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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]

This initial study used an equivalent-groups design to evaluate differences in story comprehension scores between children with autism spectrum disorder (ASD) and their neurotypical (NT) peers using paper and iPad® storybooks. Fifteen children with ASD of ages 4–6 and 15 NT peers matched for receptive vocabulary age and gender met inclusion criteria. Across two individualized testing sessions, participants answered language abstraction questions about three formats of Pete the Cat stories (paper, iPad adult read, and iPad with the read-to-me feature activated) during shared storybook reading. When examining the entire group of participants, all children performed better with either type of iPad storybook compared to the paper book. The current study indicates storybooks on the iPad function in similar ways for NT children and children with ASD. Further, this research shows promise for using the iPad with young children during shared storybook reading. Directions for future research and implications for special education personnel are provided. [ABSTRACT FROM AUTHOR]

Ethnographic researchers have long relied upon observation as a powerful means to learn about social relations. This paper discusses research observation that was conducted as a part of an institutional ethnography (IE) investigating how people use the language and ideas of neurodiversity across different settings. While our research protocol initially called for ethnographic observation to take place at in-person events in Southern Ontario, our approach needed to be re-formulated with the switch to online events during the COVID-19 pandemic. After the shift to online-only spaces, a total of 52 sessions at 7 online events related to neurodiversity or autism were observed by a team of 5 researchers: these events were no longer geographically restricted but were officially "hosted" by institutions in Canada, the US, and the UK. This paper reflects upon the challenges and opportunities we encountered as we conducted observations in digital spaces, including our experiences of navigating the "chat" feature. We discuss the need to analyze the format as well as the content of online events, and present findings on how neurodiversity appeared in these social spaces. Finally, we consider the implications of this research for people who are conducting ethnographic observation in an increasingly online world. [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]

Background: In recent years, a significant proportion of inpatient facilities for people with intellectual disabilities and/or autism has been de-commissioned in England, This has resulted in individuals with intellectual disabilities being sent to distant hospitals far away from their families and carers leading to challenges in follow-up, community care and interventions. The impact of de-institutionalisation, has often caused patient trauma, family distress and subsequent discharge difficulties. Not every individual with intellectual disabilities and/or autism requires inpatient care but inpatient care when needed has to be local, adequate and appropriate. Aims: To evaluate current evidence of utility of inpatient models for people with intellectual disabilities and outline best clinical practice. Method: PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, Web of Science were searched with key search terms. The search was conducted by the information specialist and identified abstracts screened further for inclusion criteria, methodological issues, and other appropriate characteristics. Twenty-three papers were included in the rapid review. Papers shortlisted had the inclusion criteria applied against the full text version independently by two reviewers. Disagreements regarding eligibility of studies was resolved by discussion and consensus within the project team. Key data related to in-patient models of care was extracted from the included papers, which included year of study, design, study objectives, target population, method/s tested, outcomes reported, country of study/studies, and results. Data extraction was performed by two reviewers and reviewed by the project team. Results: From the review of services for people with intellectual disabilities, we came across four broad models/frameworks/approaches. Evidence on what worked for inpatient service provision tended to be based on models developed and implemented locally. Conclusions: We make recommendations for the best clinical practice and standards. Both clinical service providers and policymakers need to be aware of specific needs of individuals with intellectual disability and/or autism. [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]

