Do Occupational Therapy Goals for Children with Autism Spectrum Disorder Reflect Participation? A Mapping to the ICF - CY and ICF Core Sets Study

Autism Spectrum Disorder (ASD) is on the rise worldwide with an increasing acknowledgement that its continuum of care to enhance participation should be multidisciplinary. The International Classification of Functioning, Disability, and Health (ICF) and its derivatives ICF - Children and Youth (ICF - CY) and ICF Core Sets have been increasingly used among health professionals to enhance communication and documentation of outcomes. This study aimed at investigating the comprehensiveness of the ICF - CY and ICF Core Sets with regard to occupational therapy goals and the extent of participation representation in these goals. Forty occupational therapists working with children with ASD stated their most common three long-term goals. The goals were then mapped to the ICF - CY two level classification. The percentage of goals reflecting "Participation" was calculated. The overlap between ICF - CY and the ICF ASD Core Sets was assessed. A total of 155 goals were extracted, of which only seven (4.5%) related to sensory processing were not linked to the ICF - CY categories. 35.1% of the total linked goals were regarded as reflecting "Participation". 84.5% of ICF - CY categories overlapped with the ICF ASD Core Sets. Categories related to hand function, and taking care of body parts were found to be lacking in the ICF ASD Core Sets. The ICF - CY and the ICF ASD Core Sets may be feasible clinical tools for children with ASD, however, they may not be sufficient to cover occupational therapy goals. Goals also need to be modified to better reflect participation.

Autistic Traits Modulate Social Synchronizations Between School-Aged Children: Insights From Three fNIRS Hyperscanning Experiments

The current study investigated how autistic traits modulate peer interactions using functional near-infrared spectroscopy (fNIRS) hyperscanning. Across three experiments, we tested the effect of copresence, joint activity, and a tangible goal during cooperative interactions on interbrain coherence (IBC) in school-aged children between 9 and 11 years old. Twenty-three dyads of children watched a video alone or together in Experiment 1, engaged in joint or self-paced book reading in Experiment 2, and pretended to play a Jenga game or played for real in Experiment 3. We found that all three formats of social interactions increased IBC in the frontotemporoparietal networks, which have been reported to support social interaction. Further, our results revealed the shared and unique interbrain connections that were predictive of the lower and higher parent-reported autism-spectrum quotient scores, which indicated child autistic traits. Results from a convergence of three experiments provide the first evidence to date that IBC is modulated by child autistic traits.

Bullying Victimization is Associated with Heightened Rates of Anxiety and Depression Among Autistic and ADHD Youth: National Survey of Children's Health 2016-2020

Autistic youth and youth with ADHD have heightened rates of bullying victimization, anxiety, and depression. The purpose of this research is to use nationally representative US data to 1) estimate the prevalence of anxiety and depression among bullied neurodivergent youth and 2) investigate whether the association between bullying victimization and anxiety or depression is significantly greater among autistic youth and youth with ADHD. For this research, we used five years of data (2016-2020) from the nationally representative National Survey of Children's Health (NSCH), youth ages 12-17 years (n = 71,973). Data were analyzed with R and the R survey package to estimate average marginal percentages, risk differences, and additive interactions as recommended by STROBE guidelines. The study identified heightened anxiety and depression among bullied autistic or ADHD youth. Results also showed that the increase in the rate of anxiety or depression associated with bullying victimization was significantly greater among autistic youth and youth with ADHD relative to non-autistic non-ADHD youth; interactions were significant among both male and female youth. Autistic youth, youth with ADHD, and youth with co-occurring autism and ADHD are particularly vulnerable to bullying victimization and associated depression and anxiety. Future research is needed to understand why the association between bullying victimization and depression/anxiety is significantly greater among autistic and non-autistic ADHD youth. Recommendations include exploring school-wide anti-stigma initiatives to stop the reciprocal bullying-anxiety/depression cycle, routine bullying and mental health screening of autistic and ADHD youth, and clinical management of bullied autistic and ADHD youth with anxiety or depression.

Using Life Course Theory to Explore the Association Between Autistic Traits, Child, Family, and School Factors and the Successful Transition to Secondary School

Life Course Theory contends that school transitions can interrupt academic and wellbeing trajectories, depending on child, family, and school factors. Hierarchical regression analyses examined how autistic traits were associated with school transition outcomes. Autistic traits explained 12% of the variance in Quality of Life (QOL), 24% of the variance in mental health and 9% of the variance in school belonging. When autistic traits were accounted for, gender was a significant predictor of changes in QOL whereas changes in school belonging were predicted by cognitive functioning, parent education, school attendance and school refusal. Changes in mental health after transition were mostly predicted by family factors including family structure, family functioning and parent education but were also significantly predicted by sleep problems.

