1. Wright P, Moseley R, Tomasulo D, Srinivasan H, Wilson J, Woods S, Rashid T. Integrating Positive Psychology and Autism: A Roundtable. Autism in Adulthood. 2024; 6(4): 389-400.

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2. McQuaid GA, Strang JF, Jack A. Borderline Personality as a Factor in Late, Missed, and Mis-Diagnosis in Autistic Girls and Women: A Conceptual Analysis. Autism in Adulthood. 2024; 6(4): 401-27.

Autism without intellectual disability is diagnosed later and with greater difficulty in girls/women relative to boys/men. For autistic girls and women, the journey to an autism diagnosis may include one or more misdiagnoses. Misdiagnosis with borderline personality disorder (BPD) or borderline traits may be particularly common, and characteristics often observed in autistic girls and women may contribute specifically to a risk of misdiagnosis with BPD. This review draws from a burgeoning literature on autism in girls and women to provide a detailed discussion of differential diagnosis of BPD and autism in cisgender girls/women, with a focus on phenotypic traits and/or their presentation that may be more common in autistic girls/women and that may be particularly prone to miscategorization as BPD. Distinctions between autism and BPD are identified, emphasizing the need for scrutiny of an individual’s clinical presentation to tease apart differences between the autism and BPD phenotypes. We highlight instances in which similar phenotypic expressions may be driven by differing underlying factors. Implications for the distinction of autism and BPD/borderline traits in informing appropriate therapeutic intervention are discussed.

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3. Powell T, Parker J, Kitson H, Rogalewski M. “It Was Like the Final Piece in the Puzzle for Me”: A Qualitative Study on the Experiences of Autistic Women Initially Diagnosed with Borderline Personality Disorder. Autism in Adulthood. 2024; 6(4): 428-37.

Background: Women who self-harm and experience complex mental health difficulties are frequently diagnosed with borderline personality disorder (BPD), also known as emotionally unstable personality disorder. Emerging research suggests that self-harm may often be better explained through the lens of autism, and that greater consideration should be given to the clients’ motivations for self-harm. How time alone is experienced may also be a differentiating factor. The objective of this study was to investigate individuals’ perceptions of a change in diagnosis, experiences of self-harm, and fear of real or imagined abandonment, with the aim of improving the accuracy of initial diagnosis. Method: Eight women, first diagnosed with BPD, then autism, and with a history of self-harm and multiple admissions to a psychiatric hospital, underwent a semistructured interview, which was recorded, transcribed, and analyzed using thematic analysis. Results: Three main themes and 11 subthemes were identified. Theme one centers around participants’ ?Journey through the diagnostic and therapeutic jungle.? Theme two is entitled ?Self-harm as a developed and systematic way of coping.? Theme three is entitled ?Alone is not abandoned.? Conclusions: Better awareness and understanding of the subtle differences between BPD and autism are essential, as misdiagnosis leads to misinformed treatments, which are often contraindicative. Recognition of these specific, differentiating traits is most evident with a detailed neurodevelopmental history. This study suggests two potential factors for consideration in a neurodevelopmental history: first, the triggers and functions of self-harm, which often starts early in childhood, and second, limited awareness or absence of feelings of fear of abandonment alongside contentment with spending time alone.

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4. Gillespie-Smith K, Mair APA, Alabtullatif A, Pain H, McConachie D. A Spectrum of Understanding: A Qualitative Exploration of Autistic Adults’ Understandings and Perceptions of Friendship(s). Autism in Adulthood. 2024; 6(4): 438-50.

Background: Previous research has often documented that friendship is an area of difficulty for autistic people, however this may be caused by a neurotypical understanding of friendship. The current study aimed at adopting a more inclusive account of friendship, involving an autistic participant group representing a range of genders and communication preferences while exploring the following question?What are autistic adults’ perceptions of friendships? Method: Participants (n?=?20) were interviewed using their preferred method of communication (speaking and non-speaking) during 2021?2022. Results: The results showed that three main themes emerged under an overarching theme of A Spectrum of Understanding: Identity with Others, Sharing Value, and Shared Presence. The inclusive approaches used in the current study allowed under-researched autistic groups such as non-speaking autistic people and autistic people who identify as non-binary to participate in meaningful research. Conclusions: The study offers a new perspective on the Double Empathy theory, suggesting it may be helpful to conceptualize it as a continuum of neuro-cultural learning rather than a distinctive binary centered on an autistic-allistic misunderstanding. Increased understanding of friendships in autistic groups will help to increase awareness of social belonging and support that can protect against poor mental health outcomes.

