Special interests and subjective wellbeing in autistic adults

Global screening of health behaviors: Introducing Lev-screening (Lev-s)-development and psychometric evaluation

Poor health behaviors have been identified as a critical factor for the burden on healthcare systems and individual suffering. However, comprehensive assessment of health behaviors is time-consuming and often neglected. To address this, we introduce the Lev-screening (Lev-s), a new, brief tool that covers multiple health behaviors. The Lev-s assesses ten health behaviors-physical activity, diet, alcohol use, tobacco use, illegal drug use, sleep, social relations, meaningful activities, sexual health, and screen health-using 33 items. This article details the development and psychometric evaluation of Lev-s with a sample of 2,279 participants aged 18-87. Test-retest reliability estimated as intra-class correlation coefficients for the different health behaviors ranged from .71 to .98 (n = 157), indicating moderate to excellent reliability. Lev-s showed associations with quality of life, demonstrated inter-correlations among included health behaviors, and detected group differences between individuals with and without neurodevelopmental conditions. The Lev-s exhibits satisfactory psychometric properties and holds promise as an efficient tool for screening of health behaviors.

A systematic review and meta-analysis of atypical visual attention towards non-social stimuli in preschoolers with autism spectrum disorder

Research on attention towards non-social stimuli in preschoolers with autism spectrum disorder (ASD) has increased over the past decade; however, findings have been inconsistent. It has been suggested that stimuli relating to common circumscribed interests (CIs) elicit more attention than non-CI related stimuli. This meta-analysis synthesizes results from 31 studies that compared attention towards non-social stimuli in children with ASD under the age of five with typically developing (TD) controls using eye-tracking. Additional subgroup analysis comparing studies that employed non-social stimuli related to CIs frequently reported in adults with ASD to studies using non-CI related stimuli were conducted. Meta-regressions with age, sex, stimulus dimension, nonverbal DQ, and symptom severity were conducted. Results show small (g = 0.39) but significantly higher attention towards non-social stimuli for the ASD group. However, when studies were split based on stimulus type no significant differences for non-CI related stimuli was found. Meanwhile studies employing CI related stimuli reported significant large effects on attention allocation (g = 0.69). None of the conducted regressions reached significance. The findings show increased non-social attention in children with ASD is driven by CI related content rather than a general non-social attentional bias. The findings and future research directions are discussed.

Autistic adults in China and the Netherlands: Proxy-reported community integration and life satisfaction

LAY ABSTRACT

Even though there are about 10 million Chinese autistic individuals, we know little about autistic adults in China. This study examined how well young autistic adults in China integrate into their communities (such as having a job, living independently and having friends) and how satisfied they are with their lives as reported by their caregivers. We compared them to autistic adults with similar characteristics (such as high support needs) from the Netherlands. We included 99 autistic adults in China and 109 in the Netherlands (18-30 years). In both countries, autistic adults were reported to have a hard time fitting into their communities. They often had no work, did not live on their own and had few close friends. Also, in both countries, caregivers reported that autistic adults felt low satisfaction with their life. Chinese adults were less satisfied with their life than Dutch adults, as indicated by their caregivers. This could be because of a lack of support for autistic adults in China, higher parental stress in Chinese caregivers, or general cross-country differences in happiness. Only in the Dutch group, younger compared with older adults fitted better into their communities, and adults without additional psychiatric conditions were reported to have higher life satisfaction. Country was a significant predictor of independent living only, with Dutch participants more likely living in care facilities than Chinese participants. In conclusion, our study shows that autistic adults with high support needs generally face similar challenges in both China and the Netherlands.

Interest paradigm for early identification of autism spectrum disorder: an analysis from electroencephalography combined with eye tracking

Introduction

Early identification of Autism Spectrum Disorder (ASD) is critical for effective intervention. Restricted interests (RIs), a subset of repetitive behaviors, are a prominent but underutilized domain for early ASD diagnosis. This study aimed to identify objective biomarkers for ASD by integrating electroencephalography (EEG) and eye-tracking (ET) to analyze toddlers' visual attention and cortical responses to RI versus neutral interest (NI) objects.

Methods

The study involved 59 toddlers aged 2-4 years, including 32 with ASD and 27 non-ASD controls. Participants underwent a 24-object passive viewing paradigm, featuring RI (e.g., transportation items) and NI objects (e.g., balloons). ET metrics (fixation time and pupil size) and EEG time-frequency (TF) power in theta (4-8 Hz) and alpha (8-13 Hz) bands were analyzed. Statistical methods included logistic regression models to assess the predictive potential of combined EEG and ET biomarkers.

Results

Toddlers with ASD exhibited significantly increased fixation times and pupil sizes for RI objects compared to NI objects, alongside distinct EEG patterns with elevated theta and reduced alpha power in occipital regions during RI stimuli. The multimodal logistic regression model, incorporating EEG and ET metrics, achieved an area under the curve (AUC) of 0.75, demonstrating robust predictive capability for ASD.

Discussion

This novel integration of ET and EEG metrics highlights the potential of RIs as diagnostic markers for ASD. The observed neural and attentional distinctions underscore the utility of multimodal biomarkers for early diagnosis and personalized intervention strategies. Future work should validate findings across broader age ranges and diverse populations.

Disability barriers autistic girls face in secondary education: A systematic review

LAY ABSTRACT

Autistic adolescent girls face complex and diverse challenges in the school setting, specifically mental health issues, unmet social and education needs, and social exclusion. The purpose of this review was to provide a general idea of research relating to the experiences of autistic females in secondary school settings by reporting on their experiences and the lived experiences of autistic women reflecting on their past. Based on the identified articles, the barriers girls face in the compulsory education setting centred on four themes of societal barriers grounded in gender; the institutional or physical barriers of schools; social and communicative expectations; and stigmatization. The study highlighted that there is a need to sensitize and educate widely on the topic of autism for teachers, to support staff, school psychologists and peers of autistic youth. The results call attention to the need for future research to focus on the different lived experiences and knowledge of autistic girls.

Resilience in the face of neurodivergence: A scoping review of resilience and factors promoting positive outcomes

Neurodivergent individuals, including a range of conditions impacting neurological function, are at an increased likelihood of poor life outcomes, such as in functional adaptation, mental health, and well-being. Yet, many live meaningful and fulfilling lives. Resilience may provide some explanation for the heterogeneity in outcomes observed in neurodivergent populations. We conducted a scoping review embedded in a neurodiversity-affirmative approach to provide an understanding of resilience in neurodivergent populations. A total of 176 articles were included in this review and were synthesized using a two-phased process. First, findings were synthesized narratively to examine how resilience has been conceptualized and explored in neurodivergent populations. Second, to identify the bio-psycho-social factors important for resilience in neurodivergent individuals, we converted concepts identified in articles to the nomenclature of the World Health Organizations' International Classification of Functioning, Disability and Health (ICF) using a standardized linking process. We find considerable variability in how resilience is conceptualized and measured in neurodivergent populations. We identified 83 unique ICF categories representing resilience factors, of which only 20 appeared in more than 5% of the articles. Identified ICF categories highlight the importance of support systems such as families and friends, community participation and acceptance, and individual capabilities for resilience.

