Search

Autism spectrum conditions were once seen as a predominantly male condition. This has caused a paucity of information on common events in the lives of women, such as menstruation and menopause. Some smaller studies indicate that autistic women might suffer from increased difficulties surrounding these events. This study aims to investigate whether autistic women experience more frequent premenstrual dysphoric disorder, and increased complaints surrounding menopause. In partly overlapping samples (premenstrual dysphoric disorder, n = 70, nASC = 28, ncomparisons = 42; menopause, n = 65, nASC = 30, ncomparisons = 35), we investigated premenstrual dysphoric disorder prevalence and menopausal complaints. In 70 individuals, we did not find an increased prevalence of premenstrual dysphoric disorder in autistic women (14.3%) compared with non-autistic women (9.5%). In 65 women aged 40 years and above, we found that autistic women did experience higher levels of menopausal complaints. In autistic women, higher menopausal complaints were associated with higher levels of depression and autistic traits. In non-autistic women, menopausal complaints were associated with increased inattention, hyperactivity/impulsivity (i.e. attention deficit hyperactivity disorder traits), and depression. With this work, we show the important role that major reproductive milestones can have in an autistic woman’s life. Lay abstract Autism spectrum conditions were once seen as a predominantly male condition, but this has caused research to have little focus on women. Therefore, little is known about menstruation and menopause in autism spectrum conditions. Some smaller studies indicate that autistic individuals might suffer from increased difficulties surrounding these events. This study aimed to investigate whether autistic women experience more frequent premenstrual dysphoric disorder, causing extreme physical, emotional, and functional impairment. In a partly overlapping sample, we also examined whether women with autism spectrum condition experience increased complaints surrounding menopause. We did not find an increased prevalence of premenstrual dysphoric disorder in autism spectrum conditions (14.3%) compared with non-autistic women (9.5%). Those with autism spectrum conditions did experience increased menopausal complaints. These menopausal complaints were associated with higher levels of depression and autistic traits. In non-autistic women, menopausal complaints were associated with increased inattention, hyperactivity/impulsivity (i.e. attention deficit hyperactivity disorder traits), and depression. With this work, we show the important role that major reproductive milestones can have in an autistic woman’s life.

Autism in adulthood is characterized by heterogeneity, complicating the provision of tailored support. In previous work, we aimed to capture this heterogeneity by identification of subgroups of autistic adults that differed in clinical outcomes: cognitive failures, psychological difficulties, and quality of life (QoL). The current pre-registered study involves a longitudinal extension to determine (a) stability and (b) predictive value of the previously identified two subgroups. Subgroups were identified using community detection based on 14 self-report measures related to demographic, psychological, and lifestyle characteristics in two separate samples (aged 31-86 years): Sample 1 (NAutism=80) measured five years after baseline and Sample 2 (NAutism=241, NComparison=211) measured two years after baseline. The stability over time was assessed based on (a) the number of subgroups, (b) subgroup profiles, and (c) subgroup membership. Predictive validity was assessed for cognitive failures, psychological difficulties, and QoL. Results indicated that autistic and non-autistic adults formed distinct subgroups. Within both autism samples, the two previously identified autism subgroups were replicated at follow-up. Subgroup profiles were similar for >50% of the variables at two-year follow-up, and 21% at five-year follow-up. Moreover, 79% remained in the same subgroup at two-year follow-up, and 64% after five years. Subgroup membership was predictive of external clinical outcomes up to five years. Thus, this study demonstrated the stability and predictive value of the autism subgroups. A further focus on their clinical utility might not just increase the aptness of support, but may also provide more insight into the aging process when being autistic.

Cognitive strategy use in autism seems to mimic patterns of strategy use at older age as both younger autistic, and older non-autistic individuals seem to make less use of semantic affordance when performing visual memory tasks. Hypothetically, initial difficulties in semantic strategy use in autism become beneficial at older age (i.e., “protective aging”), due to enhanced visual processing. The current study aimed to investigate 1) whether differences in strategy use at younger age translate to differences in strategy use at older age, and 2) possible protective age-related differences in autism. Participants (ntotal=147) in four groups (autistic younger/older, non-autistic younger/older) completed a recognition version of the Visual Patterns Test (VPT) assessing semantic strategy use during visual memory performance, the Just Noticeable Difference (JND) size task assessing visual processing, and Multifactorial Memory Questionnaire (MMQ) on subjective memory performance. Unexpectedly, on the VPT all groups - except the younger non-autistic group – benefited from high semantic affordance, although the older groups (autistic/non-autistic) performed less accurately and slower. On the JND size task, the autistic groups did not show enhanced visual processing. Subjectively, autistic adults rated their memory performance worse than non-autistic adults, despite higher reported rates of strategy use. These results might shift our perspectives on cognitive strategy use in older and autistic adults, showing that, in a recognition paradigm, (semantic) strategy use might be more similar between younger/older and autistic/non-autistic people than previously expected. Although no protective age-related effects were observed, these results substantiate previous research suggesting parallel cognitive aging in autism.

