Perspective-taking is two-sided: Misunderstandings between people with Asperger's syndrome and their family members

Variability in first impressions of autistic adults made by neurotypical raters is driven more by characteristics of the rater than by characteristics of autistic adults

Previous work indicates that first impressions of autistic adults are more favorable when neurotypical raters know their clinical diagnosis and have high understanding about autism, suggesting that social experiences of autistic adults are affected by the knowledge and beliefs of the neurotypical individuals they encounter. Here, we examine these patterns in more detail by assessing variability in first impression ratings of autistic adults (N = 20) by neurotypical raters (N = 505). Variability in ratings was driven more by characteristics of raters than those of autistic adults, particularly for items related to "intentions to interact." Specifically, variability in rater stigma toward autism and autism knowledge contributed to first impression ratings. Only ratings of "awkwardness" were driven more by characteristics of the autistic adults than characteristics of the raters. Furthermore, although first impressions of autistic adults generally improved when raters were informed of their autism status, providing a diagnosis worsened impressions made by neurotypical raters with high stigma toward autism. Variations in how the diagnosis was labeled (e.g. "autistic" vs "has autism") did not affect results. These findings indicate a large role of neurotypical perceptions and biases in shaping the social experiences for autistic adults that may be improved by reducing stigma and increasing acceptance.

Examining the Diagnostic Validity of Autism Measures Among Adults in an Outpatient Clinic Sample

Background

Previous research has questioned the validity of diagnostic measures for autism spectrum disorder (ASD) among adults. This study examined the correspondence between several measures and clinician diagnosis.

Methods

We conducted a retrospective chart review for 93 adults (18-61 years; 72% male) who received an ASD evaluation at a specialty outpatient clinic. Thirty-one individuals (33%) in the sample were diagnosed with ASD. We compared participant scores on the Autism Spectrum Quotient (AQ), the Ritvo Autism Asperger's Diagnostic Scale-Revised (RAADS-R), and the Autism Diagnostic Observation Schedule (ADOS) to clinician diagnosis of ASD. We calculated sensitivity, specificity, and area under the curve (AUC) for each measure.

Results

Participants diagnosed with ASD scored significantly higher, on average, on the ADOS than those who were not diagnosed with ASD, but not on the RAADS-R or AQ. The AUC was relatively low for each measure: ADOS = 0.69 (95% confidence interval [CI] 0.58-0.81), RAADS-R = 0.58 (95% CI 0.46-0.72), and AQ = 0.40 (95% CI 0.28-0.52). Sensitivity and specificity of all three measures were in the poor to fair range. When dichotomized at the optimal cutoffs for this sample, the ADOS had a sensitivity of 0.65 and a specificity of 0.76; the RAADS-R had a sensitivity of 0.52 and a specificity of 0.73; and the AQ had a sensitivity of 0.45 and a specificity of 0.52.

Conclusions

Results of the study suggest that clinicians should not rely solely on self-report measures or the ADOS when diagnosing adults on the spectrum. Further development of measures is needed, including self-report measures with higher diagnostic validity, that are sensitive across age, gender, and cognitive functioning, and that differentiate autism from psychiatric diagnoses.