How can non-autistic adults facilitate social learning with children on the spectrum? A new theoretical understanding of autism is currently emerging that has made this question more relevant than ever. At the intersection of two growing research areas in the field of autism, the borderland that separates the experience of social interaction between neurotypes is increasingly mapped out. By integrating anthropological research on autistic sociality and the neurocognitive framework of predictive processing, this paper explores the question: If autistic people experience the world in a fundamentally different way, what is a meaningful strategy for supporting them in developing their socialities? Methods: The paper reports an in-depth analysis of a 2-min sequence in which a non-autistic adult facilitates a collaboration game between three autistic children (8–12 years). The data comes from a participatory research project that develops a new pedagogical approach to social learning based on open-ended construction play. The analytical strategy is informed by conversation analysis. Results: We find that the facilitation supports the children in accomplishing social interaction and collaboration, but it also in several instances gives rise to misunderstandings between the children. Whereas the facilitator aims to support the children's direct verbal communication about the construction task, we observe that the children use a broad repertoire of non-direct communication strategies that enables them to coordinate and align their shared process. We find that the children's actions with their hands in the construction task count as turns in the communication. Regarding the play-based learning environment, we find that the children are engaged in the shared construction task and that they competently navigate social tension when it arises without the facilitator's help. Conclusion: We conclude that the misunderstandings between the children created by the facilitation from a non-autistic adult emerge from a discrepancy of attention in the situation. The facilitator focuses on the words, but the children focus on the task. Even though this discrepancy is not necessarily a result of different neurotypes, we find that it emerges from the social dynamics of facilitation by non-autistic adults that is key in many social intervention settings. Furthermore, we conclude that the play-based learning environment enables the facilitator to support the children without directly instructing them in their social behavior. This appears to give the children an opportunity to acquire complex social experiences through their collaboration. Implications: The interaction dynamics in the data clip is shaped by the non-autistic adult's expectations of the children's interaction. This made us wonder whether we can establish a learning environment that begins from the learners' perspectives instead. The analysis caused us to change the facilitation strategy that we employ in our project. It is our hope that our approach will inspire reflection and curiosity in researchers and practitioners who develop social interventions targeting autistic people. [ABSTRACT FROM AUTHOR]

Background and aims: Participatory research involves academic partners working together with the community that is affected by research to make decisions about that research. Such approaches often result in research that is more respectful of, and responsive to, community preferences – and is vital in the context of autism research with culturally and linguistically diverse (CALD) communities. Whilst participatory approaches are becoming more commonplace within CALD autism research, no studies have explored the experiences of being involved in autism research from the perspectives of CALD community partners over the course of a study. This paper intended to address this gap by reporting on the experiences of CALD parents of autistic children who were community partners in a 1-year Australian research project exploring home–school partnerships for CALD parents of autistic children. We aimed to: (1) report on how parents' involvement in the research process shaped the home–school partnerships study over time and (2) understand their experiences of being community partners on the home–school partnerships project. Methods: Using key principles of participatory approaches, we established Chinese and Vietnamese parent advisory groups to contribute to a project exploring home–school partnerships for parents of autistic children from CALD backgrounds in Australia. Advisory groups included parents of autistic children from Chinese/Vietnamese backgrounds, as well as interpreters, professionals and researchers. We documented how parents' participation as community partners shaped the home–school partnerships study over the course of the project. We also elicited parents' own views and experiences of being community partners through informal, open-ended questions at the beginning and end of the study. Results: We found that parents' input fundamentally shaped the broader home–school partnership study, from meaningful, accurate translation of interview schedules through to making decisions regarding community-specific recommendations and dissemination plans. Parents themselves reported being keen to collaborate and to hear and share opinions for the purpose of the home–school partnership study – although they noted how emotionally difficult sharing their stories could be. While they initially had some concerns about combining being involved as a community partner with their existing responsibilities, ultimately, parents were surprised by the scope of the home–school partnership study and their level of involvement as community partners. Through hearing others' stories and sharing their own in advisory group meetings, parents reported ancillary benefits of their involvement, including increased self-advocacy and well-being. Conclusions: These findings show how research that is conducted in partnership with diverse members of the autism community has the capacity to improve the quality of the research and benefit community partners. Implications: This study clearly documents the benefits and potential challenges of participatory approaches with CALD communities. These findings emphasise to researchers and funders the importance of including extra time and money within budgets in order to produce meaningful research that is respectful and responsive to communities. [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]

