Subjects -> EDUCATION (Total: 2507 journals)
    - ADULT EDUCATION (24 journals)
    - COLLEGE AND ALUMNI (10 journals)
    - E-LEARNING (37 journals)
    - EDUCATION (2141 journals)
    - HIGHER EDUCATION (158 journals)
    - INTERNATIONAL EDUCATION PROGRAMS (4 journals)
    - ONLINE EDUCATION (41 journals)
    - SCHOOL ORGANIZATION (14 journals)
    - SPECIAL EDUCATION AND REHABILITATION (40 journals)
    - TEACHING METHODS AND CURRICULUM (38 journals)

EDUCATION (2141 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 857 Journals sorted alphabetically
#Tear : Revista de Educação, Ciência e Tecnologia     Open Access   (Followers: 5)
(Pensamiento), (palabra) y obra     Open Access   (Followers: 4)
21st Century Pedagogy     Open Access   (Followers: 12)
@tic. revista d'innovació educativa     Open Access  
Abant İzzet Baysal Üniversitesi Eğitim Fakültesi Dergisi     Open Access   (Followers: 2)
ABDIMAS ALTRUIS : Jurnal Pengabdian Kepada Masyarakat     Open Access  
Abdimas Toddopuli : Jurnal Pengabdian Pada Masyarakat     Open Access   (Followers: 10)
About Campus     Hybrid Journal   (Followers: 9)
Academic Medicine     Hybrid Journal   (Followers: 82)
Academic Psychiatry     Full-text available via subscription   (Followers: 34)
Academic Questions     Hybrid Journal   (Followers: 9)
Academy of Management Learning and Education     Full-text available via subscription   (Followers: 68)
Accounting & Finance     Hybrid Journal   (Followers: 63)
Accounting Education: An International Journal     Hybrid Journal   (Followers: 25)
ACM Transactions on Computing Education (TOCE)     Hybrid Journal   (Followers: 14)
Acta Científica : Ciências Humanas     Open Access   (Followers: 2)
Acta Didactica Norge     Open Access   (Followers: 2)
Acta Educationis Generalis     Open Access   (Followers: 1)
Acta Paedagogica Vilnensia     Open Access   (Followers: 1)
Acta Scientiarum. Education     Open Access  
Action in Teacher Education     Hybrid Journal   (Followers: 91)
Action Learning: Research and Practice     Hybrid Journal   (Followers: 47)
Action Research     Hybrid Journal   (Followers: 53)
Active Learning in Higher Education     Hybrid Journal   (Followers: 399)
Actualidades Pedagógicas     Open Access  
Adelphi series     Hybrid Journal   (Followers: 14)
Adiyaman University Journal of Educational Sciences     Open Access   (Followers: 1)
Administração Educacional     Open Access  
Administration & Society     Hybrid Journal   (Followers: 18)
Administrative Science Quarterly     Full-text available via subscription   (Followers: 277)
Adult Education Quarterly     Hybrid Journal   (Followers: 263)
Advanced Education     Open Access   (Followers: 19)
Advances in Building Education     Open Access   (Followers: 8)
Advances in Health Sciences Education     Hybrid Journal   (Followers: 39)
Advances in High Energy Physics     Open Access   (Followers: 29)
Advances in School Mental Health Promotion     Partially Free   (Followers: 11)
AERA Open     Open Access   (Followers: 14)
Africa Education Review     Hybrid Journal   (Followers: 31)
African Journal of Chemical Education     Open Access   (Followers: 6)
African Journal of Educational Studies in Mathematics and Sciences     Full-text available via subscription   (Followers: 12)
African Journal of Health Professions Education     Open Access   (Followers: 7)
African Journal of Research in Mathematics, Science and Technology Education     Hybrid Journal   (Followers: 13)
African Journal of Teacher Education     Open Access   (Followers: 4)
Agora     Full-text available via subscription   (Followers: 6)
AGORA Magazine     Open Access   (Followers: 1)
Ahmad Dahlan Journal of English Studies     Open Access   (Followers: 4)
AIDS Education and Prevention     Full-text available via subscription   (Followers: 9)
Ainedidaktiikka     Open Access  
Akademos     Open Access   (Followers: 2)
AKSIOMA Journal of Mathematics Education     Open Access   (Followers: 4)
AKSIOMATIK : Jurnal Penelitian Pendidikan dan Pembelajaran Matematika     Open Access   (Followers: 1)
Aksis : Jurnal Pendidikan Bahasa dan Sastra Indonesia     Open Access  
Al-Athfaal : Jurnal Ilmiah Pendidikan Anak Usia Dini     Open Access   (Followers: 2)
Al-Bahith Journal     Open Access   (Followers: 1)
Al-Fikrah     Open Access   (Followers: 3)
Al-Idarah : Jurnal Kependidikan Islam     Open Access  
Al-Jabar : Jurnal Pendidikan Matematika     Open Access   (Followers: 1)
Al-Mudarris : Journal of Education     Open Access   (Followers: 3)
Al-Tadris : Jurnal Pendidikan Bahasa Arab     Open Access  
Al-Tadzkiyyah : Jurnal Pendidikan Islam     Open Access  
Al-Tanzim : Jurnal Manajemen Pendidikan Islam     Open Access  
Al.Qadisiya journal for the Sciences of Physical Education     Open Access  
Alberta Journal of Educational Research     Full-text available via subscription   (Followers: 9)
Aldaba     Open Access   (Followers: 1)
Alexandria : Revista de Educação em Ciência e Tecnologia     Open Access  
Alotrop     Open Access  
Alsic : Apprentissage des Langues et Systèmes d'Information et de Communication     Open Access   (Followers: 18)
Alteridad     Open Access  
Ambiente & Educação : Revista de Educação Ambiental     Open Access  
American Annals of the Deaf     Full-text available via subscription   (Followers: 16)
American Educational Research Journal     Hybrid Journal   (Followers: 260)
American Journal of Business Education     Open Access   (Followers: 17)
American Journal of Distance Education     Hybrid Journal   (Followers: 35)
American Journal of Education     Full-text available via subscription   (Followers: 295)
American Journal of Educational Research     Open Access   (Followers: 76)
American Journal of Health Education     Hybrid Journal   (Followers: 39)
American Journal of Physics     Full-text available via subscription   (Followers: 58)
American String Teacher     Full-text available via subscription   (Followers: 3)
Ana Dili Eğitimi Dergisi / Journal of Mother Tongue Education     Open Access   (Followers: 1)
ANALES de la Universidad Central del Ecuador     Open Access   (Followers: 4)
Anargya : Jurnal Ilmiah Pendidikan Matematika     Open Access   (Followers: 8)
Annales Universitatis Mariae Curie-Sklodowska, sectio N – Educatio Nova     Open Access  
Annali dell'Universita di Ferrara     Hybrid Journal  
Annals of Dyslexia     Hybrid Journal   (Followers: 11)
Annals of Modern Education     Full-text available via subscription   (Followers: 6)
Antistasis : An Open Educational Journal     Open Access   (Followers: 9)
Anuario Pilquen : Sección Divulgación Científica     Open Access  
Apertura. Revista de innovación educativa‏     Open Access   (Followers: 3)
Ápice : Revista de Educación Científica     Open Access  
Applied Environmental Education & Communication     Hybrid Journal   (Followers: 19)
Applied Measurement in Education     Hybrid Journal   (Followers: 11)
Aprender     Open Access  
AR-RIAYAH : Jurnal Pendidikan Dasar     Open Access  
Arabia     Open Access   (Followers: 1)
Arabiyatuna : Jurnal Bahasa Arab     Open Access   (Followers: 1)
Archivos de Ciencias de la Educación     Open Access   (Followers: 2)
Areté, Revista Digital del Doctorado en Educación de la Universidad Central de Venezuela     Open Access   (Followers: 1)
Arrancada     Open Access  
Ars Educandi     Open Access  
Art Design & Communication in Higher Education     Hybrid Journal   (Followers: 30)
Art Education     Hybrid Journal  
Arte e Investigación     Open Access   (Followers: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 49)
Arts Education Policy Review     Hybrid Journal   (Followers: 6)
Artseduca : Revista electrónica de educación en las ARTES     Open Access   (Followers: 1)
ASHE Higher Education Reports     Hybrid Journal   (Followers: 21)
Asia Pacific Education Review     Hybrid Journal   (Followers: 13)
Asia Pacific Journal of Education     Hybrid Journal   (Followers: 27)
Asia-Pacific Education Researcher     Hybrid Journal   (Followers: 16)
Asia-Pacific Journal of Teacher Education     Hybrid Journal   (Followers: 28)
Asia-Pacific Science Education     Open Access   (Followers: 1)
Asian Association of Open Universities Journal     Open Access   (Followers: 1)
Asian Education and Development Studies     Hybrid Journal   (Followers: 7)
Asian Journal of Distance Education     Open Access   (Followers: 5)
Asian Journal of Education and Social Studies     Open Access   (Followers: 3)
Asian Journal of English Language Teaching     Full-text available via subscription   (Followers: 19)
Asian Journal of Legal Education     Full-text available via subscription   (Followers: 4)
Asian-Pacific Journal of Second and Foreign Language Education     Open Access   (Followers: 6)
ASp     Open Access   (Followers: 4)
Assessing Writing     Hybrid Journal   (Followers: 17)
Assessment & Evaluation in Higher Education     Hybrid Journal   (Followers: 259)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 15)
Assessment in Education: Principles, Policy & Practice     Hybrid Journal   (Followers: 50)
Assessment Update     Hybrid Journal   (Followers: 7)
AStA Wirtschafts- und Sozialstatistisches Archiv     Hybrid Journal   (Followers: 5)
At-Ta'dib Jurnal Kependidikan Islam     Open Access  
At-Taqaddum     Open Access  
At-Turats     Open Access  
ATENA Didaktik     Open Access   (Followers: 5)
Atenas : Revista Científico Pedagógica     Open Access   (Followers: 1)
Athenea Digital     Open Access  
ATIKAN : Jurnal Kajian Pendidikan (Journal of Educational Studies)     Open Access  
Atthulab : Islamic Religion Teaching and Learning Journal     Open Access   (Followers: 1)
Aula Abierta     Open Access   (Followers: 2)
Aula de Encuentro     Open Access  
Australasian Journal of Educational Technology     Open Access   (Followers: 20)
Australasian Journal of Engineering Education     Hybrid Journal   (Followers: 3)
Australasian Journal of Gifted Education     Full-text available via subscription   (Followers: 8)
Australasian Marketing Journal (AMJ)     Hybrid Journal   (Followers: 6)
Australian Art Education     Full-text available via subscription   (Followers: 8)
Australian Educational Researcher     Hybrid Journal   (Followers: 34)
Australian Journal of Adult Learning     Full-text available via subscription   (Followers: 16)
Australian Journal of Career Development     Hybrid Journal   (Followers: 5)
Australian Journal of Dyslexia and Other Learning Difficulties     Full-text available via subscription   (Followers: 10)
Australian Journal of Education     Hybrid Journal   (Followers: 51)
Australian Journal of Environmental Education     Full-text available via subscription   (Followers: 11)
Australian Journal of Indigenous Education, The     Full-text available via subscription   (Followers: 15)
Australian Journal of Learning Difficulties     Hybrid Journal   (Followers: 7)
Australian Journal of Music Education     Full-text available via subscription   (Followers: 6)
Australian Journal of Public Administration     Hybrid Journal   (Followers: 473)
Australian Journal of Teacher Education     Open Access   (Followers: 31)
Australian Mathematics Teacher, The     Full-text available via subscription   (Followers: 7)
Australian Primary Mathematics Classroom     Full-text available via subscription   (Followers: 7)
Australian Screen Education     Full-text available via subscription   (Followers: 3)
Australian TAFE Teacher     Full-text available via subscription   (Followers: 4)
Australian Universities' Review, The     Full-text available via subscription   (Followers: 4)
Autism     Hybrid Journal   (Followers: 359)
Avaliação : Revista da Avaliação da Educação Superior (Campinas)     Open Access  
Azalea: Journal of Korean Literature & Culture     Full-text available via subscription   (Followers: 4)
Bahastra     Open Access  
Balkan Region Conference on Engineering and Business Education     Open Access   (Followers: 2)
Baltic Journal of Career Education and Management     Open Access   (Followers: 1)
Barn : Forskning om barn og barndom i Norden     Open Access   (Followers: 1)
Basastra : Jurnal Bahasa, Sastra, dan Pengajarannya     Open Access   (Followers: 1)
BC TEAL Journal     Open Access  
Becoming : Journal of the Georgia Middle School Association     Open Access   (Followers: 3)
Behavioural Sciences Undergraduate Journal     Open Access   (Followers: 6)
BELAJEA : Jurnal Pendidikan Islam     Open Access  
BELIA : Early Childhood Education Papers     Open Access   (Followers: 10)
BELT - Brazilian English Language Teaching Journal     Open Access   (Followers: 5)
Berkeley Review of Education     Open Access   (Followers: 10)
Beyond Behavior     Hybrid Journal   (Followers: 2)
Biblioteca Escolar em Revista     Open Access  
Biblioteka i Edukacja     Open Access   (Followers: 4)
Bio-Lectura     Open Access  
BIODIK : Jurnal Ilmiah Pendidikan Biologi     Open Access   (Followers: 1)
Bioedukasi : Jurnal Pendidikan Biologi FKIP UM Metro     Open Access   (Followers: 1)
Bioeduscience     Open Access   (Followers: 3)
Bioma : Jurnal Ilmiah Biologi     Open Access  
Biomedical Engineering Education     Hybrid Journal   (Followers: 2)
Biosaintifika : Journal of Biology & Biology Education     Open Access   (Followers: 9)
Biosfer : Jurnal Biologi dan Pendidikan Biologi     Open Access  
Biosfer : Jurnal Tadris Biologi     Open Access  
BISE : Jurnal Pendidikan Bisnis dan Ekonomi     Open Access   (Followers: 1)
Biuletyn Historii Wychowania     Open Access  
BMC Medical Education     Open Access   (Followers: 50)
BMJ Simulation & Technology Enhanced Learning     Hybrid Journal   (Followers: 13)
Boletim Cearense de Educação e História da Matemática     Open Access  
Boletim de Educação Matemática     Open Access  
Boletim Técnico do Senac     Open Access  
Bordón : Revista de Pedagogía     Open Access   (Followers: 1)
British (Jurnal Bahasa dan Sastra Inggris)     Open Access   (Followers: 1)
British Educational Research Journal     Hybrid Journal   (Followers: 281)
British Journal of Educational Studies     Hybrid Journal   (Followers: 212)
British Journal of Educational Technology     Hybrid Journal   (Followers: 211)
British Journal of Music Education     Hybrid Journal   (Followers: 28)
British Journal of Religious Education     Hybrid Journal   (Followers: 11)
British Journal of Sociology of Education     Hybrid Journal   (Followers: 66)
British Journal of Special Education     Hybrid Journal   (Followers: 60)
British Journal of Visual Impairment     Hybrid Journal   (Followers: 14)

        1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
Autism
Journal Prestige (SJR): 1.739
Citation Impact (citeScore): 4
Number of Followers: 359  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1362-3613 - ISSN (Online) 1461-7005
Published by Sage Publications Homepage  [1166 journals]
  • What do we really mean by “inclusion'”: The importance of
           terminology when discussing approaches to community engagement

    • Free pre-print version: Loading...

      Authors: Lauren A Weaver, Emelyne Bingham, Kelly Luo, A Pablo Juárez, Julie Lounds Taylor
      Pages: 2149 - 2151
      Abstract: Autism, Volume 25, Issue 8, Page 2149-2151, November 2021.

      Citation: Autism
      PubDate: 2021-09-14T01:17:45Z
      DOI: 10.1177/13623613211046688
      Issue No: Vol. 25, No. 8 (2021)
       
  • Re: Caron et al. (2021) sociocultural context and autistics quality of
           life: A comparison between Quebec and France

    • Free pre-print version: Loading...

      Authors: Jacqui Rodgers
      Abstract: Autism, Ahead of Print.
      The purpose of this letter to the editors is to highlight to the readership of Autism the recommended use of the Autism Quality of Life measure for research with autistic adults. The Autism Quality of Life was developed for use alongside the WHOQoL-BREF and WHO Disabilities module. The letter raises some concerns about the use of the Autism Quality of Life as a stand-alone measure in a recent study by Caron et al. published in Autism.
      Citation: Autism
      PubDate: 2021-10-22T07:06:19Z
      DOI: 10.1177/13623613211053667
       
  • ‘A way to be me’: Autobiographical reflections of autistic adults
           diagnosed in mid-to-late adulthood

    • Free pre-print version: Loading...

      Authors: Rozanna Lilley, Wenn Lawson, Gabrielle Hall, Joanne Mahony, Hayley Clapham, Melanie Heyworth, Samuel RC Arnold, Julian N Trollor, Michael Yudell, Elizabeth Pellicano
      Abstract: Autism, Ahead of Print.
      In this article, we report on an oral history study documenting the lives of autistic adults in Australia. This qualitative study, co-produced with autistic researchers, offers insight into the lived experiences of autistic adults diagnosed in mid-to-late adulthood. Oral history methodology was utilised to understand the experiences of autistic adults who grew up in an era before autism was well-known. The 26 interviewees were born before 1975, receiving a clinical autism diagnosis after age 35 years. All interviews were conducted by autistic researchers, transcribed and thematically analysed by a team of autistic and non-autistic researchers using the six-step process outlined by Braun and Clarke. We identified four themes relating to perceptions of the self: being different, exploring identity, the suffering self and being Autistic. Some interviewees reported a direct relationship between trauma, negative self-conceptions and suffering. For most, formal diagnosis had positive impacts on sense of self, contributing to a greater focus on strengths. Contra research suggesting autistic impairments in self-awareness, these interviewees demonstrated a deep capacity for self-reflection, highlighting the variability of autistic lives and the socio-historical contexts that shape individual biographies, including experiences of stigma and discrimination as well as the empowering potential of identifying as autistic.Lay abstractUsing oral history methods, we interviewed and recorded 26 autistic adults in Australia about their life history. We wanted to better understand interviewees’ self-reflections about their lives. The interviewers were autistic researchers and the interviews were analysed by autistic and non-autistic researchers. All of the adults we interviewed were born before 1975 and formally identified as autistic after age 35 years. This group of people is sometimes referred to as ‘late-diagnosed autistic adults’. In general, there is not much research done about autistic adults and even less is known about those diagnosed late in life. In this article, we explore what these adults said about their sense of self and how that changed over time. These autistic adults told us about many negative experiences, including trauma, which had shaped how they think about themselves. For most, autism diagnosis had a very positive impact on their sense of self, allowing them to understand more about their own past and to feel good about their autistic identity. Previously some researchers have said that autistic people have a limited or impaired sense of self. Instead, our results show some autistic people can actually reflect deeply on their lives and their changing sense of self-identity over time.
      Citation: Autism
      PubDate: 2021-10-22T07:05:49Z
      DOI: 10.1177/13623613211050694
       
  • Caregiver strain among North American parents of children from the Autism
           Treatment Network Registry Call-Back Study

    • Free pre-print version: Loading...

      Authors: Olivia J Lindly, Amy M Shui, Noa M Stotts, Karen A Kuhlthau
      Abstract: Autism, Ahead of Print.
      Elevated caregiver strain is common and linked to poor health in parents of children with autism. Yet, little research has examined caregiver strain longitudinally and in geographically diverse samples of parents whose children have autism. This study aimed to (1) examine change in caregiver strain and (2) determine correlates of improved caregiver strain in North American parents of children with autism. This was a secondary analysis of data from the Autism Treatment Network Registry Call-Back Study, conducted from 2015 to 2017 on a random sample of children with autism spectrum disorder at 12 clinical sites in the United States or Canada. Child assessments and parent-reported questionnaires were completed at two time points 1 year apart. Caregiver strain was assessed with the Caregiver Strain Questionnaire. In total, 368 children had caregiver strain data at both times. Mean caregiver strain in parents did not significantly change between Times 1 and 2 (mean difference = 0.05, t(360) = 0.1, p = 0.92). Improved caregiver strain between Times 1 and 2 was associated with improved child adaptive functioning and externalizing problem behaviors. Caregiver strain was persistent and multi-factorial. Parent training to manage challenging child behaviors and adaptively cope may benefit this vulnerable parent population.Lay abstractCaregiver strain is the adverse impact that parents of children with emotional and behavioral issues including autism often experience (e.g. negative consequences of caregiving such as financial strain and social isolation; negative feelings that are internal to the caregiver such as worry and guilt; and negative feelings directed toward the child such as anger or resentment). This study showed that on average caregiver strain did not significantly change in North American parents of children with autism during a 2-year period. Improved caregiver strain was linked to improved child functioning and behavior. Routine assessment of caregiver strain and referral to evidence-based programming and supports may help alleviate some of the burden that families of children with autism commonly experience.
      Citation: Autism
      PubDate: 2021-10-16T07:04:38Z
      DOI: 10.1177/13623613211052108
       
  • Comparing the impact of the first and second wave of COVID-19 lockdown on
           Slovak families with typically developing children and children with
           autism spectrum disorder

    • Free pre-print version: Loading...

      Authors: Katarína Polónyiová, Ivan Belica, Hana Celušáková, Katarína Janšáková, Mária Kopčíková, Žofia Szapuová, Daniela Ostatníková
      Abstract: Autism, Ahead of Print.
      The aim of this research was to compare the mental health of families with children diagnosed with autism spectrum disorder or typically developing children, during the first and the second wave of COVID-19 outbreak in Slovakia. The study is mainly focused on the prevalence of depression, anxiety, and stress among the parents and maladaptive behavior or sleep disturbances of their children. Our research sample consisted of 332 caregivers, 155 of which have children with autism spectrum disorder; 179 surveyed during the first wave and 153 during the second wave. Extensive online parent questionnaire was created, including demographic and specific topic–related questions; Depression, Anxiety, and Stress Scale–42 questionnaire; and two subscales of Vineland Adaptive Behavior Scales—internalizing and externalizing maladaptive behavior. During the first wave, high levels of anxiety were found in parents of autism spectrum disorder children. During the second wave, all parents experienced increased levels of anxiety, stress, and depression, but especially severe for parents of children with autism spectrum disorder. Internalizing maladaptive behavior of children with autism spectrum disorder grew significantly between the waves. Parental depression, anxiety, and stress positively correlated with maladaptive behavior in both autism spectrum disorder and neurotypical children, suggesting a need for therapy options for whole families.Lay abstractA global pandemic caused by a new coronavirus (severe acute respiratory syndrome coronavirus 2) affected everyday lives of all people, including individuals with special needs, such as autism spectrum disorder. The aim of this research was to compare the mental health of families with children with autism spectrum disorder to families with typically developing children, and between the first and the second wave of COVID-19 outbreak in Slovakia. This mainly included symptoms of depression, anxiety, and stress of parents and problem behavior or sleeping difficulties of their children. The research sample consisted of 332 parents (155 of which have children with autism spectrum disorder), 179 surveyed during the first wave and 153 during the second wave. Online parent questionnaire was created, including demographic and specific topic questions, Depression Anxiety and Stress Scale–42 questionnaire, and internalizing and externalizing maladaptive behavior subscales from Vineland Adaptive Behavior Scales. Our results show that during the first wave, parents of autism spectrum disorder children suffered high levels of anxiety. During the second wave, both groups of parents suffered increased anxiety, stress, and depression, but especially severe for parents of children with autism spectrum disorder. Internalizing maladaptive behavior of autistic children grew significantly between the waves. Parental depression, anxiety, and stress were interconnected with maladaptive behavior of both autism spectrum disorder and typically developing children, suggesting the importance of the therapy options for whole families.
      Citation: Autism
      PubDate: 2021-10-16T07:02:17Z
      DOI: 10.1177/13623613211051480
       
  • Sex differences in social communication behaviors in toddlers with
           suspected autism spectrum disorder as assessed by the ADOS-2 toddler
           module

    • Free pre-print version: Loading...

      Authors: Emily Ronkin, Erin C Tully, Lee Branum-Martin, Lindsey L Cohen, Christine Hall, Laura Dilly, Erin B Tone
      Abstract: Autism, Ahead of Print.
      The Autism Diagnostic Observation Schedule, 2nd-edition (ADOS-2) Toddler Module is the current gold-standard measure of autism spectrum disorder (ASD), a neurodevelopmental condition more frequently diagnosed in toddler boys than girls. Some evidence suggests that behaviors assessed by the Toddler Module may capture an ASD phenotype that is more common among boys than girls. Focus on these behaviors may contribute to sex differences in ASD diagnoses. Particularly, the ADOS-2 may equivalently weight social communication behaviors on which boys and girls are expected to look similar and behaviors that which girls may, due to early socialization, perform differently than boys. As a consequence, the Toddler Module may fail to identify ASD in girls who should qualify for the diagnosis. The current study examined the possibility that some ADOS-2 items may function differently for boys and girls by testing the degree to which eight items equivalently related to a social communication latent factor across sexes in toddlers with suspected ASD. Inconsistent with hypotheses, tests of differential item functioning revealed no evidence of sex differences, suggesting that the Toddler Module assesses these eight items similarly for boys and girls. Examination of factor loadings point to Creativity/Imagination as an area of interest for future research.Lay When toddlers are suspected of autism spectrum disorder (ASD), the gold-standard assessment technique is with the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2) Toddler Module, a behavioral observation system. ASD is a neurodevelopmental condition more frequently diagnosed in toddler boys than in toddler girls. There is some evidence that the ADOS-2 assesses behaviors that are more characteristic of boys with ASD than girls. Thus, it is possible that focusing on these behaviors contributes at least in part to why more boys are diagnosed than girls. Specifically, girls may show more social skills than boys during the ADOS-2 assessment due to their socialization histories, which may lead to missed diagnoses of ASD in toddler girls. The current study examined eight social behaviors assessed by the ADOS-2 in a sample of toddlers with suspected ASD to see if they contributed differently to the total score of those items. Examination of those items suggested that those social communication behaviors work the same for boys and girls with suspected ASD, which was inconsistent with hypotheses. However, examination of particular items raises the possibility of examining creative/imaginative play as an area for future research.
      Citation: Autism
      PubDate: 2021-10-16T06:59:45Z
      DOI: 10.1177/13623613211047070
       
  • Preemptive interventions for infants and toddlers with a high likelihood
           for autism: A systematic review and meta-analysis

    • Free pre-print version: Loading...

      Authors: Lauren H Hampton, Elizabeth M Rodriguez
      Abstract: Autism, Ahead of Print.
      Understanding the impact of preemptive interventions on development for those with a high likelihood for autism is a critical step in building a transdiagnostic model of optimized intervention. The purpose of this systematic review and meta-analysis is to examine the impact of preemptive autism interventions on parent outcomes and child developmental outcomes. A total of 345 unique records were assessed for eligibility yielding 13 unique studies with 715 total infant/toddlers with a high likelihood for autism. There was a significant association between the early interventions on parent implementation of intervention strategies immediately following the intervention. However, there was no significant association between the early interventions and child developmental outcomes. The studies reporting moderator and/or mediator analyses suggest a meaningful association between parent implementation and long-term child social communication outcomes. Taken together, these findings suggest that parent-mediated interventions are associated with improved parent use of strategies, and although these results do not translate into immediate or short-term child developmental outcomes, there is evidence that parents with the greatest implementation facilitate later improved communication outcomes for their children. There is an urgent need to develop a nuanced intervention approach during a time of ever-changing concern about child development.Lay abstractInterventions to address core symptoms for young children on the autism spectrum have a strong and growing evidence base. Adapting and delivering evidence-based interventions to infants and toddlers with a high likelihood for autism is a logical next step. This systematic review and meta-analysis summarize the association between infant and toddler interventions and developmental and family outcomes. Results indicate that these early interventions are effective for improving parent implementation of core strategies, yet the effects do not readily translate to child outcomes. However, key studies demonstrate conditional results that indicate that parent implementation is associated with child outcome. Implications for research and practice toward building adaptive interventions that respond to parent implementation and changing child characteristics are discussed.
      Citation: Autism
      PubDate: 2021-10-11T07:11:12Z
      DOI: 10.1177/13623613211050433
       
  • Feasibility of a virtual nutrition intervention for adolescents with
           autism spectrum disorder

    • Free pre-print version: Loading...

