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Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.

The Frith-Happé Animations Test, depicting interactions between triangles, is widely used to measure theory of mind (ToM) ability in autism spectrum disorder (ASD). This test began with recording, transcribing, and subjectively scoring participants' verbal descriptions, which consistently found ToM-specific difficulties in ASD. More recently in 2011, White et al. created a more objective version of this ToM test using multiple-choice questions. However, there has been surprisingly little uptake of this test, hence it is currently unclear if White et al.'s findings replicate. Further, the lack of an online version of the test may be hampering its use in large-scale studies and outside of research settings. Addressing these issues, we report the development of a web-based version of the Frith-Happé Animations Test for autistic and neurotypical adults. An online version of the test was developed in a large general population sample (study 1; N = 285) and online data were compared with those collected in a lab-based setting (study 2; N = 339). The new online test was then administered to adults with a clinical diagnosis of ASD and matched neurotypical controls (study 3; N = 231). Results demonstrated that the test could successfully be administered online to autistic adults, who showed ToM difficulties compared to neurotypical adults, replicating White et al.'s findings. Overall, we have developed a quicker, more objective, and web-based version of the Frith-Happé Animations Test that will be useful for social cognition research within and beyond the field of autism, with potential utility for clinical settings. LAY SUMMARY: Many autistic people find it hard to understand what other people are thinking. There are many tests for this 'mentalising' ability, but they often take a long time to complete and cannot be used outside of research settings. In 2011, scientists used short silent animations of moving shapes to create a fast way to measure mentalising ability. We developed this into an online test to use in research and clinics to measure mentalising ability in autism.

White and Remington (2019) found that autistic people may have increased anthropomorphic tendencies to ascribe human-like attributes to non-human agents. However, it was unclear from their study whether this relationship holds after accounting for socio-demographic variables known to be associated with anthropomorphism. The psychometric properties of the anthropomorphism questionnaire they used has also not been investigated, raising concerns about whether it measures the same construct in people with differing levels of autistic traits. Addressing these issues, we re-examined the relationship between autism and anthropomorphism in a large sample of adults ( N = 492). Conceptually replicating White and Remington, we found that autistic traits were significantly associated with greater anthropomorphic tendencies, even after accounting for age and sex (Study 1). Equally, psychometric concerns with the anthropomorphism questionnaire were revealed, leading us to refine this measure and re-analyse the data. A less clear-cut but significant association between autistic traits and anthropomorphism was found (Study 2). Our refined anthropomorphism measure also had improved psychometric properties, particularly showing that it is suitable for future autism research. Our findings are discussed in relation to individual differences in social-cognitive processing and we outline future directions for investigating mechanisms linking anthropomorphism and social cognition in autism. Lay abstract Anthropomorphism is the tendency to attribute human-like qualities (e.g. thoughts and feelings) to non-human entities (e.g. objects and weather systems). Research by White and Remington (2019) suggested that anthropomorphism is more common in autistic compared to neurotypical adults, which is interesting given that autistic individuals sometimes misunderstand the thoughts and feelings of other people. In this article, we re-examined the link between autism and anthropomorphism in a large sample of adults with varying degrees of autistic traits, with several important methodological advances on previous research. Across two studies, we found that individuals with more autistic traits reported greater anthropomorphic tendencies. As part of these analyses, we had to develop a new, refined measure of anthropomorphism, which showed better reliability and validity than the original measure. This measure will be useful in future autism-related research. Overall, advancing White and Remington’s study, these findings help us to better understand individual differences in socially relevant processes, including those that may be enhanced in autism (e.g. anthropomorphism).