The study explores the role of the Eye to I© intervention model in facilitating advancement through social stages of play in which skills contribute to the quality of social interaction and communication in children with autism. Data were collected on 11 participants, ages of 2–6 years, formally diagnosed with autism, receiving Eye to I© Social Communication therapy at Potentials Therapy Center, New Delhi, India. Eye to I© is developed in-house at Potentials and is further discussed in the paper. All participants attended a form of group intervention. A mixed-method design included quantitative measures administered pre and post intervention (Communication DEALL Developmental Checklist, Communication Matrix) and video coding of Social Communication sessions. Qualitative measures were semi-structured parent interviews conducted at the end of intervention. Thematic analysis and quantitative statistical analysis results show that by the end of the Eye to I© intervention period children engaged in social stages of play of greater developmental complexity and showed increased scores in assessments of social skills as well as generalization of skills. This suggests that skill acquisition necessary to directly support two diagnostic criteria areas of autism as per DSM-V; i.e., communication and social interaction occurred during the period of intervention. [ABSTRACT FROM AUTHOR]

Social work research should adopt a critical approach to research methodology, opposing oppression that is reproduced through epistemological assumptions or research methods and processes. However, traditional approaches to autism research have often problematised and pathologized autistic 1 individuals, reinforcing autistic people's positions as passive subjects. This has resulted in autistic people being largely excluded from the production of knowledge about autism, and about the needs of autistic people. Participatory approaches promote collaborative approaches to enquiry and posit autistic people as active co-constructors of knowledge, a stance that is congruent with social work values of social justice and liberation. However, Covid-19 is not only altering our everyday life but also upending social research. This paper discusses the challenges faced by a participatory study involving autistic people during the Covid-19 pandemic. This paper examines how Covid-19 increased the individual vulnerability of autistic participants and changed their research priorities, increased the researcher's decision-making power, and placed greater emphasis on barriers created by inaccessible methods. Covid-19 did not present novel challenges, but rather exacerbated existing tensions and inevitable challenges that are inherent in adopting an approach that aims to oppose oppression. [ABSTRACT FROM AUTHOR]

Diagnosis is a profoundly social phenomenon which, while putatively identifying disease entities, also provides insights into how societies understand and explain health, illness and deviance. In this paper, we explore how diagnosis becomes part of popular culture through its use in many non-clinical settings. From historical diagnosis of long-deceased public personalities to media diagnoses of prominent politicians and even diagnostic analysis of fictitious characters, the diagnosis does meaningful social work, explaining diversity and legitimising deviance in the popular imagination. We discuss a range of diagnostic approaches from paleopathography to fictopathography, which all take place outside of the clinic. Through pathography, diagnosis creeps into widespread and everyday domains it has not occupied previously, performing medicalisation through popularisation. We describe how these pathographies capture, not the disorders of historical or fictitious figures, rather, the anxieties of a contemporary society, eager to explain deviance in ways that helps to make sense of the world, past, present and imaginary. [ABSTRACT FROM AUTHOR]

