Autism Spectrum Disorder and School Bullying: Who is the Victim? Who is the Perpetrator?

Adverse Childhood Experiences and Autism: A Meta-Analysis

Evidence suggests that autistic children have a higher probability of experiencing adverse childhood experiences (ACEs) compared to their non-autistic peers. This meta-analysis (PROSPERO: CRD42022262635) aimed to quantify the association of autism and ACEs. Eight databases and Google Scholar were searched for studies that reported dichotomous outcomes regarding the associations between ACEs and autistic individuals, compared to non-autistic individuals. A random-effects model was used to calculate the average Odds Ratio (OR) of the relationship between a diagnosis of autism and ACEs. A total of 40 studies with 5,619,584 participants were included, generating an overall average OR 2.11 (CI 1.61, 2.77). Significant differences in the magnitude of association were found across studies with regards to the type of ACEs studied, comparison groups, and population type. Overall, moderate certainty evidence (downgraded for bias) indicates that autistic individuals are at greater risk of experiencing ACEs, compared to non-autistic individuals. Appropriate support for autistic individuals and their families are required to prevent ACEs and treat the impact of ACEs.

The traits of Autism Spectrum Disorder and bullying victimization in an epidemiological population

Autistic children (Autism Spectrum Disorder, ASD) show an increased risk of bullying victimization and often face challenges in communication and peer relationships. However, it is unclear to what extent the amount and quality of ASD traits are associated with bullying victimization. This study examined the association of bullying victimization and ASD traits in an epidemiological population of 8-year-old children (n = 4408) using parent and teacher completed Autism Spectrum Screening Questionnaires (ASSQs), both separately and combined. The ASSQ items relating to loneliness and social isolation, lack of co-operating skills, clumsiness and lack of common sense were associated with victimization in the study population. The higher the ASSQ scores, the more the children were victimized: the ASSQ scores increased in parallel with victimization from 0 (0% victimized) to 45 (64% victimized). The victimization rate was 46% in ASD sample, 2% in the total population sample and 2% in the non-ASD population sample. The results enable more targeted means for recognizing potential victimization.

Korean autistic persons facing systemic stigmatization from middle education schools: daily survival on the edge as a puppet

Introduction

Korean autistic persons who have endured an integrated secondary education system have been exposed to school bullying, causing trauma and stigma to them. It also blocks them from entering a tertiary education system and a decent work, resulting in a lower quality of life. However, research on how it affects autistic persons has not yet been conducted in Korea.

Methods

Fourteen adult autistic persons in the Republic of Korea participated in the semi-structured focused group interviews. Their conversations were analyzed through qualitative coding.

Results

The interview results show the rare voice of Korean autistic people. Although interviewees experienced physical, verbal, and sexual violence against them during the secondary education period, they could not get substantial assistance from schools and society. Interviewees agreed that bullying is inherent in the secondary education system of Korea, even in Korean culture. They experienced the cause of bullying being attributed to them as victims rather than perpetrators, and impunity is given to the bullying assailants. Early analyses of this article confirm that such experiences are combined with the sociocultural climate of elitism, meritocracy, and authoritarianism in the Republic of Korea.

Conclusion

The study confirmed that the autistic person's bullying experience does not come from the social inability of autistic people but the "profound" competition and discriminative atmosphere of the society. The result urges further studies on the bullying experience of East Asian autistic persons and the construction of Korean intervention strategies to prevent school violence against Koreans with disabilities, especially autistic pupils.

Bullying Victimization in Children and Adolescents and Its Impact on Academic Outcomes

ABSTRACT

Bullying victimization has been identified as a significant factor influencing academic outcomes. We sought to evaluate the educational outcomes and psychiatric comorbidities in children and adolescents who are victims of bullying using the National Survey of Children's Health dataset for the study. The participants were children and adolescents (age: 6-17 years) categorized into two groups: group 1, not bullied (n = 21,015), and group 2, bullied more than once (n = 21,775). Individuals whose health status was fair or poor have experienced more bullying (2.4% vs. 1.4%, p < 0.001). Individuals in the group 2 were more likely to repeat the grades than the group 1 (7.1% vs. 5.9%, p = 0.039). Individuals who were missing ≥11 school days and sometimes or never engaged in school were observed to be more in the group 2 compared with the group 1 (5.9% vs. 3.2% and 20.3% vs. 10.6%, p < 0.001). In conclusion, bullying victimization could be a risk factor and associated with decreased academic outcomes.

Less Negative Implicit Attitudes Toward Autism Spectrum Disorder in University Students: A Comparison with Physical Disabilities

People with autism spectrum disorder (ASD) experience stigmatization rooted in negative attitudes or prejudice toward them due to social awkwardness. However, little is known about implicit attitudes toward ASD, especially differences in attitudes compared to those of more visible conditions; physical disabilities. In this study, we implemented implicit association tests (IATs) to assess implicit attitudes. Sixty-three university students participated in IATs and answered questionnaires that measured explicit attitudes, social desirability, knowledge about-and familiarity with-disorders. The results demonstrated that implicit attitude toward ASD was significantly less negative than toward physical disabilities. Regarding the discrepancy, not socially awkward behavior but appearance of people with ASD can be evaluated as 'in-group' members and lead to less negative attitude compared with physical disabilities.

