Abstract

Purpose

The self is a multidimensional concept that can be represented at a pre-reflective (first-order) level, at a deeper, reflective level (second-order), or even at a meta-level (representing one’s own thoughts, i.e. self-related mentalizing). Since self-related processing and mentalizing are crucial for social cognition, both constructs have been researched in individuals with autism, who experience persistent socio-communicative difficulties. Some studies suggested autism-related reductions of the self-bias, i.e. tendency to preferentially process self-related content; while others observed a decreased ability to mentalize on one’s own thoughts in autism. However, prior research examined distinct levels of self-related processing in isolation, in the context of separate studies.

Methods

In this investigation, we directly compared self-bias, self- and other-related mentalizing within the same sample of adolescents with and without autism, to identify which of these are altered in this condition. Thirty adolescents with autism and 26 age- and IQ-matched controls performed a visual search task (first-order self-bias), a trait adjectives task (second-order self-bias), a feeling-of-knowing task (self-related mentalizing) and the Frith-Happé animations task (other-related mentalizing). Parents also completed two questionnaires (i.e. SRS, SCQ) assessing the adolescent’s degree of autism traits.

Results

Our findings replicated previous research showing reduced other-related mentalizing in autism. However, we did not find any difference between adolescents with and without autism in terms of first- or second-order self-bias, nor in the ability to mentalize on one’s own thoughts.

Conclusion

In line with recent investigations, our results do not support earlier claims of altered self-related information processing in autism.

Abstract

Infants at elevated likelihood for or later diagnosed with autism typically have smaller vocabularies than their peers, as shown by the Mullen Scales of Early Learning (MSEL) and the MacArthur-Bates Communicative Developmental Inventory (CDI). However, the extent to which MSEL and CDI scores align remains unclear, especially across clinical and non-clinical populations. This study examined whether the concurrent validity of the MSEL and CDI differs based on autism likelihood and diagnosis. Data from 720 14-month-old infants were analysed, grouped by likelihood (elevated vs. typical) and diagnosis at 36 months (diagnosed vs. not diagnosed). Vocabulary scores were compared across both likelihood and diagnostic groups. Moderate correlations were observed between the MSEL and CDI in most groups (r_s range = [.34–.58]). One exception was that the expressive scores of elevated likelihood infants on the MSEL and CDI were more closely associated than the expressive scores of typical likelihood infants. Diagnosed infants had lower vocabulary scores than non-diagnosed peers on both the MSEL and CDI. The elevated likelihood group showed lower scores on the MSEL but not the CDI compared to typical likelihood infants. The moderate correlations suggest that the MSEL and CDI assess different aspects of language in infancy. These associations were weaker than previously reported in autistic children. Differences in vocabulary scores across likelihood and diagnostic groups highlight the need for further research to understand the association between these measures.

Abstract

Many children with ASD exhibit difficulties with emotion regulation that greatly impair functioning. Certain intrinsic correlates of dysregulation have been identified in this population, but the search for potential environmental influences has been less fruitful. The current study examined several aspects of parenting as correlates of observed regulation in Autistic children, as measured in both parent-child and independent regulatory contexts. A diverse sample of 76 children with ASD aged 6 to 10 years participated in frustrating laboratory tasks with and without their primary caregivers, and the caregivers completed a parenting questionnaire. Emotion regulation, parental scaffolding, and gentle guidance were coded from videotaped interaction, and scores of parental involvement, positive parenting, and inconsistent discipline were obtained through parent report. Differential relations were observed between parenting and children’s regulation when considered across contexts, with parental scaffolding associated with children’s dyadic regulation and parents’ reports of their involvement and discipline associated with children’s independent regulation. Findings support previous evidence identifying a potential delay in the internalization of parental co-regulatory support in Autistic children, and highlight parental involvement as a previously unidentified unique correlate of independent regulation in this population. Implications for conceptualizations of emotion regulation in autism are discussed as is the importance of extending findings through further longitudinal research.