Background and aims: Having a conversation with someone or even more within a group of people is complex. We are never taught at school how to do it, which implies we consider having a conversation as something simple and straightforward. Instead, we just learn from observing others. Some people are great conversationalists – it comes naturally to them – while others struggle. Some people may not fully understand how the process works, how turn-taking happens, don't understand visual cues such as body language and facial expressions, and fail to comprehend that some topics may be appropriate or inappropriate. This can be the case for both neurotypical and neurodivergent people. The Conversation skills Assessment Tool has been developed in this first instance to help in assessing and examining conversation skills in an intervention with young autistic adults on a virtual platform (a virtual world). This paper will present the evolution of the new measure through the exploratory phase, the development phase and finally a detailed account of the inter-rater reliability process. Methods: The intervention associated with this study was carried out though a multiple baseline design with 3 autistic participants (in their early 20 s) and took place over 4 phases (15–17 sessions). The sessions involved semi-structured conversations in face-to-face (phases 1 and 4) and virtual (phases 2 and 3) settings and were videotaped with the participants' consent. Twelve of those were used by this study in the development process through iterative inter-rater reliability stages between two coding teams. Results: Evaluation of the Conversation skills Assessment Tool tool revealed the potential benefit of implementing interventions with measures that more objectively and concretely (e.g., by noting frequencies) assess observable behaviours that are associated with having positive conversations with others. Beyond this, it is anticipated that Conversation skills Assessment Tool can emerge as a tool capable of not only accounting for the environment an interaction takes place in (e.g., professional, casual), but also offers beneficial feedback for both autistic students and other populations (e.g., young children, English language learners). Conclusions: This measure has the potential to offer quantifiable and trackable guidance to people who have difficulties conversing. The authors do not wish to perpetuate an ableist social construct of what is a 'good' conversation, nor do they suggest that conversation skills training is useful solely for people with communication and/or socialization difficulties. Rather, they hope that Conversation skills Assessment Tool can be adopted more broadly to give both neurotypical and neurodivergent people a better understanding of how to communicate more effectively with others, while also becoming more aware and accepting of differing conversational styles. Implications: Because of its ability to track (or self-monitor) one's development of conversational skills over time, Conversation skills Assessment Tool could serve as an educative tool in early childhood education. It can be used by occupational/speech therapists and other professionals and also used to self-monitor one's development of conversational skills. Conversation skills Assessment Tool was developed to assess conversation skills on a one-to-one basis; therefore, another iteration of Conversation skills Assessment Tool would have to look at group conversations. [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 voices of the autistic community have been systematically forfeited in research and practice, both as a consequence of the double empathy problem and, as a direct result of albeist methodic approaches to researching and representing autism (Milton, 2012., Goodley, 2016, 2018., Heilker & Yergeau, 2011., Hobson et al, 2022., Ridout, 2017). Methodologically speaking, autism creates challenges for allistic researchers, particularly as there is an associated "exaggerated risk" of researching autistic people and as researchers frequently study and thus experience autism, from etic perspectives (Van De Hoonard, 2016, p. 585). This paper contends that these challenges have resulted in a lack of flexibility in methodologies designed to protect those at risk of harm, creating disproportionate fear and an over-surveillance of autistic research participants, despite their potential. Inertia is a direct consequence of this, which manifests itself twofold. Firstly, as the struggle researchers have in capturing meaningful and authentic autistic representation and secondly, of the methodic implications autistic inertia presents. What is suggested, therefore, is a subversion of homogeneous ways of knowing from the production of quasi-aesthetic representations of autistic voice, favoring those creative methodologies which appreciate that autism is not experienced diachronically. As to capture the realities of contemporary autistic life, dividing practices of ableism must be challenged (Goodley, 2018). Therefore, by centralizing autistic research participants as "insiders" to autistic worlds, researchers will have to lay aside academic habits and rethink, heuristically, how to privilege unobscured autistic voices through transabelism (Garland-Thompson, 2005). For in order to carve out hybrid dilatory spaces from which autistic people can develop their narrative capital, a transableist agenda must be pushed. What will ensue are creative and flexible methodologies that align with social justice beliefs and resist methodic stasis and inertia; as decisions to explore the lifeworlds we experience, as autists, comes with no modus operandi. [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]

Understanding the needs and stressors of caregivers of individuals with autism spectrum disorder (ASD) informs targeted support strategies. However, most caregiver needs measures lack the breadth of experiences relevant to these families. This study examined the underlying factor structure of the Challenges and Needs Survey (CANS), a caregiving needs measure designed for family caregivers of individuals with ASD. The sample consisted of 286 family caregivers. Participants completed the CANS either online or in the paper form. Exploratory factor analysis was used to examine the underlying structure of the measure. T-tests and correlations were used to compare results by age and gender of the participants. Exploratory factor analysis resulted in 39 items of four factors: autism-related challenges (child), functional challenges, psychological challenges (parent), and aggressive behaviors (child). Parents with both high stress and high needs reported the lowest levels of mental health functioning. [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]

