Annual Research Review: Looking back to look forward - changes in the concept of autism and implications for future research

The clinical characteristics of autistic women with restrictive eating disorders

BACKGROUND

Autistic women are at high risk of developing restrictive eating disorders (REDs), such as anorexia nervosa.

AIMS

This study provides an overview of the clinical characteristics of autistic women with REDs to (i) enhance understanding of increased risk, and (ii) support the identification of autistic women in eating disorder services.

METHOD

We compared self-reported autistic and disordered eating characteristics of: autistic participants with REDs (Autism + REDs; n = 57); autistic participants without REDs (Autism; n = 69); and women with REDs who are not autistic (REDs; n = 80). We also included a group of women with high autistic traits (HATs) and REDs, but no formal autism diagnosis (HATs + REDs; n = 38).

RESULTS

Autism + REDs participants scored similarly to Autism participants in terms of autistic characteristics and to REDs participants in terms of experiencing traditional disordered eating symptoms. Autism + REDs participants were distinguished from both groups by having more restricted and repetitive behaviours and autism-specific eating behaviours related to sensory processing, flexibility and social differences. HATs + REDs participants showed a similar pattern of scores to Autism + REDs participants, and both also presented with high levels of co-occurring mental health difficulties, particularly social anxiety.

CONCLUSION

The presentation of autistic women with REDs is complex, including both traditional disordered eating symptoms and autism-related needs, as well as high levels of co-occurring mental health difficulties. In eating disorder services, the REDs presentation of autistic women and those with HATs should be formulated with reference to autism-specific eating behaviours and co-occurring difficulties. Treatment adaptations should be offered to accommodate autistic characteristics and related needs.

A Framework for Joint Music Making: Behavioral Findings, Neural Processes, and Computational Models

Across different epochs and societies, humans occasionally gather to jointly make music. This universal form of collective behavior is as fascinating as it is fragmentedly understood. As the interest in joint music making (JMM) rapidly grows, we review the state-of-the-art of this emerging science, blending behavioral, neural, and computational contributions. We present a conceptual framework synthesizing research on JMM within four components. The framework is centered upon interpersonal coordination, a crucial requirement for JMM. The other components imply the influence of individuals' (past) experience, (current) social factors, and (future) goals on real-time coordination. Our aim is to promote the development of JMM research by organizing existing work, inspiring new questions, and fostering accessibility for researchers belonging to other research communities.

Indistinguishable behavioural and neural correlates of perceptual self-other distinction in autistic and neurotypical adults

Previous research has suggested that self-bias (i.e., enhanced cognitive processing of self-versus other-relevant information) may be atypical in autism spectrum conditions (ASC), perhaps due to difficulties with self-other distinction. However, empirical evidence for this is inconsistent, and the neural basis of processing differences remains unknown. We present two experiments that aimed to test perceptual self-bias and familiarity effects in ASC using a perceptual-association task. Participants were asked to distinguish face/label associations of the self from those of other people of differing levels of familiarity (i.e., friend vs stranger). Experiment 1 took an individual differences approach by testing whether behavioural self-bias is associated with the number of autistic traits in a neurotypical adult sample (N = 59). Experiment 2 took a case-control approach by testing whether behavioural self-bias and associated ERP responses differ between neurotypical (N = 27) and autistic (N = 30) adults. Across both experiments, behavioural results showed that participants experienced a self-bias (self > friend and stranger) and a familiarity effect (e.g., friend > stranger); neither effect was affected by the number of autistic traits or autism diagnosis. In Experiment 2, analysis of N1, N2, and P3 ERP components revealed a typical self-bias in both groups (self distinct from friend and stranger), and only the autistic group showed evidence of a familiarity effect (N2 more negative-going for stranger than friend). The findings are discussed in relation to self-other distinction ability, and the relevance of other neuropsychological and psychiatric conditions such as anxiety and alexithymia are also considered.

Differential relationships between autistic traits and anthropomorphic tendencies in adults and early adolescents

Anthropomorphism, the attribution of human-like qualities (e.g., mental states) to nonhuman entities, is a universal but variable psychological experience. Adults with professionally diagnosed autism or high levels of subclinical autistic traits consistently show greater tendencies to anthropomorphize, which has been hypothesized to reflect 1) a compensatory mechanism for lack of social connectedness and 2) a persistence of childhood anthropomorphism into adulthood. Here, we directly tested these hypotheses in a general population sample consisting of both adults (N=685, 17-58 years old) and early adolescents (N=145, 12-14 years old) using the refined 9-item Anthropomorphism Questionnaire (AnthQ9), which measures both present and childhood anthropomorphic tendencies. We found that adults with heightened autistic traits reported increased present anthropomorphism (e.g., tend more to perceive computers as having minds), which held even after controlling for social connectedness. In contrast, adolescents with heightened autistic traits did not show increased present anthropomorphism, but rather reported reduced childhood anthropomorphism (e.g., less likely to perceive toys as having feelings) after controlling for social connectedness. We also found evidence that the present and childhood subscales of the AnthQ9 may tap into fundamentally different aspects of anthropomorphism. The results suggest that increased anthropomorphic tendencies in adults with heightened autistic traits cannot be explained solely by increased sociality motivation, but may be due to delayed development of anthropomorphism, although alternative possibilities of measurement problems cannot be ruled out. Implications for the measurement of anthropomorphism and its relation with theory of mind were also discussed.

A transdiagnostic approach to neurodiversity in a representative population sample: The N+ 4 model

Background

The concept of neurodiversity draws upon scientific research, and lessons from practice and lived experience to suggest new ways of thinking about neurodevelopmental conditions. Among the formative observations are that characteristics associated with neurodevelopmental conditions are part of a "broader phenotype" of variation across the whole population, and that there appear to be "transdiagnostic" similarities as well as differences in these characteristics. These observations raise important questions that have implications for understanding diversity in neurodevelopmental conditions and in neurocognitive phenotypes across the whole population.

Method

The present work examines broader phenotypes using seven widely used self-report assessments of traits associated with autism, ADHD, dyslexia, Developmental Coordination Disorder/dyspraxia, tic disorders/Tourette's, cortical hyperexcitability associated with subclinical epilepsy, and sensory sensitivities. A representative sample of 995 adults (aged 17-77) in the UK completed self-report measures of neurodiversity, wellbeing, generalized anxiety, and depression, and cognitive abilities (nonverbal intelligence and executive functioning).

Results

We used confirmatory factor analysis to test whether variation and covariation was better characterized (1) by traditional diagnostic labels, or (2) transdiagnostically according to similarities in functions, behaviours, or phenomena. Results indicated that neurodiversity characteristics were best explained using a bifactor model with one general "N" factor and four condition-specific factors.

Conclusion

This was the largest examination to date of the factor structure of broader phenotypes relevant to neurodevelopmental conditions. It provides critical benchmark data, and a framework approach for asking systematic questions about the structure of neurocognitive diversities seen in the whole population and in people with one or more diagnoses.