      Authors: Acadia W Buro, Heewon L Gray, Russell S Kirby, Jennifer Marshall, Mikaela Strange, Tiantian Pang, Syed Hasan, Jamie Holloway
      Abstract: Autism, Ahead of Print.
      Adolescents with autism spectrum disorder are at increased risk of unhealthy eating behaviors and obesity. This study examined feasibility of a virtual implementation of Bringing Adolescent Learners with Autism Nutrition and Culinary Education, an 8-week nutrition intervention based on social cognitive theory that addresses autism spectrum disorder–specific eating behaviors and food environment challenges. The implementation process was measured with fidelity checklists, engagement records, and field notes. Feasibility of virtually assessing adolescents’ outcomes (food frequency questionnaire, psychosocial survey, height, and weight) was also evaluated. Adolescents with autism spectrum disorder aged 12–21 years were recruited through a local community partner. Six groups (n = 27; group size ranged 2–7) participated. Univariate data analyses were performed. Mean lesson attendance was 88%, participation was 3.5/4 (4 = Frequently), homework completion was 51.9%, fidelity was 98.9%, and technical difficulty prevalence was 0.4/2 (2 = Major technical difficulties). Assessment completion rate was 100% (98.9%–100%) at baseline and 92.6%–96.3% (99.5%–100%) at post-intervention. Data quality was high for 88% of food frequency questionnaires and 100% of psychosocial surveys. Findings suggest that a virtual implementation and evaluation of Bringing Adolescent Learners with Autism Nutrition and Culinary Education was feasible. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be implemented virtually to reach diverse populations of adolescents with autism spectrum disorder. Future research should examine the impact of the intervention on dietary behavior and obesity outcomes.Lay abstractAdolescents with autism spectrum disorder are at an increased risk of unhealthy eating behaviors and obesity compared to their typically developing peers. Many nutrition interventions for this population focus on improving autism spectrum disorder symptoms or managing weight rather than addressing participants’ healthy eating self-efficacy. The purpose of this study was to examine a virtual implementation of a new intervention for adolescents with autism spectrum disorder, Bringing Adolescent Learners with Autism Nutrition and Culinary Education. We used fidelity checklists, engagement records, and field notes to measure implementation. We also examined the feasibility of assessing outcome measures, including a food frequency questionnaire (FFQ), psychosocial survey, height, and weight. We recruited adolescents with autism spectrum disorder aged 12–21 years. Six groups of 2–7 adolescents (27 total) participated in the intervention and pre-/post-intervention measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education consisted of eight weekly lessons: exploring taste, flavor, and texture; mealtimes and rules; food groups and nutrients; moderation; beverages; cooking; well-being; sustaining healthy eating habits. The virtual implementation was feasible based on lesson attendance, participation, homework completion, fidelity, and prevalence of technical difficulties. Evaluation was also feasible based on response rate, completion, and data quality for the food frequency questionnaire, psychosocial survey, and height and weight measurements. Bringing Adolescent Learners with Autism Nutrition and Culinary Education may be used in virtual settings to reach diverse populations of adolescents with autism spectrum disorder. Future research is needed to evaluate the impact of Bringing Adolescent Learners with Autism Nutrition and Culinary Education on dietary behavior and obesity outcomes.
      Citation: Autism
      PubDate: 2021-10-11T07:08:36Z
      DOI: 10.1177/13623613211051150
       
  • Early diagnosis of autism in the community is associated with marked
           improvement in social symptoms within 1–2 years

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      Authors: Nitzan Gabbay-Dizdar, Michal Ilan, Gal Meiri, Michal Faroy, Analya Michaelovski, Hagit Flusser, Idan Menashe, Judah Koller, Ditza A Zachor, Ilan Dinstein
      Abstract: Autism, Ahead of Print.
      It is widely believed that early diagnosis and treatment of autism spectrum disorder is essential for better outcome. This is demonstrated by the American Academy of Pediatrics recommendation to screen all 1.5–2.5-year-old toddlers for autism spectrum disorder. However, multiple longitudinal studies of children diagnosed with autism spectrum disorder at 1.5–6 years of age and treated in community settings have not reported any associations between earlier diagnosis and improved outcome in core symptoms. Here, we quantified Longitudinal changes in core autism spectrum disorder symptoms of 131 children diagnosed at 1.2–5 years of age using the Autism Diagnostic Observation Schedule–Second Edition Calibrated Severity Scores over a 1-2 year period. We examined the prevalence and magnitude of Calibrated Severity Scores changes across children who were diagnosed at different ages. The results revealed that age of diagnosis was significantly correlated with poorer outcome (r(129) = 0.41, p 
      Citation: Autism
      PubDate: 2021-10-08T02:27:40Z
      DOI: 10.1177/13623613211049011
       
  • Influences of student race/ethnicity and gender on autism special
           education classification considerations

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      Authors: Megan E Golson, Cassity R Haverkamp, Maryellen Brunson McClain, Sarah E Schwartz, Jennifer Ha, Bryn Harris, Kandice J Benallie
      Abstract: Autism, Ahead of Print.
      Although the prevalence of autism continues to rise, identification disparities across race/ethnicity and gender persist in schools. The under- and overidentification of specific populations receiving special education services under the classification of autism contribute to misappropriation or lack of intervention services for students. Practicing school psychologists (N = 229) reviewed one of eight vignettes depicting a student displaying possible autism symptoms that varied only by student race/ethnicity and gender. Afterward, they rated the likelihood that they would consider the classification of autism and their confidence in that likelihood rating. School psychologists were more likely to consider an autism classification for Asian female students than Latinx female students. Confidence in likelihood ratings was higher for Asian students than Black students. School psychologists endorsed specific attention to student problem behaviors with minimal notice of possible contributing cultural and linguistic factors. The results highlight that potential implicit biases and lack of cultural consideration play a role in the identification of autism in schools, which may contribute to the nationally documented race/ethnicity and gender identification disparities.Lay Autism prevalence has continued to rise in recent years. However, females and children from Black, Latinx, and Asian backgrounds are often misidentified or identified less often than White males. These identification disparities make it difficult for children to receive appropriate special education and school intervention services. In this study, school psychologists read a vignette featuring a student with possible autism symptoms. The vignette varied by student race/ethnicity and gender. Afterward, participants rated the likelihood that they would classify the student with autism and their confidence in this rating. Student race/ethnicity and gender influenced both classification likelihood and confidence. These results suggest that school psychologists are influenced by implicit bias and do not fully consider cultural factors in school autism evaluations. This may contribute to identification disparities.
      Citation: Autism
      PubDate: 2021-10-08T01:11:07Z
      DOI: 10.1177/13623613211050440
       
  • Exploring the impact of adolescent cognitive inflexibility on emotional
           and behavioural problems experienced by autistic adults

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      Authors: Matthew J Hollocks, Tony Charman, Gillian Baird, Catherine Lord, Andrew Pickles, Emily Simonoff
      Abstract: Autism, Ahead of Print.
      Autistic young people experience high levels of co-occurring mental health difficulties, including anxiety, depression and behavioural difficulties, across their lifespan. Understanding the neuropsychological mechanisms which underlie these difficulties is vital in developing personalised supports and interventions. Cognitive inflexibility is one candidate mechanism which is associated with co-occurring mental health comorbidities but is also associated with other features of autism such as restricted and repetitive behaviours. This study investigates the distinct longitudinal association between cognitive inflexibility, measured using objective neuropsychological measures and emotional and behavioural problems across adolescence and early adulthood. Eighty-one autistic people from a population-based longitudinal study were assessed at 16 and 23 years on measures of emotional and behavioural problems, with cognitive inflexibility, restricted and repetitive behaviours and verbal intelligence quotient measured at 16 years. We used structural equation modelling to investigate the relationship between cognitive inflexibility and emotional and behavioural symptoms at both timepoints while accounting for the severity of restricted and repetitive behaviours and verbal intelligence quotient. Our results indicate an effect of cognitive inflexibility on increased behavioural problems at 16 years and emotional problems across timepoints, which is distinct from restricted and repetitive behaviours and verbal intelligence quotient. Exploratory mediation analyses suggest that cognitive inflexibility may be one mechanism through which emotional difficulties are maintained longitudinally.Lay abstractAutistic people experience high levels of co-occurring mental health difficulties. To develop more effective treatments, a greater understanding of the thinking processes that may lead to these difficulties is needed. Cognitive inflexibility, defined as a rigid pattern of thoughts and subsequently behaviours, is one possible thinking trait which has previously been associated with both co-occurring mental health difficulties but also other features of autism such as restricted and repetitive behaviours. Restricted and repetitive behaviours include repetitive movements, ritualistic behaviours, and/or highly focused interests. This study investigates the relationship between, cognitive inflexibility, measured using neuropsychological tasks, and emotional and behavioural problems across adolescence and early adulthood. Eighty-one autistic people who were recruited to be representative of the wider autism population were assessed at 16 and 23 years on measures of emotional and behavioural problems, with cognitive inflexibility, restricted and repetitive behaviours and verbal intelligence measured at 16 years. We used statistical modelling to investigate the relationship between cognitive inflexibility and emotional and behavioural symptoms at both timepoints while accounting for the possible relationship with restricted and repetitive behaviours and verbal intelligence quotient. Our results suggest that cognitive inflexibility may be an important factor associated with emotional difficulties across adolescence and early adulthood. This suggests that developing intervention approaches targeting cognitive inflexibility may be an important step in improving the mental health of those with autism.
      Citation: Autism
      PubDate: 2021-09-28T08:37:51Z
      DOI: 10.1177/13623613211046160
       
  • Sequence organization of autistic children’s play with caregivers:
           Rethinking follow-in directives

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      Authors: Kristen Bottema-Beutel, Shannon Crowley, So Yoon Kim
      Abstract: Autism, Ahead of Print.
      This study is a qualitative investigation of caregiver–child interactions, involving 15 autistic children who are in the early stages of language learning. Data consisted of 15-min videos of free-play interactions recorded in a University clinic. We use conversation analysis to examine the sequence organization of proposal episodes, where the caregiver proposes some course of action regarding the child’s play activity. Prior work has used a speech act theoretical framework to identify follow-in directives, which are similar to proposals, but identified at the utterance level rather than at the level of social action. According to conversation analysis, social actions are implemented over multiple interactional turns and produced in collaboration between interaction partners. Our analysis showed that caregivers design their talk in ways that enable autistic children’s participation in interactional turn-taking by forecasting the upcoming proposal. They also socialize children into expectations around turn-taking, by providing an “interaction envelope” around children’s conduct so that it can be construed as completing interactional sequences. Finally, we show how autistic children can display an orientation to turn-taking by timing their interactive moves to occur at transitional moments in the interaction in ways similar to adult conversational turn-taking.Lay abstractIn this article we use a qualitative method, conversation analysis, to examine videos of caregivers interacting with their young autistic children who are in the early phases of language learning. Conversation analysis involves preparation of detailed transcripts of video data, which are then analyzed together to understand how interactional moves (e.g. talk, gestures, and physical conduct) are linked with prior and subsequent interactional moves. We analyzed data from 15 participants, and focused on instances when caregivers made a proposal about something the child was playing with. In previous research, similar instances have been referred to as “follow-in directives.” We found that these proposals were embedded in sequences that had a similar structure, and were prefaced with a ‘pre-proposal’; where the caregiver established the child’s interest in a joint activity and signaled the upcoming proposal. The caregiver’s talk was also provided in such a way that there was a clear “slot” for the child’s turn, which made it easy for the child’s actions to become part of an interactional sequence. In addition, proposal sequences were very negotiable—the caregivers do not usually insist that the child follow through on the proposal, only that they produce an action that could be taken as a response. Finally, there were some instances where the child’s turn was very precisely timed to occur right at the end of a caregiver’s proposal; this precise timing could signal the child’s understanding of how interactional turn-taking works. We suggest that this method of examining caregiver–child interactions provides new insights into how interactions proceed, which could be useful for future intervention research.
      Citation: Autism
      PubDate: 2021-09-25T05:48:23Z
      DOI: 10.1177/13623613211046799
       
  • Leveraging telehealth to evaluate infants with prodromal autism spectrum
           disorder characteristics using the telehealth evaluation of development
           for infants

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      Authors: Meagan R Talbott, Sarah Dufek, Greg Young, Sally J Rogers
      Abstract: Autism, Ahead of Print.
      This study investigated the feasibility of recruiting and assessing infants with prodromal autism characteristics in the first year of life via telehealth. Participants included 41 infants (Mage = 10.51 months, 51.2% female, 80.5% White) whose parents had concerns about social communication delays or autism. All infants met concerns criteria on a social communication screener. Infants were subsequently assessed via telehealth using the Telehealth Evaluation of Development for Infants protocol, wherein parents are coached through a series of semi-structured interactions from which key measures of autism characteristics, communication, developmental level, and clinical best estimates of autism spectrum disorder likelihood are scored. Parents completed online questionnaires and surveys measuring the acceptability of the telehealth visits. Across both parent report and examiner-derived measures, infants demonstrated high scores on measures of purported autism traits, decreased communication skills, and delayed achievement of developmental milestones. Caregivers’ acceptability ratings were uniformly positive. Results highlight the potential for telehealth to expand the scope of studies of emerging autism beyond infant sibling designs and to increase families’ access to early evaluation services.Lay abstractMany families seeking early evaluations for autism spectrum disorder face long waitlists, must often travel to centers with appropriate expertise, and are frequently told by providers to “wait and see.” This results in significant stress for families and delayed supports to infants and their caregivers who could benefit. This study evaluated whether telehealth could be used to identify and evaluate infants with early autism spectrum disorder characteristics in the first year of life. In this study, we evaluated 41 infants via telehealth using a standard set of probes and scored behavior related to social communication, play, imitation, and other developmental domains. We found the majority of infants demonstrated elevated likelihood of autism spectrum disorder on both parent-reported questionnaires and examiner-rated behavior. Caregiver ratings of the overall utility of the protocol used in this study were high. Overall, this study demonstrates the feasibility for telehealth-based approaches to evaluate infants’ with elevated likelihood of autism spectrum disorder in the first year of life, which could help to improve families’ access to care and to expand our capacity to conduct studies evaluating possible intervention supports.
      Citation: Autism
      PubDate: 2021-09-22T12:29:28Z
      DOI: 10.1177/13623613211045596
       
  • Anthropomorphic tendencies in autism: A conceptual replication and
           extension of White and Remington (2019) and preliminary development of a
           novel anthropomorphism measure

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      Authors: Rachel A Clutterbuck, Punit Shah, Hok Sze Leung, Mitchell J Callan, Natalia Gjersoe, Lucy A Livingston
      Abstract: Autism, Ahead of Print.
      White and Remington (2019) found that autistic people may have increased anthropomorphic tendencies to ascribe human-like attributes to non-human agents. However, it was unclear from their study whether this relationship holds after accounting for socio-demographic variables known to be associated with anthropomorphism. The psychometric properties of the anthropomorphism questionnaire they used has also not been investigated, raising concerns about whether it measures the same construct in people with differing levels of autistic traits. Addressing these issues, we re-examined the relationship between autism and anthropomorphism in a large sample of adults (N = 492). Conceptually replicating White and Remington, we found that autistic traits were significantly associated with greater anthropomorphic tendencies, even after accounting for age and sex (Study 1). Equally, psychometric concerns with the anthropomorphism questionnaire were revealed, leading us to refine this measure and re-analyse the data. A less clear-cut but significant association between autistic traits and anthropomorphism was found (Study 2). Our refined anthropomorphism measure also had improved psychometric properties, particularly showing that it is suitable for future autism research. Our findings are discussed in relation to individual differences in social-cognitive processing and we outline future directions for investigating mechanisms linking anthropomorphism and social cognition in autism.Lay abstractAnthropomorphism is the tendency to attribute human-like qualities (e.g. thoughts and feelings) to non-human entities (e.g. objects and weather systems). Research by White and Remington (2019) suggested that anthropomorphism is more common in autistic compared to neurotypical adults, which is interesting given that autistic individuals sometimes misunderstand the thoughts and feelings of other people. In this article, we re-examined the link between autism and anthropomorphism in a large sample of adults with varying degrees of autistic traits, with several important methodological advances on previous research. Across two studies, we found that individuals with more autistic traits reported greater anthropomorphic tendencies. As part of these analyses, we had to develop a new, refined measure of anthropomorphism, which showed better reliability and validity than the original measure. This measure will be useful in future autism-related research. Overall, advancing White and Remington’s study, these findings help us to better understand individual differences in socially relevant processes, including those that may be enhanced in autism (e.g. anthropomorphism).
      Citation: Autism
      PubDate: 2021-09-18T12:46:56Z
      DOI: 10.1177/13623613211039387
       
  • Exploring interpersonal and environmental factors of autistic
           adolescents’ peer engagement in integrated education

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      Authors: Yu-Lun Chen, Maxwell Schneider, Kristie Patten
      Abstract: Autism, Ahead of Print.
      Autistic students often struggle to engage with peers in integrated education; however, research has largely focused on individual characteristics rather than the interpersonal and environmental factors affecting peer engagement. This mixed-methods study examined longitudinal peer interactions over a school year among 17 adolescents (seven were autistic) in an inclusive school club. The quantitative phase investigated participants’ social behavior rates to identify sessions where each student demonstrated high and low peer engagement compared with their average participation levels. The qualitative phase compared social interactions and contexts between sessions of high and low peer engagement, revealing 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.Lay abstractPeer 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.
      Citation: Autism
      PubDate: 2021-09-18T09:33:59Z
      DOI: 10.1177/13623613211046158
       
  • Short report: Call to action for autism clinicians in response to
           anti-Black racism

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      Authors: Diondra Straiton, Aksheya Sridhar
      Abstract: Autism, Ahead of Print.
      Anti-Black racism is a pervasive issue in the autism field that affects the autism service pathway, which ranges from identification of concerns to ongoing service navigation. In this short report, we provide a working model of the autism service pathway and highlight ways in which anti-Black racism affects all components of the pathway. We summarize the literature that demonstrates the effects of racism within autism assessment, treatment, and quality of care. We end with six recommendations for systemic change that clinicians can take: (1) including and amplifying Black autistic voices within their organization, (2) continuously learning about and acknowledging the ways in which their discipline perpetuates anti-Black racism, (3) recognizing that cultural humility is a lifelong process, (4) being mindful of the complex pathway that families must navigate to receive autism services, particularly when working with Black individuals, and (5) advocating for system-level changes within their organization and refining changes that are made.Lay abstractBlack autistic people experience anti-Black racism when interacting with service systems and the clinicians in those systems. In this article, we describe the various steps families take to get services and how anti-Black racism makes that process even harder. We discuss research that shows the negative effects of anti-Black racism in autism assessment, treatment, and quality of care. We then provide five recommendations that clinicians should follow to reduce anti-Black racism in the autism field: (1) find Black autistic people and listen to their opinions about your organization, (2) always keep learning about how your profession promotes anti-Black racism, (3) recognize that the process of a clinician learning to be culturally humble takes time and is never “complete,” (4) pay attention to all of the steps that families must take to receive autism services and how these steps are even harder for Black individuals, and (5) advocate for your organization to make systems-level changes in their policies and procedures.
      Citation: Autism
      PubDate: 2021-09-17T12:28:08Z
      DOI: 10.1177/13623613211043643
       
  • Associative learning under uncertainty in adults with autism: Intact
           learning of the cue-outcome contingency, but slower updating of priors

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      Authors: Laurie-Anne Sapey-Triomphe, Veith A Weilnhammer, Johan Wagemans
      Abstract: Autism, Ahead of Print.
      Predictive coding theories of autism suggest that symptoms could result from an atypical learning of expectations. We assessed whether adults with autism could learn expectations in an uncertain context. Twenty-nine neurotypicals and 25 autistic adults participated in an associative learning task. After hearing a tone, participants had to predict the rotation direction of a dot pair, and to report what they perceived. There was a probabilistic association between the tone and the rotation direction. This association could reverse within a block. Both groups were biased by their expectations, as they reported perceiving a rotation consistent with the contingency in a subset of ambiguous trials where the dots did not rotate. Participants made predictions above chance level, but contrary to neurotypicals, autistic participants updated their prior expectation less after a change in contingency. Computational modeling revealed a smaller influence of associative learning on perceptual expectations in the autism group. In an additional task, participants reported how confident they were about their percepts. Both groups expressed confidence in relation to the stimuli, but certainty ratings reflected response times in neurotypical participants only. These findings, showing a more inflexible adjustment of priors in autism, should help refining the predictive coding hypotheses of autism.Lay abstractWe have an internal representation of the world that guides our behavior, helps us predicting what comes next and therefore, reducing uncertainty. For instance, after hearing the noise of a door opening, we usually expect to see a person appearing, whose features differ depending on the context. In this example of associative learning, predictions need to be adjusted if there is a change in the environment (e.g. different person depending on the location). Recent theories suggest that the symptoms encountered in autism could be due to an atypical learning of predictions or to a decreased influence of these expectations on perception. Here, we conducted an experiment assessing whether adults with autism could learn and adjust their predictions in a changing environment. Throughout a behavioral task, participants learned to associate a sound with a visual outcome, but this association could sometimes reverse. Results showed that autistic adults could learn to make predictions that fitted the main sound–vision association, but were slower to adapt their expectations when there was an unannounced change in the environment. We also observed that both adults with and without autism tended to be biased by their expectations, as they reported seeing what they expected to see rather than what was actually shown. Altogether, our results indicate that autistic adults can learn predictions but are more inflexible to adjust these predictions in a changing environment. These results help refining recent theories of autism (called “predictive coding” theories), which intend to identify the core mechanisms underlying the autistic symptomatology.
      Citation: Autism
      PubDate: 2021-09-17T11:24:11Z
      DOI: 10.1177/13623613211045026
       
  • Coordination variability during running in adolescents with autism
           spectrum disorder

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      Authors: Hunter J Bennett, Taylor Jones, Kevin A Valenzuela, Justin A Haegele
      Abstract: Autism, Ahead of Print.
      Autistic persons exhibit variable movement, loading, and coordination patterns during walking. While much research has examined walking, little to no research exists regarding running for autistic persons despite its prevalence and benefits as a mode of physical activity. This study determined if autistic adolescents demonstrate increased coordination variability during running compared to matched controls. Seventeen autistic adolescents (aged = 13–18 years) and seventeen sex, age, and body mass index matched controls performed running at two matched speeds: self-selected of autistic adolescents and at 3.0 m/s. Modified vector coding was used to determine the patterns of movement for foot-shank, shank-thigh, left/right thigh, and contralateral arm-thigh coupling. Coordination variability, measuring cycle-to-cycle variability, was determined during loading response and pushoff phases. Mixed-model analyses of variance were used to determine group by speed interactions and main effects. Coordination variability was nearly 2× larger (all p 
      Citation: Autism
      PubDate: 2021-09-14T01:17:44Z
      DOI: 10.1177/13623613211044395
       
  • The influence of race on parental beliefs and concerns during an autism
           diagnosis: A mixed-method analysis

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      Authors: Gazi Azad, Calliope Holingue, Danika Pfeiffer, Emily Dillon, Rachel Reetzke, Luke Kalb, Deepa Menon, Ji Su Hong, Rebecca Landa
      Abstract: Autism, Ahead of Print.
      The purpose of this mixed-method study was to examine racial differences in parental beliefs and concern about autism spectrum disorder (ASD) versus clinical judgment. The sample included 489 children with ASD undergoing their first ASD evaluation. Parent belief that their child had ASD was highest among parents of White children. White children whose parents believed the child had ASD had lower ASD severity. Parents of Black/African American and Hispanic children were more likely to report communication concerns than parents of White children. Parental concern about social communication was related to higher ASD severity for Hispanic children. Implications for diagnostic processes are discussed.Lay abstractThe goal of this study was to examine if there were differences between races in parental concern and belief about autism spectrum disorder (ASD) and the perspectives of clinicians. We studied 489 children with ASD who were having their first evaluation at an ASD clinic. Parents of White children most often believed that their child had ASD. However, White children whose parents believed the child had ASD were less severe in their symptoms. Parents of Black/African American or Hispanic children were more likely to have concerns about communication than parents of White children. In Hispanic families, parental concern about social communication was related to more severe symptoms in children. We discuss the implications of our findings for diagnosis.
      Citation: Autism
      PubDate: 2021-09-14T01:17:26Z
      DOI: 10.1177/13623613211044345
       
  • Relative predictive utility of the original and Autism-Specific
           Five-Minute Speech Samples for child behaviour problems in autistic
           preschoolers: A preliminary study

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      Authors: Jodie Smith, Rhylee Sulek, Cherie C Green, Catherine A Bent, Lacey Chetcuti, Lillian Bridie, Paul R Benson, Jacqueline Barnes, Kristelle Hudry
      Abstract: Autism, Ahead of Print.
      Many autistic children have co-occurring behavioural problems influencing core autism symptomology potentially relevant for intervention planning. Parental Expressed Emotion – reflecting critical, hostile and overprotective comments – contributes to understanding and predicting behaviour in autistic school-aged children, adolescents and adults and is typically measured using the Five-Minute Speech Sample. However, limitations exist for its use with parents of younger autistic children and so the Autism-Specific Five-Minute Speech Sample was adapted with the goal of better measuring parent Expressed Emotion in the context of childhood autism. The Autism-Specific Five-Minute Speech Sample has not yet been used to explore Expressed Emotion in parents of autistic preschoolers, nor has the relative predictive utility of the Autism-Specific Five-Minute Speech Sample and Five-Minute Speech Sample been evaluated in the same sample. We compared the two measures from speech samples provided by 51 Australian parents with newly diagnosed autistic preschoolers, including investigating their predictive value for concurrent and subsequent child internalising and externalising behaviour problems. While Autism-Specific Five-Minute Speech Sample Expressed Emotion and Five-Minute Speech Sample Expressed Emotion were associated in this sample, only Autism-Specific Five-Minute Speech Sample codes contributed significant predictive value for concurrent and subsequent child problem behaviour. These preliminary data strengthen the position that the Autism-Specific Five-Minute Speech Sample may better capture Expressed Emotion, than the Five-Minute Speech Sample, among parents of autistic preschool-aged children.Lay abstractParental Expressed Emotion refers to the intensity and nature of emotion shown when a parent talks about their child, and has been linked to child behaviour outcomes. Parental Expressed Emotion has typically been measured using the Five-Minute Speech Sample; however, the Autism-Specific Five-Minute Speech Sample was developed to better capture Expressed Emotion for parents of children on the autism spectrum. In each case, parents are asked to talk for 5 min about their child and how they get along with their child. Parents’ statements are then coded for features such as number of positive and critical comments, or statements reflecting strong emotional involvement. While both the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample have been used with parents of autistic school-aged children, their relative usefulness for measuring Expressed Emotion in parents of preschool-aged children – including their links to child behaviour problems in this group – is unclear. We collected speech samples from 51 parents of newly diagnosed autistic preschoolers to investigate similarities and differences in results from the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample coding schemes. This included exploring the extent to which the Five-Minute Speech Sample and Autism-Specific Five-Minute Speech Sample, separately, or together, predicted current and future child behaviour problems. While the two measures were related, we found only the Autism-Specific Five-Minute Speech Sample – but not the Five-Minute Speech Sample – was related to child behavioural challenges. This adds support to the suggestion that the Autism-Specific Five-Minute Speech Sample may be a more useful measure of parental Expressed Emotion in this group, and provides a first step towards understanding how autistic children might be better supported by targeting parental Expressed Emotion.
      Citation: Autism
      PubDate: 2021-09-14T01:14:48Z
      DOI: 10.1177/13623613211044336
       
  • Prevalence of epilepsy in autism spectrum disorders: A systematic review
           and meta-analysis

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      Authors: Xian Liu, Xin Sun, Caihong Sun, Mingyang Zou, Yiru Chen, Junping Huang, Lijie Wu, Wen-Xiong Chen
      Abstract: Autism, Ahead of Print.
      The literature from inception to 2020 on the prevalence of epilepsy in autistic individuals was systematically reviewed and further explored by subgroup analyses and meta-regression models. This systematic review is registered with PROSPERO (CRD42020179725). A total of 66 studies from 53 articles were included. The updated pooled prevalence of epilepsy in autistic individuals was 10% (95% CI: 6–14). The respective prevalence estimate of epilepsy was 19% (95% CI: 6–35) in the clinical sample-based cross-sectional study, 7% (95% CI: 3–11) in the cohort study, and 9% (95% CI: 5–15) in the population-based cross-sectional study. The pooled prevalence of epilepsy was 7% (95% CI: 4–11) in autistic children and 19% (95% CI: 14–24) in autistic adults. Compared to the school-aged group, the adolescence group (OR: 1.15, 95% CI: 1.06–1.25) and the pre-school group (OR: 1.06, 95% CI: 0.94–1.19) were positively associated with the prevalence of epilepsy. The moderators of age, human development index of the country, gender, and intellectual function accounted for most of the heterogeneity. The prevalence estimates were associated with age, female gender, intellectual disability rate, and the human development index of countries. About 1/10 autistic individuals co-occurred with epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability, and less common in the country with high human development index.Lay abstractAutistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11–17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7–10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.
      Citation: Autism
      PubDate: 2021-09-13T08:01:05Z
      DOI: 10.1177/13623613211045029
       
  • Positive and differential diagnosis of autism in verbal women of typical
           intelligence: A Delphi study

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      Authors: Julie Cumin, Sandra Pelaez, Laurent Mottron
      Abstract: Autism, Ahead of Print.
      Diagnostic criteria for autism are relatively vague, and may lead to over and underdiagnosis when applied without clinical expertise. Indeed, autism is best reliably identified by experienced clinicians who take into account qualitative aspects of the condition. When assessing for autism in women, little guidance exists to support clinicians deciding whether to attribute adaptive difficulties to autism, a psychiatric condition, or both. The purpose of this study was therefore to propose guidelines for clinicians assessing for autism in women. To do this, we aimed to describe the clinical expertise involved in making positive and differential diagnoses of autism in adult women of typical intelligence. We interviewed 20 experienced clinicians from seven countries. We then elaborated Delphi statements summarizing participant views on the topic, which our participants rated. We obtained a final list of 37 suggested clinical guidelines to improve specificity and sensitivity of autism diagnosis in women. Participants had developed individual assessment strategies, although much overlap existed across participants. Participants provided insight to differentiate autism from post-traumatic stress disorder and Borderline Personality Disorder, and underlined the importance of being able to make differential diagnoses particularly in cases where non-autistic people had strongly self-identified with the spectrum.Lay abstractThe diagnostic criteria for autism are relatively vague and can lead to both under- and over-diagnosis if applied as a checklist. The highest level of agreement that a person is autistic occurs when experienced clinicians are able to make use of their clinical judgment. However, it is not always clear what this judgment consists of. Given that particular issues exist when assessing for autism in adult women, we wanted to explore how expert clinicians address difficult diagnostic situations in this population. We interviewed 20 experienced psychologists and psychiatrists from seven countries and discussed how they conducted autism assessments in adult women. We then came up with a list of 35 statements that described participant views. Our participants completed an online survey where they rated their agreement with these statements and provided feedback on how the statements were worded and organized. We obtained a final list of 37 suggested clinical guidelines. Participants agreed that diagnostic tools and questionnaires had to be coupled with judgment and expertise. Participants felt that trauma and Borderline Personality Disorder could be difficult to differentiate from autism, and agreed on some ways to address this issue. Participants agreed that self-identification to the autism spectrum was frequent, and that it was important to provide alternative support when they did not ultimately diagnose autism.
      Citation: Autism
      PubDate: 2021-09-11T10:06:21Z
      DOI: 10.1177/13623613211042719
       
  • Quality of the sibling relationship when one sibling has autism spectrum
           disorder: A randomized controlled trial of a sibling support group

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      Authors: Ariel Zucker, Yookyung Chang, Reena Maharaj, Wei Wang, Theresa Fiani, Susan McHugh, Daniel M Feinup, Emily A Jones
      Abstract: Autism, Ahead of Print.
      When one sibling has autism spectrum disorder, the sibling relationship is often characterized by poorer quality with fewer interactions. Because sibling relationships provide a vital social framework for development, they have the capacity to be a risk or protective factor, depending on the quality of the relationship. One way to improve the quality of the sibling relationship is through typically developing sibling participation in a support group. In this study, researchers randomly assigned typically developing siblings to a 10-week support group or attention-only control group. Typically developing siblings in the support group showed significant improvements in the quality of their sibling relationship and interactions with their sibling with autism spectrum disorder compared to the control group. Autism spectrum disorder severity and externalizing behavior moderated the effects of the support group on positive affect. Findings suggest the positive impact of a support group on sibling relationships, a relationship that has the potential to be protective.Lay abstractThe sibling relationship can be negatively impacted when one child has autism spectrum disorder. One way to improve the quality of that relationship is through typically developing sibling participation in a support group in which they learn about autism spectrum disorder and coping skills, develop a peer network, and discuss their feelings. Compared to participating in a similar group without a focus on autism spectrum disorder, siblings in the support group showed improvements in the quality of the sibling relationship. Findings suggest that sibling support groups can be a valuable resource to improve sibling relationship quality when one sibling has autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-09-09T10:12:13Z
      DOI: 10.1177/13623613211042135
       
  • A qualitative exploration of autistic mothers’ experiences II:
           Childbirth and postnatal experiences

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      Authors: Sarah Hampton, Joyce Man, Carrie Allison, Ezra Aydin, Simon Baron-Cohen, Rosemary Holt
      Abstract: Autism, Ahead of Print.
      Navigating childbirth and the postnatal period may pose additional challenges for autistic people, who can face communication and sensory barriers to accessing healthcare. However, research exploring autistic experiences of parenthood is scarce. Semi-structured interviews were conducted with 21 autistic and 25 non-autistic women 2–3 months after giving birth. Interviews concerned experiences of childbirth, postnatal healthcare and parenting. Thematic analysis revealed that sensory aspects of childbirth could be challenging for autistic participants; participants highlighted the need for sensory adjustments. Autistic participants stressed the importance of clear, direct communication from professionals during the birth. During childbirth and the postnatal period, autistic participants sometimes felt that professionals lacked knowledge of autism and this could hinder receiving appropriate adjustments. Both groups reported several parenting strengths and challenges. The findings indicate ways in which childbirth and postnatal healthcare can be improved for autistic people, including sensory and communication adjustments. They also indicate a need for greater autism-related training for professionals involved in childbirth and postnatal care.Lay abstractVery little research has looked at how autistic people experience childbirth and the first few months of parenthood. We interviewed 21 autistic and 25 non-autistic women 2–3 months after their baby was born, to find out how they experienced giving birth and being a parent. Some autistic participants found sensory aspects of giving birth difficult, such as noise and being touched. They also wanted healthcare professionals to give them clear information while giving birth. Participants sometimes thought that healthcare professionals did not know enough about autism. Autistic and non-autistic participants both found parenthood difficult at times and autistic parents sometimes had extra difficulties, such as with planning and organising. Autistic participants also felt good at understanding their baby’s needs. This research suggests that autistic people would benefit from changes to childbirth and postnatal healthcare such as being communicated with more clearly. It also indicates that healthcare professionals should receive more training about autism.
      Citation: Autism
      PubDate: 2021-09-04T11:45:03Z
      DOI: 10.1177/13623613211043701
       
