Preferences for identity-first versus person-first language in a US sample of autism stakeholders

The missing clinical guidance: a scoping review of care for autistic transgender and gender-diverse people

The co-occurrence of autism and gender diversity has been increasingly studied in the past decade. It is estimated that ∼11% of transgender and gender-diverse (TGD) individuals are diagnosed with autism. However, there is insufficient knowledge about appropriate gender-related clinical care for autistic TGD individuals. We performed a scoping review of current clinical guidance for the care of TGD individuals to identify what was said about autism. Clinical guidance documents were searched in PubMed, Web of Science, Google Scholar, Embase, Guidelines International Network, and TRIP medical database, as well as reference mining and expert recommendation. Evidence was synthesised by narrative synthesis, recommendation mapping, and reference frequency analysis. Out of the identified 31 clinical guidance documents, only eleven specifically mentioned the intersection between autism and TGD. Key concepts among the available recommendations included advocating for a multidisciplinary approach; emphasising the intersectionality of autism and gender-diverse experiences during assessments; and-importantly-recognising that autism, in itself, does not serve as an exclusion criterion for receiving gender-related care. However, detailed and practical clinical guidance is lacking due to a gap in evidence. Empirical research into the care experiences and outcomes of autistic TGD individuals using a developmental, lifespan, and strengths-based approach is needed to generate evidence-informed and tailored guidance.

Funding

This study was funded through a Canadian Institutes of Health Research Sex and Gender Science Chair program (GSB 171373) awarded to M-CL.

No "Top of the triangle kids": Toward conceptual clarity of students, behavior, and tiers in MTSS to advance social justice

Schools have increasingly adopted multitier systems of support to address a variety of educational aims. Despite their grounding in behavioral science and the public health model of prevention, in many settings there has been a shift from a foundational focus on behavioral principles to emphasize categorization and treatment of "top of the triangle" or "Tier 3" students. Herein, we first discuss how such emphasis on situating individuals, rather than behaviors, within the continuum of supports is counter to the principles and goals of MTSS, as well as undermining efforts to support prevention and social justice. Next, we apply a critical lens to review the related literature on problem-solving, labeling, marginalization of disabled students, and discipline disparities to provide a rationale for equity-centered MTSS with corresponding recommendations for practice.

Social media shaping autism perception and identity

LAY ABSTRACT

This study suggested that social media can provide important information about autism to autistic people. We interviewed 12 autistic adults (aged 18-49 years) and talked to them about the use of social media to find both general information and content specifically about autism, autism identity and online autistic communities. There is little research exploring how autistic people find information about autism on social media and how that makes them feel. Therefore, it is important to ask autistic people about their experiences with using social media to obtain content about autism. The 12 participants explained that when they searched for information about autism on the official health pages, they often felt that the information they found was insufficient and could not answer their questions. In addition, they searched on social media platforms for information about autism despite that they perceived social media as an unreliable source. On the social media platforms, many found content that was positive in relation to their autistic identities. The participants also found comfort in some of the forums and social media groups and received helpful advice. Nevertheless, some of the discussions were aggressive and the participants felt alienated, which did not provide a sense of community online. The findings from the study may advice on what is missing in the official pages about autism, and highlight the need to involve the autistic community in writing the content on such platforms.

Person- and identity-first language in autism research: A systematic analysis of abstracts from 11 autism journals

LAY ABSTRACT

There are many ways to refer to an individual who is on the autism spectrum. A recommended approach has been to use person-first language (PFL), such as "person with autism." A different approach is to use identity-first language (IFL), such as "autistic person." Recent studies focused on different groups of people (e.g. autistic self-advocates, parents, and practitioners) show that some groups prefer PFL (practitioners) while others prefer IFL (autistic self-advocates). However, less is known about how researchers use PFL and IFL in academic writing (e.g. studies published in scientific journals) involving autistic research participants. Our study examined 12,962 journal abstracts (short summaries of scientific articles) from 11 academic journals that publish autism research findings. We wanted to know (a) about the use of PFL and IFL across abstracts, and (b) how PFL and IFL use has changed annually over time. We examined data for all journals individually and grouped together. Our findings showed that journal abstracts generally use PFL (65%) with some using either IFL (16%) or both PFL and IFL (20%). However, journals varied, with some showing a clear majority for PFL and a couple for IFL. Examining trends over time across journals showed that while PFL appeared to be the majority for most journals, IFL has steadily increased in the recent few years. Our study helps us understand how autism researchers write about autistic individuals and offers implications for helping researchers intentionally make choices about the language used in their autism research studies.

Clinical genetic counselors' use of people- and identity-first language in regard to patients' identification with disability

The language surrounding disabilities has evolved from derogatory terms to the adoption of people-first language. However, identity-first language is being advocated for by some within the disability community. Using the preferred terminology is crucial to demonstrate respect and prevent stigmatization, especially in healthcare settings like genetic counseling, where language can impact relationships with the community. However, the specific language practices of genetic counselors and their underlying reasons are unclear. This qualitative study explored the language practices employed by genetic counselors when interacting with individuals with disabilities. Fifteen interviews were conducted with genetic counselors who had clinical experience. Reflexive thematic analysis revealed that the perceptions and practices about language used with patients and disability communities overall varied, with overarching themes of people-first language is the preferred and default language, counselors mirror patient language with some exceptions, acknowledging the evolving nature of language, recognizing differences in language preferences, and reacting to outdated terminology. These findings show the importance of continuing education to stay abreast of preferred verbiage within communities and individual patients.

Profiles of nonverbal skills used by young pre-verbal children with autism on the ADOS-2: Relation to screening disposition and outcomes

Autistic individuals exhibit differences in their use and understanding of nonverbal communication; however, individual patterns of nonverbal strengths and challenges vary significantly. This heterogeneity can complicate the diagnostic and screening processes and can result in delayed or missed diagnoses. In this study, we characterize various profiles of nonverbal communication skills among 215 pre-verbal children with autism (Mage = 36.27 months, range = 18-70) and explore how these profiles are related to screening outcomes, diagnostic certainty, and developmental and behavioral features. We conducted a latent class analysis of nine items assessing nonverbal communication skills from the Toddler Module and Module 1 of the Autism Diagnostic Observation Schedule, 2nd Edition. Five nonverbal profiles were identified that differentiated children based on the form, function, and frequency of their nonverbal communication skills. Furthermore, screening outcomes and clinician certainty in autism diagnosis varied by nonverbal profile. False negative screening outcomes based on parent report were highest for children who used a range of nonverbal skills but with limited frequency or consistency. Clinicians, on the other hand, tended to have high certainty in an autism diagnosis for children with this profile, and instead rated their lowest certainty in diagnosing children who demonstrated consistent integration of eye contact with their nonverbal communication. The profiles identified in this study could be clinically useful in helping to identify children at highest likelihood of being overlooked during the screening or diagnostic processes, providing an opportunity to improve early identification and intervention for autism.

"Living Independently Means Everything to Me": The Voice of Australian Autistic Adults

Background

Despite the desire of many autistic adults to live independently, recent studies suggest that only about one in six autistic adults do. This includes living alone, with a partner, or with friends. This is a rate that is lower than adults with other disabilities. Existing studies from other countries have explored the potential barriers to independent living, with very few exploring the actual experiences of autistic adults. To the best of our knowledge, there have been no published studies exploring the firsthand moving out experiences of autistic adults globally and none that have explored their independent living experiences in Australia.

Methods

Autistic adults with independent living experience in Australia were invited to partake in an interview to understand their moving out and independent living experiences. Interviews were held virtually, audio recorded, and transcribed. Transcriptions were coded in NVivo and thematically analyzed.

