1. Robinson A, Yong E. Emotion transformation: a grounded theory for uncovering painful triggers and repairing relational connection for parents of autistic children. Advances in Autism;2023;9(1):2-18.

Purpose It is often voiced that parents of autistic children are the expert of their child, whereas parenting programmes target them as effective mediators for change. This paper aims to explore this unchallenged heuristic to develop an understanding of both emotional and relational needs of parents through trainers’ experiences of delivering emotion-focused and autism parent training. Design/methodology/approach This qualitative study used a constructivist approach of grounded theory to gain an in-depth understanding of trainers’ experiences from their encounters when delivering parent training. Six expert trainers were interviewed, and a two-phased coding of ground theory and an adapted thematic analysis was used. Findings An overarching theme emerged: emotion transformation from painful triggers, to enhanced attunement and relational repair. Four main themes containing 13 subthemes were identified. The interaction of these themes and subthemes are presented in a three-phase process model. Phase 1: uncovering painful emotions from a shared journey contained one theme: parent painful triggers. Phase 2: uncovering interpersonal rupture cycle contained one theme: relational rupture cycle within non-synchrony of attunement. Phase 3: parent–child relational repair contained two themes: repairing attachment bonds and therapist’s prizing stance. Social implications The authors challenge the parent as expert heuristic and propose that not all parents feel expert in neurotypical-neurodivergent intersubjectivity. The authors are curious to see whether trainers/therapists can guide parents through unprocessed emotions and non-synchrony of attunement to promote healing and relational repair, which requires further investigation. Originality/value To the best of the authors’ knowledge, this is the first emotion-transformation process model grounded in humanistic principles of relational acceptance and emotion theory. The authors propose that a focus on process rather than outcome is more likely to result in higher parenting self-efficacy.

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2. Poorkhorshidi N, Zohari Anboohi S, Mohtashami J, Alavi Majd H. “Iranian family caregivers of autistic children: the experience of stigma”. Advances in Autism;2023;9(1):19-28.

Purpose Autistic children and their family caregivers are impacted widely by the social arrangements, which bring up a variety of problems and make their caregiving duties even more difficult. One of the main troubles family caregivers struggle with is the “Autism stigma” that eventually leads to social exclusion. This study aims to identify shreds of evidence of Autism stigma experienced by family caregivers of autistic children. The study also aims to present some general comparison between the findings in Iran and a few other countries’ available respective data to the “Autism stigma.” Design/methodology/approach This study is an inductive qualitative content analysis. Twelve family caregivers were purposefully selected. Data were gathered exercising semi-structured, in-depth interviews and scrutinized using content analysis method. Findings In the interviews with the participants, a new category called “Autism stigma” was discerned. This category includes three subcategories: “Diagnosis process,” “Lack of awareness” and “Presence in the society.” Originality/value In Iran, Autism is considered a kind of social stigma. It mainly happens due to a lack of public awareness about this psychological disorder. The family caregivers in the community suffer from the stigma of autism, which leads them to distance themselves from society. This paper aims to improve the social awareness in regard to the negative impacts of Autism stigma.

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3. Murphy D, Broyd JG. Suspected feigning of autism in adults: a clinician survey, indications and proposed guidelines. Advances in Autism;2023;9(1):29-41.

Purpose This paper aims to provide a discussion and summary of a clinician survey exploring the experiences of suspected feigned autism. Design/methodology/approach This study is an online survey targeting a range of autism professionals, with varying levels of experience, working in different clinical settings. Findings Approximately half of the professionals who completed the survey reported experiencing situations of suspected feigning of adult autism across a range of clinical contexts and with various motivations. In terms of best indications of potential feigning, most clinicians reported “textbook” self-descriptions of problem behaviours with vague examples, as well as inconsistent presenting problems and mismatch with any known developmental history. Approximately half of clinicians expressed the view that autism was more difficult to feign than a psychiatric disorder and had experienced situations involving differences in professional opinion as to an individual autism diagnosis. Research limitations/implications The survey is limited by a potential sample bias and no information regarding the clinical characteristics of those suspected to have feigned autism. However, these initial findings offer further questions for future research to pursue. Originality/value As an initial examination of practicing clinicians’ experiences of suspected feigned autism, the survey highlights the complexities of an autism diagnosis and suggests feigning is a potential clinical scenario. Some guidance as to when to suspect possible feigned autism is also offered, as well as a provisional assessment protocol.

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4. Watkins LV, Angus-Leppan H. Increasing incidence of autism spectrum disorder: are we over-diagnosing?. Advances in Autism;2023;9(1):42-52.