  • Autism Voices: A novel method to access first-person perspective of
           autistic youth

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      Authors: Valérie Courchesne, Rackeb Tesfaye, Pat Mirenda, David Nicholas, Wendy Mitchell, Ilina Singh, Lonnie Zwaigenbaum, Mayada Elsabbagh
      Abstract: Autism, Ahead of Print.
      Opportunities to communicate first-person perspectives are essential for self-determination. However, many autistic youth are excluded from sharing their perspectives, specifically those who are minimally verbal or with lower intellectual functioning. Current challenges to capturing their voices include a lack of appropriate inclusive methodologies. Propose an inclusive strength-oriented method to capture first-person perspectives of autistic adolescents. Our protocol (“Autism Voices”) includes a pre-interview survey and semi-structured interview using universal design strategies. It was piloted with 33 participants who were representative of diverse language and cognitive abilities. A coding scheme was developed to identify communicative acts used by participants and mitigation strategies used by interviewers to enhance communication. Interviewer strategies that enhanced communication included question formulation, use of pictures, offering various output modalities, and flexible implementation of the protocol. Non-verbal and alternative communication responses (e.g. choosing to not respond) were informative to youth’s lived experience, especially for minimally verbal participants. Overall, our results highlight that communication goes beyond verbally answering questions and that participants’ unconventional communication conveyed rich information. Autism Voices provides a promising method to promote the inclusion of autistic youth in research.Lay The perspective of autistic individuals is often left uncaptured, and as a result they are often excluded from making decisions that impact them. Conventional communication can be challenging for many autistic individuals, especially those who are minimally verbal or who have an associated intellectual disability. Currently, a lack of appropriate methods to capture voices across the spectrum is a barrier. In the present study, we developed the Autism Voices protocol using universal design principles to capture the perspectives and experiences of autistic youth with a range of language or intellectual abilities. This protocol was then used with 33 autistic youth aged 11 to 18 years. A scoring rubric was developed to capture the unconventional communication used by the participants and the mitigation strategies used by interviewers to facilitate the interview. Many components of the protocol were found to effectively facilitate communication between the participant and interviewer, including the use of picture cards to support verbal questions/prompts, the fact that participants could respond with their preferred communication methods (writing, texting, pointing), and the fact that interviews were applied flexibly to adapt to each participant. Unconventional communication and mitigation strategies were mostly observed in interviews with minimally verbal individuals, but a fine-grained analysis showed participants were still communicating something through this unconventional communication. Our protocol could help promote the inclusion of more autistic individuals in research and showed that unconventional modes of communication like echolalia provide an understanding that participants’ are invested in conversations and certain topics are more meaningful than others.
      Citation: Autism
      PubDate: 2021-09-04T07:24:47Z
      DOI: 10.1177/13623613211042128
       
  • A preliminary randomized, controlled trial of executive function training
           for children with autism spectrum disorder

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      Authors: Susan Faja, Tessa Clarkson, Rachel Gilbert, Akshita Vaidyanathan, Gabriella Greco, M Rosario Rueda, Lina M Combita, Kate Driscoll
      Abstract: Autism, Ahead of Print.
      This randomized, controlled study examined the initial efficacy of an executive function training program for children with autism spectrum disorder. Seventy 7- to 11 year-olds with autism spectrum disorder and intelligence quotients ⩾80 were randomly assigned to receive a web-based set of executive function training games combined with in-person metacognition coaching or to a waitlist. Primary outcomes were evaluated for neural responses related to executive function, lab-based executive function behavior, and generalization of executive function skills. Secondary outcomes included measures of social function. Post-testing and analyses were conducted by staff naïve to group assignment. Children exhibited a change in neural response following training relative to the waitlist group [math]. Training effects were not detected via lab-based tasks [math] or generalized to caregiver-reported executive function skills outside the lab [math]. However, the training group demonstrated reduced symptoms of repetitive behavior [math] following training. There were no adverse events or attrition from the training group. Findings suggest that brief, targeted computer-based training program accompanied by coaching is feasible and may improve neural responses and repetitive behaviors of school-aged children with autism spectrum disorder.Lay abstractExecutive function, which is a set of thinking skills that includes stopping unwanted responses, being flexible, and remembering information needed to solve problems, is a challenge for many children on the autism spectrum. This study tested whether executive function could be improved with a computerized executive function training program under the guidance of a coach who reinforced the use of executive function skills. Seventy children with autism spectrum disorder from age 7 to 11 years of age participated in the study. They were randomly assigned to receive training or to a waiting group. The tests most likely to determine whether the training may be effective were chosen from a larger battery before the study started and included one task measuring brain responses, two measures of executive function in the lab, and a parent questionnaire. Changes in social functioning and repetitive behaviors were also explored. All children assigned to training completed the program and families generally reported the experience was positive. Brain responses of the training group changed following training, but not within the waiting group during a similar time period. Children who received training did not exhibit behavioral changes during the two the lab-based tasks. Parent report on questionnaires indicated that neither group showed a significant change in their broad use of executive function in other settings. Yet, children who received training were reported to have fewer restricted and repetitive behaviors following training. These initial findings suggest that short executive function training activities are feasible and may improve some functioning of school-aged children on the autism spectrum.
      Citation: Autism
      PubDate: 2021-09-03T04:51:10Z
      DOI: 10.1177/13623613211014990
       
  • If you want to develop an effective autism training, ask autistic students
           to help you

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      Authors: Kristen Gillespie-Lynch, Jennifer B Bisson, Sabine Saade, Rita Obeid, Bella Kofner, Ashley Johnson Harrison, Nidal Daou, Nicholas Tricarico, Jin Delos Santos, William Pinkava, Allison Jordan
      Abstract: Autism, Ahead of Print.
      Autistic university students face stigma. Online trainings have been used to improve explicit autism stigma (social distance) and knowledge among university students in different countries. However, autistic university students have not typically been involved in developing such trainings. We developed two autism trainings: a participatory training (developed in collaboration with autistic university students) and a non-participatory training. We evaluated these trainings with undergraduate students in the United States and Lebanon. A pilot study revealed improvements in implicit biases (measured with an Implicit Association Test) and knowledge following both trainings, but no clear benefit of the participatory training in particular. Feedback revealed that participants found the Implicit Association Test tedious, suggesting that it might have dampened effects by boring participants. To increase engagement, we removed the Implicit Association Test and conducted a cross-university training comparison which revealed evidence that the participatory training was more effective than the non-participatory training at improving autism knowledge, explicit stigma, and attitudes toward inclusion. Autistic co-authors coded participant feedback and identified three key themes to guide future training development and adaptation: an (inter)personal element, accessibility, and clarity of information. These studies provide empirical support for the oft-cited, but rarely directed tested, benefits of involving autistic people in research about autism.Lay abstractAutistic university students are often left out because people do not understand autism. We wanted to help people understand autism. Most autism trainings are not made by autistic people. Autistic people know what it is like to be autistic. So autistic people may be the best teachers when it comes to teaching about autism. Autistic students and non-autistic professors made an autism training. The students made videos for the training. They also helped make questions to see what people learned from the trainings. Professors who are not autistic made a training on their own. Students in New York City tried out the trainings. After they answered questions, they did either the training the autistic students helped make or the training made by only professors. Then, they answered questions again. We learned from the students how to make our trainings better. Then, students from two universities in the United States and one university in Lebanon did our trainings and questions. Both trainings made hidden feelings about autism better. The training autistic students helped make taught students more than the training professors made on their own. The autistic-led training also helped students accept autism more. These studies show that autistic students can make autism research and trainings better. At the end of this article, autistic students share their ideas for how to make autism trainings even better in the future.
      Citation: Autism
      PubDate: 2021-09-02T10:30:08Z
      DOI: 10.1177/13623613211041006
       
  • Atypicalities in the developmental trajectory of cortico-striatal
           functional connectivity in autism spectrum disorder

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      Authors: Zeng-Hui Ma, Bin Lu, Xue Li, Ting Mei, Yan-Qing Guo, Liu Yang, Hui Wang, Xin-Zhou Tang, Zhao-Zheng Ji, Jing-Ran Liu, Ling-Zi Xu, Yu-Lu Yang, Qing-Jiu Cao, Chao-Gan Yan, Jing Liu
      Abstract: Autism, Ahead of Print.
      The last decades of neuroimaging research has revealed atypical development of intrinsic functional connectivity within and between large-scale cortical networks in autism spectrum disorder, but much remains unknown about cortico-subcortical developmental connectivity atypicalities. This study examined cortico-striatal developmental intrinsic functional connectivity changes in autism spectrum disorder and explored how those changes may be correlated with autistic traits. We studied 49 individuals with autism spectrum disorder and 52 age-, sex-, and head motion–matched typically developing individuals (5–30 years old (14.0 ± 5.6)) using resting-state functional magnetic resonance imaging. Age-related differences in striatal intrinsic functional connectivity were compared between the two groups by adopting functional network–based parcellations of the striatum as seeds. Relative to typically developing individuals, autism spectrum disorder individuals showed atypical developmental changes in intrinsic functional connectivities between almost all striatal networks and sensorimotor network/default network, with connectivity increasing with age in the autism spectrum disorder group and decreasing or constant in typically developing individuals. Age-related degree centrality and voxel-mirrored homotopic connectivity atypicalities in sensorimotor network/default network and voxel-mirrored homotopic connectivity disruptions in striatal regions were also observed in autism spectrum disorder. Significant correlations were found between cortico-striatal intrinsic functional connectivities and Autism Diagnostic Observation Schedule communication/repetitive and restricted-behavior subscores in autism spectrum disorder. Our results indicated that developmental atypicalities of cortico-striatal intrinsic functional connectivities might contribute to the neuropathology of autism spectrum disorder.Lay abstractAutism spectrum disorder has long been conceptualized as a disorder of “atypical development of functional brain connectivity (which refers to correlations in activity levels of distant brain regions).” However, most of the research has focused on the connectivity between cortical regions, and much remains unknown about the developmental changes of functional connectivity between subcortical and cortical areas in autism spectrum disorder. We used the technique of resting-state functional magnetic resonance imaging to explore the developmental characteristics of intrinsic functional connectivity (functional brain connectivity when people are asked not to do anything) between subcortical and cortical regions in individuals with and without autism spectrum disorder aged 6–30 years. We focused on one important subcortical structure called striatum, which has roles in motor, cognitive, and affective processes. We found that cortico-striatal intrinsic functional connectivities showed opposite developmental trajectories in autism spectrum disorder and typically developing individuals, with connectivity increasing with age in autism spectrum disorder and decreasing or constant in typically developing individuals. We also found significant negative behavioral correlations between those atypical cortico-striatal intrinsic functional connectivities and autistic symptoms, such as social-communication deficits, and restricted/repetitive behaviors and interests. Taken together, this work highlights that the atypical development of cortico-subcortical functional connectivity might be largely involved in the neuropathological mechanisms of autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-09-01T06:25:32Z
      DOI: 10.1177/13623613211041904
       
  • Real-world executive functioning for autistic children in school and home
           settings

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      Authors: Jessica E Tschida, Benjamin E Yerys
      Abstract: Autism, Ahead of Print.
      Executive function challenges are commonly reported in the home setting for children with an autism spectrum disorder diagnosis (hereafter, autism), but little is known about these challenges in the school setting. A total of 337 youth (autism, N = 241 and typically developing, N = 96) were assessed using Behavior Rating Inventory of Executive Function ratings from home and school settings. Within each setting, we examined differences in specific executive function skills between diagnostic groups. Then, we examined if the autism group showed similar peak executive function impairments, associations with age, and relationships with adaptive behavior across settings. Finally, we examined inter-rater reliability. Autism and typically developing groups differed on all Behavior Rating Inventory of Executive Function scales in both settings. The Shift scale was the peak impairment in the autism group in both settings. There was also an effect of age on executive function impairment in both settings, and executive function ratings in both settings significantly predicted individual adaptive behavior domains. Inter-rater correlations for autistic participants were similar to inter-rater reliability correlations from the Behavior Rating Inventory of Executive Function standardization sample. This study shows that autistic children experience similar but not identical real-world executive function challenges across school and home settings and that supports may vary by setting.Lay abstractExecutive functioning skills are important for children to be able to control thoughts, emotions, and actions, and for their ability to adapt to different settings. Previous studies have found that autistic children have difficulty with executive functioning, but most of these studies took place in the home setting. Executive functioning skills in autistic children have not yet been fully examined in the school setting. This is a knowledge gap that needs to be addressed because the school setting is potentially one of the most demanding in terms of executive functioning and is a setting where executive function interventions are already being used for autistic children. In order to learn more about executive functioning for autistic children in the school setting, this study compared ratings of executive function from autistic children’s caregivers and school professionals. The study found that autistic children experience similar but not identical executive function challenges across school and home settings and that supports may differ in each setting. Having information about differences in executive functioning challenges and supports for autistic children across settings can help lead to development of supports that are tailored to each setting.
      Citation: Autism
      PubDate: 2021-09-01T06:24:13Z
      DOI: 10.1177/13623613211041189
       
  • Camouflaging in autism spectrum disorder: Examining the roles of sex,
           gender identity, and diagnostic timing

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      Authors: Goldie A McQuaid, Nancy Raitano Lee, Gregory L Wallace
      Abstract: Autism, Ahead of Print.
      Camouflaging in autism spectrum disorder could be a factor in later diagnosis of individuals without co-occurring intellectual disability, particularly among those designated female sex at birth. Little research to date has examined how gender identity impacts camouflaging, however. Further, no study has compared groups that differ in diagnostic timing to directly investigate if later-diagnosed individuals demonstrate elevated camouflaging relative to those receiving an earlier diagnosis. Using the Camouflaging Autistic Traits Questionnaire subscales (Assimilation, Compensation, and Masking), we investigated the roles of sex, gender identity (gender diverse vs cisgender), and diagnostic timing (childhood/adolescent-diagnosed vs adult-diagnosed), and the interactions of these factors, in autistic adults (N = 502; age 18–49 years). Main effects of sex, gender identity, and diagnostic timing were revealed. Autistic females reported more camouflaging across Camouflaging Autistic Traits Questionnaire subscales compared to males. Gender diverse adults reported elevated camouflaging on the Compensation subscale compared to cisgender adults. Adulthood-diagnosed individuals reported elevated Assimilation and Compensation compared to childhood/adolescence-diagnosed individuals. We discuss how aspects of camouflaging may have particular implications for later diagnostic timing and for the intersection of neurodiversity and gender diversity.Lay abstractCamouflaging in autism spectrum disorder refers to behaviors and/or strategies that mask the presentation of autism spectrum disorder features in social contexts in order to appear “non-autistic” (Attwood, 2007). Camouflaging modifies the behavioral presentation of core autism spectrum disorder features (e.g. social and communication differences), but the underlying autistic profile is unaffected, yielding a mismatch between external observable features and the internal lived experience of autism. Camouflaging could be an important factor in later diagnosis of individuals without co-occurring intellectual disability, especially among those designated female sex at birth. Little research to date has examined how gender identity impacts camouflaging, however. Furthermore, no study has compared groups that differ in diagnostic timing to directly investigate if later-diagnosed individuals show elevated camouflaging relative to those receiving an earlier diagnosis. We used the Camouflaging Autistic Traits Questionnaire subscales (Assimilation, Compensation, and Masking) and investigated the roles of sex, gender identity (gender diverse vs cisgender), and diagnostic timing (childhood/adolescent-diagnosed vs adult-diagnosed), and the interactions of these factors, in autistic adults (N = 502; ages 18–49 years). Main effects of sex, gender identity, and diagnostic timing were revealed. Autistic females reported more camouflaging across all three Camouflaging Autistic Traits Questionnaire subscales compared to males. Gender diverse adults reported elevated camouflaging on the Compensation subscale compared to cisgender adults. Adulthood-diagnosed individuals reported elevated Assimilation and Compensation compared to childhood/adolescence-diagnosed individuals. We discuss how the aspects of camouflaging may have unique implications for later diagnostic timing and for the intersection of neurodiversity and gender diversity.
      Citation: Autism
      PubDate: 2021-08-23T08:43:23Z
      DOI: 10.1177/13623613211042131
       
  • COVID-19 risk: Adult Medicaid beneficiaries with autism, intellectual
           disability, and mental health conditions

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      Authors: Whitney Schott, Sha Tao, Lindsay Shea
      Abstract: Autism, Ahead of Print.
      Adults on the autism spectrum and those with intellectual disability or mental health conditions may be at increased risk of contracting COVID-19 or experiencing more severe illness if infected. We identified risk factors for COVID-19 among adults enrolled in Medicaid with an autism spectrum disorder diagnosis, intellectual disability, or mental health conditions. We examined adults ages 20–64 years with 9-month continuous enrollment over 2008–2012 using Medicaid Analytic eXtract data. There were 83,150 autistic adults and 615,607 adults with intellectual disability meeting inclusion criteria; of a random sample of 1 million beneficiaries without autism spectrum disorder or intellectual disability, 35.3% had any mental health condition. Beneficiaries on the spectrum, those with intellectual disability, and those with mental health conditions all had higher odds of risk factors for becoming infected with COVID-19 (living in a residential facility, receiving services in the home from outside caregivers, having had a long hospitalization, and having had avoidable hospitalizations) and higher odds of comorbidities associated with severe illness from COVID-19. Clinicians should anticipate high prevalence of comorbidities and risk factors for severe illness from COVID-19 among these populations. Health officials and non-governmental organizations should target these groups with outreach for the COVID-19 vaccine and support continued efforts for appropriate mitigation measures.Lay abstractAutistic adults, adults with intellectual disability, and adults with other mental health conditions may have higher risk of contracting COVID-19 or experiencing more severe illness from COVID-19 if infected. We used data from Medicaid to look at whether autistic adults and other adults with intellectual disability and other mental health conditions were more likely to have risk factors for COVID-19, such as living in a residential facility, receiving services regularly in the home from outside caregivers, having had a long hospitalization, having had avoidable hospitalizations, and having high-risk health conditions. We found that autistic adults had higher odds of living in a residential facility, receiving in-home services from outside caregivers, having had an avoidable hospitalization, and having a high-risk health condition, compared to neurotypical adults without mental health conditions. Adults with intellectual disability had similar odds of having these conditions. Adults with other mental health conditions were also more likely to live in a residential facility, receive services from outside caregivers, and have had avoidable hospitalizations compared to the neurotypical population without mental health conditions. They had three times higher odds of having a high-risk health condition. High risk of COVID-19 among autistic adults and adults with intellectual disability and mental health conditions should be recognized by clinicians, and these groups should be prioritized for vaccine outreach.
      Citation: Autism
      PubDate: 2021-08-21T11:12:16Z
      DOI: 10.1177/13623613211039662
       
  • Systematic review of prenatal exposure to endocrine disrupting chemicals
           and autism spectrum disorder in offspring

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      Authors: Salvador Marí-Bauset, Isabel Peraita-Costa, Carolina Donat-Vargas, Agustín Llopis-González, Amelia Marí-Sanchis, Juan Llopis-Morales, María Morales Suárez-Varela
      Abstract: Autism, Ahead of Print.
      Epidemiological studies, which can have inherent methodological limitations, are used to study the relation between endocrine disrupting chemicals and autism spectrum disorder. The objective is to systematically review the treatment of methodological limitations and assess the quality and strength of the findings in the available literature. The quality and strength of the evidence were evaluated using the Navigation Guide Systematic Review Methodology. The overall quality and strength of the available studies were “moderate” and “limited,” respectively. Risk of bias due to the methodological limitations regarding the exclusion of potential confounding factors and the lack of accuracy of exposure assessment methods were the most prevalent and were also considered to arrive at these results. The omnipresence of endocrine disrupting chemicals, their persistence and bioaccumulation, and the biological plausibility of the association between prenatal exposure to these and later development of autism spectrum disorder highlight the need to carry out well-designed epidemiological studies that overcome the methodological limitations observed in the currently available literature in order to be able to inform public policy to prevent exposure to these potentially harmful chemicals.Lay abstractAutism spectrum disorders comprise a complex group with many subtypes of behaviorally defined neurodevelopmental abnormalities in two core areas: deficits in social communication and fixated, restricted, repetitive, or stereotyped behaviors and interests each with potential unique risk factors and characteristics. The underlying mechanisms and the possible causes of autism spectrum disorder remain elusive and while increased prevalence is undoubtable, it is unclear if it is a reflection of diagnostic improvement or emerging risk factors such as endocrine disrupting chemicals. Epidemiological studies, which are used to study the relation between endocrine disrupting chemicals and autism spectrum disorder, can have inherent methodological challenges that limit the quality and strength of their findings. The objective of this work is to systematically review the treatment of these challenges and assess the quality and strength of the findings in the currently available literature. The overall quality and strength were “moderate” and “limited,” respectively. Risk of bias due to the exclusion of potential confounding factors and the lack of accuracy of exposure assessment methods were the most prevalent. The omnipresence of endocrine disrupting chemicals and the biological plausibility of the association between prenatal exposure and later development of autism spectrum disorder highlight the need to carry out well-designed epidemiological studies that overcome the methodological challenges observed in the currently available literature in order to be able to inform public policy to prevent exposure to these potentially harmful chemicals and aid in the establishment of predictor variables to facilitate early diagnosis of autism spectrum disorder and improve long-term outcomes.
      Citation: Autism
      PubDate: 2021-08-20T05:14:47Z
      DOI: 10.1177/13623613211039950
       
  • Association of turn-taking functions with joint attention in toddlers with
           autism

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      Authors: Kwangwon Lee, Hannah H Schertz
      Abstract: Autism, Ahead of Print.
      Nonverbal turn taking, defined as back-and-forth exchanges, may be used to convey instrumental or social intent. It has been theorized that social turn taking is foundational to joint attention and, as such, it has been incorporated as a component of early interventions for children with autism, who often have challenges in joint attention competency. The purpose of this study was to analyze the relationships between two turn-taking functions and joint attention as observed during interactions between 20 toddlers with autism who received intervention and their caregivers. It was hypothesized that socially driven turn taking would be positively related to joint attention, but instrumentally motivated turn taking would not. Video analysis revealed a positive relationship between social turn taking and joint attention, but not between instrumental turn taking and joint attention. While not causal, the findings support the promotion of social content in intervention and the concept that social turn taking may be a precursory competency to joint attention.Lay abstractBack-and-forth interaction, or turn taking, may support later joint attention, a more complex form of interaction, when promoted in interventions for young children with autism, especially depending on the child’s intent when interacting. In the present study, we observed videos of 20 toddlers with autism engaging in turn taking with their caregivers during an intervention designed to support children’s joint attention. We sought to identify when the children displayed turn taking socially and when they were using it for nonsocial purposes in the intervention videos. We also observed videos after the intervention was complete to identify when children used joint attention when interacting with their caregivers. After these observations, we used these video data to explore the relationship of social turn taking to joint attention, and the relationship of nonsocial turn taking to joint attention. We found a significant relationship between social turn taking and joint attention, but not between nonsocial turn taking and joint attention. These findings support the importance of considering social turn taking in interactions between young children with autism and their caregivers.
      Citation: Autism
      PubDate: 2021-08-19T06:43:25Z
      DOI: 10.1177/13623613211039945
       
  • Differentiation of autism spectrum disorder and mood or anxiety disorder

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      Authors: Sarah Wittkopf, Sanna Stroth, Anika Langmann, Nicole Wolff, Veit Roessner, Stefan Roepke, Luise Poustka, Inge Kamp-Becker
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder shares many symptoms with other mental health disorders, and comorbid disorders such as mood and anxiety disorders are common, making the diagnostic process challenging. We aimed to explore the diagnostic accuracy of two standard autism spectrum disorder diagnostic instruments and to identify those behavioral items that best differentiate between autism spectrum disorder and mood and anxiety disorder in a naturalistic sample of patients utilizing autism spectrum disorder specialist services. The study included data of 847 participants (5–65 years of age, n = 586 with autism spectrum disorder, n = 261 with mood and anxiety disorder) all evaluated with the Autism Diagnostic Observation Schedule in the context of the diagnostic process. Data of the Autism Diagnostic Interview–Revised were available for 428 participants (5–51 years of age, n = 367 with autism spectrum disorder, n = 61 with mood and anxiety disorder). By means of binominal logistic regressions and an ensemble feature selection, we identified a subset of items that best differentiated between autism spectrum disorder and mood and anxiety disorder. Overall, the results indicate that a combination of communicational deficits and unusual and/or inappropriate social overtures differentiates autism spectrum disorder and mood and anxiety disorder. Aspects of social cognition are also relevant. Limitations of the current study and implications for research and practice are discussed.Lay abstractSymptoms of mood and anxiety disorders overlap with symptoms of autism spectrum disorder, making the diagnostic process challenging. This study found that a combination of communicational deficits and unusual and/or inappropriate social overtures facilitates differentiation between autism spectrum disorder and mood and anxiety disorders. Furthermore, the results confirm the essential need of a behavioral observation with the Autism Diagnostic Observation Schedule in combination with a full Autism Diagnostic Interview–Revised to support diagnostic decisions.
      Citation: Autism
      PubDate: 2021-08-18T08:53:07Z
      DOI: 10.1177/13623613211039673
       
  • Autism spectrum disorder screening in Chinese-language preschools

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      Authors: Kathy Kar-man Shum, Rose Mui-fong Wong, Angel Hoe-chi Au, Terry Kit-fong Au
      Abstract: Autism, Ahead of Print.
      This study examined the reliability and validity of the 13-item Classroom Observation Scale as used by teachers and non-clinically trained observers to identify children who more likely than their peers to have autism spectrum disorder in less-resourced preschools. A total of 534 children (ages 2;10 to 4;5, Mean = 3;8) from nine Chinese-language preschools serving families from lower-middle to middle socioeconomic backgrounds in Hong Kong were observed in their first preschool year using the Classroom Observation Scale. The 75 screen-positive children and 55 randomly selected typically developing peers were clinically assessed for autism spectrum disorder 1 year later. The Classroom Observation Scale as used by teachers and non-clinically trained researchers helped to identify preschoolers who were later diagnosed with autism spectrum disorder with odds ratios of 3.11 and 8.66, respectively. This study provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and observers with little or no clinical training in the early identification of children with autism spectrum disorder in community settings.Lay abstractThe 13-item Classroom Observation Scale is an autism spectrum disorder screening tool for teachers and non-clinically trained observers to make real-time observation of children’s peer interaction (or the lack thereof) in regular preschool classrooms. The Classroom Observation Scale was originally developed in English and validated with ethnically diverse preschoolers at English-speaking international schools serving families from middle to middle-upper socioeconomic backgrounds in Hong Kong. These private schools can usually afford a higher teacher–student ratio, which is not typical for most preschools. This study, therefore, investigated whether the Classroom Observation Scale is ecologically valid when used by Chinese teachers with teacher–student ratios typically found in less-resourced preschools. We found that the Classroom Observation Scale reliably helped observers with little or no clinical training—research assistants with just a few hours of Classroom Observation Scale training and preschool teachers with an hour of briefing—to identify children in their first year of Chinese-language preschool who were more likely than their peers to have autism spectrum disorder. Reliability estimates of Classroom Observation Scale-Teacher and Classroom Observation Scale-Researcher in this study were comparable to those for the original English Classroom Observation Scale. Our results provided further evidence on the versatility and ecological validity of the Classroom Observation Scale for use by preschool teachers and non-clinically trained observers in the early identification of children with autism spectrum disorder in community settings.
      Citation: Autism
      PubDate: 2021-08-17T05:54:06Z
      DOI: 10.1177/13623613211039373
       
  • The impact of socio-cultural values on autistic women: An interpretative
           phenomenological analysis

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      Authors: Stella Mo, Nina Viljoen, Shivani Sharma
      Abstract: Autism, Ahead of Print.
      It is well recognised that culture plays an important role in how people experience the world. However, there is limited knowledge on the impact of socio-cultural norms and values on the lives of autistic women. This qualitative study used individual semi-structured interviews to explore how eight cis-gendered autistic women, without co-occurring intellectual disabilities, describe dominant socio-cultural beliefs, values and norms and their influence on their own sense of self. Findings elucidated three interdependent themes related to the ‘pervasive influence of cultural values’, ‘individualisation as an autistic woman’ and ‘social connectivity’. Autistic women described how they experienced their environments and made choices about their place within the dominant culture and the impact of these decisions on their identities and experience. The findings of this study have implications for the continued need to shift societal and clinical attitudes towards understanding and appreciating diversity among autistic women.Lay abstractAutistic women with average or above intellectual abilities are often overlooked clinically or identified at older ages compared to autistic males. Their experiences can provide insight into the socio-cultural factors that impact on how they develop and are seen by others. This study asked autistic women to describe the culture around them and explore how this has influenced their lived experiences. Individual semi-structured interviews were conducted with eight autistic women without a co-occurring diagnosis of intellectual disabilities. These were used for interpretative phenomenological analysis. Overall, we found three closely connected themes on the pervasive influence of cultural values on autistic women, how autistic women define themselves and the importance of connecting with society. These findings suggest that dominant cultural beliefs, values and norms effect how autistic women are recognised by others and develop their sense of self. Broadening how people think about autistic women in society and clinically may benefit how we identify and support autistic women.
      Citation: Autism
      PubDate: 2021-08-14T06:05:29Z
      DOI: 10.1177/13623613211037896
       
  • The lived experience of gender dysphoria in autistic adults: An
           interpretative phenomenological analysis

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      Authors: Kate Cooper, William Mandy, Catherine Butler, Ailsa Russell
      Abstract: Autism, Ahead of Print.
      Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about this incongruence or gender dysphoria. Few studies have aimed to understand the inner experiences of this group. In this study, we used Interpretive Phenomenological Analysis to understand the lived experience of gender dysphoria. Twenty-one autistic adults were interviewed about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. The interviews were transcribed and analysed using Interpretive Phenomenological Analysis. Participants described significant distress because their bodies did not match their gender identities, their need to understand their identities more broadly and to manage complex intersecting needs. Participants experienced distress due to living in a world which is not always accepting of gender- and neuro-diversity. Participants described barriers in accessing healthcare for their gender needs. Some participants felt being autistic had facilitated their understanding of their gender identity. Other participants described challenges such as a tension between their need to undergo a physical gender transition versus a need for sameness and routine. In conclusion, there can be both positive experiences and additional challenges for autistic transgender people.Lay Autistic people are more likely to be transgender, which means having a gender identity different to one’s sex assigned at birth. Some transgender people experience distress about their gender and sex assigned at birth not matching which is called gender dysphoria. Research has focused on finding out why autistic people are more likely to have gender dysphoria, and less on what the experience of gender dysphoria is like for autistic people. We interviewed 21 autistic adults about their experience of incongruence between their gender identity and sex assigned at birth, and any associated distress. We carefully read the transcripts of the interviews, focusing on how participants understood their experiences. We found a range of themes from the interviews. Participants were distressed because their bodies did not match their gender identities. Participants told us they had to work hard to understand themselves and who they were, and to manage having multiple different needs such as mental health needs. It was upsetting for participants to experience discrimination because of being autistic and/or transgender. Some participants said it was more difficult to get transgender healthcare as an autistic person. Some participants thought being autistic had helped them understand their gender identity more than non-autistic people. Other participants found it was challenging to be both autistic and transgender. For example, most participants wanted to change their bodies to match their gender identity, but some participants were nervous about making changes to themselves and their routine due to being autistic. We conclude that autism can in some ways be helpful and other ways contribute to challenges for transgender autistic people.
      Citation: Autism
      PubDate: 2021-08-11T07:23:40Z
      DOI: 10.1177/13623613211039113
       