Where do autistic people work? The distribution and predictors of occupational sectors of autistic and general population employees

LAY ABSTRACT

Studies on employment of autistic individuals mainly assessed if they work and what their working conditions are (e.g. weekly hours, salary) while less is known about where they work. We explore this issue in our study, by examining which employment sectors do autistic adults work in, and comparing them to the general workforce in the Netherlands. We also explored the possibility that gender, age, age at diagnosis, level of education, degree of autistic traits and presence of focused interests could lead to a higher likelihood of working in specific sectors. We assessed data from a survey filled in by 1115 employed autistic adults (476 male; 627 female; 12 other; mean age: 40.75). Dutch workforce information was based on data form the Central Bureau of Statistics. Results showed that a higher proportion of autistic employees worked in healthcare & welfare, information technology, and the public-army-charity sectors. These were the three most-common sectors for this group. A lower proportion of autistic employees worked in economics & finances, and industry & construction, compared to the general workforce. Most autistic employees in the healthcare & welfare sector were females while having a higher educational degree and being male increased the chance of working in information technology. In addition to the common impression that most autistic individuals have interests or abilities that align with employment in information technology and technology sectors, we found that autistic employees worked in various sectors. It is important to address individual characteristics and needs of autistic individuals, while encouraging diverse employment opportunities.

More similar than different: Characterizing special interests in autistic boys and girls based on caregiver report

Almost all autistic youths have special interests (SIs), which are focused, intense areas of passion and interest in a particular topic. Emerging research suggests that there are gender differences in SIs among autistic youth; however, commonly used measures that assess for the presence of SIs may not fully capture the granular nature of those differences between autistic boys and girls. Characterizing these differences is important for autism identification in girls, as SIs in autistic girls may often be overlooked by caregivers, teachers, and clinicians due to their more "typical" and more socially oriented content areas compared to autistic boys. This study therefore aimed to more fully characterize gender differences in SIs using a newly developed caregiver-report measure of SIs (the Special Interests Survey; SIS). Caregivers of 1921 autistic youth completed the SIS. Analyses revealed many similarities between boys and girls; there were no gender differences in mean age SI onset, caregivers' perceptions of uniqueness or interferences of endorsed SIs, or duration of previous SIs. There were gender differences in endorsement of less than half (39%) of the SI categories measured, and there were minor differences in the number of endorsed current and past SIs. Categories with significant gender differences fell along typical gender lines (e.g., more boys interested in math and construction, more girls interested in animals and arts/crafts). This study extends the growing literature on SIs and gender differences in autism and has important implications for supporting autistic youth and their families.

Psychosocial Outcomes in Autistic Children Before and During the COVID-19 Pandemic

Studies on the impact of the COVID-19 pandemic on autistic children's psychosocial outcomes have shown mixed results. In the current study we aimed to gain a better insight into the effect of the COVID-19 pandemic by comparing psychosocial outcomes collected pre-pandemic with data collected during the pandemic. We used the Strengths and Difficulties Questionnaire (SDQ) to examine change over time in psychosocial outcomes of autistic children from pre-pandemic (T0) to lockdown I (T1) and lockdown II (T2) in the Netherlands. We expected a deterioration in psychosocial outcomes. There were 224 participants in T0 and T1, of which 141 also participated in T2. The results showed a surprising improvement in psychosocial outcomes from T0 to T1. Special education and female gender were associated with increased difficulties over time, while higher age was associated with decreased difficulties. At the subdomain level we found that emotional problems remained stable, while hyperactivity, conduct problems, and peer problems decreased, and prosocial behavior increased. Attending special education predicted increased peer problems over time, while higher age predicted both decreased conduct problems and increased prosocial behavior over time. The COVID-19 pandemic may have temporarily improved the fit between the psychosocial needs and the environment for children with autism in the Netherlands.

Association of Irritability with Restricted, Repetitive Behaviors and Social Communication Challenges in Autistic Youth

Although affective irritability is a common and concerning problem for autistic youth, limited research has examined relations among core autism characteristics and irritability. Therefore, this study investigated potential associations among types of restricted/repetitive behaviors (RRBs) and social communication challenges and irritability in autistic children and adolescents. Participants were 107 autistic youth recruited from a university-based autism clinical research program. Two hierarchical multiple regressions were conducted with Affective Reactivity Index as the dependent variable. Covariates were entered at step 1, followed by the independent variables of interest at step 2. For the first model, independent variables of interest were Repetitive Behavior Scale-Revised subscales: stereotyped behavior, self-injurious behavior, compulsive behavior, ritualistic behavior, sameness behavior, and restricted behavior. For the second model, independent variables of interest were Social Responsiveness Scale, Second Edition subscales: social awareness, social cognitive, social communication, and social motivation. Irritability was significantly associated with several categories of RRBs (i.e., insistence on sameness, stereotypic behavior, and restricted interests/activities). Nonetheless, irritability was not associated with categories of social communication and interaction challenges in autistic youth. Results from this study indicated differing associations between core autism characteristics and affective irritability. Findings highlight the importance of differentiating types of restricted, repetitive behaviors and social communication and interaction challenges in conceptualizing mental health concerns in autistic youth.

The How Rather than the What: A Qualitative Analysis of Modalities and Caregiver Descriptions of Special Interests in Autistic Youth

Nearly all autistic youth have special interests (SIs), which are associated with many benefits and challenges. Most research on SIs has focused on the subject matter of SIs, with less focus on understanding how youth engage in their SIs. We conducted a qualitative study using inductive content analysis (ICA) to examine: (1) The modalities youth use to engage in their SIs, (2) the degree to which such modalities are described by caregivers as adaptive or maladaptive, and (3) the extent to which the SIs themselves are described by caregivers positively or negatively. We coded responses from 1922 caregivers of autistic youths who completed an online version of the Special Interests Survey, a caregiver-report measure of SIs. Responses to open-ended questions on the SIS, wherein caregivers describe the specific interest within the endorsed SI category, were used as data for the ICA. Frequencies of the codes were derived from cross-tabulation data. The ICA yielded eight modalities: perseverating, creating, information-seeking, memorizing, collecting, attachment, sensory-seeking, and self-soothing. Perseverating, collecting, and attachment were described as maladaptive and negatively by caregivers, whereas creating and information-seeking were described as adaptive. SIs with the greatest proportion of positive and negative descriptions were Plants and Objects, respectively. These findings suggest that SIs - and the degree to which they are described as beneficial or problematic - may be associated with modality and the subject matter. Considering how autistic individuals engage in SIs has implications for clinical work and future research in this area.

Evaluating measures to assess loneliness in autistic adults

LAY ABSTRACT

There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people.