'We have so much to offer': Community members' perspectives on autism research

LAY ABSTRACT

Autism research is changing. Autistic activists and researchers want Autistic people in the community to have more of a say about what is researched and how. But we haven't asked people in the community what they think. This study used the information obtained from 55 community members, including Autistic people, their families, and professionals working with Autistic people, from an existing study on their priorities for autism research. We re-looked at what was said to see if we could understand community members' views and experiences of autism research. People agreed strongly that research can play a powerful role in shaping good Autistic lives. They also felt that big changes were needed for research to do this. Some of these changes were that researchers should stop thinking about autism narrowly and in a negative way, where Autistic people are seen as the problem. Researchers need to think more about how to improve systems, experiences and how other people respond to Autistic people. They also want the autism community to be more involved in what is researched and how it is researched. The findings from our study here highlight the potential for research to be positive when Autistic people and their families are listened to, approached with understanding, and are respected and valued as individuals in the research process.

Parental Experiences of Distance Learning in Families with and without an Adolescent with ADHD/ASD: A Large Qualitative Survey Study

One of the greatest COVID-19-related challenges for children and their families was managing distance learning due to school closures. We also know from previous research that families with a child with a neurodevelopmental disorder such as ADHD or ASD were struggling more than others but also experienced some positive effects. However, few qualitative studies have been conducted. The present study therefore aimed to investigate parental experiences of the negative and positive effects of distance learning during the COVID-19 pandemic in a large sample of families with an adolescent with ADHD and/or ASD and a matched comparison group (n = 682). Data were collected through open-ended questions as part of a larger survey study. Five main themes with different sub-themes were identified for both negative and positive effects: (1) Teaching, (2) Social, (3) Support, (4) Child factors, and (5) Home environment. In addition, the main theme "Technical problems" was identified for negative effects. Families with a child with ADHD/ASD reported negative effects related to "Child factors" and "Support" more frequently than the controls, as well as negative effects related to some aspects of "Teaching" and "Technical problems". Regarding positive effects, significant group differences were primarily found for the theme "Child factors". These findings are discussed both in terms of how to best prepare for possible future pandemics, but also of how to best provide educational support for children with ADHD and/or ASD when schools are open.

"It's a learning curve throughout your entire life": Experiences and impact of FASD in adolescence explored in online photovoice research

BACKGROUND

Research into the lived experience and disability of Fetal Alcohol Spectrum Disorder (FASD) is sparse in adolescence, despite its relevance to supports and life outcomes.

AIMS

The study explored adolescents' lived experiences of FASD and access to support across home, school, and community.

METHODS AND PROCEDURES

An online photovoice study was undertaken with eight young people (age 12-19, in education), integrating an Interpretative Phenomenological Analysis (IPA) approach. The research process comprised two individual interviews, group training, individual photo-taking, and group sessions for photo analysis/ dissemination.

OUTCOMES AND RESULTS

Participant-led analysis of their photos identified how activities at home and in the community had functions of relaxation, sensory gratification, and enabled concentration. Researcher-led analysis found that young people identified with the disability of FASD through experiences at home and school. While they acknowledged the value of support and relationships, education was not always an inclusive experience.

CONCLUSIONS AND IMPLICATIONS

Participatory online research allowed insight into the impact of FASD as a disability and underlines a consistent need for support in adolescence and the transition into adulthood. Young people with FASD require explicit support to develop their advocacy skills to improve educational outcomes.