  • Content validation of common measures of functioning for young children
           against the International Classification of Functioning, Disability and
           Health and Code and Core Sets relevant to neurodevelopmental conditions

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      Authors: Emily D’Arcy, Kerry Wallace, Angela Chamberlain, Kiah Evans, Benjamin Milbourn, Sven Bölte, Andrew JO Whitehouse, Sonya Girdler
      Abstract: Autism, Ahead of Print.
      Content validity describes the extent to which a measure represents, and is relevant to, the construct it aims to assess. The International Classification of Functioning, Disability and Health and derived Core/Code Sets (Sets) for autism, attention deficit-hyperactivity disorder, cerebral palsy and early developmental delay and disability are adequate to establish the content validity of measures aiming to assess functioning in young children with neurodevelopmental conditions (NDCs). This article aimed to assess the content validity of comprehensive assessments of functioning for young children with NDCs against these standards. Twenty-two common measures of functioning were evaluated for content validity against the International Classification of Functioning, Disability and Health at a domain level, with 10 measures analysed at the item-level and compared to the Sets relevant to young children with NDCs. Measures covered between 21% and 57% of the combined Set codes and 19% to 63% of codes from specific Sets. Much of this variation was between measures, with some variation due to differences between individual Sets. The percentages reflect that measures heavily focus on activities and participation areas, with environmental factors rarely assessed. These findings are useful for clinicians, policymakers, and researchers in identifying the most appropriate measures for assessing functioning in young children with neurodevelopmental conditions.Lay abstractYoung children who have developmental delay, autism, or other neurodevelopmental conditions can have difficulties doing things in different areas of their life. What they can and cannot do is called their level of functioning. There are lots of assessment measures that aim to assess functioning. But, we are not sure if these measures assess all the things we need to know about these children’s functioning. Other research has identified lists of items (codes) that need to be assessed to understand functioning for young children with different neurodevelopmental conditions fully. These lists include body functions (the things a child’s body or brain can do), activities and participation (the activities and tasks a child does) and environmental factors (parts of the environment that can influence functioning). In this study, we looked at the items from these lists assessed by different functioning measures to see how they compared to what should be assessed. The measures that we looked at covered 21%–57% of all the codes and 19%–63% of the codes for lists specific to different conditions. Most of the measures focused on activity and participation codes, and they rarely assessed environmental factors. Knowing which codes and how much of the lists the measures assess can help researchers, clinicians and policymakers to choose measures that are more appropriate for young children with neurodevelopmental conditions.
      Citation: Autism
      PubDate: 2021-08-09T06:15:17Z
      DOI: 10.1177/13623613211036809
       
  • COVID-19, social isolation and the mental health of autistic people and
           their families: A qualitative study

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      Authors: Elizabeth Pellicano, Simon Brett, Jacquiline den Houting, Melanie Heyworth, Iliana Magiati, Robyn Steward, Anna Urbanowicz, Marc Stears
      Abstract: Autism, Ahead of Print.
      The COVID-19 pandemic and its policy responses have had a detrimental effect on millions of people’s mental health. Here, we investigate its impact on autistic people and their families using qualitative methods. Specifically, we addressed: how did autistic people experience an increase in social isolation during the initial lockdown' And how was their mental health impacted by lockdown' Autistic and non-autistic researchers conducted 144 semi-structured interviews with autistic adults (n = 44), parents of autistic children (n = 84) including autistic parents and autistic young people (n = 16). We deployed thematic analysis to identify key themes. The enhanced social isolation accompanying the pandemic had a serious and damaging impact on autistic people’s mental health and subjective wellbeing. They spoke of intensely missing friends and more incidental forms of social connection. They also reported intense dissatisfaction with the substitution of embodied, person-to-person connection in health services by online/telephone-based alternatives, sometimes accompanied by serious negative consequences. These findings reveal the fundamental importance of supporting autistic people to maintain direct and incidental social contact during the pandemic and beyond. They speak against established theories that downplay autistic people’s need for human connection and the extent to which they have been affected by social isolation during lockdowns.Lay abstractIn this study, we show that autistic people and their families have found it very difficult to deal with the lockdowns during the COVID-19 pandemic. Autistic and non-autistic researchers spoke to 144 people, including 44 autistic adults, 84 parents of autistic children and 16 autistic young people (12–18 years old). We asked them about their everyday lives and mental health during lockdown. People told us that they enjoyed having fewer obligations and demands compared to pre-COVID-19 life. They felt that life was quieter and calmer. But people also told us again and again how much they missed meeting people in real life, especially their friends, and their therapists and support workers. People told us that their mental health suffered because they did not have contact with their friends and services. Importantly, many people (including researchers) think that autistic people do not want friends or to be around people. But our results show that is not true. Many autistic people do want friends and to be around other people. Some people’s mental health has been damaged by not being able to see people during COVID-19. Autistic people need support in many areas of life so they can keep socialising and seeing their friends even through difficult times, like pandemics.
      Citation: Autism
      PubDate: 2021-08-07T05:12:34Z
      DOI: 10.1177/13623613211035936
       
  • Acceptability and feasibility of the World Health Organization’s
           Caregiver Skills Training implemented in the Italian National Health
           System

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      Authors: Erica Salomone, Camilla Ferrante, Arianna Salandin, Federica Ferrara, Elisabetta Torchio, Giulia Foletti, Sabrina Ghersi, Laura Pacione, Chiara Servili
      Abstract: Autism, Ahead of Print.
      The Caregiver Skills Training programme is an evidence-informed group intervention developed by the World Health Organization to counter the treatment gap for neurodevelopmental disorders in children. We examined feasibility and acceptability of Caregiver Skills Training in public child neuropsychiatry services in Italy. Following a formative adaptation process and a pre-pilot implementation, the programme was piloted in six centres. Caregivers of children (2–5 years) with autism spectrum disorder were randomised to either Caregiver Skills Training (n = 43) or treatment as usual (n = 43). Professionals’ and caregivers’ experiences in the treatment arm were examined with focus groups and questionnaires. The programme was largely considered acceptable, relevant and feasible. Specific implementation challenges and suggestions for optimising the package are discussed.Lay abstractAcross the globe, children with neurodevelopmental disorders, including autism, have limited access to care through public services. To improve access to care the World Health Organization developed a novel, open-access programme: the Caregiver Skills Training programme. The Caregiver Skills Training consists of nine group sessions and three individual home visits, focused on training the caregiver on how to use everyday play and home routines as opportunities for learning and development. We implemented Caregiver Skills Training in public child neuropsychiatry services in Italy and examined with questionnaires and focus groups how feasible it was to deliver the programme in public health settings and how acceptable and relevant it was for caregiver users. We found that the Caregiver Skills Training was largely considered acceptable and relevant for families and feasible to deliver. We discuss potential solutions to address the specific implementation challenges that were identified, such as strategies to improve training of interventionists and overcome barriers to caregiver participation.
      Citation: Autism
      PubDate: 2021-08-07T05:10:40Z
      DOI: 10.1177/13623613211035228
       
  • Potential role for immune-related genes in autism spectrum disorders:
           Evidence from genome-wide association meta-analysis of autistic traits

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      Authors: Martina Arenella, Gemma Cadby, Ward De Witte, Rachel M Jones, Andrew JO Whitehouse, Eric K Moses, Alex Fornito, Mark A Bellgrove, Ziarih Hawi, Beth Johnson, Jeggan Tiego, Jan K Buitelaar, Lambertus A Kiemeney, Geert Poelmans, Janita Bralten
      Abstract: Autism, Ahead of Print.
      The clinical heterogeneity of autism spectrum disorders majorly challenges their genetic study. Autism spectrum disorders symptoms occur in milder forms in the general population, as autistic-like traits, and share genetic factors with autism spectrum disorders. Here, we investigate the genetics of individual autistic-like traits to improve our understanding of autism spectrum disorders. We meta-analysed four population-based genome-wide association studies investigating four autistic-like traits – ‘attention-to-detail’, ‘imagination’, ‘rigidity’ and ‘social-skills’ (n = 4600). Using autism spectrum disorder summary statistics from the Psychiatric Genomic Consortium (N = 46,350), we applied polygenic risk score analyses to understand the genetic relationship between autism spectrum disorders and autistic-like traits. Using MAGMA, we performed gene-based and gene co-expression network analyses to delineate involved genes and pathways. We identified two novel genome-wide significant loci – rs6125844 and rs3731197 – associated with ‘attention-to-detail’. We demonstrated shared genetic aetiology between autism spectrum disorders and ‘rigidity’. Analysing top variants and genes, we demonstrated a role of the immune-related genes RNF114, CDKN2A, KAZN, SPATA2 and ZNF816A in autistic-like traits. Brain-based genetic expression analyses further linked autistic-like traits to genes involved in immune functioning, and neuronal and synaptic signalling. Overall, our findings highlight the potential of the autistic-like trait–based approach to address the challenges of genetic research in autism spectrum disorders. We provide novel insights showing a potential role of the immune system in specific autism spectrum disorder dimensions.Lay abstractAutism spectrum disorders are complex, with a strong genetic basis. Genetic research in autism spectrum disorders is limited by the fact that these disorders are largely heterogeneous so that patients are variable in their clinical presentations. To address this limitation, we investigated the genetics of individual dimensions of the autism spectrum disorder phenotypes, or autistic-like traits. These autistic-like traits are continuous variations in autistic behaviours that occur in the general population. Therefore, we meta-analysed data from four different population cohorts in which autistic-like traits were measured. We performed a set of genetic analyses to identify common variants for autistic-like traits, understand how these variants related to autism spectrum disorders, and how they contribute to neurobiological processes. Our results showed genetic associations with specific autistic-like traits and a link to the immune system. We offer an example of the potential to use a dimensional approach when dealing with heterogeneous, complex disorder like autism spectrum disorder. Decomposing the complex autism spectrum disorder phenotype in its core features can inform on the specific biology of these features which is likely to account to clinical variability in patients.
      Citation: Autism
      PubDate: 2021-08-04T08:58:29Z
      DOI: 10.1177/13623613211019547
       
  • Special education for students with autism during the COVID-19 pandemic:
           “Each day brings new challenges”

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      Authors: Sarah Hurwitz, Blaine Garman-McClaine, Kane Carlock
      Abstract: Autism, Ahead of Print.
      The novel coronavirus (COVID-19) disrupted how educators provided supports and services for students with autism spectrum disorder. School closures and related pivoting between learning modalities were difficult for all students, but especially for students with autism, who rely on routine and often require individualized instruction. There has been limited opportunity for teachers to share their experiences of rapidly changing educational circumstances. The purpose of this mixed-methods study was to investigate how special educators and school-based specialists adapted practices for such students in response to pandemic conditions. One hundred and six educators from 40 school districts completed a written survey inquiring about the modifications they made to Individualized Education Programs (IEPs) and their efforts to implement evidence-based practices. Participants reported adding individualized contingency learning plans to Individualized Education Programs, adjusting service minutes, and sometimes eliminating social goals. A thematic analysis (Braun and Clarke, 2006) of educators’ written reflections identified four themes, highlighting a renewed importance on collaboration with parents, who helped deliver intervention and monitor progress in the home setting. While students with more intense needs struggled, others actually preferred virtual instruction. This raises concerns for what will happen in the future, when social expectations resume. Despite the overwhelming challenges posed by COVID-19, participants demonstrated remarkable resiliency and innovation.Lay abstractThe novel coronavirus (COVID-19) disrupted how special educators provided supports and services for students with autism spectrum disorder. School closures and the related pivoting between learning modalities (i.e. virtual, hybrid, and face-to-face) were difficult for all students, but especially for students with autism, who rely on routine and require individualized instruction. In this study, we surveyed 106 special education teachers, behavior specialists, and speech pathologists who work with autistic students to learn about how they adapted instruction to comply with the complex social distancing rules and changing expectations of the pandemic. Participants reported “making the best out of a bad situation” and “constantly using ‘trial & error’ to find the best way for our students to eLearn.” They emphasized the importance of collaboration with parents, who helped deliver intervention and monitor progress across settings. They made alterations to Individualized Education Programs, by adding individualized contingency learning plans, adjusting service minutes, and sometimes eliminating social goals. Participants were surprised that while students with more intense needs struggled, others actually preferred virtual instruction. This raises concerns for what will happen in the future, when social expectations resume. Despite the overwhelming challenges posed by COVID-19, participants demonstrated remarkable resiliency and an innovative ability to adapt instruction.
      Citation: Autism
      PubDate: 2021-08-04T06:30:08Z
      DOI: 10.1177/13623613211035935
       
  • Sociocultural context and autistics’ quality of life: A comparison
           between Québec and France

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      Authors: Vicky Caron, Nuria Jeanneret, Mathieu Giroux, Lucila Guerrero, Mélanie Ouimet, Baudouin Forgeot d’Arc, Isabelle Soulières, Isabelle Courcy
      Abstract: Autism, Ahead of Print.
      Quality of life is important for the development and evaluation of interventions for autistic people. It is a multidimensional concept, anchored in a sociocultural context and based on a person’s subjective assessment of their life. The aim of this study is to examine whether the determinants of perceived quality of life vary by country (or culture) by comparing two groups of French-speaking autistic adults (n = 430), one in France and the other in Québec (Canada). A cross-sectional survey was conducted to provide information on the quality of life (Autism Quality of Life Measure—ASQoL), diagnosis and health conditions, self-evaluation of autistic traits (Autism-Spectrum Quotient—AQ10), and sociodemographic characteristics of these two samples. The results of our comparison of French-speaking autistic adults in France and Québec suggest that sociocultural context has an impact on autistic people’s quality of life (r2 = 0.280). The Québec group reported a superior quality of life. The social experience of autism-related stigmatization emerges as a strong predictor of lower quality of life in both groups. However, the two groups differ with other predictors. This study demonstrates the importance of considering sociocultural context in measuring quality of life in autistic adults. It emphasizes the need for awareness programs and public campaigns aimed at identifying and countering stigmatization processes.Lay abstractWhat is already known about the topic' Quality of life refers to how people perceive aspects of their life such as physical health, material security, and interpersonal relationships. Studies have reported lower quality of life among autistic individuals than in the general population.What does this article contribute' This article contributes to a better understanding of quality of life and its measures from the point of view of autistic adults. By comparing two groups of French-speaking autistic adults from two different places (France and Québec—Canada), this research shows that the perception of quality of life and its determining factors differ for autistic adults living in each country. The Québec group reported a superior quality of life, and some quality of life predictors were different in each group. The social experience of autism-related stigmatization, however, was a powerful predictor of quality of life for all.Implications for practice, research, and policy To promote a higher quality of life for autistic people, it is important to consider the sociocultural context and implement awareness programs and public campaigns aimed at identifying and countering stigmatization processes.
      Citation: Autism
      PubDate: 2021-07-30T07:19:00Z
      DOI: 10.1177/13623613211035229
       
  • Is autism stigma higher in South Korea than the United States'
           Examining cultural tightness, intergroup bias, and concerns about heredity
           as contributors to heightened autism stigma

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      Authors: So Yoon Kim, Jeong Eun Cheon, Kristen Gillespie-Lynch, Young-Hoon Kim
      Abstract: Autism, Ahead of Print.
      South Korea, a relatively collectivistic and homogeneous country with heightened cultural tightness, is believed to have particularly high levels of stigma toward autistic individuals, who sometimes engage in behaviors that diverge from social norms. This study investigated cross-cultural differences in autism stigma (assessed with a Social Distance Scale) in the United States and South Korea. Two-hundred and seventy-six American and 494 Korean participants who completed an online survey were included in the analysis. We conducted a multiple regression predicting autism stigma with variables that were correlated with stigma. Koreans reported greater autism stigma than Americans. Greater vertical individualism, lesser horizontal collectivism, less accurate autism knowledge, less pleasant and frequent previous contact with autism, concerns about the marriageability of family members, and higher cultural tightness predicted greater stigma. Cultural tightness, or an emphasis on social norms, which was heightened among Korean participants, contributed to greater autism stigma in South Korea. Findings highlight the need to increase autism knowledge and foster pleasant and frequent contact with autistic individuals, especially for those who accept inequality as a part of human interactions in both South Korea and the United States. Moreover, interventions that help Koreans understand the relativeness of social appropriateness may reduce autism stigma in South Korea.Lay abstractMisunderstandings about autism may be more common in South Korea than the United States. Koreans often have clear ideas about how people should act. Another way of saying this is that Korea has a tight culture. Americans are looser, meaning people are freer to act as they like. Autistic people often do not act as people expect them to. This makes autistic people stand out. Autistic people may stand out more in tight cultures like South Korea. We studied how people in South Korea and the United States feel about autism. We wanted to see why Korean people might reject autistic people more than people in the United States do. American and Korean people did online surveys. Koreans said they did not want to get close to autistic people more than Americans did. People who understood autism and had met and liked autistic people wanted to get closer to autistic people. We were surprised to learn that Americans said having an autistic brother or sister makes it harder to find a romantic partner more than Korean people did. People who believed that autism makes it harder for family members to find love did not want to get very close to autistic people. Koreans said people should act as expected more than Americans did. People who believed that acting as expected was important did not want to get very close to autistic people. Teaching people that there are many ways of being a good person may help them understand and appreciate autistic people.
      Citation: Autism
      PubDate: 2021-07-30T07:17:28Z
      DOI: 10.1177/13623613211029520
       
  • Keeping up with the evidence base: Survey of behavior professionals about
           Naturalistic Developmental Behavioral Interventions

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      Authors: Lauren H Hampton, Micheal P Sandbank
      Abstract: Autism, Ahead of Print.
      Professionals who primarily deliver services to children on the autism spectrum employ a range of techniques and supports that are colloquially known as applied behavior analysis therapy. The landscape of evidence supporting interventions for children on the autism spectrum has vastly transformed in the last decade. A substantial, relatively high-quality literature base supports the effectiveness of Naturalistic Developmental Behavior Interventions for supporting development in children on the autism spectrum, yet few professionals serving this population receive training in this category of interventions. Board Certified Behavior Analysts and related professionals are the primary service providers for this population. The purpose of this survey study is to describe and understand the knowledge and beliefs that Behavior Analyst Certification Board certificants have around Naturalistic Developmental Behavior Interventions, and the implications for training the professionals most likely to serve young children on the autism spectrum. A total of 901 respondents completed the survey. Respondents indicated, on average, little to no knowledge of Naturalistic Developmental Behavior Intervention practices and that few believe these practices to be effective or appropriate for the field. We discuss the implications and needs for future training and research in this area.Lay abstractPrimary service providers for young children on the autism spectrum and developmentally delayed children use many strategies under the umbrella of applied behavior analysis therapy. The evidence supporting interventions for children on the autism spectrum has changed last decade, and powerful research supports the relative effectiveness of Naturalistic Developmental Behavior Interventions, yet a few professionals serving young children on the autism spectrum receive training in this category of interventions. Board Certified Behavior Analysts and related professionals are the primary service providers for this population. The purpose of this survey study is to describe and understand the knowledge and beliefs that Behavior Analyst Certification Board certificants have around Naturalistic Developmental Behavior Interventions. The survey was completed by 901 respondents. Respondents indicated, on average, little to no knowledge of Naturalistic Developmental Behavior Intervention practices and few believe that these practices are effective or appropriate for the field. Recommendations include increasing training opportunities for related professionals, and changing certification requirements to match the current evidence.
      Citation: Autism
      PubDate: 2021-07-29T05:31:06Z
      DOI: 10.1177/13623613211035233
       
  • A balancing act: An interpretive description of healthcare providers’
           and families’ perspective on the surgical experiences of children with
           autism spectrum disorder

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      Authors: Stephanie L Snow, Isabel M Smith, Margot Latimer, Emma Stirling Cameron, Jennifer Fox, Jill Chorney
      Abstract: Autism, Ahead of Print.
      Children with an autism spectrum disorder (autism) are vulnerable to negative experiences within the surgical setting. This qualitative study used Interpretive Description. Individual interviews were conducted with 8 parents of children with autism who had recently undergone surgery, and 15 healthcare providers (HCPs) with experience caring for children with autism. Participants were asked open-ended questions on the approaches used to support children with autism around the time of surgery and their effectiveness, how the surgical experience could be improved, and the barriers and facilitators to potential improvements. Results yielded three main themes within an overarching metaphor of a balancing act. The first theme, finding your footing through an uncertain journey, described individual factors (e.g. anticipatory anxiety) that set the foundation for surgery-related experiences. The second theme, relationships can help to keep everyone steady, highlighted how interpersonal dynamics (e.g. collaboration and empathy) influence the experience. Finally, the systems shape the experience theme captured the impact of systemic factors (e.g. the hospital environment) on the balancing act. These findings enriched our understanding of how individual, interpersonal, and systemic factors influence the surgical experiences of children with autism, families, and HCPs. Insights gained from this study can be used to inform future interventions.Lay abstractChildren with an autism spectrum disorder (autism) often have negative experiences within the surgical setting. We conducted individual interviews with 8 parents of children with autism who had recently undergone surgery, and 15 healthcare providers (HCPs) with experience caring for children with autism. We asked open-ended questions on the approaches used to support children with autism around the time of surgery, how effective they were, suggestions for improvement, and the barriers and facilitators to improvement. Three main themes emerged within an overarching metaphor of a balancing act. The first theme, finding your footing through an uncertain journey, described individual factors (e.g. anticipatory anxiety) that set the foundation for experiences. The second theme, relationships can help to keep everyone steady, highlighted how personal interactions (e.g. collaboration and empathy) influence the experience. Finally, the systems shape the experience theme captured how systemic factors (e.g. the hospital environment) affected the balancing act. These findings enriched our understanding of the surgical experiences of children with autism, families, and HCPs by demonstrating the importance of individual characteristics, relationships, and systemic factors. Future interventions should consider this complexity and intervene not just with children, but also their parents, healthcare providers, and in policy to improve experiences.
      Citation: Autism
      PubDate: 2021-07-29T05:28:06Z
      DOI: 10.1177/13623613211034057
       
  • Revisiting an RCT study of a parent education program for Latinx parents
           in the United States: Are treatment effects maintained over time'

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      Authors: Weiwen Zeng, Sandy Magaña, Kristina Lopez, Yue Xu, J Marisol Marroquín
      Abstract: Autism, Ahead of Print.
      This study examined maintenance of treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder using a behavior maintenance framework. In a two-site randomized waitlist-control study, we compared differences in parent and child outcomes across three timepoints using linear mixed models to determine whether outcomes observed at 4 months after baseline (Time 2) were maintained for an additional 4-month period (Time 3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder. Results showed that at Time 3, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. Site-specific treatment differences were found in outcomes such as parent-reported empowerment and child social communication impairments. Findings suggest that the intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation.Lay abstractBackground: We conducted a follow-up investigation of a two-site randomized controlled trial in the United States. We examined whether the treatment effects in a culturally tailored parent education program for Latinx families of children with autism spectrum disorder were maintained over time.Methods: Using linear mixed models, we compared differences in parent and child outcomes across three timepoints: baseline, 4 months after baseline (Time 2), and 8 months after baseline (T3). Parent outcomes included family empowerment, self-reported confidence in, and frequency of using evidence-based strategies. Child outcomes included parent-reported challenging behaviors, social communication impairments, and the number of services received. Participants were 109 Latina mothers (intervention = 54, control = 55) of children with autism spectrum disorder.Results: After intervention at both Time 2 and Time 3 in both sites, mothers in the intervention groups reported significantly greater confidence in and frequency of using evidence-based strategies, and that their child received significantly more services. We also found that there were treatment differences across the two study sites in several outcomes.Implications: The intervention for Latinx parents of children with autism spectrum disorder was efficacious and could be maintained, and that site-specific policy and service differences may need to be examined in future research to inform dissemination and implementation.
      Citation: Autism
      PubDate: 2021-07-29T05:27:12Z
      DOI: 10.1177/13623613211033108
       
  • The comorbidity between autism spectrum disorder and post-traumatic stress
           disorder is mediated by brooding rumination

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      Authors: Ofer Golan, Nirit Haruvi-Lamdan, Nathaniel Laor, Danny Horesh
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted, repetitive behaviors. Autism spectrum disorder is highly co-morbid with other neuro-psychiatric disorders such as attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Furthermore, the understanding of shared mechanisms underlying autism spectrum disorder co-morbidity with other conditions may assist in both diagnostic and intervention efforts with affected individuals. This short report examined the role of brooding and reflective rumination as mediators between autism spectrum disorder and post-traumatic stress disorder. A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing controls, comparable on age and gender, filled out the PTSD Checklist for DSM-5 and the Rumination Response Scale. The results indicated increased post-traumatic stress disorder symptoms, as well as elevated brooding levels, in adults with autism spectrum disorder, compared to typically developing controls. Brooding, but not reflective rumination, mediated the association between autism spectrum disorder and post-traumatic stress disorder symptoms. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, may exacerbate post-traumatic symptoms among traumatized individuals who have autism spectrum disorder. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder. Future studies should examine other psychological mechanisms which may underlie the autism spectrum disorder–post-traumatic stress disorder co-morbidity.Lay abstractAutism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted repetitive behaviors. Individuals with autism spectrum disorder are often diagnosed with other psychiatric conditions, including attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Nonetheless, studies have shown that those with autism spectrum disorder may face an increased risk of exposure to traumatic events. Separate lines of research in autism spectrum disorder and post-traumatic stress disorder have shown that the two may share several vulnerability factors. One of those is ruminative thinking, that is, one’s tendency to re-hash thoughts and ideas, in a repetitive manner. This article examined the role of two rumination types as potential factors connecting autism spectrum disorder and post-traumatic stress disorder: brooding (continuously comparing one’s current condition to one’s desired condition) and reflection (an introspective effort to cognitively solve one’s problems). A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing adults completed questionnaires assessing post-traumatic stress disorder symptoms and rumination. The results showed increased post-traumatic stress disorder symptoms in adults with autism spectrum disorder, compared to typically developing adults. Brooding rumination was also higher among those with autism spectrum disorder. Finally, brooding, but not reflection, served as a mechanism connecting autism spectrum disorder and post-traumatic stress disorder, that is, those with autism spectrum disorder showed increased brooding, which in turn predicted more post-traumatic stress disorder symptoms. This study has potential clinical implications. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, could exacerbate post-traumatic symptoms among individuals with autism spectrum disorder who experience traumatic events. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-07-28T10:07:36Z
      DOI: 10.1177/13623613211035240
       
  • Cognitive processes in autism: Repetitive thinking in autistic versus
           non-autistic adults

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      Authors: Kate Cooper, Ailsa Russell, Steph Calley, Huilin Chen, Jaxon Kramer, Bas Verplanken
      Abstract: Autism, Ahead of Print.
      Repetitive and restricted behaviours are a core feature of autism, and cognition in autistic individuals may also be repetitive and restricted. We aimed to investigate the relationship between repetitive behaviours and repetitive thinking. We predicted that autistic people would experience more repetitive, perseverative, visual and negative cognition than controls. We predicted that repetitive thinking would be associated with repetitive behaviours in the autistic participants. We recruited autistic (n = 54) and control (n = 66) participants who completed measures of insistence on sameness and obsessive-compulsive behaviours. Participants then took part in 5 days of descriptive experiencing sampling, recording their thoughts when a random alarm sounded. Consistent with our hypothesis, autistic participants reported more repetitive thinking. Contrary with our other hypotheses, autistic participants reported equivalent frequency of perseveration, visual thoughts and negative thoughts to non-autistic participants. Moreover, participants who reported more obsessive thinking reported more repetitive behaviour (insistence on sameness), but there was no such relationship between repetitive thinking and behaviour. Autistic participants who reported more repeated thoughts in the descriptive experience sampling had significantly lower obsessive thinking scores. We conclude that anxiety focused cognitions may drive insistence on sameness behaviours, and that the relationship between repetitive cognition and behaviour is complex and warrants further investigation.Lay abstractA core feature of autism is the tendency to do the same activity or behaviour repetitively. We wanted to find out if autistic people also experience repetitive thinking, for example, having the same thoughts repeatedly. We thought that there would be a link between repetitive behaviour and repetitive thinking. We asked 54 autistic people and 66 non-autistic people to complete questionnaires measuring repetitive behaviours and obsessive thinking. Next, participants were trained by a researcher to record their thoughts using a structured paper form. They then completed 5 days of thought recording, which they did each time a random alarm sounded on their mobile phone. We found that autistic people had more repetitive thoughts than non-autistic people, but they did not report having more negative or visual thoughts compared with non-autistic people. Autistic people who had more repetitive thoughts during the 5 days of thought recording did not report more repetitive behaviour. However, autistic people who reported more obsessive thinking, for example, more negative and unwanted thoughts, also reported higher levels of repetitive behaviour. We conclude that some repetitive behaviours may be linked to anxiety and that more research is needed to better understand repetitive behaviours in autism.
      Citation: Autism
      PubDate: 2021-07-22T09:44:01Z
      DOI: 10.1177/13623613211034380
       
  • Caregiver perspectives on the impact of uncertainty on the everyday lives
           of autistic children and their families

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      Authors: Jane Goodwin, Priyanka Rob, Mark Freeston, Deborah Garland, Victoria Grahame, Ashleigh Kernohan, Marie Labus, Malcolm Osborne, Jeremy R Parr, Catharine Wright, Jacqui Rodgers
      Abstract: Autism, Ahead of Print.
      Approximately 50% of autistic children experience high anxiety. Intolerance of uncertainty (tendency to react negatively to uncertain situations) is a key mechanism in the development and maintenance of anxiety. This study aimed to provide a descriptive, thematic analysis of the impact on uncertainty on the daily lives of autistic children and their families. Semi-structured interviews were conducted with parents and caregivers of 53 autistic children (including 3 dyads) aged 6–16 years to elicit examples of uncertain situations that the children found challenging and to explore the impact of these situations on family life. Thematic analysis revealed five overarching themes: child’s reactions to uncertainty, trying to reduce uncertainty, the impact of difficulties with uncertainty, the impact of uncertainty on parenting and the impact on parents. These findings provide a crucial understanding into the range of uncertain situations autistic children with anxiety experience. Anxiety-reduction approaches based on increasing tolerance to everyday uncertain situations could help improve well-being, quality of life and participation for autistic children and their families.Lay abstractAnxiety is common in autistic children. Research shows that this may be related to intolerance of uncertainty, which is a tendency to react negatively to uncertain situations. Understanding when, why and how autistic children respond to uncertainty is important in the development of anxiety programmes. We asked 53 (including 3 dyads) parents of autistic children about the types of uncertain situations that cause difficulties for their child and how uncertainty impacts on daily life for them and their families. We found that uncertain situations made autistic children and their families feel sad, worried, frustrated and angry through the themes: child’s reactions to uncertainty, trying to reduce uncertainty, the impact of difficulties with uncertainty, the impact of uncertainty on parenting and the impact on parents. There are lots of situations that are anxiety provoking for autistic children because of uncertainty, such as school. Programmes to reduce anxiety and increase autistic children’s ability to cope with everyday uncertain situations could improve quality of life for autistic children and their families.
      Citation: Autism
      PubDate: 2021-07-22T09:42:41Z
      DOI: 10.1177/13623613211033757
       
  • In their own words: The impact of subtle language and communication
           difficulties as described by autistic girls and boys without intellectual
           disability

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      Authors: Alexandra Sturrock, Helen Chilton, Katie Foy, Jenny Freed, Catherine Adams
      Abstract: Autism, Ahead of Print.
      Subtle language and communication difficulties are persistent and pervasive for autistic individuals without intellectual disability. They are thought to impact negatively on functionality, social interrelations and emotional well-being, although this relationship is under-explored in the literature. The personal accounts of autistic children could add valuable insight into how they experience subtle language and communication difficulties and what impact this has on their daily lives. In this study, 12 autistic children (9–14 years), without intellectual disability, were interviewed on this topic, using specially developed methods/materials to facilitate rich self-reporting. Results showed the children could provide detailed insight into their difficulties and the impact of these on key aspects of functionality (education and daily living) and social interrelations (including friendship building). They also demonstrated a potentially bi-directional relationship between subtle language and communication difficulties and negative emotions; with negative emotions limiting communicative competence and subtle linguistic difficulties leading to negative emotional responses. This study indicates the need for further investigation into the subtle difficulties experienced by autistic children without intellectual disability and its likely impact. Implications for clinical practice include the need for better identification of subtle language and communication difficulties and provision of appropriate therapeutic services which may help to ameliorate negative functional, social and emotional sequelae.Lay abstractSubtle language and communication difficulties are experienced by many autistic individuals even when they do not have additional learning disabilities. These difficulties may affect a person’s day-to-day living, social relationships and emotional well-being. However, currently, there is not much research into this topic. To date, no one has asked autistic children about their own language and communication difficulties or how they feel it affects them. Asking the children could provide valuable new insights. In this study, 12 autistic children (9–14 years), without learning disability, were interviewed on this topic. We developed interview questions, resources and interview procedures with the support of the autistic community. We also worked with an autistic researcher to analyse our results. We aimed to get the most genuine report of the autistic child’s experiences. Our results showed that the children could give detailed insight into their language and communication difficulties if they were given the right support. They told us about how subtle language and communication difficulties affected their ability to learn, take part in certain activities and seek help. They talked about how subtle difficulties affect their ability to talk to new people, talk in groups and ultimately make friends. They also told us about the emotional upset that these subtle difficulties could have. They suggest that communication breakdown leads to negative feelings, but also that negative feelings can lead to more difficulties explaining themselves. The results of this study suggest that we should do more research on the effects of subtle language and communication difficulties. There are also implications for clinical practice. We should identify subtle language and communication difficulties through thorough assessment because these are often missed. We should also develop therapy and strategies that are aimed at individuals with subtle language and communication difficulties because this could help prevent additional difficulties with learning, help-seeking, friendship-making and emotional well-being.
      Citation: Autism
      PubDate: 2021-07-22T09:39:52Z
      DOI: 10.1177/13623613211002047
       
  • When autism researchers disregard harms: A commentary

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      Authors: Michelle Dawson, Sue Fletcher-Watson
      Abstract: Autism, Ahead of Print.

