1. Kandeh Mariama S, Kandeh Mariama K, Martin N, Krupa J. Autism in black, Asian and minority ethnic communities : a report on the first Autism Voice UK Symposium. Advances in Autism ;2020 ;6(2):165-175.

Purpose Little is known about the way autism is interpreted and accepted among the black, Asian and minority ethnic (BAME) populations in the UK. This report summarises a Symposium on autism in the UK-BAME community in 2018, organised by Autism Voice UK, Participatory Autism Research Collective and the Critical Autism and Disabilities Studies Research Group at London South Bank University.Design/methodology/approach The stance a family or community takes about a condition such as autism is influenced by their cultural background. The aims of the Symposium were to highlight different perspectives about autism in BAME communities and to preserve the cultural dignity of the community in supporting autistic members. Beliefs about autism, its diagnosis and acceptance of and support for autistic people from a specific cultural perspective of BAME communities must be cautiously interpreted by autism professionals because beliefs vary among different cultural groups.Findings Thematic analysis of feedback from participants yielded the following foci. Firstly, cultural, ethnic and religious sensitivities were important to participants who felt that these were often ignored by non-BAME professionals. Secondly, the need for collaboration to improve autism awareness within the community and understanding by professionals of the intersectionality between autism and identity in BAME families was prioritised. Thirdly, issues around feelings of stigma were common, but delegates felt that these were not well understood beyond people identifying as BAME.Originality/value An action plan was created which highlighted raising public awareness through community engagement, improvement of access to information for parents and culturally aware autism education for professionals and BAME communities.

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2. Schwartz Jaclyn K, Agrawal M, Treminio I, Espinosa S, Rodriguez M, Richard L. Caregivers’ perspectives on health-care transition in autism. Advances in Autism ;2020 ;6(2):153-164.

Purpose Adults with autism spectrum disorder (ASD) experience significant health-care disparities across physical and mental health domains resulting in poorer health and quality of life. Poor transitions to adult care negatively impact the health of adults with ASD. Current research focuses on personal factors in research samples that lack diversity. The purpose of this study is to examine the lived health-care experiences of geographically and ethnically diverse young adults with ASD in adult care settings in the USA to understand provider and system-level factors affecting their health.Design/methodology/approach Nine caregivers of young adults with ASD participated in key informant interviews describing their experiences in navigating the health-care system. Data were analyzed using a grounded theory approach.Findings The data indicated that limited quantity of services, poor quality of services, and high cost of services had a negative effect on the health of adults with ASD. Issues cascaded to become more complex.Practical implications Practical implications for payors, providers, persons with ASD and their families are discussed in this paper.Originality/value To the best of the authors’ knowledge, this study answers the call to better understand system-level factors affecting the health of geographically and ethnically diverse people with ASD.

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3. Martin Ann M, Stavropoulos K, Blacher J. Differential diagnosis of autism spectrum disorder and early onset schizophrenia : two clinical cases. Advances in Autism ;2020 ;6(2):139-151.

Purpose Historically, children with autism spectrum disorder (ASD) were sometimes diagnosed with schizophrenia or major psychosis. Although significant advancements in the process of differential diagnosis have been made since 1950s, there still exists a problematic delay in diagnosis due to overlap of symptoms. Negative symptoms of schizophrenia can mimic the social difficulties and stereotyped behaviors characteristic of ASD, whereas positive symptoms of schizophrenia can be perceived as restricted and repetitive behaviors, complicating the diagnostic process. The purpose of this paper is to present two clinical cases that highlight the complexities in differential diagnosis of early psychosis, schizophrenia and ASD.Design/methodology/approach Two females, 14 and 16 years of age, were referred to a free screening clinic in Southern California to be assessed for possible ASD. Both females were referred because of the presentation of restricted and repetitive behaviors and social communication difficulties. Both females and their families were administered a battery of measures to ascertain the youths’ cognitive functioning, adaptive living skills and severity of autism-related behaviors.Findings The 14-year-old presented with early-stage (prodromal or at-risk mental state) psychosis ; 16-year-old met criteria for schizophrenia. Both were referred to clinics specializing in treatment for psychosis and/or schizophrenia. Neither met criteria for ASD.Originality/value More published studies are needed on the overlap of symptoms between ASD and schizophrenia to help prevent diagnostic overshadowing of autistic symptoms and promote treatment during the early stages of psychosis. This is particularly important given the strong evidence that early treatment for psychosis improves social, cognitive and functional outcomes.

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4. Kojima M. Subjective well-being of people with ASD in Japan. Advances in Autism ;2020 ;6(2):129-138.

Purpose The purpose of this paper is to investigate developmental changes and factors affecting subjective well-being (SWB) of people with autism spectrum disorders (ASDs) in Japan.Design/methodology/approach Questionnaires were distributed to participants (n = 87) and interviews(n = 33) were conducted to investigate factors affecting SWB.Findings This study suggested that the SWB of people with ASD might be closely correlated with their self-esteem. Moreover, high school and university students have negative feelings such as anxiety and worries that affected their SWB, whereas working adults have positive feelings and thinking that influenced their SWB. Furthermore, hobbies were the source of happiness for people with ASD.Originality/value This study suggests the factors affecting SWB of people with ASD.

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5. Whitney D, Stansfield Alison J. Should we be accepting self-referrals for Autism assessments ?. Advances in Autism ;2019 ;6(2):121-127.

