1. Stewart M, Day A, Bertilsdotter Rosqvist H. Call for Papers: Autism and Aging: A Lifespan Approach. Autism in Adulthood;2023 (2023/12/01);5(4):345-346.

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2. White SW, Schall C, Santos JD, Maddox BB, Hillier A, Klinger L, Pugliese C. Promoting Quality of Life: Suggestions for Mental Health Care Providers Working with Young Autistic Adults. Autism in Adulthood;2023 (2023/12/01);5(4):347-355.

There is a growing population of autistic adults in need of supports from a service delivery system that, at present, fails to accommodate their needs adequately and equitably. Unfortunately, there is a shortage of trained behavioral health service providers to meet the needs of young autistic adults. Quality of life (QoL), or one’s perception of, and satisfaction with, life in relation to held goals and expectations, has been identified as a key outcome of interest by autistic self-advocates. By supporting autistic clients to hone their strengths and interests, integrate various aspects of their identity, identify goals, and connect to appropriate resources, providers can promote clients’ self-knowledge and self-determination, in the service of improving QoL. In this Perspectives article, we offer concrete recommendations to mental health providers, including those who do not specialize in autism, with the goal of supporting implementation of evidence-based strategies that improve QoL and promote self-determination among young autistic clients.

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3. Jones M, Milbourn B, Falkmer M, Vinci B, Tan T, Bölte S, Girdler S. A Practical Framework for Delivering Strength-Based Technology Clubs for Autistic Adolescents. Autism in Adulthood;2023 (2023/12/01);5(4):356-365.

Autistic individuals experience poor vocational outcomes internationally. Transition planning and interventions during adolescence may assist in improving outcomes in adulthood. Strength-based technology clubs show promise in improving outcomes for autistic adolescents by developing skills specific to the Information and Communication Technology industry, and fostering positive traits, such as self-determination. Although strength-based technology clubs have been examined with autistic adolescents, to date, no framework has been proposed to underpin their design and delivery. In this conceptual analysis, we propose a practical framework for delivering strength-based technology clubs for autistic adolescents. The framework builds on work from a previous systematic review of qualitative research and a realist evaluation study of technology clubs for autistic adolescents, combined with theoretical understandings from three health models. The new framework comprised the components of interests, value, autonomy, and requirements, forming the acronym IVAR. Interests refer to strategies drawing on adolescents’ areas of interest. Value represents a culture of valuing autistic adolescents as individuals for their unique strengths and skills. Autonomy refers to providing opportunities for adolescents to make decisions, and Requirements refers to aspects of the social and physical environment. Practical recommendations of the framework are discussed, including design and delivery of future strength-based technology clubs, facilitator training, and design activities. The proposed IVAR framework may be useful in guiding the development of strength-based technology clubs. Future research is needed to validate the feasibility and efficacy of the IVAR framework in underpinning the delivery of strength-based technology clubs to autistic adolescents.

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4. Davis SA, Annis IE, Hughes PM, DeJong NA, Christian RB, Ruble LA, Thomas KC. Patterns of Mental Health Service Use During the Transition to Adulthood Among Autistic Adolescents and Young Adults. Autism in Adulthood;2023 (2023/12/01);5(4):366-373.

Background: The time of transition into adulthood, especially when leaving school, is a time when many autistic adolescents and young adults (AYA) may stop receiving mental health services that they have relied on, leading to worse mental health outcomes. The purpose of this study was to describe patterns of mental health service use during transition to adulthood among autistic AYAs. Methods: We performed a cross-sectional study using electronic health records from years 2015 to 2019 from one large university health care system. We included autistic individuals ages 11?27 with at least one clinical encounter annually in the cohort. Outcomes included psychotropic medications and psychotherapy received, psychotropic polypharmacy, psychiatric emergency department (ED) visits, and adverse drug events. Results: Almost half of the 529 patients in the cohort received polypharmacy. The most common treatment was medication only (56.9%), followed by no treatment (22.7%), medication plus psychotherapy (18.7%), and psychotherapy only (data masked). The 17?21 age group had the highest odds of a psychiatric ED visit, whereas the 22?27 age group had the highest odds of receiving psychotropic medications and polypharmacy. Black AYA were more likely to receive psychotherapy and less likely to receive psychotropic polypharmacy than non-Hispanic Whites. Conclusion: Autistic individuals may benefit from more support from the health care system for their transition into adulthood to maintain use of beneficial mental health services as they leave school and to reduce the frequency of adverse outcomes. Access to providers experienced treating the complex needs of autistic individuals is important to reduce disparities.