Abstract

The current study examined the associations between internalizing symptoms, social motivation, and gender among autistic and non-autistic youth. Caregivers of 386 participants age 6 to 14 years completed measures of their child’s internalizing symptoms and social motivation. Correlation and hierarchical regression analyses were conducted to compare internalizing symptoms and social motivation across autistic and non-autistic girls and boys. Social motivation was found to be higher among non-autistic participants compared to autistic participants, with no significant gender differences observed in social motivation within groups. Social motivation was found to be a significant predictor of internalizing symptoms. The association between social motivation and internalizing symptoms varied by gender and diagnostic status. Higher internalizing symptom scores were associated with lower social motivation among autistic girls, non-autistic girls, and non-autistic boys, but no association was found among autistic boys. The current study found that the relations between social motivation and anxiety, depression, and somatization symptoms in autistic youth varied by gender. The strong association between internalizing symptoms and social motivation among autistic girls and not autistic boys may be due to the unique social experiences and expectations associated with the intersecting gender and neurodivergent identities of autistic girls. The findings of the current study underscore the value of adopting an intersectionality perspective by considering both the influence of gender and neurodivergent identities together when addressing the social experiences and mental health of autistic youth.

Abstract

Objective

To identify the tools used to assess eating behaviors in individuals with Autism Spectrum Disorder (ASD) and summarize their distribution, citation rates, journal publication, JCR scores, and psychometric properties.

Methods

A literature review was conducted to identify studies on eating behavior in individuals with ASD. The search included various descriptors and combinations of keywords in databases such as Medline/PubMed, Science Direct, Scopus, SciELO, and Web of Science. The studies were filtered to focus on articles published in the last five years. Thirty-seven relevant studies were identified and analyzed to summarize the tools used, their distribution in the literature, citation rates, and psychometric properties.

Results

Thirty-seven relevant studies were identified. The Journal of Autism and Developmental Disorders published the most studies (5). The Brief Autism Mealtime Behavior Inventory (BAMBI) was the most frequently used instrument, appearing in 15 studies, followed by the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in 8 studies. Both instruments demonstrated solid psychometric properties, with BAMBI showing good internal consistency (α = 0.88) and BPFAS a Cronbach’s alpha of 0.82.

Conclusion

Most of the instruments used in studies on eating behavior in individuals with ASD demonstrate satisfactory psychometric properties. BAMBI and BPFAS stand out for their widespread use but are limited to covering only specific age ranges.

Abstract

The use of literal prompts (LPs) and inferential prompts (IPs) in shared book reading (SBR) facilitates children’s use of language and promotes their thinking and understanding about the stories discussed and beyond. Furthermore, SBR provides a platform for mildly autistic children to have multiple rounds of communication with educators. This study investigated the contribution of LPs and IPs on the language development and affective factors of language learning in mildly autistic children. This study included 187 mildly autistic Chinese children who were stratified by random sampling and assigned into three groups (LP, IP and control). The mildly autistic children’s language skills were tested immediately before and after the 12-week SBR intervention. Their parents were also included in this study. The results indicated that using prompts had positive effects on the mildly autistic children’s language skills and on the affective factors central to language development. Moreover, LPs were beneficial in fostering mildly autistic children’s affective factor development, whilst IPs fostered their Chinese word reading and listening comprehension skills. These findings indicated the benefits of using prompts during parent–child SBR, along with the extent to which prompts contribute to different language skills and affective factors central to language development in mildly autistic children.

Abstract

Although autistic females often “camouflage” their autism, few studies examine the degree to which adolescent females demonstrate these behaviors in inclusive school settings. We examined: (a) the nature, extent, and underlying motivation of camouflaging in high school; (b) the extent to which autistic girls’ characteristics related to camouflaging settings, people, benefits, costs, and school supports; and (c) how girls’ open-ended descriptions agreed with closed-ended camouflaging ratings. Using quantitative and qualitative analyses, this study examined the extent, domains, costs, and benefits of autistic females’ school-based camouflaging. Thirty-one autistic female adolescents, all included in general education classrooms, answered rating and interview questions. Autistic females camouflaged most often in general education classrooms and with teachers and neurotypical peers that they did not know well; least often at home or with neurodivergent friends. Later age of diagnosis was associated with more camouflaging and camouflaging costs. Qualitative analyses revealed four themes: autistic identity; negative peer experiences; negative consequences of camouflaging; and value of neurodivergent friends. Some qualitative findings converged with quantitative findings, others diverged. Implications are discussed for research and practice for supporting autistic females in general education school settings.