Reducing stigma toward autistic peers: a pilot investigation of a virtual autism acceptance program for children

Inclusive educational practices can be beneficial for autistic children, especially when the general education classroom can better meet the child's academic and socio-emotional needs than a special education classroom. Unfortunately, autistic children may not thrive in general education classrooms if they are perceived negatively, subject to bullying, and are socially isolated and rejected by their typically developing peers. Autism acceptance programs may help address the root cause of these problems, autism stigma. Thus, this study evaluated the effectiveness of a virtual autism acceptance program presented to typically developing, 8-10-year-old children through remote learning technology. The 5-week, stakeholder-approved pilot program included a themed module each week (e.g., facts about autism and reducing stigma, sensory sensitivities, strengths of those with autism) presented through a variety of online educational materials. Pretest, posttest, and maintenance results showed that the program was effective in improving children's knowledge about autism, and children's attitudes and behavioral intentions toward their peers with autism. In addition to reducing autism stigma, study findings suggest that remote learning and virtual tools can be used to implement an efficacious autism acceptance program to children, allowing for greater and more cost-effective outreach to children and schools.

Negative first impression judgements of autistic children by non-autistic adults

Introduction

Although autism inclusion and acceptance has increased in recent years, autistic people continue to face stigmatization, exclusion, and victimization. Based on brief 10-second videos, non-autistic adults rate autistic adults less favourably than they rate non-autistic adults in terms of traits and behavioural intentions. In the current study, we extended this paradigm to investigate the first impressions of autistic and non-autistic children by non-autistic adult raters and examined the relationship between the rater's own characteristics and bias against autistic children.

Method

Segments of video recorded interviews from 15 autistic and 15 non-autistic children were shown to 346 undergraduate students in audio with video, audio only, video only, transcript, or still image conditions. Participants rated each child on a series of traits and behavioural intentions toward the child, and then completed a series of questionnaires measuring their own social competence, autistic traits, quantity and quality of past experiences with autistic people, and explicit autism stigma.

Results

Overall, autistic children were rated more negatively than non-autistic children, particularly in conditions containing audio. Raters with higher social competence and explicit autism stigma rated autistic children more negatively, whereas raters with more autistic traits and more positive past experiences with autistic people rated autistic children more positively.

Discussion

These rapid negative judgments may contribute to the social exclusion experienced by autistic children. The findings indicate that certain personal characteristics may be related to more stigmatised views of autism and decreased willingness to interact with the autistic person. The implications of the findings are discussed in relation to the social inclusion and well-being of autistic people.

Prevalence of Victimisation in Autistic Individuals: A Systematic Review and Meta-Analysis

Autistic individuals are at an increased risk of experiencing victimisation. Previous reviews have focussed specific types of victimisation. Thus, a clearer picture considering the range of victimisation experiences autistic people face is required. This systematic review aims to identify the prevalence of victimisation in autistic individuals considering a variety of victimisation types (e.g., bulling, sexual victimisation, and crime) in both adults and children from clinical and community settings. Through systematic searches of relevant databases, 291 studies met the criteria for review. Of those, 34 studies met the inclusion criteria: a) quantitative studies, b) involving autistic individuals, c) reporting prevalence rates of victimisation. Meta-analysis found a pooled prevalence rate of victimisation of 44% in autistic individuals. Subgroup analysis examined moderating factors as high heterogeneity was present. This found the pooled prevalence rates for bullying to be 47%, 16% for child abuse, 40% for sexual victimisation, 13% for cyberbullying, and 84% for multiple forms of victimisation in autistic individuals, though heterogeneity remained. Correction for participants' age, reporter used, and the population which the sample was recruited from did not reduce heterogeneity. Although heterogeneity impedes the definitive interpretation of the findings, this review illustrates the need for strategies and interventions to reduce the incidence of victimisation.

Autism, autistic traits and multiple risk behaviours in adolescence: a longitudinal birth cohort study

BACKGROUND

Multiple risk behaviours (MRBs), typically beginning in adolescence, are associated with increased risk of adverse health and social outcomes. The association between autism and MRBs is little understood.

METHODS

Data were from the Avon Longitudinal Study of Parents and Children, an UK-based longitudinal, birth cohort study. Exposures were diagnosed autism and four autistic traits: social communication difficulties, pragmatic language, repetitive behaviours and reduced sociability. Outcomes were participation in up to 14 risk behaviours, including alcohol consumption, smoking, risky sexual behaviours and physical inactivity. Outcome data were collected at ages approximately 12, 14, 16 and 18.

