Autism, Ahead of Print.
Deception is a multi-faceted social behaviour that is pervasive in human communication. Due to differences in social communication and experiences, autistic and non-autistic adults may contrast in how they respond to situations that elicit deceptive decision-making. This study examined whether autistic and non-autistic adults differed in their general lie frequency, their inclination to produce different lie types, and their emotional experiences of lying. Fifty-eight non-autistic and fifty-six autistic university students matched on age and gender completed self-report measures of their general lying patterns, how often they lied in the past 24 hours, and whether they would lie across hypothetical scenarios with differing beneficiaries (self, other, group) and motivations (protective, beneficial). The groups did not significantly differ in their general lying behaviour or frequency of lies told over 24 hours. Yet, autistic adults indicated that they would be significantly less likely to lie in group scenarios and would experience increased difficulty, more guilt, and greater concerns about their believability when lying. These results advance theoretical understanding by suggesting that autistic adults’ deceptive decision-making may be context-dependent. Future research may benefit from examining autistic deception across numerous social situations as more general lie frequency measures may be insensitive to nuanced population differences.Lay AbstractLying, a universal social behaviour, is frequent in everyday communication. Due to differences in social communication and experiences, autistic and non-autistic adults may react differently in situations where they must decide whether to lie or tell the truth. We investigated whether autistic and non-autistic adults differ in their general lying behaviour (e.g. how often they lie) and their likelihood of lying in a range of hypothetical social scenarios with different motivations (why people lie – to benefit or protect) and orientations (who people lie for; themselves, other, a group). We also examined participants’ emotional experiences of lying and truth-telling. We found that autistic and non-autistic adults’ general lying frequencies and emotional experiences were similar. However, the social scenario responses revealed that autistic adults would be less likely to lie to benefit or protect a social group they are part of. Moreover, autistic adults indicated that they would find lying more difficult across all social scenarios, experience more guilt, and would be less confident that their lie would be believed. This research highlights how autistic adults’ lying may be context-dependent and considers how a reduction in the likelihood of lying for their social group could increase strain on autistic adults’ social relationships.

Autism, Ahead of Print.
Children with autism or attention-deficit/hyperactivity disorder (ADHD) are more likely than neurotypical children to experience eating difficulties, such as picky/selective eating, slow eating, and over/under-eating. Recent studies show that eating difficulties can persist into adulthood for autistic individuals. Yet little is known about the mechanisms involved and whether adults with ADHD also experience such challenges. We (1) compare eating difficulties among adults with autism, ADHD, autism/ADHD, and neither condition and (2) identify predictors of overall eating pathology and of food selectivity. The sample was 50% female and 78% White, consisting of 961 adults aged 19-57 who self-reported their diagnostic status: 184 with autism, 416 with ADHD, 292 with autism/ADHD, and 69 comparisons. Eating difficulties were assessed via self-report survey using the Swedish Eating Assessment for Autism (SWEAA) and Food Preferences Questionnaire. Autistic adults, with or without ADHD, reported significantly more eating difficulties than all other groups. Total eating difficulties were associated with increased insistence on sameness, other autistic features, food selectivity, and hyperactivity-impulsivity. Food selectivity was predicted by increased insistence on sameness, sensory sensitivity, and other core features of autism, and lower hyperactivity-impulsivity. The high degree of eating difficulties in autistic adults warrants clinical attention on this topic.Lay AbstractSome people do not like many foods, eat very quickly or slowly, or eat too much or too little. These problems are more common in children with autism or ADHD and may continue for a long time, but we do not know much about these problems in adults. Our goal was to understand how eating difficulties are similar and different in adults with autism, ADHD, both autism/ADHD, and neither condition. We also wanted to understand factors that relate to picky eating and overall eating difficulties. We found that autistic adults had the most problems with eating compared to all other groups. Adults with ADHD had more eating problems than adults with neither condition. Adults with autism and/or ADHD were more sensitive to taste and texture of foods, had difficulty with spilling food, and found it hard to tell whether they are hungry or full compared to people without these conditions. We also found that autism and ADHD traits were linked to picky eating and having more eating problems. The results show that many autistic adults and some with ADHD might need support with eating. Doctors should pay attention to eating problems to help people get the care they need. Results also show that wanting things to stay the same may be more related to eating problems than researchers previously thought. We need more research to understand how to support adults with eating difficulties.