Results

A total of 11 autistic adults were interviewed (aged 21-50 years). Three key themes were derived from the interviews. Autistic adults perceived independent living as important to have their own space with added autonomy and control (Theme 1). However, autistic adults shared that the moving out process and independent living comes with many challenges, and currently supports are limited (Theme 2). Nine of the 11 participants were diagnosed as adults, and they shared the importance of diagnosis and how an earlier diagnosis may have influenced their choice of accommodation and living arrangements (Theme 3).

Conclusions

Findings from this study reiterate the importance of independent living to autistic adults and shed light on the challenges of transitioning to independent living. It further adds to the growing literature about the importance of early diagnosis on later life choices. Better pathways toward adult diagnosis and the provision of supports for the moving out process would be useful to ease transition to independent living for autistic adults.

Exploring the Intersection of Autism, Theory of Mind, and Driving Performance in Novice Drivers

This study explores the intersection of Theory of Mind (ToM) abilities and driving performance among novice drivers, with a focus on autistic individuals. The purpose is to investigate how ToM deficits may impact driving behaviors and decision-making, ultimately informing the development of tailored interventions and training programs for autistic drivers. We conducted a series of driving simulations using a custom-built driving simulator, capturing multimodal data including driving performance metrics, attention allocation, and physiological responses. Participants were categorized based on NEPSY scores, which assess ToM abilities, and self-reported autism spectrum disorder (ASD) diagnosis. Driving tasks were designed to simulate real-world scenarios, particularly focusing on intersections and merging, where ToM skills are crucial for safe navigation. Our analysis revealed differences in driving behaviors among participants with varying ToM abilities as determined through the NEPSY. Participants with lower NEPSY scores exhibited less smooth driving behaviors, increased risk-taking tendencies, and differences in attention allocation compared to those with higher scores. Alternatively, individuals with ASD displayed comparable driving patterns overall. ToM abilities influence driving behaviors and decision-making, particularly in complex social driving scenarios. Tailored interventions addressing ToM deficits and stress management could improve driving safety and accessibility for autistic individuals. This study underscores the importance of considering social cognitive factors in driving education and licensure pathways, aiming for greater inclusivity and accessibility in transportation systems.

More similar than different: Characterizing special interests in autistic boys and girls based on caregiver report

Almost all autistic youths have special interests (SIs), which are focused, intense areas of passion and interest in a particular topic. Emerging research suggests that there are gender differences in SIs among autistic youth; however, commonly used measures that assess for the presence of SIs may not fully capture the granular nature of those differences between autistic boys and girls. Characterizing these differences is important for autism identification in girls, as SIs in autistic girls may often be overlooked by caregivers, teachers, and clinicians due to their more "typical" and more socially oriented content areas compared to autistic boys. This study therefore aimed to more fully characterize gender differences in SIs using a newly developed caregiver-report measure of SIs (the Special Interests Survey; SIS). Caregivers of 1921 autistic youth completed the SIS. Analyses revealed many similarities between boys and girls; there were no gender differences in mean age SI onset, caregivers' perceptions of uniqueness or interferences of endorsed SIs, or duration of previous SIs. There were gender differences in endorsement of less than half (39%) of the SI categories measured, and there were minor differences in the number of endorsed current and past SIs. Categories with significant gender differences fell along typical gender lines (e.g., more boys interested in math and construction, more girls interested in animals and arts/crafts). This study extends the growing literature on SIs and gender differences in autism and has important implications for supporting autistic youth and their families.

Reported Barriers and Facilitators for Autistic Individuals, Persons with Other Intellectual and Developmental Disabilities, and Their Caregivers to Receive the COVID-19 Vaccine: A Pilot Study

Autistic individuals and persons with other intellectual or developmental disabilities (IDD) may experience challenges in social engagement, sensory processing, and behavior rigidity. This population is more likely to face barriers to successful preventative healthcare, including vaccines, compared to neurotypical peers. Autistic individuals and persons with other IDD may be at greater risk for COVID-19 infection due to sensory dysregulation that interferes with mitigation such as wearing masks, and challenges in social communication that impose difficulties in understanding and adhering to prevention measures. Adaptations are needed to make vaccine opportunities more accessible for neurodivergent individuals. A series of seven Sensory-Friendly COVID-19 Vaccine Clinics (SFVCs) were conducted between December 2021 and August 2022 in collaboration with the A.J. Drexel Autism Institute and the Academy of Natural Sciences of Drexel University. SFVCs examined perceived barriers and facilitators to vaccine experiences, based on feedback from autistic individual/persons with IDD and their caregivers. Surveys were administered to autistic individuals/persons with IDD or their caregivers (n = 35) from the larger sample who attended the clinic; 18 participants also complete a supplemental interview. Scaled survey questions were analyzed to determine the acceptability of the SFVCs. Open-ended survey questions and interview responses were coded thematically to identify barriers, facilitators, and areas of improvement. All individuals who came to a SFVC with intent to be vaccinated were successfully administered a COVID-19 vaccine. More than 90% of participants reported that experiences at the SFVCs were positive, promoted retention, and they would recommend clinics to others. Staff clinical expertise, sensory-friendly elements, and hosting clinics at a neutral location (free from past medical history) served as facilitators to successful vaccine administration, whereas factors such as ill-equipped pharmacy staff, behavioral challenges, and logistical issues may serve as barriers. Incorporating reported barriers, facilitators, and accommodations of SFVC experiences may lead to more successful preventative healthcare processes for neurodivergent individuals.

The overlap of disordered eating, autism and ADHD: future research priorities as identified by adults with lived experience

The focus of mental health research in emerging fields should be driven by the priorities of people with relevant lived experience. Autism and ADHD are childhood-onset neurodevelopmental conditions that are associated with a range of health inequalities, including increased risk for eating disorders. The evidence base for how best to support neurodivergent individuals who experience disordered eating is still in its infancy, but research suggests that existing clinical approaches are not currently fit for purpose. In this Personal View, through community consultation with autistic people and people with ADHD who have experienced disordered eating, we present a comprehensive ranked list of research topics that people with lived experience prioritise. These priorities could be clustered into two areas: improving outcomes and identifying causal mechanisms. Within the theme of improving disordered eating outcomes, priorities are the improvement of treatment, the need for neurodiversity training in clinical services, and the identification and minimisation of unintended adverse effects of psychological intervention. Within the theme of identifying causal mechanisms, priorities are the identification of risk factors and a better understanding of the effect of autistic or ADHD neurocognitive profiles as potential contributors to eating disorder vulnerability. The final top ten research priorities are contextualised in terms of how they compare to the existing literature on the overlap between autism or ADHD and eating disorders, and concrete suggestions are made for how to implement these research priorities as testable hypotheses. Research informed by these priorities will build necessary understanding of the reasons behind the increased risk for eating disorders in neurodivergent people, and how to best support people who are affected by disordered eating to live positive and fulfilling lives.

Does Terminology Matter? Perspectives From People With Limb Difference, Clinicians, and Researchers

OBJECTIVE

To elicit the preferred terminology among people with limb difference as well as health care and/or research professionals.

DESIGN

Cross-sectional survey.

SETTING

Online.

PARTICIPANTS

A convenience sample of N=122 individuals (people with limb difference, n=65; health care and/or research professionals, n=57) completed an online survey. People were included if they (1) were aged ≥18 years; (2) self-identified as having limb difference (regardless of etiology) or as a health care or research professional (with experience working with people with limb difference); and (3) lived in the United States for most of the time in their selected role.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Importance of terminology, preference toward person-first or identity-first terms, preferred terms, and individual perspectives on terminology preferences.