      Citation: Autism
      PubDate: 2021-07-22T09:37:48Z
      DOI: 10.1177/13623613211031403
       
  • A community-engaged approach to examining barriers and facilitators to
           accessing autism services in Korean immigrant families

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      Authors: Vanessa C Fong, Bo Sang Lee, Grace Iarocci
      Abstract: Autism, Ahead of Print.
      This study adopted a community-engaged approach to explore Korean parents’ perceptions of barriers and facilitators to accessing autism services in British Columbia, Canada. Understanding the experiences of culturally and linguistically diverse families and their children may help facilitate the development of more inclusive, appropriate, and culturally sensitive services. Semi-structured interviews with 20 Korean parents of autistic children were analyzed using a thematic approach. Barriers and facilitators at the system, provider, and family/cultural level were identified. Barriers at the system level included delays and waitlists for services, and ineffective school policies to address child behavioral challenges. At the provider level, barriers included a lack of qualified professionals, negative attitudes, and lack of guidance navigating services. For family/cultural-related barriers, language and communication difficulties, out-of-pocket costs, and stigma impeded service access. Facilitators at the system level included family-centered care and prioritization of mental health supports. At the provider level, strengths included culturally competent and bilingual professionals. The family/cultural-related facilitators identified were informal support networks, characteristics of the parent, and connections to cultural community organizations. The findings emphasize the need to understand and consider diverse experiences, preferences, and values in the design and provision of autism services for families and their children.Lay abstractPerceptions and experiences of culturally and linguistically diverse groups in accessing autism services in Canada are extremely limited. Thus, this study partnered with a community member to explore Korean immigrant parents’ perceptions of barriers and facilitators to accessing autism services in British Columbia, Canada. Interviews were conducted with 20 Korean parents of autistic children. Barriers and facilitators at the system, provider, and family/cultural level were identified. Barriers at the system level included delays and waitlists for services, and ineffective school policies to address child behavioral challenges. At the provider level, barriers included a lack of qualified professionals, negative attitudes, and lack of guidance navigating services. For family/cultural-related barriers, these included language and communication difficulties, out-of-pocket costs, and stigma impeded service access. Facilitators at the system level included family-centered care and prioritization of mental health supports. At the provider level, strengths included culturally competent and bilingual professionals. The family/cultural-related facilitators identified were informal support networks, characteristics of the parent, and connections to cultural community organizations. The findings emphasize the need to understand and consider diverse experiences, preferences, and values in the design and provision of autism services for families and their children.
      Citation: Autism
      PubDate: 2021-07-21T10:29:55Z
      DOI: 10.1177/13623613211034067
       
  • Adapting and validating the Autism Diagnostic Interview - Revised for use
           with deaf children and young people

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      Authors: Barry Wright, Helen Phillips, Victoria Allgar, Jennifer Sweetman, Rachel Hodkinson, Emily Hayward, Amelia Ralph-Lewis, Catarina Teige, Martin Bland, Ann Le Couteur
      Abstract: Autism, Ahead of Print.
      A Delphi consensus methodology was used to adapt the Autism Diagnostic Interview–Revised for the assessment of deaf children with suspected autism spectrum disorder. Each Autism Diagnostic Interview–Revised item was considered by a panel of nine international experts in terms of relevance and acceptability. Modifications were proposed and agreed by the expert panel for 45% of items. The pre-specified criterion for agreement between experts was set at 80% for each item. A first validation of the revised version, adapted for deaf children (Autism Diagnostic Interview–Revised Deaf Adaptation), was undertaken with a UK sample of 78 parents/carers of deaf children with autism spectrum disorder and 126 parents/carers with deaf children without autism spectrum disorder. When compared to National Institute for Health and Care Excellence guideline standard clinical assessments, the Autism Diagnostic Interview–Revised Deaf Adaptation diagnostic algorithm cut-off/threshold scores achieved a sensitivity of 89% (79%–96%) and specificity of 81% (70%–89%) for autism spectrum disorder. The alpha coefficients for each algorithm symptom domain ranged from 0.80 to 0.91, suggesting that the items had high internal consistency. Our findings indicate that the Autism Diagnostic Interview–Revised Deaf Adaptation is likely to be a useful measure for the assessment of deaf children with suspected autism spectrum disorder, although further research is needed.Lay abstractAutism assessment processes need to improve for deaf children as they are currently being diagnosed later than their hearing counterparts and misdiagnosis can occur. We took one of the most commonly used parent developmental interviews for autism spectrum disorder the Autism Diagnostic Interview–Revised and adapted it using international expert advice. Modifications were proposed and agreed by the expert panel for 45% of items; the remaining 55% of items were unchanged. We then tested the revised version, adapted for deaf children (Autism Diagnostic Interview–Revised Deaf Adaptation), in a UK sample of 78 parents/carers of deaf children with autism spectrum disorder and 126 parents/carers with deaf children without autism spectrum disorder. When compared to National Institute for Health and Care Excellence guideline standard clinical assessments, the Autism Diagnostic Interview–Revised Deaf Adaptation diagnostic algorithm threshold scores could identify those deaf children with a definite diagnosis (true autism spectrum disorder positives) well (sensitivity of 89% (79%–96%)) and those deaf children who did not have autism spectrum disorder (true autism spectrum disorder negatives) well (specificity of 81% (70%–89%)). Our findings indicate that the Autism Diagnostic Interview–Revised Deaf Adaptation is likely to prove a useful measure for the assessment of deaf children with suspected autism spectrum disorder and that further research would be helpful.
      Citation: Autism
      PubDate: 2021-07-16T10:37:03Z
      DOI: 10.1177/13623613211029116
       
  • Supporting autistic adults’ episodic memory recall in interviews: The
           role of executive functions, theory of mind, and language abilities

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      Authors: Jade Eloise Norris, Katie Maras
      Abstract: Autism, Ahead of Print.
      Autistic people have difficulties recalling episodic memories, including retrieving fewer or less specific and detailed memories compared to typically developing people. However, the ability to effectively recall episodic memories is crucial in many real-world contexts, such as the criminal justice system, medical consultations, and employment interviews. Autistic people’s episodic memory difficulties are most apparent when open, unsupportive questions are used. The ‘Task Support Hypothesis’ posits that autistic people can recall as much information as typically developing people with more supportive questioning. Alongside problems retrieving episodic memories, autistic people also experience difficulties with executive functioning, theory of mind, and expressive language. The current study aimed to assess the impact of these abilities on recall in two previous studies by the authors that compared autistic and typically developing adults on recall specificity in police, healthcare, and employment interviews, and recall quality in employment interviews under unsupported and supported questioning. Under unsupported questioning only, autistic adults’ episodic autobiographical memory recall specificity was predicted by expressive language, whereas for the typically developing group, only theory of mind was a significant predictor. No other predictors were significant across the study. Implications for the task support hypothesis are discussed.Lay abstractAutistic people have difficulties recalling episodic memories (memories of specific events) compared to typically developing people. However, being able to effectively recall such memories is important in many real-world situations, for example, in police interviews, during medical consultations, and in employment interviews. Autistic people’s episodic memory difficulties are most noticeable when they are responding to open, unsupportive questions. However, the ‘Task Support Hypothesis’ indicates that autistic people are able to recall as much information as typically developing people, as long as they are asked more supportive questions. Autistic people also experience difficulties with executive functioning (cognitive abilities which allow us to plan, hold information in mind, inhibit interruptions, etc.), theory of mind (the ability to understand others’ perspectives and intentions), and spoken language. The current study aimed to investigate the impact of these cognitive abilities on memory recall in two previous studies which compared autistic and typically developing adults on how specific their recall was in police, healthcare, and employment interviews, and the quality of responses during an employment interview when both unsupportive and supportive questioning was used. The results show that while typically developing people may rely on theory of mind abilities, autistic people may rely more on language abilities when performing in interviews, potentially to compensate for their episodic memory difficulties, and that this effect is most apparent during more unsupportive recall (e.g. when a brief, open question is asked) compared to when open questions are followed by prompts (e.g. ‘tell me about who as there’, ‘what happened'’, etc.).
      Citation: Autism
      PubDate: 2021-07-10T05:42:53Z
      DOI: 10.1177/13623613211030772
       
  • Autism diagnosis as a social process

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      Authors: Jennie Hayes, Tamsin Ford, Rose McCabe, Ginny Russell
      Abstract: Autism, Ahead of Print.
      The diagnosis of autism can be challenging, particularly if an individual coming for assessment is considered to be near the diagnostic threshold. It is important to understand the experiences and challenges of diagnosis from the perspective of clinicians. In this study, 21 in-depth interviews were conducted with clinicians working in specialist autism assessment teams in adult and children’s services in England. Interviews were recorded and transcripts were analysed thematically. We identified four themes that represented how clinicians were frequently engaged with juggling their own professional understanding of what autism is with other factors such as the results of standardised tests and the views of patients and carers, in the context of limited resources: institutional pressure, making diagnosis make sense, seeing through an autism lens and just tools. The study illuminates the diagnostic process as a socially situated activity. We suggest that an examination of the benefits and drawbacks of assessment services specialising in autism only, the resources they require to operate effectively, and how they operate in the context of wider health services would be appropriate and timely.Lay abstractWhen a child or adult is referred for an autism diagnosis, clinicians from different backgrounds work together to make a diagnostic decision. A few studies have asked clinicians in interview how they feel about diagnosis and what the challenges are. We interviewed clinicians in child and adult assessment services in England, and from different professional backgrounds, about the challenges of autism diagnosis and the factors that might influence the assessment process. We found that there were a number of challenges in autism diagnosis, especially when someone coming for diagnosis was considered to be near the diagnostic threshold. Clinicians told us that making a diagnosis was like creating a ‘narrative’: looking at many different factors that told a story about a person, rather than just looking at the results of diagnostic tests. Clinicians do not always agree with the results of those tests and have to use their specialist clinical judgement to make decisions. Clinicians were concerned about the amount of time people have to wait for an autism assessment, and the resulting pressure on the assessment process. The findings of this work can help us to understand how diagnosis happens and consider ways in which it can be improved for adults, children and families coming for assessment, as well as clinicians.
      Citation: Autism
      PubDate: 2021-07-10T05:39:34Z
      DOI: 10.1177/13623613211030392
       
  • Adding the missing voice: How self-report of autistic youth self-report on
           an executive functioning rating scale compares to parent report and that
           of youth with attention deficit hyperactivity disorder or neurotypical
           development

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      Authors: Lauren Kenworthy, Alyssa Verbalis, Julia Bascom, Sharon daVanport, John F Strang, Cara Pugliese, Andrew Freeman, Charlotte Jeppsen, Anna C Armour, Geneva Jost, Kristina Hardy, Gregory L Wallace
      Abstract: Autism, Ahead of Print.
      Executive functions are related to key outcomes. Studies of autistic youth self-report of other nonsocial traits indicate that their insights into their own functioning and internal experiences provide important information that is not captured by their parents’ report, but youth self-report of executive function has not been researched in autism. We investigate self- and parent-report on the Behavior Rating Inventory of Executive Function-2 in 197 autistic youth without intellectual disability, including the magnitude and profile of problems reported across subdomains of executive function. We also compare autistic self-report to that of 114 youth with attention deficit hyperactivity disorder and 197 neurotypical youth. We find that autistic youth report significant executive function challenges in comparison to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverge regarding the severity of the youth’s executive function difficulties, but both emphasize flexibility problems within their profile of executive function challenges. Intraclass correlation coefficients between parent and youth ratings were moderate to poor in the autistic group, indicating that autistic youth report adds important information beyond that captured by their parents’ report. These data elevate the importance of asking autistic youth directly about their own executive function.Lay abstractExecutive functions are often impaired in autistic people and relate to important outcomes such as mental health, success in school and work, and quality of life. Evaluating executive functions helps autistic people, clinicians, and families identify targets for external supports and skill building. Youth self-report of executive function has not been studied, yet we know that self-report from autistic youth is key to understanding other cognitive/behavioral phenomena in autism such as anxiety, obsessions/compulsions, sensory sensitivities, and repetitive behaviors. We investigated self- and parent-report of executive function problems in 197 autistic youth without intellectual disability (ages 11–18 years), including the magnitude and profiles of executive function problems autistic youth report across subdomains of executive function. We compared autistic self-report with that of 114 youth with attention deficit hyperactivity disorder without intellectual disability and 197 neurotypical youth. We found that autistic youth report significant executive function problems compared to neurotypical youth and a distinctive profile of challenges in comparison to attention deficit hyperactivity disorder youth. Parents and their autistic children diverged regarding the magnitude of the youth’s executive function difficulties, but both identify inflexibility as the most impaired executive function subdomain. Autistic youth and their parents were somewhat more concordant in their report of executive function problems than youth with attention deficit hyperactivity disorder and their parents, but only showed moderate concordance at best. These findings elevate the importance of asking autistic youth directly about their executive functioning when engaging them in assessment and intervention, or researching executive functions in autism.
      Citation: Autism
      PubDate: 2021-07-09T08:42:20Z
      DOI: 10.1177/13623613211029117
       
  • Literacy instruction for autistic children who speak languages other than
           English

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      Authors: Benjamin Bailey, Joanne Arciuli
      Abstract: Autism, Ahead of Print.
      Much of what is known about autism and literacy instruction is derived from studies including monolingual English-speaking children. Yet, less than one-fifth of the world’s population are English speakers. This review examines the research on literacy instruction for children with autism learning to read and write in languages other than English. A systematic search of the literature identified potentially relevant publications, a relatively small number of these met inclusion criteria. The included studies investigated instruction methods targeted at word reading and spelling, reading comprehension, and written expression for autistic children learning to use alphabetic, syllabary or logosyllabary writing systems. Autistic children benefitted from literacy instruction methods designed for typically developing children. However, some studies showed that additional skills and supports may be required. The included studies also highlight some potential differences in effective instruction practices used when working with autistic children learning alphabetic, syllabary and logosyllabary writing systems. Studies tended to include small samples. We hope this review will bring increased awareness and research efforts in the area of autism and global literacy.Lay abstractMany autistic children across the globe speak languages other than English. However, much of the research about teaching children with autism to read and write is derived from studies including people who speak English and no other languages. Here, we review the research on teaching children with autism to read and write in languages other than English. We did this because the world’s languages, and the ways they are represented in written form, vary greatly. A broader overview that encompasses languages other than English can help us better understand how learning to read and write can be supported for autistic children around the world. The studies included in our review highlight some potential differences in effective literacy teaching for autistic children learning to read and write using different writing systems. The studies we reviewed tended to include relatively small samples of autistic children, among other limitations. We hope that our review will increase awareness and research efforts in the area of autism and global literacy.
      Citation: Autism
      PubDate: 2021-07-08T05:24:09Z
      DOI: 10.1177/13623613211025422
       
  • The utility of parent-report screening tools in differentiating autism
           versus attention-deficit/hyperactivity disorder in school-age children

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      Authors: Sara Guttentag, Somer Bishop, Rebecca Doggett, Rebecca Shalev, Megan Kaplan, Margaret Dyson, Morgan Cohen, Catherine Lord, Adriana Di Martino
      Abstract: Autism, Ahead of Print.
      Symptoms of autism spectrum disorder and attention-deficit/hyperactivity disorder often co-occur, challenging timely, and accurate diagnosis. We assessed the performance of three parent-report measures in discriminating autism spectrum disorder from attention-deficit/hyperactivity disorder without autism spectrum disorder (ADHDw/oASD) in school-age verbally fluent children. We examined the Autism Symptom Interview – School-Age and two widely used parent questionnaires: Social Responsiveness Scale – 2nd Edition and Social Communication Questionnaire – Lifetime. Receiver operating characteristic curves assessed each instrument’s performance against the best-estimate clinician Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of autism spectrum disorder or of ADHDw/oASD (n = 74, n = 102, respectively; 6–11 years). These yielded moderate accuracies: area under the curve = 0.85, 0.79, and 0.78 for Social Communication Questionnaire – Lifetime, Autism Symptom Interview, and Social Responsiveness Scale – 2nd Edition, respectively. Area under the curve pairwise comparisons reached our statistical significance (p 
      Citation: Autism
      PubDate: 2021-07-05T06:47:13Z
      DOI: 10.1177/13623613211030071
       
  • Mental health Project ECHO Autism: Increasing access to community mental
           health services for autistic individuals

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      Authors: Nicole Ginn Dreiling, Michal L Cook, Elena Lamarche, Laura Grofer Klinger
      Abstract: Autism, Ahead of Print.
      Despite the high prevalence of co-occurring autism spectrum disorders and mental health condition(s), there exist substantial barriers to mental health treatment for autistic individuals. These barriers are exacerbated by a lack of mental health provider training and self-efficacy in providing adapted services to autistic individuals. One method which has been effective in mitigating similar service gaps is the Extension for Community Healthcare Outcomes (Project ECHO) Autism model, a tele-mentoring platform that connects primary care physicians to autism spectrum disorder experts to improve physicians’ knowledge, self-efficacy, and practice. This study developed and implemented a pilot mental health version of Project ECHO Autism designed to increase mental health provider knowledge, self-efficacy, and problem-solving. Community mental health providers (N = 51) participated in the 6-month Project ECHO Autism including mental health–focused didactics and provider case presentations. Analysis of pre- and post-measures revealed improvements in all domains, including significant increases in provider knowledge of autism spectrum disorders, self-efficacy, and problem-solving. Participants additionally reported high satisfaction with their experience. Taken together, preliminary results indicate that Project ECHO Autism may be a feasible, accessible, and effective method for increasing mental health provider competence and ultimately increasing access to services for autistic individuals who have co-occurring mental health diagnoses.Lay abstractAlthough many autistic individuals have additional mental health conditions, most have a hard time getting services from mental health providers. One reason why these services can be hard to access is that many mental health providers do not feel confident in their ability to provide services to autistic individuals. To share autism expertise with local community providers and boost their confidence in working with autistic individuals, we created a mental health version of the Extension for Community Healthcare Outcomes (Project ECHO) Autism virtual teleconsultation program. In this pilot study, we recruited 51 community mental health providers to participate in Project ECHO Autism. During each biweekly session, providers received information from autism experts about how to tailor mental health interventions (e.g. attention-deficit hyperactivity disorder or anxiety interventions) for use with autistic individuals. They also had the opportunity to ask questions and get advice on their current cases. At the end of the 6-month study, mental health providers showed improvements in their confidence, in their knowledge of autism, and in their problem-solving skills. Nearly half (45%) of these providers participated from rural counties, suggesting that the Project ECHO Autism teleconsultation model was able to reach mental health providers who might not have been able to get training otherwise. This study supports the feasibility of using Project ECHO Autism to share autism knowledge with mental health providers, consequently expanding mental health service options for autistic individuals with co-occurring mental health conditions.
      Citation: Autism
      PubDate: 2021-07-03T11:01:30Z
      DOI: 10.1177/13623613211028000
       
  • Distilling innovative US autism care programs that address widely
           perceived unmet patient and family needs

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      Authors: Venus Wong, Mai Pham, Kristen Godfrey, Arnold Milstein
      Abstract: Autism, Ahead of Print.
      Current mainstream care for autistic individuals is fragmented, narrow, and poorly individualized. To better describe cutting-edge autism care, we searched for care programs in the United States that had been collaboratively designed with patients and families and that carry the highest potential to improve the quality of life of autistic individuals and their families. Using a modified Delphi method, we gathered input via conversations and surveys from 55 autistic adults, family members, practicing clinicians, and autism specialized researchers. As a result, 90 innovative autism care programs were nominated. We distilled these nominations to 15 programs across the United States by applying researcher-selected criteria, such as providing services actively and having data on program effectiveness. Then, we recruited 10 experts to rate the novelty, clinical benefits to individuals, clinical benefits to family caregivers, care costs for autistic individuals, societal costs, adaptability, and feasibility of the 15 programs. Common features of the 15 programs include care coordination and integration, care delivery, payment, and providing care in underserved clinical areas.Lay abstractCurrently, the quality of care for autistic individuals is not good. Many care services for autistic individuals are not well coordinated, nor are they tailored. We wanted to find out a better model for autism care and believed that the autism community knows where these programs are. So, we had conversations with and surveyed 55 autistic adults, family members, clinicians, and researchers. They shared 90 innovative autism care programs that had been collaboratively designed with patients and families and that are likely to improve the quality of life of autistic individuals and their families. We then narrowed down the 90 nominated programs to 15 programs across the United States by applying researcher-selected criteria, such as providing services actively and having data on program effectiveness. We compiled a list of these innovative, quality autism care programs.
      Citation: Autism
      PubDate: 2021-07-02T08:45:16Z
      DOI: 10.1177/13623613211027999
       
  • Medical symptoms and conditions in autistic women

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      Authors: Tslil Simantov, Alexa Pohl, Alexandros Tsompanidis, Elizabeth Weir, Michael V Lombardo, Amber Ruigrok, Paula Smith, Carrie Allison, Simon Baron-Cohen, Florina Uzefovsky
      Abstract: Autism, Ahead of Print.
      The sex bias in autism diagnosis suggests the involvement of sex-specific endocrine mechanisms during prenatal development, but these hormones affect health throughout life. Therefore, the current study examined the association of autism and autistic traits with conditions and symptoms related to the sex-steroid system in adult women. In total, 1230 women (361 autistic), aged 15–77 years, reported on autistic traits and medical history. Medical diagnoses and symptoms were grouped by unsupervised factor analysis, and associations with autism diagnosis and autistic traits were explored. Higher rates of reproductive system diagnoses (odds ratio = 1.035, p = 0.024), prediabetes symptoms (odds ratio = 1.319, p = 0.001), irregular puberty onset (odds ratio = 1.458, p = 0.009), and menstrual length (odds ratio = 1.368, p = 0.034) and lower rates of metabolic and vascular conditions (odds ratio = 0.654, p = 0.013) were associated with diagnosis. Reproductive system diagnoses (β = 0.114, p = 0.000), prediabetes symptoms (β = 0.188, p = 0.000), menstrual length (β = 0.071, p = 0.014), irregular puberty onset (β = 0.149, p = 0.000), excessive menstruation symptoms (β = 0.097, p = 0.003), and hyperandrogenism symptoms (β = 0.062, p = 0.040) were also associated with autistic traits. Many of the conditions and symptoms found to be associated with autism or autistic traits are also related to conditions of steroid hormones and, specifically, the sex-steroid system. The study suggests an important role for steroids in autistic women, beyond prenatal development. Clinical implications are discussed.Lay abstractSex-steroids, such as testosterone, are thought to be one of the biological factors implicated in autism. This relies on the sex bias in the diagnosis of autism (boys are approximately four times more likely to be diagnosed than girls) and findings of associations with fetal testosterone levels in traits and abilities related to autism. The current study aimed to examine the association between medical conditions and physical symptoms, which tend to manifest in adulthood, and autism in females. Moreover, we examined their association with autistic traits throughout the spectrum. We focused on autistic women because there is little research focusing on the healthcare needs of autistic women, but those that exist suggest heightened vulnerability, and lower access to medical care. We find that conditions related to steroid hormones function are more frequent in autistic women and that they correlate with autistic traits. Specifically, we found that body mass index, reproductive system diagnoses, prediabetes symptoms, irregular puberty onset, and menstrual irregularities were significantly more frequent in autistic women and were significantly correlated with autistic traits in neurotypical women. The findings have important implications for raising awareness in autistic women of the possibility of medical conditions which might need medical attention. In addition, healthcare providers should consider these associations when performing healthcare maintenance checks and/or screening for autism.
      Citation: Autism
      PubDate: 2021-06-29T11:16:14Z
      DOI: 10.1177/13623613211022091
       
  • Self-reported camouflaging behaviours used by autistic adults during
           everyday social interactions

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      Authors: Julia Cook, Laura Crane, Laura Hull, Laura Bourne, William Mandy
      Abstract: Autism, Ahead of Print.
      Autistic people may camouflage their innate autistic social behaviours to adapt to, cope within and/or influence the predominately neurotypical social landscape. This study describes behaviours exhibited, altered or avoided by autistic adults whilst camouflaging (i.e. camouflaging behaviours). Using Interpersonal Process Recall methodology, 17 autistic adults (8 women, 6 men and 3 agender/gender neutral individuals) participated in a brief social task designed to replicate a common day-to-day social situation. Participants then watched a video of their interaction with a researcher, actively identifying and describing camouflaging behaviours. Using qualitative content analysis, descriptions of 38 camouflaging behaviours described by participants were clustered into four main categories and seven subcategories: (1) masking, (2) innocuous engagement (subcategories: passive encouragement, centring social partner, deferential engagement and reducing social risk), (3) modelling neurotypical communication and (4) active self-presentation (subcategories: reciprocal social behaviours, risky social behaviours, and comfortable and familiar social behaviours). The novel use of Interpersonal Process Recall methodology addressed limitations in existing camouflaging research and facilitated the identification of previously unreported camouflaging behaviours. These camouflaging behaviours are discussed with reference to literature concerning interpersonal research and theory within and outside the field of autism.Lay abstractCamouflaging can be thought of as the process through which autistic people modify their natural social behaviours to adapt to, cope within or influence the largely neurotypical (non-autistic) social world. Many autistic people experience negative reactions to their natural or intuitive social behaviours when interacting with non-autistic people. Over time, in response to these negative reactions, autistic people’s social behaviour often changes. We refer to autistic people’s changed behaviours as ‘camouflaging behaviours’. Research exploring camouflaging behaviours is still at an early stage. This study investigated camouflaging behaviours used by autistic adults in everyday social interactions using a research method that was new to the field of autism. Specifically, 17 autistic adults were filmed taking part in a common everyday social situation – a conversation with a stranger. With the help of the video of this conversation, they then showed and described their camouflaging behaviours to a researcher. These autistic people identified and described a total of 38 different camouflaging behaviours. The detailed and specific information provided by autistic adults about camouflaging behaviours generated important new insights into the ways in which autistic people adapt to, cope within and influence the neurotypical (non-autistic) social world.
      Citation: Autism
      PubDate: 2021-06-26T10:56:03Z
      DOI: 10.1177/13623613211026754
       
  • Diagnostic- and sex-based differences in depression symptoms in autistic
           and neurotypical early adolescents

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      Authors: Jessica M Schwartzman, Zachary J Williams, Blythe A Corbett
      Abstract: Autism, Ahead of Print.
      Prevalence rates of depression are higher in autistic youth than neurotypical peers, yet the effects of autism spectrum disorder diagnosis and sex on depressive symptom severity remain incompletely understood, particularly in specific age groups. Using the Children’s Depression Inventory, Second Edition, this study explored diagnostic- and sex-based differences in depressive symptom severity in a sample of 212 autistic and neurotypical early adolescents (10:0–13:5 years). Significant group differences were found according to autism spectrum disorder diagnosis [d = 0.587, 95% confidence interval (0.308, 0.867)] and sex [d = 0.365, 95% confidence interval (0.089, 0.641)], with more depressive symptoms endorsed in the autism spectrum disorder and female groups. However, the interaction of diagnosis and sex was not significant, suggesting an additive risk of autism spectrum disorder status and female sex. Item-level analyses showed diagnostic differences on nearly half of the CDI-2 items with higher severity in the autism spectrum disorder group (Probability of Superiority range = 0.42–0.65), differences within the sexes, and differences by diagnosis, which persisted when limiting analyses to children with high levels of depressive symptoms. A more nuanced understanding of symptom endorsement and the roles of diagnosis and sex may uncover salient intervention targets for depression in the unique context of autism spectrum disorder.Lay abstractDepression is more common in autistic adolescents than their neurotypical peers, but the effects of diagnosis and sex on the severity and types of depressive symptoms remain unclear. The study explored diagnostic- and sex-based differences in depressive symptoms in 212 autistic and neurotypical early adolescents. Results show that autism spectrum disorder and female may pose elevated risks, and depressive symptoms related to interpersonal problems and negative self-esteem are more frequent in autism spectrum disorder. Autistic males and females endorsed similar severity and type of depressive symptoms, but unique differences emerged when compared to sex-matched neurotypical peers. Exploratory analyses in a clinical subsample of early adolescents with elevated depressive symptoms (Children’s Depression Inventory, Second Edition, Total T-score ⩾60) revealed more endorsement of beliefs of worthlessness in autistic early adolescents. Findings suggest initial intervention targets for treating depression in autistic early adolescents.
      Citation: Autism
      PubDate: 2021-06-26T10:54:49Z
      DOI: 10.1177/13623613211025895
       