Mentalising, also known as "Theory of Mind", is the ability to understand and infer the cognitions of others, such as their perceptions, intentions, and beliefs. Although several tools have been designed to measure mentalising in adults, there exist methodological and practical limitations. Many of the existing measures conflate mentalising with similar constructs (e.g., empathy), and most are lengthy measures that are unsuitable for large population-based studies and clinical practice. These issues are currently hampering clinical and non-clinical investigations into mentalising and related social-cognitive abilities. Drawing on questionnaire measures of social cognition, we conceived a self-report mentalising scale, the Four-Item Mentalising Index (FIMI; Studies 1a and b). The FIMI was developed through a series of studies examining its factor structure and reliability (Studies 2a and b) and by testing its construct validity against a cognitive mentalising task, autistic traits, and comparing scores in autistic and non-autistic people (Studies 3a and b). Together, we demonstrate that the FIMI is a conceptually and methodologically robust tool for measuring mentalising ability in the general population, including autistic and non-autistic people. Future research directions and practical (clinical) applications of the scale are discussed, with a focus on improving understanding and management of (a)typical mentalising ability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective:Autism spectrum disorder (ASD) is currently considered an early-onset neurodevelopmental condition. Follow-up studies of clinic-ascertained autism suggest that autistic symptoms typically decline with age, although symptom improvement is limited for some. To date there have been no population-based prospective studies investigating the natural history of autistic symptoms from childhood to adulthood. The aim of this study was to characterize the development and heterogeneity of autistic symptoms in a population-based cohort from childhood to age 25.Methods:Data were analyzed in a prospective U.K. population-based cohort (ALSPAC). Trajectories were derived using five assessments of the parent-rated Social and Communication Disorders Checklist (SCDC) spanning ages 7–25. Additional measures were used to validate symptom trajectories.Results:Three distinct SCDC symptom trajectory classes were identified: low (88.5%), declining (5.0%), and late-emerging (6.5%). Both the declining and late-emerging trajectory classes were associated with child and adult ASD measures, low IQ, communication problems, peer problems, and worse adult functioning compared with the low trajectory class. Male sex was associated with a higher likelihood of being in the declining trajectory class (odds ratio=2.84, 95% CI=2.19, 3.69). This sex difference was not observed in the late-emerging class (odds ratio=1.00, 95% CI=0.80, 1.24) compared with the low trajectory class.Conclusions:ASD symptom levels that emerged early tended to decline across development, although impairment was still present in adulthood for some. For others, autistic symptoms emerged across adolescence and adulthood. This challenges our current understanding that ASD symptoms inevitably first manifest early in development.

Funder: Medical Research Council; FundRef: https://doi.org/10.13039/501100000265, Funder: Whorrod Doctoral Scholarship, The autonomic nervous system (ANS) is responsible for the functioning of the heart, bladder, pupils and several other bodily functions. Therefore, when the ANS functions abnormally, individuals can experience a number of physical symptoms, including dizziness, abnormal sweating and digestive difficulties. Currently, it is unclear if autistic adults experience ANS dysfunction. Therefore, in this study, we investigated whether autistic adults report more ANS-related physical symptoms, indicating greater ANS dysfunction, and whether this may be related to autism, or rather anxiety, depression, or stress. The findings suggest that ANS dysfunction, where found in autism, is due to co-occurring stress and anxiety. We therefore propose that treating stress and anxiety may be an effective way to ameliorate ANS-related health problems in autistic adults.

‘Theory of Mind’ (ToM) is the ability to attribute mental states to others to make sense of their behaviour. ToM research has informed understanding of (a)typical social behaviour, including the symptoms of Autism Spectrum Disorder (ASD). This began with research on ToM in autistic children and there has been a noticeable increase in the study of ToM in autistic adults. However, methodological limitations in adult ToM research may be limiting its explanatory power of ASD symptoms and their management, therefore we discuss recent advances in measuring ToM aimed at addressing these issues. We also examine previously overlooked approaches and propose several new directions that have potential to improve the sensitivity, accuracy, and clinical utility of ToM measurement in autistic adulthood.

It has been proposed that atypical empathy in autism spectrum disorder (ASD) is due to co-occurring alexithymia. However, difficulties measuring empathy and statistical issues in previous research raise questions about the role of alexithymia in empathic processing in ASD. Addressing these issues, we compared the associations of trait alexithymia and autism with empathy in large samples from the general population. Multiple regression analyses showed that both trait autism and alexithymia were uniquely associated with atypical empathy, but dominance analysis found that trait autism, compared to alexithymia, was a more important predictor of atypical cognitive, affective, and overall empathy. Together, these findings indicate that atypical empathy in ASD is not simply due to co-occurring alexithymia. Electronic supplementary material The online version of this article (10.1007/s10803-019-04080-3) contains supplementary material, which is available to authorized users.

