Living in autistic bodies: bloggers discuss movement control and arousal regulation

'I live in extremes': A qualitative investigation of Autistic adults' experiences of inertial rest and motion

LAY ABSTRACT

'Autistic inertia' is a term used by Autistic people to refer to difficulties with starting and stopping tasks. However, there has not been much research on Autistic inertia. The research that is available on Autistic inertia has mostly focused on the negative aspects of inertia, rather than on the possible benefits of needing to continue tasks. In this research, we wanted to understand more about Autistic people's experiences of inertia and to work out what things might influence these experiences. Autistic and non-Autistic researchers spoke in-depth to 24 Autistic adults. We identified four key ideas from people's responses. Autistic people spoke about their inertial 'difficulties moving from one state to another' and described how these challenges affected them 'every single day'. While they experienced inertia as 'the single most disabling part of being Autistic', people also described the positive aspects of inertia, including the joy they felt when completely immersed in a task. Our Autistic participants emphasised that inertial difficulties are experienced by everyone, the intensity of these task-switching difficulties might be especially challenging for Autistic people. Our findings also reveal how Autistic inertia can be seen both as a disabling and as an enabling condition.

Towards the measurement of autistic burnout

LAY ABSTRACT

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

From "one big clumsy mess" to "a fundamental part of my character." Autistic adults' experiences of motor coordination

Altered motor coordination is common in autistic individuals affecting a range of movements such as manual dexterity, eye-hand coordination, balance and gait. However, motor coordination is not routinely assessed leading to undiagnosed and untreated motor coordination difficulties, particularly in adults. Few studies have investigated motor coordination difficulties and their impact from the viewpoint of autistic people. Therefore, the current study used FGs and thematic analysis to document the experience of motor coordination difficulties from the viewpoint of 17 autistic adults. Four main themes were identified. First, motor coordination difficulties were pervasive and variable, being present life-long and within multiple movements and affecting many aspects of life. Furthermore, the nature of the difficulties was variable within and between participants along with differing awareness of coordination ability. Second, participants described motor coordination as an active process, requiring concentration for most actions and at a level seemingly greater than other people. Third, motor coordination difficulties impacted upon social and emotional wellbeing by placing strain on relationships, prompting bullying and exclusion, putting safety at risk and causing a range of negative emotions. Fourth, in the absence of any support, participants described multiple learning and coping strategies. Findings highlight how it is essential to address the current lack of support for motor coordination considering the significant social and emotional consequences described by our participants. Further investigation of motor learning and interactions between sensory and motor performance in autistic adults is also warranted.

The blind men and the elephant: The case for a transdiagnostic approach to initiation

Difficulty initiating voluntary action is an under-recognized and often invisible impairment in various psychiatric, neurodevelopmental, and neurological conditions. Understanding the commonalities of volition impairments across diagnoses is limited by a lack of consistent terminology, arbitrary distinctions between conditions, the habit of looking only to the prevailing definitions and theories to explain observed traits, and the covert nature of initiation. The siloed approach to research in this area evokes the parable of the blind men and the elephant, where understanding the whole picture is impeded by a limited view. There has been little effort to consider how differing terms overlap or to use objective methods to differentiate phenomena along meaningful lines. We propose a triad of interacting elements, all of which are needed for successful initiation of voluntary action: (i) executive function, (ii) volition, and (iii) movement. Failure to initiate a response may be due to impairments in any of these, which often co-occur. This paper calls for the following considerations to improve research in this area: (i) put aside preconceptions about conditions and their mechanisms to adopt a flexible transdiagnostic approach; (ii) consider executive function, movement, and volition as possible dimensional variations with related underlying mechanisms; (iii) carefully differentiate components of complex functions; (iv) look to first-hand reports for covert and previously unrecognized traits. These approaches have the potential to elucidate the cognitive and biological mechanisms underpinning voluntary action and create a foundation to develop more appropriate and informed interventions.

Autistic preschoolers' engagement and language use in gross motor versus symbolic play settings

Background and aims: Although adjustment of the environment is recommended as a support strategy in evidence-based interventions for children with autism, the impact of doing so (and the how and why) is not well understood. One essential environmental factor to consider when providing supports for preschool-aged autistic children is the play setting, specifically, the materials available in the child's play context. The aim of this study was to compare engagement states and number of utterances produced by preschool-aged autistic children within symbolic vs. gross motor play settings. Examining the relationship between gross motor play settings and children's social engagement and spoken language use is particularly important to explore for autistic children given differences in their sensory processing, motor skill development, and choice of and interaction with toys relative to neurotypical peers. Methods: Seventy autistic children aged 25-57 months were videotaped during natural play interactions with a parent. Children's social engagement and number of spoken utterances were examined in five minutes each of play with symbolic toys and play with gross motor toys. Continuous time-tagged video coding of the child-caregiver engagement states was conducted, and the child's frequency of spoken language was identified using language sample analysis. The specific variables examined were; (a) engagement with caregiver, (b) engagement with objects only, (c) unengaged (no evident engagement with objects or people), and (d) total number of spoken utterances. The relationship between play setting (symbolic vs gross motor) and child language and engagement state variables was examined with linear mixed effects modelling. Results: Significant main effects were revealed for the interaction between play setting and autistic children's engagement. Young autistic children were more likely to engage with caregivers in play environments with gross motor toys (moderate effect) and also were more likely to have periods of unengaged time (not overtly directing their attention to objects or people; small effect) in this setting. Further, when in a setting with symbolic toys, autistic children were more likely to spend their time focusing attention solely on objects (large effect). No interaction was found between play setting and total number of utterances spoken by autistic children. Conclusions and implications: This study confirmed the importance of continued research focused on understanding the relationship between children's play settings and their social engagement and language use. Although preliminary, findings support the idea that there is an interaction between preschool-aged autistic children's social engagement and their play settings. Further, our results suggest that there can be value in clinicians differentiating children's play settings (i.e., gross motor vs symbolic) when assessing and supporting social engagement capacities of young autistic children.