RESULTS

Up to 4300 participants were included in latent basis growth curve analyses with adjustment for confounders. Social communication difficulties were associated with an above average level of MRBs engagement at ~12 years (mean difference β 0.26; 95% CI 0.13-0.40), and above average rate of engagement from ages ~12-18 (β 0.08; 95% CI 0.02-0.13). Repetitive behaviours were associated with above average levels of engagement in MRBs at ~12 years (β 0.24; 95% CI 0.09-0.38). Contrastingly, reduced sociability was associated with a reduced rate of engagement in MRBs from ages ~12-18 (β -0.06; 95% CI -0.11 to -0.02). In sex-specific analyses, persisting differences in MRB engagement patterns from ages ~12-18 were observed in males with social communication difficulties and females with reduced sociability temperament.

CONCLUSIONS

Having elevated levels of some autistic traits appear to have differentiated effects on MRB engagement patterns. These findings could reflect difficulties fitting in and/or coping mechanisms relating to difficulties with fitting in.

Sleep problems in children with autism spectrum disorder in Hong Kong: a cross-sectional study

Background

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with a growing prevalence of sleep problems associated with significant behavioral problems and more severe autism clinical presentation. Little is known about the relationships between autism traits and sleep problems in Hong Kong. Therefore, this study aimed to examine whether children with autism have increased sleep problems than non-autistic children in Hong Kong. The secondary objective was to examine the factors associated with sleep problems in an autism clinical sample.

Methods

This cross-sectional study recruited 135 children with autism and 102 with the same age range of non-autistic children, aged between 6 and 12 years. Both groups were screened and compared on their sleep behaviors using the Children's Sleep Habits Questionnaire (CSHQ).

Results

Children with autism had significantly more sleep problems than non-autistic children [t _(226.73) = 6.20, p < 0.001]. Bed -sharing [beta = 0.25, t ₍₁₆₅₎ = 2.75, p = 0.07] and maternal age at birth [beta = 0.15, t ₍₁₆₅₎ = 2.05, p = 0.043] were significant factors associated with CSHQ score on the top of autism traits. Stepwise linear regression modeling identified that only separation anxiety disorder (beta = 4.83, t = 2.40, p = 0.019) best-predicted CSHQ.

Conclusion

In summary, autistic children suffered from significantly more sleep problems and co-occurring separation anxiety disorder brings greater sleep problems as compared to non-autistic children. Clinicians should be more aware of sleep problems to provide more effective treatments to children with autism.

A qualitative study on the experience of stigma for Chinese parents of children with autism spectrum disorder

Experiencing stigma related to having a child with autism spectrum disorder (ASD) can be difficult and is detrimental to parent well-being. Since the research on stigmatized experiences among parents of children with ASD in non-Western communities is limited, this qualitative study examined the experiences, reactions and impacts of stigma on parents of children with ASD in Hong Kong. In-depth interviews were conducted with 54 Chinese parents/caregivers of children with ASD aged between 35 and 73 years old. Data were analyzed using an inductive approach. The participants reported stigma which stemmed from negative labelling of their children by schools and healthcare professionals, bullying by peers, stereotypes of ASD and stigma linked to autistic children's behavior in the community. The reactions of participants towards stigmatization were classified into internalizing reactions including apologizing, ignoring and concealing ASD and externalizing reactions such as fighting back. The participants also reported impacts of stigma on both personal and emotional levels. The results point to the urgent need for the government to allocate resources and make concerted efforts to reduce stigma by educating the community to foster more positive attitudes towards individuals with ASD and offer support and counselling services to parents.

Bullying experiences and mothers’ responses to bullying of children with autism spectrum disorder

Despite the fact that children with disabilities generally have been shown to be at a greater risk of bullying, which include physical attacks and threats, being picked on and teased and verbal abuse, there is still a need to understand bullying of children with autism spectrum disorder (ASD) and the strategies used by parents to support them in tackling this issue. This study aims to investigate the type and level of occurrence of bullying and parental support for children aged five with ASD who suffer from bullying. This study used both quantitative and qualitative analysis; a questionnaire, distributed to mothers of children with ASD, adopted from the Bullying for ASD Survey developed by Chen and Schwartz (Focus Autism Other Dev Disabil 27(4):200–212, 2012) measured types and frequency of bullying and parental support. An open-ended question was added to the survey to enable parents to write about the ways in which their child was bullied and the ways in which they supported their child. The results showed that while children suffered from all types of bullying, especially being picked on, being excluded and called names. Parental support showed a higher prevalence of involving peers and teachers for the prevention of bullying as well as avoiding strategies which included avoiding bullies and none of the mothers encouraged their children to stand up to bullies.

Performance- and Theater-Based Interventions for Supporting Social Cognition and Social Communication in Autistic Youth: A Review and Theoretical Synthesis

Social skills interventions (SSIs) are commonly used to improve social functioning in youth with autism spectrum disorder (ASD), which is a condition characterized by differences in social cognition and social communication. Although more traditional SSIs have used knowledge-based, didactic instruction, recent research has explored the utility of performance-based SSIs, which use various activities to support implicit learning of social skills in supportive, enriched environments. This article reviews the extant literature evaluating the effectiveness or efficacy of five performance-based SSIs using theater-based approaches on social cognition and social communication. Overall, this body of literature suggests social communication gains that include increased peer interactions, peer liking, and reciprocal friendships, as well as social cognitive gains in theory of mind and affect recognition. This review also discusses theoretical models that may help explain the emerging strengths of performance- and theater-based SSIs with underlying hypotheses related to the social communication and social cognitive differences in ASD. Limitations of performance-based SSIs in the evidence-base include several approaches in initial stages of research with small sample sizes and limited maintenance of effects. Future research should aim to bridge the research-to-practice gap and use more rigorous designs and more diverse samples, including those with cooccurring intellectual disability.