Autistic phenomenology: past, present, and potential future

We are now at a transition point in autism conceptualisation, science, and clinical practise, where phenomenology could play a key role. This paper takes a broad view of the history of phenomenological perspectives on the autism concept and how this has evolved over time, including contemporaneous theory and methods. Early inquiry from a clinical perspective within the tradition of classical continental phenomenology, linked closely to the consideration of schizophrenia, is contrasted with emerging observations of child development and a period in the second half of the twentieth century of scientific inquiry into a behavioural autistic phenotype where there was little or no phenomenological aspect; a phenotype that has determined the recent scientific and clinical conceptualisation of autism within current nosology. We then mark a more recent reawakening of interdisciplinary interest in subjective experience and phenomenological inquiry, which itself coincides with the increasing prominence and salience of the neurodiversity movement, autistic advocacy, and critical autism studies. We review this emerging phenomenological work alongside a contemporaneous clinical phenomenology perspective and representations of autistic experience from within the extensive literature (including life writing) from autistic people themselves; all perspectives that we argue need now be brought into juxtaposition and dialogue as the field moves forward. We argue from this for a future which could build on such accounts at a greater scale, working toward a more co-constructed, systematic, representative, and empirical autistic phenomenology, which would include citizen and participatory science approaches. Success in this would not only mean that autistic experience and subjectivity would be re-integrated back into a shared understanding of the autism concept, but we also argue that there could be the eventual goal of an enhanced descriptive nosology, in which key subjective and phenomenological experiences, discriminating for autism, could be identified alongside current behavioural and developmental descriptors. Such progress could have major benefits, including increased mutual empathy and common language between professionals and the autistic community, the provision of crucial new foci for research through aspects of autistic experience previously neglected, and potential new supportive innovations for healthcare and education. We outline a programme and methodological considerations to this end.

Extracurricular Activity Participation Among Autistic Children and Adolescents: Buffer for Internalizing Conditions and Foundation for Friendship?

PURPOSE

Internalizing conditions, such as anxiety and depression, and difficulties with developing and maintaining friendships are common among autistic children and adolescents. Participation in extracurricular activities may buffer against these challenges as they provide naturalistic opportunities to bring peers with shared interests and skills together. As such, the purpose of the current study was to examine associations between sport and club participation and (1) friendship success and (2) co-occurring anxiety and depression in a large sample of autistic youth.

METHODS

Secondary analysis was performed using data from the 2018-2019 National Survey of Children's Health. Participants were 562 autistic children (ages 6-11 years) and 818 autistic adolescents (ages 12-17 years). Within each age group, a series of binary logistic regression analyses were conducted.

RESULTS

Club participation was not associated with friendship or internalizing conditions. However, participation in sports was positively associated with friendship success among both children (OR = 2.07, p = .006) and adolescents (OR = 2.35, p = .001). Results also found that adolescents who participated in sports were 34% less likely to have diagnosis of depression (p = .048).

CONCLUSION

Findings suggest that participation in sports may play a meaningful role in protecting against depression during adolescence and serve as a context for friendship development across childhood and adolescence. Future research should address barriers to extracurricular activity participation and identify the specific components of sports that are most beneficial to autistic youth to inform activity offerings and the development of interventions targeting friendship formation and mental health outcomes.

Well-being spectrum traits are associated with polygenic scores for autism

Individuals with autism spectrum disorder (ASD) tend to experience lower well-being as demonstrated mostly for children and adolescents in epidemiological studies. A further investigation of inclusive well-being, in terms of five well-being spectrum (5-WBS) traits including neuroticism, depression, loneliness, life satisfaction, and positive affect, among adults with ASD may deepen our understanding of their well-being, and lead to the possibility to further modify societal supportive mechanisms for individuals with ASD. This study aims to investigate if a genetic predisposition for ASD is associated with 5-WBS traits using polygenic risk score (PRS) analysis. PRS for ASD were calculated based on the latest genome-wide association study of ASD by the Psychiatric Genetics Consortium (18,381 cases, 27,969 controls) and were created in the independent cohort UK Biobank. Regression analyses were performed to investigate the association between ASD PRS and 5-WBS traits in the UK Biobank population including 337,423 individuals. ASD PRS were significantly associated with all 5-WBS traits, showing a positive association with the negative WBS traits, neuroticism (max R2  = 0.04%, p < 1 × 10-4 ), depression (max R2  = 0.06%, p < 1 × 10-4 ), loneliness (max R2  = 0.04%, p < 1 × 10-4 ), and a negative association with the positive WBS traits, life satisfaction (max R2  = 0.08%, p < 1 × 10-4 ), positive affect (max R2  = 0.10%, p < 1 × 10-4 ). The findings suggest that adults carrying a high load of risk single nucleotide peptides (SNPs) for ASD are more likely to report decreased well-being. The study demonstrates a considerable connection between susceptibility to ASD, its underlying genetic etiology and well-being.

"It is like you are in a golden cage": How autistic students experience special education classrooms in general high schools

BACKGROUND

Students with autism spectrum disorder (ASD) often grapple with the challenges and demands of a general school environment. To date, studies have focused on inclusion within that environment, not distinguishing the experience of students in ASD special education classrooms within the general school. This study examined the retrospective perceptions of high-functioning autistic high school graduates who had been in ASD special education classrooms in general high schools to understand their experience, learn about their needs, and enhance future educational experiences.