Abstract

There have been disparities reported in prevalence of autism by gender, race, and socioeconomic status with older ages of diagnosis in non-White and in female children. Possible disparities in the ages of autism diagnosis are not well-established within the Military Health System (MHS) pediatric population, where we hypothesized less disparities given universal Tricare coverage for active-duty military families and theoretically equal access to the military treatment facility (MTF). We conducted retrospective cross-sectional analysis using deidentified database repository records from the MHS. We collected and analyzed demographic data on children covered by Tricare and newly diagnosed with autism within an MTF (N = 31,355) or outside of the MTF (5,579 respectively). Within the MTF, we identified younger ages of autism diagnosis in non-White children less than 18 years old (p < 2.2e⁻¹⁶), without significant differences in ages of diagnosis by race in children less than 6 years of age. There were no statistically significant differences in ages of diagnosis between males and females. Outside the MTF, we identified younger ages of autism diagnosis in males versus females with statistically significant difference in average ages of autism diagnosis between males and females less than the age of 18 years (p = 4.4e-08). This difference was not seen in children less than 6 years of age. Racial data was not available for diagnosis outside the MTF. The age of autism diagnosis in the military pediatric population within the MTF did not reflect historical disparities seen in non-White and in female children.

Abstract

The evaluation of social communication and interaction (SC/I) behaviors is foundational to the autism identification process. However, this type of evaluation is made difficult by the fact that SC/I is a construct in which perceptions and expectations are largely influenced by norms and attitudes of different sociodemographic groups. While there are many factors that influence differences in SC/I behaviors across sociodemographic groups, one factor that may be especially important is the perceived value of these behaviors. The purpose of this study is to investigate which sociodemographic factors influence the perceived importance of SC/I behaviors among caregivers of children and adolescents. Caregivers (n = 398) living in the United States completed the Social Communication and Interaction Perceptions Scale (SCIPS). Linear mixed-effect models were used to investigate the relationship between the perceived importance of SC/I behaviors and seven sociodemographic factors as well as determine if this relationship was moderated by SC/I behavior type (i.e., foundational vs. advanced behaviors). Several different sociodemographic factors (i.e., caregiver race/ethnicity, caregiver gender, household income, child disability status, child age, child gender) were associated with caregiver ratings of the perceived importance of SC/I behaviors. This relation was, in some instances (i.e., caregiver race/ethnicity, caregiver gender, child disability status), moderated by whether the SC/I behaviors were foundational or advanced. Our findings highlight the importance of considering the values of caregivers regarding perceived SC/I importance during the autism identification process.

Abstract

Empathy is multifaceted, involving sharing and understanding the emotional and mental states of others. This study investigated the factor structure of the English-language version of the Empathy Quotient for Children (EQ-C; Auyeung et al., 2009), an empathy measure previously well-validated only as a global scale. We aimed to compare children with and without educational differences (i.e., Special Educational Needs & Disabilities, SEND), and explored associations between empathy and sensory sensitivities across the whole sample. Based on responses from 680 parents, we analysed data from English-speaking children aged 6–12 years, via a series of factor analyses using polychoric correlation matrices and bass-ackward analysis. Empathy domain profiling for children with SEND status (versus children without SEND status) was investigated as group differences (t tests). Sensory sensitivities were examined via associations (correlation) and net effects (regression). We identified an optimal four-factor solution (emotional empathy, social-cognitive empathy, negative interactions, antisocial behaviours), and robust higher order one-, two- and three-factor models. Children with SEND status displayed empathy differences across all four empathy domains (all p < .001). Children with greater sensory sensitivities displayed significant differences for social-cognitive empathy and negative interactions only (both p < .001). We demonstrated the potential utility of the English-language EQ-C as a domain-level measure of empathy. Our paper discusses how the domains align with traditional emotional and cognitive dimensions in adults and cross-culturally. Our empathy profiles can be used alongside global empathy measures for different groups of children, with and without educational differences and sensory sensitivities.

