reviews with narrow focus on a few key questions may still be premature. Autistic children and teenagers are, on average, absent from school more than their peers. The aim of this review was to provide an overview of the research on absence from school in autistic learners in primary and secondary school, to help guide future research. We sifted through 4632 reports and found 42 studies with a focus on school absence and autism. We looked at how, when, and where the studies were conducted. We also summarized the results and outlined how absence was measured in the studies. Absence from school may lead to problems later in life, like incomplete education and unemployment. It is therefore important to know how common this problem is among autistic learners, what the reasons may be, and what type of support they need. The studies were from high-income countries and were mainly published in the last 10 years. Studies based on school registers from the United States and the United Kingdom clearly showed that children and teenagers with autism had higher risk of school absence than those without autism. Absence was often linked to problems with mental health or additional neurodevelopmental conditions. Several studies also showed that absence in autistic children and adolescents was related to problems in school, like bullying or lack of knowledge about autism. Support programs were only evaluated in a few studies with a small number of study participants. We conclude that more research is needed to better understand why autistic learners are absent and what they need to thrive in school. [ABSTRACT FROM AUTHOR]

Language in autism is heterogeneous, with a significant proportion of individuals having structural language difficulties and inclusion of language impairment as a specifier under Diagnostic and Statistical Manual of Mental Disorders (5th ed.) criteria for autism. This systematic review asked: What are the reporting patterns of variables pertaining to structural language in autism prior to and after publication of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.)? What norm-referenced assessments does research use to characterize the language abilities of autistic individuals with respect to language impairment? This preregistered review (PROSPERO: CRD42021260394) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches took place in September 2022 and included Linguistics and Language Behavior Abstracts, PsycINFO, PubMed, and the Directory of Open Access Journals. Search terms included three essential concepts: autism, language, and age. Two coders independently screened and evaluated articles. Searches yielded 57 qualifying studies, with mostly consistent reporting practices prior to and after the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Studies varied in how they defined language groups and in what norm-referenced measures they used. Interpreting research on structural language in autism requires attention to diagnostic and grouping criteria. Although inconsistency in reporting in original studies limited this review, better understanding the available information on structural language in autistic individuals aged 3–21 years may support identification of language needs. Under the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), language impairment can co-occur with autism. It is not yet clear how research defines, reports, and characterizes structural language abilities of autistic individuals eligible for school-based special education services (aged 3–21 years) in the United States. In the United States, students typically must be formally diagnosed to be eligible for services and supports. However, the quality of diagnosis is only as good as the research evidence on which diagnosis depends. To evaluate evidence quality, we examined how studies of school-aged autistic individuals report assessments of language ability. This systematic review included 57 studies using English language age-referenced assessments used to measure structural language. Findings showed many differences across studies in how language abilities were measured and reported. Also, none of the studies fully reported the variables relevant to characterizing language impairment. Outcomes were similar across versions of the Diagnostic and Statistical Manual of Mental Disorders. Findings indicate that researchers and clinicians should pay attention to reporting diagnostic and grouping criteria. Carefully interpreting research evidence is critical for ensuring that diagnostic criteria and supports are representative of and accessible to autistic individuals and relevant parties. [ABSTRACT FROM AUTHOR]

Concerns have been raised about genomic studies of autism. Most recently, the Spectrum 10 K study was paused due to criticism from the autistic community. This situation raised important questions about how the autistic and autism communities perceive genomic research. The Personal Experiences of Autism and Perceptions of DNA-based-research study was established to address this issue. Twenty parents of nonverbal or minimally verbal autistic children took part in the current study. Data were provided in diverse formats including online interviews, telephone interviews, and writing. This approach was co-produced with autistic experts by experience. Data were analysed using reflexive Thematic Analysis. We found that participants were supportive of autism research, including some genomic research, if it is designed to support autistic people and is ethical and transparent. However, while some believed that polygenic scores, genomic predictors of the statistical probability of being autistic, would be helpful, others argued that this would only be true in an ideal world. Participants felt that they and their children were often excluded from, and unrepresented by, the autistic and autism communities. We conclude that genomic researchers need to work with the autistic and autism communities to design future work, and that it is important to ensure a representative range of voices are heard. In Summer 2021, a genomic study of autism, Spectrum 10 K, was paused due to backlash from the autistic and autism communities. This raised important questions about how these communities perceive genomic research. The Personal Experiences of Autism and Perceptions of DNA-based research study was established to address this issue among a range of sub-groups within these communities. Twenty parents of nonverbal or minimally verbal autistic children took part in the current study. Data were provided in diverse formats including online interviews, telephone interviews, and writing. This approach was co-produced with autistic experts by experience and involved a parent of a minimally verbal autistic child. Data were analysed using reflexive Thematic Analysis. We found that participants were supportive of autism research, including some genomic research, as long as it is designed to support autistic people and is ethical and transparent. However, while some believed that polygenic scores, genomic predictors of the statistical probability of being autistic, would be helpful, others argued that this would only be true in an ideal world and that the world is too far from ideal. Participants felt excluded from the autistic and autism communities and that the dominant voices in those communities do not represent them or their children. We concluded that genomic researchers need to work with the autistic and autism communities to design future work, and that it is important to ensure a representative range of voices are heard. [ABSTRACT FROM AUTHOR]

