1. Altamimi M, Kittana M, Muhanna S, Shakhshir A, Hamdan M, Badrasawi M. Psychological distress among mothers of autistic children in Palestine: a cross-sectional study. Advances in Autism. 2025; 12(2): 121-35.

Psychological distress has been documented among parents and caregivers of autistic children. This study aims to assess the levels of psychological distress experienced by mothers of children with autism and the associated factors in Palestine.A cross-sectional study was conducted among 133 mothers, with 65 mothers of autistic children, and 68 mothers serving as controls. Self-administered questionnaires were used for data collection. Psychological distress was assessed by administering the Arabic version of the 12-item General Health Questionnaire.A significantly higher level of psychological distress in mothers of autistic children was found. Social dysfunction and depression and anxiety subscales were significantly higher in mothers of autistic children. Loss of confidence score was significantly lower in mothers of autistic children.A significant elevation in psychological distress among mothers of autistic children in the West Bank, emphasising the need for targeted interventions.

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2. Barabasz KM, Baran J, Barczuk P, Bańkowski D, Bielak K, Kamińska K, Kłaptocz P, Łukoś-Karcz K, Nowak M. Underdiagnosis of autism spectrum disorder: a narrative review of gender differences and systemic barriers. Advances in Autism. 2025; 12(2): 136-46.

This paper examines the persistent underdiagnosis of autism spectrum disorder, particularly among women, adults and minority groups. This study aims to identify how gendered symptom expression, camouflaging behaviours, systemic barriers and cultural inequities affect diagnostic accuracy and timeliness.A structured narrative review of 33 peer-reviewed empirical studies published between 2009 and 2024, with one historical paper from 1992 retained for context. Sources were retrieved from PubMed, Scopus and Web of Science. We used controlled vocabulary and free-text terms. Methodological quality was appraised with critical appraisal skills programme, Joanna Briggs Institute and A Measurement Tool to Assess Systematic Reviews, version 2. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Findings were synthesised across four domains: gender differences in diagnostic timing, camouflaging and phenotypic variability, systemic barriers and cultural and linguistic factors.Standard diagnostic frameworks (Diagnostic and statistical manual of mental disorders, Fifth Edition, International Classification of Diseases, 11th Revision) demonstrate limited sensitivity for atypical presentations, particularly among females and high-ability individuals. Delays are compounded by cultural and linguistic barriers, clinician knowledge gaps and fragmented services. Multimodal assessment and targeted clinician training are linked to better detection and greater equity.The included studies varied in methods and populations, which limits the generalisability of findings. Longitudinal and neurobiological evidence is scarce, especially in low- and middle-income countries. Future studies should validate culturally adapted screening tools and explore the neural basis of camouflaging.Routine screening in primary care, clearer referral pathways, culturally adapted instruments and telehealth-enabled access may reduce diagnostic delays and disparities. Tailored clinician education may also improve early recognition and reduce misdiagnosis.This review integrates gender, cultural and system-level perspectives on autism spectrum disorder underdiagnosis, offering actionable guidance for clinicians, educators and policymakers to support timely and equitable diagnosis.

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3. Rainey VR, Black ER, Ramey AS. Chaos and adaptive functioning for children with autism: parental worry as a mediating factor. Advances in Autism. 2025; 12(2): 147-65.

Children with autism spectrum disorder (ASD) tend to have lower adaptive functioning scores than their peers, which is the ability of one to care for themselves and communicate well with others. Previous research has established that lower adaptive functioning scores in children with ASD can be partially influenced by the presence of chaos in the home. To better understand how chaos may affect adaptive functioning, this study aims to establish whether parental worry mediated the link between chaos in the home and the adaptive functioning (communication, daily living skills, socialization) of children with ASD compared to those without ASD.Data were collected from 202 parents, 99 with a child with ASD and 103 without ASD. Parents responded to the Confusion, Hubbub and Order Scale, asking about the chaos level in their home. They also completed the Penn State Worry Questionnaire and the Vineland Adaptive Behavior Scales (VABS-3 caregiver survey).Correlations were found between chaos levels and adaptive functioning, with more chaos predicting decreases in adaptive functioning overall. Moreover, a mediation analysis, using parent worry as the mediator, found a significant mediation in daily living skills and socialization, but only for the families with an autistic child. Overall, these findings suggest that parental worry may partially influence how household chaos affects adaptive functioning in families with an autistic child, especially in areas that can be more easily shaped by the environment, like daily living skills and socialization.This study furthers the understanding of how environmental influences and parental psychological factors affect the development of adaptive behaviors in autistic children.

