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McCauley JB, Clarke EB, Schiltz HK, Lord C. Trajectories of positive affect in autistic individuals during the transition to adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241263902. [PMID: 39056304 DOI: 10.1177/13623613241263902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
LAY ABSTRACT Recent research has revealed informative patterns about health, mental health, self-help skills, autism symptoms, and social skills during the transition to adulthood for autistic individuals. This study expands on these findings by examining how positive affect (e.g. excited) changes from age 15 to 30 years using a group of individuals first referred for autism at an early age. We also examined the agreement between caregiver-report and self-report on positive affect. We found different patterns of stability and change in positive affect across the transition to adulthood that related to differences in autism severity, cognitive abilities, self-help skills, as well as social and work participation in adulthood. The agreement between caregiver-report and self-report was strong in adolescence but became much weaker after the individuals were 23 years. These results have implications for how we measure happiness, positive emotions, or other internal experiences of autistic individuals.
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Øverland E, Hauge ÅL, Orm S, Øie MG, Skogli EW, Pellicano E, Andersen PN. "I have to charge my social battery": Perspectives from autistic young adults on Quality of Life. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1369-1381. [PMID: 38629698 DOI: 10.1177/13623613241245578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
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.
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Affiliation(s)
- Elisabeth Øverland
- Innlandet Hospital Trust, Norway
- Inland Norway University of Applied Sciences, Norway
| | | | - Stian Orm
- Innlandet Hospital Trust, Norway
- Inland Norway University of Applied Sciences, Norway
| | | | - Erik Winther Skogli
- Innlandet Hospital Trust, Norway
- Inland Norway University of Applied Sciences, Norway
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Spackman E, Geng A, Smillie LD, Frazier TW, Hardan AY, Alvarez GA, Whitehouse A, Schuck RK, Leekam SR, Uljarević M. Characterising Insistence on Sameness and Circumscribed Interests: A Qualitative Study of Parent Perspectives. J Autism Dev Disord 2024:10.1007/s10803-024-06404-4. [PMID: 38809473 DOI: 10.1007/s10803-024-06404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
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.
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Affiliation(s)
- Emily Spackman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA.
| | - Alicia Geng
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA
| | - Luke D Smillie
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Thomas W Frazier
- Department of Psychology, John Carroll University, University Heights, OH, USA
| | - Antonio Y Hardan
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA
| | | | | | | | - Sue R Leekam
- School of Psychology, Cardiff University, Cardiff, UK
| | - Mirko Uljarević
- Child & Adolescent Psychiatry and Child Development, Stanford University, Stanford, CA, USA
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Williams GL, Ellis R, Holloway W, Caemawr S, Craine M, Williams K, Grant A. 'Building our own house' as an insider-only Community-Partnered Participatory Research Council: Co-creating a safe space for Autistic knowledge production. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241253014. [PMID: 38757637 DOI: 10.1177/13623613241253014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
LAY ABSTRACT In recent years, there has been a growing call for participatory Autism research (i.e. research that meaningfully involves Autistic people in its design and delivery). Community Partnered Participatory Research is a research methodology that aims to share power between researchers and members of the researched community. There is some precedent for Community Partnered Participatory Research in Autism research, but it is still quite uncommon. At the start of our new research study (called Autism: From Menstruation to Menopause), we created a community council. For the first six meetings, our council was made up of four Autistic community members who were experienced in Autism advocacy and activism and three Autistic researchers. We seven are the authors of this article. In these first six meetings, we made plans for recruiting a larger number of lay community members who would join us later for the rest of the project (8 years in total). In this article, we describe and reflect what it felt like during these first six meetings to be part of a community research council where everybody is Autistic. We discuss how we co-created a safe space, how we helped each other feel valued and how we worked together to support each other's sometimes-differing access needs so that everyone could fully participate. We provide recommendations for how to support Autistic people to lead research on their own terms with their unique insights.
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Affiliation(s)
| | | | - Willow Holloway
- Swansea University, UK
- Autistic UK, UK
- Fair Treatment for the Women of Wales, UK
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Van den Bergh BRH, Antonelli MC, Stein DJ. Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation. Curr Opin Psychiatry 2024; 37:237-250. [PMID: 38415742 DOI: 10.1097/yco.0000000000000932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health. RECENT FINDINGS (1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse. SUMMARY During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.
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Affiliation(s)
| | - Marta C Antonelli
- Laboratorio de Programación Perinatal del Neurodesarrollo, Instituto de Biología Celular y Neurociencias "Prof.E. De Robertis", Facultad de Medicina. Universidad de Buenos Aires, Buenos Aires, Argentina
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Munich, Germany
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Patten KK, Murthi K, Onwumere DD, Skaletski EC, Little LM, Tomchek SD. Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan. Am J Occup Ther 2024; 78:7803397010. [PMID: 38758762 DOI: 10.5014/ajot.2024.078301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. OBJECTIVE These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. METHOD These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. RESULTS A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.
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Affiliation(s)
- Kristie K Patten
- Kristie K. Patten, PhD, OT/L, FAOTA, is Counselor to the President and Professor, Department of Occupational Therapy, New York University, New York, NY
| | - Kavitha Murthi
- Kavitha Murthi, MSc(OT), FHEA(UK), OTR, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Dora D Onwumere
- Dora D. Onwumere, MS, OTR/L, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Emily C Skaletski
- Emily C. Skaletski, MOT, OTR/L, is PhD Candidate, Department of Kinesiology, University of Wisconsin-Madison
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, FAOTA, is Associate Dean of Research, College of Health Sciences, and Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, School of Medicine, University of Louisville, Louisville, KY
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Pugliese CE, Handsman R, You X, Anthony LG, Vaidya C, Kenworthy L. Probing heterogeneity to identify individualized treatment approaches in autism: Specific clusters of executive function challenges link to distinct co-occurring mental health problems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241246091. [PMID: 38642028 DOI: 10.1177/13623613241246091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
LAY ABSTRACT Many autistic people struggle with mental health problems like anxiety, depression, inattention, and aggression, which can be challenging to treat. Executive function challenges, which impact many autistic individuals, may serve as a risk factor for mental health problems or make treating mental health conditions more difficult. While some people respond well to medication or therapy, others do not. This study tried to understand if there are different subgroups of autistic young people who may have similar patterns of executive function strengths and challenges-like flexibility, planning, self-monitoring, and emotion regulation. Then, we investigated whether executive function subgroups were related to mental health problems in autistic youth. We found three different types of executive function subgroups in autistic youth, each with different patterns of mental health problems. This helps us identify specific profiles of executive function strengths and challenges that may be helpful with identifying personalized supports, services, and treatment strategies for mental health conditions.