Autism, Ahead of Print.
Autistic youth experience higher rates of peer victimization than their non-autistic peers. While there is some evidence that friendships may protect against the negative mental health effects of peer victimization in the general population, these protective effects have not been examined in autistic youth. The current study explored whether satisfaction with friendship support is associated with depressive symptoms among autistic youth, and whether satisfaction with friendship support buffers against the negative effects of peer victimization on mental health. Autistic youth (N = 224) between the ages of 15 and 25 years (M = 18.68 years) completed questionnaires measuring frequency of peer victimization, satisfaction with friendship support, and depressive symptoms. Satisfaction with friendship support was not associated with depressive symptoms; however, the effect of peer victimization on depressive symptoms was attenuated for youth who were more satisfied with their friendship support compared to youth who were less satisfied with their friendship support. The results of the current study therefore highlight the potential for promoting mental health of autistic youth through reducing peer victimization and increasing satisfaction with peer relationships.Lay AbstractAutistic youth are more likely to be bullied than youth who are not on the autism spectrum. Youth in the general population who are bullied experience poor mental health, but those who are satisfied with their friendships may be protected from these negative outcomes. No studies have looked at how friendships affect the mental health of autistic youth who are bullied by their peers. Autistic youth completed questionnaires that asked them to report how frequently they were bullied, whether they were satisfied with the support they received from friends, and depressive symptoms they experienced. Depressive symptoms did not differ between youth who were more satisfied and youth who were less satisfied with their friendship support. However, among youth who were frequently bullied, depressive symptoms were lower for those who were more satisfied with their friendship support compared to those who were less satisfied with their friendship support. This study shows that interventions are needed to support the mental health of autistic youth by decreasing bullying by peers and increasing positive peer relationships.

Autism, Ahead of Print.
In non-autistic populations, social motor synchrony during interactions is linked to increased interpersonal rapport – a friendly connection marked by mutual understanding and ease of communication. Previous research indicates autistic individuals show lower social motor synchrony in interactions with both autistic and non-autistic partners. However, it is unclear if this affects rapport, as synchrony’s role in social communication may differ for autistic individuals. The study had three aims: to replicate and extend previous findings of reduced social motor synchrony in dyads with at least one autistic person; second, to examine the relationship between synchrony and rapport in autistic (n = 12), non-autistic (n = 17), and mixed dyads (n = 14); and third, to investigate reliance on motor synchrony for achieving rapport among autistic and non-autistic participants. We found no evidence that dyads with at least one autistic person have less social motor synchrony than dyads without an autistic person. However, we found that social motor synchrony positively affects rapport more in non-autistic dyads than in autistic dyads. Participant-level analysis indicated that non-autistic individuals require higher social motor synchrony levels to achieve high rapport levels than autistic individuals. These results suggest that non-autistic individuals may emphasise movement synchrony as a key component of successful social interaction.Lay abstractDuring social interactions, people often mirror each other’s movements and gestures, a process called synchrony. This synchrony helps foster a sense of connection, understanding, and ease in communication. While research suggests that autistic people may show less synchrony in their movements compared to non-autistic people, the implications of this difference for building rapport remain unclear. Specifically, it is unknown whether synchrony plays a similar role in rapport-building for autistic individuals as it does for non-autistic individuals, particularly in interactions with autistic versus non-autistic partners. This study had three goals to investigate whether synchrony is lower in conversations involving at least one autistic person; to explore the relationship between synchrony and rapport; and to compare how much autistic and non-autistic people rely on synchrony to feel connected. The findings suggest that while synchrony positively influences rapport more strongly in non-autistic interactions, autistic individuals may rely less on synchrony for rapport. These results highlight differences in how social connection is built, offering deeper insight into social interactions for autistic and non-autistic people.

Autism, Ahead of Print.
Transitioning to higher education can be challenging for neurodivergent students and they can be particularly vulnerable to experiencing stress in this new environment, resulting in higher levels of non-completion. To address this issue, this study details the co-design of a support programme for neurodivergent students in higher education. It used logic modelling workshop methodology to identify the short-term and long-term outcomes, activities and resources required for implementation. The logic model was produced during a workshop that involved a range of stakeholders, including researchers, neurodivergent and neurotypical students and disability service staff at an Irish university. The qualitative data were analysed through thematic analysis and three key outcomes were generated from the logic modelling process: ‘connectedness’, ‘knowledge and awareness of neurodiversity’ and ‘empowerment’. The main activities desired by stakeholders included one-to-one mentoring and group-based mentoring, which would allow neurodivergent students to establish new friendships and develop a sense of belonging within the university. The implementation factors identified were providing a dedicated space and mentor pairing. A key finding was that stakeholders did not favour traditional peer mentoring labels of ‘mentor’ and ‘mentee’. Instead, students preferred the development of a symbiotic co-mentoring relationship between peers, with both participants being referred to as ‘mentors’.Lay abstractNeurodivergent students may require support with the social aspects of university life. Peer mentoring describes a relationship where a more experienced student helps a less experienced student by providing advice, support and knowledge. It is an effective way to support students’ transition to higher education. This study involved a wide range of stakeholders including neurodivergent students, neurotypical students, disability service staff and researchers in the design of a peer mentoring programme called Synapse. A visual representation of the proposed programme (i.e. logic model) was produced during a workshop with the stakeholders. This visual showed the key outcomes or aims of the programme that was agreed upon by the stakeholders. The workshop was audio recorded and the transcripts were analysed to highlight the main conversation themes. Stakeholders stated that neurodivergent students wanted to feel more connected to others at the university to develop a sense of belonging, they also wanted people to learn more about neurodiversity to reduce stigma and finally, they wanted to feel empowered to take control of their lives and have a voice in decision-making. The two preferred activities of the programme were one-to-one and group mentoring. Uniquely, the participants were concerned with traditional terminology around peer mentoring, in particular the terms mentor and mentee, as it inferred an unequal power dynamic in a relationship. The stakeholders believed that students in the Synapse programme should be valued and treated equally, regardless of diagnosis or experience. Therefore, all members of the Synapse programme were paired within a co-mentoring relationship.