RESULTS

Most participants identified as White (92.6%). Age significantly differed between groups (people with limb difference, 49.9±15.4y; professionals, 41.0±14.3y; P=.001). Approximately 50% of people with limb difference stated terminology was very or extremely important, compared to 70% of professionals (χ2=16.6, P=.002). While 73.7% of professionals reported a preference for person-first terminology, the sample of people with limb difference were more evenly split, as 42.9% reported a preference for identity-first terminology and 50.8% reported a preference for person-first terminology. The most frequently selected limb and population terms, respectively, were residual limb and individual/person with limb difference; however, many people with limb difference indicated they preferred "amputee" when speaking about a population.

CONCLUSIONS

Most of the participants indicated terminology was very or extremely important, and both groups tended to prefer the terms residual limb (limb term) and individual/person with limb difference (population term). However, this study was not intended to recommend terminology, but rather help inform terminology choices that are centered around people with limb difference. Individuality and context should be considered when deciding terminology. Future studies should include more participants from racially/ethnically minoritized groups and people with limb difference who have dysvascular and/or congenital etiologies.

Infant Communication Across the Transition to Walking: Developmental Cascades Among Infant Siblings of Children with Autism

New motor skills can shape how infants communicate with their caregivers. For example, learning to walk allows infants to move faster and farther than they previously could, in turn allowing them to approach their caregivers more frequently to gesture or vocalize. Does the link between walking and communication differ for infants later diagnosed with autism spectrum disorder (ASD), whose communicative and motor development differs from their neurotypically developing peers? We prospectively followed two groups of infants longitudinally during the transition from crawling to walking: (1) N = 25 infants with no family history of ASD; and (2) N = 91 infants with an older sibling with ASD. Fifteen infants were later diagnosed with ASD, and 26 infants showed a language delay (but did not receive an ASD diagnosis). After learning to walk, infants without ASD or language delay showed considerable changes in their communication: They gestured more frequently, and increasingly coordinated their gestures and vocalizations with locomotion (e.g., by approaching a caregiver and showing a toy). Infants with language delay showed similar but attenuated growth in their communication. However, infants later diagnosed with ASD did not display enhanced communication after they began to walk.

The How Rather than the What: A Qualitative Analysis of Modalities and Caregiver Descriptions of Special Interests in Autistic Youth

Nearly all autistic youth have special interests (SIs), which are associated with many benefits and challenges. Most research on SIs has focused on the subject matter of SIs, with less focus on understanding how youth engage in their SIs. We conducted a qualitative study using inductive content analysis (ICA) to examine: (1) The modalities youth use to engage in their SIs, (2) the degree to which such modalities are described by caregivers as adaptive or maladaptive, and (3) the extent to which the SIs themselves are described by caregivers positively or negatively. We coded responses from 1922 caregivers of autistic youths who completed an online version of the Special Interests Survey, a caregiver-report measure of SIs. Responses to open-ended questions on the SIS, wherein caregivers describe the specific interest within the endorsed SI category, were used as data for the ICA. Frequencies of the codes were derived from cross-tabulation data. The ICA yielded eight modalities: perseverating, creating, information-seeking, memorizing, collecting, attachment, sensory-seeking, and self-soothing. Perseverating, collecting, and attachment were described as maladaptive and negatively by caregivers, whereas creating and information-seeking were described as adaptive. SIs with the greatest proportion of positive and negative descriptions were Plants and Objects, respectively. These findings suggest that SIs - and the degree to which they are described as beneficial or problematic - may be associated with modality and the subject matter. Considering how autistic individuals engage in SIs has implications for clinical work and future research in this area.

A Systematic Review of Gender Dysphoria Measures in Autistic Samples

This systematic review investigated how studies have measured gender dysphoria (GD) in autistic samples and the impact of using different measures on study results. The literature search identified 339 relevant papers, with 12 of them meeting the inclusion criteria. Results showed that seven different measures of GD characteristics have been used with autistic samples and that the studies consistently reported a greater number of GD characteristics and a greater severity of GD in autistic compared to non-autistic samples. Methodological common practices were found in recruiting participants from clinical settings rather than the general population, having more autistic males than females in the samples, for studies being conducted in Europe, North America, and Oceania, and using single-item measures of GD for samples of autistic children. Issues were identified with study designs and measures of GD, suggesting a need for a more standardized multi-item self-report measure of GD for use in clinical and non-clinical samples across different ages and cultures.

Disparities in Telehealth Uptake for Developmental-Behavioral Pediatric Assessments by Preferred Family Language: A Developmental Behavioral Pediatrics Research Network Study

OBJECTIVE

Owing to the coronavirus disease 2019 (COVID-19) pandemic, many developmental-behavioral pediatric (DBP) practices adopted telehealth for care delivery. However, telehealth access and use for families with a preferred language other than English (PLOE) is an equity concern. Therefore, our study objective is to compare rates of telehealth utilization and visit completion by preferred family language among patients seen for DBP assessments during the COVID-19 pandemic.

METHODS

We completed a descriptive chart review using electronic health record data at 4 academic DBP practices to examine visits for patients up to 5 years seen for new-patient appointments between April 2020 and April 2021. We compared rates of in-person and telehealth visits by preferred family language and visit outcome (completed or missed).

RESULTS

A total of 3241 visits were scheduled between April 2020 and April 2021; 48.2% were for in-person and 51.8% for telehealth. Families reported the following languages: 90.5% English, 6.2% Spanish, and 3.3% other language. Missed visits accounted for 7.6% of scheduled visits. The relative percentage of in-person versus telehealth visits varied significantly by site (p < 0.001) and preferred family language (p < 0.001). English-speaking patients had 2.10 times the odds of being scheduled for telehealth compared with patients with PLOE, adjusting for site. Statistically significant differences were not found for visit outcome (completed or missed) by visit type (in-person or telehealth) (p = 0.79), including after accounting for PLOE status (p = 0.83).

CONCLUSION

At the height of the pandemic, most English-speaking families were scheduled for new DBP evaluations by telehealth, but fewer families with PLOE were. Attention to language to ensure telehealth access equity is critical.

Sensory over-responsivity and atypical neural responses to socially relevant stimuli in autism

Although aversive responses to sensory stimuli are common in autism spectrum disorder (ASD), it remains unknown whether the social relevance of aversive sensory inputs affects their processing. We used functional magnetic resonance imaging (fMRI) to investigate neural responses to mildly aversive nonsocial and social sensory stimuli as well as how sensory over-responsivity (SOR) severity relates to these responses. Participants included 21 ASD and 25 typically-developing (TD) youth, aged 8.6-18.0 years. Results showed that TD youth exhibited significant neural discrimination of socially relevant versus irrelevant aversive sensory stimuli, particularly in the amygdala and orbitofrontal cortex (OFC), regions that are crucial for sensory and social processing. In contrast, ASD youth showed reduced neural discrimination of social versus nonsocial stimuli in the amygdala and OFC, as well as overall greater neural responses to nonsocial compared with social stimuli. Moreover, higher SOR in ASD was associated with heightened responses in sensory-motor regions to socially-relevant stimuli. These findings further our understanding of the relationship between sensory and social processing in ASD, suggesting limited attention to the social relevance compared with aversiveness level of sensory input in ASD versus TD youth, particularly in ASD youth with higher SOR.

"I have to charge my social battery": Perspectives from autistic young adults on Quality of Life

LAY ABSTRACT

In this study we have asked a group of autistic young adults to describe what is important for their quality of life. The 14 participants (aged 21-29 years) were recruited from a 10-year follow-up study of autistic people. During interviews, our participants described the importance of having relationships with family, friends and pets. Having meaningful activities and being able to immerse themselves in particular interests was also reported to be important for a good quality of life. Interests had also guided their choice of what to study and what to do for work. They also spoke of how communication problems with professionals, bullying and sensory and emotional overload could have a negative impact on quality of life. Future interventions should focus on how professionals can help autistic people to connect to people/animals and meaningful activities, as the participants described this as important for having a good quality of life. These findings may be helpful in enhancing how passions and interests can be seen as opportunities for both academic and work careers for autistic people. Future research and interventions should also look at the communication barriers between autistic people and professionals, and how two-way understanding can be improved.