Abstract

Diminished responding to one’s own name is one of the strongest and earliest predictors of autism. However, research on the neural correlates of this response in autism is scarce. Here we investigate neural responses to hearing the own name in school-aged children with and without autism. Thirty-four children with autism and 33 without autism (ages 7–13) were presented with three categories of names (own name, close other’s name and unknown other name) as task-irrelevant deviant stimuli in an auditory oddball paradigm, while EEG was recorded. In line with previous findings, parietal P3 amplitudes for the own name were enhanced compared with a close other’s name. Older children showed a stronger self-specific effect than younger children. However, this self-preferential effect was not different between groups, despite the fact that parents of children with autism reported significantly less own-name responsiveness in daily life. Neither the N1 component or SON negativity showed self-specific effects. In school-aged children, only the parietal P3 component, and not the N1 or SON negativity, appears to be enhanced for the own name as compared to a close other’s name. Age seems to have an effect on the own name modulation of the P3 amplitude, which may explain the relatively small overall effect size. Against expectations, groups did not differ on this self-specific effect. Further research into neural and behavioral responses to hearing one’s own name in autism, across different age groups, is warranted.

Abstract

Purpose: Children with autism spectrum disorder (ASD) often show abnormal speech prosody. Tonal languages can pose more difficulties as speakers need to use acoustic cues to make lexical contrasts while encoding the focal function, but the acquisition of speech prosody of non-native languages, especially tonal languages has rarely been investigated. Methods: This study aims to fill in the aforementioned gap by studying prosodic focus-marking in Mandarin by native Cantonese-speaking children with ASD (n = 25), in comparison with their typically developing (TD) peers (n = 20) and native Mandarin-speaking children (n = 20). Natural prosodic marking of different types of focus was elicited by picture-based prompt questions, recorded and analyzed acoustically. Results: The autistic children made use of fewer acoustic cues and produced less evident on-focus expansion in these cues than TD, especially the native-Mandarin speaking peers. They also demonstrated a clear preference to on-focus expansion than to post-focus compression. These children, together with their native Cantonese-speaking peers, also hyper-performed in tone realization, prioritizing lexical prosody over focus marking. Such hyper-performance may further limit their use of prosodic cues in focus marking. However, the difficulties the autistic children faced in the acquisition of speech prosody in a non-native tone language, though found, are not more than those they face in their mother tongue. Conclusion: Multilingual exposure may help the autistic children master the use of some focus marking strategies though they still need interventions to help them to implement their focus-marking knowledge more sufficiently in both native and non-native languages.

Abstract

Purpose: Autistic children have an increased likelihood of anxiety, but more research is needed on the characteristics that predict various types of anxiety in this population. Methods: In this study, we examined a range of child and family predictors of various types of anxiety using a sample of 452 autistic children from the Australian Autism Biobank. We used logistic regression to examine child and family predictors of four common types of anxiety in autistic children: generalised, phobic, separation, and social anxiety. Results: We found that 62.8% of children in this sample had symptoms of at least one type of anxiety. Poor quality sleep habits were the only predictive factor consistently identified across all anxiety symptom types. Specific to children with indicated generalised, separation, and phobic anxiety symptoms were the predictive factors of being older than five years, and specific to generalised and social anxiety were the predictive factors of higher cognitive abilities. Maternal anxiety was also a predictive factor in indicated children’s separation anxiety. Conclusion: These findings can help inform the provision of more targeted support for autistic people, particularly the interaction of poor sleep habits and anxiety symptoms.