Movement of the body is an essential way to characterise autism, according to diagnostic criteria. However, qualifying descriptions of what autistic movements are, their functions and personal value, are missing from academic literature and clinical guidance. We systematically searched for autistic adults’ descriptions of their body and its movement within autobiographical narratives in blog data. Descriptions from 23 autistic authors formed a qualitative data set. The search strategy identified descriptions of movements and meanings without a priori definitions, such as being stereotyped or ritualistic, which were submitted to a thematic analysis. Authors described stigmatisation of some of their movements, causing censorship. However, movement provided personal benefits, including enhanced thinking and focus, routine, sensory regulation, release of energy, increased body connection and awareness, regulated emotion, and time without self-restraint. Examples included stimming or self-stimulating behaviour, dancing, and physical exercise. Movement was accompanied by qualifying descriptions of being natural and harmless. Moving freely, expressively, and sometimes repetitively, strengthened self-identity. In conclusion, body movements have both stigmatised and non-stigmatised appearances for autistic adults, but these cannot be distinguished by the function of the movement. Expressive, regulating and repetitive movements can be a well-being resource for autistic people. Implications for practice are discussed. What is already known? Moving the body in ‘stereotyped’, ‘repetitive’, ‘ritualised’ or ‘unusual’ ways is part of the criteria for receiving a diagnosis of autism. However, the reasons for these movements and their personal value are not well understood. Certain ways of moving have become part of a disorder, and have received negative judgements, whereas other movements have not. What this paper adds? We searched online blogs for descriptions of movement written by autistic adults, using their preferred language and definitions. The blog authors said that many types of movement attracted negative judgement, including mis-coordination shown during sports, dancing in unusual places or moving repetitively, such as when stimming. However, movement provided personal benefits, and could enhance thinking and focus, provide meaningful routine, contribute to sensory regulation, release energy, increase body awareness, emotion regulation and strengthen self-identity. Implications for practice and policy Movement could be a well-being resource, used to reduce distraction, overwhelm, confusion and distress for autistic people. This should be considered within personal coping strategies and psychological therapies. The examples provided in this study could inform autism assessments, to ensure that the meanings of movements are considered alongside the appearances of movement. Some movements such as stimming have the same functions as many other ways of moving, including dancing and exercising, which could help to reduce stigma around being autistic if reflected in policy and practice. Improving understanding is important for informing how autism is assessed, and how personal experiences of being autistic are heard. [ABSTRACT FROM AUTHOR]

The purpose of this study is to explore the views of autistic adults on randomised controlled trials, specifically on processes such as randomisation and blinding, to understand the barriers and facilitators for recruiting autistic people to randomised controlled trials involving medications. We conducted one-to-one interviews with 49 autistic adults. Interviews were audio-recorded and analysed thematically. The participants found randomised controlled trial processes acceptable and linked positive attitudes towards randomised controlled trial participation to autistic peoples' heightened sense of fairness and preference for evidence-driven knowledge. However, randomised controlled trial designs may be incompatible with a (1) preference for a controlled predictable world, (2) perceived vulnerability at physical and mental health levels and (3) history of misunderstanding and exclusion, crucially from healthcare professionals. Suggestions that emerged from our findings include efforts to co-produce research to nurture trust and adapting communication practices to improve access to trials. Autistic people are a highly motivated group to work with research teams to mitigate barriers to randomised controlled trial participation. We explored what psychosocial determinants play a role in the acceptability of randomised controlled trials to test interventions to improve quality of life and mental health in autistic adults. The study provides useful information that may help the design and conduct of more accessible trials with and for the autistic community. Large randomised controlled trials are used to test healthcare treatments. Yet there are no large randomised controlled trials on effective treatments for common mental health issues affecting autistic adults. The purpose of this study was to learn what autistic adults think about randomised controlled trials in preparation for a randomised controlled trial testing a medication for anxiety. This means we wanted to know their opinions about the way randomised controlled trials are done, such as how people are chosen to be in the study and how the study is carried out. We did this by talking to 49 autistic adults individually and asking them questions. We found that most of the people we talked to were okay with the way randomised controlled trials are done. They thought it was fair and they liked that it was based on evidence. However, some autistic people might find it hard to take part in randomised controlled trials. Some people did not like the uncertainty of not knowing what treatment they would receive in a randomised controlled trial. Others felt too vulnerable and may have had bad experiences with healthcare in the past. We found that it is important to involve autistic people early on and at every stage when designing a clinical trial. Care about how clear and precise the study communication is will build trust and improve access to research. Our study indicates that it is possible to conduct large randomised controlled trials with and for autistic people. This can ultimately contribute to the improvement of healthcare outcomes for this population. [ABSTRACT FROM AUTHOR]