Females evaluated for autism: characteristics and co-occurring and differential DSM-5 diagnoses

Objective: While sex differences in autism spectrum disorder (ASD) have been identified in areas such as neurocognitive functioning, behavior patterns, and diagnostic criteria, less work has focused on differences within females referred for ASD evaluation, including those who did not go on to receive a diagnosis. This study examined psychological and behavioral characteristics and co-occurring and differential DSM-5 diagnoses between pediatric female participants who received an ASD diagnosis (ASD+) and those who did not (ASD-). Method: Data on cognitive functioning, adaptive functioning, internalizing symptoms, externalizing symptoms, and ADOS-2 scores were analyzed among 137 3- to 20-year-old patients. The sample was divided into two age groups (ages 3-8 and ages 9-20) for analyses of between-group differences (ASD+ vs. ASD-) and predictors of group membership. Results: Females in the ASD+ group were significantly younger, had lower cognitive scores, lower internalizing and externalizing symptoms, and had higher Autism Diagnostic Observation Schedule-2 (ADOS-2) scores than those in the ASD- group. ADOS-2 scores were also the only significant predictor of ASD group membership across age groups. The ASD+ group had a higher percentage of intellectual disability while the ASD- group had higher percentages of anxiety disorder, attention-deficit/hyperactivity disorder, and disruptive behavior disorders. Conclusions: Psychological and behavioral presentations among females referred for ASD evaluation varied with age and ASD diagnostic groups. These results highlight potential female differences in ASD referrals and identification of ASD and the need to improve care for females in consideration of demographic factors.

Game Changer: Exploring the Role of Board Games in the Lives of Autistic People

This mixed methods paper reports findings from three studies examining the overlap between autism and hobbyist board gaming. The first was a quantitative survey of over 1600 board gamers, showing that autistic individuals are overrepresented in this hobby compared to the general population and that autistic traits measured by the AQ are significantly elevated amongst board gamers. Study 1 also assessed gamers' motivations and preferences and reported key differences as well as similarities between autistic and non-autistic gamers. The second was a qualitative study that reported the results of 13 interviews with autistic individuals who are hobbyist board gamers. Using Interpretive Phenomenological Analysis (IPA), four key themes were uncovered, including a preference for systemising, escapism and passions, the social lubrication effect of games and difficulties with deception. In the third, 28 autistic individuals were introduced to board games in groups of 5-10 over an afternoon. Subsequent focus groups were then analysed using IPA. This analysis uncovered themes around how board games are challenging but encouraged growth and how they were an alternative vehicle for forging social relationships. Through this paper, we discuss how and why board games may be a popular hobby amongst the autistic population, and its potential utility for improving autistic wellbeing.

Enhanced interest in letters and numbers in autistic children

BACKGROUND

An intense and precocious interest in written material, together with a discrepancy between decoding and reading comprehension skills are defining criteria for hyperlexia, which is found in up to 20% of autistic individuals. It may represent the extreme end of a broader interest in written material in autism. This study examines the magnitude and nature of the interest in written material in a large population of autistic and non-autistic children.

METHODS

All 701 children (391 autistic, 310 non-autistic) under the age of 7 referred to an autism assessment clinic over a span of 4 years were included. Ordinal logistic regressions assessed the association between diagnosis and the level of interest in letters and numbers. A nested sample of parents of 138 autistic, 99 non-autistic clinical, and 76 typically developing (TD) children completed a detailed questionnaire. Cox proportional hazards models analyzed the age of emergence of these interests. Linear regressions evaluated the association between diagnosis and interest level. The frequency of each behaviour showing interest and competence with letters and numbers were compared.

RESULTS

In the two studies, 22 to 37% of autistic children had an intense or exclusive interest in letters. The odds of having a greater interest in letters was 2.78 times higher for autistic children than for non-autistic clinical children of the same age, and 3.49 times higher for the interest in numbers, even if 76% of autistic children were minimally or non-verbal. The age of emergence of these interests did not differ between autistic and TD children and did not depend on their level of oral language. Non-autistic children showed more interest in letters within a social context.

LIMITATIONS

The study holds limitations inherent to the use of a phone questionnaire with caregivers and missing sociodemographic information.

CONCLUSIONS

The emergence of the interest of autistic children toward written language is contemporaneous to the moment in their development where they display a strong deficit in oral language. Together with recent demonstrations of non-social development of oral language in some autistic children, precocious and intense interest in written material suggests that language acquisition in autism may follow an alternative developmental pathway.

"It Helps Make the Fuzzy Go Away": Autistic Adults' Perspectives on Nature's Relationship with Well-being Through the Life Course

Background

While previous work highlights the links between nature and various positive well-being-related outcomes, the experiences of autistic people in nature have received limited empirical research. Our study aimed at gathering autistic adults' perspectives on the relationship between nature and well-being in both childhood and adulthood.

Methods

We used an online survey to capture the views of 127 autistic adults across the United Kingdom. Using reflexive thematic analysis, we analyzed responses to three questions focused on nature experiences in childhood and adulthood and how the participants felt that nature was (or was not) related to well-being. Guided by self-determination theory, we used both inductive and deductive analysis.

Results

We developed three main themes to reflect the nature experiences of autistic adults: choosing to escape into nature, supporting relatedness through connecting in (and to) nature, and nature doesn't judge, but other people do. Compared with many other contexts, nature provides a non-judgmental space through which (in both childhood and adulthood) many, but not all, autistic individuals can meet individual needs and experience autonomy, relatedness, and competence.

Conclusion

This analysis of how autistic adults in the United Kingdom utilize nature to support well-being has implications for how nature can be used in social prescribing as well as in ensuring that existing outdoor spaces, organizations, and activities are supportive of autistic people.

"I have to charge my social battery": Perspectives from autistic young adults on Quality of Life

LAY ABSTRACT

In this study we have asked a group of autistic young adults to describe what is important for their quality of life. The 14 participants (aged 21-29 years) were recruited from a 10-year follow-up study of autistic people. During interviews, our participants described the importance of having relationships with family, friends and pets. Having meaningful activities and being able to immerse themselves in particular interests was also reported to be important for a good quality of life. Interests had also guided their choice of what to study and what to do for work. They also spoke of how communication problems with professionals, bullying and sensory and emotional overload could have a negative impact on quality of life. Future interventions should focus on how professionals can help autistic people to connect to people/animals and meaningful activities, as the participants described this as important for having a good quality of life. These findings may be helpful in enhancing how passions and interests can be seen as opportunities for both academic and work careers for autistic people. Future research and interventions should also look at the communication barriers between autistic people and professionals, and how two-way understanding can be improved.

Moving from Disorder to Difference: A Systematic Review of Recent Language Use in Autism Research

Background

The neurodiversity paradigm positions autism as a neurological difference that is disabling in the societal context, shifting away from the traditional medical view of a disorder. Several recent publications recommend use of alternative neuro-affirming language (ANL) instead of traditional medical language (TML) with the aim to increase acceptance of autistic people and reduce prejudice. Examining language use within recent autism literature, including by journal and study characteristics, may offer insight into the influence of these recommendations and current disability discourse.