  • Code-related literacy profiles of kindergarten students with autism

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      Authors: Emily J Solari, Alyssa R Henry, Ryan P Grimm, Matthew C Zajic, Anita McGinty
      Abstract: Autism, Ahead of Print.
      Difficulties with reading development have been well documented in samples of children with autism spectrum disorders. This study utilized a state-level early literacy dataset of kindergarten students educationally diagnosed with autism spectrum disorder (N = 616) to investigate the development of critical early reading skills across the kindergarten year. The study employed latent profile analysis and latent transition analysis to empirically derive profiles of early readers at kindergarten entry and the end of kindergarten. Results demonstrate the heterogenous nature of early reading skills for young school-aged students with autism spectrum disorder. Results have important implications for the early instruction and intervention of early reading for young children with autism spectrum disorder.Lay abstractMany children and young students with autism have difficulties learning how to read. This study investigated early literacy development in children with autism spectrum disorder during their first year of formal schooling. The study found that children with autism spectrum disorder differ greatly on their early literacy skills, with some showing strengths in their understanding of the alphabet, spelling, and reading words. Other students in the sample had difficulties with these early reading skills. The findings of this study are important to better understand the most effective way to teach early literacy skills to children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-06-25T09:10:02Z
      DOI: 10.1177/13623613211025904
       
  • Objective and subjective psychosocial outcomes in adults with autism
           spectrum disorder: A 6-year longitudinal study

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      Authors: Anke M Scheeren, J Marieke Buil, Patricia Howlin, Meike Bartels, Sander Begeer
      Abstract: Autism, Ahead of Print.
      Research has shown lower rates of employment and independent living in adults with autism. Many of these findings are based on cross-sectional studies, predominantly involving male participants. In a 6-year longitudinal study, we examined determinants of psychosocial outcomes in 917 adults with autism spectrum disorder (425 men, 492 women, mean age 43.5 years). Most were diagnosed in adulthood and had (above) average intellectual abilities. Via a yearly online survey, participants’ objective psychosocial functioning (based on employment, independent living and friendship) and subjective well-being were assessed. Averaged across the five waves of the study, 86% of the sample showed a fair to very good level of objective psychosocial functioning. Objective psychosocial functioning and subjective well-being were positively correlated, and both improved over time. Lower intellectual ability, more autism traits, co-occurring psychiatric conditions and younger age predicted poorer objective outcomes. More autism traits and co-occurring psychiatric conditions predicted lower subjective well-being. There were no gender differences in initial levels of, or changes in, objective and subjective outcomes over time. This study has identified important risk/protective factors for psychosocial outcomes across early and middle adulthood. In general, the findings offer a more positive outlook for adults with autism and average to high intellectual abilities.Lay abstractPrevious research has shown that relatively few adults with autism have a paid job or live on their own. However, outcomes also vary a lot and may depend on many different factors. In this study, we examined the level of functioning and happiness of 917 adults with autism (425 men and 492 women) aged 18–65 years. Most of them were of average to high intellectual ability. Over 6 years, we measured whether they had a paid job, close friendships and lived on their own (i.e. their objective functioning). We also measured how happy they felt. Objectively, most autistic adults did fairly to very well. Those with better objective outcomes (e.g. those with paid work) also tended to be happier. Most adults improved in objective functioning and happiness over 6 years. Participants with a lower intellectual ability, more autism traits, mental health problems and younger age had poorer objective outcomes. Participants with more autism traits and mental health problems were less happy. Autistic men and women functioned at similar levels and were equally happy. We found important factors that predict a better (or worse) outcome for autistic adults. Overall, compared with some previous research, our findings give a more positive picture of the outcomes for autistic adults with average to high intellectual abilities.
      Citation: Autism
      PubDate: 2021-06-25T09:09:07Z
      DOI: 10.1177/13623613211027673
       
  • Face memory and face perception in autism

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      Authors: Mirta Stantić, Eri Ichijo, Caroline Catmur, Geoffrey Bird
      Abstract: Autism, Ahead of Print.
      It has been argued that autistic individuals have difficulties with face memory but typical face perception. However, only one previous study has examined both face memory and face perception in the same individuals, and this study was conducted with a small group of autistic children. Here, face recognition was examined with a group of autistic adults using two face perception tasks (including one designed to avoid a neurotypical bias) and a standard test of face memory. Self-reported face recognition difficulties in everyday life were also recorded. The group of adults with autism scored lower than a matched neurotypical control group on all face tasks and reported more problems with face recognition in everyday life. On the whole, results suggest difficulties with both face perception and face memory in autistic adults, although it should be noted that a wide range of scores were recorded from the autistic individuals, with some scoring in the neurotypical range.Lay abstractIt is well known that some people with autism have difficulties recognizing faces. It is generally thought that this is not because autistic individuals cannot perceive faces, but because autistic individuals have greater problems than people without autism in remembering faces. Here, we worked with a group of autistic adults and a group of non-autistic adults to test their ability to perceive and remember faces. We also asked each person to report any difficulties that they have with recognizing faces in everyday life. We find that, as a group, people with autism have difficulties with both remembering and perceiving faces, and report more problems recognizing faces in everyday life. However, it is worth noting that we observed a wide range of scores in the group of people with autism, with some autistic participants scoring as well as the group of people without autism.
      Citation: Autism
      PubDate: 2021-06-23T03:25:42Z
      DOI: 10.1177/13623613211027685
       
  • Self-reported parkinsonism features in older autistic adults: A
           descriptive study

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      Authors: Hilde M Geurts, Goldie A McQuaid, Sander Begeer, Gregory L Wallace
      Abstract: Autism, Ahead of Print.
      Prior research suggests that autistic adults are at increased risk for developing the core motor components of Parkinson’s disease (i.e. parkinsonism) although knowledge is limited to date. Therefore, we explore: (1) the prevalence of both continuous self-reported motor features typical of parkinsonism and the screen positivity rate for parkinsonism in two samples of older autistic adults without a suspected intellectual disability: the Netherlands-Sample (N = 296, 50–81 years; 183 males; 113 females) and the United States of America-Sample (N = 209, 50–83 years; 100 males; 109 females), and (2) whether there are differences between those who Screen+ versus Screen− for parkinsonism. Within the Netherlands-Sample only, the age of onset of the motor features was investigated. Self-reported parkinsonism features were prevalent in both samples (the Netherlands-Sample ~17% screened positive, mean age of onset ranging from 35.9 to 50.4 years; the United States of America-Sample ~33% screened positive). Autistic adults (the Netherlands-Sample) screening positive encountered more health problems than those who screened negative. In both samples, autistic adults who screened positive did not differ on current antipsychotic medication use relative to those who screened negative. The next step is to determine whether a positive screen for parkinsonism on this self-report questionnaire also implies that there is a higher risk for idiopathic Parkinson’s disease.Lay abstractAutistic adults without a suspected intellectual disability reported several motor features such as having tremors, and stiffness in one’s legs which are considered to be part of a complex of motor features called parkinsonism. This so-called parkinsonism was remarkably prevalent in middle-aged and older autistic adults in two independent studies (Dutch study: 50–81 years, 183 males, 113 females, all adulthood diagnoses; the USA study: 50–83 years, 110 females, 109 males, majority adulthood diagnosis). Parkinsonism can be part of the progressive motor disease—Parkinson’s disease. Therefore, it is important that future studies, including in-person neurological assessment, determine if (and if so, why) autistic adults who report these motor features are at increased risk for developing Parkinson’s disease.
      Citation: Autism
      PubDate: 2021-06-22T06:29:16Z
      DOI: 10.1177/13623613211020183
       
  • Experiences of autistic and non-autistic individuals participating in a
           corporate internship scheme

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      Authors: Anna Remington, Brett Heasman, Anna Melissa Romualdez, Elizabeth Pellicano
      Abstract: Autism, Ahead of Print.
      Autistic people have significant challenges in obtaining and maintaining employment yet there remains a shortage of research in this area, especially research directly comparing the experiences of autistic individuals to their non-autistic colleagues in the same organisation. The present study examined the experiences of autistic and non-autistic interns, and their managers, taking part in a corporate internship scheme. Data were gathered via semi-structured interviews and online questionnaires prior to, and following, the internship. Many commonalties were identified, with both groups of interns and managers sharing positive journeys through the internship. Specific issues raised by autistic interns centred around impact of prior employment experiences, mental health and communication. Compared to managers of non-autistic interns, managers of autistic interns reported having a greater range of pre-internship concerns, including concerns about providing the right level of support, communicating successfully and being equitable in treatment of all employees. Structured delegation of tasks and flexible communication were successful strategies used by managers to support autistic interns; clear communication and more consistent support were perceived to benefit both intern groups. The findings highlight specific challenges experienced by autistic individuals in the workplace and suggest effective ways to ensure that autistic interns succeed alongside non-autistic peers.Lay abstractAutistic people can find it difficult to find and keep a job, and fewer autistic people are employed compared with people from other disability groups. There is not enough research in this area, especially research that directly compares the experiences of autistic and non-autistic colleagues starting in an organisation at the same time. Our study looked at the experiences of autistic and non-autistic people taking part in an internship at Deutsche Bank, UK. We spoke to the interns before the internship began, and again once it had finished. We also asked the interns’ hiring managers about their experiences of the internship. We used interviews and online questionnaires to find out people’s views. Before the programme began, managers of autistic interns were more worried about the internship than managers of the non-autistic interns. They were worried about providing the right level of support, communicating successfully and treating all their employees fairly. At the end of the internship, everyone felt that the internship was a success. Managers of autistic interns explained how the experience had made them better managers. Both groups of interns and said that they benefitted from clear communication and would have likes more support. Managers of autistic interns spoke about dividing tasks up into smaller chunks and being flexible in their communication were helpful when working with the autistic interns. More work is needed to make sure that autistic interns are integrated alongside non-autistic peers. One way to make this happen might be to create guides for managers.
      Citation: Autism
      PubDate: 2021-06-19T09:31:04Z
      DOI: 10.1177/13623613211025115
       
  • Preschool teachers’ selection of social communication interventions for
           children with autism: An application of the theory of planned behavior

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      Authors: Maria L Hugh, LeAnne D Johnson, Clayton Cook
      Abstract: Autism, Ahead of Print.
      Early Childhood Special Education teachers select practices to use to promote social communication development for their students with autism spectrum disorder. Understanding what evidence-based practices teachers select and why can inform the development of dissemination and implementation supports at the critical Adoption-Decision stage of implementation. The researchers used discrete choice analysis to examine and test the effects of Early Childhood Special Education teachers’ beliefs (self-efficacy, attitude, subjective norms; Theory of Planned Behavior) about key evidence-based practices on their practice selections. To assess malleable determinants of practice selection, this study addressed these aims: (1) assess Early Childhood Special Education teachers’ beliefs (attitudes, subjective norms, and self-efficacy) about key evidence-based practices, (2) describe which evidence-based practices teachers selected, and (3) examine whether teachers’ beliefs predicted practice selections. A web-based survey gathered responses from 222 Early Childhood Special Education teachers. Participants had the most favorable beliefs about naturalistic intervention and the least about discrete trial teaching and scripting. These beliefs aligned with the frequencies with which these practices were selected, and teachers’ beliefs predicted which practices they selected. Together, these findings suggest that beliefs serve as determinants of Early Childhood Special Education teachers’ practice selections that can be acted on to tailor pre-implementation supports and improve implementation from the start.Lay abstractPreschool special educators’ are more likely to choose an educational practice to teach a young child with autism a social communication skill if they have positive beliefs about it. We asked preschool special educators to read a description of an autistic student and their social communication goal and imagine they were the student’s teacher. We then asked them to pick one of five practices to teach the student. We also asked them questions to understand their attitudes about, confidence in their ability to use, and their perception of their coworkers’ support of each practice. There are many research-based practices that a teacher could use to help children learn, and preschool teachers often make these decisions for their students. Teachers’ beliefs varied in how supportive they were of each practice, and research shows people are more likely to do something that their beliefs support. In this study, they had more supportive beliefs and were more likely to use some practices, like naturalistic intervention, than other practices, like discrete trial teaching. By knowing this, researchers can help teachers use practices that their beliefs support and help change teachers’ beliefs to be supportive of a practice they may need to use.
      Citation: Autism
      PubDate: 2021-06-15T10:18:20Z
      DOI: 10.1177/13623613211024795
       
  • Goal attainment scaling—community-based: A method to incorporate
           personalized outcomes into intervention research with youth and adults on
           the autism spectrum

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      Authors: Chung Eun Lee, Karrie A Shogren, Jordan Segal, Florencia Pezzimenti, Janeth Aleman-Tovar, Julie Lounds Taylor
      Abstract: Autism, Ahead of Print.
      Given the wide heterogeneity in the autism population, one challenge for intervention studies is to identify outcome measures that have similar meaning across individuals. This is particularly pronounced in intervention studies of adults with autism spectrum disorder, where outcomes such as employment, independence, or community living are common targets. However, these outcomes can be more challenging to obtain for those who have greater support needs, for example, and therefore may be more or less salient depending on the sample under study. Goal attainment scaling can help address this issue as it allows individuals to identify personally meaningful goals and track progress toward these goals. While goal attainment scaling is gaining popularity in the autism field as an outcome measure, most intervention studies that use goal attainment scaling have been situated in clinical or school settings. Generating reliable and scalable goals outside of these settings can be challenging. In this article, we describe the promise of goal attainment scaling for tailoring individualized outcomes among youth and adults with autism spectrum disorder and discuss the challenges of current goal attainment scaling methods in community-based intervention research. We then describe a new goal attainment scaling approach that is rigorous, practical, and can be used across research settings to measure individualized outcomes.Lay abstractAmong people with autism—all who have the same diagnosis—there are major differences on a nearly limitless number of areas, such as language, daily living skills, intellectual ability, sensory difficulties, and physical and mental health diagnoses. Despite these many differences, the targeted outcomes of intervention studies are often measured the same way across autistic adults, including outcomes such as getting a job, achieving greater independence, or getting more services. People have different goals and abilities, and it is important to have a way for intervention studies to measure outcomes in a way that is more personal to each individual. To address this issue, we developed a new approach—called “Goal Attainment Scaling—Community-based” or GAS-CB—to measure individualized outcomes across different research settings. In this article, we describe the need for individualized outcomes in autism intervention research and current approaches to gathering these outcomes, with our discussion focused on a method called goal attainment scaling. We then describe reasons why current goal attainment scaling approaches might not be useful in intervention research that takes place in the community. Finally, we discuss a new goal attainment scaling approach (GAS-CB) that can be flexibly used for research participants with very different characteristics.
      Citation: Autism
      PubDate: 2021-06-15T10:18:00Z
      DOI: 10.1177/13623613211024492
       
  • Using formative research to develop HEARTS: A curriculum-based healthy
           relationships promoting intervention for individuals on the autism
           spectrum

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      Authors: Emily F Rothman, Laura Graham Holmes
      Abstract: Autism, Ahead of Print.
      Curricula that teach relationship skills to autistic individuals are needed. The purpose of this formative research study was to describe the views of autistic youth about healthy and unhealthy friendships and dating relationships, in order to uncover what types of skills they felt would be useful to learn in a workshop-style intervention in order to have healthier peer relationships. The research was shaped by input from a five-person Advisory Board comprising autistic people. Twenty-five autistic individuals aged 16–22 years old were interviewed. The interviews were analyzed using an inductive content-based analysis approach. Interview participants described finding it challenging to remain motivated to make and maintain friendships, and that they would benefit from education about overcoming anxiety rooted in bad prior experiences that stop them from making new friends, learning when it was safe to take emotional risks, how they could cultivate reciprocity in relationships, and how to identify, communicate, and respect sexual and emotional boundaries. They also voiced a preference for mixed-gender interventions team taught by one neurotypical and one autistic facilitator. The experiences, opinions and preferences of the 25 autistic youth who were interviewed will inform the content of the forthcoming Healthy Relationships on the Autism Spectrum relationship skills intervention.Lay abstractWhat is already known about the topic' All people can benefit from education about how to have healthy friendships and dating relationships. But specific interventions on relationship skills—like respecting boundaries, identifying warning signs of abuse, or talking about sexual preferences—are too rare, particularly for autistic individuals. The goal of this study was to collect formative data from autistic emerging adults to help create a new, six-session workshop for autistic young adults to support healthy peer relationships. Twenty-five autistic youth aged 16–22 years old were interviewed.What this paper adds' The participants described a need for more and better information about how to support lasting friendships, deal with their anxiety about relationships, and know when friendships or dating relationships were reciprocal and rewarding versus unhealthy.Implications for practice, research, or policy. The results reveal a need for a new and effective intervention that supports healthy relationship skills for autistic people.
      Citation: Autism
      PubDate: 2021-06-12T08:57:19Z
      DOI: 10.1177/13623613211024521
       
  • Mental health correlates and potential childhood predictors for the wish
           to be of the opposite sex in young autistic adults

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      Authors: Jung-Chi Chang, Meng-Chuan Lai, Yueh-Ming Tai, Susan Shur-Fen Gau
      Abstract: Autism, Ahead of Print.
      Cross-sectional research has demonstrated the overrepresentation of gender dysphoria in children and adults with autism spectrum disorder. However, the predictors and underlying mechanisms of this co-occurrence remain unclear. This follow-up study aimed to explore baseline (childhood/adolescence) predictors for the follow-up (adulthood) self-reported wish to be of the opposite sex and to investigate its mental health correlates in a sample of 88 autistic individuals as compared with 42 typically developing controls. An item on the Adult Self-Report Inventory-4, “I wish I was the opposite sex,” was used. We compared mental health symptoms between adults with and without this item endorsement. We used prediction models to explore family and autism-related predictors in childhood/adolescence to endorse this item in adulthood. There were more adults endorsing the item in the autism spectrum disorder group compared with the typically developing group. Autistic adults who endorsed the item experienced more mental health challenges, more bullying victimization, more suicidal ideations, and worse quality of life. Lower parent-reported family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. It is necessary to raise more attention to gender development and related mental health impact in autistic individuals.Lay abstractAutistic people/people with autism spectrum disorder are more likely to experience gender dysphoria. However, the possible longitudinal predictors and underlying mechanisms of this co-occurrence are unclear. To fill this knowledge gap, we assessed 88 people with autism spectrum disorder and 42 typically developing individuals at their average ages of 13.0 (baseline, childhood/adolescence) and 20.2 years old (follow-up, adulthood). At follow-up, their endorsement on the item “I wish I was the opposite sex” was used to evaluate gender dysphoric symptoms. We compared mental health symptoms between adults with and without this item endorsement at the follow-up assessment. We explored parent-reported family and autism characteristics-related predictors in childhood/adolescence to this item endorsement in adulthood. We found that more autistic adults reported the wish to be of the opposite sex than did typically developing individuals. Autistic adults who endorsed this item experienced more mental health challenges, more school bullying and cyberbullying, more suicidal ideation, and worse quality of life. Moreover, parent-reported lower family support and more stereotyped/repetitive behaviors during childhood/adolescence predicted the self-reported wish to be of the opposite sex in adulthood in autistic individuals. More attention and support should be provided to autistic people regarding gender development and related mental health and quality of life impact, especially during the transition period to young adulthood.
      Citation: Autism
      PubDate: 2021-06-12T08:57:06Z
      DOI: 10.1177/13623613211024098
       
  • Influence of siblings on adaptive behavior trajectories in autism spectrum
           disorder

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      Authors: Nicole E Rosen, James B McCauley, Catherine Lord
      Abstract: Autism, Ahead of Print.
      Siblings play an important role in shaping the developmental trajectories of individuals with autism spectrum disorder. Having siblings has been associated with better social communication, non-verbal communication, and theory of mind abilities in autism spectrum disorder. However, little is known about the impact of siblings on adaptive skill growth over time, even though adaptive behavior competencies are among the strongest predictors of positive outcomes in autism spectrum disorder. This study examined the influence of sibling constellation factors, including the presence of siblings, position in birth order, gender of closest-age sibling, and gender match of sibling dyad on the adaptive behavior trajectories of individuals with autism spectrum disorder and non-spectrum disorders from ages 9 to 26 years. Participants with one or more siblings experienced faster growth rates in adaptive behavior from childhood to adulthood than participants without siblings across both Black and White participants, although effects were magnified in Black participants. Furthermore, among participants with siblings, those with male closest-age siblings and those with gender-matched siblings, irrespective of birth order, demonstrated the steepest adaptive skill growth within their respective groups over the 17-year period. Results suggest that siblings may serve an important role in improving the adaptive functioning trajectories and overall outcomes of individuals with autism spectrum disorder.Lay abstractSiblings have the potential to shape the developmental trajectories of individuals with autism spectrum disorder. Having siblings has been associated with better social communication skills, less severe non-verbal communication deficits, and improved theory of mind abilities in autism spectrum disorder. This study examined the influence of the presence of a sibling, participant’s position in the birth order, gender of the closest-age sibling, and gender match of the sibling dyad on the rate of growth in adaptive skills from ages 9 to 26 years among individuals with autism spectrum disorder and individuals with a history of non-spectrum developmental disorders. While all participants showed consistent gains in adaptive skill development as a function of age, there was variability in rates of growth based on sibling constellation group membership. Participants with at least one sibling, regardless of other sibling constellation factors, experienced greater rates of growth in adaptive behavior trajectories from childhood to adulthood than participants with no siblings across both Black and White participants, although differences were magnified in Black participants. Furthermore, among participants with siblings, those with male closest-age siblings and those with gender-matched siblings, irrespective of birth order position, demonstrated the steepest growth patterns in adaptive functioning within their respective groups over the 17-year period. Results suggest that siblings may serve an important role in improving the adaptive functioning trajectories and overall outcomes of individuals with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-06-12T08:56:46Z
      DOI: 10.1177/13623613211024096
       
  • Where are US outpatient mental health facilities that serve children with
           autism spectrum disorder' A national snapshot of geographic
           disparities

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      Authors: Jonathan Cantor, Ryan K McBain, Aaron Kofner, Bradley D Stein, Hao Yu
      Abstract: Autism, Ahead of Print.
      Despite a rise in the observed prevalence of autism spectrum disorder among children, few estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. We identified key facility- and county-level characteristics in offering mental health care for children with autism spectrum disorder. This study utilized a secret shopper telephone survey to contact almost all outpatient mental health treatment facilities in the contiguous United States. We estimated multivariable regressions to examine county- and facility-level predictors of offering services for children with autism spectrum disorder. We found that 50.3% of 6156 outpatient facilities reported offering care for children with autism spectrum disorder. Non-metro counties, counties with a lower percentage of non-White residents, counties with a higher percentage of uninsured residents, and counties with a higher poverty rate had fewer outpatient mental health treatment facilities providing care for children with autism spectrum disorder. Facilities accepting Medicaid as a form of payment, offering telehealth, and private for-profit facilities were more likely to provide services for children with autism spectrum disorder. Only half of outpatient mental health treatment facilities offered care for children with autism spectrum disorder, and both rural and lower socioeconomic status counties were less likely to have a facility offering care for children with autism spectrum disorder.Lay abstractThere has been a rise in the observed prevalence of autism spectrum disorder among children. Existing studies show the share of counties with a treatment facility that offers care for children with autism spectrum disorder. However, no estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. We identified key facility-level characteristics in offering mental health care for children with autism spectrum disorder. We used a telephone survey to contact almost all outpatient mental health treatment facilities in the contiguous United States. We asked the facilities if they provided mental health care for children with autism spectrum disorder. We took the results of this survey and estimated multivariable regressions to examine county- and facility-level predictors of offering services. We found that over half (50.3%) of the 6156 outpatient facilities reported offering care for children with autism spectrum disorder. Non-metro counties, counties with a lower percentage of non-White residents, counties with a higher percentage of uninsured residents, and counties with a higher poverty rate had fewer outpatient mental health treatment facilities providing care for children with autism spectrum disorder. Facilities accepting Medicaid as a form of payment, offering telehealth, and private for-profit facilities were more likely to provide services for children with autism spectrum disorder. Because only half of outpatient mental health treatment facilities offer care for children with autism spectrum disorder, public health officials and policymakers should do more to ensure that this vulnerable population has access to mental health services.
      Citation: Autism
      PubDate: 2021-06-12T08:56:37Z
      DOI: 10.1177/13623613211024046
       
  • Dyadic coping and coparenting among couples after their child’s
           recent autism diagnosis

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      Authors: Naomi Downes, Marie-Maude Geoffray, Pascale Isnard, Eric Lemonnier, Marie-Joëlle Orêve, Emilie Cappe
      Abstract: Autism, Ahead of Print.
      This study explores how parenting couples use their relationship to support each other after their child’s autism diagnosis by assessing the role of dyadic coping and parenting sense of competence as predictors of their coparenting quality. Mothers and fathers raising a child on the spectrum (N = 70 couples) individually completed self-report questionnaires measuring stress appraisal, dyadic coping, parenting sense of competence, and coparenting. Parents were recruited 1–36 months after their child’s autism diagnosis and data were analyzed using the actor-partner interdependence model. Parents’ dyadic coping and sense of competence were related to their level of coparenting. Partner effects were found as mothers’ dyadic coping was positively linked to fathers’ coparenting and a higher sense of competence among fathers predicted mothers’ coparenting. Further research is needed to understand how these effects evolve throughout the child’s development stages.Lay abstractWe investigated how couples support each other after their child’s autism diagnosis and whether this affects the way they work together to raise their child. We recruited 70 couples raising a child on the autism spectrum. Both partners were asked to complete the same questionnaires measuring how they perceived the experience of having a child on the autism spectrum, how they used their relationship to support each other during stressful situations, how competent they felt completing their parenting tasks, and the coparenting relationship to explore how they worked together as a team when parenting their child. Parents participated in the study 1–36 months after their child’s autism diagnosis. We used statistical techniques that allowed us to see the impact mothers and fathers had on each other. Overall, parents who felt more competent and supported by their partner worked better as a team to raise their child on the spectrum. Fathers invested in the coparenting relationship more when mothers felt more supported by fathers. Mothers invested in the coparenting relationship more when fathers felt more competent parenting their child. Further research is needed to better understand how we can support couples as their child gets older.
      Citation: Autism
      PubDate: 2021-06-08T08:17:35Z
      DOI: 10.1177/13623613211020916
       
  • Pragmatic adaptations of telehealth-delivered caregiver coaching for
           children with autism in the context of COVID-19: Perspectives from the
           United States and South Africa

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      Authors: Lauren Franz, Jill Howard, Marisa Viljoen, Linmarie Sikich, Tara Chandrasekhar, Scott H Kollins, Lawrence Lee, Minkateko Ndlovu, Maura Sabatos-DeVito, Noleen Seris, Nokuthula Shabalala, Marina Spanos, Petrus J de Vries, Geraldine Dawson
      Abstract: Autism, Ahead of Print.
      When COVID-19 disrupted autism spectrum disorder research globally, many clinical trials of behavioral interventions pivoted to telehealth. Telehealth has the potential to increase geographic reach and improve racial/ethnic diversity in research. This matters because most autism spectrum disorder intervention studies have primarily included White, upper-middle-income families from North America and Europe. Participant homogeneity limits our ability to identify what types of intervention works in which context for which populations. Importantly, telehealth needs to “fit” the local context, and in particular, include strategies that factor in the “digital divide.” This short report details contextual considerations and pre-implementation pragmatic adaptations in two autism spectrum disorder clinical trials that include Early Start Denver Model–informed caregiver coaching in the United States and South Africa. By comparing and contrasting how implementation context informed the telehealth pivot in these two clinical trials in different hemispheres, we highlight equity considerations for adaption. The pandemic is an opportunity to understand how remote intervention can “fit” diverse contexts, while providing valid scientific results. It is however important that adaptations be documented and feasibility of the adapted approach be tracked. COVID-19-related telehealth adaptations of behavioral interventions could facilitate the development of new strategies with wider global impact.Lay abstractCOVID-19 caused many autism spectrum disorder caregiver-coaching studies to move to telehealth. Telehealth can increase the diversity of people who take part in research. This matters because most autism spectrum disorder studies have included people who have resources, are White, and live in North America and Europe. When study participants are similar, it is hard to understand which interventions can help different types of people who live in different parts of the world. While telehealth may allow more people to take part in research, it needs to “fit” the local context and consider the “digital divide” because many people around the world have no access to computers and the Internet. This short report describes changes to two research studies that include caregiver coaching based on the Early Start Denver Model in the United States and South Africa. We describe how the local context, including technology and Internet access, guided the telehealth approach. By doing so, we highlight ways to make telehealth available to more people around the world. The pandemic can help us understand how telehealth can “fit” diverse places and support high-quality research. It is important that study changes are tracked and we assess how well the changes work. COVID-19 telehealth changes to caregiver coaching can result in new ways to reach more people around the world.
      Citation: Autism
      PubDate: 2021-06-08T08:17:15Z
      DOI: 10.1177/13623613211022585
       
  • Behavior analytic interventions for children with autism: Policy and
           practice in the United Kingdom and China

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      Authors: Yini Liao, Karola Dillenburger, Xiaoyi Hu
      Abstract: Autism, Ahead of Print.
      This study explored the experiences of professionals and parents from the United Kingdom and China of autism-relevant policies, school involvement, and applied behavior analysis-based interventions. Semistructured interviews involving 36 parents and professionals and direct behavioral observations were carried out of five parents and three professionals. Results found: (1) a lack of autism support and applied behavior analysis-related services in both countries; (2) applied behavior analysis-based intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular applied behavior analysis-based intervention, discrete trial teaching, was similar and increased with ongoing training. Professional and parental experiences were discussed in the context of policy and educational involvement. This study illustrates the need to support children with autism and to consider regional adaptations of evidence-based practice of behavior analysis for the affected population.Lay abstractThe prevalence of autism is increasing, and the development of these children and the lived experience of their families have become a global concern. Applied behavioral analytic intervention is proved to be effective in improving their cognitive abilities, language skills, and social and emotional skills, but the service delivery between developed and developing countries is different. A qualitative study was conducted to explore personal experiences with actual practice fidelity of behavior analytic services for children with autism in a Western developed country (United Kingdom) and an Eastern developing country (China). The study found: (1) a lack of support for autism and behavioral analytic services in both countries; (2) applied behavioral analytic intervention was not as widely endorsed by healthcare or educational systems in the United Kingdom; Chinese parents faced challenges around inclusive education and accessing high-quality services and there was a social stigma attached to autism; (3) a limited awareness and application of early intensive behavior intervention in both regions; and (4) intervention fidelity with regards to the practice of one particular aspect of behavioral analytic interventions was similar and increased with ongoing training. This study emphasizes the need to support children with autism, and to consider regional adaptations of evidence-based practice of behavior analytic interventions for the affected population.
      Citation: Autism
      PubDate: 2021-06-08T07:48:07Z
      DOI: 10.1177/13623613211020976
       
  • Meeting the needs of autistic adults in Qatar: Stakeholder perspectives on
           gaps in services and priorities for future programming