ASD Symptoms, Social Skills, and Comorbidity: Predictors of Bullying Perpetration

Children with ASD are more likely to be involved in bullying compared to typically developing peers; however, studies rarely examine bullying perpetration and the contributing factors among this population. The primary aim of this study was to examine the extent to which parent-reported ASD symptoms, social skills, and comorbid externalizing and internalizing symptoms predicted bullying perpetration in a sample of 390 children with ASD without intellectual disability. Findings from hierarchical regression analyses indicated that social skill deficits, externalizing symptoms (i.e., hyperactivity, aggression, and conduct problems), and depressive symptoms were associated with higher likelihood of bullying perpetration, while severity of ASD symptoms and anxiety were not significant predictors. Further research is needed to better understand bullying perpetration among children with ASD.

Polygenic risk for mental disorder reveals distinct association profiles across social behaviour in the general population

Many mental health conditions present a spectrum of social difficulties that overlaps with social behaviour in the general population including shared but little characterised genetic links. Here, we systematically investigate heterogeneity in shared genetic liabilities with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD), bipolar disorder (BP), major depression (MD) and schizophrenia across a spectrum of different social symptoms. Longitudinally assessed low-prosociality and peer-problem scores in two UK population-based cohorts (4-17 years; parent- and teacher-reports; Avon Longitudinal Study of Parents and Children(ALSPAC): N ≤ 6,174; Twins Early Development Study(TEDS): N ≤ 7,112) were regressed on polygenic risk scores for disorder, as informed by genome-wide summary statistics from large consortia, using negative binomial regression models. Across ALSPAC and TEDS, we replicated univariate polygenic associations between social behaviour and risk for ADHD, MD and schizophrenia. Modelling variation in univariate genetic effects jointly using random-effect meta-regression revealed evidence for polygenic links between social behaviour and ADHD, ASD, MD, and schizophrenia risk, but not BP. Differences in age, reporter and social trait captured 45-88% in univariate effect variation. Cross-disorder adjusted analyses demonstrated that age-related heterogeneity in univariate effects is shared across mental health conditions, while reporter- and social trait-specific heterogeneity captures disorder-specific profiles. In particular, ADHD, MD, and ASD polygenic risk were more strongly linked to peer problems than low prosociality, while schizophrenia was associated with low prosociality only. The identified association profiles suggest differences in the social genetic architecture across mental disorders when investigating polygenic overlap with population-based social symptoms spanning 13 years of child and adolescent development.

Population-Based Psychiatric Comorbidity in Children and Adolescents With Autism Spectrum Disorder: A Meta-Analysis

Psychiatric comorbidity in autism spectrum disorder (ASD) is a subject of critical scientific importance, affecting the quality of life, prognosis, and functional outcomes. The prevalence of psychiatric disorders vary considerably according to variables such as index subject characteristics, study setting, sampling frame, diagnostic methods used, as well as country of geographic origin. To date, most studies comprise clinical or treatment referral samples in tertiary care or subjects enrolled in clinical trials and genetic cohort collections. Such samples carry the potential for overestimation of both the frequency and severity of psychiatric comorbidity. A systematic literature search was performed using PubMed and Web of Science databases restricted to population-based study publications in the English between May 1, 2015, and May 31, 2020. A comprehensive keyword list was generated to investigate co-occurrence of psychiatric disorders in children and adolescents with ASD. A wide range of DSM-5 based disorders such as anxiety, mood, ADHD, intellectual disability/intellectual developmental disorder, eating/feeding, gender dysphoria and sleep-wake disorders were assessed. Initial search revealed a total of 1674 articles after removal of duplicates. Two independent researchers conducted a parallel-blinded screening process to identify the eligible studies based on titles and abstracts; 39 studies were analyzed in the current review. The main findings show prevalence estimates of 22.9% (95% CI: 17.7- 29.2) for intellectual disability; 26.2% (22-31) for attention-deficit hyperactivity disorder; 11.1% (8.6-14.1) for anxiety disorders; 19.7% (11.9-30.7) for sleep disorders; 7% (5.2- 9.3) for disruptive disorders; 2% (1.3- 3.1) for bipolar disorders; 2.7% (1.8- 4.2) for depression; 1.8% (0.4-8.7) for obsessive-compulsive disorder; and 0.6% (0.3-1.1) for psychosis. Psychiatric comorbidity in population-based studies is lower than in clinical and referred samples. However, our results also indicate that the frequency of psychiatric comorbidity in children and adolescents with ASD in the population context is considerable, without the influence of referral bias implicit in clinical and treatment samples. There is a need for better targeted diagnostic tools to detect psychiatric comorbidity in children and youth in future population-based studies, as an essential component in providing care as well as new insights into the nature and mechanisms of its underlying associations.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234464].