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5. McKenney EE, Brunwasser SM, Richards JK, Day TC, Kofner B, McDonald RG, Williams ZJ, Gillespie-Lynch K, Kang E, Lerner MD, Gotham KO. Repetitive Negative Thinking As a Transdiagnostic Prospective Predictor of Depression and Anxiety Symptoms in Neurodiverse First-Semester College Students. Autism in Adulthood;2023 (2023/12/01);5(4):374-388.

Background: Improving the understanding and treatment of mental health concerns, including depression and anxiety, are significant priorities for autistic adults. While several theories have been proposed to explain the high prevalence of internalizing symptoms in autistic populations, little longitudinal research has been done to investigate potential causal mechanisms. Additional research is needed to explore how proposed contributors to depression from general population research predict and/or moderate the development of internalizing symptoms in autistic individuals. In this study, we investigated the relation of one established risk factor, repetitive negative thinking (RNT), to internalizing symptoms over the course of college students’ first semester, additionally examining whether this association is moderated by a measure of autistic traits. Methods: Students were recruited from 4 northeastern U.S. universities: 144 participating students included 97 nonautistic students and 47 participants who either reported a formal autism diagnosis (n?=?15) or endorsed a history of self and/or others thinking that they may be autistic (n?=?32). Participants completed a baseline survey battery within their first 2 weeks of starting college, a brief biweekly survey throughout their first semester (up to 24 times across 12 weeks), and an endpoint packet. Results: Elevated trait-like RNT at baseline was prospectively associated with biweekly ratings of depression and anxiety symptoms across the semester. In addition, greater RNT was synchronously related to elevated sadness, anhedonia, and anxiety throughout the semester. Contrary to hypotheses, a shorter term predictive relationship between RNT at one timepoint and mood symptoms at the next was largely unsupported. While these patterns were observed across neurotypes, students with higher self-reported autistic traits were more likely to experience RNT, as well as depressive and anxiety symptoms. Conclusions: These preliminary findings highlight RNT as a specific mechanism that may be a useful prevention and/or intervention target toward reducing the elevated depression and anxiety rates in the autistic community.

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6. Love AMA, Edwards C, Cai RY, Gibbs V. Using Experience Sampling Methodology to Capture Disclosure Opportunities for Autistic Adults. Autism in Adulthood;2023 (2023/12/01);5(4):389-400.

Background: Despite a recent surge in literature contributing to our understanding of autistic individuals’ disclosure experiences, the findings remain mixed. Research based on autistic people’s perspective often indicates negative outcomes, while research that focuses on nonautistic perspectives is more positive. In addition, no disclosure study has used ecologically valid research methods, which help to reduce the risk of memory biases and are more representative of real-world experiences. The aim of this research was to capture outcomes from real-world disclosure opportunities as reported by a diverse range of autistic adults. Methods: Thirty-six autistic adults reported their disclosure opportunities through experience sampling methodology (58% female, 28% male, and 14% nonbinary), multiple times per day or week for 2 months. Importantly, we embedded coproduction from conception to dissemination, ensuring that the outputs are relevant and beneficial for the autistic community. Results: In total, participants recorded 231 disclosure opportunities (M?=?6.42, SD?=?4.83). Two-thirds of opportunities (n?=?153) were categorized as disclosure, where the participants decided to share they were autistic, and 33.8% (n?=?78) were labeled nondisclosure, where the participants decided not to share that they were autistic. Qualitative thematic analysis of open responses resulted in five themes that illustrated the thought processes during disclosure opportunities, the reactions of others, and reflections following disclosure for autistic adults in our study. Conclusion: These findings show that disclosure decisions and outcomes are complex and are influenced by both internal and external factors. Both support for autistic adults navigating this process and knowledge for nonautistic individuals on the experiences of their autistic friends, family, and community members will help to alleviate negative experiences and improve the mental well-being of autistic adults who face these decisions daily.

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7. Grosvenor LP, Errichetti CL, Holingue C, Beasley JB, Kalb LG. Self-Report Measurement of Well-Being in Autistic Adults: Psychometric Properties of the PERMA Profiler. Autism in Adulthood;2023 (2023/12/01);5(4):401-410.