Some autistic people use strategies to hide autistic behaviour and appear more neurotypical. Previous research has linked this 'social camouflaging' with mental health difficulties. This review synthesised qualitative research to explore the relationship between camouflaging and mental health. Thirteen studies were systematically identified, appraised and synthesised using meta-ethnography. Four third-order concepts were developed, describing camouflaging as an attempt to cope with stressful social contexts which impact mental health. Many autistic people experienced unintended negative consequences of their camouflaging that increased stress. Potential mechanisms for the relationship between camouflaging and mental health related to the qualities of the strategies that were used. Camouflaging strategies that were superficially 'successful' involved high levels of self-monitoring, were highly cognitively demanding or highly habitual and appeared more linked to poor mental health. This should be investigated in future research and has potential implications for how clinicians support autistic people with mental health difficulties. Some autistic people describe trying to hide autistic behaviour and seem more neurotypical. Researchers called this 'social camouflaging' and have linked it with mental health difficulties. We used a step-by-step approach to identify research where autistic people talk about social camouflaging to explore the relationship between camouflaging and poor mental health. Thirteen studies were combined. The results describe how society negatively impacts autistic people's mental health, and camouflaging is a way to try and cope with this. Many autistic people find their camouflaging strategies have accidental negative consequences which also affect their mental health. Strategies which seemed 'successful' involved a lot of self-monitoring, were very mentally demanding or were very habitual and seemed to have more of an effect on mental health. This might be important for clinicians who support autistic people with mental health difficulties. [ABSTRACT FROM AUTHOR]

Many autistic people and people with non-spectrum neurodevelopmental disabilities (e.g. intellectual disability) report feeling lonely, which can negatively impact their well-being. There is little longitudinal research, however, tracking changes in how autistic people experience, conceptualize, and cope with loneliness throughout their lives. A longitudinal sample of 114 people, which included autistic participants and participants with neurodevelopmental disabilities, characterized experiences of loneliness, perceptions of other people's loneliness, and strategies used to cope with loneliness from childhood to adulthood. Level of loneliness and coping strategies were coded from Autism Diagnostic Observation Schedule Modules 3 and 4 protocol forms. Autism Diagnostic Observation Schedule Loneliness Ratings were correlated across time and increased from adolescence to young adulthood. The most common loneliness coping strategies were Behavioral Distraction (e.g. watching TV) and Instrumental Action (e.g. seeking social contact), which were both used by more people in adulthood than childhood. Those who used Behavioral Distraction and a greater number of coping strategies had higher Autism Diagnostic Observation Schedule Loneliness–Self Ratings (i.e. were lonelier) during adolescence and adulthood. Findings highlight adulthood as a particularly vulnerable time for loneliness and indicate a need for more support and social opportunities for autistic adults and adults with neurodevelopmental disabilities who wish to make more social connections. We know that many autistic people feel lonely, but we don't know whether their loneliness changes over time. Our research study followed autistic people and people with other non-spectrum neurodevelopmental disabilities from childhood through young adulthood and asked them about their loneliness. While many people told us they felt lonely or very lonely, a sizable group also told us that they do not feel lonely. We found that people who reported feeling lonely earlier in life were likely to also report feeling lonely later in life. Overall, autistic people and people with other neurodevelopmental disabilities in our study became lonelier from adolescence to adulthood. People described multiple ways they cope with feeling lonely, such as distracting themselves or reaching out to connect with another person. People who used distraction tended to be lonelier than those who did not. Our findings tell us that there is a need for greater support of social connections for many autistic people as they become adults. [ABSTRACT FROM AUTHOR]

Children with neurodevelopmental diagnoses often experience discrimination from their peers at school. This may result from a lack of understanding, and intolerance of differences in their thinking, communication and social interactions. Learning About Neurodiversity at School (LEANS) is a teaching programme designed to educate primary school children about the concept of neurodiversity. The LEANS programme was created by a neurodiverse team, using participatory methods. In the current study, we evaluated whether the wider neurodiverse community endorsed the planned design generated by our participatory approach. Respondents (n = 111) rated their support for key elements of the planned LEANS content, via an online survey. Participants were majority neurodivergent (70%), 98% of whom reported moderate-to-high familiarity with neurodiversity concepts. Over 90% of respondents expressed support for the planned content presented, and 73% of respondents endorsed the draft neurodiversity definition provided. A small number of respondents provided open-ended comments giving further detail on their views. Overall, the LEANS programme plan received a high level of support from this independent, neurodiversity-aware sample – demonstrating the potential of small-group participatory methods to generate wider community support. The completed resource is now available as a free online download. 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. [ABSTRACT FROM AUTHOR]