Development and Validation of the Assessment of Bullying Experiences Questionnaire for Neurodivergent Youth

Bullying victimization is a prevalent concern for neurodivergent (e.g., autistic, ADHD) youth. Bullying assessment methods vary widely and there is currently no questionnaire specific to neurodivergent youth. The Assessment of Bullying Experiences (ABE) was created to fill this gap. The ABE questionnaire was completed by 335 parents of school-age youth characterized as autistic, having ADHD, or community comparison. Exploratory and Confirmatory Factor Analysis identified a four-factor solution, aligning with verbal, physical, relational, and cyber victimization. Construct validity analyses indicate the ABE converges with an existing bullying questionnaire and diverges from disruptive behavior or internalizing symptoms. The ABE questionnaire is a valid measure of bullying that furthers understanding of nuance in peer victimization for neurodivergent youth and informs group-specific intervention.

The relationship between social and academic outcomes and anxiety for children and adolescents on the autism spectrum: A systematic review

Anxiety is the most common co-occurring condition in children on the autism spectrum but the potential impacts of anxiety on social and academic outcomes of children on the autism spectrum have not been systematically examined. In this review, 50 studies were identified that explore the relationship between anxiety and scores on social or academic measures in children on the autism spectrum. Social competence was frequently measured, and the findings of these studies were mixed. While other social constructs have received little attention, associations were found between anxiety and victimisation, and anxiety and social relationships. Only three studies focused on the impact of anxiety on scores on academic measures, highlighting the need for further research in this area. Anxiety was most frequently measured using subscales from broader behavioural instruments, which may not capture the range of anxiety symptoms of children on the autism spectrum. Future studies that include multi-informant methodologies and proportional representation of females and children with intellectual disability will further knowledge of the impact of anxiety in children on the spectrum.

Chinese College Students' Knowledge of Autism Spectrum Disorder (ASD) and Social Distance from Individuals with ASD: The Mediating Role of Negative Stereotypes

This study investigated whether negative stereotypes are responsible for the effect of ASD knowledge on social distance from individuals with ASD among college students. A sample of 869 neurotypical Chinese college students completed a cross-sectional survey to assess social distance, ASD knowledge, and negative stereotypes. Pearson correlation analysis yielded significant correlations between social distance, ASD knowledge, and negative stereotypes. Multiple mediation analysis showed that negative stereotypes mediated the link between social distance and ASD knowledge. Specifically, greater ASD knowledge predicted reduced social distance through decreased stereotyping related to dangerousness, personal responsibility for the disorder, and discontinuity, but also predicted greater social distance through increased stereotyping related to social inappropriateness. The findings deepen our understanding of the association between ASD knowledge and social distance by revealing the mediating role of negative stereotypes, and provide information that can help improve anti-stigma initiatives in college settings.

Preventing and improving interactions between autistic individuals and the criminal justice system: A roadmap for research

Researchers have identified that autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. The prevalence of autism spectrum disorder (ASD) is increasing and generating a comprehensive approach to addressing criminal justice system involvement among autistic individuals is a timely and urgent need. Revisions to an established framework generated for use among individuals with mental health diagnoses, the sequential Intercept Model (SIM), were produced by an international consortium of interdisciplinary stakeholders presenting a new opportunity to identify gaps in ASD research and generate preventive solutions across the criminal justice system. The revised SIM maps each criminal justice system component, or Intercept, and includes paths for the experiences of autistic individuals as victims or witnesses to crimes as well as offenders to catalyze new and interdisciplinary research, policy, and practice efforts. As the field of ASD research continues to grow, the revised SIM is a promising pathway to avoiding siloed research approaches, including diverse autistic voices, and contributing to international dialogue about criminal justice reform at a critical juncture. LAY SUMMARY: Autistic individuals are encountering the criminal justice system as victims, offenders, and witnesses at high rates. A revised version of the SIM generated by an international consortium provides a cohesive framework to ensure research focused on this topic extends across the criminal justice system. Preventing and improving interactions between autistic individuals and the criminal justice system is an urgent research, policy, and practice need.

Brief Report: Predictors of School Refusal Due to Bullying in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

Children with Autism Spectrum Disorder (ASD) or Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for bullying victimization. School refusal is a 'red flag' for identification of bullying in children with ASD and/or ADHD. This study examined the impact of diagnoses, demographics, and school variables on school refusal due to bullying. Participants were 97 parents of 154 children with ASD, ADHD, ASD + ADHD, other diagnoses, or no diagnosis. Children with ASD + ADHD were most likely to refuse school due to bullying. Classroom aides and behavior problems were protective and risk factors, respectively. In the final regression model, child diagnosis no longer predicted school refusal. School refusal and problem behavior warrant consideration as a marker of distress for victimized children.