Lay Summary

Why was this study done?: Diagnosing adults with autism spectrum disorder (ASD) is difficult. Other research has suggested that the few measures that exist for autistic adults may not be very effective for accurate diagnoses. We wanted to see how closely the results of commonly used ASD assessment tools compared with clinical diagnoses in a real-life outpatient setting.What did the researchers do?: This study looked at adults who went to an adult ASD outpatient clinic for an initial ASD diagnosis over 3 years. Of these 93 adults, one-third were diagnosed as autistic. As part of the evaluation, all participants completed two commonly used autism screening surveys-the Autism Spectrum Quotient (AQ) and the Ritvo Autism Asperger's Diagnostic Scale-Revised (RAADS-R)-and took part in a semistructured diagnostic interview called the Autism Diagnostic Observation Schedule (ADOS). The clinicians also collected additional information and, when possible, spoke to family members before jointly making a diagnosis. The researchers compared how those diagnosed with ASD and those who were not diagnosed with ASD scored on the AQ, the RAADS-R, and the ADOS.What were the results of this study?: Although adults on the spectrum scored higher on average on the ADOS clinical interview than those who did not receive an autism diagnosis, they did not score higher on the AQ and RAADS-R self-report measures. All three of the measures were only moderately effective at showing who would be diagnosed with ASD and who was not.What do these findings add to what was already known?: These results confirm and expand on findings from other prior studies. The findings suggest that ASD diagnostic measures should not be used alone or considered the only source of information when making an initial autism diagnosis in adulthood.What are potential weaknesses in the study?: When studying the accuracy of diagnostic tests, it is best to compare the results of the tests being studied with an "independent gold standard," that is, a test that we know is very good and that is totally separate from the tests being studied. In this case, there is no clear "gold standard," so we had to compare the tests with the next best thing-the clinicians' final decision about whether or not a client has a diagnosis of ASD. It is possible that the clinicians did not make the right diagnosis. Also, the diagnosis was not "independent" of the tests being studied, since the clinicians used the results of the tests to help make the diagnosis. Clinicians only diagnosed about one-third of adults in this study with ASD, whereas previous studies in community clinics have had a higher percentage of adults diagnosed; this factor may have influenced the measures' accuracy. Lastly, clinicians in this study did not assess clients for any other mental health conditions, which may have provided more information about the clients who were not diagnosed with ASD.How will these findings help autistic adults now or in the future?: The findings from this study suggest that none of these measures are very accurate on their own. Thus, we recommend multiple measures (interviews and questionnaires) should be used together when clinicians diagnose ASD in adulthood. Results of this study also suggest that measures for adults with ASD should be tested in real-world community clinics, so that clinicians and researchers see how the measures perform when used for initial diagnosis in adulthood.

Anxiety and Interpretation of Ambiguity in Autistic Children, Typical Children and Their Mothers

Anxiety is highly prevalent in autistic children. Yet interpretation biases implicated in anxiety in non-autistic individuals have received little research attention in this group. Twenty-two autistic children and 25 typical children completed an ambiguous scenarios interview and questionnaire-based measures of anxiety. A subsample of mothers completed parent-report and adult relevant versions of the interview and anxiety questionnaires. Autistic children self-reported similar interpretations of ambiguous scenarios, and similar levels of anxiety, to their typical peers. In contrast, mothers of autistic children reported greater levels of anxiety, and more negative interpretations of ambiguous scenarios in both their children and themselves, relative to mothers of typical children. These data highlight the importance of including autistic children's self-reports when measuring and treating anxiety.

Understanding, attitudes and dehumanisation towards autistic people

Research suggests that while individuals may self-report positive attitudes towards autism, dehumanising attitudes (seeing another as less than human) may still prevail. This study investigated knowledge, openness and dehumanising attitudes of non-autistic people towards autistic people. A total of 361 participants completed a survey measuring autism openness, knowledge and experience, along with a measure of dehumanisation. Results showed that knowledge of autism was comparable to past research and females were more open towards autism. Findings also indicated evidence for dehumanisation, with a particular denial of 'human uniqueness' traits. Furthermore, dehumanisation was related to openness towards autism. These findings have implications for targeting attitudes to reduce stigma associated with autism.

What am I thinking? Perspective-taking from the perspective of adolescents with autism

Autistic people are often described as being impaired with regard to theory of mind, though more recent literature finds flaws in the theory of mind deficit paradigm. In addition, the predominant methods for examining theory of mind often rely on "observational" modes of assessment and do not adequately reflect the dynamic process of real-life perspective taking. Thus, it is imperative that researchers continue to test the autistic theory of mind deficit paradigm and explore theory of mind experiences through more naturalistic approaches. This study qualitatively examined theory of mind in 12 autistic adolescents through a series of semi-structured interviews. Interpretive phenomenological analysis of the data revealed four core themes in participants' theory of mind experiences and strategies, all of which highlighted how a more accurate representation of autistic theory of mind is one of difference rather than deficit. For instance, data showed that autistic heightened perceptual abilities may contribute to mentalizing strengths and that honesty in autism may be less dependent on systemizing rather than personal experience and choice. Such findings suggest that future research should reexamine autistic characteristics in light of their ability to enhance theory of mind processing. Understanding how an autistic theory of mind is uniquely functional is an imperative step toward both destigmatizing the condition and advocating for neurodiversity.