Background and aims: Although young children's gaze behaviors in experimental task contexts have been shown to be potential biobehavioral markers relevant to autism spectrum disorder (ASD), we know little about their everyday gaze behaviors. The present study aims (1) to document early gaze behaviors that occur within a live, social interactive context among children with and without ASD and their parents, and (2) to examine how children's and parents' gaze behaviors are related for ASD and typically developing (TD) groups. A head-mounted eye-tracking system was used to record the frequency and duration of a set of gaze behaviors (such as sustained attention [SA] and joint attention [JA]) that are relevant to early cognitive and language development. Methods: Twenty-six parent–child dyads (ASD group = 13, TD group = 13) participated. Children were between the ages of 3 and 8 years old. We placed head-mounted eye trackers on parents and children to record their parent- and child-centered views, and we also recorded their interactive parent–child object play scene from both a wall- and ceiling-mounted camera. We then annotated the frequency and duration of gaze behaviors (saccades, fixation, SA, and JA) for different regions of interest (object, face, and hands), and attention shifting. Independent group t-tests and ANOVAs were used to observe group comparisons, and linear regression was used to test the predictiveness of parent gaze behaviors for JA. Results: The present study found no differences in visual experiences between children with and without ASD. Interestingly, however, significant group differences were found for parent gaze behaviors. Compared to parents of ASD children, parents of TD children focused on objects and shifted their attention between objects and their children's faces more. In contrast, parents of ASD children were more likely to shift their attention between their own hands and their children. JA experiences were also predicted differently, depending on the group: among parents of TD children, attention to objects predicted JA, but among parents of ASD children, attention to their children predicted JA. Conclusion: Although no differences were found between gaze behaviors of autistic and TD children in this study, there were significant group differences in parents' looking behaviors. This suggests potentially differential pathways for the scaffolding effect of parental gaze for ASD children compared with TD children. Implications: The present study revealed the impact of everyday life, social interactive context on early visual experiences, and point to potentially different pathways by which parental looking behaviors guide the looking behaviors of children with and without ASD. Identifying parental social input relevant to early attention development (e.g., JA) among autistic children has implications for mechanisms that could support socially mediated attention behaviors that have been documented to facilitate early cognitive and language development and implications for the development of parent-mediated interventions for young children with or at risk for ASD. Note: This paper uses a combination of person-first and identity-first language, an intentional decision aligning with comments put forth by Vivanti (Vivanti, 2020), recognizing the complexities of known and unknown preferences of those in the larger autism community. [ABSTRACT FROM AUTHOR]

Background & aims: Echolalia, the repetition of one's or others' utterances, is a behavior present in typical development, autism spectrum disorder, aphasias, Tourette's, and other clinical groups. Despite the broad range of conditions in which echolalia can occur, it is considered primarily through a disorder-specific lens, which limits a full understanding of the behavior. Method: Empirical and review papers on echolalia across disciplines and etiologies were considered for this narrative review. Literatures were condensed into three primary sections, including echolalia presentations, neural mechanisms, and treatment approaches. Main contribution: Echolalia, commonly observed in autism and other developmental conditions, is assessed, observed, and treated in a siloed fashion, which reduces our collective knowledge of this communication difference. Echolalia should be considered as a developmental, transdiagnostic, and communicative phenomenon. Echolalia is commonly considered as a communicative behavior, but little is known about its neural etiologies or efficacious treatments. Conclusions: This review is the first to synthesize echolalia from a transdiagnostic perspective, which allows for the direct comparisons across and within clinical groups to inform assessment, treatment, conceptualization, and research recommendations. Implications: Considering echolalia transdiagnostically highlights the lack of consensus on operationalization and measurement across and within disorders. Clinical and research future directions need to prioritize consistent definitions of echolalia, which can be used to derive accurate prevalence estimates. Echolalia should be considered as a communication strategy, used similarly across developmental and clinical groups, with recommended strategies of shaping to increase its effectiveness. [ABSTRACT FROM AUTHOR]

Influenced by theories of intersectionality, performativity and gender hegemony, this review sought to explore the intersection of autism and gender in qualitative research into autistic identity. Twelve papers were subjected to a thematic metasynthesis following a systematic search. Study participants were predominantly cisgender female or gender-diverse: perspectives of cisgender autistic males were lacking. The three superordinate themes developed related to: (1) the ways in which autism discourses restricted gender identities, through the influence of the "extreme male brain" and "masking" narratives and the use of autism to explain gender non-conformity and gender diversity; (2) the ways in which gendered autistic identities were positioned within social power hierarchies as "othered", subordinate and less acceptable ways of being; and (3) possibilities for finding spaces of belonging and resistance. While autism as an identity may offer community and freedom from normative expectations, dominant autism discourses act to restrict and police gender, reinforcing existing power hierarchies. We encourage practitioners to reflect on the clinical, ethical and political implications of their positioning in relation to the constructs of "autism" and "gender", and to explore alongside people seeking support the personal and political impacts of gendered autism discourses. [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]