Underlying Thinking Pattern Profiles Predict Parent-Reported Distress Responses in Autism Spectrum Disorder

Appreciating autistic neurodiversity is important when supporting autistic people who experience distress. Specifically, use of a profiling model can reveal less visible autistic differences, including strengths and abilities. Binary logistic regressions showed that the likelihood of extreme distress responses could be interpreted based on parent-reported autistic thinking pattern profiles for 140 young people. Perspective-taking (specifically empathy), extreme demand avoidance, and over-sensory sensitivity each contributed to the combined regression models. From the clinical perspective of autism as a multi-dimensional and inter-connected construct, there may be implications for planning support and building positive self-understanding. Individually tailored adjustments and support strategies may be identified more easily after delineating variables found across four core aspects: sensory coherence, flexible thinking, perspective-taking, and regulation.

Assessment of medical morbidities in a rhesus monkey model of naturally occurring low sociality

People with autism spectrum disorder (ASD) exhibit a variety of medical morbidities at significantly higher rates than the general population. Using an established monkey model of naturally occurring low sociality, we investigated whether low-social monkeys show an increased burden of medical morbidities compared to their high-social counterparts. We systematically reviewed the medical records of N = 152 (n = 73 low-social; n = 79 high-social) rhesus macaques (Macaca mulatta) to assess the number of traumatic injury, gastrointestinal, and inflammatory events, as well as the presence of rare medical conditions. Subjects' nonsocial scores, determined by the frequency they were observed in a nonsocial state (i.e., alone), and macaque Social Responsiveness Scale-Revised (mSRS-R) scores were also used to test whether individual differences in social functioning were related to medical morbidity burden. Medical morbidity type significantly differed by group, such that low-social monkeys incurred higher rates of traumatic injury compared to high-social monkeys. Nonsocial scores and mSRS-R scores also significantly and positively predicted traumatic injury rates, indicating that monkeys with the greatest social impairment were most impacted on this health measure. These findings from low-social monkeys are consistent with well-documented evidence that people with ASD incur a greater number of traumatic injuries and receive more peer bullying than their neurotypical peers, and add to growing evidence for the face validity of this primate model. LAY SUMMARY: People with autism exhibit multiple medical problems at higher rates than the general population. We conducted a comprehensive medical record review of monkeys that naturally exhibit differences in sociality and found that low-social monkeys are more susceptible to traumatic injuries than high-social monkeys. These results are consistent with reports that people with autism also incur greater traumatic injury and peer bullying and add to growing evidence for the validity of this monkey model.

Family and Developmental History of Individuals With Autism Spectrum Disorder: Importance of the Clinical Diagnostic Interview for Diagnosis in Adolescents. An Explorative Study

Background: Diagnosis of autism spectrum disorder (ASD) can be made early in childhood, but also later in adolescence or adulthood. In the latter cases, concerns about an individual's behavior typically lead to consultation of a mental health professional (MHP). As part of the initial clinical examination by the MHP, a clinical diagnostic interview is performed, in order to obtain the patient's history, and may lead to the hypothesis of ASD. We were here interested to study family and developmental history as key parts of the patient's history. The aim of the study was to investigate empirical differences between adolescents with ASD and adolescent control persons in family and developmental history. Method: Clinical diagnostic interview items addressing family and developmental history were adopted from their regular use at several university hospitals and in leading textbooks. Parents of male adolescents with normal intelligence and an ASD diagnosis (n = 67) and parents of male adolescents without psychiatric diagnosis (n = 51) between the age of 12 and 17 years were investigated. Data were operationalized into three categories: 0 = normal behavior, 1 = minor pathological behavior, and 2 = major pathological behavior. Differences were analyzed by multiple t-test of two-way ANOVA. Results: Adolescents with ASD expressed a profile of items significantly differing from control persons. Comparison of significant items with the empirical ASD literature indicated robust accordance. Conclusions: Our findings support the importance and feasibility of the clinical diagnostic interview of family and developmental history for initiation of the diagnostic process of ASD in adolescents.

Chinese Validation of the Multidimensional Attitude Scale toward Persons with Disabilities (MAS): Attitudes toward Autism Spectrum Disorders

The literature on tools of attitudes towards ASD was limited. This study is the first to examine the factor structure and psychometric properties of the multidimensional attitudes scale toward persons with disabilities (MAS) in a sample of Chinese college students (N = 1002, 32.10% males). Confirmatory factor analysis supported the G-MAS-R model's 4-factor structure: calm, negative affect, positive cognitions and behavioral avoidance. The results suggest that the Chinese version of the MAS has satisfactory internal consistency. Pearson correlation analysis showed that the MAS scores were significantly correlated with the Social Distance Scale and Autism Stigma and Knowledge Questionnaire scores. Overall, the findings indicate that the MAS is appropriate for assessing attitudes toward people with ASD in a Chinese context.

