Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science

Effects of Social Skills Training for Adolescents on the Autism Spectrum: a Randomized Controlled Trial of the Polish Adaptation of the PEERS® Intervention via Hybrid and In-Person Delivery

The study examined the efficacy of the Polish adaptation of the PEERS® curriculum for adolescents on the autism spectrum. Twenty-nine adolescents (aged 11-16) were randomized into a Treatment and a Waitlist Control Group. Due to COVID-19-related restrictions, the Treatment Group received part of the intervention online (in hybrid mode). Results showed large effects of PEERS® increasing the teens' social skills, knowledge about social skills, and the number of get-togethers with peers. Most of the effects were maintained over a six-month follow-up period. There was no impact of the delivery mode on the treatment effects. The study demonstrates the feasibility and efficacy of the Polish adaptation of PEERS® and encourages future research on the online/hybrid delivery of Social Skills Training.

What can neurodiversity tell us about inner speech, and vice versa? A theoretical perspective

Inner speech refers to the experience of talking to oneself in one's head. While notoriously challenging to investigate, it has also been central to a range of questions concerning mind, brain, and behaviour. Posited as a key component in executive function and self-regulation, inner speech has been claimed to be crucial in higher cognitive operations, self-knowledge and self-awareness. Such arguments have traditionally been supported with examples of atypical development. But variations in inner speech - and in some cases, significant diversity - in fact pose several key challenges to such claims, and raises many more questions for, language, thought and mental health more generally. In this review, we will summarise evidence on the experience and operation of inner speech in child and adult neurotypical populations, autistic people and other neurodivergent groups, and people with diverse experiences of linguistic and sensory development, including deafness. We will demonstrate that the relationship between inner speech and cognitive operations may be more complex than first assumed when explored through the lens of cognitive and neurological diversity, and the implications of that for understanding the developing brain in all populations. We discuss why and how the experience of inner speech in neurodivergent groups has often been assumed rather than investigated, making it an important opportunity for researchers to develop innovative future work that integrates participatory insights with cognitive methodology. Finally, we will outline why variations in inner speech - in neurotypical and neurodivergent populations alike - nevertheless have a range of important implications for mental health vulnerability and unmet need. In this sense, the example of inner speech offers us both a way of looking back at the logic of developmental psychology and neuropsychology, and a clue to its future in a neurodiverse world.

Diagnostic assessment of autism in adults - current considerations in neurodevelopmentally informed professional learning with reference to ADOS-2

Services for the assessment and diagnosis of autism in adults have been widely criticized and there is an identified need for further research in this field. There is a call for diagnostic services to become more accessible, person-centered, neurodiversity affirming, and respectful. There is a need for workforce development which will increase capacity for diagnostic assessment and support for adults. ADOS-2 is a gold-standard diagnostic assessment tool for autism recommended in clinical guidelines. However, diagnostic procedures such as the ADOS-2 are rooted in the medical model and do not always sit comfortably alongside the neurodiversity paradigm or preferences of the autistic community. Training and educational materials need to account for the differences between these approaches and support clinicians to provide services which meet the needs of the adults they serve. The National Autism Implementation Team worked alongside ADOS-2 training providers to support clinicians in Scotland, to provide effective and respectful diagnostic assessment. The team engaged with clinicians who had attended ADOS training to identify areas of uncertainty or concern. Training materials were developed to support ADOS assessors to incorporate key principles including "nothing about us without us"; "difference not deficit"; "environment first"; "diagnosis matters," "language and mindsets matter"; and "a neurodevelopmental lens," to support the provision of neurodiversity affirming assessment practice. The National Autism Implementation Team also provided examples of actions which can be undertaken by clinicians to improve the assessment experience for those seeking a diagnosis. Training materials are based on research evidence, clinical experience, and the needs and wishes of autistic people.

Mental health challenges faced by autistic people

Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.

Towards the measurement of autistic burnout

LAY ABSTRACT

Autistic burnout has been talked about by autistic adults for some time on blogs and in social media. Now, research describes fatigue, exhaustion and other related symptoms experienced by autistic people. We need new ways to help identify autistic burnout. In this study, we tested a new questionnaire called the AASPIRE Autistic Burnout Measure, and we investigated things that are linked to worse autistic burnout. We also trialled a group of Autistic Burnout Severity Items that we made. Working with an autistic researcher, we made the Autistic Burnout Severity Items based on published definitions of autistic burnout. Autistic adults (n = 141) who had experienced autistic burnout completed an online survey. We found that autistic burnout was connected to masking and depression. The Autistic Burnout Measure tool was associated with depression but not with masking. It was not very accurate in telling apart participants who were currently experiencing burnout versus those who were reporting on their past experience. The Autistic Burnout Severity Items might have problems with subscales adding together to measure autistic burnout. More work is needed on how to measure autistic burnout. Our research and other recent studies show autistic people experience a combination of exhaustion, withdrawal and problems with their concentration and thinking. Burnout seems to be linked to the stress experienced by autistic people in their daily lives. We need more research to understand the difference between autistic burnout and other conditions and experiences. We need to develop assessment tools that can help identify this burnout.

Confirming the nature of autistic burnout

LAY ABSTRACT

Autistic burnout is something autistic people have been talking about for a while (see #AutBurnout and #AutisticBurnout on social media). Recently, researchers published two different definitions of autistic burnout. We wanted to test these definitions. We wanted to confirm the duration and frequency of autistic burnout. That is, how long and how often do people get autistic burnout? We surveyed 141 autistic adults who had autistic burnout. We used descriptive statistics, content analysis and reflexive thematic analysis to analyse the survey responses. Autistic adults strongly agreed with the definition published by Higgins et al. How long and how often people get autistic burnout was not clear. Participants told us they have both short and long episodes. Participants told us that autistic burnout leads to exhaustion. They needed to withdraw from being with other people. They needed to stay away from autism unfriendly places. Many had been misdiagnosed as having depression, anxiety, bipolar disorder, borderline personality disorder or other conditions. We need increased awareness of autistic burnout. Autistic people need more help. More research is needed, we need to have bigger studies to understand autistic burnout.

The experiences of autistic medical students: A phenomenological study

BACKGROUND

Increasing recognition of autism is reflected in the growing awareness of autistic health care providers. Regulatory bodies including the UK General Medical Council and the UK Medical Schools Council have published guidance fostering inclusion. Whilst many autistic doctors and students are thriving, many may not disclose their diagnosis unless difficulties arise, which perpetuates stereotypes. No studies have explored the experiences of autistic medical students. We aimed to do this.

METHODS

This was an interpretive phenomenological study. Autistic medical students were recruited using Facebook announcements. Participants underwent audio-recorded, loosely structured interviews. Recordings were transcribed verbatim and underwent an interpretive phenomenological analysis.