Profiles of minimally verbal autistic children: Illuminating the neglected end of the spectrum

Heterogeneity among individuals on the autism spectrum is widely acknowledged as a barrier to develop effective interventions. Overcoming this challenge requires characterization of individual differences, especially for children that are minimally verbal and often excluded from research studies. Most studies that describe autistic subgroups identify a single minimally verbal verbal group based on a single identifying measure (e.g., ADOS module one or single item indicating absence of phrase speech). Determining personalized courses of intervention requires a more detailed understanding since a single intervention will not be effective for all who are minimally verbal. The present study identified comprehensive profiles of cognitive, language, and social communication skills within a large, diverse, group of minimally verbal children with autism. The analysis combined baseline data from two studies to yield a sample of 344 participants, who were 3 to 8 years old at the time of study onset, with 60% who identified as having a race/ethnicity other than White. Via latent profile analysis (LPA), a three-group model was identified as best fit to the data. Profile identification was dependent on a participant's combination of cognitive, expressive, and social communication characteristics, rather than a single domain. One group (n = 206) had global delays, while the other two groups (n = 95 and n = 43) had variable strengths in cognition and communication. Findings suggest that low-frequency/minimally verbal communicators with autism have heterogeneous characteristics that can be systematically organized.

Moving from Disorder to Difference: A Systematic Review of Recent Language Use in Autism Research

Background

The neurodiversity paradigm positions autism as a neurological difference that is disabling in the societal context, shifting away from the traditional medical view of a disorder. Several recent publications recommend use of alternative neuro-affirming language (ANL) instead of traditional medical language (TML) with the aim to increase acceptance of autistic people and reduce prejudice. Examining language use within recent autism literature, including by journal and study characteristics, may offer insight into the influence of these recommendations and current disability discourse.

Methods

A systematic review was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines in autism research from 2021 (n = 2322 articles; 394 journals). Articles were coded according to topic, participants, and use of self-report. Journals were coded by topic, geographic region, and language guidelines. Terminology use was extracted using QDA Miner software.

Results

Many articles primarily used TML with a smaller subset primarily using ANL. There was a positive correlation between ANL use and publication date. More ANL was associated with articles on topics of autistic traits, diversity, equity, and inclusion (DEI), or lifespan and that included autistic adults or autistic self-report. More ANL was also found in journals from Australasia or Europe or those that had identify-first language (IFL) guidelines. Less ANL (more TML) was associated with articles on biology/causes or treatment and that included autistic or non-autistic parents, autistic youth, siblings, or other clinical groups, and were published in medical journals.

Conclusion

TML continues to largely dominate language choices in autism research, with an emerging shift toward ANL in recent literature. Increased ANL may be facilitated by journal and article language recommendations. Neuro-affirming language was also more likely in articles on topics prioritized by the autistic community, that included autistic adults, and may also be driven by cultural differences. Researchers and practitioners should consider the potential for their language use to impact individual and societal views of autistic people.

Adaptation of COMPASS for use in Autism-Specific Schools in Australia: A Cluster Randomized Trial

Autistic students are educated in Australia across a variety of contexts and almost all educators use individualized goal-setting as a way of ensuring appropriate accommodations and curriculum modifications. Educators experience similar challenges when developing individualized goals for students, including lack of a standardized process for goal setting, inconsistent support networks, and challenges with data-driven goal-setting. The purpose of our research was to adapt and trial the Collaborative Model for Competence and Success (COMPASS), a research-based intervention aimed at improving the individualized goal-setting process for autistic students. Our primary hypothesis was that autistic students who participate in COMPASS would demonstrate more growth on their individualized outcomes relative to autistic students who receive services as usual (SAU). To answer our primary research question, we applied a single-blind cluster randomized trial. Participants were randomized into one of two groups: (a) a COMPASS intervention group and (b) a SAU group. Results indicate that students whose teachers received the intervention made more progress on their final individualized goals than those who received SAU, replicating previous findings regarding COMPASS in the US. Also, the adaptation of COMPASS for an Australian context showed high rates of satisfaction and fidelity. The success of this intervention in improving the progress that students make on their individualized goals demonstrates the benefits of a standardized intervention that supports teachers and families in this critical practice.

Enrichment of a subset of Neanderthal polymorphisms in autistic probands and siblings

Homo sapiens and Neanderthals underwent hybridization during the Middle/Upper Paleolithic age, culminating in retention of small amounts of Neanderthal-derived DNA in the modern human genome. In the current study, we address the potential roles Neanderthal single nucleotide polymorphisms (SNP) may be playing in autism susceptibility in samples of black non-Hispanic, white Hispanic, and white non-Hispanic people using data from the Simons Foundation Powering Autism Research (SPARK), Genotype-Tissue Expression (GTEx), and 1000 Genomes (1000G) databases. We have discovered that rare variants are significantly enriched in autistic probands compared to race-matched controls. In addition, we have identified 25 rare and common SNPs that are significantly enriched in autism on different ethnic backgrounds, some of which show significant clinical associations. We have also identified other SNPs that share more specific genotype-phenotype correlations but which are not necessarily enriched in autism and yet may nevertheless play roles in comorbid phenotype expression (e.g., intellectual disability, epilepsy, and language regression). These results strongly suggest Neanderthal-derived DNA is playing a significant role in autism susceptibility across major populations in the United States.

Development of a Self-Report Measure of Prediction in Daily Life: The Prediction-Related Experiences Questionnaire

PURPOSE

Predictions are complex, multisensory, and dynamic processes involving real-time adjustments based on environmental inputs. Disruptions to prediction abilities have been proposed to underlie characteristics associated with autism. While there is substantial empirical literature related to prediction, the field lacks a self-assessment measure of prediction skills related to daily tasks. Such a measure would be useful to better understand the nature of day-to-day prediction-related activities and characterize these abilities in individuals who struggle with prediction.

METHODS

An interdisciplinary mixed-methods approach was utilized to develop and validate a self-report questionnaire of prediction skills for adults, the Prediction-Related Experiences Questionnaire (PRE-Q). Two rounds of online field testing were completed in samples of autistic and neurotypical (NT) adults. Qualitative feedback from a subset of these participants regarding question content and quality was integrated and Rasch modeling of the item responses was applied.

RESULTS

The final PRE-Q includes 19 items across 3 domains (Sensory, Motor, Social), with evidence supporting the validity of the measure's 4-point response categories, internal structure, and relationship to other outcome measures associated with prediction. Consistent with models of prediction challenges in autism, autistic participants indicated more prediction-related difficulties than the NT group.

CONCLUSIONS

This study provides evidence for the validity of a novel self-report questionnaire designed to measure the day-to-day prediction skills of autistic and non-autistic adults. Future research should focus on characterizing the relationship between the PRE-Q and lab-based measures of prediction, and understanding how the PRE-Q may be used to identify potential areas for clinical supports for individuals with prediction-related challenges.

Language Preferences in the Dutch Autism Community: A Social Psychological Approach

This research examined the preference for identity-first language (IFL) versus person-first language (PFL) among 215 respondents (Mage = 30.24 years, SD = 9.92) from the Dutch autism community. We found that a stronger identification with the autism community and a later age of diagnosis predicted a stronger IFL preference and a weaker PFL preference. Both effects were mediated by the perceived consequences (justice to identity, prejudice reduction) of PFL. Participants' own explanations were in line with these statistical analyses but also provided nuance to the IFL-PFL debate. Our results are consistent with the Social Identity Approach (Reicher et al., 2010) and Identity Uncertainty Theory (Hogg, 2007) and demonstrate the value of a social psychological approach to study disability language preferences.