Neurodivergent intersubjectivity: Distinctive features of how autistic people create shared understanding

Autistic people are neurologically divergent, yet approaches to studying autism are framed by neurotypical definitions of being social. Using the concept of intersubjectivity, which conceptualises a variety of ways of socially relating, we investigate distinctive features of how autistic people build social understanding. A total of 30 members of a charity supporting adults with autism were video-recorded during a social activity they enjoyed, namely collaborative video gaming. Mapping the coherence, affect and symmetry of each conversational turn revealed shifting patterns of intersubjectivity within each interaction. Focussing on clusters of consistent and fragmented turns led us to identify two features of neurodivergent intersubjectivity: a generous assumption of common ground that, when understood, led to rapid rapport, and, when not understood, resulted in potentially disruptive utterances; and a low demand for coordination that ameliorated many challenges associated with disruptive turns. Our findings suggest that neurodivergent intersubjectivity reveals potential for unconventional forms of social relating and that a within-interaction analysis is a viable methodology for exploring neurodivergent communication. Future research should examine the varieties of neurodivergent intersubjectivity, with associated problems and potentials, and how those forms of intersubjectivity can be enabled to flourish, particularly in autistic-to-neurotypical encounters.

Risk markers for suicidality in autistic adults

Background

Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies.

Methods

Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online.

Results

A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality.

Conclusions

Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.

Risk markers for suicidality in autistic adults

BACKGROUND

Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies.

METHODS

Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and 'camouflaging' ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online.

RESULTS

A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality.

CONCLUSIONS

Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.

Experiences of Autism Acceptance and Mental Health in Autistic Adults

Mental health difficulties are highly prevalent in individuals on the autism spectrum. The current study examined how experiences and perceptions of autism acceptance could impact on the mental health of autistic adults. 111 adults on the autism spectrum completed an online survey examining their experiences of autism acceptance, along with symptoms of depression, anxiety and stress. Regression analyses showed that autism acceptance from external sources and personal acceptance significantly predicted depression. Acceptance from others also significantly predicted stress but acceptance did not predict anxiety. Further analyses suggested that experiences of "camouflaging" could relate to higher rates of depression. The current study highlights the importance of considering how autism acceptance could contribute to mental health in autism.

Experiences of Autism Acceptance and Mental Health in Autistic Adults

Mental health difficulties are highly prevalent in individuals on the autism spectrum. The current study examined how experiences and perceptions of autism acceptance could impact on the mental health of autistic adults. 111 adults on the autism spectrum completed an online survey examining their experiences of autism acceptance, along with symptoms of depression, anxiety and stress. Regression analyses showed that autism acceptance from external sources and personal acceptance significantly predicted depression. Acceptance from others also significantly predicted stress but acceptance did not predict anxiety. Further analyses suggested that experiences of "camouflaging" could relate to higher rates of depression. The current study highlights the importance of considering how autism acceptance could contribute to mental health in autism.

Metaperception in Adolescents With and Without Autism Spectrum Disorder

This study compared how adolescents with and without autism spectrum disorder (ASD) evaluated unfamiliar peers (i.e., perceptions), as well as how adolescents believed they were evaluated by peers (i.e., metaperceptions). The Perceptions and Metaperceptions Questionnaire was designed to quantify perceptions and metaperceptions following a live interaction. For all adolescents, more positive perceptions of the peer were associated with more positive metaperceptions. Adolescents with ASD exhibited more accurate metaperceptions than did typically developing adolescents. More positive perceptions and metaperceptions were associated with higher levels of observed social competence across groups. Findings extend our understanding of typically and atypically developing adolescents' impressions of unfamiliar peers and their ability to discern what peers think of them.