Background: Studies of positive psychology and emotional well-being have broadened our understanding of mental health. However, mental health research involving autistic adults has been largely deficit-focused. Few studies have examined well-being using established positive psychological frameworks. Methods: This study examined the psychometric characteristics of the PERMA Profiler, a 23-item questionnaire that measures well-being across five subscales (Positive emotion, Engagement, Relationships, Meaning, and Accomplishment), in a sample of 517 autistic adults ages 18?84 years (M?=?39.5, standard deviation [SD]?=?13.3). Reliability (internal consistency), structural validity (via confirmatory factor analysis including bifactor modeling), and concurrent validity were examined. Results: The PERMA Profiler mean (SD) well-being score was 5.4 (SD?=?1.7), which is notably lower than the mean of 7.0 previously found in nonautistic samples. Subscale scores were highest for Engagement (M?=?6.8; SD?=?1.9), followed by Accomplishment (M?=?5.6; SD?=?2.2), Relationships (M?=?5.2; SD?=?2.6), Meaning (M?=?5.2; SD?=?2.7), and Positive emotion (M?=?5.0; SD?=?2.4). Factor analyses revealed strong psychometrics (Cronbach’s α?=?0.93; Comparative Fit Index?=?0.94; Tucker?Lewis Index?=?0.97; root mean square error of approximation?=?0.08; standardized root mean residual?=?0.05) and superior fit of the bifactor model, supporting a general factor for conceptualizing well-being as opposed to a five-factor model. PERMA well-being and subscale scores were significantly correlated (p?

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8. MacLennan K, Woolley C, andsensory E, Heasman B, Starns J, George B, Manning C. “It Is a Big Spider Web of Things”: Sensory Experiences of Autistic Adults in Public Spaces. Autism in Adulthood;2022 (2023/12/01);5(4):411-422.

Background: Sensory processing differences are commonly experienced by autistic individuals, and some sensory experiences can greatly impact the mental health and quality of life of individuals. Previous research suggests that adapting the sensory nature of environments may improve individual experiences and engagement with these spaces. However, knowledge about which public places are particularly disabling is limited, especially from the perspective of autistic individuals. Little is also known about what in the sensory environment makes them particularly disabling. Methods: In this participatory research study, we investigated the sensory experiences of autistic adults in public spaces. We used an online focus group method, recruiting 24 autistic adults across 7 focus groups. We applied content analysis, reflexive thematic analysis, and case study analysis. Results: The results of the content analysis showed that supermarkets, eateries (i.e., restaurants, cafés, pubs), highstreets and city/town centers, public transport, health care settings (i.e., doctor’s surgeries and hospitals), and retail shops and shopping centers are experienced to be commonly disabling sensory environments for autistic adults. However, outdoor spaces, retail shops, museums, concert venues/clubs, cinemas/theaters, and stadiums are identified to be commonly less disabling sensory environments. In addition, through reflexive thematic analysis we identified 6 key principles that underlie how disabling or enabling sensory environments are: Sensoryscape (sensory environment), Space, Predictability, Understanding, Adjustments, and Recovery. We represented these principles as a web to emphasize the interconnected, dimensional spectrum of the different themes. Lastly, we used case study analysis to evidence these principles in the commonly disabling sensory environments for richer detail and context and to provide credibility for the principles. Conclusions: Our findings have important implications for businesses, policy, and built environment designers to reduce the sensory impact of public places to make them more enabling for autistic people. By making public spaces more enabling, we may be able to improve quality of life for autistic individuals.

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9. Huang Y, Trollor JN, Foley K-R, Arnold SRC. “I’ve Spent My Whole Life Striving to Be Normal”: Internalized Stigma and Perceived Impact of Diagnosis in Autistic Adults. Autism in Adulthood;2023 (2023/12/01);5(4):423-436.

Background: Receiving an autism diagnosis in adulthood often leads to improved self-understanding and deeper self-reflection, which can have major impacts on people’s well-being and sense of identity. However, autism diagnosis also exposes individuals to societal stigma, which may become internalized over time. This study aimed to explore relationships between psychological and service-related impacts of diagnosis and internalized stigma using mixed methods. Methods: One hundred forty-three autistic adults completed an online survey involving impact of diagnosis domains of Self-Understanding, Well-being, Clinician Support, and Service Access, internalized stigma, and open-ended questions on beliefs about autism diagnosis. Results: On average, participants reported mild levels of internalized stigma and positive impact of diagnosis in all domains except Service Access. Older age at diagnosis was positively associated with Clinician Support only. The path analysis model showed positive relationships between impact of diagnosis domains, with Self-Understanding having a positive effect on Well-being via lowered internalized stigma. We developed four themes of Continuity and Acceptance, Late Diagnosis as Regret and Freedom, Coming to Terms with Being Autistic, and Stigma Resistance from qualitative data. Conclusions: Self-understanding protects against the development of internalized autism stigma. Diagnosticians and service providers play an important role in improving self-understanding and well-being in autistic adults. More research is needed to understand the role of age at diagnosis and mechanisms behind positive identity development after autism diagnosis.

