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Emerging research suggests overrepresentation of gender diversity among autistic youth. Previous gender diversity research with autistic children has relied on parent-report based on a single question. The "Gender Diversity Screening Questionnaire--Self-Report and Parent-Report" assessed gender diversity experiences from 244 children (140 autism spectrum disorder and 104 typically developing), between 10 and 13 years, and their parents. Parent-report "Child Behavior Checklist" Item-110, "Wishes to be the opposite sex," was also collected. Autistic children endorsed higher Gender Diversity Screening Questionnaire--Self-Report Binary Gender Diversity, t(223.21) = -2.83, adjusted p = 0.02, d = -0.35, and Nonbinary Gender Diversity, t(191.15) = -3.79, adjusted p = 0.001, d = -0.46, than typically developing children. Similarly, for Gender Diversity Screening Questionnaire--Parent-Report, there was a significant gender-body incongruence difference between the groups, t(189.59) = -2.28, adjusted p = 0.05, d = -0.30. Within-group analyses revealed that parents of autistic females-assigned-at-birth reported significantly more gender-body incongruence than males-assigned-at-birth, t(32.91) = -3.78, p < 0.001, d = -1.11. Moreover, distinct within-group profiles of gender experiences and internalizing symptoms were revealed, showing associations between gender profiles and symptoms of anxiety, depression, and suicidality. Results extend reports showing increased rates of gender diversity in autistic children based on both self-report and parent-report, underscoring the need to better understand and support the unique and complex needs of autistic children who experience gender diversity.

Executive functions are related to key outcomes. Studies of autistic youth self-report of other nonsocial traits indicate that their insights into their own functioning and internal experiences provide important information that is not captured by their parents' report, but youth self-report of executive function has not been researched in autism. We investigate self- and parent-report on the Behavior Rating Inventory of Executive Function-2 in 197 autistic youth without intellectual disability, including the magnitude and profile of problems reported across subdomains of executive function. We also compare autistic self-report to that of 114 youth with attention deficit hyperactivity disorder and 197 neurotypical youth. We find that autistic youth report significant executive function challenges in comparison to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverge regarding the severity of the youth's executive function difficulties, but both emphasize flexibility problems within their profile of executive function challenges. Intraclass correlation coefficients between parent and youth ratings were moderate to poor in the autistic group, indicating that autistic youth report adds important information beyond that captured by their parents' report. These data elevate the importance of asking autistic youth directly about their own executive function.

Purpose: Pubertal suppression is standard of care for early pubertal transgender youth to prevent the development of undesired and distressing secondary sex characteristics incongruent with gender identity. Preliminary evidence suggests pubertal suppression improves mental health functioning. Given the widespread changes in brain and cognition that occur during puberty, a critical question is whether this treatment impacts neurodevelopment. Methods: A Delphi consensus procedure engaged 24 international experts in neurodevelopment, gender development, puberty/adolescence, neuroendocrinology, and statistics/psychometrics to identify priority research methodologies to address the empirical question: is pubertal suppression treatment associated with real-world neurocognitive sequelae? Recommended study approaches reaching 80% consensus were included in the consensus parameter. Results: The Delphi procedure identified 160 initial expert recommendations, 44 of which ultimately achieved consensus. Consensus study design elements include the following: a minimum of three measurement time points, pubertal staging at baseline, statistical modeling of sex in analyses, use of analytic approaches that account for heterogeneity, and use of multiple comparison groups to minimize the limitations of any one group. Consensus study comparison groups include untreated transgender youth matched on pubertal stage, cisgender (i.e., gender congruent) youth matched on pubertal stage, and an independent sample from a large-scale youth development database. The consensus domains for assessment includes: mental health, executive function/cognitive control, and social awareness/functioning. Conclusion: An international interdisciplinary team of experts achieved consensus around primary methods and domains for assessing neurodevelopmental effects (i.e., benefits and/or difficulties) of pubertal suppression treatment in transgender youth.

Introduction: Long-acting injectable buprenorphine (LAIB) is a new treatment for opioid use disorder. Drawing upon new materialism and the concept of social capital, this article provides a focused analysis of how LAIB affects, and is affected by, patients' relationships with other people. Methods: Data derive from a longitudinal qualitative study. Twenty-six people (18 males; 8 females) initiating LAIB were recruited from England and Wales (2020/2021) and interviewed up to six times each over a year (125 interviews in total). Interviews were audio-recorded, transcribed, and coded. Coded relationship data were summarized in Excel and analyzed via Iterative Categorization. Results: Core significant others who did not use substances offered participants important support with LAIB. Children and grandchildren provided motivation for LAIB, whilst other family relationships could be supportive and unsupportive. Participants wanted to avoid friends, peers and associates who might offer them substances, but valued sharing experiences with others in similar circumstances. Whilst some participants were unconcerned when treatment staff did not contact them, others were angry and upset. Those who did not continue LAIB or were lost from the study were more isolated at recruitment. Meanwhile, participants who remained on LAIB described increased sociability over time. Conclusions: Findings are consistent with ideas relating to new materialism (LAIB is part of an interacting network of material and non-material factors) and social capital (those with supportive relationships benefited more from LAIB). Interpersonal relationships need to be considered as part of routine care and should be reviewed with patients throughout the treatment journey. [ABSTRACT FROM AUTHOR]