The growing number of autistic adults challenges the limited adult service system. While data on service use and barriers are available, there is limited information from the individual's perspective on which services are most helpful in adulthood and how service use is connected to community participation outcomes. Forty autistic adults participated in a study combining global positioning system community participation measures with survey and interview data on service use, including which services are most helpful in adulthood, barriers to services, and service needs. Participation outcomes were analyzed relative to demographics, number and types of services received in the past 2 years, and current mental health service use. Participants received an average of two services in the past 2 years, most frequently mental health and employment services. Individuals currently seeing a mental health counselor were more likely to be working full-time and visit more community locations compared to those who were not seeing a counselor. Participants reported mental health services as the most helpful service received in adulthood followed by employment services. While an emphasis is often placed on employment services in the transition to adulthood, findings suggest a need for integrated mental health and employment services for autistic adults. The number of autistic adults is growing, but there are fewer services to support them in adulthood. Many autistic adults need some support services to lead successful adult lives. We know a lot about the services autistic adults use and some of the problems with using these services, but we do not know which services are most helpful to them and how the services they use relate to how they interact with their communities. Forty autistic adults took part in a study about service use and community participation. They completed surveys, interviews, and carried a global positioning system tracker. They answered questions about which services are most helpful in adulthood, things that make it hard to use services, and what services they needed. Most participants used two services in the past 2 years, most frequently mental health and employment services. Adults who were currently seeing a mental health counselor were more likely to be working full-time and visit more locations in the community compared to those who were not seeing a counselor. Mental health services were reported as the most helpful service they received as adults, followed by employment services. We often focus on the importance of employment services after high school, but our findings show a need for both mental health and employment services for autistic adults. [ABSTRACT FROM AUTHOR]

There is a dearth of research into the experience of adult diagnosis of autism spectrum disorder, and targeted research is needed to understand the needs of these adults. The aim of this coproduced review was to assess existing qualitative data on the lived experience of receiving an autism spectrum disorder diagnosis, identify recurring themes, and synthesize them into a visual model representing the journey through diagnosis. Using thematic analysis, we analyzed qualitative data from 24 studies of adult experiences of autism spectrum disorder diagnosis from PsycINFO, Embase, MEDLINE, and CINAHL. Thirty-two "descriptive" themes and three superordinate themes were identified. These themes represented how factors relating to identity and relationships are impacted by the diagnosis of autism spectrum disorder and the role of adaptation and assimilation. While the diagnostic process was confusing and disappointing for many, it often led to a sense of relief and clarity regarding past experiences. It created opportunities to connect with other autistic individuals and to access services, though appropriate supports were widely lacking. Recommendations are made that the diagnosis process explicitly considers needs in relation to: the impact of the diagnosis on identity, interactions with other people, choices regarding disclosure, and whether and how to make informed adaptations. There is little research looking at the experience of individuals diagnosed with autism spectrum disorder as adults. Adults diagnosed with autism spectrum disorder face different challenges than children, and more research is needed to better understand those challenges. For this review, autistic and non-autistic researchers looked at research on the experience of receiving a diagnosis of autism spectrum disorder as an adult. We looked for themes in people's experience leading up to diagnosis, going through the diagnostic process, and living their life after diagnosis. We analyzed 24 studies and found three overarching themes that captured thirty-two themes describing the experience of diagnosis. The three overarching themes expressed issues with identity and relationships before and after the diagnosis and identified that the diagnosis of autism spectrum disorder in adulthood impacted people's adaptation to and assimilation (i.e. the making sense of and internalizing the diagnosis) of autism spectrum disorder. While the diagnostic process itself was confusing and disappointing for many, it often led to a sense of relief and clarity regarding past experiences and had effects on identity and self-esteem. It created opportunities to connect with other autistic individuals and to access services, though appropriate supports were widely lacking. Recommendations are made that the impact of the diagnosis on people's identity and choices about telling others about their diagnosis, and whether and how people want to make adaptations, should be discussed and thought through in the process of diagnosis. [ABSTRACT FROM AUTHOR]