Auditory feedback decreases timing variability for discontinuous and continuous motor tasks in autistic adults

Introduction

Autistic individuals demonstrate greater variability and timing error in their motor performance than neurotypical individuals, likely due at least in part to atypical cerebellar characteristics and connectivity. These motor difficulties may differentially affect discrete as opposed to continuous movements in autistic individuals. Augmented auditory feedback has the potential to aid motor timing and variability due to intact auditory-motor pathways in autism and high sensitivity in autistic individuals to auditory stimuli.

Methods

This experiment investigated whether there were differences in timing accuracy and variability in autistic adults as a function of task (discontinuous vs. continuous movements) and condition (augmented auditory feedback vs. no auditory feedback) in a synchronization-continuation paradigm. Ten autistic young adults aged 17-27 years of age completed the within-subjects study that involved drawing circles at 800 milliseconds intervals on a touch screen. In the discontinuous task, participants traced a series of discrete circles and paused at the top of each circle for at least 60 milliseconds. In the continuous task, participants traced the circles without pausing. Participants traced circles in either a non-auditory condition, or an auditory condition in which they heard a tone each time that they completed a circle drawing.

Results

Participants had significantly better timing accuracy on the continuous timing task as opposed to the discontinuous task. Timing consistency was significantly higher for tasks performed with auditory feedback.

Discussion

This research reveals that motor difficulties in autistic individuals affect discrete timing tasks more than continuous tasks, and provides evidence that augmented auditory feedback may be able to mitigate some of the timing variability present in autistic persons' movements. These results provide support for future investigation on the use of music-based therapies involving auditory feedback to address motor dysfunction in autistic individuals.

"I Can Do It": Perceived Competence of Parents of Autistic Children After Participating in a Physical Activity Intervention

BACKGROUND

Autistic children can benefit from physical activity (PA) in a variety of ways. However, autistic children tend not to meet PA recommendations and, consequently, may not experience the associated benefits. Parental PA support can facilitate PA participation among autistic children, but parents of autistic children may lack the skills to help their child engage in PA. Few studies, to date, have examined the outcomes of parent-mediated PA interventions for autistic children. The purpose of this study was to explore parents' perceived behavioral control (PBC) to support their autistic children in PA after their participation in a PA intervention.

METHODS

The theory of planned behavior served as the framework for this descriptive-qualitative investigation. Fifteen parents (each with 1 autistic child in the intervention) participated in semistructured interviews (3 wk after the intervention), which were transcribed and then analyzed using thematic line-by-line analysis.

RESULTS

Three themes characterized the changes to parents' PBC after completing the PA intervention. Those themes were: (1) I learned by son! (2) You are my coach! and (3) I can do it!

CONCLUSIONS

The results showed that by participating in a parent-mediated PA intervention, parents experienced improved confidence and awareness of their child's abilities, thus enhancing their PBC. Future research is needed to examine how these improvements in PBC may influence the actual PA behaviors of autistic children.

A pilot, single-arm feasibility study of an integrated cognitive-behavioral treatment for anxiety in young autistic children

OBJECTIVE

Anxiety is prevalent in young autistic children under 7 years of age. Yet there is a paucity of empirically based interventions for this age group. DINO Strategies for Anxiety and Uncertainty Reduction (DINOSAUR) is an innovative cognitive behavioral intervention that seeks to optimize treatment response in young autistic children by targeting anxiety and the contributing mechanisms of intolerance of uncertainty and parental accommodation using a telehealth delivery model. This pilot, single-arm study examines the preliminary feasibility of DINOSAUR.

METHODS

Fourteen autistic children ages 4-6 years with average language and cognitive skills and their parents received the intervention. Quantitative and qualitative data pertaining to parent satisfaction and treatment outcomes were collected.

RESULTS

Attendance, retention, and parent satisfaction ratings offer preliminary support for the feasibility of the treatment model. Change in clinical severity ratings on a semi-structured parent interview of anxiety and parents' qualitative report suggests the potential to benefit young autistic children.

CONCLUSIONS

Results support future study of the DINOSAUR model in a larger, randomized controlled trial.

Prevalence of bias against neurodivergence-related terms in artificial intelligence language models

Given the increasing role of artificial intelligence (AI) in many decision-making processes, we investigate the presence of AI bias towards terms related to a range of neurodivergent conditions, including autism, ADHD, schizophrenia, and obsessive-compulsive disorder (OCD). We use 11 different language model encoders to test the degree to which words related to neurodiversity are associated with groups of words related to danger, disease, badness, and other negative concepts. For each group of words tested, we report the mean strength of association (Word Embedding Association Test [WEAT] score) averaged over all encoders and find generally high levels of bias. Additionally, we show that bias occurs even when testing words associated with autistic or neurodivergent strengths. For example, embedders had a negative average association between words related to autism and words related to honesty, despite honesty being considered a common strength of autistic individuals. Finally, we introduce a sentence similarity ratio test and demonstrate that many sentences describing types of disabilities, for example, "I have autism" or "I have epilepsy," have even stronger negative associations than control sentences such as "I am a bank robber."

Ableism, Code-Switching, and Camouflaging: A Letter to the Editor on Gerlach-Houck and DeThorne (2023)

PURPOSE

This letter to the editor is in response to the Gerlach-Houck and DeThorne (2023) epilogue regarding their proposal for speech-language pathologists to offer Autistic code-switching (Autistic masking and camouflage) as a viable, non-ableist social communication tool that Autistic clients may choose to use in "high-stakes" social situations. In connection with Autistic code-switching, the authors reference "the debate" regarding code-switching in "African American Vernacular English speakers," specifically, whether "standard" English should be encouraged as a way to access "conventional forms of success."

CONCLUSION

Professionally training Autistic clients to "code-switch" with the goal of improving the client's chances of accessing conventional forms of success is essentially training Autistic masking and camouflaging. This type of therapy reinforces to both the Autistic client, as well as society, the position that hiding a person's Autistic traits is a pathway to acceptance and success. Autistic camouflaging has detrimental ramifications for mental health outcomes; perpetuates both internalized and societal stigma; hinders bias and discrimination deconstruction; reinforces ableist values; and fails to dismantle power inequities and social barriers that lead to marginalization, oppression, and exclusion.

Adults with Autism Prefer Person-First Language in Dutch: A Cross-Country Study

The correct language to refer to someone with a diagnosis of autism spectrum disorder has received a lot of attention in recent years. Studies in English-speaking countries found a main identity-first language (IFL) preference (e.g. autistic person) opposed to a person-first language preference (PFL) (e.g. person with autism) among adults with autism. However, a recent study conducted in a Dutch-speaking country (the Netherlands) reported a PFL preference (Buijsman et al., 2023). The goal of the current study was to gain insights into language preferences in two Dutch-speaking countries and, in contrast to previous studies, give participants the option to indicate not having a specific language preference. In the current study, we asked 414 Dutch-speaking adults with autism, living either in Belgium or the Netherlands, to fill in an online questionnaire about their language preference. We found that over half of the participants had a PFL preference (54%), followed by having no preference (27%). Only 14% of them had an IFL preference, and 5% proposed another term. Having more years of education was identified as a predictor for having an IFL preference when compared to a PFL preference, while being older predicted having no preference compared to a PFL preference. The majority of Dutch-speaking adults with autism showed a PFL preference, which is in contrast to findings from English-speaking countries, but in accord with a recent study conducted in the Netherlands (Buijsman et al., 2023). Implications of this finding for language use are discussed.