Autism, Ahead of Print.
Although autistic adults may establish better dyadic rapport with autistic relative to non-autistic partners, it is unclear whether this extends to group settings. The current study examined whether rapport differs between autistic groups, non-autistic groups, and mixed groups of autistic and non-autistic adults, and whether differing diagnostically from the rest of the group results in lower rapport. One hundred and forty-three adults were assigned to one of four group types of four participants each: all-autistic, all-non-autistic, non-autistic majority (three non-autistic, one autistic), and autistic majority (three autistic, one non-autistic). Groups participated in a 5-minute building activity and afterwards completed a 5-item rapport measure assessing their experience. The all-autistic groups did not differ on overall rapport from the all-non-autistic groups and had significantly higher rapport on two items (enjoying the interaction and friendliness of the group) than both types of mixed groups. At the individual level, autistic participants expressed more ease and enjoyment when interacting with other autistic adults relative to non-autistic adults, and their rapport declined as more non-autistic participants were included in the group. In contrast, rapport for non-autistic participants remained relatively consistent regardless of group composition. We discuss potential reasons why autistic participants were more affected by group composition than non-autistic participants.Lay abstractAutistic adults sometimes get along better with other autistic people compared to non-autistic people, but so far this has only been studied in two-person interactions. This study examined how well autistic and non-autistic people develop rapport in a group setting and whether rapport differs when group members share or do not share a diagnosis. We assigned 143 adults to 36 groups of four adults each. Some groups only had autistic members, some only had non-autistic members, and some were “mixed” groups of autistic and non-autistic members. Groups participated in a tower-building task for 5 minutes and afterwards completed a survey about rapport with the group. The groups of all-autistic participants expressed that their interactions were more enjoyable and friendly than the mixed groups. Autistic participants reported lower rapport when interacting with non-autistic adults, while non-autistic participants reported similar rapport whether interacting with autistic or non-autistic group members. Overall, findings are not consistent with a social deficit model of autism, as autistic adults often established rapport with partners in a group setting. Their level of rapport, however, depended strongly on the social context, particularly whether other autistic people were also in the group.

Autism, Ahead of Print.
Sleep disturbances are one of the most common comorbidities in autistic children and adolescence. Considering the impact of sleep disorders on development and daily functioning, it is important to know which treatments are considered effective in literature. This systematic review and meta-analysis study specifically aimed to investigate the effectiveness of non-pharmacological interventions for the treatment of sleep disorders in autistic children and adolescents without intellectual disability. Search across PubMed, PsycINFO, Scopus, and Web of Science were identified 11 randomized controlled trial studies published between 2012 and 2024 that met the inclusion criteria. The results indicate that the interventions considered (Behavioral/psychological, Physical activity, and Somatosensory sleep interventions) significantly improve sleep parameters in this population (p < 0.05). Objective data from actigraphy show an increase in total sleep time and sleep efficiency and a reduction in sleep onset latency. The results also show an improvement in sleep quality assessed through the Children’s Sleep Habits Questionnaire filled out by parents. This study is one of the first to examine through a meta-analysis the positive impact of non-pharmacological therapies in the treatment of sleep disorders in autistic children and adolescents without intellectual disability. Alternative treatments are essential, particularly for those who are intolerant to medication, as it allows clinicians to provide effective interventions tailored to this population.Lay AbstractSleep disorders are common in people on the autistic spectrum and can affect their development, daily function, and overall well-being. This study examined the effectiveness of non-pharmacological intervention to improve sleep in autistic children and adolescents without intellectual disability. We considered 11 studies of non-pharmacological treatments for autistic children and adolescents. The results indicate that these interventions help to improve several sleep parameters, either by increasing, for example, the total time and quality of sleep, or by reducing the time needed for falling asleep. These approaches offer important treatment options especially for those cases where medication is not feasible, allowing physicians and specialists to propose more targeted and safer solutions for managing sleep difficulties in this population.