METHOD

Using interpretative phenomenological analysis (IPA) as a methodological framework, semi-structured interviews were conducted with 12 autistic individuals aged 19-27 that were enrolled in those particularized classrooms during high school. Data were analyzed using Thematic Analysis.

RESULTS

Three overarching themes were identified: (1) the challenge of heterogeneity among students in these classrooms; (2) exclusion and labeling; and (3) identity confusion.

CONCLUSIONS

The findings of this paper highlight the need for greater attention to the voices and experiences of individuals with ASD regarding this educational model of ASD special education classrooms in general schools. Participants' perceptions about their educational experience in ASD special education classrooms need to be addressed at all levels of inclusive policy and practice.

An Interactive and Neurodiversity-Affirming Approach to Communication Supports for Autistic Students Through Videogaming

PURPOSE

Videogaming offers an interactive, enjoyable, and socially valid context for interaction between autistic and non-autistic students in schools. In this tutorial, I describe an approach that supports communication and peer interaction through group-based videogaming. This approach creates an opportunity for autistic and non-autistic students to engage in a meaningful and enjoyable activity and to promote acceptance and appreciation of communication differences.

METHOD

This tutorial includes development, planning, essential components, goal writing, and a list of resources and directions to implement the videogaming-based group intervention in middle and high school settings. This tutorial is grounded in a supports-based, anti-ableist, neurodiversity framework that embraces a difference-based view of autistic communication. Cost-effectiveness and ease of implementation make this intervention feasible for school settings.

CONCLUSIONS

Ableist practices are pervasive in academic and clinical settings. There is an urgency within the field of speech-language pathology to address misconceptions regarding autism and autistic individuals, increase the understanding and appreciation of diversity in autistic communication, and eliminate practices that may promote autistic masking. These can be achieved by developing supports that value the preferences and experiences of autistic individuals and honor their strengths. Videogaming is one context that supports social communication. It does not hinge upon normative communication as a benchmark. Increased contact and exposure to autistic peers through fun and engaging game-based interactions help reduce stigma and prejudice toward autistic students.

"He's shouting so loud but nobody's hearing him": A multi-informant study of autistic pupils' experiences of school non-attendance and exclusion

Background and aims

Children and young people on the autism spectrum frequently report a range of negative educational experiences and face disproportionally high rates of school non-attendance, including school avoidance and permanent exclusion, which can have a significant impact on their well-being as well as educational and broader life outcomes. To date, few studies have examined the full range of proximal (child, parent/family, school levels) and distal (community and society levels) barriers to ensuring the school attendance and the inclusion of autistic pupils. The current study sought to do just that by examining autistic young peoples' school non-attendance and exclusion experiences from the perspectives of multiple informants.

Methods

We recruited 12 autistic pupils, who had previously experienced school avoidance and/or exclusion, from one local authority in England, United Kingdom. We conducted semi-structured interviews with the young people themselves, ten of their parents, eight of their current teachers and nine local authority professionals, including six educational psychologists and three specialist autism teachers. We analyzed interviewees' responses using reflexive thematic analysis.

Results

Interviewees gave overwhelmingly negative accounts of autistic pupils' school non-attendance and exclusion experiences. Our analysis identified a range of school-related factors they felt led to, or exacerbated, negative experiences in their former mainstream schools, and which ultimately led to their or their children's school non-attendance. It also went further to identify distal factors, including fragmented educational experiences, parents "fighting" against a complex bureaucratic system to secure appropriate education for their children, and limited professional involvement.

Conclusions

Our findings emphasize the importance of examining the broader context in which autistic pupils are embedded and demonstrate that such pupils are able to successfully attend-and even enjoy-school when they receive the appropriate care and support.

Implications

Schools and local authority professionals should seek to work in partnership with parents and autistic pupils to secure the necessary support for their inclusion in mainstream education. Government policy should support the provision of sufficient local authority professionals to adopt a more proactive approach to mitigate autistic pupils' avoidance of and exclusion from school.

'Someone like-minded in a big place': Autistic young adults' attitudes towards autistic peer support in mainstream education

LAY ABSTRACT

Autistic young people may struggle in mainstream schools and feel disconnected from their peers and their school. We know that autistic adults can benefit from spending time with other autistic people, but we don't know if this is the case for younger autistic people. We conducted interviews with 13 autistic young adults in the United Kingdom who recently left mainstream schooling. We asked them if they would have been interested in being involved in autistic peer support when they were at school, and if so, what that peer support should look like. Results indicated that autistic young people were enthusiastic about the idea of peer support. They thought it was important that peer support was flexible to suit their needs at different times, as well as inclusive, positive, and embracing neurodiversity. They also discussed the potential benefits and difficulties of having a peer support system within a school setting. This adds to the growing body of research on the potential benefits of autistic-autistic interactions on autistic people's well-being and sense of belonging. Findings can be used to help design pilot peer support projects in schools that can be tested to see how effective they are.

