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Depression is common among autistic youth and is associated with worse quality of life in this group. Despite significant need for high-quality efficacious treatments, there has been very limited research on interventions for depression in autistic youth. This single-arm pilot study examined the feasibility and preliminary efficacy of a novel, behavior-based approach for treatment of depression symptoms in autistic adolescents without intellectual disability (i.e. Behavioral Activation for Autistic Adolescents, BA-A). BA-A is an individually delivered manualized 12-session treatment that utilizes established BA strategies and incorporates common mental health treatment adaptations for autistic young people. Of the 18 youth (11-16 years old) who enrolled, 15 completed all 12 treatment sessions, as well as pre-treatment, post-treatment, and follow-up assessment visits. Clinician treatment fidelity was quite high. Paired sample t-tests found that depression symptoms decreased pre- to post-BA-A according to multiple informants (i.e. self, caregiver, and independent evaluator), and treatment gains were maintained at 1-month follow-up. Paired sample t-tests also found that caregiver-reported anxiety symptoms and social skills improved pre-treatment to post-treatment. The results, although preliminary, indicate that BA-A may improve depression symptoms in autistic youth without intellectual disability. Furthermore, these promising findings suggest that a randomized controlled trial of BA-A is warranted.

Purpose: Internalizing conditions, such as anxiety and depression, and difficulties with developing and maintaining friendships are common among autistic children and adolescents. Participation in extracurricular activities may buffer against these challenges as they provide naturalistic opportunities to bring peers with shared interests and skills together. As such, the purpose of the current study was to examine associations between sport and club participation and (1) friendship success and (2) co-occurring anxiety and depression in a large sample of autistic youth. Methods: Secondary analysis was performed using data from the 2018-2019 National Survey of Children's Health. Participants were 562 autistic children (ages 6-11 years) and 818 autistic adolescents (ages 12-17 years). Within each age group, a series of binary logistic regression analyses were conducted. Results: Club participation was not associated with friendship or internalizing conditions. However, participation in sports was positively associated with friendship success among both children (OR = 2.07, p = 0.006) and adolescents (OR = 2.35, p = 0.001). Results also found that adolescents who participated in sports were 34% less likely to have diagnosis of depression (p = 0.048). Conclusion: Findings suggest that participation in sports may play a meaningful role in protecting against depression during adolescence and serve as a context for friendship development across childhood and adolescence. Future research should address barriers to extracurricular activity participation and identify the specific components of sports that are most beneficial to autistic youth to inform activity offerings and the development of interventions targeting friendship formation and mental health outcomes.

The capacity of the workforce lags behind the current demand for timely autism diagnostic assessment. Primary care providers (PCPs) are well-positioned to diagnose autism at earlier ages than providers from other disciplines. Thus, bolstering PCPs' diagnostic capabilities has been the focus of many recent capacity-building initiatives. Using data from the National Survey of Children's Health, this study aimed to evaluate whether diagnosis of autism in primary care has changed over time and whether diagnosis in primary care relates to age at autism diagnosis. Results indicated that the likelihood of being diagnosed with autism by a PCP decreased by about 2% with every passing year from 2004 to 2019 when controlling for demographic characteristics. PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychiatrists and psychologists), which supports the critical role PCPs can play in timely diagnosis. Further research is needed to understand why the proportion of children diagnosed by PCPs has decreased over time; however, these findings suggest that capacity-building initiatives have not yet reached community practice. Future research should focus on the dissemination and implementation of training initiatives in community-based primary care practices.

Autistic youth engage in higher levels of screen time and are more likely to experience mental health problems than their typically developing peers; however, few studies have investigated a potential relationship between daily screen time hours and mental health in autistic youth. This study examined the relations among daily screen time hours and commonly co-occurring psychopathology (i.e., anxiety, depression, conduct/behavioral problems, and attention-deficit/hyperactivity disorder [ADHD]) in autistic youth utilizing data from the 2018-2019 National Survey of Children's Health. Results indicated screen time was significantly related to conduct problems; however, contrary to findings from studies with neurotypical samples, screen time was not significantly related to anxiety, depression, or ADHD diagnoses in autistic children and adolescents.

The COVID-19 pandemic disrupted a range of health services for children across the United States. Autistic children have well-documented deficits in health-related services compared to nonautistic children. Parents of autistic children reported an increase in mental health and behavior problems with the onset of the pandemic, increasing the need for supportive services. The current study used data from the National Survey of Children's Health from 2019 and 2020 to conduct logistic regressions predicting the likelihood of having unmet service needs before and after the onset of the pandemic. Results suggested that autistic children were more likely to have unmet medical, dental, and mental health service needs across years compared to nonautistic children, but there were no interactions by year. All children experienced an increased likelihood of having unmet needs from pre- to post-pandemic. Results suggest that although the pandemic disrupted services across the board, autistic children lacked health services regardless of the pandemic, pointing to persisting disparities in service receipt. A discussion of ongoing barriers to services and issues related to virtual services is included. Future research should further investigate the feasibility of virtual services as well as ways of reducing barriers to all services for autistic children.

This study sought to compare frequency of paid work by autistic adolescents to paid work by adolescents with other neurodevelopmental disorders and typically developing adolescents, and to examine whether demographic and clinical characteristics were associated with autistic adolescent employment with data from 2016-2019 National Survey of Children's Health. Rate of paid work was significantly lower in the autistic group (22.01%) than typically developing (49.38%) and other neurodevelopmental disorders (44.27%) groups. Younger age, lower household income, co-occurring intellectual disability, and more severe autism were associated with lower odds of an autistic adolescent having worked. This study indicates that work disparities impacting autistic individuals begin in youth and highlights the need for improved vocational support to address employment barriers for autistic youth., (©AAIDD.)