Exploring Identity Importance for Autistic Adults and Associations with Disclosure Experiences: A Brief Report

Background

A strong autistic identity can help to support mental well-being, reduce anxiety and depression, increase self-esteem, and strengthen a shared community for autistic people. Autistic people are regularly faced with a decision to disclose their autistic identity to others and report a range of experiences after disclosure. The purpose of this brief report was to examine the association between identity and disclosure decisions in a sample of autistic adults to gather preliminary evidence justifying future research. Specifically, we were interested in learning more about how autistic identity is associated with one's approach to disclosure, while also exploring associations with other identities such as ethnic, gender, sexual, and religious identity.

Methods

Participants (N = 111) completed an online questionnaire about their intersecting identities and their approach to disclosure. The research team that conducted this study was composed of both autistic and nonautistic researchers.

Results

Results demonstrated that participants who felt their autistic identity and sexual identity were highly important also reported frequent disclosure of being autistic. Religious, gender, and ethnic identity were not associated with one's disclosure decisions or their disclosure outcomes.

Conclusion

Overall, the results of this study emphasize the link between autistic and sexual identities and autism disclosure, but more research in this space is needed to better support the wider autism community.

Recovering Individuals' Feelings About Addict and Alcoholic as Stigmatized Terms: Implications for Treatment

Background

The current emphasis among addiction treatment providers is to use person-first language, such as "a person with a substance use disorder," as a way to reduce stigma around addiction and resulting barriers to treatment. This study considers how individuals recovering from substance use feel about the terms "alcoholic" and "addict," particularly how they self-identify and whether they believe the terms carry stigma.

Method

Thirty-five individuals were interviewed, recruited primarily, but not exclusively, from 12-step meetings (Alcoholics Anonymous, Narcotics Anonymous), from 3 locations throughout a rural New England state. Interviews were transcribed and coded in Atlas Ti qualitative analysis software, and a content analysis of text coded with "stigma" was conducted.

Results

Some comments reflected a belief that the terms "addict" and "alcoholic" carry a stigma. However, more comments rejected the notion of these being stigmatized terms; or acknowledged the stigma but reflected the subject's lack of internalizing of any stigma. Comments reflected other themes including a sense of pride, identity and ownership when self-identifying as an addict or alcoholic. Several comments suggested that person-first language is part of a larger movement to "soften everything," without changing the underlying condition (addiction). The findings may reflect the fact that subjects were recruited from 12-step programs, where the convention is to self-identity using the terms "alcoholic" and/or "addict."

Conclusions

Some individuals seeking treatment for addiction may prefer self-identifying using old-school terminology (addict, alcoholic) rather than person-first language, for a variety of reasons (eg, they do not internalize the stigma of such terms).

Continua of Support: A New Direction in the Identity-First/People-First Language Debate

PURPOSE

This letter expresses the opinion that identity-first language and perspectives in care are essential. It argues that all individuals' support needs should be conceptualized along continua. One such continua is support for communication. It suggests that decisions to receive supports should be left to the individual and, when necessary, invested others who can share potential benefits and costs of support/no-support decisions. Dialogue on this important issue is recommended.

A systematic review of interventions for echolalia in autistic children

INTRODUCTION

Echolalia, the repetition of others' speech, is a common observation in autistic people. Research has established that echolalia is functional and meaningful for many; however, some clinicians and researchers continue to characterise it as pathological and in need of reduction. The aim of this systematic review was to understand the range and impact of interventions for echolalia in autistic children.

METHOD

A systematic search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 15 studies met predetermined inclusion criteria. Screening, data extraction and quality rating using the Scientific Merit Rating Scale (SMRS) were performed in duplicate.

RESULTS

Ten interventions across 15 papers were found. Results indicated that interventions generally decreased levels of echolalia. However, there were considerable inconsistencies in the definitions and conceptualisations of echolalia, administration, generalisation techniques and the measures used. The quality of the studies was very low.

CONCLUSION

Interventions for echolalia vary widely in terms of administration and measurement. There is limited consensus on the definition of echolalia among the reviewed studies, and no evidence that echolalia is recognised as functional or meaningful to the autistic children. Further, the lack of methodological rigour makes it difficult to draw clinical conclusions about the interventions.

WHAT THIS PAPER ADDS

What is already known Echolalia is the immediate or delayed repetition of others' speech and is a common observation in autistic children and in some older autistic people. While research and practice has established that echolalia is a functional and meaningful form of communication, particularly for those first developing spoken communication, some clinicians and researchers continue to characterise it as problematic and suggest that echolalia should be reduced or eliminated. What this study adds We systematically searched the literature about echolalia interventions to try to find out about the types of interventions that aim to reduce or eliminate echolalia. We found 15 studies on this topic. The way they defined echolalia was varied, and there was a range of interventions researched. None of the research papers recognised echolalia as functional or meaningful and the quality of the research was very low. What are the potential or actual clinical implications of this work? Clinicians, families and researchers should think carefully and critically about suggesting any programs or supports that aim to reduce echolalia as no recommendations can be drawn from the research we studied. Echolalia should be considered functional, and efforts made to understand the meaning and purpose of echolalic speech.

A mixed method comparison of stigma toward autism and schizophrenia and effects of person-first versus identity-first language

Introduction

While stigma toward autistic individuals has been well documented, less is known about how autism is perceived relative to other stigmatized disabilities. As a highly stigmatized condition with similar social cognitive features to autism, schizophrenia may offer a useful comparison for stigma. Previous studies have found that autistic people may be perceived more favorably than those with schizophrenia, but little is known about the underlying volitional thoughts that contribute to differences in how these conditions are perceived.

Methods

The present study utilizes a mixed-methods approach, allowing for a detailed understanding of how young adults perceive different diagnostic labels. 533 college undergraduates completed questionnaires reflecting their perceptions of one of eight diagnostic labels: four related to autism (autism, autistic, autism spectrum disorder, or Asperger's), two related to schizophrenia (schizophrenia or schizophrenic), and two related to an unspecified clinical condition (clinical diagnosis or clinical disorder). Participants also completed an open-ended question regarding their thoughts about, and exposure to, these labels. Responses were compared across broader diagnostic categories (autism, schizophrenia, general clinical condition), with thematic analysis used to assess the broader themes occurring within the open-ended text.

Results

While perceptions did not differ significantly for person-first and identity-first language within labels, several differences were apparent across labels. Specifically, quantitative results indicated greater prejudice towards autism and schizophrenia than the generic clinical condition, with schizophrenia associated with more perceived fear and danger, as well as an increased preference for social distance, compared to autism. Patterns in initial codes differed across diagnostic labels, with greater variation in responses about autism than responses about schizophrenia or the general clinical condition. While participants described a range of attitudes toward autism (patronizing, exclusionary, and accepting) and schizophrenia (fear, prejudice, and empathy), they refrained from describing their attitudes toward the general clinical label, highlighting the centrality of a cohesive group identity for the development of stigma. Finally, participants reported a number of misconceptions about autism and schizophrenia, with many believing features such as savant syndrome to be core characteristics of the conditions.

Conclusion

These findings offer a more detailed account of how non-autistic individuals view autism and may therefore aid in the development of targeted programs to improve attitudes toward autism.