Autism, Ahead of Print.
Autistic individuals are frequently exposed to stigmatizing attitudes and discrimination. Through the lived experience of stigmatizing attitudes, autistic people can internalize the negative stereotypes associated with autism. This phenomenon is known as self-stigma. In non-autistic populations, self-stigma is associated with shame and negative mental health outcomes. In this study, we aim to better understand the mental health outcomes associated with self-stigma in autism and to investigate whether and how self-compassion compared to camouflaging may protect from self-stigma in autistic individuals. For this purpose, 689 adults who reported a diagnosis of autism were recruited online and completed self-reported questionnaires for self-stigma (Internalized Stigma of Mental Illness Scale–9 items), self-compassion (Self-Compassion Scale–short form), depression (Depression, Anxiety and Stress Scale-21) and camouflaging (Camouflaging Autistic Traits Questionnaire). We conducted mediation analysis and moderated mediation analysis. Our results indicate that self-stigma is highly prevalent in autistic adults (45.5%), correlated to depression (ρ (687) = 0.437, p < 0.001) and that internalized shame mediates the relationship between self-stigma and depressive symptoms (b = 1.48, 95% confidence interval = (1.11, 1.94)). Self-compassion moderates this mediation (Indirect Effect, IE = −0.305, 95% confidence interval = (0.601, 0.014), β = 0.183, z = 2.012, p = 0.044), whereas camouflaging does not (IE = 0.003, 95% confidence interval = (0.009, 0.015), β = 0.0531, z = 0.514, p = 0.607). These results highlight the protective effect of self-compassion on the negative impacts of self-stigma in autistic individuals. Future research should explore how to adapt existing compassion-focused interventions and evaluate their feasibility and efficacy to reduce self-stigma and shame in autistic populations.Lay abstractWhat is already known about the topic?Autistic individuals are frequently exposed to stigmatizing attitudes and discrimination. Negative stereotypes about autism, such as dangerousness or inability to work, are very frequent in our societies. Through exposure to these stigmatizing ideas, autistic people can internalize these ideas and begin to believe them to be true about themselves. This is self-stigma. Past research conducted with non-autistic individuals indicate that self-stigma can lead people to feel ashamed of who they are and deteriorate their mental health.What this paper adds?In this paper, we found that self-stigma in autistic people increases depressive symptoms through feelings of shame. We then showed that relating to self with compassion – that is, to be friendly towards oneself (kindness), be aware of one’s feelings and thoughts (mindful awareness) and realize that everyone feels pain and makes mistakes (common humanity) – helps reducing the negatives consequences of self-stigma on mental health. We also demonstrated that camouflaging does not modify the impact of self-stigma on mental health.Implications for practice, research or policy?Because self-compassion can protect from the negative effects of self-stigma, future research should explore how to adapt existing compassion-focused interventions and evaluate their feasibility and efficacy to reduce self-stigma and shame in autistic people.

Autism, Ahead of Print.
Play is a central feature of childhood and a fundamental right of all children. Currently, our understanding of autistic play is based on a deficit perspective, most often framed in comparison to neurotypical ‘norms’ and assumptions where the views of the players themselves have been overlooked. In moving towards a strengths-based neuroaffirmative understanding of autistic play, this study consulted with 19 autistic children (aged 5 to 13 years) using a series of semi-structured interviews and a range of creative and participatory methods. Reflexive thematic analysis generated three themes where children conceptualised: (1) enjoyment and pleasure as central to the definition of play, (2) social connections as fundamental to play and (3) play as engagement with meaningful materials and activities. Children’s autonomy and agency in play was important to all themes. These findings challenge long-standing deficit-oriented assumptions that have persisted throughout the literature for decades and have implications for future programmes of research, theory and practice, in particular on the importance of providing and facilitating authentic play experiences for autistic children in education and care contexts.Lay abstractAutistic play is generally described from a deficit perspective where the players themselves have been overlooked. It is important to consult with autistic children themselves about their understanding of play. We asked autistic children about their views on play using many different creative ways that were chosen by the children themselves. We analysed findings using reflexive thematic analysis. Autistic children in this research described play as involving feelings and emotions of pleasure and joy, autonomy and agency, playing by themselves and with others and engagement with materials and activities as meaningful. It is very important that we ask the players themselves what they think about play rather than relying on deficit framed, non-autistic definitions of autistic play. In this article, we will discuss how these findings will help develop future research, theory and practice in respecting children’s right to authentic play experiences.

Autism, Ahead of Print.
Adaptive behavior is paramount for independent living and is varyingly impaired in different neurodevelopmental disorders. This study aimed to investigate differences in adaptive behavior between children with autism spectrum disorder and social communication disorder, two conditions characterized by deficits in social communication. Data from 232 children with autism spectrum disorder and 90 children with social communication disorder were analyzed. Adaptive behavior was assessed using the Vineland Adaptive Behavior Scale-III. Diagnoses were made independently using the Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria and the AIIMS Modified INCLEN Diagnostic Tool-autism spectrum disorder Diagnostic Evaluation for autism spectrum disorder. Statistical analyses included non-parametric tests and generalized linear models to account for age and sex differences. The results showed that children with social communication disorder exhibited better adaptive behavior than those with autism spectrum disorder across all domains (p < 0.001). The most significant differences were observed in the Vineland Adaptive Behavior Scale-III standard scores in communication (autism spectrum disorder: 50.40 ± 15.51; social communication disorder: 70.53 ± 9.69) and socialization (autism spectrum disorder: 69.46 ± 8.77; social communication disorder: 80.07 ± 6.16) domains. Age and overall adaptive behavior scores correlated well with group membership (p < 0.001). These findings emphasize the importance of distinguishing between autism spectrum disorder and social communication disorder in clinical practice. The results support the use of adaptive behavior assessments in diagnostic evaluations, highlighting the need for tailored interventions.Lay abstractThis study compared adaptive behavior skills between children with autism spectrum disorder and social communication disorder using the Vineland Adaptive Behavior Scale-III. The researchers analyzed data from 232 children with autism spectrum disorder and 90 with social communication disorder. Key findings showed that children with social communication disorder demonstrated significantly better adaptive functioning across all areas compared to those with autism spectrum disorder. The largest differences were seen in communication and social skills. However, both groups still showed impairments compared to typical development, especially in expressive language. The study also found that younger children with lower overall adaptive behavior scores were more likely to be diagnosed with autism spectrum disorder. In addition, there was a higher proportion of males in the social communication disorder group than the autism spectrum disorder group. These results highlight important differences between autism spectrum disorder and social communication disorder, supporting their classification as distinct disorders. The findings emphasize the need for comprehensive adaptive behavior assessment during diagnosis and tailored interventions for each condition. Early identification and targeted support may be particularly crucial for children with autism spectrum disorder.