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10. Petty S, Allen S, Pickup H, Woodier B. A Blog-Based Study of Autistic Adults’ Experiences of Aloneness and Connection and the Interplay with Well-Being: Corpus-Based and Thematic Analyses. Autism in Adulthood;2023 (2023/12/01);5(4):437-449.

Background: Autistic adults appear to be more vulnerable to mental ill health, with loneliness being a variable associated with multiple outcomes of poorer well-being. However, a description of meaningful social connection that is suitable for autistic adults is missing from this research, along with a missing understanding of the conditions that contribute to well-being. Methods: In this study, autistic adults’ experiences of connectedness and aloneness were systematically searched for within data collected from blogs. This contributed a creative method to hear the viewpoint of autistic adults. Corpus-based and thematic analyses explored the descriptions and contexts of relationships. A total of 16 autistic authors contributed views. Results: Social connection was desired and was achieved through self-acceptance and rejecting deficit-based views of being autistic, and selectively choosing important relationships. Meaningful social connection changed over time, being more difficult to attain in childhood, and benefiting from self-learning and effortfully applying neuro-normative skills in social communication. Loneliness was only described alongside other causes of unhappiness and was not associated with being autistic. Conclusions: The findings offer some explanation for the high estimates of both loneliness and mental ill health for autistic adults. We consider the implications for autistic individuals, clinicians, educators, and researchers. We are also cautious not to imply that these views reflect all autistic people. The findings suggest that improvements are needed in society to share communication differences and relationship expectations for autistic individuals to be accepted and valued.

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11. Love AMA, Cai RY, Edwards C, Gibbs V. Exploring Identity Importance for Autistic Adults and Associations with Disclosure Experiences: A Brief Report. Autism in Adulthood;2023 (2023/12/01);5(4):450-456.

Background: A strong autistic identity can help to support mental well-being, reduce anxiety and depression, increase self-esteem, and strengthen a shared community for autistic people. Autistic people are regularly faced with a decision to disclose their autistic identity to others and report a range of experiences after disclosure. The purpose of this brief report was to examine the association between identity and disclosure decisions in a sample of autistic adults to gather preliminary evidence justifying future research. Specifically, we were interested in learning more about how autistic identity is associated with one’s approach to disclosure, while also exploring associations with other identities such as ethnic, gender, sexual, and religious identity.* Methods: Participants (N?=?111) completed an online questionnaire about their intersecting identities and their approach to disclosure. The research team that conducted this study was composed of both autistic and nonautistic researchers. Results: Results demonstrated that participants who felt their autistic identity and sexual identity were highly important also reported frequent disclosure of being autistic. Religious, gender, and ethnic identity were not associated with one’s disclosure decisions or their disclosure outcomes. Conclusion: Overall, the results of this study emphasize the link between autistic and sexual identities and autism disclosure, but more research in this space is needed to better support the wider autism community.

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12. Di Rezze B, O’Connor I, Georgiades S, Brennan R, Honeyman S, DiFazio A, Hall GB, Chan L, Steele R, Fallowfield E, Bennett T. The Development and Evaluation of a Cross-Context Employment Program for Autistic Adolescents. Autism in Adulthood;2022 (2023/12/01);5(4):457-467.

Vocational programs typically focus on building the skills of autistic youth. However, there is growing recognition that the supportive environment (or ecosystem) around an individual plays an important role in finding and maintaining work. Programs at the ecosystem-level can be established by coordinating support before high school ends. Cocreation of a vocational program by support providers can facilitate an integrated effort to prepare autistic youth for employment. In this study, we describe and evaluate the Job-Train Program (JTP), a vocational program for autistic high school students codesigned with educators and a community-based social services agency. A school board, community-based social services agency, and academics partnered to cocreate JTP. JTP combined skill teaching and paid supported employment on a university campus. This pilot study evaluated JTP using qualitative and quantitative data. Twelve autistic youth were recruited, aged 15?18 years (10 males, 2 females) with an average intelligence quotient of 101.9 (standard deviation?=?14.4), from the Wechsler Abbreviated Scale of Intelligence-2. Youth and parents completed self-report measures (pre?post), including the primary outcome, Canadian Occupational Performance Measure (COPM). Post-JTP, interviews, focus groups, and surveys collected additional information from youth (n?=?11), parents (n?=?10), job coaches (n?=?5), and employers (n?=?8). Youth COPM scores indicated significant improvements in self-perceived ratings of skill performance (z?=??2.5, p?=?0.01) and satisfaction (z?=??2.6, p?=?0.01). Qualitative data corroborated COPM results noting youth skill improvements in self-esteem, independence, communication, and understanding work. Findings demonstrated a promising vocational training model for autistic high school students informing the development of integrated service pathways to support preparation for employment.

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