Later autism diagnosis is associated with increased mental health risks. Understanding disparities in diagnostic timing is important to reduce psychiatric burden for autistic people. One characteristic associated with later autism diagnosis is female sex assigned at birth. However, literature to date does not characterize, differentiate, or account for gender identity beyond assigned sex at birth. Gender diversity may be more common in autistic relative to neurotypical people, and autism is proportionally overrepresented in gender-diverse populations. We examined age at autism diagnosis by assigned sex at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. Three independent cohorts representing different ascertainments were examined: a research-recruited academic medical center sample (N = 193; 8.0–18.0 years); a clinic-based sample (N = 1550; 1.3–25.4 years); and a community-enriched sample (N = 244, 18.2–30.0 years). The clinic-based and community-enriched samples revealed disparities in diagnostic timing: people assigned female at birth, people of female gender, and gender-diverse people were diagnosed with autism significantly later than persons assigned male at birth, persons of male gender, and cisgender persons, respectively. Birth-sex, gender identity, and gender diversity may each uniquely relate to disparities in autism diagnostic timing. The influence of ascertainment strategies, particularly in studies examining assigned sex at birth or gender identity, should be considered. Later autism diagnosis is associated with risk for mental health problems. Understanding factors related to later autism diagnosis may help reduce mental health risks for autistic people. One characteristic associated with later autism diagnosis is female sex. However, studies often do not distinguish sex assigned at birth and gender identity. Gender diversity may be more common in autistic relative to neurotypical people, and autism is more common in gender-diverse populations. We studied age at autism diagnosis by sex assigned at birth, gender identity, and gender diversity (gender-diverse vs cisgender) status, separately. We studied three separate autistic samples, each of which differed in how they were diagnosed and how they were recruited. The samples included 193 persons (8.0–18.0 years) from a research-recruited academic medical center sample; 1,550 people (1.3–25.4 years) from a clinic-based sample; and 244 people (18.2–30.0 years) from a community-enriched sample. We found significant differences in the clinic-based and community-enriched samples. People assigned female sex at birth were diagnosed with autism significantly later than people assigned male at birth. People of female gender were diagnosed significantly later than people of male gender. Gender-diverse people were diagnosed significantly later than cisgender people. Sex assigned at birth, gender identity, and gender diversity may each show unique relationships with age of autism diagnosis. Differences in how autistic people are diagnosed and recruited are important to consider in studies that examine sex assigned at birth or gender identity. More research into autism diagnosis in adulthood is needed. [ABSTRACT FROM AUTHOR]

Cognitive and behavioral flexibility are important predictors of adaptive behavior in school-age autistic youth. While prior research has utilized broad measures of flexibility, the current study uses the multi-dimensional Flexibility Scale-Revised to examine which specific flexibility skills relate to adaptive functioning. Through parent-report measures on 216 autistic youth, flexibility explained 22.2% of variance in adaptive socialization skills (p < 0.001). Specifically, Social Flexibility accounted for significant variance in adaptive socialization skills, while Transitions/Change approached significance. In exploratory analyses, flexibility explained 11.5% of variance in Communication skills (p < 0.001). This pattern remained after controlling for co-occurring ADHD symptoms. The current study helps to refine the relationship between flexibility and adaptive behavior, which may ultimately help to inform more targeted interventions.

Despite research exploring autism in gender-diverse adolescents, no studies have elicited these individuals' perspectives. In-depth interviews with 22 well-characterized autistic gender-diverse adolescents revealed critical themes, including: recollections of pre-pubertal gender nonconformity; vivid experiences of gender dysphoria; a fear of social gender expression due to perceived animosity toward transgender people; and specific challenges that result from the interplay of gender diversity and neurodiversity. During the ~ 22 month study social gender affirmation increased in six participants and gender dysphoria attenuated in four participants. Given the ethical imperative to understand and prioritize the voiced perspectives and needs of autistic gender minority adolescents as well as the discovery of shared themes and experiences in this population, results should inform clinical research approaches and priorities.

The cause of the high degree of variability in cognition and behavior among individuals with Down syndrome (DS) is unknown. We hypothesized that birth defects requiring surgery in the first years of life (congenital heart defects and gastrointestinal defects) might affect an individual's level of function. We used data from the first 234 individuals, age 6-25 years, enrolled in the Down Syndrome Cognition Project (DSCP) to test this hypothesis. Data were drawn from medical records, parent interviews, and a cognitive and behavior assessment battery. Results did not support our hypothesis. That is, we found no evidence that either birth defect was associated with poorer outcomes, adjusting for gender, race/ethnicity, and socioeconomic status. Implications for study design and measurement are discussed.