Autism, Ahead of Print.
There is a great demand for quality early intervention services for autistic children and their families. Caregiver-mediated interventions are critical components of evidence-based early intervention. However, their implementation in publicly funded systems is often done with poor fidelity. Qualitative evidence suggests that family characteristics impact clinicians’ use of caregiver-mediated intervention coaching strategies. We estimated associations between family characteristics and clinicians’ use of a caregiver-mediated intervention in a publicly funded early intervention system, leveraging data from a pilot randomized trial. Data were collected from 12 clinicians and 34 families. We used multiple linear regression models to estimate associations. The association between household income and clinicians’ overall coaching fidelity demonstrated a quadratic trend (b = −10.4, standard error = 4.1, p < 0.05) with low fidelity for low- and high-income families relative to middle-income families. Use of in vivo feedback, one component of coaching, was similarly associated with income (b = −0.5, standard error = 0.2, p < 0.05). Clinicians’ coaching fidelity was lower among families in exclusively English-speaking homes than for families who speak other languages (b = 18.4, standard error = 8.8, p < 0.05). Results suggest that associations between family characteristics and clinician behavior may be more nuanced than previously understood.Lay abstractThere is a high demand for quality early intervention services for autistic children and their families. A key part of effective early intervention is teaching caregivers how to support their child’s development through caregiver-mediated interventions. However, in publicly funded programs, these strategies are often not followed correctly. Some studies suggest that family characteristics may influence how well clinicians apply these coaching methods. In this study, we explored the connection between family factors, like household income and language spoken at home, and the way clinicians coached families. We found that clinicians used coaching strategies less consistently with both lower- and higher-income families compared to middle-income ones. In addition, families that spoke only English at home received less consistent coaching than those who spoke other languages. These findings highlight the complex relationship between family background and how early intervention services are delivered, suggesting a need for further research.

Autism, Ahead of Print.
Limited research exists on fathers’ experiences of interparental conflict (IPC) in families with autistic children. We aimed to identify: (1) the extent to which these fathers report IPC across 10 years of child development (4–14 years) and how this compares to fathers of non-autistic children; (2) distinct trajectories of IPC for fathers of autistic children and (3) factors associated with trajectories of IPC among fathers of autistic children. This is a retrospective study using a national dataset. Participants were 281 fathers of autistic children and 7046 fathers of non-autistic children. Although small effect sizes, fathers of autistic children, on average, reported significantly higher IPC when their child was 4–5, 6–7, 8–9 and 10–12 years of age, compared to fathers of non-autistic children. For fathers of autistic children, longitudinal latent class analysis revealed three profiles reflecting ‘low and stable’, ‘moderate and stable’ and ‘persistently elevated’ levels of IPC over time. Regression analysis revealed a range of predictors (e.g. co-parenting support, father age) for fathers of autistic children experiencing ‘moderate and stable’ and ‘persistently elevated’ IPC as compared to fathers who experienced low levels of IPC. There is a significant portion of fathers of autistic children who experience ongoing and heightened IPC, highlighting the need for targeted support.Lay AbstractNot much is known about how fathers experience conflict with their partners (either verbal or physical) while raising an autistic child. This study focused on understanding these experiences over 10 years, following children from the age of 4 to 14 years. The study had two main goals: (1) to track how fathers experience conflict with their partners over this time and identify different patterns to these experiences; and (2) to find psychosocial factors in early childhood that might impact these patterns. The study included 281 fathers of autistic children and 7046 fathers of non-autistic children who took part in ‘Growing Up in Australia: Longitudinal Study of Australian Children’. Using a statistical method to group fathers based on the partner conflict they reported over the 10 years, results showed that there were three groups: (1) ‘low and stable’, (2) ‘moderate and stable’ and (3) ‘persistently elevated’ experiences of partner conflict. Additional analysis showed that fathers’ confidence in their parenting, perceived support from their partners and concerns about their child’s language skills were associated with ongoing moderate levels of partner conflict. On the other hand, fathers who were older, had lower perceived support from their partners, partners experiencing psychological distress and higher parent-reported child social functioning were more likely to experience consistently high levels of conflict over time. In our study, we described different levels of conflict with their partners reported by fathers of autistic children. We also identified some of the factors that were associated with different levels of conflict. These might be used to inform interventions to reduce parental conflict in the future.