Prevalence of and Factors Associated with School Bullying in Students with Autism Spectrum Disorder: A Cross-Cultural Meta-Analysis

Through this meta-analysis, we sought to examine the prevalence of, risks for, and factors associated with bullying involvement (victimization, perpetration, perpetration-victimization) among students with autism spectrum disorder (ASD). Additionally, we attempted to examine sources of variance in the prevalence and effect sizes of bullying in students with ASD across studies. Systematic database and literature review identified 34 relevant studies (31 for Western countries, three for Eastern countries). Pooled prevalence estimates for victimization, perpetration, and perpetration-victimization in general were 67%, 29%, and 14%, respectively. The risk of victimization in students with ASD was significantly higher than that in typically developing students and students with other disabilities. Further, deficits in social interaction and communication, externalizing symptoms, internalizing symptoms, and integrated inclusive school settings were related to higher victimization, and externalizing symptoms were related to higher perpetration. Finally, moderation analyses revealed significant variations in the pooled prevalences thereof depending on culture, age, school settings, and methodological quality and in the pooled effect sizes according to publication year and methodological quality. Our results highlight needs for bullying intervention for students with ASD, especially those who are younger, are in an inclusive school setting, and have higher social difficulties and externalizing/internalizing symptoms; for intensive research of bullying experiences among students with ASD in Eastern countries; and for efforts to improve the methodological quality of such research.

Public Stigma of Autism Spectrum Disorder at School: Implicit Attitudes Matter

This study examines the public stigma of children with autism spectrum disorder (ASD) by their school-aged peers, focusing on both explicit and implicit attitudes. The twofold aims were to provide a broader picture of public stigma and to explore age-related changes in attitudes. Students completed an explicit measure of the public stigma and an implicit measure of attitudes after watching a video displaying children with ASD vs. typically developing (TD) children. Both measures showed more negative perceptions towards children with ASD compared to TD children. However, while explicit attitudes improved with age, implicit attitudes remained constantly negative. This finding suggests that both explicit and implicit attitudes should be considered when promoting an inclusive climate at school.

Risk and Protective Factors for Bullying at 11 Years of Age in a Spanish Birth Cohort Study

(1) Background: Bullying affects a large number of children worldwide. This study has two objectives, to provide data on the prevalence of bullying in Spain, and to identify risk and protective factors associated with bullying. (2) Methods: Participants were 858 eleven-year-old children. Bullying was assessed using a short version of the Olweus Bully Victim Questionnaire, and the following data were gathered to explore potential predictors: individual (inattention, behavior problems, attention deficit hyperactivity disorder symptomatology, traumatic life events), family-related (sociodemographic characteristics, family context, child-parent relations), school-related (school characteristics, peer and social support, school environment) and community-related data. (3) Results: 9.3% of the children were victims, 1.4% bullies and 1.6% bully-victims. Results showed that a higher level of attention deficit hyperactivity disorder symptomatology increased the risk of victimization, whereas having better relationships with parents and stronger social support were associated with a lower risk of victimization. Children having strong peer relationships and social support was also associated with less risk of perpetrating bullying. Finally, having behavior problems at 8 years of age was associated with being a bully-victim. (4) Conclusions: The findings emphasize the importance of studying all bullying predictors together, regarding three of the roles children may take in bullying situations.

Autism Spectrum Disorder Symptoms and Bullying Victimization Among Children with Autism in the United States

Children with autism spectrum disorder (ASD) experience more frequent bullying victimization compared to their neurotypical peers. This study used the 2011 Survey of Pathways to Diagnosis and Services to examine associations between six Children's Social Behavior Questionnaire (CSBQ) subscales and bullying victimization among 1057 children with ASD. Bivariate results showed significant correlations between each CSBQ subscale and more frequent bullying victimization. Yet results from multinomial logistic regression models indicated that after adjusting for all CSBQ subscales and covariates, two of the CSBQ subscales remained significantly associated with greater risk of bullying victimization: not being optimally tuned to the social situation, and resistance to changes. Implications for future research and efforts toward reducing bullying victimization among children with ASD are discussed.

Teacher Harassment Victimization in Adolescents with High-Functioning Autism Spectrum Disorder: Related Factors and Its Relationships with Emotional Problems

This study aimed to examine the prevalence, related factors, and emotional problems associated with teacher harassment victimization in adolescents with autism spectrum disorder (ASD) assessed by self-reports and parent reports. A total of 219 adolescents with ASD participated in this study. The self-reported and parent-reported rates of teacher harassment victimization were calculated. Sociodemographic characteristics, parent-reported social communication deficits, attention-deficit and hyperactivity disorder (ADHD) symptoms, oppositional defiant disorder (ODD) symptoms, self-reported depression and anxiety symptoms, and suicidality were surveyed. In total, 26 (11.9%) adolescents with ASD experienced teacher harassment based on self-reports or parent reports; the convergence between adolescent and parent reports on adolescent experiences of teacher harassment was low. Victims of teacher harassment exhibited more severe social communication deficits and ODD symptoms than nonvictims of teacher harassment. Victims of teacher harassment displayed more severe depression and anxiety and were more likely to have suicidality. Socio-communication deficits and ODD symptoms were related to teacher harassment victimization, which in turn was significantly associated with emotional problems among adolescents with ASD.