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Yoon WH, Seo J, Je C. Korean autistic persons facing systemic stigmatization from middle education schools: daily survival on the edge as a puppet. Front Psychiatry 2024; 15:1260318. [PMID: 38606409 PMCID: PMC11007699 DOI: 10.3389/fpsyt.2024.1260318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/22/2024] [Indexed: 04/13/2024] Open
Abstract
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.
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Affiliation(s)
- Wn-ho Yoon
- Korean Research Center for Guardianship and Trusts, Hanyang University, Seongdong-gu, Seoul, Republic of Korea
| | - JaeKyung Seo
- Korean Research Center for Guardianship and Trusts, Hanyang University, Seongdong-gu, Seoul, Republic of Korea
- Social Welfare Institute, Sungkonghoe University, Guro-Gu, Seoul, Republic of Korea
| | - Cheolung Je
- Korean Research Center for Guardianship and Trusts, Hanyang University, Seongdong-gu, Seoul, Republic of Korea
- School of Law, Hanyang University, Seoul, Republic of Korea
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Keates N, Martin F, Waldock KE. Autistic People's Perspectives on Functioning Labels and Associated Reasons, and Community Connectedness. J Autism Dev Disord 2024:10.1007/s10803-024-06316-3. [PMID: 38507152 DOI: 10.1007/s10803-024-06316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE Functioning labels have been used in relation to autistic people and differentiating between support needs. The main purpose of our study was to identify perspectives regarding language about being autistic. In regard to themselves and functioning. Furthermore, we investigated the influential factor of community connectedness on use of language acceptability and functioning labels. METHODS 516 autistic respondents completed our survey. We asked about demographic characteristics, how respondents would like autistic people to be termed in the survey, and their acceptability (person with autism, Aspergers, disorder, conditions, living with autism, autistic). We also asked about respondents? Autistic Community Connectedness, acknowledging the implicit nature of language and identity (Stets & Serpe in New directions in identity theory and research, Oxford University Press, 2016). The main focus of our survey was whether or not to use functioning labels, and the supporting rationale. RESULTS 97% of respondents stated that they find the term 'autistic' acceptable. Respondents who did see merit in using functioning labels to describe autistic people also reported not necessarily using them about themselves. Community membership was found to impact the participants' language preferences to describe the support needs of autistic people, including the use of functioning labels. CONCLUSION The proposed best option for language preferences is not to find consensus but instead, opt for the optimal choice that people find the least offensive or disagreeable. This means using identity-first language and not using functioning labels.
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Affiliation(s)
- Nathan Keates
- University of Sunderland in London, 197 Marsh Wall, Docklands, London, E14 9SG, UK.
| | - Farradeh Martin
- School of History, University of Kent, Canterbury, Kent, CT2 7NZ, UK
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Pellicano E, Adams D, Crane L, Hollingue C, Allen C, Almendinger K, Botha M, Haar T, Kapp SK, Wheeley E. Letter to the Editor: A possible threat to data integrity for online qualitative autism research. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:786-792. [PMID: 37212144 DOI: 10.1177/13623613231174543] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
LAY ABSTRACT Doing research online, via Zoom, Teams, or live chat, is becoming more and more common. It can help researchers to reach more people, including from different parts of the world. It can also make the research more accessible for participants, especially those with different communication preferences. However, online research can have its downsides too. We have recently been involved in three studies in which we had in-depth discussions with autistic people and/or parents of autistic children about various topics. It turns out, though, that some of these participants were not genuine. Instead, we believe they were "scammer participants": people posing as autistic people or parents of autistic children, possibly to gain money from doing the research. This is a real problem because we need research data that we can trust. In this letter, we encourage autism researchers to be wary of scammer participants in their own research.
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Clarke EB, McCauley JB, Lutz A, Gotelli M, Sheinkopf SJ, Lord C. Understanding profound autism: implications for stigma and supports. Front Psychiatry 2024; 15:1287096. [PMID: 38317766 PMCID: PMC10839016 DOI: 10.3389/fpsyt.2024.1287096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Introduction Societal perceptions and lack of understanding of autism spectrum disorder can be stigmatizing for autistic individuals and their families. This may be particularly the case for individuals who meet criteria for profound autism. Despite the considerable service needs of this marginalized group, there is little data on the prevalence of profound autism, nor on the experiences of those with profound autism and their families. Methods The current study leveraged a mixed-methods approach to address these gaps. First, the prevalence of profound autism was examined in six samples-three from the United States and three from Western Europe. Second, inductive thematic analysis was used to code interviews from 20 caregivers of profoundly autistic adults. Results The prevalence of profound autism varied widely across the six samples-from 11% to 48%. There were also notable differences between samples in prevalence by gender, race, and ethnicity. Two overarching themes were identified via inductive thematic analysis: Community Perceptions of Autism and Family Support Needs and Advocacy Challenges. Though caregivers were not directly asked about stigmatization during interviews, 85% of caregivers reported at least one instance of perceived stigma. Discussion Future research should continue to examine the unique needs and stigmatization experiences of profoundly autistic individuals and their families across the life course.