"My Autism Is My Own": Autistic Identity and Intersectionality in the School Context

Background

School is an important context for identity development across childhood and adolescence. These formative experiences impact adulthood. Minimal research has examined first-person autistic perspectives of how school experiences shape autistic identity as well as other intersecting identities. In this study, we examined the school messages that autistic individuals received and how individuals engaged with these external messages to formulate their identities.

Methods

Ten U.S.-based autistic adolescents and adults ages 15-35 participated in qualitative interviews about their elementary through secondary school experiences, interactions with teachers and peers, and how these shaped their identities. Two interviewees also engaged in three follow-up interviews each for member checking and further data gathering. Using a critical constructivist approach informed by grounded theory, we coded interviews inductively. We ensured the trustworthiness of data through peer debriefing, reflexive journaling, memoing, and member checking.

Results

In the school context, autistic students received stigmatizing messages from teachers and peers regarding their autism. These messages varied in relation to students' other identities, including race and gender. Participants felt that, following autism disclosure, teachers viewed them narrowly through an autism lens. Participants actively resisted these negative messages from teachers and peers by reclaiming their autistic identity. They reframed and redefined their autistic identity, embraced their autism-related strengths, and actively made choices about how, when, and to whom to disclose their autism. Decisions around autism disclosure intersected with decisions to emphasize other identities such as race or mental health, especially when these identities were more visible or more acceptable to others.

Conclusions

The school context conveyed powerful, stigmatizing messages around autism. In response, autistic students actively reclaimed and shaped their identities to prioritize a positive, empowered sense of self. Findings show a need for educators to model positive perceptions of autism, build an inclusive school community, and advocate for autistic representation in schools to facilitate autism-affirming messages.

A capabilities approach to understanding and supporting autistic adulthood

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

The impact of a positive autism identity and autistic community solidarity on social anxiety and mental health in autistic young people

LAY ABSTRACT

Autism is a diagnosis given to individuals by professionals but is also increasingly seen as an identity which an individual can choose for themselves. We wanted to explore how having autism as an identity affects autistic young people. There is evidence that autistic adults have better psychological well-being when they feel more solidarity with other autistic people and feel positively about being autistic. We know that autistic teenagers often feel anxious in social situations. Having a positive autism identity might help alleviate social anxiety associated with being autistic. We wanted to find out if autistic young people who felt more solidarity with other autistic people, and had more positive feelings about autism, had better psychological well-being and less social anxiety. We asked 121 autistic people aged 15-22 years to complete some questionnaires. These questionnaires asked about the young person's autism traits, social anxiety, and psychological well-being. The questionnaires also asked how satisfied they felt to be autistic (satisfaction) and how much solidarity they felt with the autism community (solidarity). We found that autistic young people who had higher autism satisfaction had better psychological well-being and lower social anxiety. Young people who felt more solidarity with other autistic people had higher psychological well-being. There was no association between autism solidarity and social anxiety. We conclude that is important to support autistic young people to develop positive feelings about autism and to feel solidarity with other autistic people.

Exploring the role of interpersonal contexts in peer relationships among autistic and non-autistic youth in integrated education

The double empathy problem theory posits that autistic social difficulties emerge from an interpersonal misalignment in social experiences and expectations between autistic and non-autistic people. Supporting this, emerging research reveals better social outcomes in interactions within than across neurotypes among autistic and non-autistic people, emphasizing the need to examine the role of the interpersonal context in autistic social outcomes. However, research on peer relationships among autistic youth primarily focuses on individual characteristics in isolation from the interpersonal context. To address this, this preliminary study explored the effects of student-peer neurotype match on peer relationships among autistic and non-autistic youth in an integrated educational setting. We plotted the peer relationship networks among youth in a school club based on systematic observations of peer interactions over eight 45-min sessions. Descriptive network statistics (node degree and strength) showed that both autistic and non-autistic youth had more and stronger peer relationships with their same- than cross-neurotype peers. Assortativity coefficients revealed a tendency for youth to connect with peers of the same neurotype, rather than with peers with similar social popularity or activity. We further modeled the effects of student-peer neurotype match on peer relationships using exponential random graph models. The findings suggested that student-peer neurotype match predicted the total strength of peer relationships above and beyond the effects of student neurotype, individual heterogeneity in social popularity and activity, and the tendency of mutuality in social relationships. We discussed the strengths and limitations of this study and the implications for future research and inclusion practice.