School refusal and bullying in children with autism spectrum disorder

BACKGROUND

Few studies have explored school refusal in children with autism spectrum disorder (ASD), despite being considered a serious problem. One of the leading causes of school refusal is bullying, which is defined by the feelings of students who are bullied or not, and psychological suffering caused by a psychological or physical attack. This study investigated the characteristics of school refusal in children with ASD.

METHODS

A total of 94 outpatients with school refusal and ASD and 143 outpatients with school refusal without ASD aged 6-18 years were included. Chi squared tests and Mann-Whitney tests were used to compare the characteristics of school refusal in children with and without ASD. Univariate and multivariate logistic regression analyses were performed to analyze the reasons for school refusal in children with ASD by sex.

RESULTS

School refusal significantly occurred earlier in children with ASD than in those without. In addition, "bullying" was significantly associated with school refusal in both boys and girls with ASD.

CONCLUSIONS

These findings suggest that school refusal should be monitored early in children with ASD. The importance of recognizing bullying among children with ASD should be highlighted as an opportunity for early intervention.

Approaches to Inclusion and Social Participation in School for Adolescents with Autism Spectrum Conditions (ASC)—a Systematic Research Review

This systematic research review identifies approaches of inclusive education concerning adolescents with autism spectrum (ASC) without intellectual disability (ID). The definitions of inclusion, whose perspectives are taken into account, approaches, and the implications suggested for best practices are reviewed in the articles included in this study. The results show how inclusion is defined as a sense of social acceptance and an approach that physical placement in a regular class can lead to social participation. Taking into account students’ perspectives is seen as important. Implications for best practice include information on how to improve school personnel’s reflections on their responsibilities and expectations of students with disabilities and points to difficulties for teachers in meeting the diversity of students in the classroom.

Role of School Bullying Involvement in Depression, Anxiety, Suicidality, and Low Self-Esteem Among Adolescents With High-Functioning Autism Spectrum Disorder

This study aimed to compare the severities of psychopathologies and the level of self-esteem among 219 adolescents with high-functioning autism spectrum disorder (ASD) who were classified into pure perpetrators, pure victims, perpetrator-victims, and neutrals in Taiwan. The experiences of school bullying involvement in the previous 1 year were measured using the Chinese version of the School Bullying Experience Questionnaire. The severities of depression, anxiety, and suicidality were measured using the Center for Epidemiological Studies Depression Scale, the Multidimensional Anxiety Scale for Children, and the 5-item questionnaire from the epidemiological version of the Kiddie Schedule for Affective Disorders and Schizophrenia, respectively. The level of self-esteem was measured using the Rosenberg Self-Esteem Scale. The results indicated that compared with the self-reported neutrals, the self-reported perpetrator-victims and pure victims had more severe depression and anxiety. No difference in depression, suicidality, anxiety, and self-esteem was found among the four groups of various parent-reported bullying involvement experiences. Mental health problems in adolescents with ASD who experienced bullying victimization should be routinely surveyed.

Cyberbullying Victimization and Perpetration in Adolescents with High-Functioning Autism Spectrum Disorder: Correlations with Depression, Anxiety, and Suicidality

The present study examined the associations between cyberbullying involvement and sociodemographic characteristics, autistic social impairment and attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD) symptoms in 219 adolescents with high-functioning autism spectrum disorder (ASD). Moreover, the associations between cyberbullying involvement and depression, anxiety, and suicidality were also examined. Adolescents self-reported higher rates of being a victim or perpetrator of cyberbullying than were reported by their parents. Increased age and had more severe ODD symptoms were significantly associated with being victims or perpetrators of cyberbullying. Being a victim but not a perpetrator of cyberbullying was significantly associated with depression, anxiety, and suicidality. Cyberbullying victimization and perpetration should be routinely surveyed in adolescents with high-functioning ASD.

Self-Reported and Parent-Reported School Bullying in Adolescents with High Functioning Autism Spectrum Disorder: The Roles of Autistic Social Impairment, Attention-Deficit/Hyperactivity and Oppositional Defiant Disorder Symptoms

The aim of this study was to examine the prevalence of self-reported and parent-reported bullying victimization, perpetration, and victimization-perpetration and the associations of autistic social impairment and attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms with bullying involvement in adolescents with high functioning autism spectrum disorder (ASD). A total of 219 adolescents with high functioning ASD participated in this study. The associations of sociodemographic characteristics, parent-reported autistic social impairment, and parent-reported ADHD and ODD symptoms with self-reported and parent-reported bullying victimization, perpetration, and victimization-perpetration were examined using logistic regression analysis. The results found that the agreement between self-reported and parent-reported bullying involvement was low. Compared with bullying involvement experiences reported by adolescents themselves, parents reported higher rates of pure bullying victimization (23.7% vs. 17.8%) and victimization-perpetration (28.8% vs. 9.1%) but a lower rate of pure bullying perpetration (5.9% vs. 9.1%). Deficit in socio-communication increases the risk of being pure victims and victim-perpetrators. Parent-reported victim-perpetrators had more severe ODD symptoms than did parent-reported pure victims.