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Lay Abstract: Many previous studies reported that autistic children have fewer social connections. Yet, recent studies also show that autistic children more often feel lonely in school than allistic (i.e. non-autistic) children. This outcome seems to go against the traditional view that autistic children do not desire to have social connections. Therefore, this study aimed to find out how autistic and allistic children feel about their social connections. We included 47 autistic and 52 neurodiverse-allistic children from two special education primary schools (aged 8-13 years). We tested their social connections and loneliness in school, through a new approach. This new approach includes questionnaires, and sensors for tracking social contacts on playgrounds during school breaks. We found that allistic children felt more loneliness when they spent little time in social contacts during school breaks. Yet, autistic children felt more loneliness when their peers did not like to play with them. For these autistic children, feelings of loneliness may go beyond face-to-face contacts. Being liked as part of a peer group was key. Understanding differences in children's needs can lead to a more effective design for a welcoming school climate., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Autism is associated with challenges in emotion recognition. Yet, little is known about how emotion recognition develops over time in autistic children. This four-wave longitudinal study followed the development of three emotion-recognition abilities regarding four basic emotions in children with and without autism aged 2.5 to 6 years over three years. Behavioral tasks were used to examine whether children could differentiate facial expressions (emotion differentiation), identify facial expressions with verbal labels (emotion identification), and attribute emotions to emotion-provoking situations (emotion attribution). We confirmed previous findings that autistic children experienced more difficulties in emotion recognition than non-autistic children and the group differences were present already from the preschool age. However, the group differences were observed only when children processed emotional information from facial expressions. When emotional information could be deduced from situational cues, most group differences disappeared. Furthermore, this study provided novel longitudinal evidence that emotion recognition improved with age in autistic children: compared to non-autistic children, autistic children showed similar learning curves in emotion discrimination and emotion attribution, and they showed greater improvements in emotion identification. We suggest that inclusion and respect in an environment free of stereotyping are likely to foster the development of emotion recognition among autistic children.

Background: Autism is often missed in girls. Their problems may appear more subtle, but their suffering is not less., Aim: To describe the diagnostic picture of autistic girls., Method: Using retrospective file research, the autism behavioral descriptions of 17 girls aged three to ten were reported., Results: There were deficits on the same autism core domains. Girls often had a strong adaptability, and as a result their limitations were expressed differently in different settings., Conclusion: For clinicians, it is important to look beyond the technical level of social skills, by more in-depth questioning and by paying attention to the quality of these skills. Clinical expertise in this area is important.

Lay Abstract: Autistic young people are often misunderstood by non-autistic young people, and this can lead to difficulties in their friendships. We know that friendship is very important for our mental health. For non-autistic young people, having good friendships is linked to better mental health and having problems in friendship can cause mental health problems. This study aimed to compare the positive and negative features of friendship that autistic non-autistic young people experience. The study also aimed to understand if having positive or negative friendship features is related to signs of mental health problems (anxiety and depression). 306 young people aged 9-16 took part in this study. These were 86 autistic boys, 18 autistic girls, 91 non-autistic boys and 111 non-autistic girls. The findings of this study showed that autistic young people have less positive friendship features than non-autistic young people. For all young people in the study, having more positive friendship features was related to fewer signs of depression, while having more negative friendship features was related to more signs of depression. Just for autistic girls, having more positive friendship features was related to more signs of anxiety. These findings show that support is needed to help autistic young people have more positive friendships. For example, by teaching non-autistic young people how to be supportive friends to their autistic peers.

Feeding problems are prevalent in children with ASD. We investigated whether the Montreal Children's Hospital Feeding Scale (MCH-FS, Ramsay et al. in Pediatrics and Child Health 16:147-151, 2011) can be used for young children with ASD. Participants (1-6 years) were selected from a clinical ASD sample (n = 80) and a general population sample (n = 1389). Internal consistency was good in both samples. In general, parents of children with ASD reported more feeding problems than those from the population sample. The response patterns on the individual items was highly similar. There was a slight increase in symptoms with age in the population sample, but not in the ASD sample. These results suggest that the MCH-FS can be used in populations that include children with ASD., (© 2021. The Author(s).)

Questionnaires are widely used in autism assessment. However, their psychometric properties are generally not evaluated in clinical practice, and the comparability and applicability of such research is limited because questionnaires are often not simultaneously evaluated. This certainly pertains to predictive values which are highly population and setting specific. This study evaluated the power of AQ and SRS-A in predicting an ASD diagnosis within the same clinical population. The patient records of 92 adults, referred for autism assessment, were analyzed. The AQ proved somewhat better than the SRS-A at discriminating and predicting autism. The predictive values of both questionnaires were lower than reported in general population studies. Psychometric results in core publications appear less representative for clinical practice.

Background: Bullying and poor theory of mind (ToM) are both considered to negatively impact academic performance. However, it is unclear if they have separate effects., Aim: The aim of the current study was to examine the potentially separate associations of bullying and ToM with academic performance., Sample: A general population sample of 1,170 children aged 11-12 years., Methods: Information on bullying, type of involvement (none, victim (only), bully (only), victim-bully (both)), ToM, and estimated intelligence was obtained at face-to-face assessments. Information on academic performance was obtained from Danish school registers., Results: ToM was positively associated with academic performance, and involvement in bullying was negatively associated with academic performance. Academic performance differed between types of involvement in bullying. Pairwise post hoc analyses showed that in the full sample, the only significant difference was between those not involved and those involved as victim (only). This was also the case for girls. Adjusting for potential shared variance with gender, estimated intelligence and ToM being victim (only) and victim-bully (both) were negatively associated with academic performance compared to no involvement. Thus, being a victim (or victim-bully) contributes negatively to academic performance beyond the effects of ToM and intelligence, and regardless of gender. Similarly, ToM remained positively associated with academic performance after adjusting for shared variance., Conclusion: ToM and involvement in bullying were both separately associated with later academic performance. These results remained even after adjusting for shared variance, and for shared variance with gender and estimated IQ., (© 2018 The British Psychological Society.)

To investigate whether theory of mind (ToM), an important requirement for adaptive social functioning, is different between children with pharmacologically refractory epilepsy who undergo epilepsy surgery and healthy control children, whether ToM is affected by epilepsy surgery in these children, and whether ToM is associated with demographic or epilepsy variables. The "ToM storybooks", a psychometrically sound ToM instrument designed for children, was administered shortly before and 0.5, one and two years after surgery as part of a neuropsychological assessment. Fifteen patients (mean age: 7.1 years) completed the ToM storybooks before and at least twice after surgery. Two sex- and age-matched healthy control children were included per patient. Linear mixed models were used to analyse differences between patients and controls. The association between ToM and demographic, epilepsy and surgical variables was explored. Patients had lower ToM scores than healthy control children, even when corrected for verbal intelligence quotient (VIQ). Epilepsy surgery had neither a harmful nor a favourable effect on ToM. Later epilepsy onset and temporal origin of epilepsy were associated with higher (better) ToM scores relative to earlier epilepsy onset and extra-temporal epilepsy (including hemispherotomy in one case). Children in whom the amygdala was resected had worse ToM scores. Children with refractory epilepsy have a ToM deficit that may not be accounted for by lower VIQ. Epilepsy surgery does not affect ToM functioning. Younger age at epilepsy onset is associated with poorer ToM, and temporal epilepsy with better ToM. Finally, the amygdala is implicated in ToM deficit. Patients and their parents should be educated about the possible consequences of epilepsy with regards to the development of social cognition and should be guided in order to help improve ToM.