RESULTS

Five participated from five different UK medical schools. Constructed themes included: Autistic profiles and stereotypes-'I'm a lot better with patients than I am with my peers, with staff, which is hard for a lot of people to understand'; sensory processing and the learning environment-'noises really hurt my ears … It actually hurts'; me, myself and masking-'so, medicine's hard. But I'm also studying myself and I'm figuring myself out and that degree is harder'; the social world-'I always feel like I'm watching my back'; and navigating the system-'[they say] "but you're going to be a doctor one day, so you need to get used to it"'.

CONCLUSION

Participants longed for understanding and support from their medical schools. They reported experiences of isolation, bullying and anxiety. Most felt themselves to be victims of the system, whereby they were expected to adapt themselves in order to appear non-autistic. When participants reported not coping due to being autistic, most were advised to 'take time out'. None were offered personalised adjustments to their learning environment. All reported strengths associated with being autistic. This supports the assertion that autistic people can be safe, effective and skilled doctors.

The Perfect Match! A Review and Tutorial on Issues Related to Matching Groups in Investigations of Children with Neurodevelopmental Conditions

Research concerned with children and young people who have neurodevelopmental disabilities (ND) in relation to early language acquisition usually involves comparisons with matched group(s) of typically developing individuals. In these studies, several important and complex issues need to be addressed. Three major issues are related to: (1) the choice of a variables on which to carry out group matching; (2) recruiting children into the study; and (3) the statistical analysis of the data. To assist future research on this topic, we discuss each of these three issues and provide recommendations about what we believe to be the best course of action. To provide a comprehensive review of the methodological issues, we draw on research beyond the topic of early language acquisition. Our overall aim is to contribute to research that considers questions about delay or differences in development patterns of development and about identifying potentially causal variables.

The Earlier, the Better? An In-Depth Interview Study on the Ethics of Early Detection with Parents of Children at an Elevated Likelihood for Autism

Autism is increasingly viewed as an expression of neurodiversity deserving accommodation, rather than merely as a disorder in need of remediation or even prevention. This reconceptualization has inspired calls to broaden the ethical debate on early autism care beyond matters of efficient screenings and effective interventions. We conducted 14 in-depth interviews with 26 parents of infants at an increased likelihood for autism (siblings, preterms and children with persistent feeding difficulties) to understand which benefits and risks these parents see for the implementation of a systematic, early autism detection program in our region. With this study, we aim to contribute empirically to the ethical debate on good and just early autism care in the age of neurodiversity. Data were analyzed according to the QUAGOL-methodology. Three main themes emerged from our analysis. In their evaluation of early autism detection, parents discussed how a diagnosis helps gain a different perspective fostering understanding and recognition for both child and parent. Second, a diagnosis supports parents in adjusting their parenting practices, to justify this deviation from "normal" parenting and to strive for such adjusted environments beyond the nuclear family. Third, an autism diagnosis induces ambiguities parents need to navigate, involving questions on whether and when to mobilize the diagnostic label and which language to use to talk about autism. We discuss the complex position of parents of a (potentially) autistic child in terms of moving back and forth across the ab/normal binary and describe implications for the ethical debate on early autism detection.

Embracing neurodiversity in doll play: Investigating neural and language correlates of doll play in a neurodiverse sample

Doll play may provide opportunities for children to rehearse social interactions, even when playing alone. Previous research has found that the posterior superior temporal sulcus (pSTS) was more engaged when children played with dolls alone, compared to playing with tablet games alone. Children's use of internal state language (ISL) about others was also associated with pSTS activity. As differences in social cognition are frequently observed in autistic people, we were interested in the brain and language correlates of doll play in children with varying levels of autistic traits. We investigated children's (N = 57, mean age = 6.72, SD = 1.53) use of ISL and their pSTS brain activity using functional near-infrared spectroscopy (fNIRS) as they played with dolls and tablet games, both alone and with a social partner. We also investigated whether there were any effects of autistic traits using the parent-report Autism Spectrum Quotient-Children's Version (AQ-Child). We found that the left pSTS was engaged more as children played with dolls or a tablet with a partner, and when playing with dolls alone, compared to when playing with a tablet alone. Relations between language and neural correlates of social processing were distinct based on the degree of autistic traits. For children with fewer autistic traits, greater pSTS activity was associated with using ISL about others. For children with more autistic traits, greater pSTS activity was associated with experimenter talk during solo play. These divergent pathways highlight the importance of embracing neurodiversity in children's play patterns to best support their development through play.

Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people

Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.

Addressing the autism mental health crisis: the potential of phenomenology in neurodiversity-affirming clinical practices

The neurodiversity movement has introduced a new era for autism research. Yet, the neurodiversity paradigm and the autism clinic remain largely unconnected. With the present work, we aim to contribute to filling this lacuna by putting forward phenomenology as a foundation for developing neurodiversity-affirming clinical interventions for autism. In the first part of this paper, we highlight that autistic people face a severe mental health crisis. We argue that approaches focused on reducing autistic 'symptoms' are unlikely to solve the problem, as autistic mental health is positively correlated with autism acceptance and perceived quality of support provided, not necessarily with lack of 'symptomatologic severity'. Therefore, the development and dissemination of neurodiversity-affirming clinical interventions is key for addressing the autism mental health crisis. However, therapists and researchers exploring such neurodiversity-affirming practices are faced with two significant challenges. First, they lack concrete methodological principles regarding the incorporation of neurodiversity into clinical work. Second, they need to find ways to acknowledge rightful calls to respect the 'autistic self' within the clinic, while also challenging certain beliefs and behaviors of autistic clients in a manner that is sine qua non for therapy, irrespective of neurotype. In the second part of the paper, we introduce phenomenological psychology as a potential resource for engaging with these challenges in neurodiversity-affirming approaches to psychotherapy. In this vein, we put forward specific directions for adapting cognitive behavioral and interpersonal psychotherapy for autism.

Towards a concept of embodied autonomy: In what ways can a patient's body contribute to the autonomy of medical decisions?

"Bodily autonomy" has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient's bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient's capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper is aligned with traditional theories that conceive autonomy in terms of an individual's capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient's body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law.

Prepotent response inhibition in autism: Not an inhibitory deficit?

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.

Developmental Trajectories of Autism

OBJECTIVES

The goal of this study was to describe the typical, longitudinal, developmental trajectories of communication and social functioning in individuals with autism spectrum disorder from childhood through adulthood and to determine the correlates of these trajectories.