A 3D approach to understanding heterogeneity in early developing autisms

Phenotypic heterogeneity in early language, intellectual, motor, and adaptive functioning (LIMA) features are amongst the most striking features that distinguish different types of autistic individuals. Yet the current diagnostic criteria uses a single label of autism and implicitly emphasizes what individuals have in common as core social-communicative and restricted repetitive behavior difficulties. Subtype labels based on the non-core LIMA features may help to more meaningfully distinguish types of autisms with differing developmental paths and differential underlying biology. Using relatively large (n=615) publicly available data from early developing (24-68 months) standardized clinical tests tapping LIMA features, we show that stability-based relative cluster validation analysis can identify two robust and replicable clusters in the autism population with high levels of generalization accuracy (98%). These clusters can be described as Type I versus Type II autisms differentiated by relatively high versus low scores on LIMA features. These two types of autisms are also distinguished by different developmental trajectories over the first decade of life. Finally, these two types of autisms reveal striking differences in functional and structural neuroimaging phenotypes and their relationships with gene expression. This work emphasizes the potential importance of stratifying autism by a Type I versus Type II distinction focused on LIMA features and which may be of high prognostic and biological significance.

Sleep quality relates to language impairment in children with autism spectrum disorder without intellectual disability

OBJECTIVES

This study aimed to identify sleep quality profiles of children with autism spectrum disorder (ASD), to compare these profiles with those of typically developing (TD) children, and to verify whether there are differences between them in terms of language skills.

METHODS

We evaluated the sleep quality and language skills of 47 children with ASD without intellectual disability (ID) and 32 children with TD. Using a hierarchical cluster analysis, we identified two sleep quality ASD profiles (poor and good). We then performed a series of MANCOVAs and ANOVAs to compare the sleep quality and language skills of the two ASD clusters and the TD group.

RESULTS

A main group effect (TD, "poor" cluster, and "good" cluster) was found in the total sleep quality and all its dimensions. Significant differences were revealed between the "good" and "poor" clusters in the total structural language score (F1,46 = 10.75, p < 0.001) and three of its subscales (speech: F1,46 = 9.19, p < 0.001; syntax, F1,46 = 8.61, p = 0.001; coherence: F1,46 = 11.36, p < 0.001); the total pragmatic language score (F1,46 = 7.00, p = 0.001) and three of its subscales (inappropriate initiation: F1,46 = 8.02, p = 0.001; use of context: F1,46 = 8.07, p = 0.001; nonverbal communication: F1,46 = 7.35, p = 0.001); and the social relations score (F1,46 = 9.97, p = 0.003).

CONCLUSIONS

Sleep quality in children with ASD (especially a subgroup) is worse than in children with TD. There is an association between sleep quality and language skills, both at the pragmatic and structural levels.

Identifying autistic children: Priorities for research arising from a systematic review of parents' experiences of the assessment process

LAY ABSTRACT

Hearing about parents' experiences of having their child recognised as autistic could help improve the supports offered to parents. Our article may also help guide future research on this topic. We made a list of the type of research that interested us. We searched the studies already completed, only studying the research that matched our interests. After reading the studies, we rated their quality using the Critical Appraisal Skills Programme tool.It became clear that parents went through four phases during the identification process. The first phase occurred before their child was identified as autistic. The second involved the actual assessment of their child. Parents' emotional reactions to the news were the focus of the third phase. The final phase occurred after their child was identified as autistic. We discuss the findings of our research. As there are sensitivities involved in conducting research on this topic, we identify how researchers can ensure that their research is of the best quality. We are committed to respecting the human rights of all involved, so we emphasise the need for professionals to develop good relationships with the parents of autistic children. Researchers have recently come to see autism as typical of human diversity. We encourage the professionals involved to adopt this understanding of autistic children and make practical suggestions to enable them to do so.

Five interdisciplinary tensions and opportunities in neurodiversity research

Improving our understanding of autism, ADHD, dyslexia and other neurodevelopmental conditions requires collaborations between genetics, psychiatry, the social sciences and other fields of research.

Why are females less likely to be diagnosed with ADHD in childhood than males?

ADHD is less likely to be diagnosed in females than males, especially in childhood. Females also typically receive the diagnosis later than males and are less likely to be prescribed ADHD medication. Understanding why these sex differences in clinical care and treatment for ADHD occur is key to improving timely diagnosis in people affected by ADHD. This Personal View is a conceptual review synthesising literature on this topic. This publication considers potential biological explanations (eg, genetic factors), influence of diagnostic practices (eg, criteria suitability, diagnostic overshadowing, and sex-specific diagnostic thresholds), and sociocultural explanations (eg, sex differences in presentation and compensatory behaviours), for the observed sex differences in ADHD clinical practice. This Personal View also outlines future research directions for improving understanding of sex differences in recognition and diagnosis of ADHD.

The relationship between camouflaging and mental health: Are there differences among subgroups in autistic adults?

LAY ABSTRACT

When autistic people use strategies to hide their autistic characteristics, we call this camouflaging. Autistic adults suggested that camouflaging can result in mental health difficulties. That is, people who report to camouflage also report mental health difficulties. However, since there are many differences between autistic people, this relationship may also differ between subgroups. Therefore, in this study we investigated whether camouflaging and mental health difficulties are related and whether this relationship is equal for all autistic adults. For this study, 352 autistic adults aged 30-84 years filled in the Dutch Camouflaging Autistic Traits Questionnaire to measure camouflaging and the Symptom Checklist-90 Revised to measure mental health difficulties. We found that camouflaging was moderately related to mental health difficulties. This means that people who report more camouflaging also report more mental health difficulties. When we looked closer, we found that this relationship was strong for only a small subgroup of autistic adults. In most other autistic adults, there was a small or no relationship between camouflaging and mental health difficulties. Therefore, it is important that clinicians are aware of camouflaging and its possible relationship with mental health difficulties, but that they do not generalize the negative consequences to everyone.

Unpacking the overlap between Autism and ADHD in adults: A multi-method approach

The overlap between Autism and Attention-Deficit Hyperactivity Disorder (ADHD) is widely observed in clinical settings, with growing interest in their co-occurrence in neurodiversity research. Until relatively recently, however, concurrent diagnoses of Autism and ADHD were not possible. This has limited the scope for large-scale research on their cross-condition associations, further stymied by a dearth of open science practices in the neurodiversity field. Additionally, almost all previous research linking Autism and ADHD has focused on children and adolescents, despite them being lifelong conditions. Tackling these limitations in previous research, 5504 adults - including a nationally representative sample of the UK (Study 1; n = 504) and a large pre-registered study (Study 2; n = 5000) - completed well-established self-report measures of Autism and ADHD traits. A series of network analyses unpacked the associations between Autism and ADHD at the individual trait level. Low inter-item connectivity was consistently found between conditions, supporting the distinction between Autism and ADHD as separable constructs. Subjective social enjoyment and hyperactivity-impulsivity traits were most condition-specific to Autism and ADHD, respectively. Traits related to attention control showed the greatest Bridge Expected Influence across conditions, revealing a potential transdiagnostic process underlying the overlap between Autism and ADHD. To investigate this further at the cognitive level, participants completed a large, well-powered, and pre-registered study measuring the relative contributions of Autism and ADHD traits to attention control (Study 3; n = 500). We detected age- and sex-related effects, however, attention control did not account for the covariance between Autism and ADHD traits. We situate our findings and discuss future directions in the cognitive science of Autism, ADHD, and neurodiversity, noting how our open datasets may be used in future research.