The sensory experiences of autistic people: A metasynthesis

LAY ABSTRACT

Sensory atypicalities are very common among autistic people and are integrated in several theories and explanatory models of autism. Qualitative studies have explored these singular sensory experiences from the perspectives of autistic people themselves. This article gathers all these qualitative studies and provides original findings regarding the everyday sensory experience of autistic people, that is, around four dimensions - physical, emotional, relational and social - experienced holistically, as inseparable, and not hierarchically or in terms of cause and effect. Adopting this holistic view could improve the adaptation of the sensory environment in health care facilities and the training of professionals around this specific issue.

Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science

Since its initial description, the concept of autism has been firmly rooted within the conventional medical paradigm of child psychiatry. Increasingly, there have been calls from the autistic community and, more recently, nonautistic researchers, to rethink the way in which autism science is framed and conducted. Neurodiversity, where autism is seen as one form of variation within a diversity of minds, has been proposed as a potential alternative paradigm. In this review, we concentrate on three major challenges to the conventional medical paradigm - an overfocus on deficits, an emphasis on the individual as opposed to their broader context and a narrowness of perspective - each of which necessarily constrains what we can know about autism and how we are able to know it. We then outline the ways in which fundamental elements of the neurodiversity paradigm can potentially help researchers respond to the medical model's limitations. We conclude by considering the implications of a shift towards the neurodiversity paradigm for autism science.

"A different environment for success:" a mixed-methods exploration of social participation outcomes among adolescents on the autism spectrum in an inclusive, interest-based school club

Background: Adolescents on the autism spectrum often experience challenges participating socially in inclusive education. The majority of school-based social supports focuses on social skills training, although research shows that students on the spectrum prefer activity-based social groups over social instructions. Thus, activity-based school clubs incorporating student interests may support social participation. Method: This mixed-methods study explored the preliminary social participation outcomes of adolescents on the spectrum in an inclusive Maker Club at three public schools. The quantitative phase examined longitudinal social behavior rates throughout the school club among students (n = 12). The qualitative phase interviewed six teachers in three schools (n = 6) to explore teacher perceptions of student social outcomes compared to general classrooms and program outcomes associated with the programs. Results: Mixed-effects modeling revealed increased social response rates and social reciprocity over time in both students on the spectrum and non-autistic peers without any group differences. Teachers reported that students on the spectrum engaged more socially than in general classrooms and attributed the positive outcomes to activities encouraging shared interests and the flexible social environment. Conclusions: Inclusive school clubs incorporating shared interests and joint activities among students may socially support students on the spectrum in inclusive education.

Parent perspectives on inclusive education for students with intellectual disability: A scoping review of the literature

The aim of this study was to collect and analyze research on inclusive education from the perspective of parents of students with intellectual disability (ID). The review examined characteristics and trends related to geographical origin of research, design, data collection, publication source and year, source of data, age of individuals with ID, and research focus. The initial database search produced a total of 2,540 non-duplicated articles published between 1994 and 2019. In total, 63 articles were included from the initial search and a subsequent ancestry search. The results show a significant increase in publication on the topic in the final one-tenth of the review time parameter, suggesting a continued upward trend. The majority of articles were qualitative in design, used interviews and surveys to collect data, and focus on the perspectives and beliefs of parents on inclusive education. Gaps in the existing set of research included a lack of family perspectives beyond that of mothers (e.g. father, grandparent) and a limited focus beyond perspectives and beliefs, to that of parent experiences of inclusive education.

Exploring interpersonal and environmental factors of autistic adolescents' peer engagement in integrated education

LAY ABSTRACT

Peer engagement is essential but often challenging for autistic students in integrated education, especially for adolescents. Although peer engagement is bidirectional and context-dependent, research has largely focused on individual characteristics rather than the interpersonal and environmental factors affecting peer engagement. This mixed-methods study examined peer interactions over a school year among 17 adolescents (seven were autistic) in an inclusive school club at a public middle school in the Northeastern United States. The study began with a quantitative phase identifying sessions in which each student was socially engaged with peers more or less often than usual for them. We then qualitatively compared the social interactions and contexts between sessions where each participant experienced high and low peer engagement. Thematic analysis revealed four themes regarding contextual supports and barriers to autistic peer engagement: (1) peer engagement is a participatory process where a student and their peer(s) navigate mutual understanding, shaped by both student and peer social characteristics, openness, and involvement; (2) student-peer synchronicity, such as shared interests or compatibility of social styles, was essential to autistic peer engagement; (3) peer engagement can be supported by activities facilitating joint engagement and exploration of mutual interests; (4) classroom interventions emphasizing strengths can support peer engagement, while normative behavioral standards without peer education on individual differences and diversity can perpetuate peers' negative perceptions of autistic difficulties. The findings have implications for better inclusive practice to support autistic social participation by modifying the peer environments, activities, and classroom interventions.