Methods

A systematic review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines in autism research from 2021 (n = 2322 articles; 394 journals). Articles were coded according to topic, participants, and use of self-report. Journals were coded by topic, geographic region, and language guidelines. Terminology use was extracted using QDA Miner software.

Results

Many articles primarily used TML with a smaller subset primarily using ANL. There was a positive correlation between ANL use and publication date. More ANL was associated with articles on topics of autistic traits, diversity, equity, and inclusion (DEI), or lifespan and that included autistic adults or autistic self-report. More ANL was also found in journals from Australasia or Europe or those that had identify-first language (IFL) guidelines. Less ANL (more TML) was associated with articles on biology/causes or treatment and that included autistic or non-autistic parents, autistic youth, siblings, or other clinical groups, and were published in medical journals.

Conclusion

TML continues to largely dominate language choices in autism research, with an emerging shift toward ANL in recent literature. Increased ANL may be facilitated by journal and article language recommendations. Neuro-affirming language was also more likely in articles on topics prioritized by the autistic community, that included autistic adults, and may also be driven by cultural differences. Researchers and practitioners should consider the potential for their language use to impact individual and societal views of autistic people.

Characterising Insistence on Sameness and Circumscribed Interests: A Qualitative Study of Parent Perspectives

Manifestations of insistence on sameness (IS) and circumscribed interests (CI) are complex, with individuals varying considerably, not only in the types of behaviours they express, but also in terms of a behaviour's frequency, intensity, trajectory, adaptive benefits, and impacts. However, current quantitative RRB instruments capture only certain aspects of these behaviours (e.g., mostly frequency or general "severity"). Thus, the current study utilised a semi-structured caregiver interview to provide an in-depth, qualitative characterization of different aspects of IS and CI presentation. Caregivers of 27 autistic children and adolescents displaying IS and/or CI behaviours (3-16 years; 18 males; 9 females) participated in a semi-structured interview. Responses were analysed using thematic framework analysis. Framework analysis identified nine different aspects of IS and CI presentation: (1) intensity, (2) frequency, (3) emergence of behaviour, (4) changes over time, (5) day-to-day fluctuations, (6) purpose/adaptive benefit, (7) experiences of distress, (8) challenges for the individual, their family, and their socialisation, and (9) management strategies and their effectiveness. Autistic children and adolescents were reported to vary greatly on each of these dimensions. Findings demonstrate the complexity of IS and CI presentations and highlight the need for more comprehensive quantitative assessments that independently assess the frequency, intensity, and impact of behaviours. Further, findings reported here emphasize the need for ecologically valid measures that assess the contexts in which these behaviours occur and how their presentations can change within and across days.

Do focused interests support word learning? A study with autistic and nonautistic children

Although focused interests are often associated with a diagnosis of autism, they are common in nonautistic individuals as well. Previous studies have explored how these interests impact cognitive, social, and language development. While some research has suggested that strong interests can detract from learning (particularly for autistic children), newer research has indicated that they can be advantageous. In this pre-registered study, we asked whether focused interests support word learning in 44 autistic children and a vocabulary-matched sample of 44 nonautistic children (mean ages 58 and 34 months respectively). In a word-learning task administered over Zoom, children were exposed to an action labeled by a novel word. The action was either depicted by their focused interest or by a neutral image; stimuli were personalized for each child. At test, they were asked to identify the referent of the novel word, and their eye gaze was evaluated as a measure of learning. The preregistered analyses revealed an effect of focused interests, and post-hoc analyses clarified that autistic children learned the novel word in both the focused interest and neutral conditions, while nonautistic children only showed evidence of learning in the neutral condition. These results suggest that focused interests are not disruptive for vocabulary learning in autism, and thus they could be utilized in programming that supports early language learning in this population.

Specific interests as a social boundary and bridge: A qualitative interview study with autistic individuals

LAY ABSTRACT

Growing evidence shows that specific interests can help autistic individuals cope with difficulties in social communication and interaction. However, it is unclear which specific characteristics of these interests make them suitable for this coping role. Therefore, this study explored how specific interests can help autistic individuals navigate social communication and interaction. We conducted semi-structured interviews with nine autistic individuals to inquire about their perspectives on the meanings and functions of their specific interest in their (social) life. We found that specific interests served two important social functions. First, the interests provided a way to disconnect from the challenging outside world, through a shift in the attentional focus of participants. Second, the interests served as a "social compass," providing structure and meaning to social situations and helping the participants feel more connected to others. Based on these findings, we propose a conceptual model suggesting that specific interests create the experience of a "protective boundary" between oneself and others, which helps autistic individuals feel safe during social interactions. Namely, engaging in specific interests not only creates a space where autistic individuals can retreat when they feel overwhelmed, but also provides a framework with delineations in time and space, as well as explicit rules for social interactions, which make them more predictable and regulated. The study suggests that incorporating specific interests into therapy can help improve social communication and interaction for autistic individuals while still prioritizing their personal well-being.

A systematic review and meta-synthesis on perspectives of autistic young people and their parents on psychological well-being

Autistic adolescents are at increased risk of developing mental health problems. Improving psychological well-being could reduce the likelihood of such problems developing. Research has tended to prioritise the voices of non-autistic people and has neglected to consult autistic young people themselves. Our meta-synthesis aimed to systematically review qualitative research on the perspectives of autistic young people and their parents on the lived experience of psychological well-being. We conducted a pre-planned systematic search which identified 2552 papers, with 37 of those meeting full inclusion criteria. Included papers were published between 2008 and 2023, with three-quarters published since 2018. We extracted qualitative data from each paper pertaining to the lived experience of psychological well-being in autistic young people and conducted a thematic synthesis. We identified three themes; Walking a tightrope: the need for growth versus recharging through rest and familiarity; Developing a positive sense of self in the social world; Internally driven sources of happiness. Psychological interventions aiming to improve well-being in autistic young people should respect their autonomy and need for rest whilst encouraging growth and skills development, provide opportunities to understand social needs and differences, and promote opportunities to enjoy special interests.

Research Review: A systematic review and meta-analysis of sex differences in narrow constructs of restricted and repetitive behaviours and interests in autistic children, adolescents, and adults

BACKGROUND

Evidence that autism often manifests differently between males and females is growing, particularly in terms of social interaction and communication, but it is unclear if there are sex differences in restricted and repetitive behaviours and interests (RRBIs) when rigorously focusing on the narrow construct level (i.e., stereotyped behaviour, restricted interests, insistence on sameness, and/or sensory experiences).

METHODS

We conducted a systematic review and four random effects meta-analyses investigating sex differences in narrow construct measures of RRBIs in autistic children, adolescents, and adults (Prospero registration ID: CRD42021254221). Study quality was appraised using the Newcastle-Ottawa Quality Assessment Scale.