A mixed method examination: how stigma experienced by autistic adults relates to metrics of social identity and social functioning

A recent meta-analysis reveals almost half of autistic individuals experience some form of victimization in their lifetime, including bullying and other forms of stigma. Research among caregivers of autistic individuals demonstrates that stigma can have a long-lasting impact on other aspects of a social identity, such as self-esteem, but less research has specifically examined this among autistic adults themselves, in spite of research suggesting these are likely constructs that contribute to the internalization of stigma and subsequent mental health consequences. The current study used a mixed method approach to assess the relation between stigma and several components of social identity and social functioning. More specifically, among 45 autistic young adults, three dimensions of self-reported stigma (discrimination, disclosure, and positive aspects) were examined in relation to self-esteem, self-efficacy, social satisfaction and adaptive social functioning. Quantitative analyses revealed higher reported discriminative and disclosure stigma were significantly associated with lower self-efficacy. Increased experience with all types of stigma were associated with lower social satisfaction. Greater reported disclosure stigma was also associated with lower self-esteem. Qualitative interviewing among eight autistic young adults helped to better understand the nature of stigma and the impact of these experiences. Thematic analysis of the qualitative data revealed that all of the participants experienced stigma in the form of exclusion or isolation and that a majority also experienced verbal bullying. Many of the negative interactions came from educators, peers, and family members. Most participants indicated that these stigmatizing interactions directly contributed to decreased social satisfaction, diminished self-efficacy, and lowered self-esteem. A greater understanding of the negative consequences of stigma can inform efforts to increase awareness and acceptance of autism.

The role of interpersonal synchrony in forming impressions of autistic and non-autistic adults

When people meet, they almost instantaneously form an impression of each other. First impressions of character traits and rapport are less favourable when people with autism spectrum condition (ASC) are judged compared to non-autistic people. Little is known about the behavioural differences that drive these altered impressions. In the present study, we investigated the influence of interpersonal synchrony on impression formation of autistic and non-autistic people. Specifically, we used lagged cross-correlations to assess how much each interactant's motion energy, a measure which can be determined from video recordings, influenced the other interactant's motion energy. In short, silent clips of dyadic conversations, we asked non-autistic participants to rate their impression of one of the two interactants, which was solely based on the outlines of both interactants. We expected that the amount of leading of the target interactant, their diagnostic status as well as the interaction of these factors would influence impression formation. We found that while the amount of leading had a positive effect on the impressions of non-autistic interactants, this was not true for interactants with ASC. This suggests that interpersonal synchrony of motion energy is one driver of less favourable impressions of autistic compared to non-autistic people.

Addressing the autism mental health crisis: the potential of phenomenology in neurodiversity-affirming clinical practices

The neurodiversity movement has introduced a new era for autism research. Yet, the neurodiversity paradigm and the autism clinic remain largely unconnected. With the present work, we aim to contribute to filling this lacuna by putting forward phenomenology as a foundation for developing neurodiversity-affirming clinical interventions for autism. In the first part of this paper, we highlight that autistic people face a severe mental health crisis. We argue that approaches focused on reducing autistic 'symptoms' are unlikely to solve the problem, as autistic mental health is positively correlated with autism acceptance and perceived quality of support provided, not necessarily with lack of 'symptomatologic severity'. Therefore, the development and dissemination of neurodiversity-affirming clinical interventions is key for addressing the autism mental health crisis. However, therapists and researchers exploring such neurodiversity-affirming practices are faced with two significant challenges. First, they lack concrete methodological principles regarding the incorporation of neurodiversity into clinical work. Second, they need to find ways to acknowledge rightful calls to respect the 'autistic self' within the clinic, while also challenging certain beliefs and behaviors of autistic clients in a manner that is sine qua non for therapy, irrespective of neurotype. In the second part of the paper, we introduce phenomenological psychology as a potential resource for engaging with these challenges in neurodiversity-affirming approaches to psychotherapy. In this vein, we put forward specific directions for adapting cognitive behavioral and interpersonal psychotherapy for autism.

Mindshift in autism: a call to professionals in research, clinical, and educational settings

Autistic people often have poor outcomes over the life course, including in health, education, employment, and community inclusion. Many professionals working with Autistic adults in research, clinical, and educational settings devote their careers to trying to improve such outcomes. However, we maintain that real progress cannot happen without a fundamental mindshift. The status quo for professionals is to view autism as an illness. Instead, the neurodiversity movement encourages us to value and embrace autism as an aspect of human diversity and asks us to view Autistic people as a marginalized group that experiences significant disparities. While some professionals may be adopting language and concepts from the neurodiversity movement, we argue that making this mindshift fundamentally changes our practice across research, clinical, and educational settings. In this perspective, we call on professionals to embrace this mindshift to reduce discrimination and stigma, halt the spread of harmful ideologies, and help Autistic adults live fulfilling lives.

Examining the latent structure and correlates of sensory reactivity in autism: a multi-site integrative data analysis by the autism sensory research consortium

BACKGROUND

Differences in responding to sensory stimuli, including sensory hyperreactivity (HYPER), hyporeactivity (HYPO), and sensory seeking (SEEK) have been observed in autistic individuals across sensory modalities, but few studies have examined the structure of these "supra-modal" traits in the autistic population.

METHODS

Leveraging a combined sample of 3868 autistic youth drawn from 12 distinct data sources (ages 3-18 years and representing the full range of cognitive ability), the current study used modern psychometric and meta-analytic techniques to interrogate the latent structure and correlates of caregiver-reported HYPER, HYPO, and SEEK within and across sensory modalities. Bifactor statistical indices were used to both evaluate the strength of a "general response pattern" factor for each supra-modal construct and determine the added value of "modality-specific response pattern" scores (e.g., Visual HYPER). Bayesian random-effects integrative data analysis models were used to examine the clinical and demographic correlates of all interpretable HYPER, HYPO, and SEEK (sub)constructs.

RESULTS

All modality-specific HYPER subconstructs could be reliably and validly measured, whereas certain modality-specific HYPO and SEEK subconstructs were psychometrically inadequate when measured using existing items. Bifactor analyses supported the validity of a supra-modal HYPER construct (ωH = .800) but not a supra-modal HYPO construct (ωH = .653), and supra-modal SEEK models suggested a more limited version of the construct that excluded some sensory modalities (ωH = .800; 4/7 modalities). Modality-specific subscales demonstrated significant added value for all response patterns. Meta-analytic correlations varied by construct, although sensory features tended to correlate most with other domains of core autism features and co-occurring psychiatric symptoms (with general HYPER and speech HYPO demonstrating the largest numbers of practically significant correlations).

LIMITATIONS

Conclusions may not be generalizable beyond the specific pool of items used in the current study, which was limited to caregiver report of observable behaviors and excluded multisensory items that reflect many "real-world" sensory experiences.

CONCLUSION

Of the three sensory response patterns, only HYPER demonstrated sufficient evidence for valid interpretation at the supra-modal level, whereas supra-modal HYPO/SEEK constructs demonstrated substantial psychometric limitations. For clinicians and researchers seeking to characterize sensory reactivity in autism, modality-specific response pattern scores may represent viable alternatives that overcome many of these limitations.

Priorities, barriers, and facilitators for nutrition-related care for autistic children: a qualitative study comparing interdisciplinary health professional and parent perspectives

Introduction

Children with autism spectrum disorder often face nutrition-related challenges, such as food selectivity, gastrointestinal issues, overweight and obesity, and inadequate nutrient intake. However, the role of routine nutrition-related screening or care by interdisciplinary health professionals is not well understood. This study aimed to compare the beliefs of health professionals with those of parents of autistic children regarding high-priority nutrition-related challenges, barriers and facilitators to care, and desired education and resources related to nutrition for autistic children.

Participants

Interdisciplinary health professionals (n = 25) (i.e., pediatricians, occupational therapists, speech-language pathologists, board certified behavior analysts, registered dietitians) and parents of autistic children (n = 22).

Methods

The study used semi-structured phone interviews, which were recorded, transcribed, verified, and double-coded using the Framework Method.