Perspectives of autistic adolescent girls and women on the determinants of their mental health and social and emotional well-being: A systematic review and thematic synthesis of lived experience

LAY ABSTRACT

Difficulties with mental health and low levels of well-being are more common among autistic girls and women than non-autistic people, but we do not fully understand why. Research does not focus enough on what autistic girls and women could tell us about this. This review aims to summarise the studies where autistic girls and women explain things that affect their mental health and well-being to help us understand how to prevent these difficulties from developing. Three research databases were searched to find possibly relevant studies. There were 877 studies found, which two researchers screened according to particular criteria. They found 52 studies that could be included in this review. One researcher evaluated the quality of these studies and extracted the key information from them. This review summarises the views of 973 autistic girls and women aged between 13 and 70+. The findings from the 52 studies were analysed, and we found many factors that affect the mental health and well-being of autistic girls and women. These factors fall into two categories: (1) difficulties living in a world not designed for autistic people and (2) the impact of stigma due to being autistic.

Intolerance of Uncertainty and Anxiety (but not Alexithymia) Mediate the Association Between Autistic Traits and Quality of Life

Previous research has indicated that autistic individuals report lower quality of life (QoL) than non-autistic people. It is unclear whether it is the autism traits themselves or co-occurring thinking styles or mental health difficulties that most impair QoL. This study tested a hypothesised model to explore how 'intolerance of uncertainty' (IU), alexithymia (difficulty in identifying and describing own emotions), and anxiety play into the association between autistic traits and QoL. Online survey data were analysed from 116 autistic and 51 non-autistic adults who completed six standardised questionnaires measuring autistic traits, alexithymia, IU, anxiety and QoL (physical health, psychological health, social relations, and environment domains). The autistic group reported higher scores for alexithymia, IU and anxiety, and lower scores for QoL across domains, compared to the non-autistic group. Across the entire sample, autistic traits, alexithymia, IU and anxiety were positively correlated with one another, and negatively related to the four domains of QoL. Finally, IU and anxiety partially serially mediated the pathways from autistic traits to physical health and environment domains of QoL, and fully mediated the pathways from autistic traits to psychological health and social relations domains of QoL, across the full sample. The lower QoL experienced by autistic people may be explained in part by the mediating effect of both IU and anxiety (but not alexithymia). This study highlights the need for evidence-based interventions to address both IU and anxiety to improve QoL for autistic people/those with high levels of autistic traits.

Sensorimotor Features and Daily Living Skills in Autistic Children With and Without ADHD

Attention-deficit/hyperactivity disorder (ADHD) commonly co-occurs in autistic children. However, additional research is needed to explore the differences in motor skills and sensory features in autistic children with and without ADHD, as well as the impacts of these factors on daily living skills (DLS). This observational study sought to fill this gap with 67 autistic children (6.14-10.84 years-old), 43 of whom had ADHD. Autistic children with ADHD demonstrated higher sensory features and lower motor skills than autistic children without ADHD. In examining autism and ADHD features dimensionally, we found that overall sensory features, seeking, and hyporesponsiveness were driven by both autism and ADHD features, whereas motor skills, enhanced perception, and hyperresponsiveness were driven by only autism features. Additionally, in using these dimensional variables of autism and ADHD features, we found that differences in motor skills, sensory and autism features, but not ADHD features, impact DLS of autistic children, with autism features and motor skills being the strongest individual predictors of DLS. Together, these results demonstrate the uniqueness of motor skills and sensory features in autistic children with and without ADHD, as well as how autism features, sensory features, and motor skills contribute to DLS, emphasizing the importance of a comprehensive understanding of each individual and complexities of human development when supporting autistic children.

Parental Competences and Stress Levels in Mothers of Children with Autism Spectrum Disorders and Children Developing Neurotypically

(1) Background: the aim of this study was to explore parental competences and stress levels in the mothers of children with autism in relation to the mothers of neurotypical children. (2) Methods: the study used the Parental Competence Test and the PSS-10 scale to assess the intensity of stress related to one's own life situation over the past month. Forty mothers of children with ASD (n = 20) and neurotypical children (n = 20) participated in the study. (3) Results: the mothers of children with ASD showed higher levels of stress (p = 0.0002). The mothers of neurotypical children achieved higher scores in parental competences (r = -0.49). The competence of mothers of children with ASD was correlated with rigour (r = 0.50), permissiveness (r = -0.60), overprotectiveness (r = 0.71), and helplessness (r = -0.77). (4) Conclusions: mothers of children with autism demonstrate lower parental competences than mothers of neurotypical children. Mothers of children with autism are less rigorous but more permissive, overprotective, and helpless. They tend to become heavily involved with their child. An overprotective attitude and greater tolerance for antisocial behaviours among parents of children with ASDs protect them from excessive stress.

Differences in own-face but not own-name discrimination between autistic and neurotypical adults: A fast periodic visual stimulation-EEG study

Self-related processing is thought to be altered in autism, with several studies reporting that autistic individuals show a diminished neural response relative to neurotypicals for their own name and face. However, evidence remains scarce and is mostly based on event-related potential studies. Here, we used EEG to measure the neural activity of autistic adults (20 for faces, 27 for names) and neurotypical adults (24 for faces, 25 for names) while they were watching rapidly alternating faces and names, through a relatively new technique called Fast Periodic Visual Stimulation. We presented strangers' faces or names at a base frequency of 5.77 Hz, while one's own, a close other's, and a specific stranger's face/name was presented at an oddball frequency of 1.154 Hz. The neurotypical group showed a significantly greater response to their own face than both close other and stranger faces, and a greater response for close other than for stranger faces. In contrast, in the autism group, own and close other faces showed stronger responses than the stranger's face, but the difference between own and close other faces was not significant in a bilateral parieto-occipital cluster. No group differences in the enhanced response to familiar names were found. These results replicate and extend results obtained using traditional electroencephalographic techniques which suggest atypical responses to self-relevant stimuli in autism.

Age effects on autism heritability and etiological stability of autistic traits

BACKGROUND

Autism and autistic traits onset in childhood but persist into adulthood. Little is known about how genetic and environmental factors influence autism and autistic traits into adulthood. We aimed to determine age effects on the heritability of clinically diagnosed autism and the etiological stability of autistic traits from childhood to adulthood using twin methods.