RESULTS

Forty-six studies were narratively synthesised and 25 of these were included in four random effects meta-analyses. Results found that autistic males had significantly higher levels of stereotyped behaviours (SMD = 0.21, 95% confidence interval (CI) [0.09, 0.33], p < .001) and restricted interests (SMD = 0.18, 95% CI [0.07, 0.29], p < .001) compared to autistic females. In contrast, there were no significant sex differences for sensory experiences (SMD = -0.09, 95% CI [-0.27, 0.09], p = .32) and insistence on sameness (SMD = 0.01, 95% CI [-0.03, 0.05], p = .68). The findings from the narrative synthesis were generally consistent with those from the meta-analyses and also found qualitative sex differences in the way RRBIs manifest.

CONCLUSIONS

Our findings show significant differences in narrowly defined RRBIs in males and females. Practitioners need to be aware of such differences, which could be contributing to the under-recognition of autism in females and may not be captured by current diagnostic instruments.

Bringing the autistic lifeworld to supportive technology design: an enactive approach

Supportive technologies for autistic individuals are promising in principle, yet their uptake remains limited. Critics argue that in current designs of supportive technologies, autism is mostly framed as a 'disorder' whose limitations can be pragmatically compensated for. To increase uptake, designers should get a better handle on how to incorporate the full richness of the autistic experience into the design process. This paper presents an integrative framework of the autistic lifeworld, called Autistic Lifeworld Design (hereafter: ALD). ALD evolved in a transdisciplinary research setting, substantiated by 11 design case studies with autistic young adults as well as theoretical inquiries into enactivism, design and autism. It consists of four dimensions of experience - sensory, habitual, social, and affective -, each providing specific pointers on how to better understand how autistic people experience the world and how supportive technologies may complement that experience. By adopting an enactive approach, ALD enables a reframing of supportive technology as helping to sustain different levels of homoeostasis. It offers a novel lens that allows designers to put the lived experiences of autistic individuals at the centre of the design process, with special attention to the role of bodily structures and processing in shaping these experiences.

PEERS® for Preschoolers preliminary outcomes and predictors of treatment response

PEERS® for Preschoolers (P4P) is a social skills group program for young autistic children and their caregivers, which provides everyday tools for interacting and communicating with others. Twenty-two caregiver-child dyads participated and completed pre-treatment, post-treatment, and follow-up measures (4-16 weeks after). Using single-subject analyses to examine social skills, 60% demonstrated post-treatment improvement, and 53.85% demonstrated follow-up improvement. Regarding a secondary outcome of behavioral difficulties, 33.33% demonstrated post-treatment reduction, and 7.69% demonstrated follow-up reduction. Using regressions, autistic traits predicted outcomes; fewer social communication difficulties predicted both greater social skills and fewer behavioral difficulties at post-treatment, while fewer repetitive behaviors predicted fewer post-treatment and follow-up behavioral difficulties. These results preliminarily demonstrate the benefits of P4P and how autistic traits may impact P4P outcomes.

Improving autism identification and support for individuals assigned female at birth: clinical suggestions and research priorities

Emerging evidence suggests that the higher prevalence of autism in individuals who are assigned male than assigned female at birth results from both biological factors and identification biases. Autistic individuals who are assigned female at birth (AFAB) and those who are gender diverse experience health disparities and clinical inequity, including late or missed diagnosis and inadequate support. In this Viewpoint, an international panel of clinicians, scientists, and community members with lived experiences of autism reviewed the challenges in identifying autism in individuals who are AFAB and proposed clinical and research directions to promote the health, development, and wellbeing of autistic AFAB individuals. The recognition challenges stem from the interplay between cognitive differences and nuanced or different presentations of autism in some AFAB individuals; expectancy, gender-related, and autism-related biases held by clinicians; and social determinants. We recommend that professional development for clinicians be supported by health-care systems, professional societies, and governing bodies to improve equitable access to assessment and earlier identification of autism in AFAB individuals. Autistic AFAB individuals should receive tailored support in education, identity development, health care, and social and professional sense of belonging.

Autistic adults' experiences of managing wellbeing and implications for social prescribing

Autistic people demonstrate poor outcomes on objective measures of wellbeing, yet research centring lived experience provides a more nuanced picture. There is growing support for person-centred, holistic and community approaches to enhancing wellbeing for autistic people. Social prescribing may be one such approach. This qualitative study explored the concept of wellbeing for autistic adults - including barriers and self-management - and the implications of this for modifying social prescribing. It involved semi-structured interviews with 21 autistic adults in the UK. Reflexive thematic analysis of the data supports research suggesting that self-determination may underlie many aspects of wellbeing for autistic people. The COVID-19 pandemic provided new opportunities to develop wellbeing strategies but also had negative impacts. Social prescribing could promote self-determination by signposting autistic people to peer support opportunities building on intrinsic interests.

Advice for autistic people considering a career in academia

LAY ABSTRACT

One of the recognised strengths of autistic people is their ability to absorb and retain large amounts of information; autistic children and adolescents are often described as 'little professors'. So, is the life of a university researcher or teacher the ideal career for an autistic person? In this study, 37 autistic people working in universities and colleges provide advice to young people considering a future career as an academic. They emphasise the importance of understanding the complexities and requirements of the role, understanding and valuing yourself and your strengths, and finding the right people to work with and learn from. They also discuss the importance of maintaining a balance between work and well-being, and between caution and passion. The life of an academic can be ideally suited to an autistic person, but it can also be very challenging.

Should We Continue to Tell Autistic People that Their Brains are Different?

Autism is often considered to reflect categorically 'different brains'. Neuropsychological research on autism spectrum disorder (ASD) however, has struggled to define this difference, or derive clear-cut boundaries between autism and non-autism. Consequently, restructuring or disbanding the ASD diagnosis is becoming increasingly advocated within research. Nonetheless, autism now exists as a salient social construction, of which 'difference' is a key facet. Clinical and educational professionals must influence this cautiously, as changes to autism's social construction may counterproductively affect the quality of life of autistic people. This paper therefore reviews ASD's value as both neuropsychological and social constructs. Although lacking neuropsychological validity, the autism label may be beneficial for autistic self-identity, reduction of stigma, and administering support. Whilst a shift away from case-control ASD research is warranted, lay notions of 'different brains' may be preserved.

Profiles of circumscribed interests in autistic youth

Circumscribed interests (CI) encompass a range of different interests and related behaviors that can be characterized by either a high intensity but otherwise usual topic [referred to as restricted interests (RI)] or by a focus on topics that are not salient outside of autism [referred to as unusual interests (UI)]. Previous research has suggested that there is pronounced variability across individuals in terms of the endorsement of different interests, however, this variability has not been quantified using formal subtyping approaches. Therefore, using Latent Profile Analysis in a sample of 1,892 autistic youth (M_age = 10.82, SD_age = 4.14; 420 females), this study aimed to identify subgroups based on the RU and UI profiles. Three profiles of autistic individuals were identified. They were characterized as Low CI, Predominantly RI, and Predominantly UI. Importantly, profiles differed on several key demographic and clinical variables, including age, sex composition, IQ, language level, social and communication abilities, anxiety, and obsessive-compulsive behaviors. Although replication across other samples is needed, the profiles identified in this study are potentially promising for future research given their distinct profiles of RI and UI and unique patterns of associations with key cognitive and clinical variables. Therefore, this study represents an important initial step towards more individualized assessment and support for diverse presentations of CI in autistic youth.