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      Authors: Serene Habayeb, Sanaa Al-Harahsheh, Allison Ratto, Alyssa Verbalis, Cara Pugliese, Nicole Nadwodny, Feras Al-Meer, Maha El-Akoum
      Abstract: Autism, Ahead of Print.
      Autism services in Qatar are expanding rapidly, but focus predominantly on young children. The shortage of qualified autism providers and minimal opportunities for autistic youth to participate in school, work, and community have led to a growing population of autistic youth transitioning to adulthood with substantial unmet needs for behavioral support and instruction in critical life skills. Our objective was to identify the needs and preferences for respite care for autistic adolescents and young adults in Qatar utilizing family and stakeholder input. Researchers from the United States collaborated with researchers and community leaders from Qatar to evaluate perspectives regarding respite care with families of autistic people (n = 11) and providers/community stakeholders (n = 20) through surveys and focus groups. Four main themes emerged including (1) a need for trust and reliability of individuals and of systems to support autistic adults, (2) prioritizing quality of life for autistic individuals and their families, (3) seeking meaningful inclusion, and (4) challenges stemming from service delivery systems. Families in Qatar endorsed clear interest in respite care services for young adults with autism, regardless of their child’s age. This study highlights the value of including both provider expertise and family concerns in developing new services for an under-served community.Lay abstractQatar is expanding the services that it offers for autistic people, but these services focus mainly on diagnosing and treating young children. Because there are not enough autism providers in Qatar and few opportunities for autistic youth to participate in the community, more and more autistic teens and young adults have unmet needs during their transition to adulthood. The goal of this study was to conduct a needs assessment of transition-age autistic youth in Qatar and their families in order to inform the development of an adult respite care and support center. Respite care is a service that provides families with stress relief and time to participate in activities that are more difficult to do when their loved one with a disability is with them. The objective of this study was to use family and stakeholder input to identify the needs and preferences for respite care for autistic youth in Qatar. The project was conducted with a local research team in Qatar and a team of clinical researchers in the United States specializing in autism. Stakeholders, including parents of autistic people and providers working with individuals with autism, completed surveys and participated in focus groups. Families and providers in Qatar were very interested increasing services for young adults with autism to improve quality of life, although wanted to make sure the service providers would be reliable and trustworthy. Implications from this study may substantially improve the lives of autistic adults in Qatar.
      Citation: Autism
      PubDate: 2021-06-07T04:51:50Z
      DOI: 10.1177/13623613211020623
       
  • Participatory autism research: Early career and established
           researchers’ views and experiences

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      Authors: Hannah Pickard, Elizabeth Pellicano, Jacquiline den Houting, Laura Crane
      Abstract: Autism, Ahead of Print.
      Despite more autism research taking place than ever before, there is a disconnect between the current landscape of autism research and what autistic people and their allies want from research. While participatory research has been proposed as a potential solution, we know little about how researchers (particularly, early career researchers) employ this approach. We interviewed 25 researchers (14 early career and 11 established researchers) about their views and experiences of participatory autism research. Through reflexive thematic analysis of interview and focus group data, we identified three themes. First, our participants emphasised the flexible nature of participatory research, and the many forms it can take; yet noted that this flexibility could cause confusion. Second, our participants highlighted the importance of building relationships with research partners, while commenting on the challenges around effective communication and working with diverse groups of people who may have limited research experience. Finally, participants described the challenges of working within academic environments that are not conducive to participatory research (e.g. due to limited time, funding and support). We discuss these issues with regard to changes required at both an individual and systemic level, ensuring that efforts are made to meaningfully involve autistic people and their allies in all stages of the research process.Lay abstract‘Participatory autism research’ refers to ways of involving autistic people and their allies (e.g. family members) in making decisions about research. These decisions can include what research gets done, how it gets done and how research findings are used. While there is more and more interest in participatory autism research, we know little about how researchers at different stages of their careers use this approach. To find out more, we discussed these issues with 25 researchers. Fourteen of these were at an early stage of their careers, and 11 were more senior researchers. We spoke to people in individual interviews or in groups. We then used a technique called thematic analysis to analyse our data, which involved us looking for common topics or ‘themes’ discussed by our participants. What did we find' Our participants told us that participatory autism research was a flexible approach, meaning that autistic people can be involved in research in many different ways. While people viewed this flexibility in a positive way, it also caused some confusion about what does or does not ‘count’ as participatory research. Our participants also spoke about how important it was to build relationships with those involved in their research, but they also said it could be difficult to communicate well with diverse groups of people who may not have much experience of research. Finally, our participants said it was hard to do participatory research when there was not much time, funding or support available to researchers. In this article, we discuss these findings, focusing on what needs to change to ensure that autistic people and their allies are meaningfully involved in autism research.
      Citation: Autism
      PubDate: 2021-06-05T05:56:21Z
      DOI: 10.1177/13623613211019594
       
  • Cognitive profiles of children with autism spectrum disorder with
           parent-reported extraordinary talents and personal strengths

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      Authors: Vanessa H Bal, Ellen Wilkinson, Megan Fok
      Abstract: Autism, Ahead of Print.
      It is essential to recognize the strengths and talents of autistic individuals. Previous studies of extraordinary talents (i.e. skills that stand out relative to the general population) have combined individuals with different skills (e.g. calendrical calculation, drawing) into one group. There has been limited investigation of talents in specific areas and even less consideration of personal strengths (i.e. skills that stand out relative to that person’s other abilities, but not the general population). We extend this literature by examining the relationship between parent-reported talents and strengths and performance on standardized cognitive tests in 1470 children (4–18 years) from the Simons Simplex Collection with autism and IQ above 70. Almost half (46%) had at least one parent-reported talent and an additional 23% without extraordinary talents had at least one personal strength. Children with parent-reported talents and strengths had different cognitive profiles than children with no reported skill in visuospatial, drawing, computation, or music. Those highlighted for their memory abilities had somewhat more even verbal and nonverbal abilities, relative to children whose memory was not emphasized as a special skill. These results emphasize the importance of exploring strengths separately by domain and a need for more research in this area.Lay abstractPrevious research has suggested that focusing on impairments can be detrimental to the well-being of autistic individuals, yet little research has focused on strengths and positive qualities in autism. Some studies explored “savant skills” (herein referred to as “extraordinary talents”), that is, skills that stand out compared to the general population. These often group everyone who has a specific talent, rather than exploring subgroups with strengths in specific areas. There has been even less research focused on personal strengths (i.e. skills that stand out relative to the individual’s other abilities, but not the general population). To expand this research, we use a sample of 1470 children (ages 4–18 years) from the Simons Simplex Collection without cognitive impairment to examine the relationship between having a parent-reported skill in a specific area and performance on a standardized cognitive test. Almost half (46%) had at least one parent-reported talent and an additional 23% without extraordinary talents had at least one personal strength. Children with these parent-reported skills had different patterns of performance on these standardized tests than children without skills in that area (i.e. visuospatial, drawing, computation, reading, and memory). Specific skills in computation or reading were associated with higher overall performance on the standardized tests. These results emphasize the importance of considering strengths separately by area, rather than combining individuals with different types of strengths. The high number of children with skills in this study underscores the need for more research in this area, particularly using instruments focused on understanding the nuances of these strengths. It is important for future studies to consider these skills in children with cognitive impairment.
      Citation: Autism
      PubDate: 2021-06-05T05:55:50Z
      DOI: 10.1177/13623613211020618
       
  • Male autistic youth experiences of belonging in integrated physical
           education

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      Authors: Justin A Haegele, Anthony J Maher
      Abstract: Autism, Ahead of Print.
      The study examined the subjective experiences of autistic youth regarding the role of peer interactions and relationships in feelings of belonging in integrated physical education classes. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. Eight autistic youth (all male, aged 13–18 years) who had received most of their physical education in integrated classes acted as participants. Semi-structured interviews were used to generate qualitative data, which were analyzed using a reflexive thematic approach. Findings are presented in three themes: (a) bullying can lead to self-harm and self-isolation, (b) peer interactions and relationships in the locker room, and (c) peer relationships are based on shared interests and take time to develop. Even though autistic students were educated in the same spaces as their non-autistic peers, feelings of belonging were largely unavailable to them.Lay abstractRecent years have seen calls to amplify the voices of autistic people in research about their subjective experiences. Despite this, we know little about how autistic youth experience integrated physical education, particularly in the United States. The term integrated is used to describe a setting in which all students, regardless of educational needs, are educated in the same physical space. In this study, we sought to explore the perspectives of autistic youth toward their experiences in integrated physical education, and the roles of social interactions and relationships with peers in those experiences. Findings noted that several factors influenced the ways and extent to which our participants interacted with their peers during physical education. Unfortunately, most of our participants recalled experiencing bullying, and that physical education offered an environment where bullying was most frequent and comparatively unique compared to other contexts throughout the school day. The locker room, a space linked to physical education, was of particular concern because of a lack of teacher presence. Despite the negative views of and experiences in physical education, there was evidence of participants actively pursuing to connect with peers in this context. However, most instances where participants recalled pursuing friendship were not welcomed from others, which stunted their sense of belonging in this space. Given the role that belonging plays in what it means “to be included,” our research supports emerging ideas that even though autistic students were educated in the same physical spaces as their non-autistic peers, feelings of inclusion were largely absent.
      Citation: Autism
      PubDate: 2021-06-02T09:13:30Z
      DOI: 10.1177/13623613211018637
       
  • Recognition of affective prosody in autism spectrum conditions: A
           systematic review and meta-analysis

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      Authors: Minyue Zhang, Suyun Xu, Yu Chen, Yi Lin, Hongwei Ding, Yang Zhang
      Abstract: Autism, Ahead of Print.
      Affective prosody recognition is an important area of research in autism spectrum conditions where difficulties in social cognition have been frequently observed. To probe into the mixed results reported in the literature, we conducted a systematic review with meta-analysis and examined potential factors that could explain the inconsistent results. Our literature search included six electronic databases for studies that compared the affective prosody recognition performance in individuals with autism spectrum condition with typically developing participants, which yielded 23 papers eligible for quantitative synthesis. Using a random-effects model, we obtained a moderate-to-large pooled effect (Hedges’ g = −0.63) for the overall affective prosody recognition performance of autism spectrum condition participants, which, however, reduced substantially (to −0.26) and became non-significant after the correction for publication bias. The number of answer codes was found to be a significant moderator for the effect estimate, whereas the number of speakers was not. Moreover, the magnitude of the pooled effect estimate varied across emotions. The findings suggested moderate differences in affective prosody recognition ability between autism spectrum condition and typically developing individuals, which reduced to marginal difficulties for autism spectrum condition when the impact of publication bias was taken into account. Diversity in the number of answer codes could have differential effects on affective prosody recognition performance in autism spectrum condition, which varied across emotions. The present review and meta-analysis demonstrated the insufficiency of research on affective prosody recognition in autism spectrum condition, highlighting a need for further exploration of the contributors and underlying mechanisms for specific affective prosody recognition difficulties.Lay abstractDifferences in understanding others’ emotions and attitudes through features in speech (e.g. intonation) have been observed in individuals with autism spectrum conditions, which contribute greatly to their social communication challenges. However, some studies reported that individuals with autism spectrum condition performed comparably to typically developing individuals on affective prosody recognition. Here, we provide a comprehensive review with statistical analysis of 23 existing studies on this topic to examine potential factors that could explain the discrepancies. Compared with typically developing individuals, autism spectrum condition participants generally appeared to encounter more difficulties in affective prosody recognition. But this finding was likely due to the tendency of the existing research to overly focus on deficits in autism. The affective prosody recognition performance in individuals with autism spectrum condition was closely related to the number of answer options offered to them. Moreover, the degree of difficulty in affective prosody recognition encountered by individuals with autism spectrum condition varied across emotions. The findings of this systematic review highlighted the need for further research on affective prosody recognition in autism (e.g. studies that include tonal language speakers and autism spectrum condition individuals with lower cognitive or verbal abilities).
      Citation: Autism
      PubDate: 2021-03-16T04:55:19Z
      DOI: 10.1177/1362361321995725
       
  • Oxytocin levels tend to be lower in autistic children: A meta-analysis of
           31 studies

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      Authors: Simon John, Adrian V Jaeggi
      First page: 2152
      Abstract: Autism, Ahead of Print.
      The oxytocin system may be different in autistic people, which could explain some of the deficits in social behavior and cognition associated with autism spectrum disorder. However, studies comparing oxytocin levels in autistic and neurotypical individuals have shown conflicting results and a 2016 meta-analysis on seven studies concluded that there was no significant difference. Here, we greatly expanded the sample of studies to 31, warranting a reassessment of this finding. We searched Web of Science with MEDLINE®, SciELO Citation Index, and BIOSIS Citation Index for articles that measured oxytocin in plasma/serum (k = 26 studies), saliva (4), or cerebrospinal fluid (1) in autistic individuals (total n = 1233 participants) compared to neurotypical individuals (n = 1304). We found that oxytocin levels were significantly lower in autistic people (Cohen’s d = −0.36, 95% confidence interval = [−0.61, −0.10], p = 0.007), with no evidence for publication bias. This overall effect was driven entirely by differences among children (k = 25, d = −0.44, 95% confidence interval = [−0.72, −0.16], p = 0.002) but not adults (k = 6, d = 0.03, 95% confidence interval = [−0.55, 0.61], p = 0.92). These results support further research into the use of oxytocin to treat social deficits in children.Lay abstractOxytocin is a hormone that mediates interpersonal relationships through enhancing social recognition, social memory, and reducing stress. It is released centrally into the cerebrospinal fluid, as well as peripherally into the blood, where it can easily be measured. Some studies indicate that the oxytocin system with its social implications might be different in people with autism spectrum disorder. With summarizing evidence of 31 studies, this meta-analysis suggests that children with autism spectrum disorder have lower blood oxytocin levels compared to neurotypical individuals. This might not be the case for adults with autism spectrum disorder, where we could not find a difference. Our findings motivate further exploration of the oxytocin system in children with autism spectrum disorder. This could lead to therapeutic options in treating autism spectrum disorder in childhood.
      Citation: Autism
      PubDate: 2021-07-26T05:20:02Z
      DOI: 10.1177/13623613211034375
       
  • Pathological demand avoidance in children and adolescents: A systematic
           review

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      Authors: Arvid N Kildahl, Sissel B Helverschou, Anne L Rysstad, Elisabeth Wigaard, Jane MA Hellerud, Linn B Ludvigsen, Patricia Howlin
      First page: 2162
      Abstract: Autism, Ahead of Print.
      Requests for pathological demand avoidance diagnoses have increased over recent years but pathological demand avoidance remains a controversial issue. We undertook a systematic review of peer-reviewed studies of pathological demand avoidance, using standardised appraisal and synthesis methods, to assess how pathological demand avoidance is identified and to explore the relationships between pathological demand avoidance, autism and other developmental/psychiatric disorders. A search of PsycINFO/PubMed/MEDLINE/Embase identified 13 studies meeting inclusion criteria. Narrative synthesis was chosen due to methodological heterogeneity of the identified studies. Autistic children/adolescents constituted the majority of participants in most studies. Most studies provided clearly defined inclusion criteria together with adequate descriptions of participants and study settings. Almost all studies relied on the parental report of pathological demand avoidance symptoms/diagnosis. Identification of pathological demand avoidance in all studies seemed to be, directly or indirectly, based on the criteria developed by Newson et al. While eight studies used objective criteria for the identification of pathological demand avoidance, the measures used have methodological limitations. Though associations with anxiety have been reported, few studies took account of possible relationships between pathological demand avoidance and other conditions, such as anxiety. Methodological limitations restrict current conclusions regarding the uniformity or stability of the constellation of behaviours associated with pathological demand avoidance or the characteristics of individuals displaying them. Clinical implications of current research are discussed.Lay Requests for diagnoses of pathological demand avoidance have increased over recent years, but pathological demand avoidance remains a controversial issue. The concept of pathological demand avoidance has been criticised for undermining the self-advocacy of autistic people and neglecting the potential role of anxiety as a possible underlying or contributing cause. The current study was undertaken to summarise and review the methodological quality and findings from current research into pathological demand avoidance in children and adolescents. Further aims were to describe how pathological demand avoidance has been identified and to explore the relationships with autism and other developmental and psychiatric disorders. After a comprehensive search, 13 relevant studies using a wide range of methods were identified and systematic quality assessments were undertaken. All the studies had based the identification of pathological demand avoidance, directly or indirectly, on descriptions from the original study by Newson and colleagues. However, the methods used to develop these criteria were not clearly described. Most studies relied exclusively on parental report for data, and there was a general failure to take account of alternative explanations for the behaviours under study. No studies explored the views of individuals with pathological demand avoidance themselves. Problems concerning definition and measurement in the reviewed studies currently limit any conclusions regarding the uniformity or stability of the behaviours described, or the characteristics of individuals displaying them. Relationships between pathological demand avoidance and other emotional and behavioural difficulties should be explored in future research, as should the perspectives of individuals with pathological demand avoidance themselves.
      Citation: Autism
      PubDate: 2021-07-29T05:29:48Z
      DOI: 10.1177/13623613211034382
       
  • Non-autistic employees’ perspectives on the implementation of an
           autism employment programme

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      Authors: Jennifer R Spoor, Simon M Bury, Darren Hedley
      First page: 2177
      Abstract: Autism, Ahead of Print.
      Although employees’ attitudes towards an autism employment programme may impact its ultimate success, there is limited research examining the implementation of these programmes from the perspective of non-autistic employees (i.e. co-workers and managers). This study explored the implementation of an Australian-based supported autism employment programme, drawing on qualitative data collected from 32 employees working with autistic trainees in the programme. Thematic analysis revealed three main themes. The programme benefits theme suggested that the employment programme and autistic trainees were generally viewed positively, with the programme benefitting both the trainees and the organisation, and leading to greater understanding of autism. However, negative attitudes and perceptions of special treatment contributed to programme challenges, which paralleled challenges that have been observed with other disability and diversity programmes. The design of this specific programme led to concerns about workforce integration, such as reduced opportunity for social and work integration into the broader workplace. This research extends the research on diversity management in the context of autism employment and provides practical insights into barriers and facilitators associated with implementing autism employment programmes.Lay abstractWe asked 32 employees who work alongside autistic trainees for their thoughts about the autism employment programme that is running in their company. Specifically, we analysed their responses to understand how the employees perceived the autism employment programme’s implementation and outcomes. How employees within an organisation view diversity, and the nature of specific programmes to increase the inclusion of certain groups of individuals (e.g. autistic employees) in their organisation, can impact the success of these programmes. Research in other organisations has suggested that diversity perspectives that fully support the inclusion of people with diverse backgrounds in the organisation lead to better outcomes. Thematic analysis of the responses in this study revealed that the views of the employees fit three main themes: programme benefits, programme challenges and concerns about workforce integration. The programme benefits theme suggested that the autism employment programme was viewed positively. However, negative attitudes and perceptions of special treatment contributed to programme challenges, which were similar to challenges that have been observed with other disability and diversity programmes. The design of this specific programme led to concerns about workforce integration, such as reduced opportunity for social and work integration into the broader workplace. This research extends the research on diversity management in the context of autism employment, and it provides practical understanding into ways in which organisational-based autism employment programmes are more and less successful.
      Citation: Autism
      PubDate: 2021-05-08T04:57:20Z
      DOI: 10.1177/13623613211012880
       
  • Parental relationship status and age at autism spectrum disorder diagnosis
           of their child

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      Authors: Luther G Kalb, Calliope Holingue, Danika Pfeiffer, Rachel Reetzke, Emily Dillon, Gazi Azad, Brian Freedman, Rebecca Landa
      First page: 2189
      Abstract: Autism, Ahead of Print.
      A reliable autism spectrum disorder (ASD) diagnosis can occur as early as 18 months; however, the average age at diagnosis in the United States is over 2 years later. While there are numerous well-known barriers to seeking an ASD diagnosis, no research has examined if separation between a child’s biological parents affects timing of ASD diagnosis for their child. Data for this study were obtained from 561 children (M age = 5.4 years, SD = 3.9 years) referred to an urban, outpatient ASD specialty clinic for their first ASD evaluation. Biological parents self-reported their relationship status during the evaluation, which was then categorized as either “together” (married or living together but not married) or “not together” (separated, divorced, or never married). An inverse-probability of exposure weighted linear regression model, which adjusted for 16 different child, family, and sociodemographic variables, was utilized to assess differences in child age of ASD diagnosis between groups. At the time of diagnosis, most children’s biological parents were together (69%) versus not together (31%). In the fully adjusted model, children of parents who were together were diagnosed 1.4 years earlier than those who were not together (p < 0.001). Strategies for supporting these families and reducing age disparities are indicated.Lay abstractAutism spectrum disorder (ASD) can be diagnosed as early as 18 months of age. However, the average age at diagnosis in the United States is over 2 years later. A lot has been written about the many barriers families face when seeking a diagnosis for their child. One area of research that has received no attention is whether separation between a child’s biological parents affects the age at which a child is diagnosed with ASD. This study was conducted among 561 children who were receiving an ASD diagnosis for the first time. On average, these children were 5 years of age. The study took place in an urban, outpatient specialty autism clinic in the United States. Biological parents self-reported their relationship status during the evaluation. This was categorized as either “together” (married or living together but not married) or “not together” (separated, divorced, or never married). At the time of diagnosis, most children’s biological parents were together (69%). We found children of parents who were together were diagnosed 1.4 years earlier than those who were not together. These findings have important implications for providing support to families that separate early in a child’s life, with the goal of reducing the age at ASD evaluation among single parents and those who have been separated from their child’s other biological parent. Providing support to these families is important since earlier age at diagnosis leads to earlier intervention, which can improve long-term outcomes for the child, family, and community as a whole.
      Citation: Autism
      PubDate: 2021-05-19T06:24:13Z
      DOI: 10.1177/13623613211013683
       
  • Unmet health care needs and health care quality in youth with autism
           spectrum disorder with and without intellectual disability

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      Authors: Michelle Menezes, Melissa F Robinson, Christina Harkins, Eleonora Sadikova, Micah O Mazurek
      First page: 2199
      Abstract: Autism, Ahead of Print.
      Research indicates that youth with autism spectrum disorder often experience unmet health care needs and receive poorer quality of care. Intellectual disability commonly co-occurs with autism spectrum disorder; however, the nature of unmet health care needs and health care quality in youth with autism spectrum disorder and intellectual disability have not been investigated. As such, this study sought to examine associations among co-occurring intellectual disability, unmet physical and mental health care needs, and health care quality in youth with autism spectrum disorder. Data from this study were acquired from the 2016–2018 National Survey of Children’s Health, a nationally distributed caregiver-report questionnaire. Results found that the frequency of unmet mental health care need was significantly higher among children with autism spectrum disorder with co-occurring intellectual disability than those without intellectual disability. Using a structural equation modeling approach, it was found that the total effect of co-occurring intellectual disability on composite health care quality was significant. Investigation of indirect effects indicated that unmet mental health care need mediated the relationship between co-occurring intellectual disability and health care quality. These findings suggest that youth with autism spectrum disorder and co-occurring intellectual disability may be more likely to experience unmet mental health care needs, and that their unmet mental health care needs may negatively impact their health care quality.Lay abstractThe increase in the prevalence of autism spectrum disorder has placed greater demands on the health care system. Children and adolescents with autism spectrum disorder often experience challenges accessing high-quality physical and mental health care due to characteristic social-communication deficits and behavioral difficulties, as well as high rates of complex medical and psychiatric comorbidities. Intellectual disability commonly co-occurs with autism spectrum disorder and individuals affected by this co-occurrence may have additional impairments that compound challenges accessing health care. This study investigated the relations among co-occurring intellectual disability, unmet physical and mental health care needs, and health care quality in a large, nationally distributed sample of youth with autism spectrum disorder using structural equation modeling techniques. Co-occurring intellectual disability was significantly associated with unmet mental health care needs in children with autism. In addition, unmet mental health care needs mediated the relationship between co-occurring intellectual disability and health care quality; youth with autism spectrum disorder and co-occurring intellectual disability who had a past-year unmet mental health need had significantly poorer caregiver-reported health care quality. These findings suggest that youth with autism spectrum disorder and co-occurring intellectual disability may be more likely to experience unmet mental health care needs and receive poorer quality of care than the broader autism spectrum disorder population.
      Citation: Autism
      PubDate: 2021-05-25T04:52:09Z
      DOI: 10.1177/13623613211014721
       
  • The effect of ambient sounds on decision-making and heart rate variability
           in autism

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      Authors: Rachel Bellamy, Howard Ring, Peter Watson, Andrew Kemp, Giles Munn, Isabel CH Clare
      First page: 2209
      Abstract: Autism, Ahead of Print.
      Autistic people report difficulties with the demands of a neurotypical world, but little research has assessed the impact of the environment on such difficulties. We investigated the effect of ambient sounds on decision-making and heart rate variability. Adults without intellectual disability were allocated to autistic (n = 38) or neurotypical (n = 37) groups matched on age, intellectual functioning and self-reported gender. Participants completed a shopping decision-making task in three randomly ordered sound conditions: no sound, non-social shopping sound (e.g. fridges humming) and social shopping sound (e.g. people talking). Decision-making latency, decision-making consistency, and heart rate variability were measured. Participants also provided qualitative reports of their experiences. Qualitative analyses indicated that autistic participants experienced (1) the non-social and social sound conditions more negatively than the no sound condition and (2) the social sound condition more negatively than neurotypical participants. However, there were no statistically significant differences in decision-making latency, decision-making consistency, or heart rate variability across sound conditions and participant groups. Further research should consider alternative quantitative measures to explore subjective experience to help understand further which aspects of the environment autistic people are sensitive to, in turn, enabling more evidence-based autism-friendly changes to be made.Lay abstractMany autistic people report difficulties making decisions during everyday tasks, such as shopping. To examine the effect of sounds on decision-making, we developed a supermarket task where people watched a film shown from the shopper’s perspective and were asked to make decisions between different products. The task was divided into three sections and participants completed each section in a different auditory environment: (1) no sounds, (2) non-social sounds (e.g. fridges humming) and (3) social sounds (e.g. people talking). Thirty-eight autistic and 37 neurotypical adults took part. We measured decision-making by examining how long it took to make a decision and how consistent people were with their decisions. We also measured heart rate variability because this biological response provides a measure of anxiety. After the supermarket shopping task, participants told us in their own words about their experiences. Autistic participants said that they found the non-social and social sound conditions more difficult than the no sound condition, and autistic participants found the social sound condition more negative than neurotypical participants. However, decision-making and heart rate variability were similar for autistic and neurotypical participants across the sound conditions, suggesting that these measures may not have been sensitive enough to reflect the experiences the autistic participants reported. Further research should consider alternative measures to explore the experiences reported by autistic people to help us understand which specific aspects of the environment autistic people are sensitive to. This, in turn, may enable more specific and evidence-based autism-friendly changes to be made.
      Citation: Autism
      PubDate: 2021-06-16T11:10:01Z
      DOI: 10.1177/13623613211014993
       
  • Autism spectrum disorder: An examination of sex differences in
           neuropsychological and self-report measures of executive and non-executive
           cognitive function

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      Authors: Eleni A Demetriou, Karen L Pepper, Shin Ho Park, Liz Pellicano, Yun Ju C Song, Sharon L Naismith, Ian B Hickie, Emma E Thomas, Adam J Guastella
      First page: 2223
      Abstract: Autism, Ahead of Print.
      Sex differences in autism may in part be understood by an atypical sex profile of executive function and non-executive function. In this study, we compared females and males with autism against non-autistic individuals on neuropsychological and self-report measures to examine whether any sex differences in executive function and non-executive function might be unique to autism. Our study showed a significant overall female advantage for measures of psychomotor speed, cognitive flexibility, verbal learning and memory and semantic fluency. There was no significant interaction effect between diagnosis and sex. No sex differences were observed on the self-report measure of executive function. Our results suggest that while females show different cognitive performance to males, these sex differences were not specific to the autistic cohort.Lay abstractResearch comparing females and males with a diagnosis of autism suggests that there are sex differences in some characteristics such as behaviour regulation. One area not studied in detail is whether females and males with autism perform differently in tests of cognitive ability. The results of previous research are quite mixed. One explanation may be that some research comparing females and males with autism did not include a neurotypical control group for comparison. As a result, it is not clear whether the sex differences in cognitive ability observed in people with autism are similar to differences between neurotypical males and females. To better understand whether there are unique differences between males and females with autism, it is important to also compare them with neurotypical males and females. In our research, we included a neurotypical group and compared males and females with and without a diagnosis of autism. We found that the sex differences in autism are similar to what we observe in males and females without autism. Our study showed that compared with males, females (with and without autism) do better in assessments of processing speed, cognitive flexibility, verbal learning and memory and semantic fluency. Our results suggest that although females show different cognitive performance to males, these sex differences were not specific to the group with a diagnosis of autism.
      Citation: Autism
      PubDate: 2021-06-25T09:56:50Z
      DOI: 10.1177/13623613211014991
       
  • Neuronal and glial cell number is altered in a cortical layer-specific
           manner in autism

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      Authors: Carmen Falcone, Natalie-Ya Mevises, Tiffany Hong, Brett Dufour, Xiaohui Chen, Stephen C. Noctor, Verónica Martínez Cerdeño
      First page: 2238
      Abstract: Autism, Ahead of Print.
      Autism spectrum disorder is a neurodevelopmental condition characterized by impaired social communication and repetitive behaviors. Changes in the number of specific cell types in the cerebral cortex could produce a dramatic alteration in the regulation of cortical circuits, and thus an alteration of behavior. We investigated whether there are layer-specific changes in the number of neurons, astrocytes, and oligodendrocytes in the prefrontal cortex in postmortem human brains from autism spectrum disorder subjects. We quantified the number of specific cell types in the prefrontal cortex (Brodmann areas 9, 46, and 47) of 10 cases with autism spectrum disorder and 10 age-matched control cases. We found that the number of neurons was increased and the number of astrocytes was decreased in layer II of all three prefrontal areas. Area BA47 was most widely affected presenting with an increased number of neurons and a decreased number of astrocytes in layer II and deeper layers of the cortex. Among other possibilities, the alterations in neuron and glial cell number we report here are consistent with a failure of radial glial cells to shift daughter cell production from neurons to astrocytes during prenatal cortical development in autism spectrum disorder. The data provided here are key anatomical findings that shed light on autism spectrum disorder pathogenesis.Lay abstractThe cerebral cortex affected with autism spectrum disorder presents changes in the number of neurons and glia cells, possibly leading to a dysregulation of brain circuits and affecting behavior. However, little is known about cell number alteration in specific layers of the cortex in autism spectrum disorder. We found an increase in the number of neurons and a decrease in the number of astrocytes in specific layers of the prefrontal cortex in postmortem human brains from autism spectrum disorder cases. We hypothesize that this may be due to a failure in neural stem cells to shift differentiation from neurons to glial cells during prenatal brain development. These data provide key anatomical findings that contribute to the bases of autism spectrum disorder pathogenesis.
      Citation: Autism
      PubDate: 2021-06-10T08:38:56Z
      DOI: 10.1177/13623613211014408
       
  • What are the odds' Predicting the likelihood of a negative episode in
           a sample of toddlers with autism spectrum disorder