METHODS

Children with autism spectrum disorder who were born in California from 1992 through 2016 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations in the database were excluded, resulting in a sample of 71 285 individuals. Score sequences were constructed based on evaluative items for communication and social functioning. Typical trajectories were identified using group-based latent trajectory modeling, and logistic regression was used to determine the odds of classification into a social adolescent decline trajectory by individual-, family-, and zip code-level factors.

RESULTS

Six typical patterns of communication functioning and 7 typical patterns of social functioning were identified. Whereas the majority of autistic individuals exhibit improved communication functioning as they age, the majority of individuals exhibit steady social functioning. A small group of individuals (5.0%) exhibits high social functioning in childhood that declines in adolescence. Membership in this adolescent decline group is associated with maternal non-Hispanic white race and ethnicity, female sex, moderate levels of maternal education, lower zip code-level median home values and population density, and higher zip code-level inequality.

CONCLUSIONS

Most autistic individuals show improved communication and social functioning as they age, but not all do. Trajectory group membership is correlated with socioeconomic status. Future research should investigate what drives these correlations.

The Foundations of Autistic Flourishing

PURPOSE OF REVIEW

All people-including Autistic people-deserve to live flourishing lives. But what does a flourishing life look like for Autistic people? We suggest that the hidden biases, methodological errors, and key assumptions of autism science have obscured answers to this question. Here, we seek to initiate a broader discussion about what the foundations for a good Autistic life might be and how this discussion might be framed.

RECENT FINDINGS

We identify five ways in which autism science can help us all to secure those foundations, including by (1) giving Autistic well-being prominence in research, (2) amplifying Autistic autonomy, (3) attending better to everyday experiences, (4) acknowledging context, and (5) working in partnership with Autistic people and their families and allies to ensure that they are at the heart of research decision-making. Such an approach would direct the focus of autism research to help shape good Autistic lives.

The identification of exceptional skills in school-age autistic children: Prevalence, misconceptions and the alignment of informant perspectives

BACKGROUND

Although autism is commonly described in terms of deficits, many autistic individuals have been found to demonstrate exceptional skills. The shift to a strengths-based approach in the field of autism necessitates increased understanding of these skills.

AIMS

This study examined (1) rates of exceptional skills in autistic school-age children as reported by parents and teachers, (2) associations between exceptional skills, autism severity and intellectual disability and (3) correlations between parent and teacher reports of exceptional skills.

METHOD

Parents and teachers of 76 children attending autism-specific schools in Australia completed online questionnaires. Thereafter, 35 parents and teachers who identified their child as having one or more exceptional skills were interviewed by a clinical psychologist.

RESULTS

Forty parents (53%) and 16 (21%) teachers reported that their child had at least one exceptional skill (agreement between the parent and teacher reports was low; κ = .03, p = .74). In comparison, clinical psychologist assessments identified 22 children (29%) as having at least one such skill. No statistically significant relationships were identified between exceptional skills, autism severity and intellectual disability.

CONCLUSION

While different exceptional skills were identified, regardless of children's intellectual functioning or autism severity, parents and teachers varied substantially in their evaluations of these skills. Furthermore, the identified prevalence rates of exceptional skills did not always align with the rates identified in previous studies. The study findings highlight the need for definitional consensus on different types of exceptional skills, and the importance of multiple criteria/multi-instrument approaches in the identification of exceptional skills in autistic children.

The experiences of autistic doctors: a cross-sectional study

Introduction

Medicine may select for autistic characteristics. As awareness and diagnosis of autism are growing, more medical students and doctors may be discovering they are autistic. No studies have explored the experiences of autistic doctors. This study aimed to fill that gap.

Methods

This is a cross-sectional study. A participatory approach was used to identify the need for the project and to modify a pre-existing survey for use exploring the experiences of autistic doctors.

Results

We received 225 responses. 64% had a formal diagnosis of autism. The mean age of receiving a formal diagnosis was 36 (range 3-61). Most were currently working as doctors (82%). The most common specialties were general practice / family medicine (31%), psychiatry (18%), and anesthesia (11%). Almost half of those working had completed specialty training (46%) and 40% were current trainees. 29% had not disclosed being autistic to anyone at work. 46% had requested adjustments in the workplace but of these, only half had them implemented.Three quarters had considered suicide (77%), one quarter had attempted suicide (24%) and half had engaged in self-harm (49%). 80% reported having worked with another doctor they suspected was autistic, but only 22% reported having worked with another doctor they knew was autistic. Having never worked with a potentially autistic colleague was associated with having considered suicide.Most preferred to be called "autistic doctors" (64%). Most considered autism to be a difference (83%). Considering autism to be a disorder was associated with preference for the term "doctors with autism," and with having attempted suicide.

Conclusion

Autistic doctors reported many challenges in the workplace. This may have contributed to a culture of nondisclosure. Mental health was poor with high rates of suicidal ideation, self-harm, and prior suicide attempts. Despite inhospitable environments, most were persevering and working successfully. Viewing autism as a disorder was associated with prior suicide attempts and a preference for person-first language. A neurodiversity-affirmative approach to autism may lead to a more positive self-identity and improved mental health. Furthermore, providing adequate supports and improving awareness of autistic medical professionals may promote inclusion in the medical workforce.

Item Understanding of Common Quality of Life Measures for use with Autistic Adults

Quality of life (QOL) and life satisfaction are important research priorities for autistic adults. As such, we saw a need to evaluate individual items of commonly used subjective QOL scales to understand how they are interpreted and perceived by autistic adults. This study used cognitive interviews and repeated sampling to evaluate the accessibility, test-retest reliability and internal consistency of several common QOL measures in a sample of young autistic adults (n = 20; aged 19-32). Cognitive interviews suggested that the Satisfaction with Life Scale was well understood and demonstrated excellent internal consistency and test-retest reliability. While the WHOQoL-BREF and WHOQoL Disability Modules had adequate reliability, cognitive interviews suggested that additional instructions and examples would further enhance their accessibility for use with autistic adults.

Fears towards disability and their impact on teaching practices in inclusive classrooms: An empirical study with teachers in Greece

Our research examines Greek special and general education teachers' fears toward disability and their impact on teaching in inclusive classrooms. We interviewed 12 teachers from the region of Attica (Athens) and documented attitudes and beliefs toward disability, with the goal of identifying teachers' personal sources of resistance to inclusion. Medical paradigm of understanding disability and the absence of inclusive school culture are some of the results that revealed teachers' sources of resisting to inclusive changes and the way these affect their teaching. Based on these findings, we discuss a two-pronged process that shifts the existing culture of understanding disability and welcomes diversity in schools.

"I struggle at times to see her struggle": Mothers' perspectives on dyslexia-related school struggles and the inter-connected nature of mother and child well-being

INTRODUCTION

Parents of children with dyslexia may be at elevated risk for parenting stress and mental health concerns. Our aim was to explore the emotional experience of growing up with dyslexia in Australia from parents' perspectives. In so doing, we also developed an understanding of parents' own mental health and support needs informed by their lived experience.