The quantity and quality of research focused on autism spectrum disorder (ASD) have grown over the past several decades. Ensuring that research findings are accessible and understood by education professionals is essential for improving outcomes for individuals with ASD. In this study, we evaluated education professionals' knowledge about ASD, specifically (a) beliefs about causes of ASD, (b) their familiarity with evidence-based practices (EBPs) and non-EBPs, (c) the likelihood of using or recommending EBPs compared with non-EBPs, and (d) the extent to which source credibility influenced the likelihood of using or recommending different types of practices. Education professionals (N = 62) completed a paper survey. Responses on a modified version of the Illness Perception Questionnaire–Revised (Moss-Morris et al., 2002) were used to evaluate participants' beliefs regarding causal attributes of ASD. Educators were also asked to read texts describing four EBPs and four non-EBPs. The text presentation was based on a 2 × 2 within-subjects factorial design with practice status (EBP or non-EBP) and source credibility (credible or not credible) as the independent variables. After reading each text, participants reported on whether they were (a) familiar with the practice and (b) the extent to which they would use or recommend the practice. Results indicate that school personnel were highly confident that neurobiological factors were a causal attribute of ASD. In addition, respondents were more familiar with, and more likely to recommend or use, EBPs as compared with non-EBPs. Source credibility did not significantly affect participants' likelihood of using or recommending practices. [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]

Autism is called "spectrum" disorder because there is a wide variation in the type and the severity of symptoms that people experience. India has a vast population, diverse cultures, and multiple languages, making it crucial to under- stand the unique challenges faced by individuals with autism spectrum disorder in the Indian context. This narrative review explores the current state of knowledge about autism spectrum disorder in the Indian context. Databases such as PubMed, Google Scholar, Sage journals, and other sources were searched with relevant terms for preparing this review. All published literature till January 2023 was studied and those which met the inclusion criteria were included. The resources included were original research articles, review articles, web pages, and book chapters addressing the purpose of the paper. Forty-eight such studies which met the inclusion criteria were included in the study. Results showed that the prevalence of autism varied across different studies in India. The study found advanced paternal age, fetal distress, gestational respiratory infections, labor complications, preterm birth, neonatal jaundice, delayed birth cry, birth asphyxia, late initiation of breastfeeding, neonatal seizures, use of maternal hormonal intervention, and consanguinity as some of the identified risk factors of autism spectrum disorder. Parents and families of children with autism have to go through a complex negative experience, both in the family and the community. This negative experience is further compounded by the lack of awareness and access to appropriate professional help and resources. It can be concluded that there is an urgent need for services that help parents cope with the stress of parenting a child with autism. [ABSTRACT FROM AUTHOR]

Background and aims: Autism has long been characterized by a range of spoken language features, including, for instance: the tendency to repeat words and phrases, the use of invented words, and "pedantic" language. These observations have been the source of considerable disagreement in both the theoretical and applied realms. Despite persistent professional interest in these language features, there has been little consensus around terminology, definitions and developmental/clinical interpretation. Main contribution: This review paper updates and expands an existing framework for unconventional language in autism to include a broader range of non-generative (echolalia and self-repetition) and generative (idiosyncratic phrases, neologisms and pedantic language) features often observed in the language of individuals on the autism spectrum. For each aspect of the framework, we review the various definitions and measurement approaches, and we provide a summary of individual and contextual correlates. We also propose some transitional language features that may bridge non-generative and generative domains (e.g., mitigated echolalia and gestalt language). Conclusions: This updated framework offers a unified taxonomy and nomenclature that can facilitate further investigation and interpretation of unconventional language in autism. Implications: There are important implications of this work for our understanding of the complex interplay between autism and language development. Equally important are the clinical ramifications that will guide evidence-based practice in assessment and intervention for individuals on the autism spectrum. [ABSTRACT FROM AUTHOR]