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4. Murphy D, Walker F, Lincoln H, Briscoe L. Revisiting the experiences and quality of life of autistic patients in high secure psychiatric care. Advances in Autism. 2025; 12(2): 166-79.

Evidence suggests that autistic individuals are overrepresented within forensic psychiatric settings and present with different difficulties and needs compared to their neurotypical counterparts. With respect to high secure psychiatric care (HSPC), a 2017 survey examining the experiences of autistic patients found most reported both positive and negative aspects associated with their care, and variable quality of life (QoL) ratings. Since this, several significant changes have occurred including moving to a new hospital site, the introduction of the mandatory Oliver McGowan autism awareness training and the national strategy for autistic children, young people and adults outlining the need to improve autistic individuals’ experience of the criminal justice system. This paper describes a repeat survey of patient experiences to see whether they may have changed or improved in light of these changes.Qualitative data about the experiences of autistic individuals detained in a UK HSPC hospital was gathered using semi-structured interviews and the forensic QoL questionnaire.Consistent with the previous survey, the number of autistic patients interviewed remains relatively small yet diverse, and they report positive and negative experiences within the hospital and different QoL ratings. Positive experiences include support and therapeutic opportunities, whereas the negatives echo those in the 2017 survey – notably the perception of staff knowledge of autism and inconsistency of care. The variation in patient demographics is significant as well as their experiences and QoL ratings, illustrating the importance of individualised treatment.The small scale survey highlights that whilst there have been many aspects of change and development in one HSPC hospital, individual experiences and QoL remain varied for autistic patients and similar to those reported in 2017, with perceived inconsistent care, a lack of awareness of individual autistic features by staff, and environmental issues frequently reported. The repeat survey suggests that despite modernisation in the physical environment, availability of more training around autism and the introduction of a national autism strategy, there remain ongoing challenges many autistic patients face within HSPC. Whilst staff autism training remains important, qualitative impressions suggest that it is not enough and there are other factors including perhaps consistency of staff that are important for an autism informed model of care.

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5. Mustary K, Kiari I, Nyno J, Osborne LA, Reed P. Parenting stress and coping across five countries. Advances in Autism. 2025; 12(2): 180-99.

The current report aims to provide indicators of parenting stress and coping behaviours across five diverse countries (Bangladesh, Greece, Kenya, UK, Zambia). It was hoped that the use of a single procedure would provide needed data from low-to-middle-income countries, in comparison to the better-studied higher-income countries.In total, 200 parents of children diagnosed with autism spectrum disorder (ASD); 40 in each country) completed a series of scales about their parenting stress and coping styles.The results suggested more similarities than differences. Parenting stress was high in all countries, and the highest was in the UK. Pessimism was also high in low-to-medium-income countries, and lower in Greece and the UK. Passive appraisal was used most often as a coping style, with mobilising the family being used more than social support. Cross-country, the only difference was that the UK parents used seeking spiritual support less than parents from other countries. Coping styles did not mediate the relationship between either ASD severity or behavioural problems and parenting stress.These data suggest a degree of similarity across most aspects of parenting across diverse countries, although some atypical results from the UK may mean caution is needed in drawing generalised conclusions from such higher-income countries.

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6. Daly J, Rushe D, Rabbitte K, Connon G, Healy O. “We were happy to just get an autism diagnosis”: a mixed-methods study of parents’ experience with the autism assessment protocol. Advances in Autism. 2025; 12(2): 200-19.