METHODOLOGY

Seventeen interviews with mothers of children (9-14 years; 16 with a diagnosis of dyslexia) were analysed using Braun and Clarke's reflexive thematic analysis approach.

ANALYSIS

Five themes were developed to address our aim: Theme 1: Years in the wilderness: Life before diagnosis; 2: "I struggle at times to see her struggle"; 3. School struggles: Advocating for our children and managing distress; 4. "It's a full-time job" and a "long slog"; 5: Care for the carer: Social support and coping strategies.

CONCLUSIONS

Our analysis suggests that mothers of children with dyslexia may be at elevated risk for mental health concerns. Specifically, chronic worry and stress, secondary distress, challenges to parenting self-efficacy, and lack of support and understanding (feeling isolated) were highlighted as plausible risk factors. Mothers described coping strategies at the community level (e.g., school connectedness) and at the individual level (e.g., "acceptance") as protective.

The Right to Science: Centering People With Intellectual Disability in the Process and Outcomes of Science

The right to science has been identified in multiple human rights treaties; however, there has not been a clear framework for how governments or research organizations can advance this right particularly ensuring equitable engagement of people with intellectual disability (ID) in the process of scientific research. Although the feasibility and impacts of engaging people with ID in the process of science have been repeatedly demonstrated there remain systemic barriers including ableism, racism, and other systems of oppression that sustain inequities. Researchers in the ID field must take steps to dismantle systemic barriers and advance participatory approaches that advance equity in the process and outcomes of science.

Annual Research Review: Perspectives on progress in ADHD science - from characterization to cause

The science of attention-deficit/hyperactivity disorder (ADHD) is motivated by a translational goal - the discovery and exploitation of knowledge about the nature of ADHD to the benefit of those individuals whose lives it affects. Over the past fifty years, scientific research has made enormous strides in characterizing the ADHD condition and in understanding its correlates and causes. However, the translation of these scientific insights into clinical benefits has been limited. In this review, we provide a selective and focused survey of the scientific field of ADHD, providing our personal perspectives on what constitutes the scientific consensus, important new leads to be highlighted, and the key outstanding questions to be addressed going forward. We cover two broad domains - clinical characterization and, risk factors, causal processes and neuro-biological pathways. Part one focuses on the developmental course of ADHD, co-occurring characteristics and conditions, and the functional impact of living with ADHD - including impairment, quality of life, and stigma. In part two, we explore genetic and environmental influences and putative mediating brain processes. In the final section, we reflect on the future of the ADHD construct in the light of cross-cutting scientific themes and recent conceptual reformulations that cast ADHD traits as part of a broader spectrum of neurodivergence.

Sex and gender in neurodevelopmental conditions

Health-related conditions often differ qualitatively or quantitatively between individuals of different birth-assigned sexes and gender identities, and/or with different gendered experiences, requiring tailored care. Studying the moderating and mediating effects of sex-related and gender-related factors on impairment, disability, wellbeing and health is of paramount importance especially for neurodivergent individuals, who are diagnosed with neurodevelopmental conditions with uneven sex/gender distributions. Researchers have become aware of the myriad influences that sex-related and gender-related variables have on the manifestations of neurodevelopmental conditions, and contemporary work has begun to investigate the mechanisms through which these effects are mediated. Here we describe topical concepts of sex and gender science, summarize current knowledge, and discuss research and clinical challenges related to autism, attention-deficit/hyperactivity disorder and other neurodevelopmental conditions. We consider sex and gender in the context of epidemiology, behavioural phenotypes, neurobiology, genetics, endocrinology and neighbouring disciplines. The available evidence supports the view that sex and gender are important contributors to the biological and behavioural variability in neurodevelopmental conditions. Methodological caveats such as frequent conflation of sex and gender constructs, inappropriate measurement of these constructs and under-representation of specific demographic groups (for example, female and gender minority individuals and people with intellectual disabilities) limit the translational potential of research so far. Future research and clinical implementation should integrate sex and gender into next-generation diagnostics, mechanistic investigations and support practices.

'Bodies that never grow': How psychiatric understanding of autism spectrum disorders affects autistic people's bodily experience of gender, ageing, and sexual desire

This paper investigates the intersections of gender, sexuality, ageing in the way autism spectrum disorder is medically described as a discrete category. On one hand, the construction of autism as a male-centric phenomenon results in a significant gender gap in autism diagnosis, with girls diagnosed with autism significantly less and later than boys. On the other hand, the focus on depicting autism as a pediatric condition exposes adult autistics to discriminatory practices such as infantilization and contributes to the disregard of their sexual desires or to the misconception of their sexual behaviors as dangerous or inappropriate. Both infantilization and the supposed inability of autistic people to "fit" into adulthood have a significant impact on both sexuality's expressions and ageing experiences. My study suggests how fostering knowledge and further learning on the infantilization of autism can bring important insight into understanding disability from a critical angle. By challenging normative notions of gender, ageing, and sexuality, autistic people's different bodily experiences question medical authority and social politics and criticize the public representation of autism in the broader social space.

"Peas in a pod": Oral History Reflections on Autistic Identity in Family and Community by Late-Diagnosed Adults

In this paper, we report on a participatory oral history study documenting the lives of late-diagnosed autistic adults in Australia. We interviewed 26 autistic adults about their life history and the impact of late diagnosis. All were diagnosed after the age of 35, growing up in an era when autism was not well known. Using reflexive thematic analysis, we uncovered a rich body of reflections on shared Autistic identity and identified three major themes within that data set: 'conceptualising the Autistic family', 'creating Autistic community', and 'contesting Autistic identity'. Overall, the study provides insights into the active creation of shared Autistic identity and the importance of Autistic community to these late-diagnosed autistic adults.

A portfolio analysis of autism research funding in Aotearoa New Zealand 2007-2021

LAY ABSTRACT

We aimed to document the areas of autism research that have previously been funded in Aotearoa New Zealand. We searched for research grants awarded to autism research in Aotearoa New Zealand between 2007 and 2021. We compared the funding distribution in Aotearoa New Zealand to other countries. We asked people from the autistic community and broader autism community whether they were satisfied with this funding pattern, and whether it aligned with what is important to them and to autistic people. We found that the majority of funding for autism research was awarded to biology research (67%). Members of the autistic and autism communities were dissatisfied with the funding distribution, and expressed a lack of alignment with what is important to them. People from the community indicated that the funding distribution did not address the priorities of autistic people, and that it indicated a lack of engagement with autistic people. Autism research funding needs to reflect the priorities of the autistic and autism communities. Autistic people need to be included in autism research and related funding decisions.