METHODS

From 23,849 twin pairs in the Swedish Twin Register born between 1959 and 2010, we identified 485 individuals (1.01%, 31.5% female) with a clinical autism diagnosis. We estimated and compared the relative contribution of genetic, shared, and nonshared environmental influences to autism in childhood and adulthood. We further used multivariate twin analysis with four measurement points among 1,348 twin pairs in the longitudinal Twin Study of Child and Adolescent Development to assess the phenotypic and etiological stability of autistic traits - measured with three scales from the Child Behavior Checklist - from childhood to adulthood.

RESULTS

Autism heritability was comparable from childhood, (96% [95% CI, 76-99%]) to adulthood (87% [67-96%]). Autistic traits were moderately stable (phenotypic correlation = 0.35-0.61) from childhood to adulthood, and their heritability varied between 52 and 71%. We observed stable as well as newly emerging genetic influences on autistic traits from ages 8-9 to 19-20, and unique nonshared environmental influences at each age.

CONCLUSIONS

Genetic factors are important for autism and autistic traits in adulthood and separate genetic studies in adults are warranted.

First things first: An exploration of the effects of psychoeducation for older autistic adults

LAY ABSTRACT

After receiving an autism diagnosis, psychoeducation (i.e. information regarding autism) is a first intervention. We adjusted a psychoeducation program that was originally developed by the Dutch Association for Autism for older adults to enhance its feasibility and efficacy in later life. We expected that participants would report an increase in knowledge and acceptance of the diagnosis and that people close to them would also observe this. Indeed, we found this and participants and those close to them agreed on this. Furthermore, we found some evidence that older autistic adults were better at coping with their autism. We found no positive intervention effects on psychological distress. The feedback of participants and informants about the psychoeducation program was largely positive. In future research, we advise using larger group samples and larger time scales and we also advise to further adjust the program to the needs and requirements of older adults, and to help older autistic adults to construct a new narrative of themselves, and the life they have lived, in the light of the recent autism diagnosis.

A robust microbiome signature for autism spectrum disorder across different studies using machine learning

Autism spectrum disorder (ASD) is a highly complex neurodevelopmental disorder characterized by deficits in sociability and repetitive behaviour, however there is a great heterogeneity within other comorbidities that accompany ASD. Recently, gut microbiome has been pointed out as a plausible contributing factor for ASD development as individuals diagnosed with ASD often suffer from intestinal problems and show a differentiated intestinal microbial composition. Nevertheless, gut microbiome studies in ASD rarely agree on the specific bacterial taxa involved in this disorder. Regarding the potential role of gut microbiome in ASD pathophysiology, our aim is to investigate whether there is a set of bacterial taxa relevant for ASD classification by using a sibling-controlled dataset. Additionally, we aim to validate these results across two independent cohorts as several confounding factors, such as lifestyle, influence both ASD and gut microbiome studies. A machine learning approach, recursive ensemble feature selection (REFS), was applied to 16S rRNA gene sequencing data from 117 subjects (60 ASD cases and 57 siblings) identifying 26 bacterial taxa that discriminate ASD cases from controls. The average area under the curve (AUC) of this specific set of bacteria in the sibling-controlled dataset was 81.6%. Moreover, we applied the selected bacterial taxa in a tenfold cross-validation scheme using two independent cohorts (a total of 223 samples-125 ASD cases and 98 controls). We obtained average AUCs of 74.8% and 74%, respectively. Analysis of the gut microbiome using REFS identified a set of bacterial taxa that can be used to predict the ASD status of children in three distinct cohorts with AUC over 80% for the best-performing classifiers. Our results indicate that the gut microbiome has a strong association with ASD and should not be disregarded as a potential target for therapeutic interventions. Furthermore, our work can contribute to use the proposed approach for identifying microbiome signatures across other 16S rRNA gene sequencing datasets.

Alteration of the large-scale white-matter functional networks in autism spectrum disorder

Autism spectrum disorder is a neurodevelopmental disorder whose core deficit is social dysfunction. Previous studies have indicated that structural changes in white matter are associated with autism spectrum disorder. However, few studies have explored the alteration of the large-scale white-matter functional networks in autism spectrum disorder. Here, we identified ten white-matter functional networks on resting-state functional magnetic resonance imaging data using the K-means clustering algorithm. Compared with the white matter and white-matter functional network connectivity of the healthy controls group, we found significantly decreased white matter and white-matter functional network connectivity mainly located within the Occipital network, Middle temporo-frontal network, and Deep network in autism spectrum disorder. Compared with healthy controls, findings from white-matter gray-matter functional network connectivity showed the decreased white-matter gray-matter functional network connectivity mainly distributing in the Occipital network and Deep network. Moreover, we compared the spontaneous activity of white-matter functional networks between the two groups. We found that the spontaneous activity of Middle temporo-frontal and Deep network was significantly decreased in autism spectrum disorder. Finally, the correlation analysis showed that the white matter and white-matter functional network connectivity between the Middle temporo-frontal network and others networks and the spontaneous activity of the Deep network were significantly correlated with the Social Responsiveness Scale scores of autism spectrum disorder. Together, our findings indicate that changes in the white-matter functional networks are associated behavioral deficits in autism spectrum disorder.

A Blog-Based Study of Autistic Adults' Experiences of Aloneness and Connection and the Interplay with Well-Being: Corpus-Based and Thematic Analyses

Background

Autistic adults appear to be more vulnerable to mental ill health, with loneliness being a variable associated with multiple outcomes of poorer well-being. However, a description of meaningful social connection that is suitable for autistic adults is missing from this research, along with a missing understanding of the conditions that contribute to well-being.

Methods

In this study, autistic adults' experiences of connectedness and aloneness were systematically searched for within data collected from blogs. This contributed a creative method to hear the viewpoint of autistic adults. Corpus-based and thematic analyses explored the descriptions and contexts of relationships. A total of 16 autistic authors contributed views.

Results

Social connection was desired and was achieved through self-acceptance and rejecting deficit-based views of being autistic, and selectively choosing important relationships. Meaningful social connection changed over time, being more difficult to attain in childhood, and benefiting from self-learning and effortfully applying neuro-normative skills in social communication. Loneliness was only described alongside other causes of unhappiness and was not associated with being autistic.

Conclusions

The findings offer some explanation for the high estimates of both loneliness and mental ill health for autistic adults. We consider the implications for autistic individuals, clinicians, educators, and researchers. We are also cautious not to imply that these views reflect all autistic people. The findings suggest that improvements are needed in society to share communication differences and relationship expectations for autistic individuals to be accepted and valued.