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      Authors: Amanda Dimachkie Nunnally, Kyle Sterrett, Amanda Gulsrud, Connie Kasari
      First page: 2254
      Abstract: Autism, Ahead of Print.
      Children with autism spectrum disorder exhibit challenges in regulating negativity and modifying emotional responses, a process known as emotion regulation. Such challenges affect social outcomes and response to intervention in children with autism spectrum disorder. Caregivers of children with autism spectrum disorder facilitate children’s emotion regulation through a process known as co-regulation, but there have been no attempts to describe how dyadic use of strategies interact to impact the likelihood of negativity in real time. This study used video observations of 71 toddlers (mean age = 31.2 months) with autism spectrum disorder and their caregivers engaged in a frustrating, goal-oriented task. A mixed-effects logistic regression revealed that caregivers’ use of co-regulation strategies was not a significant predictor of changes in the likelihood children’s expressed negativity. Caregiver unresponsiveness and proactiveness, however, predicted increased likelihood of children’s subsequent negativity. Children’s use of high energy, non-instrumental behaviors (tension release), was also a robust predictor of increased likelihood of subsequent negativity. These findings shed a light on the effectiveness of child and caregiver strategies in facilitating emotion regulation in toddlers with autism spectrum disorder.Lay abstractChildren with autism spectrum disorder sometimes have challenges with regulating their negative emotions. These difficulties can impact children’s social outcomes and how well they respond to intervention. We know that caregivers of children with autism spectrum disorder can help their children regulate negative emotions in a process known as co-regulation, but not much is known about how child and caregiver strategy use impacts children’s negativity in real time. In this study, 71 caregivers of toddlers with autism spectrum disorder were asked to encourage their child to unlock a locked toy box, a task which is designed to elicit frustration. Video observations of the participants completing the task were used to examine whether specific child and caregiver behaviors increased or decreased the likelihood that the child will become upset. No child strategies were predictive of a decreased likelihood of a child becoming upset, but when children used high-energy behaviors that did not serve a purpose, such as running back and forth, they were more likely to then show signs of being upset a few seconds later. The way that caregivers responded to their child was a potent caregiver predictor of the likelihood of children’s negativity, with caregivers’ unresponsiveness and proactiveness both emerging as salient predictor of increased likelihood of the child being upset a few moments later. These findings give insight into how children with autism spectrum disorder and their caregiver navigate challenging and frustrating tasks, and have the potential to influence clinical practice by giving an indication off which parent and child behaviors are most effective in reducing children’s negativity while interacting with parents and caregivers.
      Citation: Autism
      PubDate: 2021-06-08T07:48:27Z
      DOI: 10.1177/13623613211015001
       
  • ‘Anything but the phone!’: Communication mode preferences in
           the autism community

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      Authors: Philippa L Howard, Felicity Sedgewick
      First page: 2265
      Abstract: Autism, Ahead of Print.
      The communication skills and styles of autistic people have been the focus of much research, but little work has explored the communication preferences of autistic adults themselves. This study examined how autistic adults prefer to communicate in multiple scenarios. Two hundred and forty-five autistic adults completed a novel questionnaire that required six communication modes to be ranked in order of preference across seven different scenarios. Participants also provided qualitative responses to further explain their rankings, and completed the Autism Quotient, the Generalised Anxiety Disorder scale and the Camouflaging Autistic Traits Questionnaire. Quantitative data indicated that email ranked highly when accessing services, seeking customer support and communicating about research. When communicating with family, friends, in employment and in education, both face-to-face and written modes (email or text message) were preferred. In the qualitative data, four main themes were identified: Not the Phone, Written Communication, Masking versus Autistic Communication and Avoiding Communication. There is a clear message that mode of communication can be either enabling or disabling for autistic people. A reliance on phone calls can create barriers to access, yet the option to adopt written forms of communication can improve accessibility. For known connections, the preference for face-to-face communication is dependent upon how close and accepting the relationship is.Lay abstractWhat is already known about the topic'There has been a lot of research into things like how autistic people’s communication styles are different to those of non-autistic people, especially among children. This has tended to focus on parent reports and experiments, rather than asking autistic people about their own experiences and preferences regarding communication.What does this article add'This article is the first to ask autistic adults how they prefer to communicate in different scenarios. We asked whether they preferred to use a range of methods, such email, phone calls, letters and live messaging, in scenarios from education to customer services to friends and family. When contacting unknown people or organisations, we found that generally email was preferred, and phone calls were very unpopular. However, for friends, family and people they felt comfortable with, they preferred both face-to-face and written forms of communication (e.g. email and text message).Implications for practice, research or policyThe findings suggest that services should move away from a reliance on phone calls for communication. They should make sure that access to support is not dependent on the phone, and instead offer written options such as email and live messaging which are more accessible. Future research should investigate the impact of COVID-19 on autistic people’s communication preferences, as video calling has become much more commonly used and potentially combines benefits and challenges of other modes discussed in this article.
      Citation: Autism
      PubDate: 2021-06-25T09:59:33Z
      DOI: 10.1177/13623613211014995
       
  • A qualitative study of autism services and supports in Singapore:
           Perspectives of service providers, autistic adults and caregivers

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      Authors: Emeline Han, Melisa Mei Jin Tan, Laura Crane, Helena Legido-Quigley
      First page: 2279
      Abstract: Autism, Ahead of Print.
      The lifelong and complex nature of autism necessitates an array of services and supports spanning across different sectors and providers at different life stages of an autistic individual. However, research has shown that autistic individuals and their families often experience barriers accessing the autism-related services and supports that they need. This is the first qualitative study to explore the provision and coordination of autism services and supports in Singapore from the perspectives of service providers, autistic adults and caregivers. Semi-structured interviews with 21 participants revealed three main themes: (1) improving access to autism-specific services, (2) creating flexible supports in an inclusive environment and (3) addressing stigma and changing societal attitudes. Our findings suggest that Singapore may have achieved rapid growth in autism services, but broader social structures may be slower to change. To better support autistic individuals in society, autistic voices need to be amplified and a collective effort is needed to achieve a paradigm shift from impairment to capability.Lay abstractBecause autism is a lifelong and complex condition, autistic people may need a range of supports cutting across different sectors (e.g. health, education and social care) at different stages of their lives. Studies in some countries have shown that autistic people and their families face difficulties accessing the services they need, but no research has been done on this topic in Singapore. To start addressing this gap, we interviewed 21 service providers, autistic adults and caregivers/parents of autistic children to find out their perceptions and experiences of autism services and supports in Singapore. Our participants told us that beyond improving access to autism-specific services, they also hoped to see more flexible supports in an inclusive environment and a broader change in societal attitudes. This study highlights that autism service provision should be informed by autistic voices and not only focus on impairment but also recognise the strengths of autistic people alongside their very real needs. The whole of society – including policymakers, professionals, employers, educators, families and autistic people themselves – needs to work together to fight autism stigma and discrimination.
      Citation: Autism
      PubDate: 2021-05-29T06:54:10Z
      DOI: 10.1177/13623613211016112
       
  • Implementation of school-based services for students with autism: Barriers
           and facilitators across urban and rural districts and phases of
           implementation

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      Authors: Jessica Suhrheinrich, Melina Melgarejo, Brittney Root, Gregory A Aarons, Lauren Brookman-Frazee
      First page: 2291
      Abstract: Autism, Ahead of Print.
      Research regarding variables influencing evidence-based practice implementation within school services for students with autism spectrum disorder is limited. Using qualitative methods, the current study applies the Exploration, Preparation, Implementation, and Sustainment framework to characterize factors impacting the implementation of practices for students with autism spectrum disorder across urban and rural school districts. The guiding questions of the study include: (1) Are contextual factors perceived as barriers or facilitators, and do these perceptions vary by district location' and (2) What are the key factors impacting implementation across the Exploration, Preparation, Implementation, and Sustainment phases' Focus group participants (n = 33) were service providers to children with autism spectrum disorder from urban- and rural-located school districts. Several personnel-related themes (attitudes and buy-in, knowledge and skills, staffing, and burnout) were shared by participants representing both urban and rural districts. However, some themes related to system and organizational factors (leadership approval, support and expectations, district structure, competing priorities, time for effective professional development, litigation and due process, and materials and resources) differed between the district locations. This project serves as an initial step in understanding the current process of evidence-based practice implementation within the school context and may help identify intervention targets to include in implementation planning.Lay abstractThe law requires that schools use evidence-based practices to educate students with autism spectrum disorder. However, these practices are often not used, or are not used correctly in school programs. Understanding barriers and facilitators of use of evidence-based practices in schools will help improve the implementation process. This study uses focus groups to characterize how school-based providers representing urban or rural school districts perceive barriers and facilitators for implementing new practices for students with autism spectrum disorder. Guiding questions include the following: (1) Are contextual factors perceived as barriers or facilitators and how do these vary by district location' and (2) What are the key factors impacting implementation across the Exploration, Preparation, Implementation, and Sustainment phases' Focus group participants (n = 33) were service providers to children with autism spectrum disorder from urban- and rural-located school districts. Several personnel-related themes (attitudes and buy-in, knowledge and skills, staffing, and burnout) were shared by participants representing both urban and rural districts. However, some personnel-related themes and organizational factors were unique to rural or urban districts. For example, themes related to system and organizational factors (leadership approval, support and expectations, district structure, competing priorities, time for effective professional development, litigation and due process, and materials and resources) differed between the district locations. This project serves as an initial step in identifying implementation strategies that may improve the use of evidence-based practices in schools.
      Citation: Autism
      PubDate: 2021-06-16T11:09:30Z
      DOI: 10.1177/13623613211016729
       
  • The relationship between sensory reactivity, intolerance of uncertainty
           and anxiety subtypes in preschool-age autistic children

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      Authors: Keren MacLennan, Timothy Rossow, Teresa Tavassoli
      First page: 2305
      Abstract: Autism, Ahead of Print.
      Sensory reactivity differences are a diagnostic criterion of autism. Sensory hyperreactivity has been linked to intolerance of uncertainty and anxiety in autistic children. However, research is yet to explore the mediating relationships or sensory hyporeactivity, seeking and anxiety subtypes in preschool-age autistic children. Therefore, we aimed to elucidate the relationships between sensory reactivity, intolerance of uncertainty and anxiety subtypes in a heterogeneous group of 54 preschool-age autistic children, age 3–5 years, using observation and parent-report assessments. Correlational analysis found sensory hyperreactivity, intolerance of uncertainty and total anxiety were significantly intercorrelated. In addition, sensory hyperreactivity was significantly correlated with separation anxiety when controlling for autism traits. Serial mediation analyses indicated significant full mediation between sensory hyperreactivity and anxiety through intolerance of uncertainty, and significant full mediation between sensory hyperreactivity and intolerance of uncertainty through anxiety. Our results suggest that sensory hyperreactivity is a key early factor in the development of anxiety, and supports that intolerance of uncertainty is an important interrelated construct in the development and maintenance of anxiety in autism. Our findings have important implications for the development of effective interventions. However, due to limitations with the measures, our research also highlights a pressing need for objective assessments of anxiety and intolerance of uncertainty that can be used with preschool-age autistic children.Lay abstractThis study found links between greater sensory hyperreactivity (e.g., over-sensitive to sensory input), intolerance of uncertainty and anxiety, including separation anxiety, in autistic pre-schoolers. Sensory hyperreactivity may predict both anxiety and intolerance of uncertainty, and anxiety and intolerance of uncertainty may both be mutually important, mediating factors. These findings have implications for early anxiety interventions. But there is a pressing need for objective assessments that can be used with preschool-age autistic children.
      Citation: Autism
      PubDate: 2021-05-25T05:00:08Z
      DOI: 10.1177/13623613211016110
       
  • A mixed-methods examination of the gap between intelligence and adaptive
           functioning in autistic young adults without intellectual disability

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      Authors: Nicole L Matthews, Kyla Christenson, Sarah Kiefer, Christopher J Smith
      First page: 2317
      Abstract: Autism, Ahead of Print.
      This study examined adaptive functioning, strategies used to develop adaptive functioning skills, and areas where additional services could benefit autistic young adults without intellectual disability. Participants were 21 autistic young adults and at least one parent of each young adult. Quantitative analyses replicated previous reports of an adaptive functioning disadvantage relative to intellectual functioning such that adaptive functioning standard scores were significantly lower than intelligence quotient scores. Qualitative analysis utilized grounded theory methodology and yielded a conceptual model describing the nature and development of adaptive functioning in this demographic. Together, findings provide a more nuanced understanding of the gap between intellectual and adaptive functioning in autistic young adults without intellectual disability.Lay abstractAdaptive functioning describes the age-appropriate skills necessary for independent living. Research suggests that autistic children, adolescents, and adults who do not have an intellectual disability demonstrate adaptive functioning challenges relative to their intellectual ability. Thus, even though many of these individuals have the intellectual capacity to excel in mainstream educational and vocational settings, their adaptive functioning challenges may serve as an obstacle to independence. The research on adaptive functioning in autistic adults is focused on statistical analysis of standardized assessments (e.g. parent-report on multiple choice questionnaires). Qualitative research that examines the narratives of young adults and their parents is needed to better understand adaptive functioning in young adults and their resulting service needs. This study combined statistical analysis of standardized assessments with qualitative analysis of interview responses from autistic young adults without intellectual disability and their parents. Findings replicated previous reports of adaptive functioning challenges and identified influences on adaptive functioning development, consequences of independence, and service needs. Taken together, findings indicate the need for interventions and services that facilitate adaptive functioning development in autistic adolescents and young adults and provide insight into potential intervention targets and strategies.
      Citation: Autism
      PubDate: 2021-06-02T09:13:19Z
      DOI: 10.1177/13623613211018334
       
  • Gender differences between adolescents with autism in emergency psychiatry

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      Authors: Pety So, André I Wierdsma, Christine van Boeijen, Robert RJM Vermeiren, Niels CL Mulder
      First page: 2331
      Abstract: Autism, Ahead of Print.
      Adolescents, particularly those with autism spectrum disorders, increasingly use psychiatric emergency services. Such risk is further greater in girls. Available knowledge on young people with autism during crises lacks understanding of gender differences and of differences between typically developing adolescents and adolescents with autism. After psychiatric emergency consultations, we therefore compared the symptomatology and comorbidity of girls and boys with autism, and also to their typically developing male and female counterparts. We used registry data (2009–2017) on 1378 adolescents aged 12–18 years referred for urgent consultation to mobile psychiatric emergency services. This showed an increase in diagnoses of autism spectrum disorder from 7.9% in 2009 to 18.1% in 2016; autistic girls showed a steeper increase than autistic boys. A higher percentage of girls than boys with autism presented with comorbid anxiety disorders and a higher risk of suicide or self-harm, while the persistence of their complaints over time was rated lower. Adolescents with autism experienced more severe impairment in overall functioning, while being diagnosed less often with comorbid disorders as compared to typically developing adolescents. Outpatient care for autistic youth should include easy access to specialized professionals to help young people with autism cope with the challenges of adolescence.Lay abstractAmong adolescents seen for psychiatric emergency consultation, the percentage of adolescents with autism is increasing over the years. This applies even more to girls than to boys. We collected data of 1378 adolescents aged 12–18 years who were seen for urgent consultation by mobile psychiatric emergency services in the Netherlands. Among these, there were 64 autistic girls and 125 autistic boys. We wanted to know more about differences in problems between autistic and typical developing adolescents in crisis, both to prevent crisis and to improve services. The percentage of adolescents with autism increased over the years studied. Autistic adolescents experienced more severe impairment in functioning compared to typically developing adolescents. Compared to other adolescents, both boys and girls on the autism spectrum were diagnosed less frequently with mood disorders, behavioral disorders, relational problems, and abuse. Autistic girls had a higher suicide risk and suffered more often from anxiety disorders than autistic boys, while autistic boys had a longer history of problems. Outpatient care for children with autism should include easy access to specialized professionals who aim to reduce anxiety and help young people with autism to cope with the challenges of adolescence. Because possibly signs were missed during the emergency consultation, we recommend that as part of the routine procedure in crisis situations adolescents with autism are asked about mood and behavioral problems explicitly, as well as about negative life events.
      Citation: Autism
      PubDate: 2021-06-03T10:22:46Z
      DOI: 10.1177/13623613211019855
       
  • The impact of atypical sensory processing on adaptive functioning within
           and beyond autism: The role of familial factors

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      Authors: Janina Neufeld, Lisa Hederos Eriksson, Richard Hammarsten, Karl Lundin Remnélius, Julian Tillmann, Johan Isaksson, Sven Bölte
      First page: 2341
      Abstract: Autism, Ahead of Print.
      Atypical sensory processing is prevalent across neurodevelopmental conditions and a key diagnostic criterion of autism spectrum disorder. It may have cascading effects on the development of adaptive functions. However, its unique contribution to adaptive functioning and the genetic/environmental influences on this link are unclear. In a clinically enriched twin sample (n = 289, 60 diagnosed with autism spectrum disorder), we investigated the associations between the quadrants of the Adult/Adolescent Sensory Profile (low registration, sensory sensitivity, sensation seeking, and sensation avoiding) and adaptive functioning. Associations were modeled across the cohort accounting for the effects of clinical diagnosis, IQ, sex and age, and within-twin pairs, additionally implicitly adjusting for familial factors. Furthermore, we explored interaction effects between atypical sensory processing and autism spectrum disorder diagnosis. Sensory sensitivity and sensation avoiding were associated with reduced adaptive functioning across individuals, but not within-twin pairs. An interaction effect was found between sensation seeking and autism spectrum disorder diagnosis, showing a negative association between sensation seeking and adaptive functioning only in individuals diagnosed with autism spectrum disorder. The results suggest that atypical sensory processing is associated with reduced adaptive functioning and that familial factors influence this link. In addition, sensation seeking behaviors might interfere with adaptive functioning specifically in individuals with autism spectrum disorder.Lay abstractIndividuals diagnosed with autism tend to process sensory information differently than individuals without autism, resulting for instance in increased sensitivity to sounds or smells. This leads to challenges in everyday life and may restrict the individual’s daily functioning. How direct this link is, however, is currently unclear. We investigated this question in 289 twins of whom 60 were diagnosed with autism and further 61 were diagnosed with other neurodevelopmental disorders. We looked at the association between unusual sensory processing and adaptive skills, both across individuals and within-twin pairs, testing whether individuals with higher levels of atypical sensory processing showed reduced adaptive skills compared to their twins. Since twins share 50%–100% of their genes and part of their environment (e.g. family background), associations within-twin pairs are free from effects of these familial factors. We found that an increased sensitivity to, as well as the avoiding of, sensory input (hyper-responsiveness) was linked to reduced adaptive skills across individuals—but not within-twin pairs. We also found an association between the degree to which individuals seek for sensory input (sensation seeking) and reduced adaptive skills, but only in individuals diagnosed with autism. The results suggest that sensory hyper-responsiveness has negative effects on individuals’ general ability to function, but that this link is influenced by familial factors and hence not direct. In addition, sensation seeking behaviors might have a negative impact on adaptive skills specifically in autistic individuals.
      Citation: Autism
      PubDate: 2021-08-03T06:20:11Z
      DOI: 10.1177/13623613211019852
       
  • Defining autistic burnout through experts by lived experience: Grounded
           Delphi method investigating #AutisticBurnout

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      Authors: Julianne M Higgins, Samuel RC Arnold, Janelle Weise, Elizabeth Pellicano, Julian N Trollor
      First page: 2356
      Abstract: Autism, Ahead of Print.
      Although commonly described on social media by autistic people, there is little recognition of autistic burnout in the academic literature. Anecdotally, autistic burnout is described as a debilitating condition that severely impacts functioning, is linked to suicidal ideation and is driven by the stress of masking and living in an unaccommodating neurotypical world. We sought to define autistic burnout using the Grounded Delphi method. Autistic adults, experts by the lived experience of autistic burnout (n = 23), co-produced and agreed to a definition intended for clinicians and the autistic and autism communities. A thick description and conceptual framework were developed from the open-ended round 1 survey, with a high majority of agreement reached in the round 3 survey. Autistic burnout was defined as a highly debilitating condition characterised by exhaustion, withdrawal, executive function problems and generally reduced functioning, with increased manifestation of autistic traits – and distinct from depression and non-autistic burnout. Further work is needed to differentiate autistic burnout from other conditions and to build clinician understanding of the accompanying complexity to be considered in treatment planning.Lay abstractAutistic burnout has been commonly described in social media by autistic people. There is little mention of autistic burnout in the academic literature. Only one recent study has used interviews and reviews of social media descriptions to try to understand autistic burnout. Anecdotally, autistic burnout is a very debilitating condition that reduced people’s daily living skills and can lead to suicide attempts. It is suggested that autistic burnout is caused by the stress of masking and living in an unaccommodating neurotypical world. We wanted to create a definition of autistic burnout that could be used by clinicians and the autism community. We used the Grounded Delphi method, which allowed autistic voice to lead the study. Autistic adults who had experienced autistic burnout were considered as experts on the topic, in the co-production of this definition. The definition describes autistic burnout as a condition involving exhaustion, withdrawal, problems with thinking, reduced daily living skills and increases in the manifestation of autistic traits. It is important for future research that there is a specific description of the condition. In practice, it is important for clinicians to be aware that autistic burnout is different from depression. Psychological treatments for depression potentially could make autistic burnout worse. Further awareness of autistic burnout is needed, as well as further research to prove this condition is separate from depression, chronic fatigue and non-autistic burnout.
      Citation: Autism
      PubDate: 2021-06-05T05:56:04Z
      DOI: 10.1177/13623613211019858
       
  • The effects of JASPER intervention for children with autism spectrum
           disorder: A systematic review

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      Authors: Hannah Waddington, Jess E Reynolds, Ella Macaskill, Sally Curtis, Lauren J Taylor, Andrew JO Whitehouse
      First page: 2370
      Abstract: Autism, Ahead of Print.
      Naturalistic developmental behavioural interventions are promising approaches for young children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation intervention (JASPER) is a well-researched naturalistic developmental behavioural intervention but, to date, no reviews have specifically evaluated its effects. This systematic literature review examined the effects of JASPER intervention and its components on child, parent and educator outcomes. Of the 96 articles screened, 19 were eligible for inclusion in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills and language skills compared to the comparison group. Implementation outcomes for parents and educators were generally positive. There were no consistent predictors or mediators of treatment effects. None of the studies met all of the quality indicators outlined by the Council of Exceptional Children, and the majority of outcome measures were classified as proximal. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.Lay abstractInterventions which are delivered in natural contexts and use both developmental and behavioural techniques may be helpful for children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation (JASPER) is a type of intervention, which falls under this category. Although several studies have examined the effects of JASPER, this has not yet been summarised in a review. This systematic literature review examined the effects of JASPER intervention, and the techniques that make up JASPER, on child, parent and educator outcomes. We screened 96 articles and, of these, 19 were included in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills, and language skills compared to children who did not receive JASPER intervention. Parents and educators were mostly able to use the JASPER techniques. There were no consistent child, parent, teacher or treatment characteristics that influenced the effects of the JASPER intervention. None of the studies met all of the indicators of being a good quality study outlined by the Council of Exceptional Children. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-08-05T04:50:22Z
      DOI: 10.1177/13623613211019162
       
  • The Toddler Autism Symptom Inventory: Use in diagnostic evaluations of
           toddlers

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      Authors: Kirsty L Coulter, Marianne L Barton, Hilary Boorstein, Cara Cordeaux, Thyde Dumont-Mathieu, Lauren Haisley, Lauren Herlihy, Dasal Tenzin Jashar, Diana L Robins, Wendy L Stone, Deborah A Fein
      First page: 2386
      Abstract: Autism, Ahead of Print.
      Although symptoms of autism are present early in life and early diagnosis can lead to better outcomes, there is a dearth of validated caregiver-report interviews designed for children under the age of 3 years. We developed the Toddler Autism Symptom Inventory, a semi-structured interview designed to assess the presence and absence of skills and symptoms in children aged 12–36 months. Reliability and validity of items and a cutoff score for likelihood of autism spectrum disorder were established. Specificity and sensitivity of this cutoff were confirmed with a cross-validation sample. The Toddler Autism Symptom Inventory effectively identified most children with autism without excessive false positives. The Toddler Autism Symptom Inventory is a developmentally appropriate caregiver interview for use in diagnostic evaluations of children under age 3 years that offers clearly operationalized diagnostic criteria and a cutoff for autism likelihood for very young children.Lay abstractDetermining whether a young child has an autism spectrum disorder requires direct observation of the child and caregiver report of the child’s everyday behaviors. There are few interviews for parents that are specifically designed for children under 3 years of age. The Toddler Autism Symptom Inventory is a new interview that asks caregivers of children age 12–36 months about symptoms of possible autism spectrum disorder. The Toddler Autism Symptom Inventory uses a cutoff score to indicate likelihood for autism spectrum disorder; this cutoff score appears to accurately identify most children who are diagnosed with autism spectrum disorder without identifying too many who do not have autism spectrum disorder. The Toddler Autism Symptom Inventory interview can help clinicians to determine whether a young child shows symptoms suggestive of an autism spectrum disorder.
      Citation: Autism
      PubDate: 2021-06-15T10:17:48Z
      DOI: 10.1177/13623613211021699
       
  • Food insecurity in the households of children with autism spectrum
           disorders and intellectual disabilities in the United States: Analysis of
           the National Survey of Children’s Health Data 2016–2018

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      Authors: Arun Karpur, Vijay Vasudevan, Angela Lello, Thomas W Frazier, Andy Shih
      First page: 2400
      Abstract: Autism, Ahead of Print.
      Individuals with autism spectrum disorder and co-occurring intellectual disabilities experience substantial challenges in accessing needed supports. This research aimed to understand the prevalence and factors associated with food insecurity among families of children with autism spectrum disorder and co-occurring intellectual disabilities. Utilizing the National Survey of Children’s Health (2016–2018) data, this article illustrated that the households of children with autism spectrum disorder and co-occurring intellectual disabilities were about two times more likely to be food insecure than the households of children without disabilities. Furthermore, the households of children with autism spectrum disorder were 1.5 times more likely, and those with other disabilities were 1.3 times more likely to be food insecure than the households of children without disabilities. Implications of these findings in the context of the COVID-19 pandemic are discussed.Lay abstractFamilies of children with autism spectrum disorder are more likely to experience financial strain and resulting food insecurity due to additional cost of care, disparate access to needed services, and loss of income resulting from parental job loss. Utilizing nationally representative data, this analysis indicates that the families of children with autism spectrum disorder and co-occurring intellectual disabilities are twice as likely to experience food insecurity than families of children without disabilities after adjusting for various factors. Several factors, ranging from state-level policies such as Medicaid expansion to individual-level factors such as higher utilization of emergency room services, were associated with the higher prevalence of food insecurity in families of children with autism spectrum disorder and co-occurring intellectual disabilities. Implications of these findings on programs and policies supporting families in the COVID-19 pandemic are discussed.
      Citation: Autism
      PubDate: 2021-06-02T09:14:12Z
      DOI: 10.1177/13623613211019159
       
  • The treatment of sleep problems in autistic adults in the United Kingdom

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      Authors: Elizabeth Halstead, Emma Sullivan, Zoe Zambelli, Jason G Ellis, Dagmara Dimitriou
      First page: 2412
      Abstract: Autism, Ahead of Print.
      Sleep problems are one of the most common complaints in autistic adults. This study aimed to report the perspectives of autistic adults in the United Kingdom on treatment of their sleep problems. A total of 288 autistic adults living in the United Kingdom completed an online survey including assessments of their sleep quality using the Pittsburgh Sleep Quality Index, reporting their experiences and preferences of sleep treatment with UK healthcare professionals and, their experiences of self-management of their sleep. Self-report data revealed 58% of participants had not attended a consultation with a healthcare professional regarding their sleep problem despite 90% meeting the criteria for poor sleep quality (based on the Pittsburgh Sleep Quality Index). Of the participants who attended a consultation for their sleep, 72% were prescribed medication and 60% were not satisfied with the outcome. Self-management of sleep problems was not effective for 80% of participants; 41% reported a preference for non-medication options such as education, advice and talking therapies for sleep treatment. This report highlights the need for a fundamental shift in the consideration of sleep problems in autistic adults given the high levels of co-morbidity. The development of successful management strategies in adulthood that importantly considering autistic adults’ preferences could reduce sleep problems and overall improve quality of life for autistic adults. Long term this could also reduce the need for prescribed medication in this population.Lay abstractSleep problems are one of the most common complaints by autistic adults. This study aimed to report the perspectives of autistic adults on treatment of their sleep problems; 288 autistic adults living in the United Kingdom completed an online survey which assessed their sleep quality. We also gathered data on experiences and preferences of sleep treatment with UK healthcare professionals and their experiences of self-management of their sleep; 58% of autistic adults never had a visit with a healthcare professional regarding their sleep problem, despite 90% meeting the criteria for poor sleep quality. Some of those who attended a consultation for their sleep were prescribed medication (72%), but 60% were not satisfied with the outcome. The participants also reported that sleep self-management was not effective (80%); 41% reported a preference for non-medication including education, advice and talking therapies for sleep treatment. This report highlights the need for a fundamental shift in treatment of sleep problems in autistic adults. The current treatments are not resolving sleep issues; hence, it is imperative to develop management strategies that considers autistic adults’ preferences, reduces sleep problems and thus improves quality of life for autistic adults.
      Citation: Autism
      PubDate: 2021-05-10T04:31:00Z
      DOI: 10.1177/13623613211007226
       
  • How set switching affects the use of context-appropriate language by
           autistic and neuro-typical children

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      Authors: Louise Malkin, Kirsten Abbot-Smith
      First page: 2418
      Abstract: Autism, Ahead of Print.
      Autistic children have difficulties in adapting their language for particular listeners and contexts. We asked whether these difficulties are more prominent when children are required to be cognitively flexible, when changing how they have previously referred to a particular object. We compared autistic (N = 30) with neuro-typical 5- to 7-year-olds. Each child participated in two conditions. In the switch condition, the same animal had to be re-described across trials to be appropriately informative (e.g. a participant could appropriately describe a picture as ‘dog’ on one trial but later the participant needed to re-describe the same picture as ‘spotty dog’ to differentiate it from a co-present black dog). In the no-switch condition, no picture needed to be re-described. Nonetheless, the conditions were matched regarding the requirement to use both complex (e.g. spotty cat) versus simple expressions (e.g. horse). Autistic children were more over-informative than peers even prior to the requirement to re-describe an animal. Overall, we found a main effect of the switch condition and no interaction with group. Switching a description hinders the ability of children to be appropriately informative. As autistic children are generally less appropriately informative, the requirement to switch leads to particularly poor performance in autism.Lay abstractThe way autistic individuals use language often gives the impression that they are not considering how much information listeners need in a given context. The same child can give too much information in one context (e.g. saying ‘the big cup’ with only one cup present) and too little information in another context (e.g. entering a room and announcing ‘the red one’ when the listener has no prior knowledge regarding what this refers to). We asked whether many autistic children particularly struggle to tailor their language appropriately in situations where this means changing how they have previously described something. That is, if a speaker has recently described an object as ‘the cup’, the need to switch to describing it as ‘the big cup’ could hinder the speaker’s ability to use language in a context-appropriate way. We found that switching descriptions indeed makes it more difficult for children to use language in a context-appropriate way, but that this effect did not play out differently for autistic versus neuro-typical children. Autistic children were, however, less likely to provide a context-appropriate amount of information overall than were neuro-typical peers. The combination of these effects meant that when object re-description was required, autistic children only produced an appropriate description half the time. In contrast, without a requirement to re-describe, autistic children could indeed take listener informational needs into account. Applied professionals should consider whether a requirement to change the way the child has previously said something may hinder a child’s ability to communicate effectively.
      Citation: Autism
      PubDate: 2021-05-10T04:41:23Z
      DOI: 10.1177/13623613211012860
       
  • Language, interests and autism: A tribute to Dr. Dinah Murray
           (1946–2021), an autism pioneer

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      Authors: Wenn B Lawson
      First page: 2423
      Abstract: Autism, Ahead of Print.
      So much has changed in our understanding of how autism impacts our lives. We still have a long way to go, however, until it becomes the norm that the principle of ‘nothing about me without me’ is upheld throughout autism research and autism practice. Autistic researchers and practitioners will play a central role in delivering this vision. Currently, the autistic community is mourning the passing of one such person, a true pioneer, Dr. Dinah Murray. It is fitting that we pay a tribute to her achievements and contributions, for these have enriched our lives and over-laid the autism landscape with understanding, acceptance, action and advocacy.
      Citation: Autism
      PubDate: 2021-08-20T06:56:43Z
      DOI: 10.1177/13623613211034072
       
 
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