Autism, Volume 29, Issue 2, Page 275-283, February 2025.

Autism, Ahead of Print.
The COVID-19 pandemic caused significant health distress among autistic adults in the United States. While there is considerable evidence that autistic adults’ COVID-19 health distress was related to increases in mental health concerns (e.g. depression, anxiety, and stress), there is a less clear understanding of the possible mechanisms by which this process occurs. Accordingly, our participatory action research team assessed whether psychological flexibility, a strengths-based mechanism from acceptance and commitment therapy, mediated the association between COVID-19-related health distress and mental health concerns (e.g. depression, anxiety, and stress). We found that among 281 autistic adults the positive relationship between COVID-19 health distress and mental health concerns was partially mediated by values progress (a component of psychological flexibility) and values obstruction (a component of psychological inflexibility). Results provide preliminary support that the strengths-based mechanism of psychological flexibility might be a salient therapeutic target to improve mental health among autistic adults experiencing health distress.Lay AbstractWhat is already known?In the United States, the COVID-19 Pandemic caused many autistic adults to be fearful and worried about their health. There is a lot of research that says that when autistic adults experience health distress it can worsen their mental health. We do not know, however, what might explain how experiencing health distress negatively affects mental health. Because of this, our participatory action research team wanted to understand if there are strengths-based processes that help us understand the relationship between health distress and mental health concerns.What does this paper add?We examined among 281 autistic adults how a strengths-based construct from acceptance and commitment therapy called psychological flexibility might explain the relationship between health distress and mental health concerns. We found that for adults that had more values progress, doing the things that mattered to them, was associated with better mental health even while experiencing health distress. We also found that values obstruction, getting stuck on uncomfortable thoughts and feelings and trying to avoid them, explained worse mental health for autistic adults experiencing health distress.Implications for research and practice?The findings of this study provide initial support that psychological flexibility can explain the relationship between health distress and mental health concerns among autistic adults. Interventions that seek to improve psychological flexibility, like acceptance and commitment therapy, might be useful in improving autistic adults’ mental health while they are experiencing health distress.

Autism, Ahead of Print.
Autistic people are at elevated risk of mental health conditions and experience significant barriers to effective support. While adaptations to therapy for autistic people have been proposed by clinicians, there is limited research on how helpful autistic people themselves rate these. We aimed to address this gap. Participants were 130 autistic adults aged 18 to 64 years (85.4% female) who completed an online survey of the helpfulness of 55 therapy adaptations. Overall, we found positive ratings of helpfulness for approximately half of the adaptations. However, significant variability was found at an individual level with most adaptations rated from not helpful through to extremely helpful. Neurodiversity-affirming adaptations were rated highest overall. Participants shared additional adaptations including general good practice, financial, modality, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Findings highlight similarities and differences between clinician and autistic people’s perspectives, underscoring the need to include autistic people. Limitations of the restricted sample and generalizability are acknowledged. Future research including more diverse samples would be of value to expand on this research. The need to understand general preferences of autistic people and to individualize to the specific client is underscored by findings to begin bridging the mental health support gap for autistic people.Lay AbstractAutistic people experience more mental health conditions like depression or anxiety than non-autistic people. They are also more likely to experience difficulties in accessing mental health supports Clinicians have published suggestions on how to improve therapy for autistic people. However, whether these ways to adapt (i.e. adaptations) therapy for autistic people are seen as helpful by autistic people themselves has not been investigated. We recruited 130 autistic adults to complete an online survey. They rated 55 adaptations to therapy from “Not at all helpful” to “Extremely helpful.” We also asked for ideas of additional adaptations. Adaptations classified as neurodiversity affirming (e.g. having a therapist that embraces differences in brains and provides support to affirm neurodivergent identity) were rated highest. Approximately half of adaptations were rated positively at a group level. However, for almost every adaptation at least one person rated it as not at all helpful and at least one rated it as extremely helpful. Additional adaptations were around general good practice, financial cost, neurodiversity-affirming practices, practical, sensory/environmental, structure, and therapy style/techniques. Our findings add how helpful autistic people themselves rate adaptations to therapy and similarities and differences to clinicians. This is important to consider how these perspectives can differ. Findings also identify additional suggestions that clinicians could use in their practice and ideas for future research. Findings can help autistic adults in advocating for adaptations to therapy that address their needs by providing a list of possible adaptations. Furthermore, findings may help clinicians to better support their autistic clients.