Patterns of Continuity and Change in the Psychosocial Outcomes of Young Autistic People: a Mixed-Methods Study

Long-term longitudinal studies have consistently demonstrated that the outcomes of autistic individuals are highly variable. Yet, these studies have typically focused on aspects of functioning deemed to be critical by non-autistic researchers, rather than autistic people themselves. Here, we uniquely examined the long-term psychosocial outcomes of a group of young autistic people (n = 27; M age = 17 years; 10 months; 2 female) followed from childhood using a combination of approaches, including (1) the standard, normative approach, which examined changes in diagnostic outcomes, autistic features and adaptive functioning over a 9-year period and (2) a qualitative approach, which involved semi-structured interviews to understand young people's own subjective experiences of their current functioning. On average, there was no significant change in young people's diagnostic outcomes and autistic features over the 9-year period, although there was much variability at the individual level. There was far less variability, however, in young people's everyday functioning, with marked declines over the same period. While these often-substantial everyday challenges aligned well with young people's subjective reports, there was no straightforward one-to-one mapping between self-reported experiences of being autistic and standard measures of severity. These findings call for concerted efforts to understand autistic outcomes through the mixing of quantitative and qualitative reports and for sustained and targeted interventions during adolescence in those areas that matter most to young people themselves.

How children with autism spectrum disorder perceive themselves: A narrative research

AIM

The purpose of this article is, through a dialog between the child and the author, to clarify how children with autism spectrum disorder (ASD) perceive themselves.

METHODS

The qualitative study's participants were nine children with ASD. Their ages were 8-18 years. Data were collected through two sessions of dialog between the child and the author. Data were analyzed through a qualitative inductive approach based on the perspectives of narrative analysis.

RESULTS

There were eight categories of how the children perceive themselves. The children talked about themselves as follows. The children with ASD wished to share feelings with others, sensitively read between the lines, and talked about the belief to cherish their friends. They were able to anticipate that repetitive behavior or interest in one thing would end someday. And they then made an effort to deal with problematic matters in social life.

CONCLUSION

This article proposes to understand the experience of "increasing alienation" in children with ASD. As a type of support to understand the child, this article proposed a dialog that elicits communication arrangements, specifically a dialog that focuses on forming a profound relationship of being able to share and communicate with each other.

"It just fits my needs better": Autistic students and parents' experiences of learning from home during the early phase of the COVID-19 pandemic

Background and aims

The COVID-19 pandemic has caused unprecedented disruption to people's lives, especially for families, whose children have been taken out of schools during lockdown restrictions and required to learn from home. Little is known, however, about the perceived impact of the lockdown restrictions on the educational experiences of autistic children and young people - a group whose conventional schooling experiences are already often challenging. In this study, we sought to (1) understand these experiences from the perspectives of autistic young people and their parents, and (2) identify the underlying sources of positive experiences at this challenging time, in order to inform the ways in which autistic children might flourish at school in more normal times.

Methods

Ninety-one Australian participants, including 16 autistic young people aged 12-18 years, 32 autistic parents and 43 non-autistic parents of autistic young people aged 3-18 years, took part in semi-structured interviews about their experiences of life during the initial phase of the COVID-19 pandemic. The interviews were subjected to reflexive, thematic analysis to identify themes and subthemes for each research question.

Results

Overall, our participants initially found the transition to learning from home extremely challenging, with parents reporting that the support received from schools was far from adequate. After that initial period of transition, however, many autistic children reported flourishing at home both educationally and personally. For these children and families, we identified three key ingredients essential to this flourishing, including: (i) the importance of connected, trusting relationships ('people'); (ii) the sensory and social safety of home ('place'); and (iii) the flexibility to pace and structure learning to suit the individual child ('time').

Conclusions

While the initial COVID-19 lockdown presented many challenges to children learning at home, there were aspects of this otherwise-unsettling situation that enabled children to thrive and from which we can learn for the future.