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Affiliation(s)
- Elaine B. Clarke
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - James B. McCauley
- Department of Psychology, St. Mary’s College of California, Moraga, CA, United States
| | - Amy Lutz
- Department of History and Sociology of Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Marina Gotelli
- Fundación Brincar por un Autismo Feliz, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas Y Técnicas, Buenos Aires, Argentina
| | - Stephen J. Sheinkopf
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, United States
| | - Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Cage E, Botha M, McDevitt L, King KN, Biscoe L, Tucker K, Pearson A. Diagnosis as a new beginning not an end: A participatory photovoice study on navigating an autism diagnosis in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613231220418. [PMID: 38230649 DOI: 10.1177/13623613231220418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
LAY ABSTRACT Lots of people seek an autism diagnosis as an adult, and they often say that being diagnosed can be positively life-changing, but the experience of getting a diagnosis can be difficult. We often do not hear the views of people currently looking for a diagnosis, or talk to them about how diagnosis relates to their identity. In our study, we looked at experiences of people currently seeking an autism diagnosis in the UK. We used participatory methods, where six people seeking diagnosis were included as collaborators in the research. They took part in four different sessions, where they helped to shape the research, took part in interviews about their experiences and helped to analyse the patterns in all the interviews. We also used something called photovoice during the interviews, where they could use photos to show how they felt about navigating a diagnosis. We identified four common themes: (1) everyone had experienced some form of crisis before seeking diagnosis; (2) when they realised they were autistic, they felt seen; (3) the diagnostic process and criteria were not working, and they felt judged by clinicians and (4) there was limited support available after diagnosis. In another session, we identified actions that need to be taken which have implications for policy and practice, including improving the diagnostic process and criteria with autistic people, autistic people being listened to more by people like general practitioners and clinicians and diagnosis services needing to be more flexible and appreciate different aspects of someone's identity and neurodivergence.
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Onovbiona H, Quetsch L, Bradley R. Racial and Practical Barriers to Diagnostic and Treatment Services for Black Families of Autistic Youth: A Mixed-Method Exploration. J Autism Dev Disord 2023:10.1007/s10803-023-06166-5. [PMID: 38038872 DOI: 10.1007/s10803-023-06166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/02/2023]
Abstract
The present study explored the role race-related barriers and practical barriers to treatment participation play in treatment effectiveness and satisfaction among Black families with autistic youth using a mixed-method approach. In a sample of Black caregivers with autistic youth (N = 101), multiple regressions were conducted to examine the impact of reported racial and practical barriers on parental stress, treatment effectiveness, and treatment satisfaction. Caregivers provided further narratives on their experience navigating diagnostic and treatment services in qualitative interviews. The study demonstrated that Black caregivers of autistic youth are still encountering several racial and logistical barriers when seeking treatment and diagnostic services for their children. These barriers negatively impact caregiver stress and caregiver perceived treatment quality. Contrary to the barriers and stress experienced by Black caregivers, caregivers are generally satisfied with the treatments they are utilizing and find them helpful. The narratives told by caregivers further elucidate the tumultuous experiences of Black caregivers as they seek diagnostic and treatment services for their children. An experience that may be worsened by family, professional, and systemic barriers, and can be improved by advocacy, acceptance, peer and community support, and increased knowledge. Black families of autistic youth call for increased compassion, support, training, and humility among professionals who serve autistic youth.
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Maggio R, Turriziani L, Campestre C, Di Cara M, Tripodi E, Impallomeni C, Quartarone A, Passantino C, Cucinotta F. An individual-supported program to enhance placement in a sheltered work environment of autistic individuals mostly with intellectual disability: a prospective observational case series in an Italian community service. Front Psychiatry 2023; 14:1225236. [PMID: 38025472 PMCID: PMC10651717 DOI: 10.3389/fpsyt.2023.1225236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/22/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Autism spectrum disorder is a lifelong neurodevelopmental disorder. The profile of functioning in autistic people is very heterogeneous, and it is necessary to take into account individual characteristics to better support integration in the workplace. However, unemployment rates are higher for autistic people than for other types of disabilities. We present a prospective case series to explore the feasibility and efficacy of an individual-supported program to enhance placement in a sheltered work environment delivered by an Italian community day care center. Methods Autistic subjects, aged from 12 to 31 years, participated in an individual-supported program regarding employment in sheltered art workshops, integrated into the regular activity of a semi-residential center three times a week for 1 year. Their feasibility retention rate and time worked per session were registered; moreover, working methods efficacy and self-organization improvement were tracked by the Likert-based rating system. Secondary outcome measures span functional levels, challenge behaviors, and sensory problems. Results All the individuals presented a good adaptation to the environment, with a significant increase in time worked per session. After 1 year, the intervention allowed an increase in tasks completed in an assigned complex job and an improvement in self-organization within the work schedule in a group of subjects consisting mainly of severe-to-moderate levels of autism severity (86.6%). Finally, we observed a significant increase in independent functioning areas of the TEACCH transitional assessment profile. Challenge behaviors and sensory problems were also recorded. Conclusion This case series supports the idea that individual-supported programs for placement in sheltered job environments delivered by community day care centers could be feasible and effective for ASD with higher levels of severity and co-occurring intellectual disability. Further targeted studies based on community models and accessible methods need to be planned to define the effectiveness of the intervention and promote improved practice at the community level with a better social impact.