Autism, Ahead of Print.
Autistic adults have reported experiencing discrimination across settings. Nonetheless, population-based research examining the prevalence of discrimination against autistic individuals has been more limited. Therefore, this study aimed to examine the prevalence of types of discrimination (i.e., due to race or ethnicity, due to sexual orientation or gender identity, and due to health condition or disability) experienced by autistic youth (n = 2339) compared to youth with other neurodevelopmental diagnoses (i.e. attention-deficit/hyperactivity disorder, learning disability, and speech or other language disorder; n = 10,325) and neurotypical youth (n = 44,781) 6–17 years of age utilizing a large, population-based sample. Data for this study were acquired from the 2021–2022 National Survey of Children’s Health, a nationally distributed caregiver-report questionnaire. Results found that the prevalence of discrimination due to race or ethnicity and sexual orientation or gender identity was higher among autistic youth than neurotypical youth. Notably, results also found that discrimination due to health condition or disability was far more prevalent among autistic youth than neurotypical youth and youth with other neurodevelopmental diagnoses. Findings highlight the increased prevalence of discrimination experienced by autistic youth and should prompt researchers, policymakers, and vested community members to action to address this problem.Lay abstractAutistic individuals have described facing unfair or discriminatory treatment across settings, such as in school and at work. However, there have been few studies examining how widespread or prevalent discrimination is against autistic individuals. We aimed to fill that gap by examining how prevalent or common it is for autistic youth to experience discrimination based on race or ethnicity, sexual orientation or gender identity, and health condition or disability. We compared rates of discrimination against autistic youth to youth without developmental differences/diagnoses and youth with other developmental differences (i.e. youth diagnosed with attention-deficit/hyperactivity disorder [ADHD], learning disability, and speech/language disorders). We analyzed data from the 2021–2022 National Survey of Children’s Health, which is a nationwide survey on which parents report about aspects of their children’s lives. We found that autistic youth experience higher rates of discrimination based on race or ethnicity and sexual orientation or gender identity compared to youth who are typically developing and do not have a diagnosis (such as a speech or language disorder). Importantly, they also face significantly more discrimination due to their disability than youth with other diagnoses, such as ADHD, and youth without a developmental diagnosis. These results show that autistic youth are at risk for experiencing discriminatory treatment. Our study should motivate researchers, policymakers, and community members to address this critical issue.

Autism, Ahead of Print.
Difficulties regulating emotions have been coined as inherent to autism, possibly even presenting a core difficulty of autism. While several models of emotion regulation have been proposed in the past, in this targeted review article, we aim to map emotion regulation difficulties in autistic individuals within the framework of the extended process model of emotion regulation. This model can be considered the most comprehensive one currently incorporating not only different emotion regulation strategy groups but also different stages and processes involved in successful self-focused emotion regulation. Within this model, we will identify areas and domains as specifically impacted by autistic individuals. We will also outline gaps in the literature and provide suggestions for future research that can help deepen our understanding of the emotion regulation processes of autistic individuals. The ultimate goal is to develop specific support programs that address specific emotion regulation mechanisms, providing a much more individualized support approach.Lay abstractWhat do we already know about emotion regulation in autism?We know that many autistic children, youth, and adults experience difficulties regulating emotions. Existing research has focused mainly on the differences in emotion regulation capabilities between autistic and non-autistic individuals, the relationships between autistic traits and emotion regulation, and how emotion regulation relates to other outcomes, such as social skills and mental health.What does this paper add?We want to take a new approach to review the existing emotion regulation research through the lens of a specific theoretical model: the extended process model of emotion regulation. Professor James Gross developed this model. It consists of four emotion regulation phases: identification, selection, implementation, and monitoring.Our review revealed specific areas within these emotion regulation phases that could significantly impact the emotion regulation experiences of autistic individuals. We also outline the gaps in the research and propose avenues for future investigation.Implications for practiceBy deepening our understanding of emotion regulation in autistic individuals through the proposed future research, researchers and clinicians can pave the way for the development of tailored support programs. These programs will directly target specific emotion regulation mechanisms, offering a much-needed individualized support approach.

Autism, Ahead of Print.
Genetic tests, such as Fragile X and Chromosomal Microarray, are recommended as a standard of care during the evaluation of autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, previous research demonstrates low rates of genetic testing. This study aimed to identify the rates of genetic testing and patient demographic factors that may be associated by conducting a retrospective chart review of 7539 electronic health records of patients who were evaluated for ASD or other neurodevelopmental disorders within a university healthcare network. Researchers created a database that listed patient demographics (race, gender, insurance, zip code), records of ordered but not completed tests, genetic test results and reasons for declining genetic tests (if noted), and other known barriers to genetic testing. Statistical analyses were conducted to determine associations between genetic testing rates and sociodemographic factors. 30.57% of patients received at least one indicated genetic test, while 11.31% received recommended concordant genetic testing. Findings suggest that while gender did not impact whether a patient received at least one genetic test, race and insurance did. Our review demonstrates that genetic testing is not sufficiently offered by physicians, and there are multiple barriers preventing patients from receiving genetic testing, which must be further investigated.Lay abstractGenetic testing is recommended by various professional organizations as part of clinical guidelines during the evaluation of autism spectrum disorder (ASD) and other neurodevelopmental disorders. However, previous studies demonstrate that rates of genetic testing are low. This study aimed to identify the rates of genetic testing within a large university healthcare network and factors that may be associated with higher or lower rates. Researchers reviewed over 7500 electronic health records of patients who were evaluated for ASD or other neurodevelopmental disorders. Some factors that were recorded include patient demographics (race, gender, insurance, zip code), ordered but not completed tests, genetic test results and reasons for declining genetic tests if noted, and other known barriers to genetic testing such as blood draws and specialties of providers seen by patients. Statistical analysis was conducted to determine associations between rates of genetic testing and different factors recorded in our database. Our results demonstrate that less than half of patients received at least one indicated genetic test, while a smaller percentage received recommended genetic tests. While sex assigned at birth and gender did not impact whether a patient received at least one indicated genetic test, race and insurance did. Our review reveals that genetic testing is not sufficiently offered by physicians, and we have identified multiple obstacles that prevent patients from receiving genetic testing which must be further investigated.