Background: Research on cognitive aging in autism yielded inconclusive results, which could be due to the heterogeneity among autistic adults. Possibly, some autistic adults are more vulnerable to accelerated cognitive aging than others. We previously identified two subgroups of autistic adults that differed on behavioral (psychological, demographic and lifestyle) characteristics, with one reporting more difficulties in daily life. This study aims to assess whether these subgroups are associated with different patterns of cognitive aging. Methods: Two autism subgroups (N1=65, N2=78) were compared on eleven separate cognitive outcomes, and on their entire cognitive profile. We assessed age-related effects between the subgroups on five cognitive outcomes, cross-sectionally and longitudinally. Next to these pre-registered analyses, the subgroups were compared to a non-autistic comparison group (N=254). Results: The subgroups did not differ significantly on the cognitive outcomes or entire cognitive profile. Moreover, no differences in age-related effects or decline were observed. Differences with the non-autistic comparison group were similar across subgroups. Conclusions: The current results provide evidence for fairly similar cognitive aging across two autism subgroups. Differences in behavioral characteristics between autism subgroups do not necessarily translate to differences in cognition, at least in those with (above) average intellectual abilities and adulthood diagnoses.

Background: Camouflaging behavior is often defined as using strategies to hide autistic characteristics. In this study, we investigated how to measure camouflaging behavior by performing a conceptual replication of the original study of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and testing whether the self-reported camouflaging behavior is measuring the same construct as the second most used manner to measure camouflaging behavior, the discrepancy method. Method: In total, 674 individuals (356 autistic) aged 30–92 years, filled out the Dutch translation of the CAT-Q (CAT-Q-NL) and the Autism Spectrum Quotient (AQ). In 90 autistic adults the Autism Diagnostic Observation Schedule (ADOS-2) was administered. We executed preregistered analyses (AsPredicted #37800) to investigate the factor structure, measurement invariance, internal consistency, convergent validity and group differences. Results: Our analyses showed that the original three-factor structure had an acceptable fit and internal consistency ranged from sufficient to good. However, there was no measurement invariance between autistic and non-autistic individuals and correlations between CAT-Q-NL-scores and the discrepancy between AQ and ADOS-2 varied between low to mediocre (r = 0.04 to.28). Conclusions: The CAT-Q-NL can be used to measure camouflaging between and within autistic adults, but not between autistic and non-autistic adults and its convergent validity is limited. Despite these caveats, the CAT-Q-NL can serve as a useful addition to the clinical assessment toolbox because gaining insight in the level of camouflaging of autistic adults may help provide better mental health care. However, more research is needed into how to optimally measure the camouflaging construct.

Purpose: Differences in (autism) characteristics are often reported between autistic and non-autistic adults, but also between autistic adults. We aim to determine whether mean differences correspond to differences in network structure of these characteristics in (a) autistic and non-autistic adults, and (b) two previously identified autism subgroups. Methods: 16 network variables related to demographic and psychological characteristics were included. First, Gaussian Graphical Models were used for network estimation in 261 autistic adults and 384 non-autistic comparisons aged 30-85 years. Second, we repeated this step within two previously identified autism subgroups (N1=124, N2=130). Third, sex differences were explored in the networks of the autism subgroups. Results: The networks of the autism and comparison groups differed on individual edges and visual inspection, although the Network Comparison Test showed no overall differences. The networks of autism subgroups were similar based on visual inspection and statistical comparisons. Sex did not impact the subgroup networks differently. Conclusion: Networks were more similar than different, but observed edge differences could be informative for targeted support. Focusing on mean differences is not sufficient to determine which factors (and associations) are important for autistic people. Thus, network analysis provides a valuable tool beyond assessing mean differences for autistic adults.