A new approach to diagnosing and researching developmental prosopagnosia: Excluded cases are impaired too

Developmental prosopagnosia is characterized by severe, lifelong difficulties when recognizing facial identity. Unfortunately, the most common diagnostic assessment (Cambridge Face Memory Test) misses 50-65% of individuals who believe that they have this condition. This results in such excluded cases' absence from scientific knowledge, effect sizes of impairment potentially overestimated, treatment efficacy underrated, and may elicit in them a negative experience of research. To estimate their symptomology and group-level impairments in face processing, we recruited a large cohort who believes that they have prosopagnosia. Matching prior reports, 56% did not meet criteria on the Cambridge Face Memory Test. However, the severity of their prosopagnosia symptoms and holistic perception deficits were comparable to those who did meet criteria. Excluded cases also exhibited face perception and memory impairments that were roughly one standard deviation below neurotypical norms, indicating the presence of objective problems. As the prosopagnosia index correctly classified virtually every case, we propose it should be the primary method for providing a diagnosis, prior to subtype categorization. We present researchers with a plan on how they can analyze these excluded prosopagnosia cases in their future work without negatively impacting their traditional findings. We anticipate such inclusion will enhance scientific knowledge, more accurately estimate effect sizes of impairments and treatments, and identify commonalities and distinctions between these different forms of prosopagnosia. Owing to their atypicalities in visual perception, we recommend that the prosopagnosia index should be used to screen out potential prosopagnosia cases from broader vision research.

Conceptualization of the latent structure of autism: further evidence and discussion of dimensional and hybrid models

Autism spectrum disorder (ASD) might be conceptualized as an essentially dimensional, categorical, or hybrid model. Yet, current empirical studies are inconclusive and the latent structure of ASD has explicitly been examined only in a few studies. The aim of our study was to identify and discuss the latent model structure of behavioral symptoms related to ASD and to address the question of whether categories and/or dimensions best represent ASD symptoms. We included data of 2920 participants (1-72 years of age), evaluated with the Autism Diagnostic Observation Schedule (Modules 1-4). We applied latent class analysis, confirmatory factor analysis, and factor mixture modeling and evaluated the model fit by a combination of criteria. Based on the model selection criteria, the model fits, the interpretability as well as the clinical utility we conclude that the hybrid model serves best for conceptualization and assessment of ASD symptoms. It is both grounded in empirical evidence and in clinical usefulness, is in line with the current classification system (DSM-5) and has the potential of being more specific than the dimensional approach (decreasing false positive diagnoses).

The role of intellectual disability and emotional regulation in the autism-depression relationship

LAY ABSTRACT

Many people with autism and intellectual disability have significant levels of depressive symptoms. However, this relationship is not clear. For this reason, knowing the factors that are associated with having depression in autism and intellectual disability is important. Emotion regulation is associated with depression in autism spectrum disorder and intellectual disability. After evaluating a group of people with autism and intellectual disability, we found that people with mild intellectual disability have problems regulating their emotions which lead them to develop depressive symptoms. These findings suggest that interventions designed to prevent or reduce depressive symptoms in people with autism spectrum disorder and mild intellectual disability should include among their goals emotional regulation.

How are Autistic People Involved in the Design of Extended Reality Technologies? A Systematic Literature Review

The primary aim of this systematic review is to investigate the inclusion of autistic individuals in the design process of immersive technologies. This study follows the preferred reporting items for systematic reviews and meta-analyses standards for systematic literature reviews. To ensure the research questions and subsequent stages of the review incorporate pertinent parameters, the problem, interest, context framework has also been employed. Findings highlight that, while early proponents of immersive technology emphasized the importance of user involvement in design of new technology, immaturity of the technology often limited the implementation of direct user input to the design process. Nonetheless, analysis of the literature published between 2002-2022 identified 20 studies in which substantial influence of autistic individuals and stakeholders was found in the design process of immersive technologies. The roles of autistic individuals varied from active co-designers and co-creators to essential contributors in refining prototypes and providing critical feedback, ensuring the final products align with their needs and preferences. Results underscore the need to align research and design of immersive technologies more closely with the priorities and preferences of autistic individuals. Further is needed regarding actively involving autistic individuals in the design and implementation of immersive technology applications. On this basis, we maintain that more inclusive and effective deployment of immersive technologies is needed in order to ensure that resultant technologies are fit for purpose and address the actual needs of the autistic community.

Public concerns and attitudes towards autism on Chinese social media based on K-means algorithm

To investigate the hot topics and attitudes of autism in the larger community. In this study, we analyzed and summarized experimental texts from the social media platform Zhihu using the TF-IDF algorithm and K-means clustering approach. Based on the analysis of the 1,740,826-word experimental text, we found that the popularity of autism has steadily risen over recent years. Sufferers and their parents primarily discuss autism. The K-means clustering algorithm revealed that the most popular topics are divided into four categories: self-experience of individuals with autism, external views of individuals with autism, caring and stressful behaviors of caregivers, and information about autism. This study concluded that people with autism face more incredible negative emotions, external cognitive evaluations of the autistic group reflect stereotypes, the caregiver's family suffers high financial and psychological stress, and disorders caused by disease in autistic individuals.

Longitudinal studies of challenging behaviours in autistic children and adults: A systematic review and meta-analysis

Autistic children and adults are at increased risk of showing behaviours that may be described as challenging, however, little is known about whether or how these behaviours may change over time. Given the profound impact that challenging behaviour can have on both the autistic individual and their support network, it is critical that the trajectory of challenging behaviours be better understood. This systematic review and meta-analysis identified and synthesised observational longitudinal studies of challenging behaviour in autistic individuals. Fifty-six studies were included in the systematic review, and the effect sizes of 37 independent samples arising from 34 of these reports were examined through meta-analysis. Crucially, across the 37 samples, scores on the measures of challenging behaviour reduced by a small, yet significant, extent over time. Although age of the sample at baseline assessment did not moderate the effect, the time between the baseline assessment and final follow-up and age at final follow-up both moderated the magnitude of the effect, with challenging behaviour scores reducing to a larger extent in (a) studies with longer intervals between baseline and final follow-up and (b) studies with older samples at follow-up. The results from the current systematic review and meta-analysis have both theoretical and practical implications for understanding challenging behaviour over time in autistic individuals. Avenues for future research are also highlighted that may allow better understanding, and therefore support of, challenging behaviour in autistic individuals.

Mental health in autistic adults: A rapid review of prevalence of psychiatric disorders and umbrella review of the effectiveness of interventions within a neurodiversity informed perspective

BACKGROUND

Autistic adults have high risk of mental ill-health and some available interventions have been associated with increased psychiatric diagnoses. Understanding prevalence of psychiatric diagnoses is important to inform the development of individualised treatment and support for autistic adults which have been identified as a research priority by the autistic community. Interventions require to be evaluated both in terms of effectiveness and regarding their acceptability to the autistic community.

OBJECTIVE

This rapid review identified the prevalence of psychiatric disorders in autistic adults, then systematic reviews of interventions aimed at supporting autistic adults were examined. A rapid review of prevalence studies was completed concurrently with an umbrella review of interventions. Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed, including protocol registration (PROSPERO#CRD42021283570).

DATA SOURCES

MEDLINE, CINAHL, PsycINFO, and Cochrane Database of Systematic Reviews.

STUDY ELIGIBILITY CRITERIA

English language; published 2011-2022; primary studies describing prevalence of psychiatric conditions in autistic adults; or systematic reviews evaluating interventions for autistic adults.