Abstract

Autism spectrum disorder (ASD) is characterized by impairments in social affective engagement. The present study uses a mild social stressor task to add to inconclusive past literature concerning differences in affective expressivity between autistic young adults and non-autistic individuals from the general population (GP). Young adults (mean age = 21.5) diagnosed with ASD (n = 18) and a non-autistic comparison group (n = 17) participated in the novel social stress task. Valence (positive/negative) and intensity of facial affect were coded across four observational episodes that alternated between engagement and disengagement of social conversational partner. Results indicated an overall attenuation in expressivity in the ASD group in comparison to the non-autistic group. Mean affect differed between groups, especially in the amount of affective expression. Both groups responded with increased positive expressions during social engagement episodes. The affect difference was driven by a smaller proportion of positive and a greater proportion of neutral affect displays in the ASD group compared to the non-autistic group during these episodes, and less so by negative affect differences. The results suggest that friendly, non-threatening social interactions should not be assumed to be aversive to autistic individuals, and that these individuals may respond to such situations with muted positive valence. These findings are consistent with past reports of decreased expressivity in autistic individuals compared to individuals from the general population, specifically in an ecologically valid social context.

Abstract

The prevalence of autistic students in schools is continuously increasing. Typically, the social and sensory differences associated with autism can make the school environment difficult to manage. Autistic students are more likely to experience mental health difficulties than their non-autistic peers. It is therefore important to listen to autistic people about their educational experiences and explore ways that the environment could be changed to reduce anxiety. Purpose. The current research explores whether the relationship between school belonging and anxiety in secondary-aged autistic students is mediated by camouflaging. Methods. An anonymous online survey was completed by 72 autistic students attending mainstream schools in the UK and Ireland. The survey included questionnaires about school belonging (simple sense of belonging scale), anxiety (ASC-ASD) and camouflaging traits (CAT-Q). Further, the survey included open-ended questions about environmental factors related to school belonging and camouflaging. Qualitative content analysis was used to interpret answers to open ended questions. Results. The results found that, as predicted, camouflaging did mediate the relationship between school belonging and anxiety. Categories were created for each question, for example, ‘the school environment’ and ‘acceptance and understanding’. Conclusion. Social relationships; individual factors; the environment and adaptations, and acceptance and understanding, influence students’ sense of belonging.

Abstract

This research aimed to establish whether 12 weeks of bicycle-riding skills exercises with massed and distributed practice frequency at low and high intensity affect communication performance and stereotyped behavior among adolescent boys with autism. Fifty autistic boys aged 13.3 ± 1.32 years participated in the study. The participants were divided into homogeneous experimental groups (N = 10) with dissimilar training frequencies and intensities, along with a control group. Pre-tests using the GARS-2 test were administered to assess stereotyped behavior and communication skills, followed by post-tests and a one-month follow-up. Non-parametric Kruskal Wallis and ANCOVA results at a significance level of 0.05 showed that there was a significant difference in the post-test of stereotyped behavior and communication skills (p = 0.001 and p = 0.002, respectively) and follow-up test one month later (p = 0.003, p = 0.048, respectively) between the intervention and control groups after performing bike riding skills exercises with low and high intensities and frequencies (one and three sessions per week). Regardless of the intensity and frequency, bike riding skills training during the critical period of adolescence can significantly reduce stereotyped behaviors and enhance communication skills, which can also support positive development in other domains for individuals with autism.

Abstract

Much of the current autism and gender literature has been based within a medical deficiency model; where both are seen as deficiencies rather than differences. However, there is currently minimal knowledge about the experiences of being an autistic adolescent who is both assigned female at birth and has gender dysphoria (GD), whilst even less is known about their experiences of social identity, self-concept and resilience. This study aims to explore experiences of GD with a particular focus on identity and resilience to promote parent and healthcare staff understanding; particularly around gender-affirming care, to foster positive mental health outcomes. Five assigned female at birth autistic adolescents, who identify as trans men/boys, took part in one-to-one semi-structured interviews, which were analysed using an Interpretative Phenomenological Approach. Five subordinate themes arose; “Having both autism and GD”, “Finding where I belong”, “Being more than labels”, “Trying to cope” and “Making support successful”. Our findings build on current literature and theory regarding the experience of concurrent autism and GD; highlighting its legitimacy, the ways in which autism impacts upon GD and how healthcare approaches and policy can increase accessibility and suitability of gender-affirming care.