Characterizing restricted and unusual interests in autistic youth

A broad range of interests characterized by unusual content and/or intensity, labeled as circumscribed interests (CI), are a core diagnostic feature of autism. Recent evidence suggests that a distinction can be drawn between interests that, although characterized by unusually high intensity and/or inflexibility, are otherwise common in terms of their content (e.g., an interest in movies or animals), labeled as restricted interests (RI), and interests that are generally not salient outside of autism (e.g., an interest in traffic lights or categorization), labeled as unusual interests (UI). The current study aimed to further characterize RI and UI by exploring their association with age, sex, IQ, and social motivation, as well as to examine differences in the adaptive benefits and negative impacts of these two subdomains. Parents of 1892 autistic children and adolescents (M_age  = 10.82, SD_age  = 4.14; 420 females) completed an online survey including the Dimensional Assessment of Restricted and Repetitive Behaviors and the Social Communication Questionnaire. Both RI and UI were found to be highly frequent. Sex-based differences were observed in the content, but not intensity, of CI such that females were more likely to show interests with a social component. Finally, RI and UI showed distinct patterns of association with age, sex, IQ, and social motivation, as well as metrics of adaptive benefits and negative impacts. Findings afford a more nuanced understanding of sex-based differences in CI and, crucially, provide preliminary evidence that RI and UI represent distinct constructs that should be studied independently in future research.

The network structure of the Special Interests Survey

Despite the prevalence of special interests (SIs) in autistic youth, research on SIs and how they are characterized is limited. Indeed, a significant challenge in identifying and classifying SIs lies in capturing the vast and diverse scope of potential interests in this population. The recently developed Special Interest Survey (SIS) is a caregiver-report measure to improve SI characterization by capturing a broad range of past and current SIs. In the present study, we performed a network analysis of the SIS to examine relations between SIs and identify distinct interest clusters. We analyzed data from 1992 caregivers of autistic youths who completed the SIS. The network of SIs was densely interconnected, characterized by six communities of interests: Fact-seeking, Engineering, Order-seeking, Object Attachment, Entertainment, and Scholarly Pursuits. Findings suggest that the structure of the observed network is likely to generalize to similar samples. Of all the SIs and their respective communities, behaviors related to Fact-seeking were identified as the most central, meaning that endorsement of these interests was most strongly related to co-endorsement of other SIs. These findings lay the groundwork for future work on SIs, such as improved assessment techniques and linkage of SIs to a broad range of demographic variables, youth characteristics, and autism symptoms.

Effects of nonsocial and circumscribed interest images on neural mechanisms of emotion regulation in autistic adults

Introduction

Emotion dysregulation is commonly reported among autistic individuals. Prior work investigating the neurofunctional mechanisms of emotion regulation (ER) in autistic adults has illustrated alterations in dorsolateral prefrontal cortex (dlPFC) activity, as well as concurrent atypical patterns of activation in subcortical regions related to affect during cognitive reappraisal of social images. Whereas most research examining ER in autism has focused on regulation of negative emotions, the effects of regulating positive emotions has been generally understudied. This is surprising given the relevance of positive motivational states to understanding circumscribed interests (CI) in autism.

Methods

Accordingly, the purpose of this study was to use fMRI with simultaneous eye-tracking and pupillometry to investigate the neural mechanisms of ER during passive viewing and cognitive reappraisal of a standardized set of nonsocial images and personalized (self-selected) CI images.

Results

The autistic group demonstrated comparatively reduced modulation of posterior cingulate cortex (PCC) activation during cognitive reappraisal of CI images compared to viewing of CI, although no eye-tracking/pupillometry differences emerged between-groups. Further, the autistic group demonstrated increased PCC connectivity with left lateral occipital and right supramarginal areas when engaging in cognitive reappraisal vs. viewing CI.

Discussion

In autistic adults, CI may be differentially modulated via PCC. Considering the documented role of the PCC as a core hub of the default mode network, we further postulate that ER of CI could potentially be related to self-referential cognition.

Examining the special interest areas of autistic adults with a focus on their employment and mental health outcomes

BACKGROUND: Many individuals with autism spectrum disorder (ASD) have special interest areas (SIAs) which are characterized by significant depth and breadth of knowledge in a particular topic. These interests can continue through adulthood. OBJECTIVE: We conducted this study to develop a better understanding of the relation between SIAs and employment and mental health outcomes of adults with ASD. METHODS: Qualitative and quantitative analyses were used to examine the data with an emphasis on bringing autistic voices to the forefront of the discussion. Seventy-two adults with ASD, ages 18–53, completed an online survey describing their SIA engagement, employment status, and current mental health measured by two standardized assessments. Respondents provided open-ended responses describing their SIA and beliefs regarding SIAs broadly. RESULTS: Open-ended responses indicated adults with ASD have highly diverse SIAs that are rarely utilized in their employment experiences. Hierarchical regressions revealed SIA-related bullying was associated with higher levels of depression, anxiety, and stress. SIA employment was associated with depression such that those who were not currently employed in their SIA reported higher levels of depression. Respondents without support from people in their life related to their SIA reported higher levels of stress. CONCLUSION: SIAs are extremely important in the lives of autistic adults and should be utilized to enhance their employment experiences and overall well-being. Family members, adult service providers, and educational professionals should support and encourage SIAs.

Neurodiversity and Autism Intervention: Reconciling Perspectives Through a Naturalistic Developmental Behavioral Intervention Framework

Proponents of autism intervention and those of the neurodiversity movement often appear at odds, the former advocating for intensive treatments and the latter arguing that autism must be accepted as a form of diversity. The history of behavioral intervention has understandably outraged many in the Autistic community, though many still value supports focused on quality of life. This commentary argues that Naturalistic Developmental Behavioral Interventions (NDBIs) hold promise for bridging the gap between early intervention and the neurodiversity movement. However, we recognize NDBIs have much room to grow and suggest multiple strategies for improvement. We believe these updates are not only feasible for clinicians and researchers to implement but will ultimately lead to improved quality of life for Autistic individuals.

A capabilities approach to understanding and supporting autistic adulthood

There is little comprehensive research into autistic adulthood, and even less into the services and supports that are most likely to foster flourishing adult autistic lives. This limited research is partly because autism is largely conceived as a condition of childhood, but this focus of research has also resulted from the orthodox scientific approach to autism, which conceptualizes autistic experience almost entirely as a series of biologically derived functional deficits. Approaching autism in this way severely limits what is known about this neurodevelopmental difference, how research is conducted and the services and supports available. In this Review, we adopt an alternative research strategy: we apply Martha Nussbaum's capabilities approach, which focuses on ten core elements of a thriving human life, to research on autistic adulthood. In doing so, we identify areas where autistic adults thrive and where they often struggle, and highlight issues to which researchers, clinicians and policymakers should respond. The resulting picture is far more complex than conventional accounts of autism imply. It also reveals the importance of engaging autistic adults directly in the research process to make progress towards genuinely knowing autism and supporting flourishing autistic lives.