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5. Aller TB, Kelley HH, Barrett TS, Covington B, Levin ME, Brunson McClain M. An Examination of Psychological Flexibility as a Mediator Between Mental Health Concerns and Satisfaction with Life Among Autistic Adults. Autism in Adulthood. 2024; 6(4): 451-61.

Background: Experiencing mental health concerns (MHC; e.g., depression, anxiety, stress) can have negative effects on satisfaction with life (SWL) for autistic adults. Current mental health supports that may promote SWL do not effectively meet the needs of autistic adults, often due to deficit-based approaches. Methods: To begin addressing the gap in research surrounding mental health supports among autistic adults, we designed a preregistered longitudinal study that used structural equation modeling to assess 289 autistic adults from the Simons Powering Autism Research (SPARK) program to determine whether progress toward one’s values, a strengths-based component of psychological flexibility, is a potential mechanism through which MHC (i.e., depression, anxiety, and stress) impacts SWL. Results: Results suggested that depression (but not anxiety or stress) negatively affected participants’ SWL. However, when including components of psychological flexibility as a mediator, there was no longer a significant direct effect between depression and SWL, suggesting that influences on SWL were explained through participants’ levels of components of psychological flexibility. The influence of values progress on the association between depression and SWL was significantly stronger than that of value obstruction (a deficit-based construct). Associations did not differ across gender. Conclusion: These findings provide preliminary support for interventions targeting improvements in psychological flexibility as they may help address core issues of deficit-based mental health services while also being able to emphasize outcomes that matter most to the autism community.

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6. Peachey M, Crane L. “I Don’t Understand Their Sense of Belonging”: Exploring How Nonbinary Autistic Adults Experience Gender. Autism in Adulthood. 2024; 6(4): 462-73.

Background: The term ?nonbinary? refers to all gender identities that are not exclusively male or female. Nonbinary identities are more common in autistic people than in nonautistic people. Yet research meaningfully exploring the unique intersection between autism and nonbinary identities is limited. Furthermore, little is known about how the experience of being nonbinary and autistic impacts access to autistic and queer communities; spaces that can protect against poor mental health outcomes. Methods: We examined: (1) how nonbinary autistic people make sense of gender and (2) how they negotiate community. A participatory approach was adopted, involving a consulting group of 18 nonbinary autistic people at every stage of the research process. A separate group of five nonbinary autistic adults from the United Kingdom took part in semistructured interviews about autism, gender, and community. We analyzed interviews using Interpretative Phenomenological Analysis. Results: Within an emergent framework (gender as two dimensional), we identified three themes: (1) Where do I belong? (2) (Re)framing difference. (3) Space to be (neuro)queer. Participants understood that being autistic and nonbinary problematized how they connected with ?gender,? a self-defined concept of high significance. Crucially, the queer community was felt to facilitate positive identity development, but participants emphasized a continued struggle with being misunderstood, largely by their nonautistic peers. Conclusion: This study celebrates neuroqueer ways of being. We recommend that nonautistic people are given improved education on nonbinary autistic identities; supporting autistic people to understand their differences and facilitating positive identity development within queer spaces. Creating autistic-led community groups is furthermore key, due to the linguistic and embodied complexities of autistic gender identities.

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7. Sagar E, Khera SN, Garg N. “I Wish They’d Just Let Us Be.” Experiences of Indian Autistic Individuals Around Stimming Behaviors at the Workplace. Autism in Adulthood. 2023; 6(4): 474-84.