Purpose In 2016, 1 in 54 children were estimated to have autism in the USA compared to 1 in 2,500 in 1955. This study aims to consider whether there has been a worldwide rise in incidence over time that is contributing to the rise in prevalence. Design/methodology/approach A systematic review of the literature with strict inclusion criteria was performed to identify large population-based studies that include raw incidence rate data with clearly defined diagnostic criteria. The data from the included studies were pooled and analysed descriptively to compare incidence rates by decade. Findings Seven studies were included in the final quantitative analysis including incidence rate data from 1988 to 2015 with 29,026 cases, over a total of 69,562,748 person years. Considering the most robust data, the incidence rate ratio between the decade 1990–1999 and 2000–2009 provides an estimated relative risk of 4.21 (95% CI; 4.11–4.32). If we compare the limited data available in 1988–1989 and 2010–2015, there is an estimated 75 times (95% CI 49.56–115.04) increased rate of diagnosis. Originality/value The broadening of diagnostic criteria and its increasing application in clinical practice needs further consideration to ensure individuals receive the most appropriate personalised support. A true rise in the incidence of autism will influence the level of service provision required in future with the potential for significant under resourcing. More detailed assessment of the clinical characteristics of those diagnosed will help predict risk factors for specialist service involvement in future.

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5. Cai RY, Gallagher E, Haas K, Love A, Gibbs V. Exploring the income, savings and debt levels of autistic adults living in Australia. Advances in Autism;2023;9(1):53-64.

Purpose Many autistic adults experience unemployment, which may impact their financial circumstances. However, no research has examined their personal financial circumstances. Therefore, this study aims to examine the self-reported income, savings and debt of autistic adults living in Australia, as well as the demographic associates and predictors of income and savings. Design/methodology/approach Sixty-four autistic adults aged 18–67 years (Mage = 32.78, SDage = 11.36) completed an online survey containing questions relating to their financial circumstances and the autism spectrum quotient-short. Findings Overall, the authors found that many autistic adults are financially disadvantaged. The mode of income levels was below AU$25,000, which is substantially lower than the mean annual Australian full-time income of AU$89,123. Higher savings was associated with not having any debt or having a greater ability to repay debt. Autism traits were positively associated with income levels. As predicted, being employed was associated with and predicted higher income. People who were employed were four times more likely to have a higher income than unemployed individuals. The authors did not find a relationship between having a co-occurring mental condition with income or savings. The authors also did not find a significant association between employment status and savings. Practical implications These research findings have implications on how we can improve the financial circumstances of autistic adults and provide additional evidence for the importance of increasing employment opportunities for autistic individuals. Originality/value To the best of the authors’ knowledge, this is the first study to examine the personal financial circumstances of autistic adults.

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6. Goñi-Cervera J, Martínez Romillo MC, Polo-Blanco I. Strategies used by students with autism when solving multiplicative problems: an exploratory study. Advances in Autism;2023;9(1):65-81.

Purpose This paper aims to study the strategies used by ten students diagnosed with autism when solving multiplication and division problems because these operations are rarely studied in students with this condition. Design/methodology/approach This study conducted an exploratory study with ten students diagnosed with autism to explore and describe the strategies used in solving equal group problems. The authors also describe in detail the case of a student whom the authors deem to be representative because of the reasoning the student employed. Findings The informal strategies that they used are described, as well as the difficulties observed in the various problems, depending on the operation required to solve them. The strategies used include direct modeling with counting and others that relied on incorrect additive relationships, with strategies based on multiplication and division operations being scarce. Difficulties were observed in several problems, with measurement division being particularly challenging for the study participants. Practical implications The detailed description of the strategies used by the students revealed the meanings that they associate with the operations they are executing and brought to light potential difficulties, which can help teachers plan their instruction. Originality/value This research supplements other studies focusing on mathematical problem-solving with autistic students.

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7. Sidhu HK, Greene MC. A scoping review of disparities in health and health-care service provisions experienced by adults with autism spectrum disorder. Advances in Autism;2023;9(1):82-93.

Purpose Adults with autism spectrum disorder (ASD) are more likely to have a poor health status because of being diagnosed with a range of physical and mental health conditions and experience disparities in health care. The purpose of this study is to find barriers to health care experienced by adults with ASD and find gaps in health care which health-care providers can work to fill. Design/methodology/approach This scoping review aimed to identify studies that report on disparities in health and health-care service provisions experienced by adults with ASD. The authors included articles that described health-care disparities for patients with ASD and were published in peer-reviewed journals between January 2010 and April 2022. The authors searched the following databases and medical journals to search for eligible studies: Google Scholar, Pubmed, Elsevier, Sage Publications and Embase. The authors comprehensively searched key terms related to ASD, health care and disparities. Findings The core defining features of ASD, which include communication and social impairments and deficits in sensory processing, were found to be barriers in the health-care experience of adults with ASD. Continued research and changes in health care, such as developing interventions to empower patients, adequately training providers and increasing the accessibility of the health-care system, are necessary to ensure adults with ASD receive adequate medical care. Research limitations/implications Additionally, clarifying the current literature on this topic can guide future research efforts to explore the influence of factors such as gender and the spectrum of autism itself leading to various levels of abilities and their influence on the health-care experience of adults with ASD. Practical implications Overall, the findings from this scoping review underline the importance of providing readily accessible evidence-based, age-appropriate primary and hospital health care for adults with ASD. Social implications Further interventions are needed to empower patients, adequately train providers, increase the accessibility of the health-care system, increase support for ASD patients and decrease discrimination. Originality/value This paper is a scoping literature review of the original work done by researchers in the field of developmental disorders and health care.

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