Impact of Belgian COVID-19 lockdown restrictions on autistic individuals' socio-communicative behaviors and their parents' quality of life

BACKGROUND

In the spring of 2020, Belgian authorities enforced a full lockdown period to contain the spread of the SARS-CoV-2 virus. This lockdown drastically disrupted the daily life of autistic individuals' and that of their families. In the midst of these extraordinary circumstances, we assessed the impact of social restrictions on autistic individuals' behavior and their parents' or caregivers' quality of life; we also sought to identify individual characteristics that may influence such changes.

METHODS

We designed an online survey targeting caregivers living with an autistic child or adult. The questionnaire included 125 five-point Likert questions which targeted changes in families' quality of life and in autistic individuals' behavior, as well as factors likely to influence the extent and direction of these changes.

RESULTS

We collected data from 209 French-speaking Belgian respondents. Respondents reported that the lockdown brought about a higher frequency of nonfunctional socio-communicative behaviors, as well as a decrease in families' quality of life. Parents who had less access to respite care experienced a steeper decrease in their quality of life. Autistic individuals with comorbidities, and whose parents had less access to respite care and implemented fewer rules at home during lockdown were more likely to display nonfunctional socio-communicative behaviors.

CONCLUSION

COVID-19 lockdown restrictions had a negative impact on both autistic individuals and their parents.

Autism Through the Ages: A Mixed Methods Approach to Understanding How Age and Age of Diagnosis Affect Quality of Life

A significant proportion of autistic adults today were not diagnosed until later in life, a group referred to as the 'lost generation,' which may affect mental health. In Study 1 we explored quality of life and autistic trait levels in 420 autistic and TD adults, and in Study 2 we explored the experiences of 8 autistic adults diagnosed as adults. We found that autistic adults had lower quality of life outcomes and higher autistic trait levels which related to age of diagnosis, and qualitative findings indicated that while adults were empowered by their new diagnosis, they still require specialized supports. Our findings are discussed, emphasizing future directions and implications for the current care system in place for autistic adults.

Experience of Autistic Children and Their Families During the Pandemic: From Distress to Coping Strategies

To understand the perspectives and needs of autistic children and their families in the context of an emergency, 109 parents and 56 autistic children (5.75-18 years) from Canada completed an online survey about needs, barriers and facilitators to coping with the pandemic. Parents' concerns about their child's development and difficulties managing their child's behaviors before and during pandemic were significantly associated. Parents identified maintaining social relationships and implementing appropriate interventions to their child's characteristics as facilitators during the pandemic. Both children and parents identified lack of socialization as a main difficulty. Among children, 92.9% associated electronic devices with their well-being. This study highlighted the need to consider the child's autistic characteristics and interests to implement emergency accommodations and services.

What Is Autistic Burnout? A Thematic Analysis of Posts on Two Online Platforms

Background

Compared with adults in the general population, autistic adults are more likely to experience poor mental health, which can contribute to increased suicidality. While the autistic community has long identified autistic burnout as a significant mental health risk, to date, only one study has been published. Early research has highlighted the harmful impact of autistic burnout among autistic adults and the urgent need to better understand this phenomenon.

Methods

To understand the lived experiences of autistic adults, we used data scraping to extract public posts about autistic burnout from 2 online platforms shared between 2005 and 2019, which yielded 1127 posts. Using reflexive thematic analysis and an inductive "bottom-up" approach, we sought to understand the etiology, symptoms, and impact of autistic burnout, as well as prevention and recovery strategies. Two autistic researchers with self-reported experience of autistic burnout reviewed the themes and provided insight and feedback.

Results

We identified eight primary themes and three subthemes across the data. (1) Systemic, pervasive lack of autism awareness. (1.1) Discrimination and stigma. (2) A chronic or recurrent condition. (3) Direct impact on health and well-being. (4) A life unlived. (5) A blessing in disguise? (6) Self-awareness and personal control influence risk. (6.1) "You need enough balloons to manage the weight of the rocks." (7) Masking: Damned if you do, damned if you don't. (8) Ask the experts. (8.1) Stronger together. The overarching theme was that a pervasive lack of awareness and stigma about autism underlie autistic burnout.

Conclusions

We identified a set of distinct yet interrelated factors that characterize autistic burnout as a recurring condition that can, directly and indirectly, impact autistic people's functioning, mental health, quality of life, and well-being. The findings suggest that increased awareness and acceptance of autism could be key to burnout prevention and recovery.

Autism and chronic ill health: an observational study of symptoms and diagnoses of central sensitivity syndromes in autistic adults

BACKGROUND

Autistic adults, particularly women, are more likely to experience chronic ill health than the general population. Central sensitivity syndromes (CSS) are a group of related conditions that are thought to include an underlying sensitisation of the central nervous system; heightened sensory sensitivity is a common feature. Anecdotal evidence suggests autistic adults may be more prone to developing a CSS. This study aimed to investigate the occurrence of CSS diagnoses and symptoms in autistic adults, and to explore whether CSS symptoms were related to autistic traits, mental health, sensory sensitivity, or gender.

METHODS

The full sample of participants included 973 autistic adults (410 men, 563 women, mean age = 44.6) registered at the Netherlands Autism Register, who completed questionnaires assessing autistic traits, sensory sensitivity, CSS, physical and mental health symptoms. The reliability and validity of the Central Sensitization Inventory (CSI) in an autistic sample was established using exploratory and confirmatory factor analyses. Chi2 analyses, independent t-tests, hierarchical regression and path analysis were used to analyse relationships between CSS symptoms, autistic traits, measures of mental health and wellbeing, sensory sensitivity, age and gender.

RESULTS

21% of participants reported one or more CSS diagnosis, and 60% scored at or above the clinical cut-off for a CSS. Autistic women were more likely to report a CSS diagnosis and experienced more CSS symptoms than men. Sensory sensitivity, anxiety, age and gender were significant predictors of CSS symptoms, with sensory sensitivity and anxiety fully mediating the relationship between autistic traits and CSS symptoms.

LIMITATIONS

Although this study included a large sample of autistic adults, we did not have a control group or a CSS only group. We also could not include a non-binary group due to lack of statistical power.

CONCLUSIONS

CSS diagnoses and symptoms appear to be very common in the autistic population. Increased awareness of an association between autism and central sensitisation should inform clinicians and guide diagnostic practice, particularly for women where CSS are common and autism under recognised.