Autism, Ahead of Print.
The study was designed to review autism-associated policies, describe policy characteristics, and determine potential policy gaps compared with the recommendations set by the World Health Organization. Autism-associated policies in 15 government agencies and public institutions were thoroughly searched on ministry websites up to December 2022, where 81 of 2504 were retained. And 42 of the 81 policies were issued in 2021 and 2022. Twelve of the 15 included ministries were involved in policymaking, yet fewer than one third of the policy documents were jointly issued by multiple ministries, which are crucial for the effective implementation of autism-associated policies. Compared with the World Health Organization recommendations (the Comprehensive Mental Health Action Plan 2013–2030 and the Six Building Blocks of Health System), several areas showed a strong policy commitment, including leadership and governance, service delivery, and access to medicines and facility. Several potential gaps remained, including a relative lack of emphasis on health information and the health workforce, and insufficient attention to the community. Despite these potential gaps, encouragingly, the nation has increasingly focused on autism groups. This study can provide a basis for future policymaking to provide more comprehensive and better services for individuals with autism.Lay abstractPolicies have been found to play a crucial role in supporting the health and well-being of individuals with autism. Yet, relatively few policy reviews are related to autism, and the current level of autism-associated policies and potential gaps in comparison with the World Health Organization recommendations remain unclear. Our study reviewed autism-associated policies, described policy characteristics, and determined potential policy gaps in mainland China. We conducted a comprehensive search of autism-associated policies from 15 websites of government agencies and public institutions up to December 2022, where 81 of 2504 were retained. We found that 42 of the 81 policies were issued in 2021 and 2022. Twelve of the 15 included ministries were involved in policymaking and fewer than one third of the policy documents were issued by two or more ministries. With respect to recommendations proposed by the World Health Organization (the Comprehensive Mental Health Action Plan 2013–2030 and the Six Building Blocks of Health System), several areas received extensive national attention, including leadership and governance, service delivery, and access to medicines and facility, while there was limited policy attention on the other components. Despite these potential gaps, encouragingly, the nation has increasingly focused on autism groups. This study can provide a basis for future policymaking to provide more comprehensive and better services for individuals with autism.

Autism, Ahead of Print.
Sensorimotor difficulties are common in children with autism spectrum disorder, and it has been suggested that motor planning problems underlie their atypical movements. At early school-age, motor planning development typically involves changes in visuomotor integration, a function known to be affected in autism spectrum disorder. However, there is a lack of detailed characterization of typical motor planning development during this stage, and how motor planning develops in children with autism spectrum disorder is largely unknown. This longitudinal kinematic study examined goal-directed sequential manual movements in children with autism spectrum disorder and in typically developing children across ages 7, 8, and 9 years. We manipulated goal-difficulty and availability of initial visual information to investigate visuomotor integration and chaining of subparts during movement performance. The results revealed emerging group differences at older age, suggesting atypical motor planning development in children with autism spectrum disorder. Notably, unlike the typically developing group, availability of initial visual information did not facilitate motor planning for the autism spectrum disorder group. The results show that motor planning differences in autism spectrum disorder appear related to atypical visuomotor integration and global processing of sensorimotor information. The findings also emphasize the importance of considering developmental aspects in research and practice related to motor problems in children with autism spectrum disorder.Lay abstractMany children with autism struggle with movement difficulties, yet the causes of these difficulties remain unclear. One possible explanation is atypical motor planning and integration of visual and motoric information. Before performing a goal-directed movement, the brain creates a prediction of the movement based on visual and sensory information and previous experience, forming a “blueprint” of the motor steps needed to achieve the goal. This process is called motor planning. During movement, adjustments to the plan can be made through feedback mechanisms. This longitudinal study aimed to examine the development of motor planning in children with autism and typically developing children over early school-age (7–9 years). The children performed a sequential manual peg-rotation task, which involved grasping, rotating, and placing a peg, while detailed measures of movement were collected. Task end-goal difficulty varied, and the goal was either initially occluded or fully visible. The results revealed that children with autism showed atypical motor planning development compared with typically developing peers, and these differences became more pronounced as the children grew older. As the typically developing children matured, they appeared to rely more on initial visual information, which assisted them in motor planning. However, this facilitation did not occur for children with autism. These findings suggest that the differences in motor planning seen in children with autism may be linked to atypical visuomotor integration, highlighting the need for individualized interventions. Furthermore, it is crucial to consider developmental aspects to fully understand motor planning in children with autism.