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Affiliation(s)
- Roberta Maggio
- Center for Autism “Dopo di noi”, Barcellona Pozzo di Gotto, Messina, Italy
| | - Laura Turriziani
- Center for Autism “Dopo di noi”, Barcellona Pozzo di Gotto, Messina, Italy
- Unit of Child Neurology and Psychiatry, Department of Human Pathology of the Adult and Developmental Age, “Gaetano Barresi” University of Messina, Messina, Italy
| | - Caterina Campestre
- Center for Autism “Dopo di noi”, Barcellona Pozzo di Gotto, Messina, Italy
| | | | | | | | | | - Claudio Passantino
- Center for Autism “Dopo di noi”, Barcellona Pozzo di Gotto, Messina, Italy
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15
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Kripke-Ludwig R. "Profound Autism" Label Does Not Predict Strengths or Help Plan Supports. Public Health Rep 2023; 138:849-850. [PMID: 37732335 PMCID: PMC10576471 DOI: 10.1177/00333549231199480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- Rachel Kripke-Ludwig
- Academic Autism Spectrum Partnership in Research and Education, Portland, OR, USA
- CommunicationFIRST, Washington, DC, USA
- Open Mind School, Menlo Park, CA, USA
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16
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Poulsen R, Dwyer P, Gassner D, Heyworth M, Williams ZJ. The INSAR Community Collaborator Request: Using community-academic partnerships to enhance outcomes of participatory autism research. Autism Res 2023; 16:2071-2076. [PMID: 37688487 DOI: 10.1002/aur.3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 08/21/2023] [Indexed: 09/11/2023]
Abstract
Participatory approaches, in which researchers work together with members of the autism community (e.g., autistic people, family members, caregivers, or other stakeholders) to design, conduct, and disseminate research, have become increasingly prominent within the field of autism research over the past decade. Despite growing academic and community interest in conducting participatory studies, stakeholder collaboration remains infrequent in autism research, at least partially due to systemic barriers. To help reduce barriers to engaging in participatory autism research, the International Society for Autism Research (INSAR) Autistic Researchers Committee has launched the INSAR Community Collaborator Request (ICCR; https://www.autism-insar.org/page/iccr), a platform on the INSAR website that allows autism researchers conducting participatory research to seek out stakeholder collaborators from the autism community (including both autistic people and their family members/caregivers, as relevant to a given research project). Interested stakeholders also have the opportunity to subscribe to ICCR posts, allowing them to be alerted of new opportunities for collaboration and potentially increasing their involvement in autism research. Overall, the ICCR provides a venue to connect autism researchers with potential community collaborators, reducing barriers to participatory autism research and increasing the frequency of successful community-academic partnerships within the field. We are hopeful that in the long term, such changes will lead to greater alignment between research outputs and the goals of the greater autism community, and consequently an increase in the overall quality and relevance of autism research.
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Affiliation(s)
- Rebecca Poulsen
- Macquarie University Hearing, Department of Linguistics, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Reframing Autism, St Leonards, New South Wales, Australia
| | - Patrick Dwyer
- Center for Mind and Brain, University of California Davis, Davis, California, USA
- Department of Psychology, University of California Davis, Davis, California, USA
- MIND Institute, UC Davis Health, Sacramento, California, USA
| | - Dena Gassner
- School of Social Work, Adelphi University, Garden City, New York, USA
- Department of Health Sciences, Towson University, Towson, Maryland, USA
| | - Melanie Heyworth
- Reframing Autism, St Leonards, New South Wales, Australia
- Macquarie School of Education, Macquarie University, Sydney, New South Wales, Australia
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, Tennessee, USA
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Gardner L, Gilchrest C, Campbell JM. Intellectual, Adaptive, and Behavioral Functioning Associated with Designated Levels of Support in a Sample of Autistic Children Referred for Tertiary Assessment. J Autism Dev Disord 2023:10.1007/s10803-023-06141-0. [PMID: 37815671 DOI: 10.1007/s10803-023-06141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
The diagnostic criteria for autism spectrum disorder in the DSM-5-TR features the option to designate levels of support for social communication (SC) and restricted, repetitive behaviors (RRB). These levels are conceptual in nature, but research indicates standardized assessment outcomes correspond with clinician-assigned levels of support. The purpose of the present study was to identify factors that influence designated levels of support for SC and RRBs when diagnosing autism. Standardized assessment scores across intellectual functioning, adaptive skills, and ASD symptomology were analyzed to determine corresponding levels of support in SC and RRBs assigned by clinicians for 136 autistic children following a comprehensive diagnostic evaluation. At diagnosis, approximately 46% of participants were described as needing substantial support (Level 2) for SC and 49% were described as needing substantial support (Level 2) for RRB. There was a consistent pattern of higher to lower intellectual and adaptive functioning needing Level 1-Level 3 support. Autism assessment results followed a gradient of fewer to greater autism symptoms from Level 1 to Level 3 support. Findings indicated clinician-assigned levels of support for SC and RRB were associated with intellectual functioning, adaptive functioning, autism symptomology, and age, but not sex.
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Affiliation(s)
- Lauren Gardner
- Department of Psychology, Johns Hopkins All Children's Hospital, 880 6th Street South, Suite 420, St. Petersburg, FL, 33701, USA.
| | - Callie Gilchrest
- Department of Psychology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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18
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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19
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Bottema-Beutel K, Kapp SK, Sasson N, Gernsbacher MA, Natri H, Botha M. Anti-ableism and scientific accuracy in autism research: a false dichotomy. Front Psychiatry 2023; 14:1244451. [PMID: 37743979 PMCID: PMC10514488 DOI: 10.3389/fpsyt.2023.1244451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
It was recently argued that autism researchers committed to rejecting ableist frameworks in their research may sacrifice "scientifically accurate" conceptualizations of autism. In this perspective piece, we argue that: (a) anti-ableism vs. scientific accuracy is a false dichotomy, (b) there is no ideology-free science that has claim to scientific accuracy, and (c) autism science has a history of false leads in part because of unexamined ableist ideologies that undergird researcher framings and interpretations of evidence. To illustrate our claims, we discuss several avenues of autism research that were promoted as scientific advances, but were eventually debunked or shown to have much less explanatory value than initially proposed. These research programs have involved claims about autism etiology, the nature of autism and autistic characteristics, and autism intervention. Common to these false leads have been ableist assumptions about autism that inform researcher perspectives. Negative impacts of this work have been mitigated in some areas of autism research, but these perspectives continue to exert influence on the lives of autistic people, including the availability of services, discourses about autism, and sociocultural conceptualizations of autistic people. Examining these false leads may help current researchers better understand how ableism may negatively influence their areas of inquiry. We close with a positive argument that promoting anti-ableism can be done in tandem with increasing scientific accuracy.