Implications

These findings have important implications for understanding how and when autistic children might thrive in institutional educational settings once the pandemic subsides, focusing on the relationships between teachers and students, the nature of the physical learning environment and the need for greater flexibility in planning the school day.

Does the learning environment 'make the grade'? A systematic review of accommodations for children on the autism spectrum in mainstream school

BACKGROUND

The 2030 Agenda for Sustainable Development adapted by the United Nations envisions inclusive and equitable quality education. While there is a growing body of research on interventions designed to help children on the autism spectrum adapt to the school environment, accommodations to children needs have been given less attention.

OBJECTIVE

To synthesize the literature on accommodations in the learning environment for children on the autism spectrum (ages 5-19 years) in mainstream school, with a specific focus on the effects on functioning, educational outcomes and well-being.

METHODS

A systematic search was conducted. The study selection and data extraction were performed by two independent reviewers. Eligible studies were assessed according to the What Works Clearinghouse (WWC) standards.

RESULTS

The search yielded 6102 citations. Only 37 eligible studies were identified, of which 14 met the WWC standards. This inconclusive and heterogeneous body of research tentatively suggest that accommodations in the pedagogical and psychosocial leaning environment can improve performance and function in school.

CONCLUSION AND SIGNIFICANCE

Accommodations in the learning environment is a promising but understudied approach. Creative research and innovation will be needed to support policy makers and school personnel in their quest to ensure inclusive and equitable education.

School Inclusion in Children and Adolescents with Autism Spectrum Disorders in France: Report from the ELENA French Cohort Study

Children and adolescents with ASD are increasingly included in regular school settings, however little is known about how placement decisions are made. In the present study, we examined the types and duration of school attendance among children and adolescents in the ELENA Cohort, a multi-center study of children and adolescents with ASD, ages 2-16 years, in France. Results showed that 88% of subjects were attending school and that children and adolescents with more severe adaptive and cognitive deficits were less likely to attend school. The results provide a topography on school inclusion and ASD in France. Challenging behaviors and sensory processing difficulties were associated with partial-inclusion; and co-occurring anxiety symptoms were associated with inclusion on a full-time basis.

"I don't feel different. But then again, I wouldn't know what it feels like to be normal": Perspectives of Adolescents with Autism Spectrum Disorder

There is minimal research regarding the personal experiences and perceptions of youth with autism spectrum disorder (ASD). Yet, the positive and negative perceptions that youth internalize about their diagnoses are crucial, as they may have a strong impact on individuals' self-concept and well-being. This paper utilizes mixed methods to describe the perceptions of 38 adolescents with ASD about their diagnoses, as elicited via semi-structured interviews. Quantitative analyses explore links between youths' perceptions and other aspects of their social-emotional well-being. Implications are highlighted regarding the importance of shifting the narrative that individuals with ASD develop about themselves and their diagnoses.

Short Report: Social Perception of High School Students with ASD in Norway

An increasing number of students with autism spectrum disorder (ASD) enroll in inclusive schools and classrooms. The aim of this study was to research how students with ASD experience the social aspect of inclusive high schools. Five adolescences with Asperger syndrome were interviewed, and the results show that high school was perceived as an important platform for social training, and an equally important place to find new friends and acquaintances. A majority of the participants had experienced loneliness and bullying in junior high school. However, they experienced high school as a new start, with a more open and inclusive environment. Nevertheless, several of the participants expressed that they used quite a lot of energy on social settings, such as interpreting social situations and on being amongst a larger group of students. In order to support this group of adolescents in their schooling, it is important to look at their strength and resources, and not only focus on the challenges and difficulties.

'I definitely feel more in control of my life': The perspectives of young autistic people and their parents on emerging adulthood

Long-term outcomes studies often paint a discouraging picture of the lives lived by autistic adults. Yet, their outcomes are often measured against normative markers of traditional adult roles, which may not apply to autistic people making the transition to adulthood. Here, we investigated the transition experiences of a group of young autistic people who were followed from childhood. Twenty-six young people and their parents (n = 28) participated in semistructured interviews on the process of transition and their aspirations for the future. Parents often voiced serious concerns about the ongoing support their children would require and the severe lack of services designed to support them as adults. Yet, overall, young people reported feeling more in control of their own lives, including developing a sense of identity and personal autonomy, both of which may be rooted in young autistic people's executive skills and their ability to develop and maintain trusting relationships with others - two potential candidate areas for targeted support. These results call into question whether the traditional standards to which we often hold young autistic people are developmentally appropriate and suggest that the pressures of striving towards more normative ways of engaging in the world may be detrimental to their well-being.