Using electronic tablets to present flash cards for teaching skills is becoming common among practitioners. However, no published study compared the effectiveness of the electronic tablet-based flash cards to paper flash cards for teaching receptive labeling skills. The purpose of this study was to compare the efficacy of the iPad-based and paper flash cards for teaching receptive labeling to learners with autism. An adapted alternating treatments design was used. Participants included one preschool student with autism and one elementary school student with autism. Findings indicated that iPad-assisted instruction resulted in a slightly faster acquisition and slightly lower levels of prompts for both participants. No differences were found in the generalization and maintenance of the skills between the two instructional mediums. Mixed results were found for challenging behaviors associated with each intervention. Implications and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

This paper systematically identifies, maps and evaluates specific types of provision for autistic students published on university websites at 120 institutions throughout the UK. Within these data we identify trends in relation to geographical region, university group, and the Teaching Excellence Framework rating. We employ Nancy Fraser's theory of social justice to unpack the reasons that underlie the differentials in provision across UK higher education institutions. Findings identify eight categories of provision tailored specifically for autistic students from 'supporting transition to university' to 'social groups' and suggest that there are institutions across the UK with evidence of more developed provision. Our data show, however, that resources and provision are not distributed equitably, raising implications for autistic students' parity of participation in higher education. [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]

Background and Aims: Echolalia, the repetition of speech, is highly prevalent in school aged children with Autism. Prior research has found that individuals with echolalia use their repetitions to engage in communicatively functional speech, in the absence of self-generated speech. Educators are the natural audience for a wide vary of echoed utterances across environments and in differing contexts. The objectives of this paper were three-fold: (1) to systematically investigate how researchers identify and ascribe communicative function to echoed utterances; (2) to gather and evaluate the evidence that might assist teachers to identify and better understand echoed utterances as being communicatively purposeful; and (3) to provide teachers with evidence-informed response strategies they can use to assist their students on their journey towards more self-generated speech. Main Contribution: Prior research in the field of echolalia has generally been segmented into opposing viewpoints. A paucity of work in the echolalia field has meant that there is limited work that has sought to view how a communicative function to echolalia has been ascribed from across multiple disciplines and fields. As such, there is limited literature to guide the practice of classroom educators. This review combines communicative models from across various disciplines with the view to supporting classroom educators by providing guidance on how they might assist their students with echolalia. This review represents the first contribution to the research literature in this area. Conclusions and Implications: Research into echolalia did not originally emanate from the field of education; however, anecdotes from classroom educators were cited as the primary impetus for the creation of some of the communicatively functional models. We found that although there are many techniques that researchers have used to attribute a communicative function to echolalia, some of these can be easily employed by educators in their practice. By adopting these techniques, educators are placed in a position that may assist with the identification of communicative echolalia; subsequently they are better placed to acknowledge and respond to their students. [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]

This position paper explores the needs of rural families of children, adolescents, and adults with autism spectrum disorder (ASD) during the COVID-19 pandemic. Prior to COVID-19, literature portrays elevated stress in families of individuals with ASD and health and socioeconomic disparities for rural and underserved populations. These disparities were exacerbated due to COVID-19 and subsequent lockdowns and economic turmoil. Academic and adaptive skills training were particularly impacted due to school closures, with parents tasked with taking some responsibility for training these skills. Our goals for this article focus on special considerations for rural families regarding (a) neurobiological and developmental impacts of stressful experiences like COVID-19, (b) delineation of the impacts on individuals with ASD and other comorbid and related conditions, and (c) education and intervention needs during these times. Finally, we offer suggestions for future care during pandemic events, including recommendations for improving service delivery under such conditions. [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]