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Affiliation(s)
- Kristen Bottema-Beutel
- Lynch School of Education and Human Development, Boston College, Boston, MA, United States
| | - Steven K. Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Noah Sasson
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, United States
| | | | - Heini Natri
- The Translational Genomics Research Institute, Phoenix, AZ, United States
| | - Monique Botha
- Psychology Department, Stirling University, Stirling, United Kingdom
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20
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Rivera RA, Bennetto L. Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people. Front Psychiatry 2023; 14:1243657. [PMID: 37743980 PMCID: PMC10511883 DOI: 10.3389/fpsyt.2023.1243657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.
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Affiliation(s)
- Rachel A. Rivera
- Department of Psychology, University of Rochester, Rochester, NY, United States
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21
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Woods R, Williams K, Watts C. "Profound autism": The dire consequences of diagnostic overshadowing. Autism Res 2023; 16:1656-1657. [PMID: 37583296 DOI: 10.1002/aur.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Richard Woods
- School of Law and Social Sciences, London South Bank University, London, UK
| | - Kathryn Williams
- School of Social Sciences, Cardiff University, Cardiff, UK
- Autistic UK CIC, Llandudno, UK
| | - Courtney Watts
- College of Human & Social Futures, The University of Newcastle, Newcastle, New South Wales, Australia
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22
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Kover ST, Abbeduto L. Toward Equity in Research on Intellectual and Developmental Disabilities. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:350-370. [PMID: 37644865 PMCID: PMC10786180 DOI: 10.1352/1944-7558-128.5.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/19/2022] [Indexed: 08/31/2023]
Abstract
Lack of diversity in IDD research is typically conceptualized only in terms of (1) recruitment of samples that do not appropriately represent the sociodemographics of the population, or (2) the limited number of researchers from historically marginalized backgrounds. Critically, the field also suffers from over-reliance on perspectives and social systems of dominant culture-both in how disability is regarded and in relation to other dimensions of identity and culture. These lenses lead to research findings that reinforce, rather than reduce, social inequities. We propose a framework that minimizes reliance on diagnostic categories, shifts from deficit- to person-centered models, acknowledges people's multiple identities, and includes self-advocates and diverse communities as partners in the research enterprise. The systems change necessary to support this framework is described.
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23
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Tan DW. Early-Career Autism Researchers Are Shifting Their Research Directions: Tragedy or Opportunity? AUTISM IN ADULTHOOD 2023; 5:218-224. [PMID: 37663448 PMCID: PMC10468548 DOI: 10.1089/aut.2023.0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Early-career researchers (ECRs) are among the most creative, talented, and energetic researchers, and they play an important role in knowledge production and pushing scientific boundaries. Recent debates have implied that many early-career autism researchers are compelled to shift their areas of focus within autism research as a consequence of their work being scrutinized by the autistic and autism communities. In this Perspective, I draw on my own experience as an early-career autism researcher having recently pivoted my research focus to become more aligned with community priorities. I reflect on whether these putative shifts in research direction are, indeed, a tragedy, as has previously been suggested, or, in fact, an opportunity for autism researchers. I argue that pivoting in research is a demonstration of science adapting to the ever-evolving needs in society and changes in our understanding of neurodiversity, neurodivergence, and research methods. While disagreements between the autistic, autism, and research communities may well feel uncomfortable, these tensions also present an opportunity for us-as non-autistic autism researchers-to reflect and to act toward building trust with the community. I recommend three areas for reflections: the purpose of our research, our position of power, and the epistemic limits of our academic expertise. I end by encouraging ECRs to consider taking actions, however small, to lead the charge in improving practices in autism research.
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Affiliation(s)
- Diana Weiting Tan
- Macquarie School of Education, Macquarie University, Sydney, Australia
- School of Psychological Science, The University of Western Australia, Perth, Australia
- Telethon Kids Institute, Perth, Australia
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24
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Clark T, Jung JY, Roberts J, Robinson A, Howlin P. The identification of exceptional skills in school-age autistic children: Prevalence, misconceptions and the alignment of informant perspectives. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:1034-1045. [PMID: 37157995 DOI: 10.1111/jar.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/30/2023] [Accepted: 04/26/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Although autism is commonly described in terms of deficits, many autistic individuals have been found to demonstrate exceptional skills. The shift to a strengths-based approach in the field of autism necessitates increased understanding of these skills. AIMS This study examined (1) rates of exceptional skills in autistic school-age children as reported by parents and teachers, (2) associations between exceptional skills, autism severity and intellectual disability and (3) correlations between parent and teacher reports of exceptional skills. METHOD Parents and teachers of 76 children attending autism-specific schools in Australia completed online questionnaires. Thereafter, 35 parents and teachers who identified their child as having one or more exceptional skills were interviewed by a clinical psychologist. RESULTS Forty parents (53%) and 16 (21%) teachers reported that their child had at least one exceptional skill (agreement between the parent and teacher reports was low; κ = .03, p = .74). In comparison, clinical psychologist assessments identified 22 children (29%) as having at least one such skill. No statistically significant relationships were identified between exceptional skills, autism severity and intellectual disability. CONCLUSION While different exceptional skills were identified, regardless of children's intellectual functioning or autism severity, parents and teachers varied substantially in their evaluations of these skills. Furthermore, the identified prevalence rates of exceptional skills did not always align with the rates identified in previous studies. The study findings highlight the need for definitional consensus on different types of exceptional skills, and the importance of multiple criteria/multi-instrument approaches in the identification of exceptional skills in autistic children.