Autistic individuals experience higher rates of externalising and internalising symptoms that may vary with environmental factors. However, there is limited research on variation across settings that may highlight common factors with globally generalisable effects. Data were taken from two cohorts: a multinational European sample (n = 764; 453 autistic; 311 non-autistic; 6–30 years), and a South African sample (n = 100 non-autistic; 3–11 years). An exploratory factor analysis aggregated clinical (Verbal Comprehension and Perceptual Index), adaptive traits (Vineland Adaptive Behaviour Scale) and socio-economic variables (parental employment and education, home and family characteristics) in each cohort separately. With regression, we investigated the effect of these factors and autistic traits on internalising and externalising scores (measured with the Strengths and Difficulties Questionnaire). Cohorts showed similar four-factor structures (Person Characteristics, Family System, Parental and Material Resources). The 'Family System' factor captured family size and maternal factors and was associated with lower internalising and externalising symptoms in both cohorts. In the European cohort, high autistic traits reduced this effect; the opposite was found in the South Africa cohort. Our exploratory findings from two separate analyses represent consistent evidence that Family System is associated with internalising and externalising symptoms, with a context-specific impact in persons with high autism traits. Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings – in Europe and South Africa – to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people. [ABSTRACT FROM AUTHOR]

Differences in (autism) characteristics are often reported between autistic and non-autistic adults but also between autistic adults. We aimed to determine whether mean differences correspond to differences in network structure of these characteristics in (1) autistic and non-autistic adults and (2) two previously identified autism subgroups. A total of 16 network variables related to demographic and psychological characteristics were included. First, Gaussian Graphical Models (GGMs) were used for network estimation in 261 autistic adults and 384 non-autistic comparisons aged 30–85 years. Second, we repeated this step within two previously identified autism subgroups (N 1 = 124, N 2 = 130). Third, sex differences were explored in the networks of the autism subgroups. The networks of the autism and comparison groups differed on individual edges and visual inspection, although the Network Comparison Test (NCT) showed no overall differences. The networks of autism subgroups were similar based on visual inspection and statistical comparisons. Sex did not impact the subgroup networks differently. Networks were more similar than different, but observed edge differences could be informative for targeted support. Focusing on mean differences is not sufficient to determine which factors (and associations) are important for autistic people. Thus, network analysis provides a valuable tool beyond assessing mean differences for autistic adults. There are large differences in the level of demographic, psychological, and lifestyle characteristics between autistic and non-autistic adults but also among autistic people. Our goal was to test whether these differences correspond to differences in underlying relationships between these characteristics—also referred to as network structure—to determine which characteristics (and relationships between them) are important. We tested differences in network structure in (1) autistic and non-autistic adults and (2) two previously identified subgroups of autistic adults. We showed that comparing networks of autistic and non-autistic adults provides subtle differences, whereas networks of the autism subgroups were similar. There were also no sex differences in the networks of the autism subgroups. Thus, the previously observed differences in the level of characteristics did not correspond to differences across subgroups in how these characteristics relate to one another (i.e. network structure). Consequently, a focus on differences in characteristics is not sufficient to determine which characteristics (and relationships between them) are of importance. Hence, network analysis provides a valuable tool beyond looking at (sub)group level differences. These results could provide hints for clinical practice, to eventually determine whether psychological distress, cognitive failures, and reduced quality of life in autistic adults can be addressed by tailored support. However, it is important that these results are first replicated before we move toward intervention or support. [ABSTRACT FROM AUTHOR]

Many autistic adults are likely to experience poor financial wellbeing and hardship due to unemployment and under-employment. Research in the general population demonstrates that subjective financial wellbeing—how people perceive their financial situation—influences quality of life. There is no research, however, examining the subjective financial wellbeing of autistic people. This study therefore aimed to (1) understand the subjective financial wellbeing of a sample of autistic adults living in Australia compared to a general Australian population sample and (2) identify the predictors of subjective financial wellbeing in this sample of autistic adults. To this end, 191 autistic adults aged 18–83 years (mean = 39.28, standard deviation = 11.74) completed an online survey about their economic status, financial wellbeing, financial behaviors, confidence in money management skills, and anxiety and depression symptoms. Almost half of our sample felt it was a struggle to make ends meet, whereas only one-third of the general Australian population felt this way. Similar to the general population, autistic people's income and their financial behaviors (specifically, saving and not borrowing for everyday expenses) predicted their sense of financial wellbeing. Our findings have implications for both research and practice. Researchers have found the way people feel about their financial situation is related to their quality of life. We know that many autistic people find it hard to find a job. And for those autistic people who have a job, they are often underpaid. Not having a job or being underpaid often means having low income. Having low income is likely to influence how autistic people feel about their financial situation. However, no research has looked at these issues for autistic people. This is the first study that helps us learn more about what autistic adults think about their financial situation. We looked at autistic people's thoughts on this issue compared to people from the general Australian population. We also looked at what things might impact how autistic people feel about their financial situation—which might be how much money they earn, what they do with that money, and their mental health. Many autistic adults felt they were struggling with financial wellbeing and this was connected both to the level of their income and how they said they managed their money. Those who were able to save and not borrow for everyday expenses reported feeling a greater sense of financial wellbeing. Concrete changes might help to improve autistic people's financial wellbeing. We need to investigate how we can help autistic people find and keep well-paying jobs. And we need to work out the best ways of equipping autistic people with the skills they need in financial matters. [ABSTRACT FROM AUTHOR]