BackgroundLittle is known about the compensatory profile in autism; that is, people with autism spectrum disorder who show few symptoms in their behavioural presentation, despite continuing to report autism-related cognitive difficulties or differences. Even less is known about the specific compensatory strategies that these individuals use to disguise autism at the behavioural surface, both in the clinic and everyday life. It is also currently unclear whether individuals without a formal autism diagnosis, but experiencing autistic-like difficulties, use similar compensatory strategies, potentially enabling them to sit below the diagnostic threshold. This study aimed to investigate social compensatory strategies, and their effect on diagnosis and clinical outcome, in adults with and without autism.MethodsIn this study, individuals aged 18 years or older who responded to a study advert that was distributed worldwide via social media and the UK National Autistic Society formed a convenience sample. Participants self-reported their use and experiences of compensatory strategies using an online platform. Novel analyses, including a qualitative thematic approach, were used to interpret their responses and gain insight into compensatory strategies in autism.FindingsBetween Oct 19, 2017, and Jan 2, 2018, 136 adults (58 had a clinical diagnosis of autism, 19 self-identified but were not formally diagnosed as autistic, and 59 were not diagnosed or self-identified, but nevertheless reported social difficulties) completed the online study questions. The findings suggested that there are multiple compensatory strategies with distinct characteristics, individual and environmental factors that modulate compensatory strategy use and success, positive (social relationships, independence, employment) and negative (poor mental health, late diagnosis) outcomes associated with compensatory strategy use, and that individuals without a diagnosis use compensatory strategies that are qualitatively similar to individuals with a diagnosis.InterpretationIncreased awareness and measurement of compensatory strategy use in autism should guide future diagnostic guidelines, towards improved diagnostic accuracy and support for people with autism spectrum disorder whose cognitive difficulties are not immediately evident in observable behaviour.FundingUK Medical Research Council and UK National Institute for Health Research.

Background It is proposed that some individuals with Autism Spectrum Disorder (ASD) can ‘compensate’ for their underlying difficulties (e.g. in theory of mind; ToM), thus demonstrating relatively few behavioural symptoms, despite continued core cognitive deficits. The mechanisms underpinning compensation are largely unexplored, as is its potential impact on mental health. This study aimed to estimate compensation patterns in ASD, by contrasting overt social behaviour with ToM task performance, in order to compare the characteristics of ‘Low’ and ‘High’ Compensators. Methods A total of 136 autistic adolescents, from the ongoing Social Relationships Study, completed a range of cognitive tasks, the Autistic Diagnostic Observation Schedule (ADOS) and a self‐report anxiety questionnaire. Participants were assigned compensation group status; High Compensators demonstrated good ADOS scores despite poor ToM performance, while Low Compensators demonstrated similarly poor ToM, accompanied by poor ADOS scores. Results High Compensators demonstrated better IQ and executive function (EF), but greater self‐reported anxiety, compared with Low Compensators. Such differences were not found when comparing individuals who had good versus poor ADOS scores, when ToM performance was good. Other core autistic characteristics (weak central coherence, nonsocial symptoms) did not differentiate the High and Low Compensators. Conclusions IQ, EF and anxiety appear to be implicated in the processes by which certain autistic young people can compensate for their underlying ToM difficulties. This tendency to compensate does not appear to reflect the severity of ‘hit’ for ASD per se, suggesting that well‐compensated individuals are not experiencing a milder form of ASD. The construct of compensation in ASD has implications for research and clinical practice., Read the Commentary on this article at doi: 10.1111/jcpp.12989

Highlights • Compensation may underpin improvements in symptoms in neurodevelopmental disorders. • The construct of compensation is poorly understood and has no agreed definition. • We derive a working definition and review evidence for compensation (e.g., in ASD). • We propose a preliminary transdiagnostic framework of compensation. • We discuss potential neurocognitive mechanisms and research/clinical implications., Within research into neurodevelopmental disorders, little is known about the mechanisms underpinning changes in symptom severity across development. When the behavioural presentation of a condition improves/symptoms lessen, this may be because core underlying atypicalities in cognition/neural function have ameliorated. An alternative possibility is ‘compensation’; that the behavioural presentation appears improved, despite persisting deficits at cognitive and/or neurobiological levels. There is, however, currently no agreed technical definition of compensation or its behavioural, cognitive and neural characteristics. Furthermore, its workings in neurodevelopmental disorders have not been studied directly. Here, we review current evidence for compensation in neurodevelopmental disorders, using Autism Spectrum Disorder as an example, in order to move towards a better conceptualisation of the construct. We propose a transdiagnostic framework, where compensation represents the processes responsible for an observed mismatch between behaviour and underlying cognition in a neurodevelopmental disorder, at any point in development. Further, we explore potential cognitive and neural mechanisms driving compensation and discuss the broader relevance of the concept within research and clinical settings.