Background: Stereotyped or repetitive motor movements are a core feature of autism. In recent years, autistic individuals have asserted themselves by reclaiming these repetitive movements as ?stimming.? There is growing evidence in the form of scientific research regarding the usefulness of stereotypie movements. Recent research has captured the perspectives of autistic adults on stimming. However, to date, no research has examined the perspective of Indian autistic individuals around the display of stimming behaviors at the workplace. Methods: We used semi-structured interviews and online focus groups to ask 20 Indian autistic individuals to share their experiences centered around stimming at Indian workplaces. Data obtained were analyzed using qualitative thematic analysis. Results: The thematic analysis helped us identify three major themes: (1) stimming as a (beneficial) coping mechanism, (2) repercussions of stim suppression, and (3) (De)stigmatization of stimming. Conclusion: Most Indian workplaces lack workplace accommodations to reduce sensory overload on autistic employees. Hence, Indian managers open to employing autistic individuals must accept stimming as an autistic individual’s attempt at managing overwhelming emotions brought on by sensory overload. Acceptance of stimming behaviors by nonautistic managers would not only benefit the autistic employee by aiding them in better managing their mental and emotional health but also benefit the organization by allowing the autistic employee to function at peak productivity levels. Thus, Indian managers and colleagues of autistic employees should work to accommodate, support, and understand the stimming behaviors of autistic employees as opposed to judging them in a negative light.

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8. Schmidt EK, Williams M, Gimah L, Espinosa SM, Hickman R. Supports and Barriers to Inclusive Workplaces for LGBTQIA+ Autistic Adults in the United States. Autism in Adulthood. 2024; 6(4): 485-94.

Background: Autistic people and lesbian, gay, bisexual, transgender, queer, intersex, asexual, and people of other sexuality or gender minorities (LGBTQIA+) experience worse unemployment rates than allistic or cisgender, straight people. Yet, there is limited research to understand the employment experiences of people with both autistic and LGBTQIA+ identities. Therefore, in this study, we aim to describe the barriers and supports for inclusion in the workplace for autistic LGBTQIA+ adults. Methods: This analysis utilized data from a larger mixed method, participatory research study, including qualitative data from 35 LGBTQIA+ autistic adults who were working part- or full-time. Participants were engaged in a semi-structured interview or a focus group. Data were analyzed using an interpretative phenomenological analysis. An audit trail, checks for representativeness, and negative case analysis were utilized to promote trustworthiness of data analysis. Results: Several factors contributed to participants’ feelings of inclusion or exclusion within workplace settings. ?Red flags? such as safety concerns, accessibility issues, stereotyping, and challenges with communication contributed to feelings of exclusion and the need for compartmentalization of identities. Contrarily, ?green flags? such as workplace culture, representation, and accessibility contributed to increased feelings of inclusion and comfort disclosing identities. Conclusions: Our findings suggest that many LGBTQIA+ autistic individuals compartmentalize certain identities to protect themselves due to oppressive workplace settings, but this can be detrimental to one’s well-being and contribute to autistic burnout. These findings suggest multiple recommendations to improve inclusion in workplace settings, as well as various next steps for future research.

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9. Thorpe D, McKinlay M, Richards J, Sang K, Stewart ME. The Lived Experience of Autistic Adults in Employment: A Systematic Search and Synthesis. Autism in Adulthood. 2024; 6(4): 495-509.

Background: Employment is a critical factor contributing to the well-being and quality of life of autistic people of working age. Historically, research has tended to focus on interventions and employment-related outcomes, typically generated without the input of autistic workers. Interventions often work to help the autistic worker fit into the working environment rather than it being adjusted for the autistic worker. However, a growing body of research reflects autistic workers’ experiences of employment with consideration given to how the workplace should change to reflect the differences of this historically marginalized group. Methods: This study is a systematic analysis of existing research that focuses on and prioritizes autistic workers’ experiences of employment. Our analysis draws on the social relational model of disability (SRMD), an approach increasingly applied in contexts of autism and employment. We systematically searched five journal databases, resulting in 34 articles that reflect the lived experience of autistic people in employment. Results: We identified four themes through narrative synthesis: Navigating Social Demands; the Disabling Nature of the Work Environment designed for neurotypical workers; Adapt to Me; and Understanding, Knowledge, and Acceptance. The results draw on the SRMD, revealing nuances to inclusionary and exclusionary employment for the autistic workforce. Conclusion: Our findings encourage the prioritization of the voice of autistic workers when designing working environments. They also function as a critique of the traditional approaches that placed employers, managers, and human resource professionals as the dominant agents of decision-making. In these traditional practices, the burden of making employment viable was on the worker, rather than the employer. The results of this study framed through the SRMD allowed for enhanced understanding of the barriers and new insights into how to improve the employment experience for autistic adults.

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