Research outcomes on prepotent response inhibition in neurodevelopmental conditions during adulthood seem inconsistent, especially in autism. To gain further insight in these inconsistencies, the current study investigates inhibitory performance, as well as task strategies such as adaptive behavior during inhibitory tasks in autistic adults. As Attention-Deficit/Hyperactivity Disorder (ADHD) is often co-occurring in autism and associated with differences in both inhibition and adaptation, the role of ADHD symptoms is explored. Additionally, prior research is extended to middle- and late-adulthood, and the role of cognitive aging is assessed. Hundred-and-five autistic adults and 139 non-autistic adults (age: 20-80 yrs.) were compared on a Go-NoGo task. No significant group differences in inhibitory difficulties (commission errors) or adaptation (post error slowing) were observed, and both did not relate significantly to ADHD symptoms. However, when controlling for reaction time autistic individuals made significantly more inhibitory errors than non-autistic individuals, yet the effect size was modest (Cohen’s d =.27). Exploratory analyses showed that adaption significantly related to inhibition in non-autistic individuals only, possibly hinting at altered adaptive behavior during inhibitory tasks in autistic adults. ADHD symptoms related to response variability in the autism group only. Furthermore, task strategy changed with older age in both groups, with slower and more cautious responses at older age. Taken together, although minor differences may exist, autistic and non-autistic people show largely similar patterns of inhibitory behavior throughout adulthood. Differences in task timing and strategy seem relevant for future longitudinal studies on cognitive aging across neurodevelopmental conditions.

Longitudinal studies on cognitive aging in autism are scarce, and largely underpowered, yet essential to obtain more conclusive results on cognitive changes in autism during adulthood. In the largest longitudinal study on cognition thus far, we aimed to get more insight into cognitive aging in autism. As pre-registered, we computed reliable change indices (RCIs) and multilevel models to estimate cognitive changes in 128 autistic, and 112 non-autistic adults (range: 24-85 yrs.) over two to three timepoints (average interval: 3.5 yrs.). Participants were tested on 15 outcome measures, covering verbal memory, visual (working) memory, prospective memory, theory of mind, fluency, response speed, inhibition, planning, and switching. RCIs showed no significant differences between groups (autism/no-autism) in changes over time. Using multilevel models, most tasks showed sensitivity to cross-sectional age-related effects, and/or longitudinal changes, with worse performance at older age, and later timepoints. However, effects were not significantly different between the autism and no-autism group. This lack of group differences was substantiated by additional Bayesian analyses. In sum, the current study provides evidence for parallel (similar) cognitive aging in autism. Specifically, autistic individuals diagnosed in adulthood, without intellectual disability, do not seem at risk for accelerated cognitive decline.

Cognitive performances of autistic people vary widely. Therefore, previous group-based comparisons on cognitive aging in autistic adults might have overlooked those autistic adults that are particularly vulnerable for cognitive decline. Multivariate normative comparisons (MNC) statistically assess individual cognitive differences on the entire cognitive profile. Cognitive deviancy as indicated by MNC accurately predicts future cognitive decline, and is therefore sensitive in detecting meaningful cognitive differences. The current study aimed to 1) assess the applicability of MNC to assess cognitive performance in autism individually, and 2) understand heterogeneous cognitive performance in autistic adults. As pre-registered, we performed MNC in a sample of 254 non-autistic adults, and two independent samples of respectively 118, and 86 autistic adults (20-85 years, mean: 50 years). Cognitive performance was measured on eleven outcomes in six domains (verbal/visual memory, working memory, verbal fluency, Theory of Mind, and psychomotor speed). Using MNC, about twice as many autistic individuals had a deviant cognitive profile (i.e., deviated statistically from the multivariate normspace) as compared to non-autistic individuals. Importantly, most autistic individuals (>80%) did not have a deviant cognitive profile. Having a deviant profile was significantly associated with higher levels of psychological distress in autistic adults specifically, showing the clinical relevance of this method. Therefore, MNC seem a useful tool to individually detect meaningful cognitive differences in autism. These results are consistent with previous cognitive studies suggesting that most autistic adults show fairly similar cognitive profiles to non-autistic adults, yet highlight the necessity for approaches reflecting the heterogeneity observed in autistic people.