Decision-making in autism: A narrative review

LAY SUMMARY

Many autistic people report difficulties with real-life decision-making. However, when doing decision-making tests in laboratory experiments, autistic people often perform as well or better than non-autistic people. We review previously published studies on autistic people's decision-making, across different types of tests, to understand what type of decision-making is more challenging. To do this, we searched four databases of research papers. We found 104 studies that tested, in total, 2712 autistic and 3189 comparison participants on different decision-making tasks. We found that there were four categories of decision-making tests that were used in these experiments: perceptual (e.g. deciding which image has the most dots); reward learning (e.g. learning which deck of cards gives the best reward); metacognition (e.g. knowing how well you perform or what you want); and value-based (e.g. making a decision based on a choice between two outcomes that differ in value to you). Overall, these studies suggest that autistic and comparison participants tend to perform similarly well at perceptual and reward-learning decisions. However, autistic participants tended to decide differently from comparison participants on metacognition and value-based paradigms. This suggests that autistic people might differ from typically developing controls in how they evaluate their own performance and in how they make decisions based on weighing up the subjective value of two different options. We suggest these reflect more general differences in metacognition, thinking about thinking, in autism.

Compassionate pedagogy for neurodiversity in higher education: A conceptual analysis

The neurodiversity paradigm challenges pathologising accounts of neurodevelopmental differences, including autism, attention deficit disorder (ADHD), dyslexia, developmental language disorder (DLD) and others. From a neurodiversity perspective, these differences in the way people perceive, learn about and interact with the world are conceptualised as naturally occurring cognitive variation, akin to biodiversity in the natural environment, which may bring unique strengths and challenges for individuals. An implication of this approach is that interventions designed to create contexts in which neurodivergent people can thrive are needed, in addition to those that seek to ameliorate individual-level difficulties. In this conceptual review, we consider how higher education can offer a context in which cognitive diversity can be noticed, welcomed and accepted with warmth. In universities, neurodiversity is one dimension of difference within an increasingly diverse student population, which overlaps - but is not synonymous - with disability. We argue that improving experience and outcomes for neurodivergent students should be a priority for universities aiming to produce graduates equipped to tackle the complex problems of contemporary society. Drawing on the foundational principles of compassion-focused psychological therapies, we consider how compassion can be enacted within interpersonal interaction, curriculum design, and leadership culture in universities. We apply the insights of double empathy theory to the problem of overcoming barriers of difference in the classroom. Finally, we make recommendations for Universal Design for Learning (UDL) and strengths-based pedagogical approaches, which create a fit-for-purpose educational environment for the widest possible range of learners. This realignment with the neurodiversity paradigm offers an antidote to bolt-on provisions for students who differ from the neuro-normative, and might enable neurodivergent thinkers to flourish within and beyond higher education.

"Work WITH us": a Delphi study about improving eating disorder treatment for autistic women with anorexia nervosa

BACKGROUND

There is an increased prevalence of anorexia nervosa (AN) in autistic women and this group has poorer treatment outcomes compared to non-autistic women with AN. However, there is little research into improving eating disorder treatment for autistic women. This study investigated how best to support autistic women with AN within eating disorder services.

METHOD

A three-stage Delphi study was conducted with 49 participants with relevant expertise as a researcher, clinician, or expert by experience.

RESULTS

A total of 70 statements were generated, with 56 reaching consensus after the final round. Statements reaching consensus made recommendations for adaptations to treatment, staff training, and service organisation.

CONCLUSIONS

The results highlight the need to distinguish between autism- and AN-related difficulties, accommodate autistic traits such as sensory sensitivities and communication differences, and ensure the autistic voice is present in both the development and delivery of care. Future research should investigate the impact of these adaptations on outcomes. The applicability of these recommendations to autistic people with other eating disorders and of other genders needs to be investigated further.

Editorial Perspective: Another look at 'optimal outcome' in autism spectrum disorder

This paper addresses the hypothesis that autism spectrum disorder features follow multiple long-term developmental trajectories, including an absence of symptoms that were present in childhood, by the time of adolescence. In early work on this topic, this circumstance was called an 'optimal outcome'. To better reflect the reality of multiple excellent outcomes regardless of whether autism spectrum disorder features are present or absent, including autonomy, daily living skills, communication skills, and relationships and employment/activities outside the home, the terminology 'loss of autism diagnosis' (LAD) has been proposed as a substitute. The paper also contextualizes an LAD outcome within research, practice and advocacy.

Growing up with dyslexia: Child and parent perspectives on school struggles, self-esteem, and mental health

Children with dyslexia, compared with typically reading peers, are at increased risk of internalising (e.g., anxiety) and externalising (e.g., aggression) mental health concerns; why this is the case is largely unknown. Our aim was to explore the socio-emotional experience of growing up with dyslexia from both child and parent perspectives. In so doing, we aimed to gain a better understanding of self-esteem and mental health in the context of dyslexia. One-to-one semi-structured interviews with 17 children with reading difficulties (aged 9-14 years; 16 with a diagnosis of dyslexia) and their mothers (interviewed separately) were analysed using Braun and Clarke's reflexive thematic analysis approach with a neurodiversity lens. We developed three themes to address the research aim: (1) Different in a good/bad way; (2) Exhausted and overwhelmed; and (3) It takes a community: Family school connections. Children discussed having "worries" and experiencing school-related stress and embarrassment. Mothers perceived children's internalising and externalising behaviour (meltdowns), school refusal, and homework resistance as emotional responses to children's school struggles due to poor "person-environment fit." Our analysis highlights the particular importance of parent support, friendship, and school-connectedness for the wellbeing of children with dyslexia.

Neurodiversity, Networks, and Narratives: Exploring Intimacy and Expressive Freedom in the Time of Covid-19

The Narratives of Neurodiversity Network (NNN) is a neurodivergent academic, creative, and educator collective that came together with allies during the Covid-19 pandemic to create a network centred around emerging narratives about neurodiversity and exploring new ways of learning and socialising. The network focuses on exploring the roles of written, spoken, and visual narratives across cultural locations about neuro-atypical experiences in generating improved agency and self-advocacy for those who have been subject to pathologization through neuro-normativity and intersecting oppression. During the last year, widening access to digital platforms has provided a space to explore these issues outside of traditional academic spaces. We run a monthly "Salon," our mixed-media "reading, listening, and watching" group, in an effort to find positive representation within contemporary culture. Discussions have moved beyond mimesis and into a consideration of how narrative and storyworlds can question the supposed naturalness of certain ways of being in and perceiving the world. This article interrogates the network's core principles of nonhierarchical co-production, including the roles of creativity, community, identity, and emancipatory research which were animated by the new techno-social context. We consider the cultural lives of neurodiversity in the West and beyond, including ethical and aesthetic dimensions. We share a faith in the power of storytelling to inform new social identities for neurodivergent people and to inform scientific understandings of atypical cognition. In exploring this, we speak through a porous first-person plural narrator, to unsettle the idea that there is a hegemonic "we" speaking on behalf of all neurodivergent people.