Financial wellbeing is an important component of people's overall wellbeing, reflecting the capacity to live a comfortable and fulfilling life. Yet virtually nothing is known about this topic for autistic people. This study addressed this gap using a two-phase sequential mixed-methods design. Here, we report on findings from the Phase 2 qualitative study. In this study, 21 autistic participants were purposively selected based on the status of their financial wellbeing, including 12 people with high, and 9 with low, financial wellbeing, and interviewed by an autistic researcher. We identified four themes through reflective thematic analysis. Having access to a stable income made an enormous difference to people's financial wellbeing. Participants emphasised how their broader social supports, especially family support, shaped their financial wellbeing. Yet, planning financially was often challenging, especially for people who had insufficient money to meet their basic needs. Nevertheless, our participants reported a strong drive to stay in control and avoid unnecessary risk. Our findings revealed how much money matters in autistic people's lives. Future research should investigate the ways in which autistic people could secure more reliable incomes and identify the most effective ways to support them to achieve financial resilience. Money matters in people's lives. It helps to meet people's basic needs (food, clothes, shelter) and live the lives they want to. When people talk about 'financial wellbeing', they mean how much you feel in control over day-to-day finances and how much freedom you have to make choices to enjoy life. We don't know what autistic people think about these things. That's why we did our study. We spoke to 21 autistic adults (24–69 years) about how they felt about their financial situation. We deliberately spoke to people who had told us previously they felt 'financially well' or 'financially unwell' so we could hear a range of opinions. Autistic people told us financial wellbeing meant having enough money to pay for their basics needs, to have a safety net for unexpected bills and not having to worry about money now or in the future. But many felt that good financial wellbeing was not possible for them. They often did not have a stable income to cover day-to-day expenses. This limited the choices they could make. Despite these challenges, autistic people told us they worked hard to budget and save money when they could – because feeling financial insecure was just too stressful, especially when they could not rely on family or friends for support. It made them feel mentally unwell. Our study shows there are many factors that influence autistic people's financial wellbeing. We need more research to help us understand how autistic people can be supported to achieve financial security. [ABSTRACT FROM AUTHOR]

Autism disclosure can be a complicated decision that autistic people experience. Positive outcomes can include feelings of acceptance and support, but negative outcomes can include stigma and discrimination. Although a surge in research on this topic has led to more understanding around autism disclosure, the methodologies used may have limited who was contributing to the conversation and data. To overcome this, we analyzed 3 years (2020−2022) of social media data (Reddit and Twitter) as this was public information that did not rely on researcher data collection. Reflexive thematic analysis of 3121 posts led to the generation of four themes: People do not understand autism (with experiences related to employment, dating, healthcare and mental health), autistic people just want privacy and respect, autistic people can lead us forward and non-autistic people need to assume more responsibility. We discuss how autistic adults experience the impact of society's lack of understanding of autism on a daily basis whether they disclose or not, and that it is everybody's responsibility to challenge negative stereotypes and promote a more inclusive society. Autism disclosure – that is sharing their autism diagnosis or identity with a person or people – is a difficult decision for many autistic people. While telling people they are autistic can be positive and helpful, it can also create a lot of problems. What we have learnt is that disclosure is really complicated. Rather than asking research participants questions about what might happen, we looked at what people were saying on public social media posts (Reddit and Twitter) about what did happen. We used three years of posts that were related to autism disclosure from a wide range of adults (autistic and non-autistic). Four main ideas were created from our data, with the key finding being that society does not understand autism. This lack of understanding creates problems for autistic people in work, dating, healthcare and mental health. The remaining ideas were that autistic people should have privacy and be treated with respect, that autistic representation can help society and that non-autistic people need to do more to help autistic people. Our findings support that society needs to do more through autism advocacy, better media representation and more public role models. Increasing the accuracy of understanding of autism across society will mean that autistic people can feel safer to disclose if they want to. [ABSTRACT FROM AUTHOR]