Findings on age-related cognitive effects in autism in adulthood are inconsistent across studies. As these studies substantially differ in their methodology, replication studies are needed. In this replication study frequentist (i.e., null-hypothesis significance testing), and Bayesian statistics were used to investigate the hypothesis that in autistic adults compared to non-autistic adults mostly parallel, but also protective age-related cognitive effects can be observed. Participants were 88 autistic adults, and 88 non-autistic matched comparisons (age range: 30–89 years, mean age: 55 years). Cognitive measures were administered on the following six domains: verbal memory, visual memory, working memory, Theory of Mind (ToM), verbal fluency, and processing speed, and self-reported cognitive failures. Non-autistic adults outperformed autistic adults on ToM, verbal fluency, and verbal memory, but only the first two were confirmed with Bayesian replication analyses. Also, more cognitive failures were reported by autistic adults. No interactions between group and age were observed, suggesting a parallel age-related effect on all cognitive domains. In sum, previously observed difficulties in ToM and verbal fluency were replicated which seem to persist at older age. Previously reported parallel age-related cognitive patterns were replicated, yet no evidence for protective age-related patterns was found. Lay summary: We investigated whether our previous findings on cognitive aging in autism could be confirmed in a new study measuring the cognitive effects of age in autistic and non-autistic adults. As expected, tasks that younger autistic adults had difficulties with (theory of mind, fluency) were also difficult for older autistic adults, and the effect of age itself was similar in autistic and non-autistic adults. Unexpectedly, we observed no protective effects (less cognitive aging) in autism.

Purpose: Autism is heterogeneous, which complicates providing tailored support and future prospects. We aim to identify subgroups in autistic adults with average to high intelligence, to clarify if certain subgroups might need support. Methods: We included 14 questionnaire variables related to aging and/or autism (e.g., demographic, psychological, and lifestyle). Community detection analysis was used for subgroup identification in an original sample of 114 autistic adults with an adulthood diagnosis (Autism) and 58 non-autistic adults as comparison group (COMP), and a replication sample (NAutism = 261; NCOMP=287), both aged 30-89 years. Next, we identified subgroups and assessed external validity (for cognitive and psychological difficulties, and quality of life (QoL)) in the autism samples. To test specificity, we repeated the analysis after adding 123 adults with ADHD, aged 30-80 years. Results: As expected, the Autism and COMP groups formed distinct subgroups. Among autistic adults, we identified three subgroups of which two were replicated. One of these subgroups seemed most vulnerable on the cluster variables; this subgroup also reported the most cognitive and psychological difficulties, and lowest QoL. Adding the ADHD group did not alter results. Conclusion: Within autistic adults, one subgroup could especially benefit from support and specialized care, although this must be tested in future studies.

Autism spectrum conditions (ASC) were once seen as a predominantly male. This has caused a paucity of information on common events in the lives of women, such as menstruation and menopause. Some smaller studies indicate that autistic individuals might suffer from increased difficulties surrounding these events. This study aims to investigate, whether autistic individuals experience more frequent premenstrual dysphoric disorder (PMDD), and increased complaints surrounding menopause. In 70 individuals (ASC n=28, comparisons n= 42) we did not find an increased prevalence of PMDD in autistic individuals (14.3%) compared to non-autistic individuals (9.5%) . Autistic individuals 40 (n=75, ASC n=30, comparisons n= 35) did experience higher levels of menopausal complaints. In autistic individuals, higher menopausal complaints were associated with higher levels of depression and autistic traits. In non-autistic individuals, menopausal complaints were associated with increased inattention, hyperactivity/impulsivity (i.e., ADHD traits), and depression. With this work, we show the important role that major reproductive milestones can have in an autistic woman’s life.

IntroductionAutism spectrum conditions (ASC) develop early in life and are thought to last a lifetime. However, ASC research has two major knowledge gaps that hinder progression in understanding the concept of ASC and in providing proper support for autistic adults: (1) the majority of knowledge about ASC mainly stems from childhood studies so little is known about older autistic adults and (2) while it is broadly recognised that ASC is a heterogeneous condition, we do not yet understand the differences in trajectories leading to their future outcome. We aim to fill both knowledge gaps.Methods and analysisA multistage overlapping cohort design assessing (cognitive) ageing in ASC is designed to obtain an accelerated longitudinal data set. Data, including a multitude of questionnaires, diagnostics and cognitive tests, are collected over four waves within a 10-year time frame. This will provide information regarding actual changes in quality of life, co-occurring health conditions and cognition as well as the possibility to test external validity and temporal stability in newly formed behavioural subtypes. Participants consist of three groups of adults aged 20–90 years: (1) with a clinical diagnosis of ASC, (2) with a clinical diagnosis of attention deficit hyperactivity disorder (ADHD) but no ASC, (3) no ASC/ADHD (ie, comparison group). The sample size differs between waves and instruments. Detailed analysis plans will be preregistered in AsPredicted or at the Open Science Framework.Ethics and disseminationEthical approval for this study was obtained from the ethical review board of the Department of Psychology of the University of Amsterdam (wave 1 2011-PN-1952 and 2013-PN-2668, wave 2 2015-BC-4270, waves 3 and 4 2018-BC-9285). In line with the funding policies of the grant organisation funding this study, future papers will be published open access.