Concealing Stuttering at School: "When You Can't Fix It…the Only Alternative Is to Hide It"

PURPOSE

The purpose of this study was to explore experiences with concealing stuttering in children and young people who stutter based on recollections from adults. In addition, we explored how school-based speech therapists can be helpful or unhelpful to children who are concealing stuttering from the perspective of adults who stutter.

METHOD

Thirty adults who stutter, who previously or currently conceal stuttering, participated in semistructured interviews exploring their early experiences with hiding stuttering. Purposeful and random sampling was used to diversify experiences and opinions. Reflexive thematic analysis was used to develop themes and subthemes to describe participants' experiences.

RESULTS

All participants in the study reported beginning to conceal stuttering at 18 years of age or younger, with more than two thirds sharing that they began in elementary school. Participants reported that exposure to implicit and explicit ableist messaging about stuttering and traumatic social experiences at school contributed to their inclination to hide disfluencies. Many participants described concealment as a strategy for protecting themselves from stigma. Several participants condemned fluency shaping, calling it harmful and likening it to teaching concealment. Participants believed that speech therapists could be helpful by promoting safe and supportive school environments and by being responsive to the social and emotional challenges that can accompany speaking differently and navigating stigma at school.

CONCLUSIONS

Some children who stutter may attempt to protect themselves from stigma by concealing their disfluencies, but doing so can feel isolating and confusing. Speech therapists can play an important role in making the school environment safer and more supportive for children who stutter.

Psychological strengths and well-being: Strengths use predicts quality of life, well-being and mental health in autism

LAY ABSTRACT

It is often suggested that supporting autistic people to identify and use their strengths will lead to positive outcomes. However, little research has explored if this is true. To date, no research has explored whether autistic people already have knowledge of and use their strengths, nor whether increased strengths knowledge and use is linked to good outcomes, such as a better quality of life, well-being and improved mental health. Comparing large samples of autistic and non-autistic people, this study tested these unanswered questions. We found that autistic and non-autistic people reported similar strengths, but autistic people reported less knowledge and use of their strengths compared to non-autistic people. Importantly however, autistic people who reported using their strengths often had better quality of life, well-being and mental health than autistic people who reported using their strengths less frequently. We, therefore, propose that supporting autistic people to use their strengths more often may be a valuable way to boost well-being in this population.

Evaluating the online delivery of an autistic-led programme to support newly diagnosed or identified autistic adults

Background & aims

Exploring Being Autistic is an autistic-led group-based programme providing psychoeducation and peer support to newly identified/diagnosed autistic adults. In 2020, due to social distancing measures implemented following the coronavirus pandemic, Exploring Being Autistic was adapted for online delivery. Here, we aimed to replicate previous research into the in-person delivery of Exploring Being Autistic, to determine whether similar results were obtained when the programme was delivered online. Further, we aimed to identify the unique opportunities and challenges that online delivery afforded.

Methods

We used a community-based participatory research (CBPR) approach, whereby the autistic developer and facilitator of Exploring Being Autistic worked collaboratively with a team of academic researchers throughout the research process. Together, we evaluated two iterations of the online Exploring Being Autistic programme, involving 16 attendees. Attendees completed questionnaires before, during and after the programme. Attendees were also invited to participate in two post-programme (group or individual) interviews: one following the completion of the programme (time one) and another 6-8 months later (time two). Attendees were included in the research if they completed at least one questionnaire or interview. Data were analysed qualitatively, using reflexive thematic analysis.

Results

Experiences of participating in the programme tended to be positive. Participants appreciated the autistic-led nature of the programme, found unity in the diversity of the group, and developed a positive and practical outlook as a result of the programme. Further analyses of our data revealed mixed views regarding the online delivery of the programme. Opportunities of online delivery were noted, such as this mode of participation reducing cognitive load, enabling the programme to be accessible to more participants, and fostering meaningful social connections among participants. However, technology and practical issues were felt to cause barriers, and some human aspects of participation were felt to be 'lost in translation' (e.g., in breakout groups).

Conclusions

The online delivery of the Exploring Being Autistic programme yielded similar results to previous, in-person evaluations of the programme. While we identified positive aspects of online delivery, this mode did not entirely suit everyone's needs.

Implications

From the current findings, we can make several recommendations to develop online support for autistic people. First, flexibility is key. To make support accessible and inclusive to a broad range of autistic people, the option for attendees to engage in-person, online or in hybrid formats should be considered. Second, if delivering support online, the use of breakout rooms should be carefully considered. While participants appreciated the opportunity to meet different people, some participants found the unpredictability and lack of scaffolding associated with breakout rooms challenging. To mitigate these challenges, groups could be pre-determined and shared with the attendees in advance (although consideration should be given to how the groups 'fit' together, and whether groupings should be changed at set intervals). Gentle warnings should also be given to those in breakout rooms, to alert them of the need to re-join the main group. Finally, support with technological aspects relating to engagement should be prioritised.

"He's shouting so loud but nobody's hearing him": A multi-informant study of autistic pupils' experiences of school non-attendance and exclusion

Background and aims

Children and young people on the autism spectrum frequently report a range of negative educational experiences and face disproportionally high rates of school non-attendance, including school avoidance and permanent exclusion, which can have a significant impact on their well-being as well as educational and broader life outcomes. To date, few studies have examined the full range of proximal (child, parent/family, school levels) and distal (community and society levels) barriers to ensuring the school attendance and the inclusion of autistic pupils. The current study sought to do just that by examining autistic young peoples' school non-attendance and exclusion experiences from the perspectives of multiple informants.

Methods

We recruited 12 autistic pupils, who had previously experienced school avoidance and/or exclusion, from one local authority in England, United Kingdom. We conducted semi-structured interviews with the young people themselves, ten of their parents, eight of their current teachers and nine local authority professionals, including six educational psychologists and three specialist autism teachers. We analyzed interviewees' responses using reflexive thematic analysis.

Results

Interviewees gave overwhelmingly negative accounts of autistic pupils' school non-attendance and exclusion experiences. Our analysis identified a range of school-related factors they felt led to, or exacerbated, negative experiences in their former mainstream schools, and which ultimately led to their or their children's school non-attendance. It also went further to identify distal factors, including fragmented educational experiences, parents "fighting" against a complex bureaucratic system to secure appropriate education for their children, and limited professional involvement.