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Affiliation(s)
- Trevor Clark
- Aspect Research Centre for Autism Practice, Sydney, Australia
- Griffith Institute for Educational Research, Brisbane, Australia
| | - Jae Yup Jung
- School of Education, The University of New South Wales, Sydney, Australia
| | - Jacqueline Roberts
- Autism Centre of Excellence (ACE), Griffith Institute for Educational Research, Brisbane, Australia
| | | | - Patricia Howlin
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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25
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Natri HM, Chapman CR, Heraty S, Dwyer P, Walker N, Kapp SK, Dron HA, Martinez-Agosto JA, Mikkola L, Doherty M. Ethical challenges in autism genomics: Recommendations for researchers. Eur J Med Genet 2023; 66:104810. [PMID: 37478903 DOI: 10.1016/j.ejmg.2023.104810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/07/2023] [Accepted: 07/19/2023] [Indexed: 07/23/2023]
Abstract
Equitable and just genetic research and clinical translation require an examination of the ethical questions pertaining to vulnerable and marginalized communities. Autism research and advocate communities have expressed concerns over current practices of genetics research, urging the field to shift towards paradigms and practices that ensure benefits and avoid harm to research participants and the wider autistic community. Building upon a framework of bioethical principles, we provide the background for the concerns and present recommendations for ethically sustainable and justice-oriented genetic and genomic autism research. With the primary goal of enhancing the health, well-being, and autonomy of autistic persons, we make recommendations to guide priority setting, responsible research conduct, and informed consent practices. Further, we discuss the ethical challenges particularly pertaining to research involving highly vulnerable individuals and groups, such as those with impaired cognitive or communication ability. Finally, we consider the clinical translation of autism genetics studies, including the use of genetic testing. These guidelines, developed by an interdisciplinary working group comprising autistic and non-autistic individuals, will aid in leveraging the potential of genetics research to enhance the quality of life of autistic individuals and are widely applicable across stigmatized traits and vulnerable communities.
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Affiliation(s)
- Heini M Natri
- Translational Genomics Research Institute (TGen), Phoenix, AZ, 85004, USA.
| | - Carolyn R Chapman
- Department of Population Health (Division of Medical Ethics), NYU Grossman School of Medicine, New York, NY, 10016, USA; Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Síofra Heraty
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, University of London, Birkbeck, London, WC1E 7HX, UK
| | - Patrick Dwyer
- Center for Mind and Brain, UC Davis, Davis, CA, 95618, USA; Department of Psychology, UC Davis, Davis, CA, 95618, USA; MIND Institute, UC Davis Health, Sacramento, CA, 95817, USA
| | - Nick Walker
- California Institute of Integral Studies, San Francisco, CA, 94103, USA
| | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, Hampshire, PO1 2UP, UK
| | - Heather A Dron
- Sterilization and Social Justice Lab, UCLA Institute for Genetics and Society, Los Angeles, CA, 90095, USA
| | | | - Lea Mikkola
- Turku Bioscience Center, InFLAMES Research Flagship Center, University of Turku, Turku, 20520, Finland
| | - Mary Doherty
- Department of Neuroscience, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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26
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Heraty S, Lautarescu A, Belton D, Boyle A, Cirrincione P, Doherty M, Douglas S, Plas JRD, Van Den Bosch K, Violland P, Tercon J, Ruigrok A, Murphy DGM, Bourgeron T, Chatham C, Loth E, Oakley B, McAlonan GM, Charman T, Puts N, Gallagher L, Jones EJH. Bridge-building between communities: Imagining the future of biomedical autism research. Cell 2023; 186:3747-3752. [PMID: 37657415 DOI: 10.1016/j.cell.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023]
Abstract
A paradigm shift in research culture is required to ease perceived tensions between autistic people and the biomedical research community. As a group of autistic and non-autistic scientists and stakeholders, we contend that through participatory research, we can reject a deficit-based conceptualization of autism while building a shared vision for a neurodiversity-affirmative biomedical research paradigm.
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Affiliation(s)
- Síofra Heraty
- Department of Psychological Sciences, Birkbeck, University of London, London WC1E 7HX, UK.
| | - Alexandra Lautarescu
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London WC2R 2LS, UK
| | - David Belton
- AIMS-2-Trials A-Reps, University of Cambridge, Cambridge CB2 1TN, UK
| | - Alison Boyle
- AIMS-2-Trials A-Reps, University of Cambridge, Cambridge CB2 1TN, UK
| | | | - Mary Doherty
- AIMS-2-Trials A-Reps, University of Cambridge, Cambridge CB2 1TN, UK; Department of Neuroscience, Brighton & Sussex Medical School, Brighton, East Sussex BN1 9PX, UK
| | - Sarah Douglas
- AIMS-2-Trials A-Reps, University of Cambridge, Cambridge CB2 1TN, UK
| | | | | | - Pierre Violland
- AIMS-2-Trials A-Reps, University of Cambridge, Cambridge CB2 1TN, UK
| | - Jerneja Tercon
- AIMS-2-Trials A-Reps, University of Cambridge, Cambridge CB2 1TN, UK; Department of Developmental Pediatrics and Early Intervention, Community Health Centre Domzale, Domzale, Slovenia
| | - Amber Ruigrok
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), London SE5 8AZ, UK; Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London WC2R 2LS, UK
| | - Thomas Bourgeron
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université Paris Cité, Paris, France
| | | | - Eva Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK
| | - Bethany Oakley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK
| | - Grainne M McAlonan
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust (SLaM), London SE5 8AZ, UK; Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London WC2R 2LS, UK
| | - Tony Charman
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London WC2R 2LS, UK
| | - Nicolaas Puts
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE5 8AF, UK; Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London WC2R 2LS, UK
| | - Louise Gallagher
- Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland; Child and Youth Mental Health Collaborative, Hospital for Sick Children, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto M5T 1R8, Canada
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London WC1E 7HX, UK
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27
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Abstract
We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years-with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.