Purpose The Leeds Autism Diagnostic Service (LADS) is an all IQ service accepting professional and self-referrals, from age 18, for diagnostic assessment. LADS is unusual compared to other diagnostic services in England, in that it accepts self-referrals. The purpose of this paper is to compare diagnostic outcome between self-referrals and other referral sources.Design/methodology/approach This is a service evaluation of all 692 referrals for diagnostic assessment into LADS, over a three year period, from 2016 to 2018. The diagnostic outcomes were compared between self-referrals and other referral sources. Secondary analysis looked at age and gender differences between these groups.Findings There were 98 self-referrals over three years with autism diagnosed in 65 per cent. In total, 594 other referrals were received during this time period, with autism diagnosed in 44 per cent. This showed a significant difference of 21 per cent with 95% confidence intervals of 10–31 per cent (p=0.0001) using a n−1 χ2 test. In total, 59 per cent of self-referrals were from patients identifying as female, which compared to 35 per cent identifying as female from other referrals. This was a difference of 24 per cent with 95% confidence interval of 14–34 per cent (p<0.0001) on the n−1 χ2 test.Research limitations/implications Factors which may influence the ability to generalise from these results are : that LADS covers a large mainly urban and suburban area with a range of ethnic and socioeconomic diversity ; that LADS is an all IQ service unlike some other autism diagnostic services ; historical and service-related factors unique to Leeds may be dissimilar to other locations. It was beyond the scope of this evaluation to perform a qualitative analysis to compare the referral sources, but this may be an area for further study.Practical implications This evaluation supports the use of a self-referral route for adult autism diagnostic services on a local level and may support its use more widely in other services.Social implications This evaluation, in demonstrating proportionately significantly higher autism diagnosis from self-referrals is likely to be reducing the work load of professionals who would normally make referrals. Alternatively, it may be capturing a subgroup of the autism population who would not otherwise have sought diagnosis. In either scenario, it supports and is consistent with a patient centred approach to accessing appropriate diagnostic services.Originality/value The authors are not aware that any previous evaluation of this nature has been conducted and feel this evaluation supports the use of a self-referral pathway in adult autism diagnostic services.

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6. Khullar V, Bala M, Singh Harjit P. Interactive video-player to improve social smile in individuals with autism spectrum disorder. Advances in Autism ;2019 ;6(2):109-119.

Purpose The purpose of this paper is to propose and develop a live interaction-based video player system named LIV4Smile for the improvement of the social smile in individuals with autism spectrum disorder (ASD).Design/methodology/approach The proposed LIV4Smile intervention was a video player that operated by detecting smile using a convolutional neural network (CNN)-based algorithm. To maintain a live interaction, a CNN-based smile detector was configured and used in this system. The statistical test was also conducted to validate the performance of the system.Findings The significant improvement was observed in smile responses of individuals with ASD with the utilization of the proposed LIV4Smile system in a real-time environment.Research limitations/implications A small sample size and clinical utilizing for validation and initial training of ASD individuals for LIV4Smile could be considered under implications.Originality/value The main aim of this study was to address the inclusive practices for children with autism. The proposed CNN algorithm-based LIV4Smile intervention resulted in high accuracy in facial smile detection.

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7. Di Renzo M, Guerriero V, Petrillo M, Racinaro L, Vanadia E, Bianchi di Castelbianco F. A comprehensive assessment process for children with autism spectrum disorders. Advances in Autism ;2019 ;6(2):95-108.

Purpose The assessment of Autism Spectrum Disorders (ASD) in childhood has two essential aspects : the identification of the risk (under 30 months of age) and the definition of a diagnosis that takes into account its core areas as well as further non-specific aspects. The purpose of this paper is to present an approach that considers the combination of clinical evaluation with the use of tools that analyse the various levels of the child’s functioning as fundamental.Design/methodology/approach The comprehensive assessment at the Institute of Ortofonologia in Rome provides the ADOS-2 and the Leiter-R for the evaluation of the symptomatology, the severity level, the non-verbal cognitive functioning and the fluid reasoning ; the TCE and the UOI are used to identify, respectively, the child’s emotional skills and the ability to understand the intentions of others, as precursors of the theory of mind. Within this assessment, the Brief-P, the Short Sensory Profile and the RBS are also included for the evaluation of executive functions, sensory pattern and of restricted and repetitive behaviours, as observed by parents.Findings How to define a reliable development profile, which allows to plan a specific intervention calibrated on the potential of the child and on his development trajectory, is described. Two clinical cases are also presented.Originality/value The entire process is aimed both at a detailed assessment of the child’s functioning and at identifying a specific therapeutic project and predictive factors for achieving an optimal outcome.

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8. Fairchild Lyndsay A, Powell Margaret B, Gadke Daniel L, Spencer Jordan C, Stratton Kasee K. Increasing social engagement among college students with autism. Advances in Autism ;2020 ;6(2):83-93.

Purpose Many university-based services for individuals with autism spectrum disorder (ASD) have incorporated peer mentorship programs ; however, the research on the success of these programs to increase social engagement is extremely limited. This study aims to examine the effectiveness of a peer mentor program, both alone and combined with an incentive program, on increasing the social engagement of college students with ASD. Additionally, the perceptions of college students with ASD were also examined to determine potential barriers to participate in these social events.Design/methodology/approach A component analysis was used to determine what intervention component or combination of components, was most effective in increasing the social engagement among college students with ASD. The number of students during each component was totaled and averaged across the number of social events held during that phase. A survey regarding barriers to social engagement was also provided.Findings Results suggest that both the peer mentor program alone, as well as the peer mentor program in conjunction with an incentive program, were effective at increasing students’ attendance at weekly supervised social events. Results from the survey regarding barriers to social engagement revealed that the majority of students reported difficulties managing time to fit social events into their schedule.Originality/value To the knowledge, the use of peer-mentoring programs combined with an incentive program on increasing social engagement has not yet been investigated. Further, perceptions of the use of these programs by college students with ASD is relatively limited.

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