What I Wish You Knew: Insights on Burnout, Inertia, Meltdown, and Shutdown From Autistic Youth

Introduction: Burnout, inertia, meltdown, and shutdown (BIMS) have been identified as important parts of some autistic people's lives. This study builds on our previous work that offered early academic descriptions of these phenomena, based on the perspectives of autistic adults. Objectives: This study aimed to explore the unique knowledge and insights of eight autistic children and youth to extend and refine our earlier description of burnout, inertia, and meltdown, with additional exploration of shutdown. We also aimed to explore how these youth cope with these phenomena and what others around them do that make things better or worse, with a hope to glean knowledge to design better supports. Methods: One-to-one interviews were conducted with eight children and youth, who shared their experience with BIMS. To match individual communication strengths of children and youth, we took a flexible approach to interviews, allowing for augmentative communication systems and use of visual images to support verbal interviews, as needed. We conducted a reflexive, inductive thematic analysis, using an iterative process of coding, collating, reviewing, and mapping themes. Findings: Our analysis has identified that these youth describe BIMS as a multi-faceted experience involving emotional, cognitive and physical components. Moreover, these multifaceted experiences are often misunderstood by neurotypical adults, which contributes to inadequate support in managing BIMS. Of the four experiences, these youth identified meltdowns as most common. Conclusion: By gaining first-hand perspectives, we have identified novel insights into BIMS and developed a more holistic understanding of these phenomena. These youths' descriptions of supportive strategies for BIMS stress the importance of compassion and collaboration from trusted adults. This new knowledge will provide a foundation for how to better support autistic children and youth. Further research is required to develop an understanding of BIMS, especially with respect to how it is experienced by children and youth. Future research should leverage the insights and experiential knowledge of autistic children and youth to co-design support tool(s) for BIMS.

"Unheard minds, again and again": autistic insider perspectives and theory of mind

PURPOSE

The Theory of Mind (ToM) deficit hypothesis is a dominant construct used to explain the social and communication difficulties observed in autistic individuals. This hypothesis was based on an interpretation of autistic individuals' observable behavior, not based on insider accounts. Insider perspectives still remain mostly absent in research on ToM. We aimed to gain an understanding of the relevance and applicability of ToM by examining writings of autistic bloggers.

METHODS

As part of a series of studies examining insider autistic perspectives, we used a descriptive qualitative approach and conducted a thematic analysis of content scraped from 40 blogs written by autistic authors.

RESULTS

The blogs offered important perspectives on the applicability of ToM to autistic individuals. The primary themes reflected empirical contradictions to ToM, explicit critiques of ToM, and pointed to ToM as a source of harm.

CONCLUSION

The insider perspectives call into question the ways clinicians, researchers, and society use ToM to understand autistic individuals and point to the harmful effects of ToM on autistic lived experience. These findings emphasize the importance of attending to autistic people in building a body of knowledge that better reflects autistic experiences and promotes more effective and ethical clinical practices.Implications for RehabilitationOur paper indicates the need for a timely and thorough re-evaluation of the ToM deficit hypothesis of autism.Autistic insider perspectives not only empirically demonstrate and explicitly critique the ToM deficit hypothesis, but reveal the hypothesis as harmful to autistic experience by reinforcing negative stereotypes, prompting acts of discrimination, and perpetuating autistic insider's exclusion from the research concerning them.Given the varied experiences of autistic people and the harmful impacts of the ToM deficit hypothesis, it is safer for clinicians and researchers to presume a presence of ToM and empathy, before they presume a deficit in autistic individuals.Autistic insiders are able, eager, and deserve to be included in the research and practices that concern them.

"No Way Out Except From External Intervention": First-Hand Accounts of Autistic Inertia

This study, called for by autistic people and led by an autistic researcher, is the first to explore ‘autistic inertia,’ a widespread and often debilitating difficulty acting on their intentions. Previous research has considered initiation only in the context of social interaction or experimental conditions. This study is unique in considering difficulty initiating tasks of any type in real life settings, and by gathering qualitative data directly from autistic people. Four face-to-face and 2 online (text) focus groups were conducted with 32 autistic adults (19 female, 8 male, and 5 other), aged 23–64 who were able to express their internal experiences in words. They articulate in detail the actions they have difficulty with, what makes it easier or harder to act, and the impact on their lives. Thematic analysis of the transcripts found four overarching themes: descriptions of inertia, scaffolding to support action, the influence of wellbeing, and the impact on day-to-day activities. Participants described difficulty starting, stopping and changing activities that was not within their conscious control. While difficulty with planning was common, a subset of participants described a profound impairment in initiating even simple actions more suggestive of a movement disorder. Prompting and compatible activity in the environment promoted action, while mental health difficulties and stress exacerbated difficulties. Inertia had pervasive effects on participants’ day-to-day activities and wellbeing. This overdue research opens the door to many areas of further investigation to better understand autistic inertia and effective support strategies.