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Affiliation(s)
- Jonathan Green
- University of Manchester, Royal Manchester Children's Hospital, and Manchester Academic Health Sciences Centre, Manchester, UK
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28
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Clarke EB, Lord C. Social competence as a predictor of adult outcomes in autism spectrum disorder. Dev Psychopathol 2023:1-16. [PMID: 37381100 PMCID: PMC10755073 DOI: 10.1017/s0954579423000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
There is a wealth of literature characterizing social difficulties in autism spectrum disorder (ASD). However, little work has replicated longitudinal findings from typical development that adolescent social competence predicts positive adult outcomes in ASD. The current study examined social competence trajectories from 2 to 26 and the utility of three social competence measures collected in adolescence in predicting work, residential status, friendship, and romantic outcomes in a longitudinal cohort (n = 253) of ASD. Using group-based trajectory modeling, we identified two patterns of social competence development: a low trajectory characterized by slow linear gains throughout childhood and plateauing in adulthood, and a high trajectory characterized by steeper linear gains in childhood followed by decline in adulthood. Regression models indicated one social competence measure, Vineland Social-AE scores, significantly predicted employment, residential status, and friendships in adulthood. One other social competence measure, SSQ total scores, also significantly predicted friendship in adulthood. Only nonverbal IQ at 9 predicted the likelihood of having ever had a romantic relationship. These findings highlight the role of social competence in both atypical and typical development and suggest the social impairments associated with ASD do not necessarily impact all realms of social functioning equally.
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Affiliation(s)
- Elaine B Clarke
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Martin RJ, Crowley-Zalaket J, Gould K, Weddle S, Anderson CM. Behavioral Parent Training via Telehealth for Autistic Children: Further Exploration of Feasibility During the COVID-19 Pandemic. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2023:1-14. [PMID: 37363188 PMCID: PMC10177738 DOI: 10.1007/s41252-023-00336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
Objectives Many autistic children exhibit challenging and disruptive behaviors that can present challenges for both children and their families by interfering with acquisition of adaptive skills and affecting family and peer relationships. Behavioral parent training (BPT) is an evidence-based approach to reducing autistic children's disruptive behavior, but many families face a number of barriers to accessing BPT, such as availability of BPT in their community, and transportation and scheduling challenges. Therefore, we sought to explore the feasibility and promise of effectiveness of adapting an established BPT program to a telehealth format during the COVID-19 pandemic. Methods A feasibility trial of BPT via telehealth was conducted with fourteen parents of autistic children. Results Parents and clinicians were able to implement BPT via telehealth with a high degree of fidelity, and parents rated both BPT and the telehealth format favorably. The program also showed promise of effectiveness in reducing autistic children's disruptive behavior, improving their adaptive skills, as well as reducing parents' stress, and improving parents' sense of parenting competence. Conclusions The findings replicate and extend findings from previous studies, further demonstrating the promise of telehealth as a viable alternative format for delivering BPT. We also explore implications for future research, including the opportunity for more thorough evaluation of the effectiveness of BPT via telehealth.
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Affiliation(s)
- Ryan J. Martin
- May Institute, Randolph, MA USA
- Mosaic Pediatric Therapy, 2810 Coliseum Centre Dr, Charlotte, NC USA
| | - Jaime Crowley-Zalaket
- May Institute, Randolph, MA USA
- Children’s Specialized Hospital, New Brunswick, NJ USA
| | - Kaitlin Gould
- May Institute, Randolph, MA USA
- The College of Saint Rose, Albany, NY USA
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Burke MM, Taylor JL. To better meet the needs of autistic people, we need to rethink how we measure services. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:873-875. [PMID: 37052345 PMCID: PMC10263256 DOI: 10.1177/13623613231164495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Rodríguez Mega E. 'The best way to get it right is to listen to us' - autistic people argue for a stronger voice in research. Nature 2023; 617:238-241. [PMID: 37165246 DOI: 10.1038/d41586-023-01549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Natri HM, Abubakare O, Asasumasu K, Basargekar A, Beaud F, Botha M, Bottema-Beutel K, Brea MR, Brown LXZ, Burr DA, Cobbaert L, Dabbs C, Denome D, Rosa SDR, Doherty M, Edwards B, Edwards C, Liszk SE, Elise F, Fletcher-Watson S, Flower RL, Fuller S, Gassner D, Onaiwu MG, Good J, Grant A, Haddix VL, Heraty S, Hundt A, Kapp SK, Keates N, Kulshan T, Lampi AJ, Latimer O, Leadbitter K, Tidd JL, Manalili M, Martin M, Millichamp A, Morton H, Nair V, Pavlopoulou G, Pearson A, Pellicano L, Porter H, Poulsen R, Robertson ZS, Rodriguez K, Roux A, Russell M, Ryan J, Sasson N, Grier HS, Somerville M, Sorensen C, Stockwell KM, Szymanski T, Thompson-Hodgetts S, van Driel M, VanUitert V, Waldock K, Walker N, Watts C, Williams Z, Woods R, Yu B, Zadow M, Zimmerman J, Zisk AH. Anti-ableist language is fully compatible with high-quality autism research: Response to Singer et al. (2023). Autism Res 2023; 16:673-676. [PMID: 37087601 DOI: 10.1002/aur.2928] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/11/2023] [Indexed: 04/24/2023]
Affiliation(s)
- Heini M Natri
- The Translational Genomics Research Institute, Phoenix, Arizona, USA
| | | | | | | | - Flavien Beaud
- University of Idaho Moscow, Moscow, Idaho, USA
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Chris Edwards