Abstract

Purpose

Our goals were to: 1) examine the occurrence of behavioral and emotional symptoms in children on the autism spectrum in a large national sample, stratifying by sex, and 2) evaluate whether children with increased autism-related social communication deficits also experience more behavioral and emotional problems.

Methods

 Participants (n = 7,998) were from 37 cohorts from the Environmental influences on Child Health Outcomes (ECHO) Program. Cross-sectional information on demographic factors, parent-report of an ASD diagnosis by clinician, Social Responsiveness Scale (SRS) scores, and Child Behavior Checklist (CBCL) scores were obtained for children aged 2.5–18 years by surveys. We examined mean differences in CBCL Total Problems and DSM-oriented subscale scores by autism diagnosis and by child sex. Analyses using logistic regression were conducted to examine whether autism was associated with higher CBCL scores. We further examined if these relationships differed by child age category (< 6 years, 6–11 years, 12 + years). The relationships between SRS score and CBCL total and subscale scores were examined using quantile regression models, with analyses adjusted for child sex and age.

Results

 In ECHO, 553 youth were reported by a parent to have a clinician diagnosis of autism spectrum disorder (ASD) (432 [78%] boys and 121 [22%] girls). Youth on the spectrum had higher mean CBCL raw scores on Total Problems and all DSM-oriented subscales compared to those not on the spectrum (all p < 0.0001). Analyses adjusted for sex and stratified by age group indicated that higher odds of autism diagnosis were associated with total, depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) scales in the top 30% of the CBCL score distribution. Autistic girls were more likely to have parent-reported depression and anxiety compared to autistic boys. In quantile regression analyses, we observed evidence of stronger associations between SRS and CBCL for those in higher quantiles of CBCL total problems scale score (beta representing 1-unit change in SRS associated with 1-unit increase in CBCL total problems scale score), among children in the 70-90th percentile (β = 1.60, p < 0.01), or top 10th percentile (β = 2.43, p < 0.01) of the CBCL total problems scale score distribution. Similar findings were seen for the DSM-oriented depression, anxiety, and ADHD subscales.

Conclusion

 Results from this large national sample suggest increased behavioral and emotional problems among autistic children compared to non-autistic children throughout early life. Among children on the spectrum this may warrant increased monitoring for co-occurring behavioral and emotional problems.

Abstract

The Aberrant Behavior Checklist (ABC) was originally developed to evaluate interventions, and is a well-established assessment tool for challenging behaviours in people with intellectual disabilities and autistic people. However, whether the ABC displays longitudinal measurement invariance (i.e., whether it captures the same constructs over time) has been sparsely explored. The aim of the current study is to explore the factor structure, longitudinal measurement invariance, and clinical correlates of the ABC in autistic individuals with intellectual disabilities. Using data from a multicentre study of mental health assessment and treatment in autistic people with intellectual disabilities, the intake ABC scores of 200 autistic individuals with intellectual disabilities were used to explore the ABC factor structure, internal consistency, and clinical correlates (age, gender, level of intellectual disability, autism characteristics, communication skills). Scores across three time points (intake, post-intervention, follow-up) were used to explore longitudinal measurement invariance and internal consistency over time. The original five-factor structure showed a non-optimal but acceptable fit, which was similar or slightly improved compared to previous studies. Associations for some ABC subscales were found to be positive for autism characteristics and negative for communication skills. Four of the five subscales (irritability, social withdrawal, stereotypic behaviour, inappropriate speech) showed residual levels of longitudinal measurement invariance, while one subscale showed noninvariance (hyperactivity/noncompliance). The current study demonstrates the construct validity and applicability of the ABC in autistic individuals with intellectual disabilities, while also indicating that caution is advised for one of its subscales in comparisons across time.