Over the past few years, screen-based usage among children and youth has increased significantly, particularly among those with autism. Yet current screen time guidelines do not address the specific needs of autistic children and youth. Therefore, the objective of this study was to develop specific and clear guidelines and strategies that caregivers and expert clinicians agree upon to support the digital citizenship of children with autism. Using the Delphi method, 30 experts, including 20 clinicians and 10 caregivers, were invited to complete a series of three surveys. The experts had to rate their agreement levels on a series of statements that included possible guidelines and strategies. The final statements to be included in the guidelines were accepted by more than 75% of the panel. The final guidelines included six sections: (1) general principles, (2) considerations for timing and content of leisure screen time use, (3) strategies for caregivers and clinicians to monitor and regulate screen time use, (4) behaviors to monitor for screen time overuse, (5) additional guidelines for clinicians, and (6) resources. The agreed-upon guidelines developed in this study could be the stepping stones for clinical interventions targeting screen time overuse of children with autism, addressing the screen time challenges that many families are experiencing. Children and youth with autism use screens in their daily lives and in their rehabilitation programs. Although parents and clinicians experience specific challenges when supporting positive screen time use of children and youth with autism, no detailed information for this group exists. Therefore, this study aimed to develop clear guidelines that are agreed by expert clinicians and parents of children and youth with autism. Using a method called Delphi, 30 experts—20 clinicians and 10 caregivers, who have experience working with or caring for children and youth with autism were invited to complete a series of three surveys. In each round, the experts had to rate their agreement with statements regarding screen time management. The agreement level was set to 75%. The final themes to be included in the guidelines were accepted by more than 75% of the panel. The final guidelines included six main sections: (1) general principles, (2) considerations for timing and content of leisure screen time use, (3) strategies for caregivers and clinicians to monitor and regulate screen time use, (4) behaviors to monitor for screen time overuse, (5) additional guidelines for clinicians, and (6) resources. The new guidelines developed in this study can provide potential guidance on how to further the development of digital citizenship for children and youth with autism and provide strategies to families to help manage screen time use. [ABSTRACT FROM AUTHOR]

Autistic girls and women experience more mental health difficulties and poorer well-being than their non-autistic peers. Little emphasis has been placed on the perspectives of the girls and women within the literature. This review aims to provide an overview of the factors that impact autistic females' emotional and social well-being and mental health, as described in self-report qualitative studies. The protocol for the present review was pre-registered on PROSPERO (CRD42020184983), and this article follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PsycInfo, Academic Search Complete and MEDLINE were systematically searched using a pre-defined search string. This yielded 877 unique records, which were systematically screened by two reviewers, resulting in 52 eligible studies. Structured data extraction and quality appraisal were completed. The present review presents the perspectives of 973 autistic females aged 13–70+. Thematic synthesis identified three themes and nine subthemes. Our findings suggest that autistic girls' and women's experiences can be conceptualised within a social model, where biological and psychological factors ('The Autistic Neurotype') are experienced through the lens of social factors ('The Neurotypical World' and 'Stigma'), together shaping well-being and mental health outcomes. 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. [ABSTRACT FROM AUTHOR]

Sharing resources is fundamental for human cooperation and survival. People tend to share resources more with individuals they feel close to compared to those who are more socially distant. This decline in generosity at increasing social distance is called social discounting and is influenced by both social traits and abilities, such as empathy, and non-social psychological factors, such as decision-making biases. People who receive a diagnosis of autism show differences in social interaction as well as displaying differences in non-social domains, such as more restricted and repetitive behaviours. We investigated social discounting in autism and found that autistic adults were more generous than neurotypical participants, which was driven by greater generosity to socially distant others. Crucially, we also investigated framing effects during prosocial decision-making. Autistic participants were less susceptible to whether decisions were framed as causing monetary gains, compared to preventing monetary losses, for the potential recipient. Our results support the view of 'enhanced rationality' in autism as participants' prosocial decisions were less influenced by potential biasing information, such as the closeness of the recipient or how choices were framed. Therefore, the differences seen in autism, as well as posing certain challenges, can also have prosocial consequences. Autistic people show differences in their social behaviour. But how autism affects decisions to share resources, an important part of cooperation, was previously unclear. In our study, participants made decisions about how to share money with different people, including people they felt close to, such as a friend, and people they felt less close to, such as a stranger. We found that compared to a group of non-autistic participants, autistic adults shared more money overall and this was driven by greater generosity to strangers. The results suggest that autistic adults were more generous because they made fair decisions (an equal split of the money) more consistently regardless of how close they felt to the person they were sharing with. By showing that autistic adults display greater generosity, our results could help to change public perceptions of autism and potentially improve opportunities for autistic people. [ABSTRACT FROM AUTHOR]