Conclusions

Our findings emphasize the importance of examining the broader context in which autistic pupils are embedded and demonstrate that such pupils are able to successfully attend-and even enjoy-school when they receive the appropriate care and support.

Implications

Schools and local authority professionals should seek to work in partnership with parents and autistic pupils to secure the necessary support for their inclusion in mainstream education. Government policy should support the provision of sufficient local authority professionals to adopt a more proactive approach to mitigate autistic pupils' avoidance of and exclusion from school.

'Living in a world that's not about us': The impact of everyday life on the health and wellbeing of autistic women and gender diverse people

BACKGROUND

Autistic women and gender diverse people have specific needs related to their physical and mental health. They also experience more barriers to accessing services. While there are autobiographical accounts of the 'invisible' challenges that autistic women and gender diverse people face day-to-day, there has been limited research that explores how these experiences impact health and wellbeing.

OBJECTIVES

This study aimed to understand the everyday experiences of autistic women and gender diverse people, and their impact on health and wellbeing.

DESIGN

Qualitative methods were used to elicit rich information about the unique experiences of autistic women and gender diverse people.

METHODS

We conducted semi-structured interviews with 31 autistic adults. The data were analysed using reflexive thematic analysis.

RESULTS

We identified 3 themes and 10 subthemes. Our first theme described 'all the stuff that you have to do to get through life', including managing domestic tasks, parenting, unique health needs and co-occurring physical conditions. The second theme outlined the impact of 'living in a world that's not about us', describing how navigating the neurotypical world, managing gender role expectations and trying to fit impacts on mental health. Our third theme outlined the positive impacts of 'shedding all the layers and being myself', including the importance of formal identification, exploring autistic identity and community, and including autistic people in research to support them to 'have a good life on their own terms'.

CONCLUSION

This study emphasized the importance of shifting the responsibility of health and wellbeing from the individual, and the importance of interpersonal, community, cultural, policy and societal factors in ensuring positive health outcomes for autistic women and gender diverse people. It also highlighted areas that enable autistic women and gender diverse people to flourish, including autistic community connectedness, positive relationships and autistic-affirming support from health professionals.

A cross-cultural comparison of a measure of parent perceptions among families of children with autism in Vietnam

LAY ABSTRACT

Raising an autistic child can affect many aspects of families' lives. Parents are responsible for many decisions, from initiating evaluation to selecting and implementing treatments. How parents conceptualize the course and nature of their child's diagnosis influences these processes and parents' own well-being. Parents' perceptions about their children's autism are also affected by cultural contexts and understanding of autism. The Illness Perception Questionnaire-Revised (IPQ-R) is widely used to study cognitions in chronic health research and has been adapted and validated to measure parents' perceptions and beliefs about their children's ASD (IPQ-R-ASD). However, such studies are mostly conducted in high-income countries (HICs) with western, individualistic cultural values (e.g. United States, Canada). Therefore, it is unclear whether the IPQ-R-ASD is a useful instrument in understanding parents' perceptions of autism in Vietnam, a lower- and middle-income country (LMIC) with collectivistic Asian cultural values. These differences suggest that parents in Vietnam may have cognitive representations of their children's autism that differ from those of parents living in HIC, western countries. The purpose of this study was to examine the usability of the translated Vietnamese IPQ-R-ASD that may, ultimately, help explore Vietnamese parents' autism perceptions. While the study's result indicated the usability of the translated measure in Vietnam, when interpreted with Vietnamese norms, results also highlighted notable differences between Vietnamese and North American parents' perceptions of autism that warrant further research.

Exploring life with autism: Quality of Life, daily functioning and compensatory strategies from childhood to emerging adulthood: A qualitative study protocol

Introduction

This study aims to investigate self-perceived quality of life, daily functioning, and the use of compensatory strategies in emerging adults with autism.

Methods and analysis

Participants will be recruited from the Lillehammer Neurodevelopmental 10-year follow-up study (LINEUP), with the aim of 15 individual in-depth interviews. Subsequently, two focus groups with clinicians will be invited to reflect on the themes found in the individual interviews. All interviews will be recorded and analyzed using reflexive thematic analysis.

Ethics and dissemination

The study is approved by the Regional Committee for Medical Research Ethics in South-East Norway. The findings will be disseminated to academic and clinical audiences through journal articles and conference presentations. To reach the broader autistic and autism communities, the findings will be shared with the Autism Society at national and local meetings, in their membership magazine, and on their social media channel.

"Autism research is in crisis": A mixed method study of researcher's constructions of autistic people and autism research

Introduction

While not all autism research is ableism, autism researchers can be ableist, including by talking about autistic people in sub-human terms (dehumanization), treating autistic people like objects (objectification), and making othering statements which set autistic people apart from non-autistic people, and below in status (stigmatization).

Method

This mixed-method study aimed to investigate how autism researchers construct autistic people and autism research, and to investigate whether including autistic people more in research relates to lower ableism in narratives about autistic people. We used a survey with autism researchers (N = 195) asking five open-ended questions about autism and autism research, as well as demographics, career length, contact with autistic people (familial and non-familial) and degree to which researchers involve autistic people in their research. We used content analysis to categorize narratives used by autism researchers and cues for ableism (dehumanization, objectification, and stigmatization). We then used binary-logistic regression to identify whether narrative or higher inclusion of autistic people predicted fewer ableist cues, controlling for career length and connections to autistic people.

Results and discussion

Using medicalized narratives of autism predicted higher odds of ableist cues compared to employing social model or neutral embodiment narratives. Greater inclusion of autistic people in research predicted significantly lower odds of ableist cues, while controlling for other contact with autistic people and career length. Next, we used reflexive thematic analysis to analyze researcher's perceptions of autistic people and autism research. Narratives reflected core ideological disagreements of the field, such as whether researchers consider autism to be an intrinsic barrier to a good life, and whether researchers prioritize research which tackles "autism" versus barriers to societal inclusion for autistic people. Instrumentality (a form of objectification) was key to whether researchers considered a person to have social value with emphasis revolving around intellectual ability and independence. Lastly, language seemed to act as a tool of normalization of violence. Researchers relied on an amorphous idea of "autism" when talking about prevention or eradication, potentially because it sounds more palatable than talking about preventing "autistic people," despite autism only existing within the context of autistic people.