APPRAISAL AND SYNTHESIS

Bias was assessed using the Prevalence Critical Appraisal Instrument and AMSTAR2. Prevalence was grouped according to psychiatric diagnosis. Interventions were grouped into pharmacological, employment, psychological or mixed therapies. Strength of evidence for interventions was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Autistic researchers within the team supported interpretation.

RESULTS

Twenty prevalence studies were identified. Many included small sample sizes or failed to compare their sample group with the general population reducing validity. Prevalence of psychiatric diagnoses was variable with prevalence of any psychiatric diagnosis ranging from 15.4% to 79%. Heterogeneity was associated with age, diagnosis method, sampling methods, and country. Thirty-two systematic reviews of interventions were identified. Four reviews were high quality, four were moderate, five were low and nineteen critically low, indicating bias. Following synthesis, no intervention was rated as 'evidence based.' Acceptability of interventions to autistic adults and priorities of autistic adults were often not considered.

CONCLUSIONS

There is some understanding of the scope of mental ill-health in autism, but interventions are not tailored to the needs of autistic adults, not evidence based, and may focus on promoting neurotypical behaviours rather than the priorities of autistic people.

Finding Similarities in Differences Between Autistic Adults: Two Replicated Subgroups

Autism is heterogeneous, which complicates providing tailored support and future prospects. We aim to identify subgroups in autistic adults with average to high intelligence, to clarify if certain subgroups might need support. We included 14 questionnaire variables related to aging and/or autism (e.g., demographic, psychological, and lifestyle). Community detection analysis was used for subgroup identification in an original sample of 114 autistic adults with an adulthood diagnosis (autism) and 58 non-autistic adults as comparison group (COMP), and a replication sample (N_Autism = 261; N_COMP = 287), both aged 30-89 years. Next, we identified subgroups and assessed external validity (for cognitive and psychological difficulties, and quality of life [QoL]) in the autism samples. To test specificity, we repeated the analysis after adding 123 adults with ADHD, aged 30-80 years. As expected, the autism and COMP groups formed distinct subgroups. Among autistic adults, we identified three subgroups of which two were replicated. One of these subgroups seemed most vulnerable on the cluster variables; this subgroup also reported the most cognitive and psychological difficulties, and lowest QoL. Adding the ADHD group did not alter results. Within autistic adults, one subgroup could especially benefit from support and specialized care, although this must be tested in future studies.

Genesis, modelling and methodological remedies to autism heterogeneity

Diagnostic criteria used in autism research have undergone a shift towards the inclusion of a larger population, paralleled by increasing, but variable, estimates of autism prevalence across clinical settings and continents. A categorical diagnosis of autism spectrum disorder is now consistent with large variations in language, intelligence, comorbidity, and severity, leading to a heterogeneous sample of individuals, increasingly distant from the initial prototypical descriptions. We review the history of autism diagnosis and subtyping, and the evidence of heterogeneity in autism at the cognitive, neurological, and genetic levels. We describe two strategies to address the problem of heterogeneity: clustering, and truncated-compartmentalized enrollment strategy based on prototype recognition. The advances made using clustering methods have been modest. We present an alternative, new strategy for dissecting autism heterogeneity, emphasizing incorporation of prototypical samples in research cohorts, comparison of subgroups defined by specific ranges of values for the clinical specifiers, and retesting the generality of neurobiological results considered to be acquired from the entire autism spectrum on prototypical cohorts defined by narrow specifiers values.

Sex differences in autistic adults: A preliminary study showing differences in mentalizing, but not in narrative coherence

Studying autism might be a complex endeavor due to its clinical heterogeneity. Little is currently known about potential sex differences in autistic adults, especially regarding mentalizing and narrative coherence. In this study, male and female participants told a personal story about one of their most positive and most negative life events and performed two mentalizing tasks. One of these mentalizing tasks was a recently developed Picture and Verbal Sequencing task that has shown cerebellar recruitment, and which requires mentalizing in a sequential context (i.e., participants chronologically ordered scenarios that required true and false belief mentalizing). Our preliminary comparison shows that males were faster and more accurate on the Picture Sequencing task compared to female participants when ordering sequences involving false beliefs, but not true beliefs. No sex differences were found for the other mentalizing and narrative tasks. These results highlight the importance of looking at sex differences in autistic adults and provide a possible explanation for sex-related differences in daily life mentalizing functions, which suggest a need for more sensitive diagnosis and tailored support.

Centering the Inner Experience of Autism: Development of the Self-Assessment of Autistic Traits

Current tools for identifying autism are critiqued for their lack of specificity and sensitivity, especially in autistic people who are older, have higher verbal ability or significant compensatory skills, and are not cisgender boys. This may reflect the following: the historical focus of autism research on White (cisgender) male, upper and middle class children; limited interest in the inner, lived experience of autism; and the predominance of a deficit-based model of autism. We report here on the first attempt of which we are aware to develop a clinical self-report measure of autistic traits as described by autistic people. We believe this is an advance in methodology because prior work in the development of autistic trait/diagnostic measures has prioritized the perspectives of nonautistic clinicians and scientists. The measure was developed under the leadership of two autistic researchers and constructed by leveraging descriptions of autism by autistic people to generate items designed to encompass the range of the autistic experience, using strength-based, accessible language. The team utilized iterative feedback from a panel of autistic experts to refine and enhance the measure, called the Self Assessment of Autistic Traits (SAAT). It is intended for people 16 years or older and uses a format that is designed to increase its accessibility and acceptability for autistic respondents. Future work will report on the preliminary psychometrics of the SAAT, with a long-term goal of advancing our understanding of the inner autistic experience and enhancing the clinical and scientific assessment of autism.

Ten simple rules for socially responsible science

Guidelines concerning the potentially harmful effects of scientific studies have historically focused on ethical considerations for minimizing risk for participants. However, studies can also indirectly inflict harm on individuals and social groups through how they are designed, reported, and disseminated. As evidenced by recent criticisms and retractions of high-profile studies dealing with a wide variety of social issues, there is a scarcity of resources and guidance on how one can conduct research in a socially responsible manner. As such, even motivated researchers might publish work that has negative social impacts due to a lack of awareness. To address this, we propose 10 simple rules for researchers who wish to conduct socially responsible science. These rules, which cover major considerations throughout the life cycle of a study from inception to dissemination, are not aimed as a prescriptive list or a deterministic code of conduct. Rather, they are meant to help motivated scientists to reflect on their social responsibility as researchers and actively engage with the potential social impact of their research.

Mental health impact of autism on families of children with intellectual and developmental disabilities of genetic origin

Background

Many children with an intellectual or developmental disability (IDD) have associated autism spectrum disorders (ASD), as well as an increased risk of mental health difficulties. In a cohort with IDD of genetic aetiology, we tested the hypothesis that excess risk attached to those with ASD + IDD, in terms of both children's mental health and parental psychological distress.