Results

Thematic analysis of transcripts revealed that while health professionals and parents of autistic children shared some perspectives on nutrition-related challenges and care, they also had distinct viewpoints. Parents emphasized the importance of addressing food selectivity, behavioral eating challenges, sensory issues, and sleep disturbances affecting appetite. Both groups acknowledged the need for tailored support, access to an interdisciplinary care team, and reasonable expectations. Some health professionals perceived parents as lacking motivation or the ability to make changes. In contrast, many parents felt that health professionals lacked the knowledge and motivation to take nutrition or growth concerns seriously. Health professionals acknowledged that their lack of knowledge or capacity to provide nutrition education or referrals was a common barrier to care, particularly given limited community resources.

Discussion

Health professionals who serve autistic children are motivated to address nutrition-related challenges but lack resources related to nutrition. To promote better health outcomes for autistic children, professionals should identify and support parent motivations around nutrition-related care. Both groups expressed interest in accessing autism-specific resources for education, referral, and screening guidance. Future research could explore the development of healthcare training models that improve the competency of health professionals in providing nutrition care and referral for autistic children.

Neurocognitive and self-reported psychosocial and behavioral functioning in siblings of individuals with neurodevelopmental conditions: a study using remote self-administered testing

OBJECTIVE

This study compared and explored the neurocognitive profiles of siblings of persons with and without neurodevelopmental conditions (NDCs) and associations between objective test performance and self-reported psychosocial functioning.

METHODS

Siblings of persons with and without NDCs (64 NDC and 64 control siblings; mean age 19.88 years, range 11-27 years, 73.44% female, 75.78% White Caucasian) completed self-report questionnaires and self-administered computerized neurocognitive tests of executive functioning (EF). Using Bayesian analyses, we examined cross-sectional associations between self-reported psychosocial functioning and cognitive test performance, and predictors of EF over 15 months.

RESULTS

NDC siblings had poorer working memory, inhibition, attention, and shifting compared to controls, as measured by experimental paradigms on the backward Corsi span, N-Back 2-back task, Stop Signal Task, Sustained Attention to Response Task, and the Wisconsin Card Sorting Test (effect size δ ranging 0.49 to 0.64). Bayesian cross-sectional networks revealed negative emotion reactivity and working memory difficulties were central to the NDC sibling network. Over 15 months, poorer EF (k low test scores) was predicted by negative emotion reactivity, sleep problems, and anxiety, over and above effects of age and subclinical autistic and ADHD traits. Siblings of autistic individuals and persons with fetal alcohol spectrum disorder had higher rates of neurocognitive and psychiatric difficulties than other NDCs and controls (Bayes factors >20).

CONCLUSIONS

Neurocognitive difficulties were associated with transdiagnostic vulnerability to poorer wellbeing in NDC siblings. These findings demonstrate the feasibility of remote online cognitive testing and highlight the importance of individualized prevention and intervention for NDC siblings.

Non-autistic adults can recognize posed autistic facial expressions: Implications for internal representations of emotion

Autistic people report that their emotional expressions are sometimes misunderstood by non-autistic people. One explanation for these misunderstandings could be that the two neurotypes have different internal representations of emotion: Perhaps they have different expectations about what a facial expression showing a particular emotion looks like. In three well-powered studies with non-autistic college students in the United States (total N = 632), we investigated this possibility. In Study 1, participants recognized most facial expressions posed by autistic individuals more accurately than those posed by non-autistic individuals. Study 2 showed that one reason the autistic expressions were recognized more accurately was because they were better and more intense examples of the intended expressions than the non-autistic expressions. In Study 3, we used a set of expressions created by autistic and non-autistic individuals who could see their faces as they made the expressions, which could allow them to explicitly match the expression they produced with their internal representation of that emotional expression. Here, neither autistic expressions nor non-autistic expressions were consistently recognized more accurately. In short, these findings suggest that differences in internal representations of what emotional expressions look like are unlikely to play a major role in explaining why non-autistic people sometimes misunderstand the emotions autistic people are experiencing.

A rule-based theoretical account of social stories to address the double empathy problem

Social Stories™ (SS) is one of the most popular and researched interventions for autistic children. To date, research that focuses on outcomes has been prioritized over the investigation of the psychological mechanisms that inform the intervention. In this article we consider theoretical accounts proposed thus far which could underpin SS. We argue that mechanisms that are based on social deficit theories lack validity, and propose a rule-based theoretical account to inform a strengths-based approach toward conceptualizing the mechanisms that underpin SS. We apply this account to the 'double-empathy problem' to propose that SS can be adapted to involve all parties in the development and delivery of SS support by adopting a rule-based perspective. We use the example of systemizing (the drive to analyze and explore systems in terms of 'if-and-then' rules), which is proposed to be a relative autistic strength, as a form of rule-based thinking that can provide a theoretical account of SS and a framework to address the double-empathy problem.

Sexual and reproductive health services for autistic young people in the United States: A conceptual model of utilization

BACKGROUND

Sexual and reproductive health services promote the ability of people to have safe, satisfying, non-coercive sexual experiences and make informed decisions about pregnancy. Stakeholder input is needed to understand barriers or facilitators to service access for autistic people, who report unmet needs.

METHODS

We recruited 18 autistic people, 15 parents, and 15 service providers in the United States to participate in an interview and two surveys. Using their input, we created a conceptual model of sexual and reproductive health service needs, access barriers, and facilitators.

RESULTS

Stakeholders rated a variety of sexual and reproductive health services as important for autistic people, including those with intellectual disability or minimal verbal language. Stakeholders identified barriers to sexual and reproductive health service utilization including lack of service availability, lack of service providers with autism or neurodiversity training, lack of accurate information about autism and sexuality, verbal and communication differences that are not accommodated by service providers, and socio-cultural attitudes about sexuality. Stakeholders identified facilitators to service access including person-centered, trauma-informed care, service accommodations such as clear and detailed expectations, and long-enough appointments. We created a conceptual model based on the social ecological model of health to organize these utilization factors and support future research, provider, and policy action. Stakeholders provided feedback and responded favorably on the model's accuracy, utility for spurring research, practice, and policy improvements, and application to diverse groups of autistic people.

CONCLUSIONS

The model shows the many feasible ways to support equitable access to services for autistic people.

Compassionate pedagogy for neurodiversity in higher education: A conceptual analysis

The neurodiversity paradigm challenges pathologising accounts of neurodevelopmental differences, including autism, attention deficit disorder (ADHD), dyslexia, developmental language disorder (DLD) and others. From a neurodiversity perspective, these differences in the way people perceive, learn about and interact with the world are conceptualised as naturally occurring cognitive variation, akin to biodiversity in the natural environment, which may bring unique strengths and challenges for individuals. An implication of this approach is that interventions designed to create contexts in which neurodivergent people can thrive are needed, in addition to those that seek to ameliorate individual-level difficulties. In this conceptual review, we consider how higher education can offer a context in which cognitive diversity can be noticed, welcomed and accepted with warmth. In universities, neurodiversity is one dimension of difference within an increasingly diverse student population, which overlaps - but is not synonymous - with disability. We argue that improving experience and outcomes for neurodivergent students should be a priority for universities aiming to produce graduates equipped to tackle the complex problems of contemporary society. Drawing on the foundational principles of compassion-focused psychological therapies, we consider how compassion can be enacted within interpersonal interaction, curriculum design, and leadership culture in universities. We apply the insights of double empathy theory to the problem of overcoming barriers of difference in the classroom. Finally, we make recommendations for Universal Design for Learning (UDL) and strengths-based pedagogical approaches, which create a fit-for-purpose educational environment for the widest possible range of learners. This realignment with the neurodiversity paradigm offers an antidote to bolt-on provisions for students who differ from the neuro-normative, and might enable neurodivergent thinkers to flourish within and beyond higher education.