The Diagnosis and Management of Autism Spectrum Disorder (ASD) in Adult Females in the Presence or Absence of an Intellectual Disability

We review the reasons for the greater male predominance in the diagnosis of autism spectrum disorder in the non-intellectual disabled population and compare it to autism diagnosed in intellectually disabled individuals. Accurate and timely diagnosis is important, as it reduces health inequalities. Females often present later for the diagnosis. The differences are in core features, such as in social reciprocal interaction through 'camouflaging' and restricted repetitive behaviours, that are less noticeable in females and are potentially explained by the biological differences (female protective effect theory) and/or differences in presentation between the two sexes (female autism phenotype theory). Females more often present with internalising co-occurring conditions than males. We review these theories, highlighting the key differences and the impact of a diagnosis on females. We review methods to potentially improve diagnosis in females along with current and future management strategies.

Burnt Out and Dropping Out: A Comparison of the Experiences of Autistic and Non-autistic Students During the COVID-19 Pandemic

Autistic students are more likely to drop out of university, while facing both challenges and opportunities within university environments. This study compared the experiences of autistic and non-autistic current United Kingdom students, in terms of thoughts about dropping out, burnout, mental health and coping, during the COVID-19 pandemic. Burnout was of particular interest as this is a relatively unexamined phenomenon for autistic students. Seventy autistic and 315 non-autistic students, completed a mixed methods questionnaire with standardized measures of burnout (personal and academic), mental health (depression, stress, and anxiety), and coping styles (adaptive and maladaptive). We also included qualitative questions about dropping out and COVID-19 experiences. We found autistic participants experienced higher rates of burnout and mental health symptoms and were more likely to have thought about dropping out. Reasons given for thinking about dropping out, for both groups, focused on poor mental well-being, doubts about university, and academic challenges. For autistic participants, further analyses did not identify specific predictors of thinking about dropping out, but for non-autistic participants, this was predicted by maladaptive coping styles and academic burnout. Academic and personal burnout predicted one another for autistic students, and age, maladaptive coping, autistic characteristics, stress, and anxiety additionally predicted burnout for non-autistic students. Similarities in experiences during the pandemic were noted, with both groups experiencing negative social implications, difficulties adjusting to emergency online learning, and poorer psychological well-being. Moving forward from COVID-19, universities must find ways to enhance both academic and social support, to enable equal opportunity within Higher Education for autistic students.

Balancing the story of fetal alcohol spectrum disorder: A narrative review of the literature on strengths

For many years, researchers have explored the complex challenges experienced by individuals with fetal alcohol spectrum disorder (FASD). This research has been important for documenting the brain- and body-based impacts of prenatal alcohol exposure and the psychosocial vulnerabilities and environmental adversities frequently associated with FASD. It has also supported advocacy efforts and highlighted the necessity of providing FASD services and supports. However, with the focus on deficits and needs, there is a considerable gap in the literature on the strengths and successes of individuals with FASD. The lack of strengths-based FASD research has likely perpetuated the stress and stigma experienced by individuals with FASD and their families. Thus, there is a critical need to shift the direction of the field. Here we provide a narrative review of the literature on strengths in FASD. Our goals are to: (1) understand the state of strengths-based research related to individuals with FASD across the lifespan, and (2) describe positive characteristics, talents, and abilities of individuals with FASD that may be cultivated to promote their fulfillment and well-being. We identified a total of 19 studies, most of which were conducted to explore the lived experiences of adults with FASD. This preliminary but critical body of evidence highlights the intrinsic strengths of individuals with FASD, including strong self-awareness, receptiveness to support, capacity for human connection, perseverance through challenges, and hope for the future. Despite the importance of this emerging evidence, appraisal of the literature indicates a need for more intentional, methodologically rigorous, participatory, and theory-driven research in this area. Findings from this study, including the identified gaps in the literature, can be used to inform research, practice, and policy to meaningfully advance the field of FASD and promote positive outcomes in this population.

Toward better characterization of restricted and unusual interests in youth with autism

LAY ABSTRACT

Despite being highly prevalent among people with autism, restricted and unusual interests remain under-researched and poorly understood. This article confirms that restricted interests are very frequent and varied among children and adolescents with autism. It also further extends current knowledge in this area by characterizing the relationship between the presence, number, and type of restricted interests with chronological age, sex, cognitive functioning, and social and communication symptoms.

In Our Own Words: The Complex Sensory Experiences of Autistic Adults

Autistic adults commonly experience sensory reactivity differences. Sensory hyperreactivity is frequently researched, whilst hyporeactivity and seeking, and experiences across domains, e.g., vision, are often neglected. Therefore, we aimed to understand more about the sensory experiences of autistic adults. We conducted a mixed-methods study, co-produced with stakeholders; recruiting 49 autistic adults who completed an online survey. Firstly, quantitative results and content analysis enhanced our understanding of sensory input/contexts associated with sensory hyperreactivity, hyporeactivity, and seeking across modalities. Secondly, thematic analysis developed themes relating to 'Outcomes', 'Control', 'Tolerance and management', and 'The role of other people', informing a theoretical model of sensory reactivity differences in autistic adults. These findings have implications for support services and improving quality of life for autistic adults.

"It's like a ramp for a person in a wheelchair": Workplace accessibility for employees with autism

BACKGROUND, AIMS AND METHODS

Participation in employment by individuals with autism spectrum disorders (ASD) remains restricted despite their high motivation and evident abilities. Challenges to employment result from personal characteristics and environmental barriers. This phenomenological research explores the accessibility of a competitive work environment according to the perceptions of adults with ASD.

PROCEDURES AND OUTCOMES

We conducted in-depth interviews with 19 employees with ASD, followed by a thematic content analysis. Three themes emerged: (a) the employees' motivation for employment, (b) challenges and abilities at work, and (c) workplace accessibility (types of accommodations, implementation process).

RESULTS AND CONCLUSIONS

The findings contribute a classification of accommodations that addresses the core characteristics of autism-challenges as well as abilities and motivations for employment. Four types of accommodations were identified: job-performance communication, attitudes and interpersonal communication, daily workplace routines, and physical and sensory environments. Hence, this study supports the centrality of environmental factors in successful employment of individuals with ASD.

IMPLICATIONS

This study presents an evidence-based foundation for autism-related workplace accessibility. It offers an approach to enhance employees' abilities, strengths, and motivation for employment, as well as to decrease barriers and challenges. The findings may expand organizational policies regarding accessibility and thereby anchor workplace accommodations within organizations' corporate cultures.

Searching for What Really Matters: A Thematic Analysis of Quality of Life among Preschool Children on the Autism Spectrum

Quality of life (QoL) is an essential measure when assessing health interventions. Most early interventions for preschool children on the spectrum evaluate the effects on autism symptoms. However, researchers increasingly believe that good interventions should also improve the QoL of these children. Domains of QoL among preschool children on the autism spectrum have not previously been researched. We interviewed adults on the spectrum to explore early childhood experiences that made their lives satisfying. Our data revealed four major themes: interests, environmental regularity, sensory differences and social interactions. This study provides the first insights on aspects of life important to pre-schoolers on the spectrum. Findings will contribute to developing items for a measure of QoL among this population.