Methods

Participants with a copy number variant or single nucleotide variant (5-19 years) were recruited via UK National Health Service. 1904 caregivers competed an online assessment of child mental health and reported on their own psychological wellbeing. We used regression to examine the association between IDD with and without co-occurring ASD, and co-occurring mental health difficulties, as well as with parental psychological distress. We adjusted for children's sex, developmental level, physical health, and socio-economic deprivation.

Results

Of the 1904 participants with IDD, 701 (36.8%) had co-occurring ASD. Children with both IDD and ASD were at higher risk of associated disorders than those with IDD alone (ADHD: OR = 1.84, 95% confidence interval [CI] 1.46-2.32, p < 0.0001; emotional disorders: OR = 1.85, 95%CI 1.36-2.5, p < 0.0001; disruptive behaviour disorders: OR = 1.79, 95%CI 1.36-2.37, p < 0.0001). The severity of associated symptoms was also greater in those with ASD (hyperactivity: B = 0.25, 95%CI 0.07-0.34, p = 0.006; emotional difficulties: B = 0.91, 95%CI 0.67 to 1.14, p < 0.0001; conduct problems: B = 0.25, 95%CI 0.05 to 0.46, p = 0.013). Parents of children with IDD and ASD also reported greater psychological distress than those with IDD alone (β = 0.1, 95% CI 0.85 to 2.21, p < 0.0001). Specifically, in those with ASD, symptoms of hyperactivity (β = 0.13, 95% CI 0.29-0.63, p < 0.0001), emotional difficulties (β = 0.15, 95% CI 0.26-0.51, p < 0.0001) and conduct difficulties (β = 0.07, 95% CI 0.07-0.37, p < 0.004) all significantly contributed to parental psychological distress.

Conclusions

Among children with IDD of genetic aetiology, one third have co-occurring ASD. Not only do those with co-occurring ASD present with a wider range of associated mental health disorders and more severe mental health difficulties than those with IDD alone, but their parents also experience more psychological distress. Our findings suggest that the additional mental health and behavioural symptoms in those with ASD contributed to the degree of parental psychological distress.

"Peas in a pod": Oral History Reflections on Autistic Identity in Family and Community by Late-Diagnosed Adults

In this paper, we report on a participatory oral history study documenting the lives of late-diagnosed autistic adults in Australia. We interviewed 26 autistic adults about their life history and the impact of late diagnosis. All were diagnosed after the age of 35, growing up in an era when autism was not well known. Using reflexive thematic analysis, we uncovered a rich body of reflections on shared Autistic identity and identified three major themes within that data set: 'conceptualising the Autistic family', 'creating Autistic community', and 'contesting Autistic identity'. Overall, the study provides insights into the active creation of shared Autistic identity and the importance of Autistic community to these late-diagnosed autistic adults.

Effects of Equine-Assisted Activities and Therapies for Individuals with Autism Spectrum Disorder: Systematic Review and Meta-Analysis

Autism spectrum disorder (ASD) has become a critical public health issue that affects more than 78 million people. In many recent studies, the authors have demonstrated that equine-assisted activities and therapies (EAATs) can substantially improve the social and behavioral skills of children with ASD. However, the qualities of the studies differ, and some authors reached opposite conclusions. In this review, we systematically and objectively examined the effectiveness of EAATs for people with ASD, combining both qualitative and quantitative methods. We searched five databases (PubMed, Scopus, ERIC, ProQuest, and MEDLINE) and added relevant references, and we identified 25 articles for data extraction and analysis. According to our results, EAAT programs can substantially improve the social and behavioral functioning and language abilities of children with ASD. However, among the subdomains, the results were inconsistent. According to the meta-analyses, there were considerable improvements in the social cognition, communication, irritability, and hyperactivity domains, but not in the domains of social awareness, mannerisms, motivation, lethargy, stereotypy, or inappropriate speech. Moreover, there was a lack of sufficient comparative data to conclude that EAAT programs lead to substantial improvements in motor and sensory functioning. In addition, among the included studies, we noted the indicator of whether EAAT programs decreased parental stress and improved family functioning, and although there were four articles in which the researchers considered this aspect, we were unable to draw any conclusions because of the insufficient data and conflicting descriptive evidence. However, we need to consider the improvement in parental mental health as a factor in the effectiveness of this complementary intervention. We hope that in future studies, researchers will focus on family functioning and conduct more randomized controlled trials (RCTs) with blinded assessments using different scales and measures.

Advancing research on early autism through an integrated risk and resilience perspective

To date, a deficit-oriented approach dominates autism spectrum disorder (ASD) research, including studies of infant siblings of children with ASD at high risk (HR) for the disabilities associated with this disorder. Despite scientific advances regarding early ASD-related risk, there remains little systematic investigation of positive development, limiting the scope of research and quite possibly a deeper understanding of pathways toward and away from ASD-related impairments. In this paper, we argue that integrating a resilience framework into early ASD research has the potential to enhance knowledge on prodromal course, phenotypic heterogeneity, and developmental processes of risk and adaptation. We delineate a developmental systems resilience framework with particular reference to HR infants. To illustrate the utility of a resilience perspective, we consider the "female protective effect" and other evidence of adaptation in the face of ASD-related risk. We suggest that a resilience framework invites focal questions about the nature, timing, levels, interactions, and mechanisms by which positive adaptation occurs in relation to risk and developmental pathways toward and away from ASD-related difficulties. We conclude with recommendations for future research, including more focus on adaptive development and multisystem processes, pathways away from disorder, and reconsideration of extant evidence within an integrated risk-and-resilience framework.

Learning from the experts: Evaluating a participatory autism and universal design training for university educators

LAY ABSTRACT

Autistic university students have many strengths. They also go through difficulties that professors may not understand. Professors may not understand what college life is like for autistic students. They might judge autistic students. A team of autistic and non-autistic researchers made a training to help professors understand autistic students better. This training also gave professors ideas to help them teach all of their students. Ninety-eight professors did an online survey before the autism training. They shared how they felt about autism and teaching. Before our training, professors who knew more about autism appreciated autism more. Professors who thought people should be equal and women also appreciated autism more. Then, 89 of the professors did our training and another survey after the training. This helped us see what they learned from the training. They did one more survey a month later. This helped us see what they remembered. Our training helped professors understand and value autism. It also helped them understand how they can teach all students better. The professors remembered a lot of what we taught them. This study shows that a training that autistic people helped make can help professors understand their autistic students better.

Does Language Matter? Identity-First Versus Person-First Language Use in Autism Research: A Response to Vivanti

In response to Vivanti's 'Ask The Editor…' paper [Journal of Autism and Developmental Disorders, 50(2), 691-693], we argue that the use of language in autism research has material consequences for autistic people including stigmatisation, dehumanisation, and violence. Further, that the debate in the use of person-first language versus identity-first language should centre first and foremost on the needs, autonomy, and rights of autistic people, so in to preserve their rights to self-determination. Lastly, we provide directions for future research.