Despite increasing autism prevalence, delays in diagnostic assessments persist, likely impeding access to effective early interventions. In 2022, Ireland’s Health Service Executive piloted new, three-tiered Autism Assessment and Pathways Protocol in the Republic of Ireland.An online survey was completed by six parents of autistic children assessed through the novel, Tier 1 Assessment Pathway Protocol, and 25 parents of autistic children assessed through the standard Assessment of Need Pathway participated in this study. All respondents provided quantitative and qualitative data on their experience of the diagnostic assessment pathway, including satisfaction, self-reported stress and perceived child stress. Parental satisfaction and stress were compared between pathways.Some 65% of parents were satisfied with the diagnostic process overall. The process was stressful for both parents and children. There were no significant differences in parents’ satisfaction, stress levels or participant characteristics between the diagnostic assessment pathways. Time to assessment displayed negative correlations with parents’ satisfaction with the overall diagnostic process and self-reported stress. Four themes were identified: falling through the cracks, accessing effective supports, the emotional and psychological impact of the assessment experience and being seen, heard and understood.Parents’ experiences did not differ between the pathways, suggesting the viability of the Assessment Protocol Tier 1 pathway. Reducing waiting times and increasing post-diagnostic support to facilitate early intervention should be emphasised.To the best of the authors’ knowledge, this mixed-methods study was the first to explore parents’ experience and satisfaction with Tier 1 of this protocol.

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7. Oudet S, Howard K, Katsos N, Durrleman S. Better engagement with culturally and linguistically diverse parents of autistic children in online parent-led therapy? An interpretative phenomenological analysis. Advances in Autism. 2026; 12(2): 220-36.

This study aims to understand the lived experiences of culturally and linguistically diverse (CaLD) parents of autistic children who participated in a longitudinal self-directed (without clinical coaching) parent-led therapy (PLT) programme targeting social-communication skills, or who were unable to complete participation in the longitudinal study coached group sessions. This work explores how each participant’s specific context impacted their engagement with online PLT.Five mothers from a range of CaLD backgrounds participated in this study from different countries. Semi-structured online interviews were conducted. Interpretative phenomenological analysis was used to analyse data, focusing on understanding each participant’s lived experience.Two superordinate themes were developed: (1) cultural differences amplify barriers to online PLT; (2) linguistic adaptations of therapeutic strategies need to be contextualised for each CaLD environment.Participants had high English proficiency and academic backgrounds, which may not represent the CaLD population struggling most with PLT engagement. Further investigation among non-Western, educated, industrialised, rich, democratic populations is warranted.Specific considerations for socio-cultural adaptations are needed beyond linguistic translations.CaLD minorities without heritage links to their country of residence face amplified challenges in supporting their autistic children. Such families need more contextualised support to enhance PLT engagement.PLT is emerging as a useful support approach for parents of autistic children in bilingual environments. This study explores perspectives of CaLD parents who were not able to complete group PLT programmes to better understand to better engage parents in online PLT.

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8. Darwis FR, Bahfiarti T, Farid M. Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism. Advances in Autism. 2026; 12(2): 237-8.

The book Let’s Talk: Navigating Communication Services and Supports for Your Young Child with Autism by Rhea Paul and Donia Fahim provides a comprehensive guide for families navigating autism spectrum disorder (ASD) and communication interventions. The authors, both experienced professionals in the field, aim to help parents understand and address communication challenges in children with ASD. The book’s structure is designed to be both informative and practical, addressing key questions and concerns that parents may have when their child is diagnosed with ASD.The book begins with an overview of ASD, providing a clear and accessible explanation of the disorder and its diagnostic process. It offers insights into the common developmental patterns of children with autism and addresses the critical issues of social communication, which are central to ASD. The book emphasizes that every child with ASD is unique, making it important for parents to work with professionals to tailor interventions that meet their child’s specific needs.

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9. Cahyani AT, Mau M, Akbar M. Creating Quality of Life for Adults on the Autism Spectrum: The Story of Bittersweet Farms. Advances in Autism. 2026; 12(2): 239-42.

The book “Creating Quality of Life for Adults on the Autism Spectrum: The Story of Bittersweet Farms” by Jeanne Dennler, Carol S. Quick and Ruth Wilson is a comprehensive guide that showcases the story of Bittersweet Farms, the first farmstead community for adults with autism in North America. This model integrates therapeutic approaches, focusing on the quality of life for individuals with autism spectrum disorder (ASD) by providing a supportive environment tailored to meet the unique needs of these individuals.Jeanne Dennler is a retired clinical psychologist with over four decades of experience working with individuals with autism, including extensive involvement with Bittersweet Farms. Carol S. Quick has a background in special education and program development for individuals with disabilities. Ruth Wilson is an author with expertise in special education and nature-based interventions. Together, their diverse experiences contribute to a deep understanding of both the clinical and practical aspects of autism care.

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