Portrayals of autism in the British press: A corpus-based study

Press representations of autism and autistic people both reflect and help shape public attitudes towards autism and neurodiversity and may establish critical barriers to social integration for autistic individuals. This study examined such representations in UK newspapers in the period 2011–2020 using a corpus-based approach. It also considered how press representations changed over time and differed with regard to reporting style (tabloids vs broadsheets) and political orientation (left- vs right-leaning). We created the Autism UK Press Corpus, which included all documents (~24K) referring to autism in 10 national newspapers. We used document counts (normalised by newspaper size) to assess the ‘newsworthiness’ of autism. We also employed a synergy of corpus-based and critical-discourse-analysis methodologies to study lexicogrammatical patterns and uncover explicit and implicit attitudes towards autism. Our results showed that the coverage of autism increased slightly over time, especially in broadsheets and left-leaning newspapers. Newspapers emphasised adversities associated with autism, often used negative language, and tended to focus on boys. These representations shifted gradually towards more difference-based descriptions and included more diverse age/gender groups, especially in broadsheets and left-leaning newspapers. We discuss the broad implications of these findings for the autism community and those interested in a more inclusive society.

Lay abstract

Any thriving society must recognise, accept and celebrate all of its diverse talent. But how accepting is British society towards autism and autistic people? This research addressed this question through the lens of the press since the press both reflects and helps shape public attitudes towards various social categories. We used specialised ‘corpus-based’ methods to carry out a large-scale study, which examined all articles referring to autism or autistic people in 10 national British newspapers in the period 2011–2020. We first investigated how often newspapers referred to autism. We found that the coverage of autism increased slightly over the years, suggesting that autism was becoming an increasingly newsworthy topic. Furthermore, the rise in autism coverage differed considerably between individual newspapers: it was more pronounced in the broadsheets than tabloids, and in left-leaning than right-leaning newspapers. But what was the focus of these articles? We found that newspapers emphasised the adversities associated with autism and portrayed autism with a lot of negative language. Newspapers also tended to focus on autistic children, and particularly on boys. There were some signs of change in more recent years, with some newspapers now representing autism as a difference and, in addition, referring to more diverse groups of autistic people. However, these changes tended to be confined to broadsheets and left-leaning newspapers. Our findings suggest that representations of autism in the contemporary British press are skewed towards stereotypically negative views, which may well hinder the acceptance of autism and the fostering of a more inclusive society.

An Evaluation of the Overall Utility of Measures of Functioning Suitable for School-Aged Children on the Autism Spectrum: A Scoping Review

A diagnosis of an autism spectrum condition (autism) provides limited information regarding an individual's level of functioning, information key in determining support and funding needs. Using the framework introduced by Arksey and O'Malley, this scoping review aimed to identify measures of functioning suitable for school-aged children on the autism spectrum and evaluate their overall utility, including content validity against the International Classification of Functioning, Disability and Health (ICF) and the ICF Core Sets for Autism. The overall utility of the 13 included tools was determined using the Outcome Measures Rating Form (OMRF), with the Adaptive Behavior Assessment System (ABAS-3) receiving the highest overall utility rating. Content validity of the tools in relation to the ICF and ICF Core Sets for Autism varied, with few assessment tools including any items linking to Environmental Factors of the ICF. The ABAS-3 had the greatest total number of codes linking to the Comprehensive ICF Core Set for Autism while the Vineland Adaptive Behavior Scales (Vineland-3) had the greatest number of unique codes linking to both the Comprehensive ICF Core Set for Autism and the Brief ICF Core Set for Autism (6-16 years). Measuring functioning of school-aged children on the spectrum can be challenging, however, it is important to accurately capture their abilities to ensure equitable and individualised access to funding and supports.

Diagnosis and treatment children and adolescents with autism and ADHD

Attention-deficit/hyperactivity disorder (ADHD) and autism are neurodevelopmental disorders that emerge in childhood. There is increasing recognition that ADHD and autism frequently co-occur. Yet, questions remain among clinicians regarding the best ways to evaluate and treat co-occurring autism and ADHD. This review outlines issues relevant to providing evidence-based practice to individuals and families who may be experiencing difficulties associated with co-occurring autism and ADHD. After describing the complexities of the co-occurrence of autism and ADHD, we present practical considerations for best practice assessment and treatment of co-occurring autism and ADHD. Regarding assessment, this includes considerations for interviewing parents/caregivers and youth, using validated parent and teacher rating scales, conducting cognitive assessments, and conducting behavior observations. Regarding treatment, consideration is given to behavioral management, school-based interventions, social skills development, and the use of medications. Throughout, we note the quality of evidence that supports a particular component of assessment or treatment, highlighting when evidence is most relevant to those with co-occurring autism and ADHD across stages of development. In light of the current evidence for assessment and treatment of co-occurring autism and ADHD, we conclude by outlining practical implications for clinical and educational practice.

Parenting children with autism spectrum disorder in the United Arab Emirates: Exploring perceptions towards using the picture exchange communication system to enhance the development of children with autism spectrum disorder

Background

Autism spectrum disorder (ASD) is an interplay between biological, social and environmental factors that impact the development of individuals. However, core characteristics are social, communication and behaviour challenges that restrict children’s participation in society. Consequently, there are discussions regarding the need for society to develop interventions that are geared towards promoting the participation of children with ASD in societies. While the Picture Exchange Communication System (PECS) helps lessen the biological characteristics of children with ASD, its impact has rarely been explored in non-western societies, such as the United Arab Emirates (UAE).

Objectives

The instant study’s purpose was to explore parents’ perceptions of the effectiveness of the PECS on the communicative, social and academic developments of children with ASD in UAE.

Method

The Perception Towards Picture Exchange Communication Scale (PTPECS) was developed to collect data from the participants. The newly developed tool was piloted and validated before being implemented. The participants included 73 caregivers of children with ASD in the UAE.

Results

The following non-parametric tests were conducted: Mann-Whitney U test, Kruskal-Wallis test, and spearman rho. The results revealed that the parents were generally positive about employing the PECS to support the development of their children with ASD. There was also a positive association between using the PECS and improving communication, learning and social skills in children with ASD.

Conclusion

It is imperative that educators and policymakers envisage parents as equal partners in providing rehabilitation services to children with ASD. Various implications, such as the need for continual engagement and empowering parents of children with ASD, are discussed.

The use of language in autism research

The past three decades have seen a major shift in our understanding of the strong links between autism and identity. These developments have called for careful consideration of the language used to describe autism. Here, we briefly discuss some of these deliberations and provide guidance to researchers around language use in autism research.

Integrating autistic perspectives into autism science: A role for autistic autobiographies

LAY ABSTRACT

Autism science faces challenges in how to think about autism and what questions to focus on, and sometimes contributes to stigma against autistic people. We examine one way that non-autistic researchers may start to combat these challenges: by reading and reflecting on autistic people's descriptions of their personal experiences (e.g. autobiographies) of what it is like to be autistic. In this article, we review some of the advantages and challenges of this approach and how it may help combat some of the challenges currently facing autism science by focusing studies on the questions autistic people find most important, counteracting stereotypes, and increasing understanding of autistic experiences.