Structural and Pragmatic Language Impairments in Children Evaluated for Autism Spectrum Disorder (ASD)

Pragmatic language impairments are common in neurodevelopmental disorders, especially in autism spectrum disorder (ASD). The relationship between structural language skills and pragmatic competence in children with autistic symptoms, however, is largely unknown. We investigated this relationship based on the Children's Communication Checklist-2 and early language delay among children (N = 177, 19% females) clinically evaluated for ASD, differentiated into ASD (n = 148) and non-ASD (n = 29). Structural language deficits were common and associated with reduced pragmatic competence in both groups. Pragmatic language impairments were most profound in children with ASD. Early language delay and structural language deficits were less common in females. Our findings suggest that assessment of structural language skills should be included in the evaluation of children with suspected ASD.

The spectrum of attitudes towards the spectrum of autism and its relationship to psychological distress in mothers of children with autism

LAY ABSTRACT

Mothers of children on the autism spectrum experience high levels of emotional distress. Mothers cope with stress by having their own thoughts and opinions about their children. In this study, we tested whether the way mothers perceive autism may contribute to the level of distress they feel. Some mothers see autism as a developmental disorder that needs to be cured, but some see autism as a type of mind that needs to be accepted. Our findings showed that mothers who see autism more as a type of mind are generally less stressed. But we also showed that it matters how severe are the child's symptoms, and how heavy was the perceived burden of caring for the child. These results imply that it is worth working on attitudes towards autism to help mothers cope better. But at the same time, we argue that mothers should not be judged for their perceptions of autism, as there is a huge spectrum of a child's characteristics and family's life circumstances.

Does the gender matter?: Anxiety symptoms and emotion dysregulation in adults with autism and intellectual disabilities

Research shows high rates of anxious symptoms in people autistic spectrum disorder (ASD). Finding factors related to the development of anxiety in ASD is necessary. Emotion regulation (ER) is associated with anxiety in ASD. Moreover, some studies find higher rates of anxiety in women with ASD. A total of 121 adults (M = 35.46 years, SD = 9.46) with ASD and intellectual disabilities were evaluated to verify moderating role of gender and mediating role of ER. A moderated mediation analysis supported the moderated role of gender in the relationship mediated by emotional dysregulation between ASD and anxiety. These findings suggest that interventions designed to prevent or reduce anxiety symptoms in women with ASD should include among their goals emotional regulation. LAY SUMMARY: If we want to reduce or prevent anxiety symptoms in women with ASD we must work on emotional regulation.

A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe

Most mental disorders appear by age 14, but in most cases, they remain undiagnosed and untreated well into adulthood. A scoping review showed an absence of systematic reviews that address prevalence rates of mental disorders among children and adolescents in Europe that are based on community studies conducted between 2015 and 2020. To estimate the updated pooled prevalence of Anxiety Disorder, Depressive Disorder, Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder, Eating Disorders, Substance Use Disorders (SUD), among children and adolescents living in Europe, a search strategy was conducted using MEDLINE, Embase and Psych Info and studies were also identified from reference lists and gray literature. Eligible studies were evaluated for reliability, validity, and bias. Trends of prevalence rates for each mental disorder were calculated. Almost one in five young people in Europe were found to suffer from a mental disorder, with a pooled prevalence rate of 15.5%. Anxiety disorders had the highest pooled prevalence rate (7.9% (95% CI 5.1-11.8%, I2: 98.0%)), followed by ADHD (2.9% (95% CI 1.2-6.9%, I2 = 94.3%)), ODD (1.9% (95% CI 1.0-3.7%, I2 = 98.4%)), depressive disorder (1.7% (95% CI 1.0-2.9%, I2 = 97.7%)), CD (1.5% (95% CI 0.6-3.8%, I2 = 98.8%)) and ASD (1.4% (95% CI 0.4-5.4%, I2 = 99.7%). No studies on SUD were identified. The mental health of children and adolescents may be improved by introducing routine screening, refining diagnostic sensitivity, raising awareness of mental disorders, minimizing stigma and socioeconomic inequality, as well as developing early intervention services. These facilitators of good mental health need to be prioritized, especially at a time of unprecedented risk factors for poor mental health.

Autism traits dimensionality and multivariate relationship with alexithymia and anxiety in the general population

BACKGROUND

Autism is characterized by social and non-social alterations observed beyond the clinical diagnosis. Research analyzing the expression of autism traits in the general population helps to unravel the relationship between autism dimensions and other associated variables, such as alexithymia and anxiety. The Autism-Spectrum Quotient (AQ) was developed to assess autism traits in the general population; however, inconsistent results regarding its dimensionality have emerged.

AIMS

This study aimed to extend evidence about the AQ measurement model, and explore the multivariate relationship between autism traits, alexithymia, and trait anxiety.

METHODS

292 adults of the general population were recruited. An Exploratory Factor Analysis and Confirmatory Factor Analysis were performed to assess the factorial structure of AQ. A path analysis was carried out to explore the relationship between autism traits, alexithymia, and trait anxiety.

RESULTS

The results supported a three-factor model of AQ. The path analysis model showed evidence of a significant role of alexithymia as a mediator of the relationship between autism traits and anxiety.

CONCLUSIONS AND IMPLICATIONS

The present study provides empirical support for a three-factor model of AQ in the general population. The association between autism traits, alexithymia, and anxiety dimensions highlights the multidimensional nature of these variables and the need to account for their distinct impact on autism-related variables.

Subjective experiences as nodes within mental disorder networks

What are the functional roles of subjective experiences? Answering this question amounts to charting a course for the cognitive science of consciousness, where mental processes can be described in terms of their functions. If we strategically focus on mental disorders, preliminary answers may be in sight within 25 years.

Cognitive and Developmental Functions in Autistic and Non-Autistic Children and Adolescents: Evidence from the Intelligence and Development Scales-2

Autistic individuals often show impairments in cognitive and developmental domains beyond the core symptoms of lower social communication skills and restricted repetitive behaviors. Consequently, the assessment of cognitive and developmental functions constitutes an essential part of the diagnostic evaluation. Yet, evidence on differential validity from intelligence and developmental tests, which are commonly used with autistic individuals, varies widely. In the current study, we investigated the cognitive (i.e., intelligence, executive functions) and developmental (i.e., psychomotor skills, social-emotional skills, basic skills, motivation and attitude, participation during testing) functions of autistic and non-autistic children and adolescents using the Intelligence and Development Scales-2 (IDS-2). We compared 43 autistic (M_age = 12.30 years) with 43 non-autistic (M_age = 12.51 years) participants who were matched for age, sex, and maternal education. Autistic participants showed significantly lower mean values in psychomotor skills, language skills, and the evaluation of participation during testing of the developmental functions compared to the control sample. Our findings highlight that autistic individuals show impairments particularly in motor and language skills using the IDS-2, which therefore merit consideration in autism treatment in addition to the core symptoms and the individuals' intellectual functioning. Moreover, our findings indicate that particularly motor skills might be rather neglected in autism diagnosis and may be worthy of receiving more attention. Nonsignificant group differences in social-emotional skills could have been due to compensatory effects of average cognitive abilities in our autistic sample.