Camouflaging is hypothesized to play an important role in developing mental health difficulties. But this might not be true for everyone. It remains unclear for whom camouflaging is associated with mental health. In this preregistered study (AsPredicted #45095), we investigated whether (1) camouflaging and mental health were associated and (2) we could detect subgroups with a different association between camouflaging and mental health. For this study, 352 autistic adults aged 30–84 years filled in, among others, the Dutch Camouflaging Autistic Traits Questionnaire to measure camouflaging and the Symptom Checklist-90 Revised to measure mental health difficulties. We found a moderate correlation between camouflaging and mental health difficulties (r = 0.45). However, there was only a strong association between camouflaging and mental health in a small subgroup, while the association was small in most autistic adults. For varying levels of negative affect and (to a lesser extent) autism traits, the association between camouflaging and mental health differed, but not for biological sex, age, or educational level. Thus, while one should be careful with group-based conclusions regarding the (negative) impact of camouflaging, camouflaging can be important to consider in clinical practice, especially for people with a substantial level of negative affect. When autistic people use strategies to hide their autistic characteristics, we call this camouflaging. Autistic adults suggested that camouflaging can result in mental health difficulties. That is, people who report to camouflage also report mental health difficulties. However, since there are many differences between autistic people, this relationship may also differ between subgroups. Therefore, in this study we investigated whether camouflaging and mental health difficulties are related and whether this relationship is equal for all autistic adults. For this study, 352 autistic adults aged 30–84 years filled in the Dutch Camouflaging Autistic Traits Questionnaire to measure camouflaging and the Symptom Checklist-90 Revised to measure mental health difficulties. We found that camouflaging was moderately related to mental health difficulties. This means that people who report more camouflaging also report more mental health difficulties. When we looked closer, we found that this relationship was strong for only a small subgroup of autistic adults. In most other autistic adults, there was a small or no relationship between camouflaging and mental health difficulties. Therefore, it is important that clinicians are aware of camouflaging and its possible relationship with mental health difficulties, but that they do not generalize the negative consequences to everyone. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses the journal's community-involved research reporting or participatory methods and author positionality in autism.

Prospective memory helps us to remember to perform tasks in the future. Prospective memory can be either time or event based. The goal of this study was to determine time- and event-based prospective memory in autistic adults across the life span. Autistic (n = 82) and non-autistic (n = 111) adults, aged between 30 and 86 years, performed the lab-based Amsterdam Breakfast Task, and several naturalistic prospective memory tasks. Preregistered analyses (AsPredicted #34249) were performed using classical frequentist as well as Bayesian statistics. On none of the prospective memory tasks, group differences were observed. Our results show no effect of age on naturalistic tasks, but age did affect our lab-based measure, indicative of the age paradox often described in non-autistic adults. Moreover, we found evidence for a parallel age-related effect of lab-based and naturalistic prospective memory in autistic and non-autistic individuals.What is already known: Prospective memory is an important function for daily living. It is the cognitive function that helps you remember that you are meeting your friend for coffee at 2 pm tomorrow, or that you need to take your vitamins after breakfast. This cognitive function is particularly important in autistic adults, but how prospective memory is associated with increasing age, we currently do not know.What this paper adds: Although performance on experimental tasks that measure prospective memory decreases with age, this pattern is similar in autistic and non-autistic adults. No age effects were found for tasks that were performed outside the lab. Autistic adults and non-autistic adults perform similarly on prospective memory, and this performance remains similar when autistic and non-autistic adults age.Implications for practice, research, or policy: While our results show that prospective memory decreased with increasing age, our results do point to parallel development of prospective memory in autistic and non-autistic adults. This finding serves as a reassurance for those individuals concerned that older autistic individuals might show quicker cognitive decline. [ABSTRACT FROM AUTHOR]

International research suggests that increasing numbers of autistic people are entering higher education. Currently, very little is known about this population. For example, the rates of autistic people enrolling at UK-based higher education institutions, the demographics of this population, the subjects they study and particularly their graduate outcomes are unknown. This study is an exploratory analysis of autistic graduate outcomes. We compare outcomes between autistic students, other disabled students and non-disabled students, by sex. The article draws upon population data collected by the Higher Education Statistical Agency in the United Kingdom (N = 1,326,416) across the years 2012–2018. Our findings indicate that the academic programmes studied at university by autistic students are more diverse than typically assumed. We also found that graduates make the transition into a range of employment sectors following graduation, but experience persistent and disparities in economic activity and income. We argue that higher education institutions must focus greater attention on developing more robust and effective employment transition support for autistic students and graduates. International research suggests that more autistic people are entering higher education. Currently, very little is known about this group in the United Kingdom, for example, we have little information about how many autistic people enrol at UK-based higher education institutions, their backgrounds, the academic programmes they study and what they do once they have graduated. Our study tries to explore these issues by comparing outcomes between autistic students, other disabled students and non-disabled students. We use population data collected by the Higher Education Statistical Agency in the United Kingdom, which included 1,326,416 graduates across the years 2012–2018. Our findings indicate that the degree subjects studied at university by autistic students are more diverse than often people think. We also found that graduates go on to work in a range of employment sectors following graduation but often experience worse outcomes in terms of access to full-time work and worse pay. We argue that universities and colleges must focus greater attention on developing better employment transition support for autistic students and graduates. [ABSTRACT FROM AUTHOR]