Background and aims: Autistic children can experience challenges in making and maintaining friendships, and middle childhood (ages 6–12) may be particularly challenging as social networks become more complex. However, a large proportion of research into these experiences is based on adult reports or focuses on the experiences of adolescents, meaning that the voices of younger children are absent. Due to the exclusion of younger children from research, we have a limited understanding of their first-hand experiences of their friendships and the support they receive, which has implications for friendship support and wellbeing. This study aimed to amplify the voices of younger autistic children to explore their first-hand experiences of friendships and highlight areas of social support which may be most beneficial to primary-aged autistic children. Methods: This study used novel creative methods to support interviews with 19 autistic primary school-aged children to explore their experiences of friendship. Parent-led interviews and scrapbooks supported the children in discussing the challenges and strengths of their friendships. Results: Children discussed the challenges and strengths of their friendships including the impact of social norms on the need to have friends and their support needs in this area of life. Children also discussed gaps in their current friendships and how they would like to see these filled. It was clear that not all children required or wanted neurotypical-style friendships, with many valuing companionship and gameplay over intimacy. Analysis highlighted the heterogeneity of autistic children's friendships, especially in relation to gender and age, calling for more tailored and individualized support. Conclusion and implications: Results from the current study show that autistic children can and do have successful friendships but that these friendships may differ from those of their non-autistic peers. The study further adds to the existing literature by showing that younger autistic children can be included in research by using differentiated, accessible and creative methods, and that they are able to voice their opinions on matters surrounding support. It also calls for a tailored approach to supporting autistic children in school and speaking with children to give them autonomy over the support they want to receive. [ABSTRACT FROM AUTHOR]

Students with autism spectrum disorder (ASD) often present with difficulties in writing performance. Despite the importance of writing to achieving positive academic, employment, and social outcomes, relatively little research has been conducted examining the effects of intervention on the writing performance of individuals with ASD. Previous reviews of research examining these interventions have not evaluated the quality and rigor of studies. The purpose of this systematic review was to evaluate the extant writing intervention research for individuals with ASD using two sets of quality indicators to offer recommendations for practices and areas for future research. [ABSTRACT FROM AUTHOR]

Coaching is an essential component of supporting teachers to implement evidence-based practices (EBPs) in classrooms. The Self-Determined Learning Model of Instruction (SDLMI), an EBP designed to promote student self-determination, uses a research-based coaching model with six guiding principles. This qualitative study analyzed the content of coaching conversations between coaches and general and special education high school teachers implementing the SDLMI with autistic students to explore alignment with the guiding principles of the SDLMI coaching model. Findings highlighted the usefulness of the coaching principles in building trust between coaches and teachers, supporting teachers to set meaningful goals and build skills and competencies related to SDLMI implementation, promoting innovation and fidelity, and facilitating reflective dialogue. Implications for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Background: It can be very challenging for practitioners to talk with autistic children, especially when the conversation calls for self-regulation. Self-regulation is inextricably linked to awareness of oneself and others in social contexts. Encouraging the need for autonomy could help increase self-awareness and awareness of others in social events, which in turn could strengthen self-regulation. However, little is known about how autonomy influences competence in reasoning about self and others when regarding social events in which autistic children participate. This study explores the reasoning of self-other awareness on a microlevel timescale using ipsative, dynamic approaches to autism. The central question in this study is: to what extent can autonomy-provided scaffolding (APS) elicit high levels of reasoning about self-others in social events (RSS) over time? Method: We used video-taped interaction data from three sessions between one autistic child and a practitioner, contextualized by a set of animated DSM-5-based items of social events on which the child was asked to reflect. Interaction variables were the child's level of RSS and the practitioner's level of APS. We coded the real-time interaction. Results: First, when exploring the dynamics of the microdata, we found contingency over time within sessions. Second, over the sessions, the practitioner showed a stable high level of APS, whereas the child's level of RSS increased. Third, a coupling effect between the level of APS and RSS was found within and over sessions. Salient is that the child and practitioner increasingly adapted to each other over the three sessions, and over time, high-level APS of the practitioner elicited higher levels of RSS of the child. Discussion: Because the child showed a significant improvement in RSS over time, our research question provides a promising perspective. Contrary to what one might expect in autism, APS supported the performance of the child in reasoning about self-others in social situations. These outcomes underline the importance of giving voice to autistic children. The results may encourage researchers to develop strategies and tools that can help give a voice to children, to gain more insight into the child's reasoning. This may further develop self-other awareness and self-regulation in the social events of autistic children. [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]