- Aspect Research Centre for Autism Practice, Frenchs Forest, New South Wales, Australia
| | - Síle Ekaterin Liszk
- OK Chapter of the National Federation of the Blind, Oklahoma City, Oklahoma, USA
| | | | | | | | | | - Dena Gassner
- Adelphi University, Garden City, New York, USA
- Towson University, Towson, Maryland, USA
| | | | - Judith Good
- University of Amsterdam, Amsterdam, Netherlands
| | | | - Vicki L Haddix
- University of Memphis, Memphis, Tennessee, United States
| | | | | | | | | | | | | | | | | | | | - Marie Manalili
- University College London, London, UK
- University of London, London, UK
| | | | | | - Hannah Morton
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | - Rebecca Poulsen
- Macquarie University, Macquarie Park, New South Wales, Australia
| | | | - Kayla Rodriguez
- Autistic Women and Nonbinary Network, Lincoln, Nebraska, USA
| | - Anne Roux
- Drexel University, Philadelphia, Pennsylvania, USA
| | - Mary Russell
- Cabarrus Family Medicine, Atrium Health, Charlotte, North Carolina, USA
| | - Jackie Ryan
- University of Alberta, Edmonton, Alberta, Canada
| | - Noah Sasson
- The University of Texas at Dallas, Dallas, Texas, USA
| | | | | | - Cole Sorensen
- Minnesota Disability Support Alternatives, Plymouth, Minnesota, USA
| | | | | | | | | | | | | | - Nick Walker
- California Institute of Integral Studies, San Francisco, California, USA
| | | | - Zachary Williams
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Betty Yu
- San Francisco State University, San Francisco, California, USA
| | - Meghan Zadow
- University of Adelaide, Adelaide, South Australia, Australia
| | - Jordyn Zimmerman
- CommunicationFIRST, Washington DC, USA
- The Nora Project, Highland Park, Illinois, USA
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Bottema-Beutel K. We must improve the low standards underlying "evidence-based practice". AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:269-274. [PMID: 36588301 DOI: 10.1177/13623613221146441] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Keating CT, Hickman L, Leung J, Monk R, Montgomery A, Heath H, Sowden S. Autism-related language preferences of English-speaking individuals across the globe: A mixed methods investigation. Autism Res 2023; 16:406-428. [PMID: 36474364 PMCID: PMC10946540 DOI: 10.1002/aur.2864] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
Over the past two decades, there have been increasing discussions around which terms should be used to talk about autism. Whilst these discussions have largely revolved around the suitability of identity-first language and person-first language, more recently this debate has broadened to encompass other autism-related terminology (e.g., 'high-functioning'). To date, academic studies have not investigated the language preferences of autistic individuals outside of the United Kingdom or Australia, nor have they compared levels of endorsement across countries. Hence, the current study adopted a mixed-methods approach, employing both quantitative and qualitative techniques, to explore the linguistic preferences of 654 English-speaking autistic adults across the globe. Despite variation in levels of endorsement between countries, we found that the most popular terms were similar-the terms 'Autism', 'Autistic person', 'Is autistic', 'Neurological/Brain Difference', 'Differences', 'Challenges', 'Difficulties', 'Neurotypical people', and 'Neurotypicals' were consistently favored across countries. Despite relative consensus across groups, both our quantitative and qualitative data demonstrate that there is no universally accepted way to talk about autism. Our thematic analysis revealed the reasons underlying participants' preferences, generating six core themes, and illuminated an important guiding principle-to respect personal preferences. These findings have significant implications for informing practice, research and language policy worldwide.
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Affiliation(s)
| | - Lydia Hickman
- School of PsychologyUniversity of BirminghamBirminghamUK
| | - Joan Leung
- School of PsychologyUniversity of AucklandAucklandNew Zealand
| | - Ruth Monk
- Autistic member of the Autism New Zealand Community Advisory Group, New Zealand/School of Medical SciencesUniversity of AucklandAucklandNew Zealand
| | - Alicia Montgomery
- School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Hannah Heath
- School of PsychologyUniversity of BirminghamBirminghamUK
| | - Sophie Sowden
- School of PsychologyUniversity of BirminghamBirminghamUK
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Breinbauer C, Vidal V, Molina P, Trabucco C, Gutierrez L, Cordero M. Early Childhood Development policy in Chile: Progress and pitfalls supporting children with developmental disabilities toward school readiness. Front Public Health 2022; 10:983513. [PMID: 36311641 PMCID: PMC9597457 DOI: 10.3389/fpubh.2022.983513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Cecilia Breinbauer
- Department of Child and Adolescent Development, Center for Healthy Development, Seattle, WA, United States
| | - Verónica Vidal
- Department of Epidemiology and Health Studies and School of Speech and Language Pathology, Universidad de los Andes, Santiago, Chile
| | | | | | | | - Miguel Cordero
- Centre for Research in Food Environments and the Prevention of Chronic Diseases Associated With Nutrition, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
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Pellicano E, Fatima U, Hall G, Heyworth M, Lawson W, Lilley R, Mahony J, Stears M. A capabilities approach to understanding and supporting autistic adulthood. NATURE REVIEWS PSYCHOLOGY 2022; 1:624-639. [PMID: 36090460 PMCID: PMC9443657 DOI: 10.1038/s44159-022-00099-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/28/2022]
Abstract
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. The focus on functional deficits in conventional autism research constrains understanding of autistic lives. In this Review, Pellicano et al. appraise research on autistic adulthood through a capabilities lens to identify areas where autistic adults thrive, and where more research and services are needed to enhance their quality of life.
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